Eosinophil Cationic Protein Levels Research Articles

Eosinophil Cationic Protein in Chronic Urticaria

Abstract Background: Eosinophil Cationic Protein (ECP) is a well-known activity indicator in allergic disease. Recently eosinophils have drawn attention as a major source of tissue factors in chronic urticaria. However, there have been few reports on significance of serum ECP in chronic urticaria. Aims: To evaluate the clinical significance of serum ECP in chronic urticaria and clarify the relationship between serum total IgE and ECP in a severity index. Methods: The retrospective chart review was performed on 114 patients with chronic urticaria. Serum ECP and total IgE were measured before treatment. The treatment period required to improve clinical symptoms with two different kinds of oral antihistamines twice a day was checked and the relationship between the treatment period and serum ECP and total IgE levels were evaluated. Results: Patients showing high ECP level before treatment need more time to manage their urticarial symptoms than those with low ECP level (p=0.018). However, there were no significant differences between treatment period and serum total IgE level (p=0.543). Serum ECP and total IgE was moderately correlated with each other (r=0.200, p=0.041). Conclusions: Serum ECP can be a better indicator of disease severity in chronic urticaria than IgE. The patients showing high ECP level from the beginning require relatively longer period for symptom relief and can be helped by more than two kinds of oral antihistamines.

Reconsidering Ivor Wilks’s “Big Bang” Theory of Akan History

<h3>Aims</h3> To evaluate tear and serum IgE and eosinophil cationic protein (ECP) as severity markers for atopic keratoconjunctivitis (AKC). <h3>Methods</h3> Thirty eyes of 30 patients with AKC and 10 eyes of 10 healthy control subjects were examined in this prospective study. All subjects underwent fluorescein staining, conjunctival injection, conjunctival oedema and papillary formation grading. Tear and serum IgE and ECP levels were measured, and correlations between them investigated with reference to the ocular surface clinical parameters. <h3>Results</h3> The mean fluorescein scores, conjunctival injection, oedema scores and papillary formation were significantly higher in AKC patients compared to controls (p&lt;0.05). Higher total IgE and ECP levels were detected in AKC tears compared with the control group. Tear ECP levels showed a significant correlation with fluorescein staining, conjunctival injection and oedema scores (r=0.70, 0.62 and 0.62, respectively). Tear IgE had no correlation with clinical signs. Serum IgE and ECP levels were elevated in AKC patients but did not show any correlation with clinical signs. <h3>Conclusion</h3> This study suggests the presence of an eosinophilic response in AKC disease independent of IgE sensitisation. Tear ECP was a useful marker delineating the severity of ocular surface disease in AKC.

Role of serological markers of activated eosinophils in inflammatory bowel diseases

Activated eosinophils can infiltrate the intestinal mucosa in patients with inflammatory bowel disease (IBD), and eosinophils are also implicated in the histological damage seen in allergic diseases. To assess, in a group of patients with IBD in remission or with a mild disease activity, whether serological markers of eosinophil activation, eosinophil cationic protein (ECP) and eosinophil protein X (EPX), are related to evidence of IgE hypersensitivity and to the eosinophilia in gut mucosa. Sixty-one patients with IBD (21 Crohn's disease and 40 ulcerative colitis) in remission or with a mild disease activity were screened for IgE hypersensitivity and serological levels of ECP and EPX. Colonic biopsies were taken to assess mucosal eosinophilic infiltration. Skin prick test were positive in 31.1% of the patients with IBD, showing skin reactions to food allergens in 17.7%. Skin prick test findings were unrelated to ECP or EPX levels, or to clinical activity or eosinophil counts in the gut mucosa. A significant correlation was found between ECP and EPX levels (r=0.77; P<0.0001). Serological ECP and EPX findings did not correlate with IgE hypersensitivity findings or eosinophilic colonic infiltration in patients with IBD in remission or with mild disease activity. The role of eosinophils in IBD needs to be better characterized in the colonic mucosa, instead of relying on serological tests.

Traditional Chinese MedicineZHENGIdentification Provides a Novel Stratification Approach in Patients with Allergic Rhinitis

Background. We aimed to apply the ZHENG identification to provide an easy and useful tool to stratify the patients with allergic rhinitis (AR) through exploring the correlation between the quantified scores of AR symptoms and the TCM ZHENGs. Methods. A total of 114 AR patients were enrolled in this observational study. All participants received the examinations of anterior rhinoscopy and acoustic rhinometry. Their blood samples were collected for measurement of total serum immunoglobulin E (IgE), blood eosinophil count (Eos), and serum eosinophil cationic protein (ECP). They also received two questionnaire to assess the severity scores of AR symptoms and quantified TCM ZHENG scores. Multiple linear regression analysis was used to determine explanatory factors for the score of AR manifestations. Results. IgE and ECP level, duration of AR, the 2 derived TCMZHENG scores of “Yin-Xu − Yang-Xu”, and “Qi-Xu + Blood-Xu” were 5 explanatory variables to predict the severity scores of AR symptoms. The patients who had higher scores of “Yin-Xu − Yang-Xu” or “Qi-Xu + Blood-Xu” tended to manifest as “sneezer and runner” or “blockers,” respectively. Conclusions. The TCM ZHENG scores correlated with the severity scores of AR symptoms and provided an easy and useful tool to stratify the AR patients.

RAGE Processing in Chronic Airway Conditions: Involvement of Staphylococcus Aureus and ECP

Background The receptor for advanced glycation end products (RAGE) is a multiligand receptor that exists as a membrane-bound (mRAGE) form and a soluble (sRAGE) form. RAGE is reported to play a role in diverse pathologies including lower airway conditions, but the exact mechanism of action remains poorly understood. In the upper airways, the involvement of RAGE remains completely unexplored. Objective To investigate the involvement of RAGE in the human upper airway conditions chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP). Methods Protein levels of sRAGE, mRAGE, IL-5, and eosinophil cationic protein (ECP) were quantitatively assessed in inflamed tissue of CRSsNP and CRSwNP patients. Nasal tissue of subjects without disease served as control. Ex vivo human sinonasal tissue stimulation assays were used to assess the effect of Staphylococcus aureus and ECP on sRAGE processing. Results sRAGE protein levels were higher in CRSsNP tissue, whereas mRAGE protein levels were lower than in controls. In CRSwNP patients, both tissue sRAGE and mRAGE protein levels were reduced. Low tissue sRAGE protein concentrations were associated with high IL-5 and ECP protein levels. In vitro , S aureus induced the release of sRAGE from the tissue, while ECP was shown to be implicated in the breakdown of free sRAGE. Conclusions We demonstrate for the first time that RAGE protein is highly expressed in human upper airways under normal physiology and that it is subject to differential processing in CRSsNP and CRSwNP, identifying S aureus and ECP as novel and crucial players in this process.

Relationships between Fraction of Nitric Oxide, Airway Hyperresponsiveness, Blood Eoshinophil Counts and Serum Eosinophil Cationic Protein in Asthmatic Children

Purpose:The measurement of fraction of nitric oxide (FeNO) is a noticeable tool that reflects airway inflammation in asthmatic patients. We wanted to find out the relationship between pulmonary function, bronchial hyperresponsiveness (AHR), blood eosinophilic inflammatory markers and FeNO level before and after methacholine bronchoprovocation test in asthmatic patients. Methods:Fifty-five children, who visited the Allergy Clinic of Korea University Anam Hospital from March 2011 to February 2012, due to asthmatic symptoms, such as history of episodic wheezing or dyspnea during the previous year and resolved after using bronchodilators, were enrolled. We performed the baseline pulmonary function and methacholine bronchoprovocation test in the enrolled patients. Blood eosinophil counts and blood eosinophil cationic protein (ECP) were measured. FeNO levels were measured before and after the methacholine bronchoprovocation test. Results:The mean FeNO levels (36.3 ppb) fell after methacholine bronchoprovocation test (25.7 ppb). Forced expiratory volume in one second (FEV1) %pred inversely correlated both with FeNO level before (R 2 =0.07, P=0.029) and after (R 2 =0.059, P=0.01) methacholine bronchoprovocation test. The provocative concentration, causing a 20% decrease in FEV1 to methacholine (methacholine PC20) inversely correlated both with FeNO levels before (R 2 =0.086, P=0.001) and after (R 2 =0.141, P=0.001) the challenge. FeNO level measured at bronchoconstriction state significantly correlated with blood eosinophil counts (R 2 =0.112, P=0.028). Serum ECP levels correlated FeNO level, neither before nor after bronchoprovocation. Conclusion:The baseline FeNO levels were higher in asthmatic children. However, FeNO levels rather decreased after methacholine induced bronchoconstriction. Repeated spirometry maneuver was considered to have an effect on reducing FeNO levels. FeNO correlated with pulmonary function, airway AHR and blood eosinophil counts. (Pediatr Allergy Respir Dis(Korea) 2012;22:282-291)

Polymorphisms in the RNASE3 Gene Are Associated with Susceptibility to Cerebral Malaria in Ghanaian Children

BackgroundCerebral malaria (CM) is the most severe outcome of Plasmodium falciparum infection and a major cause of death in children from 2 to 4 years of age. A hospital based study in Ghana showed that P. falciparum induces eosinophilia and found a significantly higher serum level of eosinophil cationic protein (ECP) in CM patients than in uncomplicated malaria (UM) and severe malaria anemia (SA) patients. Single nucleotide polymorphisms (SNPs) have been described in the ECP encoding-gene (RNASE3) of which the c.371G>C polymorphism (rs2073342) results in an arginine to threonine amino acid substitution p.R124T in the polypeptide and abolishes the cytotoxicity of ECP. The present study aimed to investigate the potential association between polymorphisms in RNASE3 and CM.Methodology/Principal FindingsThe RNASE3 gene and flanking regions were sequenced in 206 Ghanaian children enrolled in a hospital based malaria study. An association study was carried out to assess the significance of five SNPs in CM (n = 45) and SA (n = 56) cases, respectively. The two severe case groups (CM and SA) were compared with the non-severe control group comprising children suffering from UM (n = 105). The 371G allele was significantly associated with CM (p = 0.00945, OR = 2.29, 95% CI = 1.22–4.32) but not with SA. Linkage disequilibrium analysis demonstrated significant linkage between three SNPs and the haplotype combination 371G/*16G/*94A was strongly associated with susceptibility to CM (p = 0.000913, OR = 4.14, 95% CI = 1.79–9.56), thus, defining a risk haplotype. The RNASE3 371GG genotype was found to be under frequency-dependent selection.Conclusions/SignificanceThe 371G allele of RNASE3 is associated with susceptibility to CM and forms part of a risk associated haplotype GGA defined by the markers: rs2073342 (G-allele), rs2233860 (G-allele) and rs8019343 (A-allele) respectively. Collectively, these results suggest a hitherto unrecognized role for eosinophils in CM pathogenesis.

Clinical effects of long-term administration of pranlukast, a leukotriene receptor antagonist, on adult patients with bronchial asthma.

Eighty-one adult patients with bronchial asthma who suffered from an unstable peak expiratory flow rate (PEFR) and asthmatic attacks that developed at irregular intervals in spite of inhaling beclometasone dipropionate (CAS 5534-09-8, BDP) in excess of 400 micrograms/day were treated with pranlukast (CAS 103177-37-3, Onon) 450 mg/day for 1 to 2 years and the clinical effects of its long-term administration were studied. The patients were divided into 3 groups: Group I with drug effect seen on peak expiratory flow rate (PEFR) in a short-term; Group II showing long term PEFR improvement; and Group III with no sustained improvement in PEFR. Those in the first two groups continued oral medication for 2 years, while those of the third group withdrew from medication after one year and their clinical course was observed. The evaluation parameters were: PEFR, frequency of beta 2-stimulant inhalation, number of night time visits to health service facilities, quantity of inhalation steroids used, amount of oral steroids used at fixed intervals, peripheral eosinophil count, serum eosinophil cationic protein (ECP) concentration and FEV1.0. In Group I, the frequency of beta 2-stimulant inhalation, number of night time visits to health service facilities, quantity of inhalation steroids used, and the amount of oral steroids used at fixed intervals were reduced; and after two years, the frequency of beta 2-stimulant inhalation and quantity of inhalation steroids used were further reduced. In Group II, reductions were seen in the peripheral eosinophil count and serum ECP level. The asthmatic severity shifted from step 3 to 2 in 12 patients and from step 4 to 3 in 4 patients in Group I; and from step 3 to 2 in 3 patients in Group II. In Group III, an increase in the number of night time visits to health service facilities after the medication was interrupted and a rise in the serum ECP concentration were recognized.

Lactobacillus salivarius plus fructo-oligosaccharide is superior to fructo-oligosaccharide alone for treating children with moderate to severe atopic dermatitis: a double-blind, randomized, clinical trial of efficacy and safety

Some probiotics can ameliorate childhood atopic dermatitis (AD). Prebiotics have also shown some efficacy, although when combined with probiotics as synbiotics, their efficacy may improve. We compared the effects of Lactobacillus salivarius and fructo-oligosaccharide (synbiotic) with fructo-oligosaccharide alone (prebiotic) on children with moderate to severe AD. We randomly assigned 60 children aged 2-14years with moderate to severe AD [SCORing AD (SCORAD)>25] to a treatment (synbiotic) or a control (prebiotic) group (30 per group). They received one capsule twice daily for 8weeks containing either L. salivarius plus fructo-oligosaccharide (treatment) or fructo-oligosaccharide only (control). SCORAD indices were monitored at weeks 0, 4, 8 and 10 (post-treatment). Laboratory results and AD medication use were also monitored. Baseline demographic and clinical characteristics and SCORAD scores were similar between the two groups. At 8weeks, the treatment group SCORAD scores (27·4±12·7) were significantly lower than for the controls (36·3±14·9) (P=0·022); this difference remained at 10weeks. At 8weeks, treatment group AD intensity was significantly lower (P=0·013); more children had mild AD in the treatment group (52%; 14/27) than the control group (30%; 8/27) (P=0·024). Medication use frequency and eosinophil cationic protein levels were significantly reduced in the treatment group at 8weeks compared with 4 weeks. A synbiotic combination of L. salivarius plus fructo-oligosaccharide is superior to the prebiotic alone for treating moderate to severe childhood AD. However, continued follow-up will be necessary to ascertain long-term benefits.

Eosinophilic Inflammation in Allergic Rhinitis and Nasal Polyposis

On histopathological examination, nasal polyps and nasal mucosa in allergic rhinitis show different forms of pseudostratified respiratory epithelium, whereas the dominant characteristic of lamina propria is an eosinophilic infiltration. The aim of this study was to compare interleukin (IL)-5 and eosinophilic cationic protein (ECP) levels in the nasal fluid of 42 patients: 12 with allergic rhinitis and nasal septal deviation, 17 non-atopic patients with nasal polyposis, and 13 atopic nasal polyp patients were enrolled in this cross-sectional study. Nasal secretion samples were collected a few days before surgery. The levels of IL-5 were measured using flow cytometry and the ECP using a commercial ELISA kit. In addition, we counted eosinophils in hematoxylin-and-eosin-stained sections of all nasal polyp and all nasal mucosa samples taken from the inferior nasal turbinates during septoplasty. A significantly higher concentration of IL-5 was found in the nasal fluid of atopic patients with nasal polyposis than in non-atopic nasal polyp patients (p=0.025) and patients with allergic rhinitis (p=0.05). ECP was higher in atopic nasal polyp patients than in patients with allergic rhinitis (p<0.0001) and than in non-atopic nasal polyp patients (p<0.0001). Polyp eosinophils were higher in atopic' than in non-atopic patients (p<0.0001) and higher than in the mucosa of patients with allergic rhinitis (p<0.0001). These however had significantly more mucosal eosinophils than was found in the polyps of non-atopic patients' (p=0.025). ECP levels in nasal fluid and eosinophil counts in tissue specimens correlated well in all three groups of patients. Our study has shown that atopic nasal polyp patients have a higher level of eosinophilic inflammation than non-atopic patients with nasal polyps and patients with allergic rhinitis.

Analysing the eosinophil cationic protein--a clue to the function of the eosinophil granulocyte.

Eosinophil granulocytes reside in respiratory mucosa including lungs, in the gastro-intestinal tract, and in lymphocyte associated organs, the thymus, lymph nodes and the spleen. In parasitic infections, atopic diseases such as atopic dermatitis and asthma, the numbers of the circulating eosinophils are frequently elevated. In conditions such as Hypereosinophilic Syndrome (HES) circulating eosinophil levels are even further raised. Although, eosinophils were identified more than hundred years ago, their roles in homeostasis and in disease still remain unclear. The most prominent feature of the eosinophils are their large secondary granules, each containing four basic proteins, the best known being the eosinophil cationic protein (ECP). This protein has been developed as a marker for eosinophilic disease and quantified in biological fluids including serum, bronchoalveolar lavage and nasal secretions. Elevated ECP levels are found in T helper lymphocyte type 2 (atopic) diseases such as allergic asthma and allergic rhinitis but also occasionally in other diseases such as bacterial sinusitis. ECP is a ribonuclease which has been attributed with cytotoxic, neurotoxic, fibrosis promoting and immune-regulatory functions. ECP regulates mucosal and immune cells and may directly act against helminth, bacterial and viral infections. The levels of ECP measured in disease in combination with the catalogue of known functions of the protein and its polymorphisms presented here will build a foundation for further speculations of the role of ECP, and ultimately the role of the eosinophil.

Effect of Mucosal TRPV1 Inhibition in Allergic Rhinitis

Transient receptor potential vanilloid-1 (TRPV1) has been implicated as a mediator of itch in allergic rhinitis. To address this possibility, we synthesized a TRPV1 blocker (SB-705498) for nasal administration in patients with seasonal allergic rhinitis. The pharmacological activity of SB-705498 was confirmed on human TRPV1-expressing HEK293 cells, using fluorometric calcium imaging, and in patients with allergic rhinitis subjected to nasal capsaicin challenges. The effect of SB-705498 was studied in patients with seasonal allergic rhinitis subjected to daily allergen challenges for 7 days, using a double-blind, placebo-controlled, randomized and cross-over design. SB-705498 was delivered by nasal lavage 2 min. before each allergen challenge. Primary end-point was total nasal symptom score on days 5-7. Nasal peak inspiratory flow (nPIF) and eosinophil cationic protein (ECP) content in nasal lavages were also monitored. Daily topical applications of SB-705498 at a concentration that inhibited capsaicin-induced nasal symptoms had no effect on total symptom score, nPIF and ECP levels in allergen-challenged patients with seasonal allergic rhinitis. The individual symptoms, nasal itch or sneezes, were also not affected. These findings may indicate that TRPV1 is not a key mediator of the symptoms in allergic rhinitis. However, additional studies, using drug formulations with a prolonged duration of action, should be conducted before TRPV1 is ruled out as a drug target in allergic rhinitis.

Extracellular Cyclophilin Levels Associate with Parameters of Asthma in Phenotypic Clusters

Objective. Leukocyte persistence during chronic (quiescent) phases of asthma is a major hallmark of the disease. The mechanisms regulating these persistent leukocyte populations are not clearly understood. An alternative family of chemoattracting proteins, cyclophilins (Cyps), has recently been shown to contribute to leukocyte recruitment in animal models of allergic asthma. The goals of this study were to determine whether Cyps are present in asthma patients during the chronic phase of the disease and to investigate whether levels of Cyps associate with clinical parameters of disease severity. Methods. Nasal wash samples from an urban cohort of 137 patients of age 6–20 years with physician-diagnosed asthma were examined for the presence of cyclophilin A (CypA), cyclophilin B (CypB), as well as several other classical chemokines. Linear, logistic, or ordinal regressions were performed to identify associations between Cyps, chemokines, and clinical parameters of asthma. The asthma cohort was further divided into previously established phenotypic clusters (cluster 1: n = 55; cluster 2: n = 31; and cluster 3: n = 51) and examined for associations. Results. Levels of CypB in the asthma group were highly elevated compared to nonasthmatic controls, while a slight increase in Monocyte Chemotactic Protein-1 (MCP-1) was also observed. CypA and MCP-1 were associated with levels of eosinophil cationic protein (ECP; a marker of eosinophil activation). Cluster-specific associations were found for CypA and CypB and clinical asthma parameters [e.g. forced expiratory volume in 1 second (FEV1) and ECP]. Conclusions. Cyps are present in nasal wash samples of asthma patients and may be a novel biomarker for clinical parameters of asthma severity.

Eosinophilic activity and bronchial hyperresponsiveness within an asthmatic paediatric population

BackgroundOur study aims to assess the importance of serum eosinophil cationic protein (ECP) levels as a non-invasive marker of bronchial hyperresponsiveness (BHR) in children with asthma, and may predict objectively the asthmatic severity and sensitivities. MethodsThis study, which was carried out on 75 asthmatic patients from a paediatric population (average age: nine years old, sex-ratio M/F: 1.64), is based on both interrogation conducted by the clinician and biological explorations, essentially serological testing of ECP and eosinophilia determination, as well as the measurement of serological IgE amounts. ResultsThe analysis of the questionnaires and the biological results allowed us to evaluate the clinico-biological relations within this population. ECP, more than eosinophilia, proves to be a relevant marker of asthma severity (p<0.05) and sensitivities within this given population (r=0.65). ConclusionWe were able to show that the evaluation of the serological levels of ECP seems to be a good biological marker of asthma.

臍帯血移植後に血清Eosinophil Cationic Protein値が高値を呈し気管支喘息様症状を呈したBronchiolitis Obliterans Organizing Pneumonia (BOOP) の1症例

臍帯血移植後に血清Eosinophil Cationic Protein値が高値を呈し気管支喘息様症状を呈したBronchiolitis Obliterans Organizing Pneumonia (BOOP) の1症例

Fecal Assays Detect Hypersensitivity to Cow's Milk Protein and Gluten in Adults With Irritable Bowel Syndrome

Some patients with irritable bowel syndrome (IBS)-like symptoms suffer from food hypersensitivity (FH); their symptoms improve when they are placed on elimination diets. No assays identify patients with FH with satisfactory levels of sensitivity. We determined the frequency of FH among patients with symptoms of IBS and the ability of fecal assays for tryptase, eosinophil cationic protein (ECP), or calprotectin to diagnose FH. The study included 160 patients with IBS, 40 patients with other gastrointestinal diseases, and 50 healthy individuals (controls). At the start of the study, patients completed a symptom severity questionnaire, fecal samples were assayed, and levels of specific immunoglobulin E were measured. Patients were observed for 4 weeks, placed on an elimination diet (without cow's milk and derivatives, wheat, egg, tomato, and chocolate) for 4 weeks, and kept a diet diary. Those who reported improvements after the elimination diet period were then diagnosed with FH, based on the results of a double-blind, placebo-controlled, oral food challenge (with cow's milk proteins and then with wheat proteins). Forty of the patients with IBS (25%) were found to have FH. Levels of fecal ECP and tryptase were significantly higher among patients with IBS and FH than those without FH. The ECP assay was the most accurate assay for diagnosis of FH, showing 65% sensitivity and 91% specificity. Twenty-five percent of patients with IBS have FH. These patients had increased levels of fecal ECP and tryptase, indicating that they might cause inflammation in patients with IBS. Fecal assays for ECP could be used to identify FH in patients with IBS.

Long-term occupational outcomes of endotoxin exposure and the effect of exposure cessation

ObjectiveTo study the possible respiratory and haematological effects of endotoxin exposure to bacterial single-cell protein (BSCP) in workers during a follow-up period of 5 years including 4 years of exposure...

Outcomes following coronary stenting and a role for eosinophils: evidence from eosinophil cationic protein

In-stent restenosis (ISR) and stent thrombosis are the main adverse reactions to coronary stent implantation, where an important role is played by individual susceptibility, along with procedural and stent-related factors [1]. In particular, the individual inflammatory reaction profoundly affects vessel response to the implanted stent. In the bare-metal stent (BMS) era, many studies suggested that C-reactive protein levels were able to predict the risk of ISR, while its role in predicting stent thrombosis was less established [1]. Drug-eluting stents (DES) have abated ISR rates occurring in the classical 1-year window, but new concern is emerging regarding late restenosis and thrombosis [2]. Interestingly, in this setting, baseline inflammation as assessed by C-reactive protein levels has been associated with stent thrombosis but not to ISR [3]. Along with common inflammatory pathways involving neutrophils, monocytes and lymphocytes, a new role is emerging for allergic inflammation involving eosinophils in determining the clinical outcome after DES implantation. Indeed, the pathogenesis of late events seems to be related to delayed healing and to allergic reactions to polymers, a process in which eosinophils play an important role [4]. Of note, a possible role for eosinophils in ISR and stent thrombosis has also been reported for BMS [5,6]. In addition to histological studies, the potential role of an allergic reaction to implanted stents also derives from studies utilizing patch test or, more recently, serum levels of eosinophil cationic protein (ECP), a marker of eosinophil activation.

Nasal allergen provocation test with multiple aeroallergens detects polysensitization in local allergic rhinitis

Patients previously given a diagnosis of nonallergic rhinitis (NAR) might have a new form of local allergic rhinitis (LAR) with local production of specific IgE antibodies and a positive response to a nasal allergen provocation test (NAPT). We evaluated an NAPT protocol using multiple aeroallergens (NAPT-M) for the detection of polysensitization to several aeroallergens in patients with LAR. NAPT-Ms with 2 different panels of aeroallergens for patients with perennial and seasonal rhinitis were performed in 25 patients with LAR and 25 patients with NAR whose disease was diagnosed by means of NAPTs 1 year earlier. The response to nasal challenge was evaluated based on subjective (nasal-ocular symptoms) and objective (acoustic rhinometry) parameters. Nasal levels of tryptase and eosinophil cationic protein were determined by means of immunoassay at baseline, 15 minutes, and 1, 2, and 24 hours after challenge. NAPT-Ms showed 100% concordance with the gold standard of NAPTs with a single aeroallergen. No false-positive or false-negative responses were detected. The use of NAPT-Ms achieved 75% reduction in the total number of visits required for final diagnosis in the NAR group (from 168 to 42 visits) and a 55% reduction in the LAR group (from 144 to 65 visits) compared with NAPTs with a single aeroallergen. These results demonstrate that clinically relevant polysensitization to aeroallergens in patients with LAR occurred and that the NAPT-M is a useful, specific, sensitive, reproducible, and less time-consuming invivo diagnostic test for the screening of patients with LAR.

Eosinophil Cationic Protein in Children With Respiratory Allergies - When Is It Useful?

Background: To assess the differences in serum eosinophilic cationic protein (ECP) concentrations between treated and untreated children with asthma, children with rhinitis, and children with both and possible influence of seasonal exposure to sensitizing allergens on ECP levels. Methods: The study included treated (n=156) and untreated (n=55) children with asthma, children with rhinitis, and children with asthma and rhinitis. Serum ECP was measured in serum collected between 8 am and 12 pm under standardized pre-analytical conditions (regarding the type of blood collection tube, time, and incubation temperature during blood clotting). Results: Untreated children had significantly higher ( P <0.0001) concentrations of ECP (M[IQR]=35.1 [29.5–50.9] μg/L) than treated children (M[IQR]=11.3 [7.1–16.1] μg/L). Eosinophilic cationic protein was significantly higher during the allergen exposure season (M[IQR]=23.9 [17.6–40] μg/L) than out of season (M[IQR]=8.3 [5.4–17.2]) μg/L, P =0.0001. Conclusions: To make ECP measurements useful in clinical practices, it is necessary to meet standardized pre-analytical conditions. * ECP : eosinophilic cationic protein IL-2 : interleukin-2 ARIA : Allergic Rhinitis and its Impact on Asthma GINA : Global Initiative for Asthma IgE : immunoglobulin E FeNO : fraction of exhaled nitric oxide