Higher Total Immunoglobulin E Levels Research Articles

Associations between Total Immunoglobulin E Levels and Urinary Albumin Excretion: A Cross-Sectional Study

Introduction: The association between total immunoglobulin E (IgE) levels and urinary albumin excretion has not been fully established. Current study aimed to evaluate the association between total IgE levels and urinary albumin-to-creatinine ratio (UACR) among adult Americans. Methods: Current cross-sectional study utilized data from the 2005 to 2006 National Health and Nutrition Examination Survey, including individuals aged 20 years and above. To assess the relationships between total IgE levels and UACR, both multivariable linear regression models and smooth curve fitting were employed. Results: The study included a total of 3,400 participants (weighted mean age: 46.6 ± 0.8 years), with 1,625 females (weighted percentage: 47.8%). After adjusting for potential confounders, we observed a positive association between higher total IgE levels on a log2 scale and increased UACR (β = 3.34; 95% CI: 1.40–5.28, p = 0.002). Furthermore, the association displayed a non-linear dose-response pattern. The interaction test revealed a significant distinction in the correlation between total IgE and UACR when stratified by hyperlipidemia (p for interaction <0.001). The results remained robust in sensitivity analyses. Conclusion: Our study revealed a significant and independent association between elevated total IgE levels and an increased UACR, which also exhibited a distinct non-linear pattern, highlighting the intricate nature of the connection between IgE levels and UACR.

Association of Maternal Asthma and Total Serum Immunoglobulin E levels with Obstetric Complications: The Japan Environment and Children's Study.

To evaluate the association between maternal asthma (MA) and obstetric complications, while considering subdivided total serum immunoglobulin E (IgE) levels. Data of the participants enrolled in the Japan Environment and Children's Study between 2011 and 2014 were analyzed. In total, 77,131 women with singleton live births at and after 22weeks of gestation were included. MA was defined based on a self-administered questionnaire. Women with MA were stratified based on the quartile of total serum IgE levels during pregnancy as follows: low IgE levels (< 52.40IU/mL), moderate IgE levels (52.40-331.00IU/mL), and high IgE levels (> 331.00IU/mL). The adjusted odds ratios (aORs) for preterm births (PTB), small for gestational age (SGA) infants, gestational diabetes mellitus, and hypertensive disorders of pregnancy (HDP) were calculated using multivariable logistic regression, while considering women without MA as reference and maternal socioeconomic factors as confounders. The aORs for SGA infants and HDP in women with MA and high total serum IgE levels were 1.26 (95% confidence interval [CI], 1.05-1.50) and 1.33 (95% CI, 1.06-1.66), respectively. The aOR for SGA infants among women with MA and moderate total serum IgE levels was 0.85 (95% CI, 0.73-0.99). The aOR for PTB among women with MA and low total serum IgE levels was 1.26 (95% CI, 1.04-1.52). MA with subdivided total serum IgE levels was associated with obstetric complications. Total serum IgE level may be a potential prognostic marker to predict obstetric complications in pregnancies with MA.

The Combination of Serum Total IgE and Blood Eosinophil Levels as a Predictor of Response to Phototherapy Treatment in Patients with Atopic Dermatitis

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease affecting approximately 25% of all people worldwide at some point during their lifetime. Although total serum immunoglobulin E (IgE) and blood eosinophil levels are not elevated in all patients with AD, they have been shown associated with AD severity. This study aimed to investigate whether IgE and blood eosinophil levels correlate with the response to phototherapy treatment, which is a second‐line treatment for moderate‐to‐severe AD, and therefore could be considered a readily available and reliable biomarker that could guide patient management. Eighty‐two patients with AD who received phototherapy at the Sheba Medical Center were retrospectively evaluated for the following: demographic characteristics, serum IgE levels, blood eosinophils count, hospitalization duration, response to phototherapy, and requirement for systemic treatment. Response to phototherapy treatment was assessed by comparing the pre‐ and post‐treatment Investigator’s Global Assessment score for each patient in relation to the aforementioned factors. The total IgE and eosinophil levels were found to be significantly higher in patients who did not respond to phototherapy (p = 0.018 and p = 0.002, accordingly). Serum values of 1780 IU/mL for IgE and 225.0 cells/μL for eosinophils showed maximum sensitivity and specificity as predictive values for treatment response. In conclusion, this study found that high total serum IgE levels and eosinophilia were correlated with a low response to phototherapy. These results suggest that escalating treatment is recommended for patients presenting these clinical features.

Correlation of serum total immunoglobulin E levels, eosinophilia and sensitization to common aero- allergens among asthmatics in Sudan.

Asthma is a chronic inflammatory disorder of pulmonary airways in which many cells and cellular elements play a role. Chronic inflammation is responsible for increased serum total Immunoglobulin E (IgE) levels, specific IgE, and blood eosinophils (B-Eos) count. We aimed in the present study to determine quantitative physiological traits: serum total IgE, and B-Eos count and assess their correlation with skin prick test (SPT) among Sudanese asthmatics, and evaluate these findings with the persistence of developing asthma. 281 subjects; 146 asthmatics and 135 controls were recruited. Pulmonary function tests (PFTs), and SPT for commonly encountered allergens were performed using the standard methods. Serum total IgE was measured using the ELISA technique, and blood smears for B-Eos count were measured using a colter counter. An interview questionnaire was filled out for each individual to determine the duration of the disease, allergic status, and environmental factors. In the majority of asthmatics; Positive SPT response to seven allergens (P &lt; 0.01), the highest exposure allergen was found to be mixed molds (85.3%), and the strongest sensitized allergen was house dust mite (HDM) (P &lt;0.001). Serum total IgE and B-Eos count were highest (P&lt;0.001) having a significant positive SPT response (P&lt;0.001). Conclusion: There is a strong association between sensitization to some allergens and asthma. High serum total IgE levels, and high eosinophil count has been found to be correlated with asthma

Profiles of sensitization and comorbidity in asthma patients with markedly increased serum total IgE (>1000kU/L).

Background: Immunoglobulin E (IgE) plays an important role in asthma, but a few patients exhibit extremely high levels of serum total IgE. Objective: This study aimed to investigate the profiles of comorbidity and/or complications, severity, and sensitizations in patients with asthma and with a total IgE level > 1000 kU/L. Methods: We retrospectively analyzed 170 patients with asthma and with total IgE levels of >1000 kU/L from the inpatient data base. Available information, including age, gender, body mass index, diagnosis, results of routine blood tests, pulmonary function, fractional exhaled nitric oxide, induced sputum (if any), IgE (both total and specific) tests and medication records were analyzed. Results: In the study subjects, >80% were adults, and the average total IgE level was median (interquartile range) 1438 kU/L (1181-2255 kU/L). Approximately 15% of the subjects had at least one comorbidity and/or complication, and 78.82% of the subjects were positive for at least one allergen. Airway infections (44.71%) and rhinosinusitis (41.18%) accounted for the two most common conditions despite age groups. Total IgE levels did not differ among the subjects with different conditions. Overall, mites had the highest positive rate (59.4%). Serum total IgE levels were positively correlated with house-dust mite specific IgE (sIgE) levels (r = 0.23; p < 0.05), peripheral blood eosinophil counts (r = 0.21; p < 0.01), and the number of confirmed sIgE positivity (r = 0.19; p < 0.01), and optimal scaling analysis showed that asthma severity was associated with Aspergillus fumigatus sIgE levels. Conclusion: In the subjects with asthma and with a total IgE level of >1000 kU/L, the two most common conditions were airway infections and rhinosinusitis, despite sensitization. A. fumigatus sIgE levels were closely associated with total IgE levels and asthma severity.

Serum total IgE may be a biomarker among chronic pulmonary aspergillosis patients with elevated serum total IgE levels: A cohort study with pathological evaluations.

High serum total IgE levels are common in chronic pulmonary aspergillosis. This novel study indicated that serum total IgE is a possible biomarker of the disease activity in the aforementioned condition. Immunofluorescence staining indicated a possible role of IgE in disease pathogenesis.

Effect of omalizumab as add-on therapy to Quality of Life Questionnaire for Korean Asthmatics (KAQLQ) in Korean patients with severe persistent allergic asthma.

Background/AimsOmalizumab is the first biologic known to be effective in patients with severe allergic asthma.MethodsThis study was conducted as a multicenter, single-group, open trial to evaluate the improvement in the quality of life with the additional administration of omalizumab for 24 weeks in Korean patients with severe persistent allergic asthma.ResultsOf the 44 patients, 31.8% were men and the mean age was 49.8 ± 11.8 years. A score improvement of 0.5 points or more in the Quality of Life Questionnaire for Korean Asthmatics (KAQLQ) was noted in 50.0% (22/44) of the patinets. In the improved group, the baseline total immunoglobulin E (IgE) level and the amount of omalizumab used were higher, and the day and night asthma symptoms were more severe, compared to those in the non-improved group. According to the Global Evaluation of Treatment Effectiveness, favorable outcomes were found in 78.6% of patients. The Korean asthma control test (p < 0.005) and forced expiratory volume in 1 second % predicted (FEV1%; p < 0.01) improved significantly in patients who received omalizumab treatment, compared to that at week 0, and the total dose of rescue systemic corticosteroids significantly decreased (p < 0.05). The improved group on KAQLQ showed a significant improvement in FEV1% (p < 0.001).ConclusionsOmalizumab can be considered a biological treatment for Korean patients with severe allergic asthma. It is recommended to consider omalizumab as add-on therapy in patients with high baseline total IgE levels and severe asthma symptoms.

Predictive Value of Radiologic Central Compartment Atopic Disease for Identifying Allergy and Asthma in Pediatric Patients.

Central compartment atopic disease (CCAD) has recently been suggested as a phenotype of chronic rhinosinusitis (CRS). This study aims to investigate the prevalence of the radiologic CCAD phenotype in CRS within a pediatric population and identify its ability to predict comorbid allergy and asthma. Computed tomography and endoscopic examination were conducted on pediatric patients with CRS either with or without nasal polyps. Allergen sensitization was determined with the multiple-allergen simultaneous test and skin prick test. Serum total immunoglobulin E (IgE), peripheral blood eosinophil percentage, and presence of asthma were also evaluated. A total of 82 pediatric patients were enrolled. Overall, 55 (67.1%) of the participants demonstrated aeroallergen sensitization, and 31 (18.9%) of the 164 sides of sinuses were radiologically defined to fit the CCAD phenotype. Patients having CRS with the CCAD phenotype had a higher prevalence of aeroallergen sensitization (87.1% vs 62.4%, P = .008), particularly house dust mite (74.2% vs 53.4%, P = .035), and a higher incidence of asthma (16.1% vs 3.8%, P = .010). Additionally, patients having CRS with the CCAD phenotype demonstrated a high serum total IgE levels (51.6% vs 30.1%, P = .023) in comparison to patients having CRS without CCAD. In pediatric CRS, the radiological CCAD phenotype was associated with allergen sensitization and asthma. Furthermore, the CCAD phenotype was associated with high serum total IgE levels, suggesting allergy etiology should be considered with this type of pediatric patients with CRS.

Dyslipidemia among allergic rhinitis patients: Frequency and risk factors

BackgroundAlthough cumulative data strongly suggest an association between dyslipidemia and allergic disorders, especially asthma, evidence regarding allergic rhinitis (AR) is lacking. We aimed to assess frequency and associated risk factors of dyslipidemia among patients with AR. MethodsThe current study is a cross-sectional study that recruited 150 AR patients by systematic randomization. Blood samples for serum lipid profile, total immunoglobulin E (IgE) and serum interleukin-17A (IL-17A) were withdrawn from all patients. ResultsDyslipidemia was prevalent in 84 AR patients (56%). Higher levels of total IgE, IL17-A, and sensitization to hay dust and mixed mites significantly increased the risk of dyslipidemia among AR patients by 1.004, 1.062, 4.057 and 3.652 respectively (P < 0.05). ConclusionHigh serum total IgE level, high serum IL-17A level, and sensitization to hay dust and mixed mites are independent risk factors for dyslipidemia among AR patients.

Immunoglobulin E as a Biomarker for the Overlap of Atopic Asthma and Chronic Obstructive Pulmonary Disease.

Asthma-COPD overlap (ACO) is a common clinical syndrome, yet there is no single objective definition. We hypothesized that immunoglobulin E (IgE) measurements could be used to refine the definition of ACO. In baseline plasma samples from 2870 participants in the COPD Genetic Epidemiology (COPDGene®) study, we measured total IgE levels and specific IgE levels to 6 common allergens. Compared to usual chronic obstructive pulmonary disease (COPD), participants with ACO (based on self-report of asthma) had higher total IgE levels (median 67.0 versus 42.2 IU/ml) and more frequently had at least one positive specific IgE (43.5% versus 24.5%). We previously used a strict definition of ACO in participants with COPD, based on self-report of a doctor's diagnosis of asthma before age 40. This strict ACO definition was refined by the presence of atopy, determined by total IgE > 100 IU/ml or at least one positive specific IgE, as was the broader definition of ACO based on self-reported asthma history. Participants with all 3 ACO definitions were younger (mean age 60.0-61.3 years), were more commonly African American (36.8%-44.2%), had a higher exacerbation frequency (1.0-1.2 in the past year), and had more airway wall thickening on quantitative analysis of chest computed tomography (CT) scans. Among participants with ACO, 37%-46% did not have atopy; these individuals had more emphysema on chest CT scan. Based on associations with exacerbations and CT airway disease, IgE did not clearly improve the clinical definition of ACO. However, IgE measurements could be used to subdivide individuals with atopic and non-atopic ACO, who might have different biologic mechanisms and potential treatments.

Rationale for the autologous serum skin test in acute versus chronic urticaria.

IntroductionAutologous serum skin test (ASST) is a rapid, in-vivo clinical test to detect functional autoantibodies in patients with chronic spontaneous urticaria (CSU), but the rationale for its use in acute urticaria (AU) is unknown.AimTo evaluate the efficacy of ASST among patients with AU or CSU.Material and methodsTreatment-naïve adult (age ≥ 18 years) patients with a diagnosis of AU (< 6 weeks’ duration) and CSU were enrolled prospectively in a cross-sectional study. Healthy age- and sex-matched subjects served as controls. Besides a detailed history and physical examination, ASST, total immunoglobulin E (IgE), freeT3 (fT3), freeT4 (fT4), anti-thyroglobulin, and anti-TPO levels were assessed in all subjects.ResultsOf 101 subjects, mean age was 34.35 ±12.68 years and the study comprised 58.4% of females with no difference between AU (n = 27), CSU (n = 46), and control groups (n = 28). The ratio of positivity in ASST was similar between AU (25.9%) and CSU groups (21.7%), but higher than in controls (10.7%, p = 0.33 for all). The ratio of patients with high total IgE levels (> 100 IU/ml) in AU (85.2%) and CSU (65.2%) groups was similar (p = 0.06), but significantly higher than in the control group (10.7%) (p< 0.001 and p< 0.001). The CSU group had significantly higher abnormal thyroid test results (45.7%) than AU (14.8%) and control groups (3.6%) (p = 0.01 and p< 0.001), whereas patients with clinically diagnosed thyroiditis were only in the CSU group (6.5%). In logistic regression analysis, there was no relation found among the possible risk factors for ASST, even if analysed separately as AU, CSU and control groups.ConclusionsEven though thyroid function test levels were found to be related with CSU, and total IgE was associated with urticaria, ASST was found to be of importance. This study confirms that ASST was insufficient to demonstrate autoimmunity and acute-chronic urticaria nature. Further tests indicating auto-antibodies in AU and CSU are needed.

Evaluation of Sensitivity Toward Storage Mites and House Dust Mites Among Nasobronchial Allergic Patients of Kolkata, India

House dust mites (HDMs) are the major constituents of house dust (HD). HD and HDM sensitization is well documented worldwide. Storage mite (SM) sensitization is presently lacking from India. The present study evaluated the sensitization of both HDM and SM among 372 allergic rhinitis patients reported to the Allergy and Asthma Research Center of Kolkata metropolitan, India. HD samples were collected from the patients' home and analyzed for the major constituent mites. HD and six constituent mites Dermatophagoides pteronyssinus (DP), Dermatophagoides farina Hughes (Acari: Pyroglyphidae) (DF), Blomia tropicalis (BT), Acarus siro Linnaeus (Acari: Acaridae) (AS), Lepidoglyphus destructor (LD), and Tyrophagus putrescentiae (Schrank) (Acari: Acaridae) (TP) are tested for the allergenic potential through Skin Prick Test (SPT). Three SMs, namely AS, LD, and TP, were newly included in the mite SPT extract for the first time in Kolkata. In total, 330 patients showed significant positive SPT toward any one allergen tested. HD was the major elicitor exhibiting 92.42% response. Individuals of age group 15-40 were the worst sufferers. DF showed the highest sensitization (87.87%) among the dust mites. The SMs also contributed significantly to prove their sensitizing potential. SPT rates for AS, LD, and TP were 33, 25, and 18%, respectively. SPT grades and total Immunoglobulin E (IgE) were positively correlated for each of the allergens. Most of the patients were multi-sensitized (95%) and represented markedly high total IgE levels (>500 IU/ml). Three SMs proved to be significant allergens for the studied population. The sensitization toward these SMs is first time reported from India and can be recommended for inclusion of routine SPT for better outcome in the future.

Identification of atopic dermatitis phenotypes with good responses to probiotics (Lactobacillus plantarum CJLP133) in children.

The therapeutic effect of probiotics in atopic dermatitis (AD) remains controversial and varies according to the individual patient. We aimed to identify a population of AD patients with a good clinical response to probiotic treatment. We recruited 76 children with a median age of 7.1 years who suffered from moderate to severe AD. After a 2-week washout period, all patients were given Lactobacillus plantarum CJLP133 at a dosage of 1×1010 colony-forming units once a day for 12 weeks. We measured eosinophil counts in the peripheral blood, the proportion of CD4+CD25+Foxp3+ regulatory T (Treg) cells in CD4+ T cells, serum total immunoglobulin E (IgE) levels, and specific IgE against common allergens before the start of the treatment (T1) and at discontinuation (T2). Responders were defined as patients with at least a 30% reduction in the SCORing of AD (SCORAD) index after treatment. There were 36 responders and 40 non-responders after probiotic treatment. The median SCORAD was reduced from 29.5 (range 20.6-46.3) at T1 to 16.4 (range 6.3-30.8) at T2 in the responder group (P<0.001). In multivariable logistic regression analysis, a good clinical response was significantly associated with high total IgE levels (aOR 5.1, 95% CI 1.1-23.6), increased expression of transforming growth factor (TGF)-β (aOR 4.6, 95% CI 1.3-15.9), and a high proportion of Treg cells in CD4+ T cells (aOR 3.7, 95% CI 1.1-12.7) at T1. In the responder group, the proportion of Treg cells was significantly increased after 12 weeks of treatment (P=0.004), while TGF-β mRNA expression was decreased (P=0.017). Our results suggest that a subgroup of patients with a specific AD phenotype showing an immunologically active state (high total IgE, increased expression of TGF-β, high numbers of Treg cells) may benefit from probiotic treatment with L. plantarum CJLP133.

Cord and blood levels of newborn IgE: Correlation, role and influence of maternal IgE

The role of cord blood immunoglobulin E (IgE) levels in predicting the development of atopy has been widely investigated. The aim of the study was to evaluate the correlation between serum and cord blood total IgE in newborns and the possible influence of the atopic status of the mother on them. It was also investigated the possible role of gestational age on neonatal total IgE levels. We considered 763 deliveries, 724≥37 weeks of gestation and 39<37 weeks of gestation. 14% of mothers (13.7% at term, 15.4% preterm) showed high total IgE levels. The results showed a significant correlation between serum and cord IgE levels both in preterm and term newborns. The data revealed also that mother’s total IgE levels affect both neonatal serum and cord total IgE levels. For the latters we also found child gender as an additional independent predictor. On the contrary total IgE levels are not affected by gestational age. Clinical limitations of total IgE is known but their determination can be useful to define atopy and to suggest follow-up of the children.

IgE and risk of cancer in 37 747 individuals from the general population.

Immunoglobulin E (IgE) is produced by plasma cells, often as part of an allergic immune response. It is currently unknown whether plasma IgE levels are associated with risk of cancer in individuals from the general population. We tested the hypothesis that high levels of plasma total IgE are associated with overall risk of cancer and with risk of specific cancers. Plasma total IgE was measured in 37 747 individuals from the general population, and the participants were followed prospectively for up to 30 years. All statistical tests were two-sided. During a mean follow-up of 7 years, a first cancer was diagnosed in 3454 participants. The multivariable adjusted hazard ratio for a 10-fold higher level of IgE was 1.05 [95% confidence interval (CI) 1.00-1.11; P = 0.04] for any cancer, 0.44 (0.30-0.64; P = 0.00002) for chronic lymphocytic leukemia (CLL), 0.53 (0.33-0.84; P = 0.007) for multiple myeloma, 1.54 (1.04-2.29; P = 0.03) for other non-Hodgkin lymphoma, 1.38 (1.04-1.84; P = 0.03) for cancer of the oral cavity and pharynx, and 1.12 (1.00-1.25; P = 0.05) for lung cancer. The findings for CLL and multiple myeloma were generally robust; however, after correcting for 27 multiple comparisons only the finding for CLL remained significant. High levels of plasma total IgE were associated with low risk of CLL and possibly of multiple myeloma, without convincing evidence for high risk of any cancer type.

An Exploratory Pilot Study of Genetic Marker for IgE-Mediated Allergic Diseases with Expressions of FcεR1α and Cε.

The high affinity immunoglobulin E (IgE) receptor-FcεR1 is mainly expressed on the surface of effector cells. Cross-linking of IgE Abs bound to FcεR1 by multi-valent antigens can induce the activation of these cells and the secretion of inflammatory mediators. Since FcεR1 plays a central role in the induction and maintenance of allergic responses, this study aimed to investigate the association of FcεR1 with the allergic phenotype of Cε expression and cytokine and histamine release from peripheral leukocytes. Peripheral leukocytes from 67 allergic and 50 non-allergic subjects were used for genotyping analysis. Peripheral mononuclear cells (PBMCs) were used for Cε expression and ELISpot analysis, while polymorphonuclear cells (PMNs) were used for histamine release. The association between genotype polymorphism of the FcεR1α promoter region (rs2427827 and rs2251746) and allergic features of Cε expression and histamine were analyzed, and their effects on leukocytes function were compared with wild type. The genotype polymorphisms of FcεR1α promoter region with CT and TT in rs2427827 and TC in rs2251746 were significantly higher in allergic patients than in non-allergic controls. Patients with single nucleotide polymorphism (SNP) of FcεR1α promoter region had high levels of total IgE, mite-specific Der p 2 (Group 2 allergen of Dermatophagoides pteronyssinus)-specific IgE and IgE secretion B cells. The mRNA expression of FcεR1α was significantly increased after Der p2 stimulation in PBMCs with SNPs of the FcεR1α promoter region. Despite the increased Cε mRNA expression in PBMCs and histamine release from PMNs and the up-regulated mRNA expression of interleukin (IL)-6 and IL-8 secretions after Der p2 stimulation, there was no statistically significant difference between SNPs of the FcεR1α promoter region and the wild type. SNPs of FcεR1α promoter region were associated with IgE expression, IgE producing B cells, and increased Der p2-induced FcεR1α mRNA expression. These SNPs may be used as a disease marker for IgE-mediated allergic inflammation caused by Dermatophagoides pteronyssinus.

Sensitization to Skin-associated Microorganisms in Adult Patients with Atopic Dermatitis is of Importance for Disease Severity

Atopic dermatitis (AD) is a chronic inflammatory skin disease. Environmental and genetic factors, as well as microbial products from yeasts and bacteria, play a role in triggering the disease. A cohort of 619 adult patients with AD was screened for severity of AD, sensitization to Malassezia sympodialis, Candida albicans, Staphylococcus aureus enterotoxins and Dermatophagoides pteronyssinus. Serum levels of interleukin (IL)-18 were measured. Immunoglobulin E (IgE) sensitization to the combination of both yeast and mite antigens was found to be associated with more severe disease and higher levels of total IgE. AD patients with IgE sensitization to several microbial antigens had more severe disease than those with no IgE sensitization to microbial antigens. Sera from patients with IgE-associated AD showed higher levels of IL-18. Skin-associated microorganisms are exogenous factors triggering IgE-response and severity of AD. These findings are clinically important, and sensitization to these organisms should be assessed and considered in treatment strategies.

The role of allergic risk and other factors that affect the occurrence of atopic dermatitis in the first 6 months of life

BackgroundAtopic dermatitis (AD) is a chronic inflammation of the skin that often appears in early childhood. The manifestation is related to the tendency towards T helper 2 cytokine immune responses (interleukin (IL)-4, IL-5). Genetic factors are suggested to play important roles in AD, and it can be transmitted to newborns, increasing their risk of developing allergies.ObjectiveTo determine the association between cord-blood cytokine levels (IL-5, interferon (IFN) γ), cord-blood total immunoglobulin E (IgE) level, perinatal environmental exposure, and the risks of allergy as well as the development of AD in the first 6 months of life.MethodsA 6-month cohort study with a nested case-control within was conducted on newborns in Jakarta from December 2008 until May 2009. After the umbilical cord blood samples were taken and stored, subjects were followed up monthly until 6 months old. The occurrence of AD and lifestyle or environmental exposures were recorded. The allergic risk was determined using a modified pediatric allergy immunology work groups scoring system based on allergic history (allergic rhinitis, asthma, AD) in the family. The levels of IL-5 and IFN-γ were measured using ELISA and total IgE by CAP system FEIA. Multivariate analysis was used to evaluate risk factors.ResultsThis study was conducted on 226 subjects. The incidence of AD was 16.4%; of those, 59% had low risk allergy, 38.5% moderate, and 2% high risk. AD mostly occurred at the age of 1 month (57%). Cord blood samples were examined in 37 subjects with AD and 51 without AD; of those, 25% showed high levels of total IgE (>1.2 IU/µL), and 51% showed normally-distributed high absorbance IL-5 values (≥0.0715, absolute value was undetected). The increased level of IL-5 was directly proportional to IgE. High absorbance IFN-γ values (≥0.0795, absolute value = 18.681 pg/µL) were observed in 52% of subjects.ConclusionThe associations between the risk of allergy in the family, cord-blood total IgE, IL-5, IFN levels, and some perinatal environmental exposure with AD in the first 6 months of life have not been established.

Prevalência de aspergilose broncopulmonar alérgica em pacientes com fibrose cística na Bahia, Brasil

To determine the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis treated at a referral center in the state of Bahia, Brazil. A cross-sectional study, with prospective data collection, carried out at the Cystic Fibrosis Referral Center of Bahia of the Octavio Mangabeira Specialized Hospital. We evaluated 74 patients diagnosed with cystic fibrosis, older than six years of age, treated between December 9, 2003 and March 7, 2005. We analyzed the following variables: gender, age, forced vital capacity, forced expiratory volume in one second, pharmacodynamic response, chest X-ray findings, facial sinus X-ray findings, wheezing, cultures for Aspergillus spp., total immunoglobulin E (IgE), specific IgE for Aspergillus fumigatus and immediate skin test reactivity to A.fumigatus antigen. Of the 74 patients, 2 were diagnosed with ABPA. We found total IgE levels > 1,000 IU/mL in 17 (23%), positive immediate skin reactivity to A. fumigatus antigen in 19 (25.7%) and wheezing in 60 (81.1%). The prevalence of ABPA was 2.7%. The high levels of total IgE, high incidence of wheezing and high rate of immediate skin test reactivity to A. fumigatus antigen suggest that these patients should be carefully monitored due to their propensity to develop ABPA.

Association of the IL12RB1 promoter polymorphisms with increased risk of atopic dermatitis and other allergic phenotypes

Atopic dermatitis (AD) is frequently associated with eosinophilia, highly elevated immunoglobulin E (IgE) levels and increased levels of T-helper 2-type (Th2) cytokines in skin lesions due to infiltrating T cells. Interleukin-12 (IL-12), in combination with interferon-gamma (IFN-gamma), inhibits IgE synthesis and Th2 cell function. As the IFN-gamma-inducing cytokines IL-12 and IL-23 utilize IL-12Rbeta1 as part of their receptors, it is possible that polymorphic variants of the IL-12Rbeta1 (IL12RB1) gene might determine an individual's susceptibility to AD. Here, we carried out a systemic search for genetic variants of the human IL12RB1 in Japanese subjects and identified 48 genetic variants. In a case-control association study, we found that promoter polymorphisms -111A/T and -2C/T were significantly associated with an increased risk of AD under a recessive model. The -111T-allele frequency in the independent population of child asthmatics was also much higher than that in the control group. In addition, the -111T/T genotype was progressively more common in AD with high total serum IgE levels in an IgE-level-dependent manner. Deletion analysis of the IL12RB1 promoter suggested that the -265 to -104 region that contained the -111A/T polymorphic site harbored an important regulatory element. Furthermore, we showed that the -111A/T substitution appeared to cause decreased gene transcriptional activity such that cells from -111A/A individuals exhibited higher IL12RB1 mRNA levels than those from -111T allele carriers. Our results suggested that in individuals with the -111T/T genotype, reduced IL-12Rbeta1 expression may lead to increased Th2 cytokine production in the skin and contribute to the development of AD and other subsequent allergic diseases.