History Of Allergic Disorders Research Articles

Phenotypic and Endotypic Determinants of Atopic Dermatitis Severity From the Atopic Dermatitis Research Network (ADRN) Registry.

Atopic dermatitis (AD) is a chronic inflammatory skin condition with a highly variable clinical phenotype. This study aimed to identify historical and clinical features and biomarkers associated with AD severity. A US registry of extensively phenotyped AD participants (aged 0.73-80 years) were enrolled at 9 academic centers. Information on family and personal medical history, examination, skin swabs (culture), and serum biomarkers was collected to evaluate their association with AD severity. Participants with AD (N= 2862) whose disease was categorized as mild (11.6%), moderate (58.0%), or severe (30.4%) based on Rajka-Langeland scoring were enrolled. The trend test, when adjusting for gender, race, and age, demonstrated that severity was strongly (P ≤ .04) associated with a personal/family history of allergic disorders, history of alopecia, exposure to passive smoke, ocular herpes infection, skin bacterial and viral infections, and history of arrhythmia. Features observed more frequently (P ≤ .002), as a function of severity, included skin infections (impetigo, human papillomavirus, and molluscum contagiosum virus), Staphylococcus aureus colonization, excoriations, hyperlinear palms, ichthyosis, blepharitis, conjunctivitis, ectropion, and wheezing. Serum IgE, allergen and food (≤6 years) Phadiatop, and eosinophilia were strongly linked to severity (P < .001). In a diverse US AD population, severity was associated with a history of atopic disorders, skin and extracutaneous bacterial and viral infections (by history and physical examination), higher IgE, eosinophilia and allergen sensitization, atopic skin manifestations (ie, excoriation, hyperlinear palms, and ichthyosis), and atopic ocular features (ie, blepharitis, conjunctivitis, and ectropion) as well as asthma findings (ie, wheezing). Data from our prospective registry significantly advance our understanding of AD phenotypes and endotypes, which is critical to achieve optimal management.

Headache Triggered by Coronavirus Disease 2019 Vaccination Increases in Line with History of Allergic Disorders and Comorbidities Like Depression and Fibromyalgia: An Analysis of the US Vaccine Adverse Event Reporting System

ABSTRACT Background: Headache is the most common neurological side effect of coronavirus disease 2019 (COVID-19) vaccination. However, the underlying reason for COVID-19 postvaccine headache has not been fully understood. In this study, we addressed the potential association of vaccine-related headaches with a history of allergy, atopic diseases, as well as other comorbid conditions to gain insight about the pathophysiology of this headache. Materials and Methods: This study analyzed the data from the Vaccine Adverse Event Reporting System database and reorganized dataset accordingly. The study included individuals aged 16–85 years who received the first or second dose of COVID-19 vaccines approved by the Food and Drug Administration. Allergy and atopic disease histories (reported food or drug allergy, allergic rhinitis, asthma, and other autoimmune diseases) and other accompanying diseases such as depression, anxiety, sleep disorders, fibromyalgia, and obesity of these subjects were examined from the revised data, and their relationship with COVID-19 vaccine-related headaches was investigated. Results: We found a statistically significant positive association in patients with a history of headache after COVID-19 vaccination and reported a history of allergy (P &lt; 0.001). In the allergy subgroup (n = 14547 [37.1%]), the frequency of headaches following COVID-19 vaccine was found to be higher in those with drug, food, and/or multiple allergies (P &lt; 0.05). A statistically significant relationship was disclosed between asthma, autoimmune diseases, and headache, but no association was found with allergic rhinitis (P &lt; 0.001, P = 0.160). Furthermore, the rate of headaches after vaccination was found to be higher in people with fibromyalgia and depression (P &lt; 0.001, both). Conclusion: Significant associations between headaches triggered by the COVID-19 vaccine and histories of allergy, fibromyalgia, and depression may suggest a shared predisposing mechanism for pathophysiology. Knowledge about allergy history and related comorbid conditions can be helpful in predicting COVID-19 vaccine headache. Future prospective data may provide further enlightenment on management.

Coexistence of asthmatic and non-respiratory allergic symptoms in children of Batumi Region, Georgia: occurrence and association with known diagnosis of asthma

Our recent studies showed that in children in the Batumi region, Georgia, underdiagnosis of asthma is 65%, and that not all children with known asthma had a history of allergic disorders. So, we decided to assess the association of known diagnosis of paediatric asthma with asthma-like symptoms and non-respiratory allergic symptoms and diseases using questionnaire-derived data provided by respiratory health survey. Subjects of the cross-sectional population-based study were 3,239 urban and 2,113 rural children aged 5-17 years whose respiratory status was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. For children with a known diagnosis of asthma, the occurrence of respiratory symptoms suggestive of asthmatic tendency and of allergic symptoms and diseases was measured and statistical association of known asthma with the respiratory and allergic symptoms was expressed as odds ratios (OR) and their 95% confidence intervals (95% CI). Respiratory and all allergic symptoms and diseases, except for eczema, were statistically significantly (p < 0.05) more prevalent in children with asthma than in children without asthma. Based on the distribution of asthma vis-à-vis asthmatic tendency without or with allergic symptoms and allergic diseases the following odds ratios expressing likelihood of asthma were obtained: for asthmatic tendency: OR = 18.09 (95% CI: 11.82-27.68), for any allergic symptom: OR = 6.85 (95% CI: 4.69-10.02), for any allergic disease: OR = 10.75 (95% CI: 7.36-15.70), for asthmatic tendency with coexisting any allergic symptom: OR = 18.94 (95% CI: 12.96-27.68), for asthmatic tendency with coexisting any allergic disease: OR = 25.65 (95% CI: 17.47-37.67), and for asthmatic tendency with coexisting any allergic symptom and allergic disease: OR = 27.02 (95% CI: 18.18-40.15). The findings support the view that in epidemiological setting questionnaire-based studies on asthma seems to more readily identify cases in children with more severe clinical presentation of the disease and with coexisting allergic disorders, perhaps reflecting diagnostic practices of consulting paediatricians.

The effect of breastfeeding on the risk of asthma in high-risk children: a case-control study in Shanghai, China

BackgroundIncreasing evidence shows that antibiotic use in pregnancy may increase the risk of childhood asthma but epidemiologic studies are still limited and findings are inconsistent. Meanwhile, exclusive and prolonged breastfeeding may prevent children from allergic diseases. We aimed to assess the association between prenatal antibiotic use and the risk of childhood asthma, and explore whether breastfeeding modifies the risk.MethodsWe conducted a case-control study in Shanghai, China, from June 2015 to January 2016. A total of 634 asthma cases and 864 controls aged 3–12 years were included. Multiple logistic regressions were used to estimate crude and adjusted odds ratios (aOR).ResultsThe prevalence of antibiotic use in pregnancy in the cases and controls was 7.1 and 3.5%, respectively. A significant association between prenatal antibiotic use and childhood asthma was observed (aOR: 1.7, 95% CI: 1.0–2.9), particularly in boys (aOR: 2.2, 95% CI: 1.1–4.4) and children with family history of allergic disorders (aOR: 3.1, 95% CI: 1.2–8.4). However, this association existed only in children who were not breastfed exclusively in the first six months of life (aOR 2.6, 95% CI 1.3–5.1) but not in children who were exclusively breastfed (aOR 0.9, 95% CI 0.4–2.1). Likewise, exclusive breastfeeding also decreased the association between antibiotic use in pregnancy and asthma in boys and in children with family histories of allergic diseases.ConclusionsAntibiotic use in pregnancy was a risk factor for childhood asthma. However, this risk may be attenuated by exclusive breastfeeding in the first six months of life, especially among high-risk children.

Asthma and hypoxia

More or less severe asthma attacks can damage the CNS and peripheral system in adults and children, both directly causing hypoxia and indirectly with the production of autoimmune antibodies. The pathogenic mechanism is still unknown; cytokines, TNFs, interleukins, free radicals and nitric oxide are often involved as causative factors for the disorders [1,2]. In this review we focus our attention on the relationship between atopy and CNS (central) or PNS (peripheral system) involvement. The main disorders associated with atopic disease are: Atopic myelitis Hopkins syndrome Hirayama disease Spinal progressive muscular atrophy (SPMA) The occurrence of myelitis in patients with atopic diathesis (atopic myelitis) affecting young adults has been widely reported especially in Japan.[2,3] In general, the disorders affect the posterior column of the cervical spinal cord, as shown clinically and by an MRI, and are characterized by hyperIgEaemia and the presence of light antigen-specific IgE. Another disease that has been reported in association with atopic disorders is Hirayama disease, a juvenile muscular atrophy of the distal upper extremity, which is also associated with airway allergies such as allergic rhinitis and atopic asthma. Our group reported on a 13-year-old girl who had recurrent acute episodes of myelitis after asthma attacks; the patient showed to be affected by Hopkins syndrome [4] (HS); a flaccid paralysis affecting one or more limbs after an asthma attack. It is a poliomyelitis-like illness, with frequent recurrences in which a possible link between the disease and atopic myelitis was reported, but until now the precise etiopathogenetic mechanism still remains unknown. Prospective study on the history of allergic disorders in known neurological diseases, an association between spinal progressive muscular atrophy and asthma as well as between myelitis and atopic dermatitis has been demonstrated. Central nervous system damage associated with atopic diathesis may be classified into two categories: eosinophilic myelitis mainly affecting the cervical spinal cord and those lower motor neuron, such as Hopkins syndrome, Hirayama disease and SPMA [2,4]. Recently we reported children with epileptic crisis related to cow's milk protein allergy; this disease can manifest itself with skin reactions, failure to thrive, and anaphylaxis as well as gastrointestinal and respiratory disorders [5]. In conclusion, the aim of this report is to analyse current data on the link between asthma and CNS/or PNS involvement and also, cow's milk protein allergy and epileptic events, highlighting the presence and scientific evidence for any potential pathogenetic mechanism.

Allergy and idiopathic generalized epilepsy: A case-control study

The aim of this case-control study was to determine whether there is any association between idiopathic generalized epilepsy and allergic disorders in children. All children with idiopathic epilepsy attending the Motahary Clinic, Shiraz, Iran, in a 7-month period were included in the study. Neurologically normal children, matched for age and sex, were considered as controls. The required data including age, gender, history of allergic disorders, history of smoking in the family members and breast versus formula feeding in the first six months of life were collected. The total number of participants was 110 patients and 100 controls. History of allergic disorders was positive in 28.2% of the patients and 36% of the controls (P = 0.225). When only patients with idiopathic generalized epilepsy were considered (100 patients), allergic disorders were reported in 28%. The prevalence of allergic disorders in patients with idiopathic generalized epilepsy was not significantly different from that in controls (P = 0.225). Family history of allergic disorders was positive in 34.5% of the patients and 45% of the controls (P = 0.122). Our study failed to demonstrate any association or link between idiopathic generalized epilepsy and allergy.

Collagen cross-linking effect on progressive keratoconus in patients younger than 18 years of age: A clinical trial.

Background:Keratoconus is a bilateral non-inflammatory corneal disease. Collagen cross-linking (CXL) is a new treatment option for the disease that uses ultraviolet A light irradiation and riboflavin administration. The aim of this study is to evaluate the effect of CXL on corneal topographic and refractive values in patients with keratoconus younger than 18 years of age.Materials and Methods:For the clinical trial study, 37 patients (64 eyes) younger than 18 years of age with progressive keratoconus were included. Age, sex, family history of keratoconus, and history of allergic disorders and eye rubbing were recorded. Refractive, topographic, and topometric indices were evaluated before and 12 months after the CXL with 3mW for 30 minutes.Results:Mean age (±SD) of the patients was 15.83 ± 1.53 years; 26 (70.3%) of the 37 patients were male. Fourteen (37.8%) had positive family history of keratoconus, 11 (29.7%) had history of allergic disorders, and 15 (40.5%) had positive history of eye rubbing. Of the refractive values, cylinder value decreased significantly from −4.50 ± 0.29 to −4.11 ± 0.28 (P = 0.001). Also, the logarithm of minimal angle of resolution (logMAR) uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) improved significantly 12 months after CXL (P = 0.012 and 0.001, respectively). Maximum keratometry before and after the operation was 53.82 ± 0.72 and 53.33 ± 0.72, respectively (P = 0.018). Differences for simulated K values, the thinnest cornea pachymetry, keratoconus index (KI), index of highest asymmetry (IHA), and index of highest decentration (IHD) before and 12 months after the CXL were statistically significant (P = 0.015, 0.034, <0.001, 0.017, 0.019, and 0.004, respectively).Conclusion:CXL improves the refractory, topographic, and topometric indices in patients with keratoconus younger than 18 years of age.

Eosinophilic Gastroenteritis: A Rare Cause Of Diarrhea

Introduction: Eosinophilic gastroenteritis (EG) is a rare condition of unclear etiology. It is characterized by peripheral eosinophilia, eosinophilic infiltration of the bowel to a variable extent, and gastrointestinal symptoms. The pathophysiology of EG may be related to allergic disorders, but it is not completely understood. Case Report: An 83-year-old female presented with brownish, watery diarrhea and dull abdominal pain for a period of 2 weeks. The patient reported 7-8 episodes of diarrhea in a day, not associated with blood or mucous. She denied any vomiting, fever, recent travel, sick contact, or antibiotic exposure. Physical examination was unremarkable except for mild abdominal tenderness in the left lower quadrant. Stool studies were negative for occult blood, Clostridium difficile, bacterial infection, ova, and parasites. Laboratory studies showed white blood cell count of 21k/mm3 and absolute eosinophil count of 4,180 cells/mm3 (19%). Colonoscopy showed diverticulosis of the colon, and biopsy was consistent with marked eosinophilic infiltration of the colonic and terminal ileal mucosa. Total IgE level was elevated to 159 Ku/L. These features led to the diagnosis of EG. Discussion: EG is an uncommon cause of gastroenteritis. Symptoms of EG depend upon the layer of bowel affected by eosinophilic infiltration. Mucosal involvement results in nausea, vomiting, non-specific abdominal pain, diarrhea, and malabsorption. Muscle layer involvement causes symptoms of intestinal obstruction, whereas subserosal infiltration causes eosinophilic ascites. It is very important to rule out intestinal parasitic infections. Irritable bowel syndrome can present with similar clinical presentation, and is one of the important differential diagnosis. Currently, treatment of EG is empiric and based upon severity of disease. Patients with mild and sporadic symptoms can be managed with reassurance and expectant observation, whereas those with severe GI symptoms and malabsorption should be treated with systemic glucocorticoids. Sodium cromolyn, ketotifen, and elimination diet may be useful in patients with history of allergic disorders. Surgical intervention is reserved for patients with obstructive symptoms.Figure 1

A Clinical Study of Vernal Keratoconjunctivitis

Objectives: To study the variations in epidemiological characteristics, clinical features, disease process and various modalities of management in VKC. Materials and Methods: A hospital based prospective study of 70 patients presenting with symptoms of allergic conjunctivitis was done at Department of Ophthalmology, J.J.M. Medical College, Davangere, from June 2012 to May 2013. Multiple epidemiological (age, sex) and clinical parameters (type, symptoms, treatment, failure of treatment) were studied. All patients were appropriately managed and reviewed once in fortnight and follow up ranged from a minimum of 3 months to 6 months.Results: Vernal keratoconjunctivitis was found to be the commonest type (64.3%) of allergic conjunctivitis. It was found to affect young males below 16 years (66.7%). Mean age group to be affected was 13.75 years with a mean duration of 4.87 years. Seasonal occurrence (75.5%) and itching (100%) were the predominant features. Palpebral form was the most common form of the disease (49%). Pulse steroid therapy was found to be a safe and effective method of management of vernal conjunctivitis. Conclusion: VKC is a common form of allergic conjunctivitis in a tropical country like ours. It is a bilateral, recurrent debilitating form of disease found to affect young males below 16 years. VKC is associated with other systemic atopy or family history of allergic disorders. Conjunctival eosinophils can be used as an evidence for diagnosis of VKC.

Eosinophilic Gastroenteritis: A Rare Case of Gastroenteritis

Introduction: Eosinophilic gastroenteritis (EG) is a rare condition of unclear etiology. It is characterized by peripheral eosinophilia, eosinophilic infiltration of the bowel to a variable extent, and gastrointestinal (GI) symptoms. The pathophysiology of EG may be related to allergic disorders, but it is not completely understood. Case Presentation: An 83-year-old female presented with brownish, watery diarrhea, weight loss of 5 lbs, and dull lower abdominal pain for a period of 2 weeks. The patient reported 7-8 episodes of diarrhea in a day, not associated with blood or mucous. She denied any fever, vomiting, recent travel, sick contact, antibiotic exposure, or food intolerance/allergy. Patient had a colonoscopy 2 years ago, which was reported as normal. Laboratory studies showed white blood cell count of 21,000/mm3 and absolute eosinophil count of 4,180 cells/mm3 (19%). Stool studies were negative for Clostridium difficile, ova, and parasites. Colonoscopy showed diverticulosis of the colon and biopsy was consistent with marked eosinophilic infiltration of the colonic and illeal mucosa. Total IgE level was elevated to 159 Ku/L (normal: 2-114 Ku/L). Patient improved clinically with intravenous fluids and was discharged after 24 hours. She remained asymptomatic at follow-up after 1-month interval. Discussion: EG is an uncommon cause of gastroenteritis. Symptoms of EG depend upon the layers of bowel affected by eosinophilic infiltration. Mucosal involvement results in nausea, non-specific abdominal pain, diarrhea, and malabsorption. Muscle layer involvement causes symptoms of intestinal obstruction, whereas subserosal infiltration causes eosinophilic ascites. Diagnosis of EG is confirmed by endoscopic biopsy and/or eosinophilic ascitic fluid. Currently, treatment of EG is empiric and based upon severity of disease. Patients with mild and sporadic symptoms can be managed with reassurance and expectant observation. Patients with severe GI symptoms and malabsorption can be treated with systemic glucocorticoids. Sodium cromolyn, ketotifen, and elimination diet may be useful in patients with history of allergic disorders. Surgical intervention is reserved for patients with obstructive symptoms.Figure

Selective IgA Deficiency: Clinical and Laboratory Features in 118 Children in Turkey

To investigate the clinical and laboratory features of children with selective immunoglobulin (Ig)A deficiency followed in a tertiary children’s hospital.The medical records of 118 children (63 boys, 55 girls), median age 7 years (range 4–18 years), seen over a 5-year period were retrospectively reviewed.Patients with IgA levels <7 g/L and normal or elevated IgG and IgM were included in this study. Medical records were reviewed and laboratory studies included quantitative immunoglobulins, IgG subclasses, IgE, and autoantibodies. Medical history was evaluated for evidence of infections, allergic disease, and autoimmunity.Sixty-one percent of these patients had been followed for >6 months, with 99 (84%) of the 118 patients with a history of recurrent infections, primarily upper respiratory infections. In addition, 51 (43%) of 118 had a history of allergic disorders, including predominantly rhinitis, asthma, and atopic dermatitis. Finally, 20 (17%) of 118 had a history of autoimmune disease with a wide range of disorders, including celiac disease and type 1 diabetes being the most prevalent.Children with selective IgA deficiency may be more prone to upper respiratory infections, allergic disease, and autoimmunity.This report focuses on children with selective IgA deficiency referred to a tertiary children’s hospital, so it suffers from a potential for significant referral bias. However, in light of another recent publication on selective IgA deficiency (Jorgensen GH, et al. Clinical symptoms in adults with selective IgA deficiency: a case-control study. J Clin Immunol 2013;33:742–747), there is a real potential that selective IgA deficiency is associated with a greater degree of clinically significant symptomatology than has previously been appreciated. Importantly, in some cases these include recurrent sinopulmonary infections with encapsulated bacteria, whereas in others it is less clear while the incidence of allergic disease and autoimmunity is significantly higher. These observations appear to suggest that secretory IgA alone plays a less significant role in protecting the mucosal surfaces from bacterial infection while it may have a more prominent role in protecting the immune system at the level of the mucosa from interactions that increase the incidence of allergic disease and autoimmunity. There are no registries for selective IgA deficiency and the bulk of published studies from the past contend that the overwhelming majority of affected individuals are asymptomatic. Because of selection bias and/or small sample size in most reports to date, resolving the actual impact of selective IgA deficiency awaits studies in which ascertainment bias is dealt with and appropriate case controls are included together with long-term follow-up.

Lack of Relationship between Birth Conditions and Allergic Disorders in Japanese Children Aged 3 Years

Background. The current cross-sectional study examined the associations between low birth weight (LBW), preterm birth, and small-for-gestational-age (SGA) and the prevalence of wheeze, asthma, and eczema in Japanese children aged 3 years. Methods. Study subjects were 2004 children. All data were obtained using a questionnaire. Outcomes were defined according to the criteria of the International Study of Asthma and Allergies in Childhood. Adjustment was made for sex, number of siblings, breastfeeding duration, paternal and maternal educational level, paternal and maternal history of allergic disorders, maternal smoking during pregnancy, secondhand smoke exposure at home, and gestational age at birth. Results. The prevalence of wheeze, asthma, and eczema in the previous 12 months were 22.1%, 9.0%, and 17.5%, respectively, and 8.4% were classified as LBW (<2500 g), 4.7% as preterm birth (<37 weeks), and 7.1% as SGA (<10th percentile). There were no significant associations between LBW, preterm birth, or SGA and the prevalence of wheeze, asthma, or eczema. A positive relationship between preterm birth and asthma was of borderline significance in children whose mothers had smoked during pregnancy (adjusted OR: 4.71 [95% CI: 0.97−21.39]), but not in those whose mothers had never smoked during pregnancy; the multiplicative interaction between preterm birth and maternal smoking during pregnancy with respect to asthma was significant (p = .04). Conclusions. The current study failed to detect significant associations between birth conditions and allergic disorders. Nevertheless, we did find evidence for an interaction between preterm birth and maternal smoking during pregnancy affecting asthma.

Granulomatous interstitial nephritis associated with atypical drug-induced hypersensitivity syndrome induced by carbamazepine

We report the case of a 70-year-old female patient with granulomatous interstitial nephritis (GIN) induced by carbamazepine (CBZ). The patient had a 22-year history of bipolar disorder. Approximately 50 days before admission to our hospital, she was switched from valproic acid to 200 mg/day CBZ for mood swings. Forty days later, she presented with mild transient platelet depletion and liver dysfunction along with a C-reactive protein (CRP) level of 2.65 mg/dL. At that time, she discontinued CBZ without consulting the doctor. She subsequently developed high fever and a pruritic maculopapular rash. Laboratory tests revealed an elevated CRP level (11.98 mg/dL) and serum creatinine (sCr) of 1.6 mg/dL. Hence, she was admitted to our hospital, where she showed eosinophilia and immunoglobulin suppression. She was diagnosed with atypical drug-induced hypersensitivity syndrome (DIHS). All drugs prescribed by the previous doctor were discontinued. A lymphocyte transformation test showed CBZ positivity; a renal biopsy revealed many granulomatous lesions connected to arterioles, without angionecrotic findings. The patient had no history of allergic disorders or tuberculosis. Because of psychological instability, we treated her conservatively without steroid administration. She had a good recovery except for mild residual renal insufficiency (sCr, 1.0 mg/dL). Although granuloma formation has been observed in kidney biopsy specimens of rare cases with DIHS, no previous studies have reported on the relationship between arterioles and granuloma formation.

U-Shaped Association between Body Mass Index and the Prevalence of Wheeze and Asthma, but not Eczema or Rhinoconjunctivitis: The Ryukyus Child Health Study

Background. Studies reporting on the association between obesity and allergies have mostly focused on asthma. Little is known about the relationship of obesity to other allergic diseases, and the information that is available has been inconsistent. We examined the association between body mass index (BMI) and the prevalence of wheeze, asthma, eczema, and rhinoconjunctivitis in Japanese schoolchildren. Methods. Study subjects were 24,399 children aged 6–15 years in Okinawa, Japan. Outcomes were based on diagnostic criteria from the International Study of Asthma and Allergies in Childhood. BMI was categorized into five groups; <5th, 5th to 35th, >35th to 65th, >65th to 95th, and >95th percentile groups. Adjustment was made for sex, age, region of residence, number of siblings, smoking in the household, physical activity, paternal and maternal history of allergic disorders, and paternal and maternal educational levels. Results. The prevalence values of wheeze, asthma, eczema, and rhinoconjunctivitis in the previous 12 months were 10.8%, 7.6%, 6.9%, and 7.6%, respectively. Compared with the referent category (>35th to 65th percentile group), higher percentile categories were positively associated with the prevalence of wheeze. A U-shaped relationship between BMI and asthma was observed. No material associations between BMI percentile categories and the prevalence of eczema or rhinoconjunctivitis were found. Conclusion. These findings suggested that being either underweight or overweight might increase the likelihood of asthma among Japanese schoolchildren.

Allergy and ACP1 genetic polymorphism

The ACP1 (acid phosphatase locus 1) gene encodes a highly polymorphic low molecular weight protein tyrosine phosphatase (LMPTP) involved in the modulation of various signal transduction pathways including T-cell receptor. Previous studies suggest an association of this enzyme with allergic disorders. The aim of this study was to review our previous data and to confirm the association by further observations. Two new independent samples of individuals were studied from the population of Rome. ACP1 genotype was determined and history of allergic disorders was recorded. All allergic subjects had at least one positive prick test. Three-way contingency table analyses were performed by a log linear model. In all samples studied from different populations (Italian, English, and Chinese for a total of 958 subjects) we found that the proportion of allergic subjects was higher among genotypes with low enzymic activity than among genotypes with high activity. Concentration of IgE was negatively correlated with ACP1 enzymic activity. Carriers of ACP1 genotypes associated with low enzymic activity may be more susceptible to allergic disorders.

Anxiety accelerates T-helper 2-tilted immune responses in patients with atopic dermatitis

Stress, which mediates anxiety, worsens skin symptoms in patients with atopic dermatitis (AD). The contribution of anxiety to immune dysfunction, which plays a critical role in the pathogenesis of AD, requires clarification. To examine the relationship between anxiety and atopy-relevant immune function in AD. Eighty-five patients with AD and 58 normal individuals without a history of allergic disorders were enrolled in this study. To assess anxiety, the state-trait anxiety inventory was completed for both groups. In the AD group, measurements were made of SCORAD scores, serum IgE levels, itching (visual analogue scale), blood eosinophil count and T-helper (Th) 1/Th2 ratio in the peripheral blood. Anxiety was significantly higher among the subjects with AD than the normal subjects, and trait anxiety (TA) was higher than state anxiety (SA) in the AD group. Serum total IgE levels were correlated positively with TA and the TA/SA ratio and inversely with SA, and the Th1/Th2 ratio was correlated inversely with TA and the TA/SA ratio. The patients with AD had higher anxiety levels than normal individuals, and those with a stronger perception of TA than SA showed enhanced serum IgE synthesis and Th2 shifting.

Risk of Physician-Diagnosed Asthma in the First 6 Years of Life

The objective of this cohort study was to determine if complications of pregnancy and labor, characteristics at birth, and exposure to infections influence the incidence of asthma in the first 6 years of life. We identified all children born between 1980 and 1990 in the Province of Manitoba, Canada. We used records of physician contacts (inpatient and outpatient) and services of the universal provincial health insurance plan to follow up 170,960 children from birth to the age of 6 years to identify the first diagnosis of asthma. Information on mothers and siblings was also obtained to determine family history of disease and exposure to infections. During the study period, a diagnosis of asthma was made in 14.1% of children by the age of 6 years. The incidence was higher in boys than in girls, in those with family history of allergic diseases. It was higher in urban than in rural areas, and lowest in those born in winter. Asthma was more likely in those with low birth weight and premature birth. Certain congenital abnormalities and complications of pregnancy and labor also increased the risk of asthma. The risk of asthma increased with maternal age. Both upper and lower respiratory infections increased the risk of subsequent asthma, and this effect was more important than exposure to familial respiratory infections, which also tended to increase asthma risk. The risk of asthma decreased with the number of siblings when siblings had a history of allergic disorders. In addition to genetic influences, intrauterine and labor conditions are determinants of asthma. Exposure to both upper and lower respiratory tract infections increases the risk; these infections do not explain the protective effect associated with the increasing number of siblings.

Relative utility of skin prick tests, total IgE and allergen-specific IgE in allergy diagnosis

Rationale The study assessed the correlation between skin prick test (SPT), determination of specific IgE antibodies and total serum IgE in patients with a history of allergic disorders. Methods 48 patients, 31 females and 17 males, age 16 to 65 years old were studied by SPT, total IgE and allergen-specific IgE. 27 patients had respiratory disorders, 15 had skin disorders and 6 had a history of systemic allergic reactions after insect stings. Results In 8 patients SPT and specific IgE were negative, 1 of whom had a slightly increased total IgE. In 8 patients SPT and specific IgE were positive, 4 of whom had increased total IgE. Among 10 patients who had dermographism and positive specific IgE, 6 had an elevated total IgE. 19 patients having negative SPTs had positive specific IgE assays, 9 also having a high level of total IgE. Conclusions There was no significant correlation between SPT and specific IgE tests, or between SPT and total serum IgE level. When SPT is positive and in agreement with the clinical history, the total and specific IgE add no additional useful information. However, in patients having dermographism or negative SPT, total and specific IgE determination may assist in confirmation of the diagnosis.

Cytokine gene polymorphism in recurrent acute otitis media.

There is increasing evidence that a strong genetic component is involved in the predisposition to recurrent acute otitis media (rAOM). Cytokines play a key role in the pathogenesis of otitis media. Constitutional polymorphisms in cytokine genes may lead to individual variations in cytokine secretion. To elucidate the role of cytokine gene polymorphisms in rAOM. University hospital. Blood samples for genetic analysis were obtained from 63 individuals with rAOM from 20 different families and from 400 healthy blood donors. The medical history of the rAOM group was based on medical records and interview data. We studied the polymorphisms of tumor necrosis factor alpha, interleukin (IL) 1 alpha, IL-1 beta, and IL-1 receptor antagonist genes. The distribution of cytokine alleles in the rAOM group did not differ significantly from that of the control group. However, in patients with rAOM without a history of allergic disorders, allele frequencies of IL-1 alpha-889 differed significantly from those of controls (P =.03). There is no clear association between the polymorphism of studied cytokine genes and rAOM. However, the IL-1 alpha gene polymorphism may be associated with recurrent middle ear infections in a subgroup of patients without allergic disorders.

Allergic disorders and attention deficit disorder in children

It has been suggested that children with attention deficit disorder-hyperactivity (ADDH) are likely to show allergic disorders, and that both ADDH and allergic disorders may share a common biological background. In a large sample of children from the general population we found no association between parent, teacher, and self-reports of ADDH behaviors and a history of allergic disorders (asthma, eczema, rhinitis, and urticaria) at ages 9 or 13 years. Similarly, reports of ADDH behaviors at age 13 years were not related to level of atopic responsiveness by skin test or serum IgE levels. Our findings call into question the hypothesis that there is a relationship between ADDH and allergic disorder.