Multiple Allergens Research Articles

Increased Risk of Asthma at Age 10 Years for Children Sensitized to Multiple Allergens

Increased Risk of Asthma at Age 10 Years for Children Sensitized to Multiple Allergens

Sensitization characteristics of cockroach in Beijing area

Objective:To investigate the sensitization characteristics of cockroach in patients with allergic rhinitis（AR） and/or allergic asthma in Beijing area, and to provide basis for the prevention and treatment of cockroach sensitized population. Methods:Clinical data of patients with allergic rhinitis and/or asthma from January 2017 to December 2019 treated in the outpatient Department of Allergy of Beijing Shijitan Hospital were retrospectively analyzed.Skin prick test （SPT） was performed with cockroach allergen reagents. The cockroach sensitization of patients with different ages and diseases was compared, and the population distribution characteristics of cockroach sensitization were observed.Statistical analysis was performed using SAS 9.4 software. Results:A total of 9915 patients were enrolled in the end.The total positive rate of cockroach SPT was 24.79%（2458/9915）,with the highest positive rate （31.65%） in 15-19 years old group. The positive rate of SPT increased with age in patients less than 14 years old, while the positive rate of SPT was basically flat with age in patients more than 20 years old .The positive rate of cockroach SPT was 24.83% （2355/9484） in allergic rhinitis patients,26.38% （410/1554） in allergic asthma patients, and 27.34% （307/1123） in allergic rhinitis combined with asthma patients. Single cockroach SPT positive accounted for 9.64% （237/2458）, cockroach with other indoor inhalation allergens SPT positive accounted for 90.36% （2221/2458）. The positive SPT rates for combined Der f , Der p,house dust, cat dander, and dog dander were 74.25% （1825/2458）, 66.27% （1629/2458）, 58.99% （1450/2458）, 43.08% （1059/2458）, and 40.85% （1004/2458）, respectively.In allergic rhinitis，asthma，and allergic rhinitis combined with asthma，the cockroach SPT positive rate was higher in the adult group than that in juvenile group，and the difference of positive rate in allergic rhinitis group was statistically significant（25.81% vs 19.07%, P<0.001）.In the juvenile group, the positive rate of SPT in AR combined with asthma was higher than that in AR and that in asthma. Conclusion:Cockroach allergy in patients with AR and/or allergic asthma in Beijing is relatively high, most of them are sensitized by multiple inhalation allergens, and the sensitization degree of adults is higher than that of juvenile.

SINGLE VERSUS MULTI-ALLERGEN ORAL IMMUNOTHERAPY FOR TREATMENT OF FOOD ALLERGY: A RETROSPECTIVE COHORT STUDY

<h3>Introduction</h3> With 40% of food-allergic children in the US being allergic to more than one food, more data on the safety and efficacy of multi-allergen oral immunotherapy (treating multiple allergens concurrently) will better inform clinician practice. <h3>Methods</h3> This retrospective study compares the safety and efficacy of multi-allergen versus single allergen oral immunotherapy (OIT) in two pediatric cohorts (single allergen n=169, multi-allergen n=147). Pearson Chi-square tests compared OIT completion rates (efficacy endpoint) and epinephrine use (safety endpoint). Multiple logistic regression models analyzed the difference between these endpoints while controlling for demographic differences between the cohorts. <h3>Results</h3> There was no statistical difference in OIT completion rates between the cohorts (85.2% single allergen vs 80.3% multi-allergen, p=0.245). There was a statistical difference in epinephrine use rates between cohorts (6.5% single vs 15.7% multi, p=0.009). More patients in the multi-allergen group had multiple food allergies (p=<0.001), asthma (p=0.043), allergic rhinitis (p=0.012), a prior reaction to the OIT treatment food (p=0.037), and a higher mean baseline allergen specific IgE (p=0.003). When analyzing OIT completion and epinephrine use endpoints while controlling for these differences using a multiple logistic regression model, neither OIT completion (odds ratio of 0.56, 95% confidence interval 0.23 – 1.37, p=0.205) nor epinephrine use (odds ratio of 1.63, 95% confidence interval 0.55 – 4.82, p=0.379) resulted in statistically significant differences between each group. <h3>Conclusion</h3> Multi-allergen OIT is as effective as single allergen OIT, however multi-allergen OIT may result in increased treatment-related epinephrine use, making it less safe than single allergen treatment.

Effectiveness and adverse reactions to subcutaneous immunotherapy in children with allergic rhinitis/asthma.

Adverse reactions, which are mostly local and rarely systemic, can be seen during subcutaneous immunotherapy (SCIT). It was not possible to continue SCIT at times due to systemic reactions. The purpose of the present study was to identify the incidence and risk factors associated with adverse reactions during subcutaneous allergen-specific immunotherapy (AIT). A total number of 344 patients under 18 years old with allergic rhinitis and/or asthma who underwent SCIT between 2005 and 2021 were included in the study. Demographic characteristics of the patients, laboratory findings [Total Immunglobulin E(IgE), aeroallergen prick test, inhaler, and allergen specific IgE(sIgE) and eosinophil counts], and adverse events observed during AIT were recorded retrospectively. Descriptive and univariate/multivariate logistic regression analyses were used to identify risk factors for adverse events. Among 344 patients, 33.4% (n=115) were female, mean age was 133.1±41.0 months, and 42.2% (n=145) were >12 years old. One hundred-thirty eight (40.1%) of the patients were mono-sensitized, 47 (13.7%) had asthma, 207 (60.2%) allergic rhinitis, and 90 (26.2%) asthma and allergic rhinitis. Single allergen content was administered to 187 (54.4%) patients (62 mite, 114 grass mix, 11 olea), and multiple allergens to 157 (45.6%) patients (121 pollen mix, 36 other (mite/alternaria)]. A total number of 33.008 injections were administered. 840 adverse reactions (262 (31.1%) at up-dosing phase, 578 (68.8%) at maintenance phase) in 195 (56.7%) patients were observed. Among the adverse reactions, 632 (75.2%) were local, 160 (19%) large local, and 48 (5.7%) (39at maintenance, 9at up-dosing) (in 31 patients) were systemic (28 Grade 1, 12 Grade 2, 8 Grade 3). Adrenalin was administered to 8 patients with Grade 3 systemic reaction (8/33008; %0.024). Adverse reactions, especially local ones, were seen more frequently in children under 12 years old (p<0.001). Patients sensitized with grass pollen (p:0.01) and mite (p:0.004), and those who had received SCIT with pollen mixture had more adverse reactions than the others. More adverse reactions were observed in SCIT containing calcium-phosphate as adjuvant (p: 0.01). Local reactions were risk factors for large local (OR=3.591, %95 CI:2.064-6.247, p<0.001) and systemic (OR=2.190, %95 CI:1.005-4.722 p=0.046) reactions at univariate analyses. Total nasal symptom scores, Visual Analog Scale and asthma symptom control test decreased after one year of treatment (p<0.01). SCIT is a safe and effective treatment method in childhood that leads to improvements in all nasal symptoms and asthma after one year of treatment.

Simultaneous quantification of six major allergens in commercial foods for children using a multiplex array on a digital versatile disc

The hypothesis of this study is centered around the logic that an enhanced analysis of potential allergens during the food production can lead to increased accuracy and reliability of food labeling. The development of a cost-effective and straightforward optoelectrical microanalytical system for the simultaneous quantification of the six most common food allergens (peanut, hazelnut, almond, milk, wheat, and soybean) is presented. The system uses a regular versatile disc (DVD) functionalized with highly selective antibodies in a microarray format and a DVD drive as the optical detector. The multiplexed assay reliably (RSD < 20 %) determines the level of the allergenic proteins ranging from 0.1 to 143.4 ng mL−1. The analysis of food consumables (biscuits, seafood substitutes, and probiotic foods) revealed a 100 % accuracy in identifying the allergens ingredients declared on the label. The method offers potential for application as a high throughput biosensing tool for screening multiple allergens in commercial foods.

Investigation of differences in allergenicity of protein from different soybean cultivars through LC/MS-MS

Soybean allergy is a health-threatening issue and identifying raw soybeans with low allergenicity is important for producing hypoallergenic soybean products. Soybean allergy is mainly triggered by soybean proteins. In this study, the protein profiles, allergen compositions, and epitopes in protein from different soybean cultivars (R1, R2 and R3) were evaluated by SDS–PAGE and LC/MS-MS, and their allergenicity was assessed by indirect ELISA and Western blot analysis using the serum IgE of patients allergic to soybeans. The lowest allergenicity was observed in R3, probably resulting from the low concentration of Gly m 4-Gly m 6. The allergenicity of soybeans is affected by multiple allergens rather than a single allergen. Venn diagram, PCA, heatmap, and peptide map analyses have shown the differences in protein and peptide profiles among soybean proteins from different soybean cultivars. Epitope analysis further demonstrated that low contents of dominant epitopes in Gly m 4 and Gly m 5 contributed to low allergenicity in R3, although R3 contained high contents of no-dominant epitopes.

COVID-19, The Frequent Use of Moist Wipes, and Multiple Allergic Sensitisations: A Case Report

During the COVID-19 pandemic, frequent handwashing and disinfection have exacerbated or caused skin diseases. This case report shows the simultaneous development of allergic contact dermatitis to Kathon CG (DuPoint, Wilmington, Delaware, USA), Euxyl K400, and fragrance mix I because of the frequent use of moist (baby) wipes during the pandemic outbreak. The sensitisation to multiple allergens was determined by patch testing, whereas the disease resolved after usage discontinuation of moist wipes. Notably, two COVID-19 pulmonary events anticipated the clinical sensitisation. This case demonstrates that changes in attitude and behaviour with concern to exposure intensity to moist wipes can induce a clinical response to many allergens.

Optical Analysis of Nasal Endoscopic Images From a Patient With Severe Acute Respiratory Syndrome Coronavirus 2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide; a simple diagnostic test is becoming increasingly important. Polymerase chain reaction tests of nasal swab samples are expensive and time-consuming. Detailed observation of the nasal cavity is required. No nasal endoscopic study regarding patients with SARS-CoV-2 has been published. Here, we compared endoscopic images of normal subjects and patients with allergic rhinitis (AR) to images from a patient with confirmed SARS-CoV-2 infection. Nasal cavity endoscopic images (of the inferior turbinate) were compared using the hue, saturation, and luminance (HSL) color system of Matrox Design Assistant, version 5.0. The multiple allergen simultaneous test was used to distinguish normal subjects from patients with AR. HSL patterns were compared among images. We enrolled 14 normal subjects and patients with AR and 1 patient with confirmed SARS-CoV-2 infection. The inferior turbinates of normal subjects and patients with AR were smooth and uniform, while those of the patient with SARS-CoV-2 were scratched and stretched. Although additional data are needed, optical analysis of nasal endoscopy images may be useful to screen for SARS-CoV-2 infection. This imaging method is rapid, non-invasive, and inexpensive.

A microfluidic diagnostic device with air plug-in valves for the simultaneous genetic detection of various food allergens

The identification of accidental allergen contamination in processed foods is crucial for risk management strategies in the food processing industry to effectively prevent food allergy incidents. Here, we propose a newly designed passive stop valve with high pressure resistance performance termed an “air plug-in valve” to further improve microfluidic devices for the detection of target nucleic acids. By implementing the air plug-in valve as a permanent stop valve, a maximal allowable flow rate of 70 µL/min could be achieved for sequential liquid dispensing into an array of 10 microchambers, which is 14 times higher than that achieved with the previous valve arrangement using single-faced stop valves. Additionally, we demonstrate the simultaneous detection of multiple food allergens (wheat, buckwheat, and peanut) based on the colorimetric loop-mediated isothermal amplification assay using our diagnostic device with 10 microchambers compactly arranged in a 20-mm-diameter circle. After running the assays at 60 °C for 60 min, any combination of the three types of food allergens and tea plant, which were used as positive and negative control samples, respectively, yielded correct test results, without any cross-contamination among the microchambers. Thus, our diagnostic device will provide a rapid and easy sample-to-answer platform for ensuring food safety and security.

Association of allergen sensitization patterns with clinical outcome of subcutaneous allergen-specific immunotherapy in polysensitized allergic patients

Abstract Introduction Understanding sensitization patterns helps clinicians tailor care more effectively. Most clinical studies with positive results used single allergens, but many patients are sensitized to multiple allergens. Aim This study was planned to assess the correlation between different allergen sensitization patterns (the presence of sensitization to some but not other allergens) and clinical effectiveness of subcutaneous allergen-specific immunotherapy. Patients and methods This ex post facto study was conducted on patients with already diagnosed allergic disorders, who were attending our allergy and immunotherapy clinic and receiving subcutaneous allergen-specific immunotherapy. Data collected include patient’s demographic data, diagnosis of allergic disorders, and sensitization pattern duration of subcutaneous immunotherapy. The outcome of subcutaneous allergen-specific immunotherapy was assessed based on symptom score, medication score, and overall clinical outcome. Results A total of 100 patients were included. The frequencies of allergens, to which the patients were sensitized, were pollen (1 and 2) (63%), mold (61%), mite (59%), hay dust (41%), and chicken feather (23%). There were no significant association between sensitization patterns and the preimmunotherapy symptom and medication. Apart from cotton pollen, all other allergens were not associated with improvement in symptom score, and apart from chicken feather and dog sensitization all other allergens were not associated with improvement in medication score. Conclusion Allergen sensitization pattern could affect clinical outcome of subcutaneous allergen-specific immunotherapy in polysensitized patients. Cotton pollen sensitization is associated with less improvement in symptoms score. Chicken feather sensitization is associated with significant improvement in medication score in contrast to dog hair sensitization. The number of allergens in each patient is not significantly associated with the clinical outcome of subcutaneous immunotherapy.

IL-1α and IL-36 Family Cytokines Can Undergo Processing and Activation by Diverse Allergen-Associated Proteases.

Inflammation driven by environmental allergens is an important source of morbidity in diseases such as asthma and eczema. How common allergens promote inflammation is still poorly understood, but previous studies have implicated the protease activity associated with many allergens as an important component of the pro-inflammatory properties of these agents. The IL-1 family cytokine, IL-33, has recently been shown to undergo processing and activation by proteases associated with multiple common allergens. However, it remains unclear whether the sensing of exogenous protease activity—as a proxy for the detection of invasive microbes, allergens and parasitic worms—is a general property of IL-1 family cytokines. In common with the majority of IL-1 family members, cytokines within the IL-36 sub-family (IL-36α, IL-36β and IL-36γ) are expressed as inactive precursors that require proteolysis within their N-termini for activation. Here we show that proteases associated with multiple common allergens of plant, insect, fungal and bacterial origin (including: Aspergillus fumigatus, ragweed, rye, house dust mite, cockroach and Bacillus licheniformis) are capable of processing and activating IL-36 family cytokines, with IL-36β being particularly susceptible to activation by multiple allergens. Furthermore, extracts from several allergens also processed and enhanced IL-1α activity. This suggests that multiple IL-1 family cytokines may serve as sentinels for exogenous proteases, coupling detection of such activity to unleashing the pro-inflammatory activity of these cytokines. Taken together with previous data on the diversity of proteases capable of activating IL-1 family cytokines, this suggests that members of this cytokine family may function as ‘activity recognition receptors’ for aberrant protease activity associated with infection, tissue injury or programmed necrosis.

Efficacy comparison and safety analysis of subcutaneous specific immunotherapy with standardized house dust mite allergen in patients with single and multiple allergic rhinitis

Efficacy comparison and safety analysis of subcutaneous specific immunotherapy with standardized house dust mite allergen in patients with single and multiple allergic rhinitis

Development and Validation of a Quantitative Method for Multiple Allergen Detection in Food Using Concatemer-Based Isotope Dilution Mass Spectrometry.

Accurate food labeling is essential to protect allergic consumers. However, allergen contaminations may occur during the whole food production process. Reliable, sensitive, and robust methods for detecting multiple allergens in food are needed. This work aims to develop and validate an LC coupled to tandem mass spectrometry (MS/MS) method for the detection and quantification of hazelnuts, peanuts, milk, and eggs in processed food products. In-house-produced incurred test materials, cookies and chocolates, were used for the method development and validation. The quantification was based on the standard addition strategy using qualified reference materials as allergen protein standards and an innovative stable isotope-labeled concatemer as an internal standard. A method targeting 19 allergen-specific peptides was developed and validated in two laboratories, which strengthens its robustness. The AOAC INTERNATIONAL performance requirements for repeatability, intermediate precision, reproducibility, and recovery were reached for at least one peptide per allergen across both matrixes, and quantification limits complied with the action levels of the Food Industry Guide to the Voluntary Incidental Trace Allergen Labelling (VITAL®) Program Version 3.0. The combination of incurred test materials, standard addition strategy, and stable isotope-labeled concatemer as an internal standard allowed us to develop and validate a robust method for detecting and quantifying multiple allergens in food with sufficient sensitivity to protect allergic consumers. The combination of characterized incurred test material, calibration with certified reference material, a single stable isotope labelled concatemer and cross-lab validation result in the required standardization and harmonization in food allergen detection according to the stakeholders' group to assess the robustness of our method.

Leukocyte redistribution as immunological biomarker of corticosteroid resistance in severe asthma.

Earlier studies have suggested that the leukocyte redistribution can be considered as an immunological marker of the clinical response to corticosteroids (CS), representing an easy measurable potential biomarker in severe asthma. The aim of this study was to determinate the utility of the leukocyte redistribution as a biomarker of disease heterogeneity in patients with severe asthma and as a bioindicator of potential CS resistance. We developed an unbiased clustering approach based on the clinical data and the flow cytometry results of peripheral blood leukocyte phenotypes of 142 patients with severe asthma before and after systemic CS administration. Based on the differences in the blood count eosinophils, neutrophils and lymphocytes, together with the flow cytometry measurements of basic T cell, B cell and NK cell subpopulations before and after systemic CS administration, we identified two severe asthma clusters, which differed in the cell frequencies, response to CS and atopy status. Patients in cluster 1had higher frequency of blood eosinophils at baseline, were sensitized to less allergens and had better steroid responsiveness, measured as the pronounced leukocyte redistribution after the administration of systemic CS. Patients in cluster 2 were determined by the higher frequency of B-cells and stronger IgE sensitization status to the multiple allergens. They also displayed higher steroid resistance, as the clinical correlate for the lower leukocyte redistribution after administration of systemic CS. The flow cytometry-based profiling of the basic populations of immune cells in the blood and its analysis before and after systemic corticosteroid administration could improve personalized treatment approaches in patients with severe asthma.

ALLERGENIC POTENTIAL AND CROSS-REACTIVITY OF FUNGAL SPECIES ISOLATED FROM THE INDOOR ENVIRONMENT

Indoor fungi are potential sensitizing agents. Their detection and quantification in indoor environments are important in the diagnosis and environmental management of fungal allergies. This study aims to analyse the allergenic potential of ten fungal species and the cross-reactivity of the two most common fungi isolated from the indoor environment samples from Sultan Idris Education University buildings. Employing in vivo (skin prick test) and in vitro (immunoblotting), the major and minor allergenic proteins of ten fungi sensitized subjects were identified. Aspergillus fumigatus and Penicillium canescens were the most common fungi with the highest potential to trigger allergies. The cross-reactivity between them was detected by immunoblotting inhibition experiments using three selected sera from subjects sensitized to each of the aforementioned species. The immunoblotting test revealed multiple major and minor allergens. Among them were 11, 25, 33, 36 &gt; 100 kDa and were also listed as causative agent triggering allergy by IUIS Allergen Nomenclature Subcommittee. Cross-reactivity of Aspergillus fumigatus against Penicillium canescens revealed that 9(64.29%) allergenic bands and 13(76.47%) allergenic bands were inhibited, respectively. Aspergillus spp. and Penicillium spp. with high cross-reactivity are most prevalent in the indoor environment of identified contaminated buildings at UPSI. Aspergillus fumigatus and Penicillium canescens can elicit sensitization among the atopic population and implicates worsening the condition of the symptomatic subjects with prolonged these fungal exposures.

Maintained disease control and steroid-sparing effect of subcutaneous immunotherapy in allergic rhinitis and asthma.

Allergen immunotherapy is the only currently available treatment strategy that modifies the immune response to the causative allergen and induces clinical improvement and a steroid-sparing effect. In this real-life study, we aimed to evaluate and compare the efficacy of subcutaneous immunotherapy (SCIT) with one allergen or multiple allergens in children and adults with asthma and/or allergic rhinitis in terms of disease control and a steroid-sparing effect. Demographics, the initial inhaled corticosteroid (ICS) and/or intranasal corticosteroid (INS) dose, and other drugs of patients receiving SCIT for at least 12 months were recorded. Data on the final dose/use of ICS/INS and asthma and/or allergic rhinitis control were gathered. Of 104 patients included, 57.1% and 64.5% of patients with asthma and allergic rhinitis, respectively, were able to discontinue ICS and INS after SCIT. The median time to INS and ICS dose reduction was 6 months. SCIT with one allergen or multiple allergens effectively reduced the ICS and INS dose and led to control of asthma and allergic rhinitis, with no significant difference between the groups. When the efficacy of SCIT was compared in children and adults, there was no significant difference in terms of a steroid-sparing effect or the control of asthma and allergic rhinitis. SCIT was effective in both children and adult patients. In this real-life observational study, we have demonstrated a marked steroid-sparing effect while maintaining control of asthma and allergic rhinitis in children and adults treated with one allergen or multiple allergens.

A neutrophil/TGF-β axis limits the pathogenicity of allergen-specific CD4+ T cells.

The intensity and longevity of inflammatory responses to inhaled allergens is determined largely by the balance between effector and regulatory immune responses, but the mechanisms that determine the relative magnitudes of these opposing forces remain poorly understood. We have found that the type of adjuvant used during allergic sensitization has a profound effect on both the nature and longevity of the pulmonary inflammation triggered by subsequent reexposure to that same provoking allergen. TLR ligand adjuvants and house dust extracts primed immune responses characterized by a mixed neutrophilic and eosinophilic inflammation that was suppressed by multiple daily allergen challenges. During TLR ligand–mediated allergic sensitization, mice displayed transient airway neutrophilia, which triggered the release of TGF-β into the airway. This neutrophil-dependent production of TGF-β during sensitization had a delayed, suppressive effect on eosinophilic responses to subsequent allergen challenge. Neutrophil depletion during sensitization did not affect numbers of Foxp3+ Tregs but increased proportions of Gata3+CD4+ T cells, which, upon their transfer to recipient mice, triggered stronger eosinophilic inflammation. Thus, a neutrophil/TGF-β axis acts during TLR-mediated allergic sensitization to fine-tune the phenotype of developing allergen-specific CD4+ T cells and limit their pathogenicity, suggesting a novel immunotherapeutic approach to control eosinophilia in asthma.

Efficacy of dual sublingual immunotherapy with Japanese cedar pollen and house dust mite allergens in patients with allergic rhinitis sensitized to multiple allergens.

ObjectiveIn the present study, we examined the effects of dual sublingual immunotherapy (SLIT) with Japanese cedar pollen (JCP) and house dust mite (HDM) allergens on nasal symptoms during the peak pollen period (PPP) and in late fall (LF) in patients with allergic rhinitis (AR) sensitized to both JCP and HDM. We then compared the efficacy of dual‐SLIT with JCP and HDM to that of mono‐SLIT with JCP at PPP.MethodsTwenty‐five bisensitized patients with AR who showed positive serum specific immunoglobulin E (IgE) against both JCP and HDM were enrolled. In dual‐SLIT, 16 patients received JCP drops/tablets and HDM tablets concurrently. In mono‐SLIT with JCP, nine patients received JCP drops/tablets. Nasal symptoms were scored on a 0–4 point scale.ResultsThe nasal scores at PPP and in LF in the bisensitized patients with AR who received dual‐SLIT with JCP and HDM in 2019 were significantly lower than those in the same patients who received antihistamines only in 2018. The decrease in scores of nasal obstruction at PPP from 2018 to 2019 in patients who received dual‐SLIT was significantly greater than those in patients who received mono‐SLIT with JCP. Dual‐SLIT was well tolerated and only had mild adverse effects.ConclusionThese findings suggest that dual‐SLIT suppressed both JCP‐induced seasonal and HDM‐induced perennial nasal symptoms in bisensitized patients with AR. Dual‐SLIT was more effective in suppressing nasal obstruction at PPP than mono‐SLIT with JCP with limitation of baseline characteristics not to be controlled between the two groups, suggesting that dual‐SLIT suppressed HDM‐induced priming effects, thus resulting in further suppression of nasal obstruction at PPP.Level of Evidence3b, a case‐controlled study

Development of Sensitization to Multiple Allergen Molecules from Preschool to School Age Is Related to Asthma

Introduction: Allergic sensitization in early life has been identified as a strong risk factor for subsequent asthma in childhood. It is still unclear why only a part of sensitized children develop asthma, and the role of specific allergen molecules in asthma pathogenesis is ambiguous [Pharmacol Ther. 2009 Feb;121(2):174–84]. We assessed the sensitization to multiple allergen molecules longitudinally and explored its relation to persistent asthma at 7 years. Methods: Seventy-two children included during an acute wheezing episode (cases) were followed prospectively from early preschool age (EPA) to age 7, and compared to 43 healthy controls at EPA. Allergen molecules were analyzed at EPA and age 7 using ImmunoCAP Solid-phase Allergen Chip (ISAC). Asthma diagnosis at 7 years was based on symptoms, medication, and spirometry. Results: At EPA, cases compared to controls showed a tendency toward having a higher prevalence of allergic sensitization (23.6% vs. 9.3%, p = 0.055). The prevalence of sensitization increased in cases from EPA to 7 years (23.6% vs. 38.9%; p = 0.048) as well as the median number (range) of immunoglobulin E (IgE)-reactive molecules 3 (3–14) versus 6.5 (1–21); p = 0.024. Sensitization to each additional molecule from EPA to the age of 7 was significantly related to asthma at 7 (OR = 1.25, 95% confidence interval [1.01, 1.54]). Conclusion: Polysensitization, assessed by allergen molecules, had a significant impact on persistent asthma at school age. The extent of sensitization, illustrated by molecular spreading from preschool to school age, was related to asthma diagnosis at 7 years in children with a history of wheezing at early life.

Relevance of patch testing in patients of chronic spontaneous urticaria and its correlation with serum IgE level

Objectives: Chronic spontaneous urticaria (CSU) is defined as short lived (&lt; 24h) wheals occurring spontaneously without any triggering factors, daily or almost daily for at least 6 weeks. Though CSU is mainly a Type 1 hypersensitivity reaction, earlier studies suggested contact allergy may have some role to play an important role in the etiopathogenesis of CSU. The objective of the study is to find out the relevance of patch test in the etiopathogenesis of and its correlation with serum IgE level. Materials and Methods: Thirty-one patients of CSU were thoroughly evaluated for clinical and laboratory parameters. We conducted patch testing with Indian Standard Series (ISS) in all of them and tried to find out the relevance of every positive reaction. Relevant positive cases were asked to avoid exposure for 2 months and were maintained only in breakthrough antihistamines. Furthermore, correlation of positive patch test reaction with high IgE and eosinophil count were studied. Results: Seventeen (55%) cases came positive for patch test. Potassium dichromate, lanolin, benzocaine, and fragrance mix were the most common offenders. Patients with very high IgE count had patch test positivity with multiple allergens. Seven of the fifteen patients who had relevant positive patch results could be followed up to remission; three were lost to follow-up. Conclusion: Patch test with ISS may give important clue to in a subset of patients of CSU and thus may be considered an important part of routine investigations of CSU.