Positive Skin Prick Test Responses Research Articles

Continuous cow’s milk protein ingestion during infancy may promote casein-specific IgG4 production

BackgroundEarly supplementation and subsequent discontinuation of cow’s milk formula (CMF) may increase the risk of cow’s milk allergy in breastfed infants, but little is known about the relationship between continuous CMF ingestion and cow’s milk protein-specific immunoglobulin production. ObjectiveThis study aimed to clarify this relationship in cow’s milk-sensitized infants. MethodsUsing data from a randomized controlled trial of a Japanese birth cohort, we performed a subgroup analysis of participants who had ingested CMF in the first 3 days of life and exhibited a positive skin prick test response to cow’s milk at 6 months of age. We compared the differences in median titers of cow’s milk-specific IgE, casein-specific IgE, and casein-specific IgG4 between participants who continued daily or intermittent CMF ingestion up to 6 months of age (“continuous group”) and participants who discontinued CMF ingestion before 6 months of age (“discontinued group”). ResultsFrom 462 trial participants, 49 (10.6%) were included in this study (continuous group: 21, discontinued group: 28). The median titer of cow’s milk-specific IgE was 0.17 kUA/L (interquartile range: <0.10-0.57) in the continuous group and 0.66 kUA/L (0.49-1.18) in the discontinued group (P=.0008). The median titer of casein-specific IgE was <0.10 kUA/L (<0.10-0.15) in the continuous group and <0.10 kUA/L (<0.10-0.37) in the discontinued group (P=.51). The median titer of casein-specific IgG4 was 2.58 mgA/L (0.77-6.73) in the continuous group and 0.09 mgA/L (0.07-0.13) in the discontinued group (P<.0001). ConclusionContinuous CMF ingestion may promote casein-specific IgG4 production in cow’s milk-sensitized infants.

Prevalence and risk factors for allergic sensitization: 3 cross-sectional studies among schoolchildren from 1996 to 2017.

The prevalence of allergic sensitization and allergic diseases has increased for decades in Northern Europe, but recent studies are lacking. We sought to study the prevalence trends of allergic sensitization, associated risk factors, and the association with asthma and allergic rhinitis (AR) among children in Northern Sweden. Three cohorts of children aged 7 to 8 years participated in a skin prick test (SPT) with 10 airborne allergens in 1996, 2006, and 2017, with 2148, 1693, and 1762 participants tested, respectively, representing 87% to 90% of schoolchildren in the catchment communities. Adjusted Poisson regression was used to identify risk factors for allergic sensitization and the association with asthma and AR. The prevalence of any positive SPT response increased from 21% in 1996 to 30% in 2006 and remained at 30% in 2017 (P< .001). Sensitization to cat was the most common for all the years. The risk factor pattern for a positive SPT response was similar in all examinations, with positive and significant associations with a family history of allergy (risk ratio, 1.4-1.5) and negative and significant associations with having a cat at home (risk ratio, 0.7-0.8). The prevalence of physician-diagnosed asthma increased, but the association with allergic sensitization weakened. The opposite trends were found for AR-decreasing prevalence and strengthened association with allergic sensitization. The prevalence of allergic sensitization increased from 1996 to 2006 but plateaued in the next decade, whereas the risk factor pattern remained stable. The diverging trends of associations between allergic sensitization and asthma and AR suggest secular trends in the clinical management of allergic diseases.

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

Prevalence of Allergen Sensitization from Allergen Skin Prick Test Reactivities of Allergic Rhinitis Patients in the MSMC

Background: Allergic rhinitis is commonly found in Thailand and its prevalence seems to be higher in each area with the commonly found allergens and different characteristics of the population. Objective: To study the prevalence of each type of allergen from a skin prick test carried out among patients with allergic rhinitis in HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC), Nakhon Nayok Province, Thailand. Materials and Methods: The study was conducted using a descriptive cross-sectional study design. Retrospective data were collected from the medical records of all patients with allergic rhinitis who took a skin prick test at the Department of Otolaryngology, MSMC between 1 April 2016 and 31 March 2021. The results of the prevalence of allergens were reported in terms of numbers and percentages. Skin prick tests giving positive results among patients with allergic rhinitis were compared to the test results of patients with allergic rhinitis and asthma. Results: In total, 304 subjects diagnosed with allergic rhinitis who took a skin prick test met the criteria for inclusion in the present study, 207 were female (68.09%). Their mean age was 39.65+12.32 years old. The study found that 198 (65.13%) patients had positive results from of the test. The standardized mite mix was the most common allergen (55.92%), followed by American cockroach (37.82%), Johnson grass (5.59%), mixed Aspergillus (3.95%), and dog epithelium (1.32%). The patients with allergic rhinitis and asthma had a higher incidence of positive results than the patients with allergic rhinitis alone (risk difference was 13.36%, 95% CI 5.06 to 21.66, p-value = 0.005). Conclusion: The present study revealed that the prevalence of a positive skin prick test response was 65.13% of patients diagnosed with allergic rhinitis. The standardized mite mix was the most frequently found allergen, followed by American cockroach, Johnson grass, mixed Aspergillus, and dog epithelium. Keywords: Skin test; Allergens; Allergic rhinitis; Prevalence

A study of skin prick test to identify common allergens in allergic rhinitis patients in and around Saharanpur

Allergic rhinitis accounts for a significant burden of allergy in whole world. Precise identification of allergens is worthwhile since it may lead to improvement in therapy. So we conducted an observational study of common allergens by skin prick test in a group of patients.A total of 2300 skin prick test were done using 46 common inhalant allergens on 50 patients of allergic rhinitis.Males were the predominant group of patients, and Allergic rhinitis was more common in 21- 29 years age group in our study. Frequency of positive skin prick test response to various group of allergens were- pollen (80%), dust (70%), mite(52%), lnsects (50%), fungi(48%) and epithelial antigen(20%).overall, pollen of parthenium (70%) followed by house dust(64%) were found to be the most common offending allergens.Skin prick test used to identify the putative allergens is valuable to the patients for instituting avoidance therapy and immunotherapy efficiently and economically.

A study of various diagnostic tests to identify offending allergens in patients of allergic rhinitis in a tertiary care centre in northern India

Background and Objectives: Allergic rhinitis, a global health issue, if left untreated cause serious conditions like asthma, sinusitis or ear infections. Precise identification of allergens is worthwhile since it may lead to improvement in therapy. Therefore, this study was undertaken to determine the common inhalant allergens causing allergy in and around Saharanpur by skin prick test, serum IgE levels, nasal smear eosinphilia and AEC levels. Materials and Methods: 50 patients diagnosed clinically to have allergic rhinitis were included in the study. Absolute eosinophil count, nasal smear for eosinophils, and total IgE levels (wherever possible) were determined. Skin prick tests using 46 common inhalant allergens were done and results analysed. Results: Increased absolute eosinophil count, nasal smear positive for eosinophil and raised total IgE levels were found to be present in 56%, 22% and 97% of the patients respectively. Frequency of positive skin prick test response to various group of allergens were — Pollen (80%), Dust (70%), Mite (52%), Insects (50%), Fungi (48%) and Epithelial antigens (20%). Overall, pollen of Parthenium (in 70%) followed by House dust (in 64%) were found to be the most common offending allergens. Conclusion: It can be concluded that skin prick test along with serum IgE levels used to identify the causative allergens is useful in the patients of allergic rhinitis. Keywords: Allergic rhinitis, Skin prick test, Aeroallergens, Nasal smear eosinophils, IgE.

Challenges in assessing the efficacy of systemic corticosteroids for severe wheezing episodes in preschool children

Summary This letter addresses the controversial issue of the use of oral corticosteroids during wheezing exacerbations in preschool-aged children by demonstrating findings of a prematurely terminated multi-center clinical trial, discussing lessons learned, and suggesting future directions.

Lower airway microbiota associates with inflammatory phenotype in severe preschool wheeze

Lower airway microbiota associates with inflammatory phenotype in severe preschool wheeze

Sensitization to Common Aeroallergens in the Atopic Population of West Bengal, India: An Investigation by Skin Prick Test

Background: Aeroallergen sensitization is increasing worldwide. The optimal management of allergic disease requires the identification of the allergic sensitivities of the patient. Complete data of offending aeroallergens are scant from West Bengal, India. Hence, we employed a retrospective analysis of an atopic population of West Bengal to investigate the rate of sensitivity toward common aeroallergens including pollens, molds and house dust mites. Objectives: The aim of the present study was to evaluate the profile of skin prick test (SPT) reactivity of an atopic population of eastern India. Methods: The prevalence aeroallergen sensitization was investigated by SPT along with a questionnaire survey of patients who visited the Allergy and Asthma Research Center of West Bengal, India, from June 2016 to May 2018. Patients were categorized according to the demographic (age, gender) and clinical aspects. Statistical tests were applied to differentiate between age and gender of the sufferers. Results: 524 out of 605 patients exhibited a positive SPT response toward one or more aeroallergens tested. One-way ANOVA following Tukey’s post hoc test reveals the age group of 15–40 years was more sensitized than that of < 15 years and no male-female discrimination was found using the paired t test. House dust mites, namely Dermatophagoides pteronyssinus and Dermatophagoides farinae, elicited most significant SPT results (80.34 and 84.92%, respectively) followed by Cocos (73.28%) and Azaridacta (57.25%) pollen. The most sensitive mold was Alternaria alternata (26.9%). Allergic rhinitis, bronchial asthma and atopic dermatitis were recorded as the common symptoms. Other influencing factors were family history, nature and season/time of onset and house conditions. Conclusion: Following the increasing trend, house dust mite sensitization still held the dominance like in any other Indian population reported earlier. This study would pave the way to construct a standard and minimal SPT panel for the atopic patients of eastern India.

Acidic polypeptides A1a, A3 and A4 of Gly m 6 (glycinin) are allergenic for piglets

Gly m 6 (glycinin) is one of the major antigenic proteins in soybeans responsible for transient hypersensitivity to soybean meal in weaned piglets. The globulin is a hexamer consisting of subunits containing basic and acidic polypeptides. Multiple acidic polypeptides have long been demonstrated to be allergens for humans and play a key role in the overall allergenicity of Gly m 6. To date, knowledge on the allergenicity of the acidic polypeptides for piglets is very limited. The purpose of this study was to identify the acidic polypeptides that were allergenic for piglets and to characterize these acidic polypeptides by ELISA, western blot, skin prick and basophile histamine release test. The IgG and IgE antibody binding capacities of the acidic polypeptides of Gly m 6 were determined using ELISA and western blot analysis with sera from Gly m 6 sensitized piglets. Skin prick test and basophile histamine release test were conducted to measure the effector cell response to the polypeptides. Specific IgG and IgE antibodies against A1a, A3 and A4 of Gly m 6 were identified in the sera of Gly m 6 sensitized piglets. Meanwhile, positive skin prick test and specific histamine release responses were also induced by the acidic polypeptide A1a, A3 and A4 of Gly m 6 from the basophiles of Gly m 6 sensitized piglets. The results demonstrate that the acidic polypeptide A1a, A3 and A4 of Gly m 6 are allergenic for piglets.

The Incidence of Delayed-Type Hypersensitivity Reactions to Apples Among Patients Allergic to Birch Pollen.

The major apple allergen Mal d 1 cross-reacts with the homologous birch pollen allergen Bet v 1 and causes immunoglobulin E (IgE)-mediated immediate-type allergic reactions. In some patients, delayed-type hypersensitivity to apples may develop within 72 hours without evidence of specific IgE or a positive skin prick test (SPT). The aim of the study was to evaluate the concomitance of delayed-type hypersensitivity reactions and immediate IgE-mediated reactions against high- and low-allergenic apple cultivars in patients with birch pollen allergy. Data were obtained from 45 adults with clinical symptoms of birch pollen allergy. Patients were exposed to apple pulp via atopy patch tests (APTs) and SPTs. Levels of IgE specific to Bet v 1 and Mal d 1 were measured with a radioallergosorbent test. Patients allergic to birch pollen showed the highest rate of positive SPT responses to Golden Delicious apples and the lowest rate to low-allergenic cultivar Grey French Reinette. Among these patients, 9% developed delayed hypersensitivity reactions to either Golden Delicious or Grey French Reinette apples; these reactions manifested clinically as erythema with papules (class ++). Fifty percent of APT-positive patients were concomitantly SPT-negative. Here, we show for the first time the clinical relevance of T cell-driven allergic reactions to apples. APTs may reveal type IV sensitization in patients who are negative for the corresponding type I sensitization tests. Thus, utilization of the APT procedure with fresh apple appears to be a valuable tool for the diagnosis of apple allergy and may improve the accuracy of food allergy diagnoses.

Isotype-specific agglutination-PCR (ISAP): A sensitive and multiplex method for measuring allergen-specific IgE

Isotype-specific agglutination-PCR (ISAP): A sensitive and multiplex method for measuring allergen-specific IgE

Common environmental chemicals do not explain atopy contrast in the Finnish and Russian Karelia.

BackgroundAtopic allergy is much more common in Finnish compared with Russian Karelia, although these areas are geographically and genetically close. To explore the role of environmental chemicals on the atopy difference a random sample of 200 individuals, 25 atopic and 25 non-atopic school-aged children and their mothers, were studied. Atopy was defined as having at least one positive skin prick test response to 14 common inhalant and food allergens tested. Concentrations of 11 common environmental pollutants were measured in blood samples.ResultsOverall, the chemical levels were much higher in Russia than in Finland, except for 2,2′,4,4′-tetra-bromodiphenyl ether (BDE47). In Finland but not in Russia, the atopic children had higher concentrations of polychlorinated biphenyls and 1,1-Dichloro-2,2-bis-(p-chlorophenyl)-ethylene (DDE) than the non-atopic children. In Russia but not in Finland, the atopic mothers had higher DDE concentrations than the non-atopic mothers.ConclusionsHigher concentrations of common environmental chemicals were measured in Russian compared with Finnish Karelian children and mothers. The chemicals did not explain the higher prevalence of atopy on the Finnish side.

The Effect of Vitamin D Levels on Pediatric Allergic Diseases: A Nationwide Population-Based Study

Hea-Kyoung Yang, Jaehee Choi, Woo Kyung Kim, So-Yeon Lee, MD, Yong Mean Park, Man-Yong Han, MD, Myung-Il Hahm, Yoomi Chae, Hye-young Kim, Kang Mo Ahn, MD, HoJang Kwon, MD, PhD, Jihyun Kim, MD; Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Environmental Health Center for Atopic Diseases, Samsung Medical Center, Seoul, Korea, Environmental Health Center for Atopic Diseases, Department of Pediatrics, Samyook Medical Center, Seoul, South Korea, Department of Pediatrics, Inje University College of Medicine, Seoul, Korea, Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Department of Pediatrics, Hallym University Secred Heart Hospital, Anyang, South Korea, Kunkuk University Hospital, South Korea, CHA University Bundang Medical Center, Seongnam, South Korea, Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Korea, Department of Occupational and Environmental Medicine, College of Medicine, Dankook University, Department of Pediatrics, Pusan National University School of Medicine, Busan, Korea, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea, South Korea, Preventive Medicine, Dankook University College of Medicine, Cheonan, South Korea, Dankook University, Cheonan, Environmental Health Center for Atopic Diseases, Seoul, South Korea, Department of Pediatrics, SamsungMedical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. RATIONALE: We aimed to investigate the association between concentration of serum vitamin D levels and recent symptoms of allergic diseases in elementary schoolchildren. METHODS: A nationwide cross-sectional survey was conducted in the first grade students from randomly selected 45 elementary schools. Recent symptoms of atopic dermatitis (AD) or asthma were defined as those who were medically treated for AD or asthma. Recent symptoms of allergic rhinitis (AR) were considered to be present if a child had the experience of treatment for AR during the last 12 months and showed a positive skin prick test responses to common 18 inhalant allergens. All the children were examined by a pediatrician to determine the presence of eczema in their neck and flexural areas of both arms. Serum 25-hydroxyvitaminD [25(OH) D] was measured by chemiluminescent microparticle immunoassay. RESULTS: The overall prevalence rates of vitamin D insufficiency (20 to 29 ng/mL) and deficiency (<20 ng/mL) were 64.1% and 18.4%. The adjusted odds ratio (aOR) for the presence of AR was 0.980 (95% CI: 0.962–0.998) for each increase of 1 ng/mL in 25(OH)D, while no association was found between 25(OH)D levels and the prevalence of AD or asthma. The aOR per increase of 1 ng/mL in 25(OH)D was 0.974 (95% CI 0.955-0.994) for the presence of eczema on the day of survey. CONCLUSIONS: A high prevalence of vitamin D deficiency and insufficiency was found in Korean elementary schoolchildren, and vitamin D level was associated with recent symptoms of AD and AR. 186 Clinical and Epidemiological Differences in Patients with Acute Urticaria and Chronic Urticaria Mehtap Haktanir Abul, MD, Fazil Orhan, Zekiye Ilke Kilic Topcu, Taner Karakas, Ali Baki; Karadeniz Technical University Faculty of Medicine Department of Pediatric Immunology and Allergy, Trabzon, Turkey, Karadeniz Technical University Faculty of Medicine Department of Pediatric Immunology and Allergy, Karadeniz Technical University Faculty of Medicine Department of Pediatric Pulmonology. RATIONALE: Urticaria is commonly seen and it is difficult to determine the etiologic factors in children. The aim of the study is to define different clinical patterns of urticaria in childhood. METHODS: This is a prospective study included the children who were referred to our clinic for evaluation of urticaria. Laboratory tests including serologic, autoimmune, and allergic analyses were conducted. RESULTS: One hundred and eighty two children (90 females and 92 males) were evaluated. The age range was 4 month17 years old. Of the cases, 58.2 % (n5106) were diagnosed with acute urticaria and 41.8 % (n576) were diagnosed with chronic urticaria. There wasn’t any significant difference in gender between acute and chronic urticaria group. The median agewas 5 years (range: 4month16 years old) and 6.5 years (range: 7 month17 years old) for acute and chronic urticaria groups respectively. CRP, IgE, eosinophil, C3 and C4 levels are higher in acute urticaria than chronic urticaria patients that were not statistically significant. Physical urticaria was commonly seen in children with chronic urticaria (48.7%). Spontaneous resolution is more frequently seen in acute urticaria patients than the chronic urticaria patients (p50.016). CONCLUSIONS: There are clinical and epidemiological differences in patients with acute urticaria and patients with chronic urticaria. Recurrence, spontaneous resolution seems to be the factors associated with the differences in both group of patients. Physical urticaria is commonly seen and should be questioned in childrenwith chronic urticaria.

Distinct transcriptome profiles differentiate nonsteroidal anti-inflammatory drug–dependent from nonsteroidal anti-inflammatory drug–independent food-induced anaphylaxis

Lipid transfer protein (LTP), an abundant protein in fruits, vegetables, and nuts, is a common food allergen in Mediterranean areas causing diverse allergic reactions. Approximately 40% of food-related anaphylaxis induced by LTPs requires nonsteroidal anti-inflammatory drugs (NSAIDs) as a triggering cofactor. We sought to better understand the determinants of NSAID-dependent and NSAID-independent LTP-induced anaphylaxis (LTP-A). Selection of patients was based on a proved clinical history of NSAID-dependent or NSAID-independent anaphylaxis to LTPs, positive skin prick test response to LTPs, and serum LTP IgE. Whole-transcriptome (RNA sequencing) analysis of blood cells from 14 patients with NSAID-related LTP-A (NSAID-LTP-A), 7 patients with LTP-A, and 13 healthy control subjects was performed to identify distinct gene expression signatures. Expression of genes regulating gastrointestinal epithelial renewal was altered in both patient sets, particularly in those with LTP-A, who also presented with gene expression profiles characteristic of an inflammatory syndrome. These included altered B-cell pathways, increased neutrophil activation markers, and increased reactive oxygen species levels. Increased expression of the IgG receptor (CD64) in patients with LTP-A was mirrored by the presence of LTP-specific IgG1 and IgG3. Conversely, patients with NSAID-LTP-A were characterized by reduced expression of IFN-γ-regulated genes and IFN-γ levels, as well as upregulated expression of adenosine receptor 3 (ADORA3) and genes related to adenosine metabolism. Gene ontology analysis suggests disturbances in gut epithelial homeostasis in both groups with LTP-A, with potential integrity breaches in patients with LTP-A that might explain their distinct inflammatory signatures. Differential regulation in patients with LTP-A and those with NSAID-LTP-A of the IFN-γ pathway, IgG receptors, and ADORA3 might provide the pathogenic basis of their distinct responses.

Association between vitamin D levels and allergy-related outcomes vary by race and other factors

Allergy-related studies that include biological measurements of vitamin D preceding well-measured outcomes are needed. We sought to examine the associations between early-life vitamin D levels and the development of allergy-related outcomes in the racially diverse Wayne County Health, Environment, Allergy, and Asthma Longitudinal Study birth cohort. 25-Hydroxyvitamin D (25[OH]D) levels were measured in stored blood samples from pregnancy, cord blood, and age 2 years. Logistic regression models were used to calculate odds ratios (ORs) with 95% CIs for a 5 ng/mL increase in 25(OH)D levels for the following outcomes at age 2 years: eczema, skin prick tests (SPTs), increased allergen-specific IgE level (≥ 0.35 IU/mL), and doctor's diagnosis of asthma (3-6 years). Prenatal 25(OH)D levels were inversely associated with eczema (OR, 0.85; 95% CI, 0.75-0.96). The association was stronger in white children (white children: OR, 0.79; 95% CI, 0.57-1.09; black children: OR, 0.96; 95% CI, 0.82-1.12), although this was not statistically significant. Cord blood 25(OH)D levels were inversely associated with having 1 or more positive SPT responses and aeroallergen sensitization. Both associations were statistically significant in white children (positive SPT response: OR, 0.50; 95% CI, 0.32-0.80; ≥ 1 aeroallergen sensitization: OR, 0.50; 95% CI, 0.28-0.92) in contrast with black children (positive SPT response: OR, 0.88; 95% CI, 0.68-1.14; ≥ 1 aeroallergen sensitization: OR, 0.85; 95% CI, 0.65-1.11). 25(OH)D levels measured concurrently with outcome assessment were inversely associated with aeroallergen sensitization (OR, 0.79; 95% CI, 0.66-0.96) only among black children (white children: OR, 1.21; 95% CI, 0.87-1.69). Prenatal and cord blood 25(OH)D levels were associated with some allergy-related outcomes, with a general pattern indicating that children with higher 25(OH)D levels tend to have fewer allergy-related outcomes.

Eucalyptus pollen allergy and asthma in children: a cross-sectional study in South-East Queensland, Australia.

ObjectivesTo investigate Eucalyptus (gum tree) pollen allergy in children in relation to geography, particularly vegetation, and its relationship to asthma.MethodsMales (n = 180) and females (n = 200) aged 9 to 14 participated. Some were healthy (asymptomatic), some had asthma, and some had other symptoms associated with atopy. School students were from three urban coastal schools and one school from a nearby semi-rural elevated area (range) near Brisbane, Australia. Coastal and range locations featured different distributions of Myrtaceae family vegetation (including Eucalyptus, Melaleuca, Leptospermum species). Skin prick test (SPT) responses to 15 commercial allergens were compared. As well, responses from coast versus range groups, and ‘asthma’ (n = 97) versus ‘healthy’ status (n = 107) groups, were compared.ResultsSPT responses (≥3mm wheal diameter) indicate that children with asthma are 31.1 times more likely to be allergic to Eucalyptus pollen extract (OR: 31.1; 95%CI 4.1- 235.7) compared to healthy children. Dust mite (p = .018), Eucalyptus (p = .046) and cockroach (p = .047) allergen SPT responses (wheals ≥3mm) were significantly greater in participants located on the coast versus range as determined by Fisher’s Exact Test (α .05). For each location, percentage of positive responses (wheals ≥3mm) was greatest for ‘dust mite’ (30.9%-46%), ‘cockroach’ (18.1% -35%) and ‘Bermuda grass’ (10.6%-19.4%).ConclusionsThe results support the hypothesis that proximity to Myrtaceae vegetation is related to positive SPT response and that Eucalyptus is an important allergen for children with asthma. Substantial response to olive allergen, in the absence of olive trees, suggests that the response may be driven by substances in other plants, perhaps Melaleuca quinquenervia, which abounds in coastal areas.ImplicationsResponse to Eucalyptus allergen indicates that changes in gardening practice in schools and public areas may be appropriate. The findings pose validity questions regarding the use of some commercial allergens due to cross-reactive responses and the sources of those responses.

Breast-feeding does not protect against allergic sensitization in early childhood and allergy-associated disease at age 7 years

Extended breast-feeding is recommended for newborn children at risk of allergy-associated diseases, but the evidence of a protective effect on sensitization and these diseases remains elusive. The aim of this study was to investigate the effects of the duration of exclusive breast-feeding on the development of sensitization in preschool children. Information on breast-feeding was gathered by interviews involving 335 children aged 1, 6, and 12 months from the Copenhagen Prospective Study on Asthma in Childhood2000 birth cohort born to mothers with a history of asthma. Skin prick test responses and specific IgE levels against 12 common inhalant and 10 food allergens were assessed longitudinally at ages ½ year, 1½ years, 4 years, and 6 years. Eczema, wheeze/asthma, and allergic rhinitis were diagnosed at the Copenhagen Prospective Studies on Asthma in Childhood clinic at 7 years of age, strictly adhering to predefined algorithms. Associations between duration of exclusive breast-feeding and outcomes were analyzed by logistic regression. We found no significant association between duration of exclusive breast-feeding and development of sensitization in the first 6 years of life (odds ratio [OR]: ½ year, 1.10 [95% CI, 0.90-1.36]; 1½ years, 1.15 [95% CI, 0.97-1.36]; 4 years, 1.08 [95% CI, 0.93-1.25]; and 6 years, 0.96 [95% CI, 0.84-1.10]) or with current eczema, wheeze/asthma, and allergic rhinitis at age 7 years (OR, 1.07 [95% CI, 0.92-1.24]; OR, 0.97 [95% CI, 0.82-1.14]; and OR, 1.02 [95% CI, 0.84-1.23], respectively). Adjusting for reverse causation by excluding children with eczema, wheeze, or a positive skin prick test response before ending exclusive breast-feeding did not alter the results. Exclusive breast-feeding does not affect sensitization in early childhood or associated diseases at 7 years of age in at-risk children.

Cellular cytokine and chemokine responses to parasite antigens and fungus and mite allergens in children co-infected with helminthes and protozoa parasites.

BackgroundIn sub-Saharan Africa poly-parasite infections are frequently observed in children, and with poly-parasitism modulating immune mechanisms, mediated by cytokines and chemokines, are required to prevent overwhelming inflammation and host tissue damage. We analyzed in children co-infected with helminthes and protozoan parasites their cellular production of regulatory and pro-inflammatory cytokines and chemokines in response to parasite antigens and allergens.MethodsIntestinal and intravascular parasite infections were detected in stool and urines samples. The in vitro cellular cytokine and chemokine responses of peripheral blood mononuclear cells (PBMC) to parasite antigens and allergens were analysed in children (n = 87) with single and poly-parasite infection, and skin prick test reactivity to fungus and mite allergens was determined in singly and poly-parasitized children (n = 509).ResultsIn children Entamoeba histolytica/dispar (62%), Necator americanus (31%), Schistosoma haematobium (28%), S. mansoni (21%), Hymenolepis nana (2%) and Strongyloides stercoralis (1%) were diagnosed. Singly infected were 37%, 47% were positive for 2 or more parasite species and 16% were infection-free. When PBMC were stimulated in vitro with parasite antigens and allergens, regulatory-type cytokine IL-27 and alarmin-type IL-33 enhanced with poly-parasite infections whilst IL-10 and pro-inflammatory MIP3-α/CCL20 and MIG/CXCL9 were produced in similar amounts in singly or poly-parasitized children. The co-stimulation in vitro of PBMC with mite allergens and Ascaris lumbricoides antigens depressed the allergen-induced pro-inflammatory IL-27, IL-33 and MIP3-α/CCL20 responses while regulatory IL-10 remained unaffected. Post albendazole and/or praziquantel treatment, the cellular release of IL-10, IL-33, MIP3-α/CCL20 and MIG/CXCL9 lessened significantly in all children infection groups. Skin prick test (SPT) reactivity to fungus Aspergillus fumigatus and mite Dermatophagoides pteronyssinus allergens was investigated in 509 children, and positive SPT responses were found in 23% of the infection-free, and in 47%, 53% and 56% of the singly, doubly and poly-parasite infected, respectively.ConclusionsIn children co-infected with helminthes and protozoan parasites a mixed cellular response profile of both inflammatory and regulatory chemokines and cytokines was stimulated by individual antigens and allergens, pro-inflammatory cytokines and chemokines enhanced with an increasing number of parasite infections, and in poly-parasitized children skin prick test reactivity to allergens extracts was highest.

Efficacy and Safety of Grass Sublingual Immunotherapy Tablet, MK-7243: A Large Randomized Controlled Trial.

J Maloney, DI Bernstein, H Nelson. Ann Allergy Asthma Immunol. 2014;112(2):146–153.e2 The goal of this study was to evaluate the safety and efficacy of treatment with a grass sublingual immunotherapy tablet (MK-7243) in children and adults with allergic rhinoconjunctivitis. Previous studies have been conducted outside of North America and have included only sparse pediatric data. Studied were 1501 North American subjects aged 5 to 65 years. The study included 283 children with a physician-diagnosed history of grass pollen–induced allergic rhinoconjunctivitis, with or without asthma, who had received treatment of their symptoms during the previous grass pollen season. Inclusion criteria were positive skin prick test response to Phleum pratense (≥5-mm wheal); positive specific IgE against P pratense …