Predictors Of Allergy Research Articles

Association between Raised Serum IgE Levels and Bronchial Asthma in Children

Introduction: Studies of allergy and respiratory diseases have traditionally used allergy skin test reactivity, serum IgE levels or peripheral blood eosinophilia to identify atopic subjects. Objectives: The main objective of the study is to find the association between Raised Serum IgE levels and bronchial asthma in children. Material and methods: This cross sectional study was conducted in Independent Medical College FSD during June 2020 to June 2021. The data was collected from 140 patients of age range 2 to 12 years. Each patient was thoroughly examined by the physician and the proforma was filled accordingly. Results: The data was collected from 140 patients. The results showed no significant associations of gender, family history of asthma, exclusive breastfeeding up to 6 months and residential set up with the elevated level of total serum IgE. The higher age group, exposure to cigarette smoke and the raised eosinophil count showed the significant associations with the elevated levels of total serum IgE in asthmatics. Conclusion: It is concluded that total serum IgE tracks with age, children who are predisposed to persistent wheezing and early sensitization to local aeroallergens already have high levels of IgE. Serum total IgE level is a good predictor of allergy in children. Keywords: Serum, Levels, IgE, Asthma

Three Characterisctics of Atopy to Diagnose Allergy in Children with Respiratory Symptomps

The prevalence of allergic diseases has increased in the last decade. Therefore, precise and reliable in predicting allergy in children were needed. However, in daily practice, most misdiagnosis occurs because it is only based on a family history of allergy. This study aims to evaluate the chronicity, recurrence of symptoms with similar exposure, and family history of allergy to be used as a predictor of allergy in children with respiratory symptoms. Cross sectional study was conducted in children who referred to the Pediatric Allergy and Immunology Outpatient Clinic, Dr. Soetomo General Hospital, Surabaya from January 1st - July 31st 2019. Children with a suspected allergy who developed respiratory symptoms was included. The data was taken from standardized medical record. The sensitivity and specificity of the 3 characteristics of atopic with positive SPT were calculated. A total of 115 children were admitted and 109 children fulfill the inclusion criteria. Gender 60% male and 40% female. The most common group of age founded was age 5-<10 years 39.4%, followed by 1-<3 years (25.8%), 3-<5 years (22.9%), 10 years 8.3%, and <1 year (3.6%). Fifty-four patients (49.5%) fulfilled 3 characteristics of atopy and there were 64 patients (58.7%) with positive SPT results. The sensitivity, specificity, positive predictive value and negative predictive value were 81.3%, 95.6%, 96.3%, and 78.2%, respectively. The 3 characteristics of atopy have good sensitivity and specificity to predict allergy in children.

Allergy and related clinical symptoms among medical students and interns.

Objectives:To determine the prevalence, types, clinical presentations, triggers, and predictors of allergic disorders among medical students and interns at King Abdulaziz University (KAU), Jeddah, Saudi Arabia.Methods:A cross-sectional design was used for this study in which 600 medical students and interns were selected by a multistage stratified random sampling. A validated, confidential, self-administered questionnaire was used during 2016 / 2017. It asked about the previous diagnosis of allergic disorders, associated factors, types, clinical symptoms and the triggering allergenic. Descriptive & inferential statistics were done and logistic regression analysis was conducted.Results:The overall prevalence of diagnosed allergic disorder(s) among the participants was 36.2%.The commonest types of allergy were skin (33.8%) followed by respiratory (29.5%) presentations. The most frequently reported allergenic triggers were the house dust (45.6%) and smoke (30.4%). The first allergy predictor was family history of allergic disorders (aOR= 4.35, 95 % CI: 2.96-6.39), followed by female gender. Regarding the outcome of allergy on students’ life, 16.1% occasionally missed classes, and 28.6% had sleep disturbance during allergic attacks.Conclusion:Allergy represents an important problem among medical students and interns. Family history and female gender were the predictors of allergy. Skin and respiratory allergies were the most common types. House dust and smoke were the commonest allergenic triggers. Detection of allergens and management of cases of allergy among medical students and interns are needed. Education and conduction of awareness campaigns about allergy are needed.

Opioid Hypersensitivity: Predictors of Allergy and Role of Drug Provocation Testing

True IgE-mediated hypersensitivity to opioids is rare and many reactions are due to direct mast cell degranulation. Opioid drug provocation testing (DPT) is the gold standard for diagnosis but is underutilized. The objective of this study was to evaluate the clinical characteristics and predictors of opioid hypersensitivity, as well as outcomes of opioid DPT. Patients referred for opioid DPT over the past 9 years were studied. Patient characteristics, indications for opioid use, symptoms of index reaction, and outcomes of DPT were analyzed. Association analysis was performed to study variables associated with a diagnosis of opioid hypersensitivity. Of the total of 98 patients referred with suspected opioid hypersensitivity, 15 (15%) were diagnosed with opioid allergy. Angioedema (odds ratio [OR]: 5.66; 95% confidence interval [CI]: 1.49-21.47; P= .011) and hypotension (OR: 5.00; 95% CI: 1.15-21.70; P= .032) were significantly more frequent in opioid allergic patients than those with a negative DPT. Patients who received opioids during anesthesia were significantly more likely to be opioid allergic (OR: 6.74; 95% CI: 2.05-22.13; P= .001). In contrast, a negative association was identified with patients who received opioids for analgesia (OR:0.27; 95% CI: 0.08-0.86; P= .008). Only 15% of our cohort were diagnosed with opioid allergy, emphasizing the importance of DPT in preventing erroneous overdiagnosis. Patients with a history of angioedema or hypotension as their index reaction were significantly more likely to be opioid allergic. DPT are safe when performed by experienced clinicians after risk stratification and using individualized protocols.

Genetic Predictors of Drug Hypersensitivity.

Our knowledge of genetic predisposing factors of drug hypersensitivity reactions (DHRs) is still scarce. The analysis of the genetic basis of these reactions may contribute to dissect the underlying mechanisms. We will outline current knowledge of the genetic predictors of most common DHRs, including reactions to betalactam antibiotics (BLs), nonsteroidal anti-inflammatory drugs (NSAIDs) and biological agents. The predictors of DHRs to BLs are mostly linked to IgE-class switching, IgE pathway and atopy (IL4R, NOD2, LGALS3) in replicated candidate gene studies, and to antigen presentation (HLA-DRA) in the single replicated GWAS performed so far. The HLA-DRA variants are predictors of allergy to penicillins, but not to cephalosporins and they influence also the sensitization against prevalent allergens. The predictors of DHRs against NSAIDs are mostly linked to metabolism of eicosanoids (ALOX5, ALOX5AP, TBXAS1, PTGDR, CYSLTR1). Single nucleotide polymorphisms (SNPs) in genes involved in histamine biosynthesis and antigen presentation, HLA, could also have a role in DHRs against NSAIDs. The intriguing association of DHRs to NSAIDs with atopy should deserve further attention. Predictors of DHRs against asparaginase and other biological agents relate to antigen presentation (HLA-DRB1 and HLA-A alleles, respectively). The potential relationship of genetic predictors of DHRs with pathomechanisms also involved in environmental exposure and atopy highlights the need to perform GWAS in contrasted populations, taking into account world-wide variations of allele frequencies and contrasted situations of environmental exposure.

Maternal Occupational Exposure and Breastfeeding Impact on Programming Child Allergy

Introduction. Epidemiologic data suggest a possible association between maternal exposure to chemical substances and risk of childhood allergy in offspring. The overall beneficial effects of breastfeeding for infants’ growth, immunity, and development have been well documented, but its role in allergy prevention is controversial. The purpose of this study was to assess the effect of maternal occupational exposure to chemical substances on programming allergy in 4–6 years children and to evaluate breastfeeding impact on these associations. Methods. This nested cases-control study included 645 mother-children pairs. Allergy was assessed by the standardized questionnaires. Logistic regression models were fitted to examine the associations as odds ratios (OR) between maternal occupational exposure, breastfeeding duration and the risk of allergy adjusted for relevant covariates. Results. As many as 67.0% of the mothers reported having occupational exposure to chemical substances more than 1 year before pregnancy. Children of mothers exposed at work to chemical substances had increased prevalence of allergy at 4–6 years age comparing with not exposed (32.6% and 25.0%, accordingly). Occupationally exposed to chemical substances mothers breastfeeding more than 3 months increased 4–6 years children allergy risk by 59 %, adjusted OR 1.59; 95% CI 0.80–3.16. These associations were robust to adjustment for covariates associated with allergy, such as maternal education, smoking during pregnancy, chronic disease, child’s gender, and low birth weight. Conclusions. Occupationally exposed to chemical substances mothers’ breastfeeding may be a predictor of allergy throughout the developmental trajectory of childhood. Further investigation is needed to elucidate the influence of chemical substances and breastfeeding on childhood allergy.

AQUA© as predictor of allergy in elite marathon runners

Background The prevalence of allergy in athletes is increasing, and its risk varies across sports. The risk is dependent mainly on the ventilation rate and environmental factors; however, the prevalence of allergy in elite runners remains unknown. Therefore, the aim of this study was to screen allergy symptoms in elite marathon runners by using a validated questionnaire for screening allergy in athletes.Methods Two hundred and one elite marathoners, who participated in the most competitive Brazilian marathons and half-marathons during 2011, were invited to complete a validated self-report Allergy Questionnaire for Athletes (AQUA©), with additional questions pertaining to training history, such as running experience, running distance per week and their best race time in marathon or half-marathon events.Results Sixty percent of the assessed athletes reported allergy symptoms as defined by a positive AQUA outcome (score [greater than or equal to] 5). No significant differences (p > 0.05) between groups (AQUA + and AQUA-) were observed for gender, age, running experience, weekly training volume and best performance time in the half-marathon and marathon. The most frequently reported symptoms were related to the respiratory tract and physical effort.Conclusions This study demonstrates that AQUA©can be used to predict allergy in elite marathon runners. In addition, these athletes have a higher prevalence of allergy symptoms to elite athletes from other sports.

Relationship of Cytokine and Regulatory Gene Expression to the Outcomes of Milk and Egg Allergy in an Atopic Cohort (COFAR2)

S A T U R D A Y 94 Relationship of Cytokine and Regulatory Gene Expression to the Outcomes of Milk and Egg Allergy in an Atopic Cohort (COFAR2) S. H. Sicherer, D. Stablein, R. A. Wood, A. W. Burks, A. H. Liu, S. M. Jones, D. M. Fleischer, L. Mayer, R. Lindblad, A. Grishin, H. A. SampsonConsortium of Food Allergy Research. Mt. Sinai School of Medicine, New York, NY, EMMES Corp., Rockville, MD, Johns Hopkins University School of Medicine, Baltimore, MD, Duke, Durham, NC, National Jewish Health, Denver, CO, University of Arkansas for Medical Sciences, Little Rock, AR. RATIONALE: To determine lymphocyte activation biomarkers associated with milk/egg allergy over time. METHODS: Children aged 3-15 months with likely milk/egg allergy and no diagnosed peanut allergywere followed at baseline, 6, 12 and 24months and categorized as egg/milk allergic or tolerant by predefined criteria. Mononuclear cell allergen stimulation screening for CD25, CISH, FOXP3, GATA3, IL-10, IL-4, IFN-gamma and TBET expression using casein and egg white as stimulants were performed at each of the time points. Repeated measures analyses with generalized linear modeling were constructed to determine if gene expression was predictive of the allergy state (allergic or tolerant). RESULTS: The number of children with a confirmed/convincing milk allergy and number tolerant in parentheses among those tested at baseline (n5492), 6 (n5432), 12 (n5420) and 24(n5367) months were: 237(105), 197(137), 197(163) and 145(190), respectively. The corresponding results for egg were: 139(23), 132(35), 129(55) and 99 (117), respectively. The significant (p < 0.05) predictors of allergy based upon current gene expression values were: increased IL4 expression (milk) and decreased GATA3 (egg). Considering change in activation from baseline, risk was associated with a decrease in TBET (milk) and increased IL4 (egg). Tolerance to egg was associated with current decreased CISH, and decreased TBET compared to baseline. However, the predictive capacity of the findingswasminimal, with only a few percentage points of risk being predicted by large changes in expression. CONCLUSIONS: Allergen-stimulated lymphocyte gene expression failed to significantly reflect allergy states over time.

Allergy from infancy to adolescence. A population-based 18-year follow-up cohort

BackgroundAnxious parents have many concerns about the future health of their atopic infants. Paediatricians and primary care practitioners need to seek knowledge on long-term outcomes in order to cope with the increasing caseload of suspected allergy and the concerns of parents. The aim of the study was to assess suspected and diagnosed allergy in infancy as predictors of allergy and asthma in adolescence.MethodsFamilies expecting their first baby and making their first visit to a maternity health care clinic in 1986 were selected as the study population in a random sample. There were 1278 eligible study families. The data were provided of the children at the ages of 9 and 18 months and 3, 5, 12, 15 and 18 years by health care professionals, parents, and adolescents (themselves).ResultsAt the age of 9 months, the prevalence of allergy suspicions was distinctly higher than that of allergy diagnoses. At the age of five years suspected allergy approaches were nil, and the prevalence of diagnosed allergy was about 9%. During the adolescence, the prevalence of self-reported allergy increases steadily up to the age of 18 years, and that of asthma remains at approximately 5%. Suspected allergy at the age of 9 or 18 months and at the 5 years of age does not predict allergy at adolescence. Compared with non-allergic children, children with definite allergy at the age of 5 were over 8 times more likely to have allergy and nearly 7 times more likely to have asthma in adolescence.ConclusionAn early ascertained diagnosis of allergy, but not suspicions of allergy, predicts prevailing allergy in adolescence. Efforts need to be focused on accurate diagnosis of early childhood allergies.

Nasal metachromatic cells in infancy in relation to the appearance of atopic disease during the first 6 years of life.

The relationship between the appearance of nasal metachromatic cells (basophils and mast cells) during the first 18 months of life and the development of respiratory and other allergic diseases up to 6 years of age was studied prospectively in 67 children. Follow-up was done at 3, 6, 9, and 18 months and 6 years. Of the 31 children who had detectable metachromatic cells in the nasal mucosa during infancy, 18 had atopic manifestations at 6 years (58%), two were probably atopic (6%), and 11 (36%) were nonatopic. The corresponding numbers for the 33 children without detectable metachromatic cells during infancy were 10 atopic (30%), two probably atopic (6%), and 21 nonatopic (64%) at 6 years (P < 0.05). Children having detectable nasal metachromatic cells at every examination were more often allergic than children with no detectable cells at any time during the 6-year follow-up period (P < 0.05). In contrast, nasal metachromatic cells were equally commonly demonstrated at 6 years in children with and without current atopic manifestations. We conclude that metachromatic cells appear at an earlier age in the nasal mucosa of atopic than nonatopic infants. The observation further supports the existence of a primary immunologic abnormality in atopic patients as related to allergic inflammatory responses. The diagnostic efficacy of this marker was too low, however, to be clinically useful as a predictor of allergy.

Predictors of atopy in newborn babies

The capacity of laboratory tests and clinical signs to predict allergic manifestations up to 18 months of age was assessed in 129 newborn babies, most of whom had family members with atopic disease. The parameters assessed included family history; skin dryness; erythema toxicum; skin reactivity to histamine and IgE levels; eosinophil counts; and peripheral white blood cell, leukocyte differential, and platelet counts in cord blood (CB). Erythema toxicum and white blood cell and platelet counts were of no value as predictors of allergy. The sensitivity of family history, skin dryness, and sensitivity to histamine, as well as IgE levels and eosinophil counts, varied 25-79% and the specificity 40-74%. The efficiency was never higher than 58%. Logistic regression, applied in order to evaluate the joint predictive power of the five parameters, showed a P value of < 0.001. The estimated probability for atopy before 18 months of age was 0.33 for neonates with normal skin texture, a CB IgE of less than 0.5 kU/l, and a history of fewer than two family members with atopy. The probability increased to 0.89 for babies with a dry skin, a history of two or more atopic family members, and a CB IgE of > or = 0.5 kU/l. In conclusion, not one parameter nor any combination of them seems suitable for general screening. However, a combination of family history and CB IgE and skin assessment may be used to identify babies at high risk of allergy for participation in prevention studies.