Rate Of Allergic Sensitization Research Articles

Inverse Trend Between Tree Pollen and Fungal Concentrations With Allergic Sensitization Rates in Seoul for 25 Years.

A growing number of individuals are developing allergic diseases due to pollen exposure. Seasonal variations and increased pollen concentrations have occurred with the increased rates of allergic sensitization among both children and adults. Temperature significantly influences pollination, particularly in spring- and early summer-flowering plants, with weather conditions affecting pollen allergen levels. Human activities, including agriculture and deforestation, increase carbon emissions, leading to higher atmospheric CO₂ levels that may enhance allergenic plant productivity. Climate change affects the range of allergenic plant species and length of pollen season. Studies indicate that higher CO₂ and temperature levels are linked to increased pollen concentrations and allergenicity, whereas atmospheric fungal concentrations have declined annually over the past 25 years. Despite more intense precipitation in summer and autumn, the number of rainy days has decreased across all seasons. This concentration of rainfall over shorter periods likely prolongs the dry season and shortens the period of fungal sporulation. Future climate changes, including atmospheric dryness, drought, and desertification could further decrease allergenic fungal sporulation. It remains unclear whether the inverse relationship between pollen and fungal concentrations and distributions directly results from climate change. It is crucial to evaluate the patterns of aeroallergens and their associated health risks.

Dust mite component Analysis: Identifying key allergens components for effective immunotherapy in allergic rhinitis

BackgroundThe aim of this study was to examine the frequency of sensitization to house dust mite (HDM) components among allergic rhinitis patients receiving subcutaneous immunotherapy (SCIT), and to assess the correlation between SCIT efficacy and specific IgE (sIgE) levels for allergenic HDM components. MethodsSerum samples and clinical data were collected from 38 allergic rhinitis patients receiving HDM-SCIT at baseline and after 1 year of treatment. Effective treatment was defined as a therapeutic index (TI) of at least 50% after 1 year. Cytokine levels were analyzed using commercial ELISA kits, while serum total and specific IgE levels were determined by the fluoroenzymeimmunoassay technique. The ALLEOS 2000 magnetic particle chemiluminescence system was used to measure sIgE levels for Der f, Der p 1, Der p 2, Der p 10, and Der p 23. ResultsAllergic rhinitis patients undergoing HDM-SCIT had a high rate of allergic sensitization to the HDM major allergens Der p (100%), Der f (100%), Der p 1 (94.74%), Der p 2 (94.74%), and Der p 23 (36.84%). Patients who responded to SCIT had higher levels of IgE for HDM components at baseline, while those with ineffective treatment showed an opposite performance, particularly for Der p 1 (P＜0.05). After 1 year of treatment, effective and ineffective patients showed opposite trends in sIgE for dust mite components (decreased in effective patients, increased in ineffective patients). HDM-SCIT led to a significant reduction in IL-2, IL-4, IL-6, and EOS% (P＜0.05). IgE for Der p, Der f, Der p 1, Der p 2, and HDM sIgE were significantly positively correlated (P < 0.001). The correlation heatmap analysis based on changes in values reveals a negative correlation between CSMS score changes and sIgE for Der f and Der p 1, and a positive correlation with IL-2, IL-10, and TNF (P < 0.05). ConclusionsThe molecular sensitization profiles during HDM-SCIT are variable and relate to treatment efficacy. Molecular diagnosis can assist allergists in identifying patients eligible for HDM-SCIT, thereby enhancing the treatment's clinical efficacy. Serum cytokine levels of IL-2, IL-4, IL-6，and EOS% may serve as useful biomarkers for monitoring HDM-SCIT efficacy.

Understanding the development of Th2 cell-driven allergic airway disease in early life.

Allergic diseases, including atopic dermatitis, allergic rhinitis, asthma, and food allergy, are caused by abnormal responses to relatively harmless foreign proteins called allergens found in pollen, fungal spores, house dust mites (HDM), animal dander, or certain foods. In particular, the activation of allergen-specific helper T cells towards a type 2 (Th2) phenotype during the first encounters with the allergen, also known as the sensitization phase, is the leading cause of the subsequent development of allergic disease. Infants and children are especially prone to developing Th2 cell responses after initial contact with allergens. But in addition, the rates of allergic sensitization and the development of allergic diseases among children are increasing in the industrialized world and have been associated with living in urban settings. Particularly for respiratory allergies, greater susceptibility to developing allergic Th2 cell responses has been shown in children living in urban environments containing low levels of microbial contaminants, principally bacterial endotoxins [lipopolysaccharide (LPS)], in the causative aeroallergens. This review highlights the current understanding of the factors that balance Th2 cell immunity to environmental allergens, with a particular focus on the determinants that program conventional dendritic cells (cDCs) toward or away from a Th2 stimulatory function. In this context, it discusses transcription factor-guided functional specialization of type-2 cDCs (cDC2s) and how the integration of signals derived from the environment drives this process. In addition, it analyzes observational and mechanistic studies supporting an essential role for innate sensing of microbial-derived products contained in aeroallergens in modulating allergic Th2 cell immune responses. Finally, this review examines whether hyporesponsiveness to microbial stimulation, particularly to LPS, is a risk factor for the induction of Th2 cell responses and allergic sensitization during infancy and early childhood and the potential factors that may affect early-age response to LPS and other environmental microbial components.

Lung function, allergic sensitization and asthma in school-aged children after viral-coinfection bronchiolitis

Our main objective was to compare the lung function, the rate of allergic sensitization and the prevalence of asthma at 7–9 years in children hospitalized for bronchiolitis with viral coinfection versus single viral infection. Observational study in children with previous bronchiolitis and current age 7–9 years. Clinical data were collected. Fraction of exhaled nitric oxide (FeNO) determination, spirometry and skin prick test for common aeroallergens were performed. A total of 181 children hospitalized for bronchiolitis (40 coinfections and 141 single infections), with median age of 8.3 years (IQR:7.5–9.1) were included. Single-HRV-infections showed lower basal FEV1(%) than coinfections (p = 0.04) and lower z-score FEV1 than single-RSV-infections (p = 0.04) or coinfections (p = 0.02). Also, single-HRV-infections had lower post-bronchodilator FEV1(%) and z-score FEV1 values than coinfections (p = 0.03 and p = 0.03). Single-HRV-bronchiolitis was an independent risk factor for FEV1 < 80% (p = 0.007). FeNO value > 25 ppb was detected in 21(12.5%) cases, without differences between viral groups (p = 0.768). The prevalence of allergic sensitization was similar in coinfections (31.4%) versus single infections (38.7%), (p = 0.428). The highest frequency of allergic rhinitis was observed in single-HRV patients (p = 0.004). The respiratory morbidity at 7–9 years of coinfected patients was similar to the single-HRV ones. In contrast, the likelihood of current asthma was up to 5 times higher in RSV/HRV coinfections than in the single-RSV-infections ones (p = 0.012). The respiratory morbidity at 7–9 years of age after severe bronchiolitis is significantly higher in single-HRV or viral coinfection patients that in single-RSV ones. Single-HRV-bronchiolitis is independently associated with lower lung function at school-age.

A Longitudinal Study of Hymenoptera Stings in Preschool Children

To prospectively determine the incidence of Hymenoptera stings in children <5 years.This is a prospective longitudinal observational study of Irish newborns from the BASELINE Cohort Study. This study included 2137 newborn infants who were recruited from 2008 to 2011 and managed until 5 years of age.Trained researchers administered questionnaires at 6 months, 12 months, 2 years, and 5 years of age. The questionnaires were used to inquire about the occurrence of sting events. At ages 2 and 5 years, all children were seen for visits and underwent skin prick testing (SPT) to bee, Vespula, and 9 other common allergens. A positive test result was a wheal 3 mm or greater, with histamine as a positive control. If the SPT result was positive or the children reported a history of a sting event, allergy-specific immunoglobulin E (spIgE) was collected.Of the 2137 newborns identified, 1226 were managed for the complete 5 years. At 6 months, 6 of 1809 (0.33%) children reported sting events. At 1 year, 16 of 1691 (0.9%) children reported sting events. At 2 years, 77 of 1209 (6.8%) children reported sting events. SPT was performed at age 2, with 11 positive results out of 1232 tests (0.89%). At 5 years, 268 of 1226 (21.9%) had reported sting events with 0 systemic reactions. SPT was performed at age 5, with 4 of 937 (0.4%) children having positive test results. None of the children that had positive SPT results at age 2 had positive results at age 5. Thirty-nine children underwent spIgE testing, with only 2 having positive results (5.1%). Of the 2 patients who tested spIgE positive, 1 had a history of a sting event without reaction and negative SPT result, and the other had a positive SPT result at age 2 years that was negative by age 5 without a sting event. Children who had a positive SPT result (62.5%) to bee or wasp were found to have a higher rate of allergic sensitization to aeroallergen and food in comparison with children with negative SPT results (23.8%). Of the total 367 sting events, 10 stings (2.7%) were systemic reactions reported by the parents that did not require evaluation or treatment by a physician.Hymenoptera sting incidence increases with age. A positive SPT result does not correlate with sting history and does not predict venom allergy in patients who have not been stung. Venom SPT should not be performed in the general preschool-aged population.This study highlights the low incidence of Hymenoptera sting events and reactions in the general preschool population. The findings confirm that “screening” tests for venom allergy should not be performed in the preschool population because results do not correlate with clinically significant reactions. Testing should be reserved for those with a clinical history suggestive of venom hypersensitivity, consistent with existing recommendations.

CHRONOLOGICAL CHANGE OF RHINITIS SYMPTOM PREVALENCE IN KOREAN CHILDREN WITH OR WITHOUT ALLERGIC SENSITIZATION

Introduction It is difficult to accurately predict the natural course of allergic rhinitis. The aim of this study is to understand the change of prevalence of rhinitis symptom by age in school aged children with or without allergic sensitization. Methods Children aged from 9 to 16 who participated in the health questionnaires and skin prick test were included for this study. The distribution of sensitization and rhinitis symptoms was compared by age groups. Results In total, 1069 participants were included in this study. The group consisted of 554 females, 515 males. Also, they consist of 468 (43.8%) elementary, 321 (30%) middle, and 280 (26.2%) high school students. Rate of Allergic sensitization was increased with age (59.2%,58.3%, and 68.2%; p=0.025). Allergic sensitization rate was significantly differ in seasonal allergen (35.0%, 37.1%, and 53.9%; Conclusions As age increases in school years, prevalence of rhinitis symptom among sensitized children was decreased even though allergic sensitization rate was increased. It might be inferred that the symptoms of later sensitized subjects are relatively inexpressive, or that the symptoms are reduced along with age. A longitudinal study to explore these possibilities should be needed. It is difficult to accurately predict the natural course of allergic rhinitis. The aim of this study is to understand the change of prevalence of rhinitis symptom by age in school aged children with or without allergic sensitization. Children aged from 9 to 16 who participated in the health questionnaires and skin prick test were included for this study. The distribution of sensitization and rhinitis symptoms was compared by age groups. In total, 1069 participants were included in this study. The group consisted of 554 females, 515 males. Also, they consist of 468 (43.8%) elementary, 321 (30%) middle, and 280 (26.2%) high school students. Rate of Allergic sensitization was increased with age (59.2%,58.3%, and 68.2%; p=0.025). Allergic sensitization rate was significantly differ in seasonal allergen (35.0%, 37.1%, and 53.9%; As age increases in school years, prevalence of rhinitis symptom among sensitized children was decreased even though allergic sensitization rate was increased. It might be inferred that the symptoms of later sensitized subjects are relatively inexpressive, or that the symptoms are reduced along with age. A longitudinal study to explore these possibilities should be needed.

P-13: Rates of Allergic Sensitization in Children With esophageal Atresia and Eosinophilic Esophagitis

P-13: Rates of Allergic Sensitization in Children With esophageal Atresia and Eosinophilic Esophagitis

Sensitization and allergic histories differ between black and white pregnant women

Racial differences in allergic diseases have been reported, with black subjects suffering disproportionately compared with white subjects, although such studies have been more commonly done in pediatric populations. We sought to determine whether there are differences in rates of allergic sensitization or prior diagnoses of asthma, hay fever, or eczema in black and white pregnant women. Women were recruited during pregnancy (regardless of allergic history) as part of a birth cohort study in the Detroit metropolitan area and were interviewed about prior doctors' diagnoses of asthma, hay fever/nasal allergies/allergic rhinitis, and eczema. Blood samples were collected, total IgE levels were determined, and specific IgE levels were measured for Alternaria alternata, cat, cockroach, dog, Dermatophagoides farinae, short ragweed, timothy grass, and egg. Black women (n= 563) were more likely than white women (n= 219) to have had at least 1 specific IgE level of 0.35 IU/mL or greater (62.5% vs 40.2%, P< .001). Black women had higher total IgE levels (geometric mean, 47.8 IU/mL [95% CI, 42.5-53.8 IU/mL] vs 20.0 IU/mL [95% CI, 16.2-24.6 IU/mL]; P< .001, Wilcoxon rank sum test). Black women were more likely to have had a prior doctor's diagnosis of asthma (22.7% vs 16.0%, P= .04) and eczema (21.9% vs 14.8%) but not hay fever (white women: 17.5% vs black women: 15.7%, P= .55). Associations persisted for total IgE levels, having 1 or more positive allergen-specific IgE levels, and eczema after adjusting for common socioeconomic or environmental variables. Racial differences in allergic sensitization and diagnoses were present, even after controlling for various factors. Future research should focus on prevention to ameliorate these disparities.

Asthma in the elderly: risk factors and impact on physical function

BackgroundThe incidence rate of asthma has increased in all age groups in the past 40 years. Asthma in older adults is underdiagnosed and undertreated, resulting in suboptimal asthma control. ObjectiveThe objectives of the study are to evaluate differences in host characteristics between older patients with asthma and persons who do not have asthma and how these differences impact overall quality of life. MethodsPatients older than age 60 years were recruited from the general population for this case/control and nested cohort study. A complete medical history, physical examination, skin prick testing (SPT), spirometry, and exhaled nitric oxide (ENO) measurements were performed. Quality of life was assessed through the standardized SF-36v2 questionnaire. Quality of life scores, spirometry, ENO, and aeroallergen sensitization differences were compared between older patients with asthma and control patients. ResultsThe mean age of the 77 patients evaluated was 68.7 ± 7.2 years, with 59 (77%) being female. A higher rate of SPT positivity was found in patients with asthma (88.9%) compared with controls (51.2%) (P = .007). The mean percent predicted forced expiratory volume in 1 second (FEV1) at baseline was lower in the asthma group (73.7 ± 21.9%) compared with controls (89.6 ± 19.1%) (P = .007). For quality of life assessed by the SF-36v2 questionnaire, the asthma group had worse general health, increased bodily pain, and worse overall physical health compared with controls (P = .02; .021; .01). ConclusionOlder adults with asthma have a higher rate of allergic sensitization, decreased lung function, and significantly worse quality of life compared with controls.

Possible role of climate changes in variations in pollen seasons and allergic sensitizations during 27 years

Climate changes may affect the quality and amount of airborne allergenic pollens. The direct assessment of such an effect requires long observation periods and a restricted geographic area. To assess variations in pollens and allergic sensitizations across 27 years in relation to climate change in a specific region. We recorded pollen counts, season durations, and prevalences of sensitizations for 5 major pollens (birch, cypress, olive, grass, and Parietaria) in western Liguria between 1981 and 2007. Pollen counts were performed using a Hirst-type trap, and sensitizations were assessed by means of skin prick testing. Meteorologic data for the same period included average temperatures, direct radiation, humidity, number of sunny days, and rainfall. There was a progressive increase in the duration of the pollen seasons for Parietaria (+85 days), olive (+18 days), and cypress (+18 days), with an overall advance of their start dates. For Parietaria, there was an advance of 2 months in 2006 vs 1981. Also, the total pollen load progressively increased for the considered species (approximately 25% on average) except for grasses. Percentages of patients sensitized to the pollens increased throughout the years, whereas the percentage of individuals sensitized to house dust mite remained stable. These behaviors paralleled the constant increase in direct radiation, temperature, and number of days with a temperature greater than 30 degrees C. The progressive climate changes, with increased temperatures, may modify the global pollen load and affect the rate of allergic sensitization across long periods.

Adiposity, serum lipid levels, and allergic sensitization in Chinese men and women

Obesity and allergic diseases have increased dramatically in recent decades. Although adiposity has been associated with asthma, associations with allergic sensitization have been inconsistent. To examine the association of adiposity and lipid profiles with allergic sensitization. This study included 1187 rural Chinese twins (653 men) age 18 to 39 years, with skin prick tests, anthropometric and dual-energy x-ray absorptiometry-assessed adiposity measures, and lipid assessments. Allergic sensitization was defined as positive SPT to >/=1 allergen (9 foods and 5 aeroallergens tested). We applied sex-stratified generalized estimating equations to assess the association of adiposity and serum lipids with allergic sensitization, and structural equation models to estimate the genetic/environmental influences on any observed associations. Men had lower percent body fat (% BF) (13.9% vs. 28.8%) but higher rates of allergic sensitization (56.2% vs 36.7%) than women. Men in the highest %BF quartile were 2.1 times more likely to be sensitized than the lowest quartile (95% CI, 1.3-3.5; P trend = .003). In men, the risk of allergic sensitization increased with high-density lipoprotein (HDL) <40 mg/dL (odds ratio = 4.0; 95% CI, 1.8-9.2) and higher low-density lipoprotein quartiles (P trend = .007). This appeared to be partially explained by shared genetic factors between serum lipid levels and allergic sensitization. In females, lower HDL was associated with increased risk of allergic sensitization. In this relatively lean Chinese population, higher %BF, lower HDL and higher LDL were associated with greater risk of allergic sensitization, most notable in men. The observed associations among adiposity, serum lipids, and allergic sensitization in men appear to be partially explained by common genetic influences on these traits.

Familial Aggregation of Skin Sensitization to Aeroallergens in a Rural Area in China

Background: The prevalence of allergic sensitization has increased all over the world during last years and allergic sensitization may be related to genetic or environmental factors or to both. The objective of this study was to estimate the prevalence rates of allergic sensitization and assess the familial aggregation of allergic sensitization to aeroallergens in asthma index families. Methods: The skin prick test (SPT) reactivity to 8 aeroallergens and the SPT reactivity-related risk factors were evaluated. The allergic sensitization was based on SPT. Univariate and multivariate logistic regressive models were used to estimate the effect size (odds ratio, OR) of correlation within families with positive SPT. Results: Of 4,213 analyzed subjects in 1,006 asthma index families, 40.9% had at least one positive SPT, 42.3% in parents (father: 43.3%; mother: 42.3%), 43.9% in first offspring, and 36.0% in subsequent offspring. The most common allergens were Dermatophagoides pteronyssinus (DP), cockroach and Dermatophagoides farinae (DF). Allergic sensitization status of both parents and first offspring was related to the risk of allergic sensitization for subsequent offspring. The OR for the positive (father)-positive (first offspring) group was 1.92 (p < 0.01), 3.26 (p < 0.01) for the positive (mother)-positive (first offspring) group, and 2.12 (p < 0.01) for the positive (father)-positive (mother) group, which were adjusted for age, sex, body mass index, history of asthma and smoking status. Conclusions: Our findings supported a significant familial aggregation of allergic sensitization in this Chinese population and highlighted the role of genetic factors in allergic sensitization.

Rates of allergic sensitization and irritation to oxybenzone‐containing sunscreen products: a quantitative meta‐analysis of 64 exaggerated use studies

Oxybenzone is an active ingredient found in sunscreen products that absorbs a broad spectrum of ultraviolet (UV) light, with absorbance peaking in the UVB region and extending into the UVA region. Although the overall incidence of sensitization and irritation associated with oxybenzone in the general population remains unclear, a few studies have reported on the incidence in specific circumstances. However, the relevance of these studies to the general population is limited, because the sample populations reported in these papers generally have consisted of individuals who sought medical attention for pre-existing skin conditions. Therefore, the reported incidence of allergic reactions to oxybenzone in these studies may be overestimated as related to the general population. The objective of this meta-analysis was to determine the safety of oxybenzone in participants recruited from the general population. The data from 64 unpublished exaggerated use human repeat insult patch tests (HRIPT) and photoallergy (PA) studies sponsored by Schering-Plough HealthCare Products Inc. between 1992 and 2006 were aggregated and analyzed to evaluate the irritancy and sensitization potential of sunscreen products containing oxybenzone at concentrations between 1% and 6%. Forty-eight of 19 570 possible dermal responses were considered to be suggestive of irritation or sensitization; the mean rate of responses across all formulations was 0.26%. Sensitization rates did not correlate significantly with oxybenzone concentration. The available re-challenge data indicated that only eight of these responses were contact allergies from oxybenzone, and the mean rate of contact allergy to oxybenzone was 0.07%. The source of the skin responses was not confirmed for 15 subjects who were lost to follow-up. However, all subjects were given the opportunity to participate in follow-up testing. Our data indicate that sunscreen products formulated with 1-6% oxybenzone do not possess a significant sensitization or irritation potential for the general public. Furthermore, these data suggest that the incidence rate implied in the published literature overestimates the actual incidence of sensitization/irritation due to oxybenzone-containing sunscreen products in the general population.

Atopy in young children with asthma

Background: A close relationship between outcome in patients with early-onset asthma and atopy has been reported. Allergic sensitization in early life seems to be an important risk factor for subsequent persistent asthma during childhood and adulthood. It might be valuable to evaluate atopy in patients with early-onset asthma in order to predict prognosis and take early intervention. Methods: Clinical data of 62 asthmatic children under 4 years of age were collected. The atopy status of each patient was determined by both personal allergic history (eczema and/or allergic rhinitis) and specific diagnosis of allergens (screening tests of fx5E, mx2 and Phadiatop conducted by fluoroenzyme-immunometric assay using the UniCAP100 system). The total serum IgE level was also measured. Logistic regression was used to analyze the effect of clinical characteristics on allergic sensitization. Results: There were 74.2% children who reported personal history of atopy and 33.9% reported parents' history of atopy based on the clinical data. The positive rates of fx5E, mx2, and Phadiatop were 40.3%, 14.5%, and 14.5% respectively. The total rate of allergic sensitization was 46.8% and the rate of sensitization to inhalant allergens was 24.2%. The allergic history of parent(s), the sensitization to food allergen, the age of first wheezing attack, and the total serum IgE level were main factors influencing sensitization to inhalant allergens. Conclusion: The asthmatic history of parent(s), the sensitization to food allergens, the age of first wheezing attack above 2 years and the significantly higher total serum IgE level may increase the possibility of sensitization to inhalant allergens in asthmatic children under 4 years of age.

Initial High-Dose Nasal Allergen Exposure Prevents Allergic Sensitization to a Neoantigen

Purpose of the Study. Epidemiologic studies have suggested that high-dose allergen exposure may protect against primary allergic sensitization—the formation of immunoglobulin E (IgE) after initial antigen exposure. This study uses a human nasal allergic sensitization model to evaluate the effect of the dose of the antigen on the rate of primary sensitization to a neoantigen, keyhole limpet hemocyanin (KLH). Study Population. Fifty-one healthy nonsmoking atopic subjects aged 18 to 55 years. Atopic status was defined by a positive skin-prick test to at least one aeroallergen; the subjects therefore had a propensity to mount an allergic (IgE) response to respiratory antigen exposure. Methods. Subjects underwent a 33-day sensitization protocol including initial exposure to 0.1-, 10-, 1000-, or 100 000-μg doses of intranasal KLH as well as later exposure to adjuvant intranasal diesel exhaust particles. At the conclusion of protocol, antigen-specific IgE, IgG, and IgG4 were measured in nasal lavage samples. Results. The rates of allergic sensitization, defined as detectable KLH-specific IgE, for the 0.1-, 10-, 1000-, or 100 000-μg dose groups were 0, 100, 57, and 11%, respectively. Furthermore, the mean KLH-specific IgE levels decreased with increasing doses of initial antigen exposure. Antigen-specific IgG and IgG4 were produced by all subjects, with the highest levels observed in the high-dose group. Conclusions. Initial high levels of respiratory antigen exposure may prevent primary allergic sensitization through induction of an antigen-specific non-IgE humoral immune response. Reviewer Comments. In children at high risk of allergic sensitization, a means of preventing primary sensitization and inducing durable allergic tolerance would be of great value. This study found that initial high-dose exposure to a neoantigen, KLH, results in a humoral immune response with high levels of antigen-specific IgG, including IgG4, and low levels of KLH-specific IgE. Whether these findings apply to other respiratory antigens remains unclear. The mechanism underlying this induction of tolerance remains unclear, and it is also not known whether this immune response represents durable allergic tolerance. Future studies investigating these issues are needed to move toward potential primary prevention therapy for allergic disease.

Long-term acquisition of allergen-specific IgE and asthma following allogeneic bone marrow transplantation from allergic donors

AbstractAdoptive transfer of allergen-specific immunoglobulin E (IgE) from atopic donors to nonatopic recipients occurs during the first year following bone marrow transplantation (BMT). Mature B- and T-cell clones with allergen-specific memory and hematopoietic progenitor cells are transferred through BMT. The objective of this study was to characterize the long-term rate of allergic sensitization and development of clinical allergic diseases following BMT from atopic donors. A long-term follow-up study was conducted in a cohort of donor and recipient pairs with moderate-to-severe allergic disease in the donor prior to BMT. Assessments of allergen-specific IgE, clinical rhinitis, and asthma were made in the donors prior to BMT and in the recipients with a mean follow-up of 15.5 years after BMT. From an initial cohort of 12 bone marrow transplant recipients who received marrow from allergic donors, 5 long-term survivors were identified. Allergen-specific IgE transferred from donor to recipient following BMT frequently persisted, and a high rate of de novo allergic sensitization was observed between 1 and 14 years after BMT. These events were associated with elevation in total IgE, and development of allergic rhinitis and asthma at long-term follow-up. We conclude that marrow-derived immune cells from allergic donors can transfer the predisposition to allergy and asthma.

The effect of neonatal BCG vaccination on atopy and asthma at age 7 to 14 years: An historical cohort study in a community with a very low prevalence of tuberculosis infection and a high prevalence of atopic disease

Background: There are conflicting reports on the effect of BCG vaccination on the subsequent development of atopy and asthma. There are no data on the effects of neonatal BCG vaccination on cytokine responses of lymphocytes that are exposed in vitro to allergens. Objectives: We sought to test the hypothesis that neonatal BCG vaccination or, alternatively, evidence of an immunologic memory of this vaccination is associated with a reduced prevalence of allergic sensitization, asthma, eczema, and hay fever during childhood. Methods: An historical cohort study was conducted among 7- to 14-year-old children who were born in 2 districts in Sydney, Australia, and whose mothers were born in southeast Asia. One district had routinely administered BCG vaccination to infants born to overseas-born mothers and the other had not. Eligible subjects were identified from birth registers. Consenting subjects completed questionnaires, performed spirometric and airway hyperresponsiveness testing, and had allergen skin prick testing and tuberculin skin testing. Blood was collected to measure total serum IgE levels and for in vitro lymphocyte culture in the presence of an extract of house dust mite, the dominant allergen in this region, and purified protein derivative of Mycobacterium tuberculosis (tuberculin). IL-4, IL-5, IL-10, and IFN-γ were measured in the culture supernatant. Results: The cohort included 309 BCG-vaccinated subjects and 442 non-BCG-vaccinated subjects. BCG-vaccinated subjects did not have a lower rate of allergic sensitization than nonvaccinated subjects. However, among the subgroup of subjects with a family history of rhinitis or eczema, BCG vaccination was associated with a lower prevalence of current asthma (defined as recent wheezing plus airway hyperresponsiveness; relative risk, 0.46; 95% CI, 0.22-0.95). BCG vaccination was also associated with lower levels of allergen-stimulated IL-10 production in vitro. Among the BCG-vaccinated subjects, the 44 (14.3%) who had tuberculin skin test reaction sizes of 5 mm or greater and the 31 (18.3%) who demonstrated an in vitro IFN-γ response to purified protein derivative of M tuberculosis did not have lower rates of allergic sensitization and, overall, did not have a lower prevalence of allergic disease than tuberculin skin test or IFN-γ nonreactors. Conclusion: We conclude that neonatal BCG vaccination has an effect on T-cell allergen responsiveness 7 to 14 years after vaccination and that among a subgroup of subjects with an inherited predisposition to allergic disease, this is associated with clinically relevant beneficial effects. The findings of this study encourage the view that external influences on the immune system in the neonatal period have consequences that extend into later childhood and influence the expression of asthma. Genetic factors are likely to modify the effect of those external factors. (J Allergy Clin Immunol 2003;111:541-9.)

Epidemiology, clinical features, and immunology of the "intrinsic" (non-IgE-mediated) type of atopic dermatitis (constitutional dermatitis).

Departmentof Pharmacology, University of Bern, Bern, SwitzerlandKey words: atopic dermatitis; clinical features;constitutional dermatitis; epidemiology; extrinsictype; immunopathology; intrinsic type.Prof. Dr B. Wu¨thrichAllergy Unit, Department of DermatologyUniversity Hospital8091 ZurichSwitzerlandAccepted for publication 22 March 2001

Allergic diseases in farmers' children.

Several studies have reported lower rates of allergic sensitization and allergies in children living in rural as compared to urban communities. This has been attributed to the lower levels of air pollution in rural areas. The question arises whether other factors in the rural environment could explain the lower prevalence rates of allergic sensitization and hay fever. A first report from rural South Bavaria in Germany demonstrated that children living in a home where coal and wood were used for heating had a significantly lower risk of suffering from hay fever (odds ratio 0.57 (0.34-0.98)), of being sensitized to common allergens (OR 0.67 (0.49-0.93)) and of having bronchial hyperresponsiveness (OR 0.55 (0.34-0.90)) than their peers living in homes with other heating systems. Subsequently, the Swiss Study on Childhood Allergy and Respiratory Symptoms with Respect to Air Pollution (SCARPOL) tested the hypothesis that farming as parental occupation was associated with a lower risk of hay fever and atopy. A total of 1620 (86.0%) 6-15-year-old schoolchildren living in three rural communities of Switzerland were examined using a standardized questionnaire completed by the parents and IgE antibodies against six common aeroallergens in serum samples of 404 (69.3.0%) of the 13-15-year-olds. Farming as parental occupation was significantly associated with lower rates of reported hay fever symptoms and allergic sensitization. Comparing children from farming with those from non-farming environments, the adjusted OR was 0.34 (95% CI: 0.12-0.89) for sneezing attacks during the pollen season, and 0.31 (95% CI: 0.13-0.73) for a sensitization to allergens. These results have recently been confirmed in a new and much larger survey in rural South Bavaria. Several alternative explanations have to be considered when interpreting these findings, namely, selection bias, the development of tolerance, increased microbial stimulation and a more traditional lifestyle (diet and housing conditions). Based on present knowledge, the underlying environmental factor explaining the protective effect of the farming environment has not yet been identified.

Respiratory Diseases and Allergies in Two Polluted Areas in East Germany

This cross-sectional epidemiological study collected health data for 2,470 school children between 5 and 14 years of age (89% of eligible children) who had lived most of their lives in either one of two counties strongly impacted by industrial pollution (Bitterfeld and Hettstedt) or in a neighboring county without any sources of industrial pollution (Zerbst). The objective of the study was to examine whether regional differences--with respect to the occurrence of childhood respiratory diseases and symptoms or allergies--exist and, if such differences are found, whether they persist when we adjust for the effects of known risk factors such as medical and sociodemographic factors or factors related to the indoor environment. Controlling for medical, sociodemographic, and indoor factors, according to parental reports, children residing in Hettstedt have about a 50% increased lifetime prevalence for physician-diagnosed allergies, eczema, and bronchitis compared to children from Zerbst and about twice the number of respiratory symptoms such as wheeze, shortness of breath, and cough without cold. Sensitization to common aeroallergens according to skin prick tests [odds ratio (OR) = 1.38; 95% confidence interval (CI), 1.02-1.86] and specific IgE levels (OR = 1.75; CI, 1.31-2.33) was more common for children from Hettstedt than children from the nonpolluted county. Bitterfeld children, on the other hand, more often received a diagnosis of asthma and eczema than children residing in Zerbst and also showed slightly increased sensitization rates. In conclusion, industrial pollution related to mining and smelting operations in the county of Hettstedt were associated with a higher lifetime prevalence of respiratory disorders and an increased rate of allergic sensitization in children between the ages of 5 and 14 years. Further studies are needed to determine what role the high dust content of heavy metals plays in Hettstedt.