Total IgE Levels Research Articles

Ефективність та безпечність підготовки до вакцинації проти вірусу SARS-COV-2 у пацієнтів із хронічною рецидивуючою кропив’янкою

Abstract. The aim: to develop a personalized algorithm for vaccination against COVID-19 for patients with severe chronic urticaria and to evaluate its effectiveness and safety. Methods. Patients with severe (according to the UAS7 scale) chronic spontaneous urticaria and concomitant gastroenterological pathology, who were observed at the City Allergology Center, were included in a prospective single-center clinical study. All patients underwent a complete physical examination, evaluation of complaints, history of life and illness, presence of concomitant pathology. Patients with a history of COVID19 or complete or partial vaccination against COVID-19 were excluded from the study. Blood tryptase level was determined before vaccination using immunofluoroenzymatic analysis (ImmunoCAP). Total serum IgE was determined using an immunochemical method. Preparation for vaccination against the SARS-COV-2 virus was carried out according to the developed algorithm: the appointment of 5 mg of desloratadine orally 30 minutes before vaccination with a normal level of tryptase (< 11 ng/l); and 20 mg of desloratadine 30 minutes before vaccination at an elevated level of tryptase (≥ 11 ng/L) with further observation of the condition of patients during the day after vaccination. Results. The study included 30 patients aged 24 to 63 years, median age 52 (39-59) years, of which 66.7 % were women. The duration of the disease was, on average, 6 years, and 63.3 % of patients suffered from urticaria for five or more years. All 100 % of patients had a severe course of chronic urticaria: from 28 to 42 points on the UAS7 scale, median 42 (42-42) points. Among patients with severe chronic urticaria and concomitant gastrointestinal pathology included in the study, 60 % had elevated serum tryptase levels, were older and had a higher prevalence of H. pylori infection, but a lower prevalence of concomitant allergic pathology. The level of tryptase did not correlate with the level of total IgE. Conclusions The developed individual algorithm for pre-vaccination preparation of patients with severe chronic urticaria has shown its effectiveness and safety in preparing such a difficult category of patients for vaccination against SARS-CoV-2 infection, which is vital today.

Experience of biological therapy in severe forms of chronic rhinosinusitis with nasal polyps in the conditions of regional healthcare

To analyze our own experience, clinical and organizational features of the application of the method of biological therapy in patients with severe forms of recurrent CRSwNP. 25 patients with severe and moderate forms of CRSwNP were examined, who, in a round-the-clock hospital (model CSG 36.018) was treated with Dupilumab, in the form of subcutaneous injections of 300 mg/2 ml 1 every two weeks. The diagnosis was confirmed on the basis of anamnestic data, SNOT-22 quality of life questionnaires, visual endoscopic examination, evaluation of CT data (Lund-Mackay scale), laboratory data. The effectiveness of treatment was monitored after 16 weeks, based on endoscopic examination data, evaluation of CT and SNOT-22 data. In 3 observations, a study of pathomorphological material for tissue eosinophilia was performed. The duration of the course of treatment ranged from 10 to 56 weeks. The most striking clinical effect was observed for signs such as sense of smell and nasal breathing (in some cases-after the first injection). The degree of regression of polyps according to CT and endoscopic examination was more prolonged in time, the same dynamics was observed in the level of total IgE. In a number of patients, the phenomenon of eosinophilia growth was observed against the background of treatment (with regression of clinical symptoms). Pathomorphological examination confirmed a high level of tissue eosinophilia as one of the fundamental signs of Th2 inflammation. One patient with concomitant chronic tubar dysfunction had an improvement in hearing. All patients with AD noted a subjective improvement in disease control (a decrease in the frequency and severity of choking attacks). The cancellation (break in treatment) of treatment was accompanied by a gradual return of symptoms in all patients at various times. Patients who have not achieved an acceptable level of control of CRSwNP,that meets the criteria of Th2 inflammation can be considered as candidates for the use of targeted biological therapy. With strict compliance with the selection criteria, there is a good clinical effect, primarily in relation to nasal symptoms (sense of smell and nasal breathing) and improved control of asthma symptoms.

Микроэлементозы как предикторы иммунологических нарушений у детей с гипофункцией щитовидной железы, проживающих в районах с различным уровнем техногенного загрязнения

Aim: to assess relationship between the humoral immunity status and the amounts of chemical elements (CE) in schoolchildren with hypothyroidism living in the regions with different levels and characteristics of technogenic environmental pollution. Patients and Methods: this study included 340 children 4–7 years old. The children underwent medical examination in the kindergartens located in a rural area of Rostov Region; industrial district of Rostov-on-Don (hereinafter referred to as Rostov); Shakhty, a city located in the coal mining area of the region; and in a dacha village in Rostov suburbs located distantly from the industrial facilities. In the rural area 105 children (group 1) were examined, in Rostov City — 125 children (group 2), in Shakhty — 90 (group 3). Group 4 (control) included 20 healthy children living in a dacha village of Rostov suburbs. The authors analyzed the Federal Service for Surveillance on Consumer Rights Protection and Human Well-being (Rospotrebnadzor) data characterizing the technogenic environmental pollution in the areas of residence of the studied children. Clinical laboratory tests were performed in all children. Results: such components of mineral fertilizers and pesticides as chlorides, nitrates, and phosphorus compounds prevailed among the technogenic contaminants in the rural regions. An intense xenogeneic burden was identified in the Rostov areas where kindergartens were located, while the highest xenogeneic burden was found in Shakhty. In groups 1, 2 and 3, free Т4 (fТ4) and free Т3 (fТ3) concentrations were lower than those in other groups. Moreover, the children of the first three groups had the highest thyrotropin (TSH) levels. In groups 1,2 and 3, serum IgM, IgG and total IgE levels were increased, and IgA level was decreased, while the most significant deviations from the normal values were found in the group 3 children who lived in the area with the highest adverse environmental impact. A positive statistically significant correlation was found between IgM and TSH levels (r=0,59, р=0,03) and between IgA и fТ4 levels (r=0.47, р=0.04). In addition, a negative statistically significant correlation was found between IgG и fТ4 levels (r=-0.49, р=0.04). In the group 1, 2 and 3 children, lead levels in the urine were higher than in the comparison group, and particularly high lead levels were detected in the group 3 children who lived in the area with the worst adverse environmental impact. In the same group, a positive statistically significant correlation was found between lead and TSH levels (r=0.62, р=0.02), between IgA and zinc (r=0.51, р=0.03), as well as between selenium and fТ4 (r=0.45, р=0.04). Also, a negative statistically significant correlation was determined between lead and fТ4 (r=-0.54, р=0.03) and between lead and IgA levels (r=-0.41, р=0.045). The ratio of selenium and lead in the group 3 children was significantly lower than in groups 1, 2 and 4. Conclusion: indicators demonstrating the intensity of humoral immunity were found in children with hypothyroidism, and the mostly pronounced pathological changes were reported in children living in the area with the highest technogenic environmental pollution. Reduced selenium and zinc levels along with increased lead concentrations in the morning sample of urine which correlated with decreased fТ4 and fТ3 levels in blood were found in children from the areas with adverse environmental conditions. KEYWORDS: thyroid, humoral immunity, chemical elements, microelementosis, iodine, iodine deficiency, xenogeneic burden. FOR CITATION: Popova V.A., Puzikova O.Z., Kozhin A.A. et al. Microelementoses as predictors of immunological disorders in children with hypothyroidism living in the regions with different levels of technogenic pollution. Russian Medical Inquiry. 2023;7(2):81–88 (in Russ.). DOI: 10.32364/2587-6821-2023-7-2-81-88.

Proportion of Allergic Bronchopulmonary Aspergillosis Presenting as Difficult-to-control Asthma in Patients Attending a Tertiary Care Centre using the Modified ISHAM Criteria: A Cross-sectional Study

Introduction: Difficult-to-control asthmatics, as defined by the Global Initiative for Management of Asthma (GINA), belong to a subset of patients whose symptoms remain uncontrolled despite adhering to maximal optimised therapy. Complex hypersensitivity reactions in response to airway colonization with Aspergillus fumigatus, which occurs in patients with asthma or cystic fibrosis, are established factors for a poor response to treatment and frequent exacerbations. Only limited data related to Allergic Bronchopulmonary Aspergillosis (ABPA) is available from India, particularly from Kerala. Aim: To assess the occurrence of ABPA in patients with difficultto-control asthma using the modified ISHAM criteria. Materials and Methods: This cross-sectional analysis was conducted in the Department of Pulmonary Medicine, Institute of Chest Diseases, Government Medical College, Kozhikode, Kerala, India from February 2019 to July 2020. The study population comprised asthmatics attending the Pulmonary Medicine Outpatient Services who were on regular medications, including optimal doses of inhaled corticosteroid and longacting beta-agonist combinations. Patients with two or more exacerbations per year requiring systemic steroids for symptom control and a positive skin test for Aspergillus fumigatus antigen were further analysed using the modified International Society for Human and Animal Mycology (IHAM) criteria to determine the proportion of difficult-to-control asthmatics with ABPA. A total of 185 subjects were enrolled. Twelve patients opted out of the study, and the remaining 173 patients were screened using the modified ISHAM criteria. Statistical analysis was performed using Stastistical Packages of Social Sciences (SPSS) software version 21.0. Continuous parameters were expressed as mean and median, while categorical parameters were measured as frequency and percentages. Results: It was observed that 104 (60.1%) patients belonged to the age group between 41-60 years, while approximately 60 patients (34.7%) were below 40 years of age. Among the 173 patients, 86 (49.7%) tested positive for Aspergillus fumigatus antigen. Applying the ISHAM criteria, it was found that only 17 (9.8%) of these patients satisfied the criteria for co-existent ABPA. A total of 101 patients (58.4%) required at least one hospital admission, while 4 (2.3%) patients required more than three hospital admissions per year. Total 21 (12.1%) patients had IgE specific to Aspergillus fumigatus, while total IgE levels were elevated in 46 (26.6%) cases. Thirty-six cases (20.8%) had a high peripheral eosinophil count. Conclusion: This study suggests the possibility of the treating physician overlooking 10% of asthmatics in this region who are being managed as difficult-to-control asthma, but who have co-existent ABPA. This subset should be identified early in the course and managed separately for better treatment response.

A Multi-Center Study of the Prevalence and Characteristics of Eosinophilic Phenotype and High IgE Levels Among Chinese Patients with Severe Asthma.

Patients with severe asthma have higher total- and asthma-related health burden than those whose disease is not severe. Recent medical advances in biologic therapies allow better control of asthma characterized by type 2 inflammation. To study the prevalence of eosinophilic phenotype and IgE levels in Chinese with severe asthma, and the relationship of these type 2 characteristics with asthma control, exacerbations and lung function. This was a multicenter cross-sectional observational study in Hong Kong, in Chinese adults with asthma on Step 4 or 5 of GINA treatment. Their blood eosinophil counts and total IgE levels were measured, and the relationship of these phenotypic parameters to the number of exacerbations in the past 12 months, and to symptom control in the past 4 weeks, were investigated. A total of 232 subjects were recruited from 6 centers. The mean age was 53.9±12.9 years, with 86 (37.1%) male, and the duration of diagnosed asthma was 26.2±15.7 years. A T-helper 2 (Th2) phenotype indicated by elevated eosinophils and/or IgE was present in 169 (72.8%) of patients. Of 232 patients, 43% had an eosinophilic phenotype (blood eosinophil count ≥300 cell/mm3), while 59% had high total IgE levels of >100 IU/mL (overlap with eosinophilic phenotype in 30%) and 44% had IgE levels of >150 IU/mL (overlap with eosinophilic phenotype in 22%). Subjects with eosinophilic phenotype and IgE >150 IU/mL had a higher rate (1.8 times) of uncontrolled asthma compared with those without such a combination. In Chinese adults with severe asthma defined by the use of conventional maintenance medication regimens, the prevalence of Th2 inflammation is comparable to that reported from other ethnic populations. Those with both eosinophil count ≥300 cell/mm3 and high IgE levels >150 IU/mL had a higher rate of uncontrolled asthma compared with those without a combination of these features.

Staphylococcal Enterotoxin-Specific IgE Sensitization: A Potential Predictor of Fixed Airflow Obstruction in Elderly Asthma.

Staphylococcus aureus enterotoxin-specific immunoglobulin E (SE-sIgE) sensitization tends to increase with age and is known to be associated with asthma and severity in older adults. However, the long-term impact of SE-sIgE in the elderly remains unknown. This study aimed to examine the relationships between SE-sIgE and fixed airflow obstruction (FAO) in a cohort of elderly asthmatics. A total of 223 elderly asthmatics and 89 controls were analyzed. Patients were assessed for demographics, history of chronic rhinosinusitis (CRS), asthma duration, acute exacerbation frequency, and lung function at baseline and then were prospectively followed up for 2 years. Serum total IgE and SE-sIgE levels were measured at baseline. Airflow obstruction was defined as forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio < 0.7 at baseline and FAO was defined as FEV1/FVC ratio < 0.7 over the 2-year follow-up. At baseline, the prevalence of airflow obstruction was 29.1%. Patients with airflow obstruction were significantly more likely to be male, and have a positive smoking history, comorbid CRS, and higher levels of SE-sIgE than those without airflow obstruction. Multivariate logistic regression analysis showed that airflow obstruction was significantly associated with current smoking and SE-sIgE sensitization at baseline. After the 2-year follow-up, baseline SE-sIgE sensitization was consistently related to FAO. Meanwhile, the number of exacerbations per year was significantly correlated with SE-sIgE levels. Baseline SE-sIgE sensitization was significantly associated with the number of asthma exacerbations and FAO after the 2-year follow-up in elderly asthmatics. These findings warrant further investigation of the direct and mediating roles of SE-sIgE sensitization on airway remodeling.

Респираторные аллергические заболевания у курящих и некурящих молодых мужчин

Background: smoking is a well-known trigger of asthma. Therefore, doctors should be alert for smok-ers with respiratory allergies. Aim: to compare the severity of respiratory allergy course, pollen and house dust sensiti-zation, and laboratory and instrumental tests in young adult male smokers and non-smokers. Patients and Methods: a retrospective analysis of the medical records of 249 men aged 16–27 years with allergic rhinitis and/or asthma was performed. Patients were examined on the basis of the standard of medical care for adults with asthma. Allergic examination included skin tests and allergen-specific IgE measurement. Results: 249 patients were divided into 2 groups: smokers (n=62) and non-smokers (n=187). The mean age of smokers and non-smokers was 19.3±0.5 and 18.6±0.3 years, respectively. The median smoking history was 2.0 [1.0; 4.0] years. Allergic asthma was more common in smokers (93.5%) than in non-smokers (89.3%). No differences in the rate of allergic rhinitis were reported. Comparative cross-sectional analysis of examination results in young patients with allergic rhinitis and asthma has demonstrated that positive tests for tree pollen and house dust prevail in both groups. No differences in sensitization between smokers and non-smokers were reported. The mean spirometry values in smokers were lower than those in non-smokers. Bron-chodilator coefficient calculated by forced expiratory volume in 1 s correlated with absolute eosinophil count only in smokers. Conclusions: no significant differences in the severity of allergic rhinitis and asthma, sen-sitization to pollen and house dust, peripheral blood eosinophil counts, and total serum IgE levels were reported between young smokers and non-smokers. KEYWORDS: smoking, asthma, allergic rhinitis, electronic cigarettes, traditional cigarettes. FOR CITATION: Devyatkova E.A., Minaeva N.V., Tarasova M.V., Shelud'ko V.S., Plotnikova E.Yu. Respiratory allergies in young adult male smokers and non-smokers. Russian Medical Inquiry. 2023;7(8):482–487 (in Russ.). DOI: 10.32364/2587-6821-2023-7-8-2.

The risk factors for food allergy in infants with atopic dermatitis.

There is a lack of information about which risk factors accompany food allergy (FA) in infants with atopic dermatitis (AD). We hypothesized that we would be able to predict FA through risk factors in infants with AD. This prospective descriptive cross-sectional study was performed with infants aged 1-12 months with newly diagnosed AD. The SCORing Atopic Dermatitis (SCORAD) and Eczema Area and Severity Index (EASI), Infants` Dermatitis Quality Of Life (IDQOL), and Family Dermatological Life Quality (FDLQ) index scores were calculated at first admission. We developed a new tool, Sites of Eczema (SoE), to score sites of eczema on the body. A total of 279 infants with AD were included. FA was found in 166 (59.5%) infants with AD, of whom 112 had single and 54 had multiple FAs. The SCORAD index, EASI scores, IDQOL1, IDQOL2, and FDQL, and SoE scores were higher in the subgroup with FA compared to that without FA (p < 0.001). In the multivariate regression model, eosinophil count (odds ratio [OR]=1.00, 95% confidence interval: [CI, 1.00-1.00]; p=0.008), serum total IgE level (OR=1.02, 95% CI: [1.00-1.03]; p=0.002), pruritus score (OR=0.87, 95% CI: [0.77-0.97]; p=0.019), SCORAD index (OR=1.04, 95% CI: [1.01-1.08]; p=0.008), FDQL index (OR=1.09, 95% CI: [1.01-1.18]; p=0.014), and SoE score (OR=1.48, 95% CI: [1.00-2.19]; p=0.046) were identified as the highest risk factors for FA in infants with AD. Serum total IgE levels, eosinophil counts and ratio, SCORAD index and EASI scores, IDQOL and FDLQ index, pruritus and sleep disturbance scores, and SoE scores were identified as risk factors for FA in infants with AD in this study. The SoE score is an important risk factor for FA in infants with AD. We recommend that the risk factors for FA in patients with AD guide the management of these patients.

Food Sensitivity in Children Diagnosed with Atopic Dermatitis in The First 2 Years: How Many of These Patients Are Truly Allergic?

In this study, it was aimed to examine food sensitivity in patients with atopic dermatitis (AD) and to investigate the frequency of food allergy in patients with food sensitivity. Patients aged 0-2 years who were followed up with the diagnosis of AD were included in the study. The characteristics of demographic and clinical and laboratory findings of the patients were recorded retrospectively. Patients were classified as mild, moderate, and severe using the SCORing AD index according to the severity of AD. The presence of food sensitivity was evaluated by skin prick test and serum-specific immunoglobulin (Ig)E results. Food allergy was diagnosed by oral food challenge (OFC) test. Of the 72 patients included in the study, 62.5% (n=45) were male, and the mean age was 9±4.8 months. When the disease severity was evaluated, it was mild in 40 patients (55.6%); moderate/severe AD was present in 32 patients (44.4%). The frequency of moderate/severe AD was higher in patients who were younger (p=0.01), whose symptoms started in the first 6 months (p=0.03), who had a family history of allergic disease (p=0.001), who breastfed for <6 months (p=0.01), who had a higher median serum total IgE level, and a higher percentage of serum eosinophils (p=0.005 and p=0.01, respectively). Food sensitivity in 45.8% of patients; food allergy was detected in 41.7% of them. The most common sensitivities and allergies were eggs white/yolk and cow's milk, respectively. The rate of food sensitivity was found to be higher in male gender (p=0.03) and breastfed patients (p=0.03), whereas it was similar in patients with mild and moderate/severe AD. In the investigation of food sensitivity in patients with AD, it is important to evaluate other demographic and clinical characteristics such as gender and breastfeeding, apart from the severity of disease. The OFC test should be performed to confirm the food allergy in patients with food sensitivity before the recommendation of an elimination diet.

A STUDY ON PREDICTION OF ALLERGIC FUNGAL RHINOSINUSITIS WITH SERUM IGE LEVELS

Background: Allergic fungal rhinosinusitis (AFRS) with IgE mediated allergic pathogenesis is a category of non-invasive fungal sinusitis. In our study, we followed up patients with AFRS who have undergone functional endoscopic sinus surgery and correlated endoscopic appearance (Kupferberg staging) with pre and postoperative total serum IgE levels. Objectives: 1. To assess preoperative and postoperative endoscopic staging as well as total serum IgE levels in patients with AFRS who underwent functional sinus surgery. 2. To assess the sensitivity of total serum IgE level in predicting the disease status in patients with AFRS on postoperative follow up. Methodology: Aprospective longitudinal cohort study was done on 68 patients diagnosedtohave AFRS. Preoperative endoscopic staging was done along with total serum IgE levels and skin allergy test for all patients. Postoperatively the patients underwent repeat endoscopy and serum IgE level testing at 4 to 7 months follow up. Results: We had 68 patients in the age group of 21-60 years in the study. The majority of the patients in the study group were males (61.8%). In our study, 54 of 68 patients had a fall in postoperative total serum IgE levels when compared to their preoperative values. The sensitivity of total serum IgE levels in this study was, therefore, 84%. The specificity of total serum IgE level was only 33.3% in our study. Conclusion: In this study on patients with AFRS who underwent total serum IgE estimation and rigid nasal endoscopy both pre and post operatively shows that total serum IgE levels is a fairly good prognostic measure in patients with AFRS. Eventhough the test specificity is low, both total serum IgE levels and clinical findings together may be ideal to asses the prognosis for the individual patients with AFRS.

The influence of &lt;i&gt;Aspergillus fumigatus&lt;/i&gt; micromycetes on immune response regulation in patients with asthma

Introduction. Aspergillus fumigatus is able not only to sensitize patients with atopy, but also to colonize the respiratory tract, remaining a constant source of allergens due to the small spore size and thermal tolerance. Currently, the role of micromycetes in the immunopathogenesis of asthma has been poorly studied. The objective was to evaluate the features of the immune response regulation in patients with allergic bronchopulmonary aspergillosis (ABPA) or asthma with sensitization to A. fumigatus. Materials and methods. There were enrolled 15 patients with ABPA, 10 patients with asthma with sensitization to A. fumigatus, 16 patients with asthma without sensitization to A. fumigatus. The control group consisted of 16 apparently healthy volunteers. All patients underwent a clinical and functional examination. The subpopulations of blood lymphocytes were assessed by flow cytometry. The A. fumigatus allergen was added to peripheral blood samples to evaluate the production of IFN, IL-10 and IL-13. The serum cytokine levels in cell culture supernatants, as well as total IgE, A. fumigatus-specific IgE (sIgE) as well as thymus and activation-regulated chemokine (TARC) level were measured by enzyme-linked immunosorbent assay. Results. Significantly higher serum levels of total IgE, A. fumigatus-specific sIgE and TARC were found in patients with ABPA and asthma with sensitization to A. fumigatus compared to patients with asthma without sensitization to A. fumigatus. The results of lymphocyte immunophenotyping revealed significant excess of memory Th2 cells and T-regulatory cells in all patients with asthma compared to the control group. The count of Tfh2 was higher but memory Th17.1 cells were lower in patients with sensitization to A. fumigatus compared to those of apparently healthy volunteers. Patients with ABPA had significantly higher count of memory Th2 cells and TARC level compared to patients with asthma sensitized to A. fumigatus. The increased activity of memory Th2 cells is confirmed by increased secretion of IL-13 and IL-10 following along with decreased IFN production in response to specific fungal allergen stimulation of blood cells compared to the patients with asthma and the control group. A positive correlation was revealed between the count of memory Th2 cells and the levels of sIgE, IgE, TARC, a negative correlation with FEV1. Conclusion. Thus, exposure to A. fumigatus significantly enhances the activity of memory Th2 cells in patients with asthma which can lead to severe disease course and development of allergic bronchopulmonary aspergillosis. The features of the immune response identified dictate a need for a personalized approach to choose therapeutic tactics in such patients.

An overview of eosinophilic esophagitis in children

Based on the patient's age, eosinophilic esophagitis (EE) has different clinical manifestations. Infants and young children frequently have vague manifestations such difficulty eating, nausea, and discomfort in the abdomen. Despite having symptoms that resemble gastroesophageal reflux, children with EE, do not respond to intensive ant reflux medication. Dysphagia and food impaction became the most common symptoms in adults and adolescents. EE should also be considered when treating adults and children who continue to have heartburn. Pediatric and adult patients frequently have concurrent allergy disorders such asthma, rhinitis, and eczema, in addition to peripheral eosinophilia and increased total blood IgE levels. Mucosal oedema, furrows, exudates, corrugated bands, strictures, and the alleged "crepe paper sign" are some of the endoscopic characteristics of EE. EE is widely seen as a distinct condition from reflux disorder. According to current understanding, the former could be a symptom of eosinophilic gastroenteritis or be induced by cell-mediated food hypersensitivity. Reports back up the effectiveness of steroid treatment or food restriction. To ascertain the cause, enable early clinical identification, and enhance treatment, more research is required.

Self-Reported Insufficient Sleep Is Associated With Clinical and Inflammatory Features of Asthma: A Prospective Cohort Study

A few studies have explored the association between short sleep duration and worse asthma outcomes in patients with self-reported asthma; however, all of them were cross-sectional. To investigate the association between self-reported sleep duration and asthma-related clinical and inflammatory characteristics and whether sleep duration is associated with asthma exacerbations (AEs) in the following year. A prospective cohort study consecutively recruitedparticipants with asthma, who were classified into short (n= 58), normal (n= 380), and long (n= 84) sleep duration groups. We investigated the clinical and inflammatory characteristics and exacerbations within a 1-year follow-up. Patients with short sleep duration were older and had significantly lower total IgE and FeNO levels and higher airway inflammation, characterized by increased levels of IL-6 and TNF-α in sputum than those of patients with normal sleep duration. Furthermore, they had a significantly increased risk for poorly controlled asthma (adjusted odds ratio= 2.741; 95% CI, 1.379-5.447; P= .004) and moderate to severe AEs (adjusted incidence rate ratio= 1.798; 95% CI, 1.098-2.942; P= .020). Short sleep duration was associated with non-type 2 inflammation and is an independent risk factor for future AEs. Therefore, as a potentially treatable trait, sleep duration may have clinical implications for asthma management.

Clinical and immunological features of the atopic dermatitis in children

Background: “atopic march” (AM) is the natural history of allergy mostly in children.&#x0D; The aim: to describe the production of biomarkers of allergic inflammation in dependence on the duration of AD.&#x0D; Patients and methods. 94 children suffered from atopic dermatitis (AD) have been included to the study. The severity of the disease has been estimated, serum level of total IgE, IL-4, interferon gamma and sIL-2R have been estimated.&#x0D; Results. Coexistence of AR and AD was diagnosed in 32/94 (34.0%) patients. Less severity of AD (SCORAD 32.3 ± 9.17 score vs 22.2 ± 2.29 score, p &lt; 0.05), but higher serum level of total IgE (Ме 123 [Q1-Q3 67–156] IU/ml vs Ме 53 [Q1-Q3 5–108] IU/ml, р &lt; 0.001), IL-4 (Ме 12.0 [Q1-Q3 8.7–16.1] pg/ml vs Me 6.0 [Q1-Q3 2.2–12.1] pg/ml, р = 0.0399) and sIL-2R (Ме 2.1 [Q1-Q3 0–20] IU/ml vs Me 0 [Q1-Q3 0–12.9] IU/ml, р = 0.3365) are detected in comorbid patients. Eposides of wheezing are associated with additional risk of AD (OR 2.3 [95% CI 1, 18–4,54]).&#x0D; Discussion. The development of AR in children with AD is considered as progression of natural history of allergy. In our study it was associated with higher level of IgE, IL-4 and sIL-2R. At the same time the comorbid patients had less severity of AD.&#x0D; Conclusion. The coexistence of AD and AR in 3-year-old children is associated with less severity of skin symptoms but higher frequency of sensitization to inhalant allergens than in AD. AM is accompanied by higher production of Th2-dependent parameters and markers of early activation of T-cells. The probability of the AM is higher in 2 times if there were wheezing episodes in the anamnesis.

Spotlight on a Short-Time Treatment with the IL-4/IL-13 Receptor Blocker in Patients with CRSwNP: microRNAs Modulations and Preliminary Clinical Evidence.

Already used for the treatment of some allergic and inflammatory diseases, such as asthma or atopic dermatitis, dupilumab has also been approved as add-on therapy for patients with CRSwNP, and it could represent the keystone to reducing the remission time as well as to improve healing and quality of life. On the other hand, the role of miRNAs as potential biomarkers of immune modulation is emerging. We analyzed the effects of a short-time treatment with dupilumab in patients with CRSwNP, analyzing the immune response modification as well as miRNAs modulations. First, in this early observation stage, all patients experienced remarkable improvement and were clinically stable. Indeed, we observed a significant decrease in CD4+ T cells and a significant reduction in total IgE (p &lt; 0.05) and serum IL-8 levels (p &lt; 0.01), indicating a reduction in the general inflammatory condition. In addition, we analyzed a panel of about 200 circulating miRNAs. After treatment, we noted a significant downregulation of hsa-mir-25-3p (p-value = 0.02415) and hsa-mir-185-5p (p-value = 0.04547), two miRNAs involved in the proliferation, inflammation, and dug-resistance, in accordance with the clinical status of patients. All these preliminary data aimed to identify new biomarkers of prognosis, identifiable with non-invasive procedures for patients. Further, these patients are still under observation, and others with different levels of responsiveness to treatment need to be enrolled to increase the statistical data.

Non-Modified CpG Oligodeoxynucleotide Forming Guanine-Quadruplex Structure Complexes with ε-Poly-L-Lysine Induce Antibody Production as Vaccine Adjuvants.

Unmethylated cytosine-phosphate-guanosine oligodeoxynucleotides (CpG ODNs) induce inflammatory cytokines and type I interferons (IFNs) to activate the immune system. To apply CpG ODNs as vaccine adjuvants, the cellular uptake and stability of phosphodiester-based, non-modified ODNs require further improvement. Previously developed new CpG ODNs forming guanine-quadruplex (G4) structures showed higher nuclease resistance and cellular uptake than linear CpG ODNs; however, the complex formation of G4-CpG ODNs with antigen proteins is necessary for their application as vaccine adjuvants. In this study, we utilized a cationic polymer, ε-poly-L-lysine (ε-PLL), as a carrier for G4-CpG ODNs and antigen. The ε-PLL/G4-CpG ODN complex exhibited enhanced stability against nucleases. Cellular uptake of the ε-PLL/G4-CpG ODN complex positively correlated with the N/P ratio. In comparison to naked G4-CpG ODNs, the ε-PLL/G4-CpG ODN complex induced extremely high levels of interleukin (IL)-6, IL-12, and IFN-β. Relative immune cytokine production was successfully tuned by N/P ratio modification. Mice with the ε-PLL/G4-CpG ODN/ovalbumin (OVA) complex showed increased OVA-specific immunoglobulin (Ig)G, IgG1, and IgG2c levels, whereas total IgE levels did not increase and weight gain rates were not affected. Therefore, ε-PLL can serve as a safe and effective phosphodiester-based, non-modified CpG ODN delivery system, and the ε-PLL/G4-CpG ODN/antigen complex is a highly promising candidate for vaccine adjuvants and can be further used in clinical research.

Severe asthma with fungal sensitization is associated with worse small airway dysfunction but similar symptom control

Severe asthma with fungal sensitization is associated with worse small airway dysfunction but similar symptom control

Уровень общего иммуноглобулина Е у пациентов с аллергическими заболеваниями

The priority task for the modern medicine is timely diagnosis, treatment and prevention of diseases. This article examines the level of total immunoglobulin E in patients with allergic diseases such as bronchial asthma, allergic rhinitis, atopic dermatitis, etc. The authors set a goal to investigate changes in the level of total immunoglobulin E in patients with allergic diseases. We analyzed the primary results of determining total IgE by enzyme immunoassay. When analyzing the primary result of total IgE in a population with a history of allergic disease (atopic dermatitis, allergic rhinitis, allergic bronchial asthma, etc.), normal levels were observed in 41 % of patients; an increased level was observed in 144 patients up to 500 IU / ml in 46 % and over 500 IU / ml – 13 %. Important in the diagnosis of type 1 allergic reactions is the level of total IgE, exceeding the maximum values (above 500 IU / ml). In other types of allergic reactions, the level of total IgE may be increased, but does not exceed the level of more than 500 IU / ml, even in the acute course of the disease. Interpretation of changes in the total level of immunoglobulin E, along with other data from the study of the immune status, can significantly help in screening for allergic diseases. When diagnosing an increased general level of immunoglobulin E and with early involvement of preventive and therapeutic measures, it is possible to significantly improve the condition of a patient with atopic forms of allergy and avoid serious complications.

Bilirubin level is decreased in patients with allergic rhinitis

BackgroundThere are limitations in detecting methods for early diagnosis and screening of allergic rhinitis. Considering the anti-inflammatory and anti-oxidative effects of bilirubin, this study aims to explore the relationship between bilirubin and allergic rhinitis and to identify bilirubin-related candidate urinary protein biomarkers associated with allergic rhinitis. Methods63 allergic rhinitis patients (AR group) and 86 healthy controls (NC group) were enrolled. Venous blood was obtained to measure serum total IgE levels and bilirubin parameters. Patients in the AR group were then classified into the AR1 group (IgE > 125 IU/mL) and the AR2 group (IgE ≤ 125 IU/mL). After randomly selecting ten urine samples from the AR1 group, ten samples were chosen from the AR2 and the NC groups, respectively, according to age and gender matching. We employed a Tandem Mass Tag-Based liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) proteomics approach and targeted parallel-reaction monitoring(PRM) to identify and validate urinary biomarkers for allergic rhinitis. ResultsCompared with the NC group, the bilirubin levels of the AR group, AR1 group, and AR2 group were significantly lower. Although the bilirubin level of the AR1 group was lower than that of the AR2 group, the difference was not significant. Further urinary proteomics analysis found that the expression levels of proteins related to bilirubin metabolism and transportation in the AR1 and AR2 groups, including ABCC1, GSTA1, GSTO1, GSTM3, GSTM5, and BLVRB, were significantly higher than those in the NC group. By PRM-based quantification, GSTA1 and GSTO1 showed significant differences in different degrees of Allergic Rhinitis groups and healthy controls. The AUC of the combined diagnosis of GSTA1 and GSTO1 was 0.79 (95% CI 0.583–0.997, P = 0.007), and the sensitivity and specificity were 100% and 60.0%, respectively. ConclusionsBilirubin levels are associated with allergic rhinitis. Our study revealed that urine proteomics has a specific value for exploring the pathophysiological mechanism of bilirubin changes in AR patients and screening possible biomarkers.

Significance of total and specific IgE in asthma of Iraqi adult patients

A case-control retrospective study was conducted during January – June 2019 on 104 patients with asthma (50 females and 54 males) and 111 non-asthmatic healthy subjects matched patients for gender (54 females and 57 males) to assess role of total and specific IgE serum levels in patho-physiology of disease using ELISA and multiplex immunoblot kits. The mean age ± standard deviation of asthma patients was 37.9 ± 12.1 years, while it was lower among control (35.9 ± 10.5 years), but the difference was not significant. Males and females were similarly distributed among asthma cases (48.1 and 51.9%, respectively) and control (48.6 and 51.4%, respectively). Most of asthma cases were observed to have mild disease (49%), followed by moderate and severe asthma (93.4 and 11.5%, respectively). It was also observed that 51.9% of patients had a family history of asthma. With respect to allergen type, 21.2% of asthma cases were seropositive for mixed types of allergens. Median level of total IgE was significantly (p &lt; 0.001(elevated in sera of asthma cases (204.1 ng/ml) compared to control subjects (163.3 ng/ml). The level positively paralleled the severity of disease. The highest level was observed in severe cases (244.9ng/ml, while the lowest level was recorded in mild cases (189.7 ng/ml). The level of specific IgE showed some variations among asthma cases distributed according to the type of allergen, the highest median was recorded in seronegative cases (215.2 ng/ml), while a lowest level was observed in cases seropositive for animal dander (189.3 ng/ml). Logistic regression analysis revealed that total asthma patients, as well as male and female cases were at an increased risk to develop asthma episodes due to elevated serum level of IgE.ROC analysis demonstrated that elevated serum level of IgE occupied a significant (p = 0.001) area under curve (AUC), which was 0.828. In conclusion, the present study confirms the significant role of total and specific IgE in patho-physiology of bronchial asthma and its correlation with disease severity and allergen type in adults