Characterization of allergic inflammation in chronic uterine cervicitis

Female genital tract chronic inflammation is common in clinics; the pathogenesis is not fully understood yet. House dust mite (HDM) involves the pathogenesis of many chronic diseases in human. This study aims to identify HDM-specific allergic response in the cervix of patients with cervical inflammation. Patients (n=80) with chronic cervicitis (CC) and non-CC control (NC) subjects (n=80) were recruited into this study. Vaginal lavage fluids (VLF) were collected from CC patients and NC subjects. Cellular components and fluid part of VLF were separated by centrifugation, and analyzed by flow cytometry and enzyme-linked immunosorbent assay. We found that a portion (52 out of 80) of CC patients responded to HDM, manifesting positive skin prick test, and HDM-specific IgE and IgG was detected in the VLF (designated CCp patients). VLF of CCp patients showed a Th2 dominant profile. HDM-specific Th2 cells were detected in VLF in CCp patients. Exposure to HDM in the culture induced proinflammatory cytokine release from CCp VLF CD4 + T cells. Exposure to CCp VLF CD4 + T cell-conditioned medium induced de novo Th2 response. Direct exposure to HDM induced allergic response in the cervix of CCp patients. In summary, a portion of CC patients respond to HDM challenge in the cervix. Exposure to HDM induces an allergy-like response in the cervix of CCp patients.

Pattern of Aeroallergen Sensitization and Quality of Life in Adult Thai Patients With Allergic Rhinitis

The prevalence of allergic rhinitis (AR) is steadily rising in the Thai population, causing a major impact on the quality of life (QoL). Enhancing knowledge on common aeroallergens in the local setting helps in the appropriate prevention and management of AR. In this study, the demographic characteristics, clinical data, aeroallergen sensitization pattern, allergic symptoms, visual analog scale (VAS) score, and QoL are described. We evaluated the association between VAS, QoL, and severity of symptoms, except the aeroallergen sensitization pattern. We retrospectively reviewed the medical records of adult AR patients with a positive skin prick test (SPT) for at least one aeroallergen from January 2018 to May 2020. Standard descriptive and inferential statistics were used for analysis. A total of 366 patients were enrolled. Indoor aeroallergen sensitization and outdoor aeroallergen sensitization were observed in 32% and 7.9% of patients, respectively. Mono-sensitization was noted in 16.9% of patients, while poly-sensitization was noted in 83.1% of patients. Mites (65%) and sedge (39.3%) were the most common indoor and outdoor allergens. Nasal obstruction (74.6%), runny nose (63.7%), and nasal itchiness (61.5%) were the primary symptoms affecting the QoL. The association between VAS and symptom scores showed a trend of association with AR severity (Allergic Rhinitis and its Impact on Asthma [ARIA] classification) and VAS. AR has a significant effect on QoL in all domains of the validated generic (short-form-36, SF-36) and specific (rhino-conjunctivitis QoL questionnaire, Rcq-36) questionnaires. Mite and sedge remain the most common indoor and outdoor aeroallergens. The pattern of sensitization and number of aeroallergens were not associated with AR based on the ARIA guidelines. Meanwhile, symptoms of patients affected the QoL and VAS scores, which can be used as a quick and reliable tool for monitoring and stepping up or stepping down the treatment according to the next-generation guidelines. AR has a significant impact on the QoL of adult Thai patients.

ASSOCIATION OF STAT6 GENE SINGLE NUCLEOTIDE POLYMORPHISM WITH FOOD ALLERGY

Background Food allergy (FA) may be IgE-mediated, non-IgE-mediated or mixed. Genetic predispositions result in dysregulation of the immune system and lead to FA when exposed to environmental triggers. The transcription factor STAT6 is activated by IL-4 and IL-13 and activates cytokine signaling in immune and target tissue cells; contributing in the pathogenesis of allergic disorders including FA. The rs324015 single nucleotide polymorphism (SNP) in the STAT6 gene was previously associated with nut and cow’s milk allergy. Objective to investigate the association of the rs324015 STAT6 gene SNP with food allergy. Patients and Methods After ethical committee approval and informed consent from the patients, this retrospective case control study was conducted on 100 Egyptian children divided into two groups. Group I consisted of 50 children with positive history of FA supported by positive skin prick test +/- oral food challenge and group II consisted of 50 healthy age-matched controls. Blood samples were collected and genotyped using Taqman® Realtime PCR assays. Results We found that the homozygous G genotype and G allele of rs324015 were significantly higher among food allergic subjects than controls. We report no effect of any specific genotype on the phenotype of allergic disease or reacting to a specific food more than others. Genotypes were also not related to disease severity, eosinophil counts, total IgE levels or a family history of atopic disease. Conclusion rs324015 STAT6 gene SNP may be involved in the pathophysiology of food allergy.

Usefulness of the Allergen Specific Nasal Provocation Test in the Diagnosis of Shellfish Allergy

Background: Shellfish allergy is an important cause of food allergy and anaphylaxis worldwide. Several allergenic proteins have been described in the last few years, but the only diagnostic tool that allows discrimination between allergic and non-allergic sensitized subjects is still the oral food challenge (OFC). Objective: The aim of this study was to evaluate the usefulness of nasal allergen provocation test (NAPT) as a diagnostic tool in the diagnosis of shellfish allergy. Methods: Forty-five subjects with confirmed sensitization to shrimp by a positive skin prick test (SPT) to a commercial shrimp extract were recruited and classified as Sensitized-Allergic or non-Allergic based on current tolerance to shrimp intake, the result of an OFC with a freeze-dried cooked shrimp mixture extract, or recent history of anaphylaxis from shrimp ingestion. These subjects and ten controls without shrimp sensitization were subjected to a NAPT with a freeze-dried cooked shrimp mixture extract. The response was evaluated by means of acoustic rhinometry (AcRh) and visual analogue scale scores (VAS). Results: Significant differences (p=.001) were found between the Sensitized-Allergic group (18/20 positive NAPT, 90%) compared to both Sensitized-non-Allergic (2/18 positive NAPT, 11.1%) and Control (0/10 positive NAPT) groups. NAPT allows differentiation between allergic and non-allergic subjects with a S: 90%, E: 89%, PPV: 90% and NPV: 89%. Conclusions: According to the study results NAPT may be a useful diagnostic tool that allows differentiating sensitized symptomatic subjects from sensitized tolerant. It could be a valuable test to consider when conducting a shrimp allergy study.

The Association Between Paranasal Mucous Retention Cysts and Allergic Sensitization

ABSTRACT Objective: Although there is no consensus regarding the etiology of paranasal mucous retention cysts (MRCs) in the literature, several studies suggest an allergic etiology. This study aimed to investigate a potential association between paranasal MRCs diagnosed with MRI scans and allergic sensitization in the pediatric population. Materials and Methods: A total of 4559 MRI scans were retrospectively evaluated for MRC in patients who presented to the pediatric neurology outpatient clinic with headache complaints. Fifty children with MRI findings conclusive for paranasal MRC and 50 children without such findings were included in the study. All study and control patients were invited for atopy/allergy evaluation. Total IgE measurements, blood eosinophil levels, nasal smear and skin prick tests were performed to evaluate the allergic status of the children. In addition, an allergic rhinitis symptom questionnaire was administered. Results: The mean age was 13.0±2.8 years (median 14 y, range 6-18 y) with a female-to-male ratio of 1.4:1 in the study group. The prevalence of MRC was found to be 1.1% (50 in 4559). The two groups did not differ with regard to the frequency of blood eosinophilia, nasal eosinophilia, serum IgE levels, and allergic rhinitis symptom severity (p>0.05). Positive skin test for at least one of the allergens tested was more common in the MRC group than the controls (40% vs. 16%, p=0.007). Multivariate analysis identified that a positive skin prick test for at least one allergen was a significant independent predictor of MRC (OR, 4.6; 95% CI 1.2-17.0, p=0.023). Conclusion: Our study showed that paranasal MRCs were significantly more frequent in atopic children compared to controls. Additionally, MRCs were found to be strongly associated with allergic sensitization. Keywords: Cysts, allergic rhinitis, children, diagnostic tests, signs and symptoms

IgE and IgG4 Repertoire in Asymptomatic HDM-Sensitized and HDM-Induced Allergic Rhinitis Patients

<b><i>Introduction:</i></b> Asymptomatic sensitization is defined as the presence of positive skin prick test (SPT) and/or positive serum allergen-specific IgE in the absence of clinical allergic symptoms. Currently, there is no convincing explanation why some people with positive allergen tests do not show symptoms. We aimed to investigate the house dust mite (HDM)-specific IgE and IgG4 repertoire in asymptomatic HDM-sensitized subjects and HDM-induced allergic rhinitis (AR) patients. <b><i>Methods:</i></b> A total of 48 subjects sensitized to HDM were included in this study: 27 had AR with/without asthma (symptomatic group), and 21 had no allergic symptoms (asymptomatic group). Six healthy individuals served as control group. Peripheral blood samples were collected for serum IgE and IgG4 assay and basophil activation tests (BATs). IgE and IgG4 assay included antibodies to <i>Dermatophagoides</i> (<i>Der</i>) <i>p1</i>, <i>2</i>, <i>7</i>, <i>10</i>, <i>21</i>, <i>23</i>, and <i>Der f1</i>, <i>2</i>. <b><i>Results:</i></b> AR patients had a larger wheal diameter of SPT (7.0 vs. 3.0 mm, <i>p</i> &#x3c; 0.0001) and a higher specific IgE to <i>Der p</i> (15.50 vs. 0.70 KU/L, <i>p</i> &#x3c; 0.0001) than asymptomatic subjects. They also showed more frequent sensitization to <i>Der p1</i> and <i>Der p2</i> (both <i>p</i> &#x3c; 0.05). However, the total IgE and specific IgG4 did not differ significantly between the 2 groups. The basophil activation response after being stimulated with HDM was observed to be higher in AR patients (all <i>p</i> &#x3c; 0.05). <b><i>Conclusions:</i></b> There are differences in SPT, serum-specific IgE to <i>Der p</i>, component allergen <i>Der p1</i> and <i>Der p2</i> level and BAT between AR patients and asymptomatic subjects sensitized to HDM. IgG4 alone cannot differentiate asymptomatic individuals from AR patients.

Blood eosinophil counts in the general population and airways disease: a comprehensive review and meta-analysis

BackgroundThe clinical context for using blood eosinophil (EOS) counts as treatment-response biomarkers in asthma and chronic obstructive pulmonary disease (COPD) requires better understanding of EOS distributions and ranges. We describe EOS distributions and ranges published in asthma, COPD, control (non-asthma/COPD) and general populations.MethodsWe conducted a comprehensive literature review and meta-analysis of observational studies (Jan 2008 to Nov 2018) that included EOS counts in asthma, severe asthma, COPD, control and general populations. Excluded studies had total sample sizes <200, EOS as inclusion criterion, hospitalised population only, exclusively paediatric participants.ResultsOverall, 91 eligible studies were identified, most had total-population-level data available: asthma (n=39 studies), severe asthma (n=12 studies), COPD (n=23 studies), control (n=7 studies), general populations (n=14 studies); some articles reported data for multiple populations. Reported EOS distributions were right-skewed (n=7 studies). Reported median EOS counts ranged from: asthma, 157–280 cells·µL−1 (n=22 studies); severe asthma, 200–400 cells·µL−1 (n=8 studies); COPD, 150–183 cells·µL−1 (n=6 studies); controls, 100–160 cells·µL−1 (n=3 studies); general populations, 100–200 cells·µL−1 (n=6 studies). The meta-analysis showed observed variability was mostly between studies rather than within studies. Factors reportedly associated with higher blood EOS counts included: current smoking, positive skin prick test, elevated total IgE, comorbid allergic rhinitis, age ≤18 years, male sex, spirometric asthma/COPD diagnosis, metabolic syndrome and adiposity.ConclusionEOS distribution and range varied by study population, and were affected by clinical factors including age, smoking history and comorbidities which, regardless of severity, should be considered during treatment decision making.

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

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

Intestinal helminthic infection and allergic disorders among school children enrolled in mass deworming program, Sululta, Ethiopia

Background Intestinal helminths have been proposed to have a protective role against allergic sensitization and atopic diseases. However, consistent data demonstrating this are lacking in Sub-Saharan countries. We aimed to assess the association between intestinal helminths and allergic disorders among school children enrolled in mass deworming program in Sululta, Ethiopia. Methods A cross sectional study was conducted among 526 school children aged 5 to 14 years old from primary government schools in Sululta district, Ethiopia. An interviewer-led questionnaire administered to parents provided information on demographic and lifestyle variables. Questions on allergic disease symptoms were collected using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire 6 months following deworming treatments. Atopy was defined as a positive skin prick test reaction to one or both dust mite (Dermatophagoides) and German cockroach (Blatella germanica) allergens. Fresh stool samples were collected, processed, and examined by direct wet mount, Kato-Katz technique, and formol-ether concentration technique. Multivariate logistic regressions were used to assess the association between allergic disorder and helminths infection. Results Of the total 526 school children, 58.2% were females. Overall, 24% (126/526) had allergic symptoms, 5.1% (27/526) had atopy, and 16.9% (89/526) had intestinal helminths. There was no association between helminthic infection and self-reported allergic symptoms (P = 0.317), but Ascaris lumbricoides infection was positively associated with atopy (AOR = 4.307, 95% CI 1.143–16.222, P = 0.031). Atopy was related to increased allergy symptoms (AOR = 2.787, 95% CI 1.253–6.197, P = 0.012), and family history of allergy was associated with increased childhood allergy (AOR = 2.753, 95% CI 1.565–4.841, P = 0.001). Deworming in the past 6 months showed a reduced odd of self-reported allergic symptoms (AOR = 0.581, 95% CI 0.366–0.954, P = 0.034). Conclusion While no significant association between self-reported allergy and helminths was found in this study, this may have been due to the low prevalence and intensity of helminthic infection in the sample. There was a positive association between Ascaris lumbricoides and atopy. To further examine the underlying mechanism behind this positive association, a longitudinal study is needed.

Impact of Allergic Rhinitis on Voice in Children

Introduction: The purpose of the present study was to determine the possible effect of allergic rhinitis (AR) on voice change in children with acoustic analysis and Turkish children’s voice handicap index-10 (TR-CVHI-10). Methods: This is a case-control study. Forty-one children with AR, and a positive skin prick test, as well as 39 children of controls who had produced a negative skin prick test and lacked a history of allergic disease, were selected for the study. Each assessment included recordings for the purposes of acoustic voice analysis (fundamental frequency [f0], jitter %, shimmer %, and harmonics-to-noise ratio (HNR)), and aerodynamic analysis (maximum phonation time (MPT) and s/z ratio). All participants completed TR-CVHI-10. Results: The mean TR-CVHI-10 score of the AR group was significantly higher than the control group (p = 0.013). No difference was observed between the AR and control groups in terms of jitter, shimmer, HNR, and MPT values and s/z ratio (p > 0.05). Conversely, the f0 value was more pronounced in controls (270.9 ± 60.3 Hz) than in the AR group (237.7 ± 54.3 Hz) (p = 0.012). Conclusion: The study’s results revealed that AR can have an effect on fundamental frequency and voice quality in children. The diagnostic process should include AR as a potential cause of voice disorders in children.