House Dust Mite Precision Allergy Molecular Diagnosis (PAMD@) in the Th2-prone Atopic Dermatitis Endotype

Atopic dermatitis (AD) endotyping might be important for developing personalized diagnostic and therapeutic strategies to the different phenotypes. The current study investigated the IgE molecular profile to Dermatophagoides pteronyssinus (D. pteronyssinus) in a subset of patients afflicted with varying severity stages of atopic dermatitis in a subtropical region subjected to a high perennial house dust mite (HDM) exposure. We selected patients showing a clinically relevant sensitization to HDM with mild-to-moderate and severe AD according to their basal Severity Scoring Atopic Dermatitis (SCORAD) index. Skin prick test (SPT) with standardized mite extracts, as well as a Precision Allergy Molecular Diagnosis (PAMD@) panel including nine different D. pteronyssinus allergens and the related protein allergenic characterization, were assessed in all serum samples. A total of 80 European American AD patients with the marked T2 endotype confirmed their eligibility for the study. Major allergens (Der p 23, Der p 2, and Der p 1) were present in more than 86% of all subjects, with mid-tier allergens (Der p 5, Der p 7, and Der p 21) reaching up to 65%. A serodominant role for Der p 11 could not be quantitatively confirmed in the present cohort. The proposed component resolved diagnosis (CRD) panel appeared to be sufficient to obtain a precise D. pteronyssinus molecular diagnosis in AD patients subjected to a climate-dependent high-mite allergen exposure. The raised seroprevalence of IgE response to Der p 23 confirmed this constituent as a major D. pteronyssinus allergen in severe stages of atopic dermatitis. A clinically driven molecular approach appears to be essential to frame a more precise diagnosis and therapy of this heterogeneous allergic condition.

1473Early life immune modulatory exposures and allergy risk in Japanese children

Background Incidence of allergies among children is increasing and is an important public health issue. We examined whether early life immune modulating exposures and surrogate measures are associated with a reduced risk of allergic diseases among Japanese children. Methods We analyzed data from the Health Diary Study comprising a nationally representative cross-sectional sample of children/adolescents aged 1 to 17 years in Japan. Data were collected on early life factors and diagnosed allergic diseases using a self-administered questionnaire. Multivariable logistic regression was conducted evaluating the effects of delivery method, breastfeeding, infections in infancy, older siblings, and daycare on the risk of any allergy and specific types. Results Among 744 children included (mean age=9.5 years; 52% males), 41% experienced an allergic condition. Infection in infancy was associated with an increased risk of asthma (OR = 1.77, 95% CI: 1.09-2.85) especially related to bronchitis and ear infection, and showed a dose-response effect with increasing number of infections (p=0.04). Having older sibling(s) modified the effect of infections on asthma risk (p-interaction=0.11). Reduction in risk of allergic rhinitis was suggestive related to exclusive breastfeeding and having two or more siblings. Conclusions Evidence is unclear regarding a protective role of early life immune modulatory exposures in allergy risk in Japanese children. In contrast, infectious episodes in infancy may increase the risk of asthma. Key messages While multiple mechanisms may be at play, infections in infancy may increase the risk of asthma which supports protection against infectious transmissions.

Allergy-induced systemic inflammation impairs tendon quality

Treatment of tendinopathies still present a major challenge, since the aetiology of the disease remains poorly understood. To determine whether the systemic inflammation accompanying predisposing factors including rheumatoid arthritis, diabetes or smoking contributes to the onset of tendinopathy, we studied the effect of a systemic inflammation induced by an allergic episode on tendon properties. To this end, we elicited an allergic response in mice by exposing them to a plant allergen and subsequently analysed both their flexor and Achilles tendons. Biomechanical testing and histological analysis revealed that tendons from allergic mice not only showed a significant reduction of both elastic modulus and tensile stress, but also alterations of the tendon matrix. Moreover, 3D tendon-like constructs treated with sera from allergic mice displayed a matrix-remodelling expression profile and the expression of macrophage-associated markers and matrix metalloproteinase 2 (MMP2) was increased in allergic Achilles tendons. Analysing data from an epidemiologic study comprising data from more than 10.000 persons, we found that persons suffering from an allergic condition appeared to have an increased propensity to develop a tendinopathy.

Haematology and serum biochemistry of broiler chickens offered extracts of dried Roselle plant (Hibiscus sabdariffa) calyx in drinking water

The challenge of antibiotics resistance and the fatality of its residues in human and animal health led to the ban of antibiotic growth promoters in animal diets. This has prompted the search for alternatives; especially through phytobiotic investigations. Therefore, this study investigated the effects of aqueous dried calyx extract of roselle plant on the haematological and serum biochemical responses of broiler chickens with the aim of establishing its optimal level as nutrient additive. The five varying concentration levels- 0, 5, 10, 20 and 30 ml of 2 litres of calyx extract solution per litre of drinking water were treatments T1, T2, T3, T4 and T5 respectively. Thirty broiler chickens were randomly assigned per treatment of three replicates each. The experiment lasted for eight weeks. The results revealed significant differences in the haematological parameters. However, the values of white 3 3 blood cells (WBC) (11400.00×10 /µl - 13466.67×10 /µl), lymphocyte (ranged between 48.33 and 61.33%), monocytes (2.00-3.67%), eosinophils (1.67-5.00%) and basophil (0.00 – 1.00%) were within the normal range for healthy chickens. Hence, roselle plant aqueous extract maintained the haematological content of the blood. The level of lymphocyte revealed adequate production of antibodies that prevented the occurrence of bacterial infection or allergic condition throughout experimental period. The influence of aqueous roselle plant on the levels of aspartate transaminase (AST) and albumin (ALB) indicated uncompromised liver function. Therefore, haematological and serum biochemistry parameters showed enhanced health and the wellbeing of the broiler chickens. The 5 ml and 10 ml levels of the extract of dried roselle calyx in drinking water were found to be similarly optimal in terms of lymphocyte levels. Levels above 10 ml could be detrimental to the health andwellbeing of the chickens. Key words: Blood constituents, Chicken health, Drinking water, Roselle calyx extract

Vernal Keratoconjunctivitis- A Survey on Practice Patterns and Perspectives of Indian Ophthalmologists

Introduction: Vernal Keratoconjunctivitis (VKC) is a common chronic allergic condition mostly affecting children and their childhood. At present, the choice of medication varies greatly for the same severity of disease from one ophthalmologist to another. A standardised grading system and a comprehensive approach towards VKC including Quality of Life (QOL) assessment is the need of the hour. Aim: To learn the practice patterns and perspectives of Indian Ophthalmologists in the management of VKC and to propose strategies for the holistic approach. Materials and Methods: A cross-sectional survey was conducted in July 2020. A semi-structured questionnaire was sent via Google form to 200 ophthalmologists. Statistical analysis used: Data was entered in excel and analysis was performed using the Statistical Package of Social Sciences (SPSS) software version 20. Results: Out of 200 ophthalmologists, 146 (73%) participated in the survey. Among the participants, 43.8% used combination therapy in the management of VKC and 68.5% resorted to steroid therapy in severe cases. Tacrolimus (0.03%) was the most preferred immunomodulator among 56% ophthalmologists and only 11% assessed QOL in the patients periodically. Conclusion: Majority (around 2/3rd) felt immunotherapy and vitamin D supplementation can be tried in the management of VKC and there was a consensus on administering a QOL questionnaire in all patients with VKC in future which would provide holistic care.

Hay fever and the effect of influenza vaccines

Hay fever is an increasing disease in Japan, and the prevalence of cedar pollinosis exceeds 20% nationwide. More than 50 kinds of pollen have been reported so far in Japan. Pollinosis often complicated other allergic conditions. Since patients with allergic diseases have lower s-IgA levels than healthy subjects, patients with hay fever have less weak mucosal immunity so that it would affect the efficacy of the influenza vaccine. Eight thousand three hundred thirty-seven (3885 men and 4452 women) participated in this survey to clarify the relationship between allergic diseases and the influenza vaccine's efficacy. In the no hay fever group, the effective vaccine rate against influenza disease was 0.2%, and in the hay fever group, it was 0.21%. No effect of the influenza vaccine was present in this population. Rather, vaccination seemed to increase influenza incidence in people with hay fever. The basic presence of allergic condition influenza vaccination increased susceptibility to influenza infection. (12.9% vs. 13.89%) (p<0.001). A tailor-made strategy for these patients should be necessary for preventing influenza.

Calcium Intake in Children with Eczema and/or Food Allergy: A Prospective Cohort Study

Eczema and food allergy may impact diet. Using data from a cohort of Manitoba children born in 1995, we examined calcium intake, defined as the frequency and quality of calcium products consumed (with the exception of cheese), amongst Manitoba adolescents (12–14 years) with eczema or food allergy in childhood (7–8 years) or adolescence. At both ages, children were assessed by a physician for eczema and food allergy. Adolescents completed food frequency questionnaires. Calcium intake was defined as 1+ vs. <1 weekly. Linear and logistic regression was used as appropriate, with adjustments for confounders. Overall, 468 adolescents were included, of whom 62 (13.3%) had eczema only in childhood, 25 (5.3%) had food allergy only, and 26 (5.6%) had eczema and food allergy. Compared to children without eczema, those with eczema only had poorer calcium intake in adolescence (β −0.44; 95%CI −0.96; 0.00). Girls, but not boys, with eczema in childhood had poorer calcium intake in adolescence than girls without eczema (β −0.84; 95%CI −1.60; −0.08). These patterns persisted even if children experienced transient vs. persistent eczema to adolescence. Similar but non-significant trends were found for food allergy. Childhood eczema is associated with significantly lower calcium intake and consumption in adolescence. These differences persist to adolescence, even if a child “outgrows” their allergic condition.

Sensitization to inhaled allergens in asthmatic children in southern Jordan: a cross-sectional study

Background: Sensitization to inhaled allergens in children with bronchial asthma significantly affects asthma pathogenesis, severity and persistence into late childhood and adulthood. The present study determined the prevalence of sensitization to inhaled allergens in children with bronchial asthma and wheezing episodes in order to investigate the effect of positive sensitization on the severity and control of asthma symptoms and to screen for other associated allergic conditions. Methods: A cross-sectional study was conducted, including children between 6 months and 14 years of age attending the chest clinic of Al-Karak, south of Jordan, between November 2013 and February 2016. Skin prick tests (SPTs) using 11 standardized allergen extracts were conducted in 277 children. The severity of asthma was determined based on the Global Initiative for Asthma (GINA) assessment and the Childhood Asthma Control Test (C-ACT) in addition to the history of use of systemic steroids and hospital admissions within the past 12 months. Results: Sixty-seven percent of children with bronchial asthma reported sensitization to one or more of the inhaled allergens. The most common allergens were olive pollens (18%), cat fur (13.5%), and Dermatophagoides pteronyssinus (11.9%). There was a significant increase in allergen sensitization with age (p < 0.001). The most common concomitant allergic condition among children was allergic rhinitis (71.5%); however, allergic conjunctivitis was the only allergic condition that correlated with the skin test reactivity (p = 0.01). A family history of bronchial asthma was confirmed in 40.4% of children. Children with positive SPTs had lower ACT scores and reported more frequent use of systemic steroids and admissions to hospital within the past 12 months; however, this effect was not statistically significant (p > 0.05). Conclusions: Sensitization to inhaled allergens is highly prevalent in children with asthma and wheezing episodes in southern Jordan and may be correlated with the severity of the disease. Therefore, appropriate measures to recognize and avoid these allergens are highly recommended. Most children in our study suffered from concomitant allergic rhinitis, indicating that an appropriate diagnosis and treatment of allergic rhinitis could significantly improve asthma control and thus the quality of life of these children.

THE LEVEL OF THE QUALITY OF EMERGENCY AND INPATIENT MEDICAL CARE FOR CHILDREN WITH ACUTE ALLERGIC PATHOLOGY

The acute allergic condition may carry life-threatening character and requires the provision of the immediate medical assistance, which is governed by approved standards and clinical guidelines on appropriate forms of pathology. There are presented data concerning the routing of patients with allergic forms of pathology through stages from emergency medical assistance, evacuation of the patient till the discharge from the hospital with recommendations for outpatient care, with the purpose of the analysis of correspondence of medical aid in acute allergic pathology to existing algorithms and clinical guidelines at different stages of the management of patients. There was performed an analysis of the data of 1327 children with acute allergic pathology requesting emergency medical assistance. 78% of patients were left in place with recommendations for further referral to specialists, 22% of patients were evacuated to various clinics for specialized medical care (SMC). At the stage of the rendering of SMC 69% of children received corticosteroids in 2014, 66% - in 2015. 60% of children were prescribed first-generation H1-antihistamines in 2014, 63%-in 2015; 25% of children were administered the lytic mixture. Only 4% of children received inhalation therapy. At the stationary stage in 2014, all children with broncho-pulmonary disease and laryngotracheitis received antibiotic therapy, 89% and 59% - in 2015, respectively Conclusion The quality of rendering of medical aid to children with acute allergic pathology at prehospital and hospital stages is not always consistent with clinical recommendations.

Serum IL-6 levels of atopic patients with recurrent aphthous stomatitis (RAS)

Introduction: Atopy is a genetic tendency of allergic condition with specific clinical manifestations such as atopic dermatitis (AD), allergic rhinitis (AR), and bronchial asthma (BA). Atopic individuals might experience other health problems that coincide with atopic manifestations, including the appearance of recurrent aphthous stomatitis (RAS) which is an oral mucosal disease that can also be influenced by allergies. This study was aimed to be the preliminary study regarding the level of IL-6 serum in atopic patients who were also having RAS. Methods: Thirty subjects were recruited and grouped into three groups with ten subjects each were group of atopic (dermatitis, allergic rhinitis, or bronchial asthma) with RAS, atopic without RAS, and control. Blood specimens were obtained with an approved institutional board review protocol. This research was cross-sectional research with consecutive sampling method conducted at Dr Hasan Sadikin Hospital Bandung. Results: There were significant differences in IL-6 log levels in all three groups (p < 0.001). The higher IL-6 levels in the group of atopic with RAS might be due to the influence of atopy because this condition can increase the acute inflammation of RAS. IL-6 is a pro-inflammatory marker found in the circulation of atopic and RAS patients. Conclusion: Serum IL-6 levels in the group of atopic patients with RAS is higher than in other groups. Keywords: Serum, IL-6, atopic, recurrent aphthous stomatitis