The association between allergy and sinusitis: a cross-sectional study based on NHANES 2005–2006

Background The relationship between allergies and sinusitis, though extensively studied, remains poorly defined. While several studies proposed a cause-and-effect relationship between allergy and chronic sinusitis, several others reported the lack of any existing association. This study aimed to investigate the relationship between allergy and sinusitis. Methods We conducted a cross-sectional study using a representative sample of the US population from the National Health and Nutrition Examination Survey 2005‒2006 (n = 7244). A self-reported allergy questionnaire and total and allergen-specific IgE levels were used for analysis. Participants were divided into positive and negative allergy symptoms groups (PAS, NAS, respectively) to eliminate the influence of allergy symptoms on the apparent incidence of sinusitis. Pearson’s chi-square test and the linear regression analysis using Durbin Watson test were used for statistical analysis. Results Sinusitis incidence in the PAS group (22.4%; 521/2327) was significantly higher than that in the NAS group (7.1%; 348/4917) [odds ratios (OR) = 3.788, 95% confidence interval (CI) 3.272‒4.384, P < 0.001]. sinusitis incidence in non-sensitized and sensitized groups was not statistically different. After controlling for allergy symptoms, there was a negative correlation between sensitization status and the occurrence of sinusitis in the PAS group (OR = 1.407, 95% CI 1.156‒1.711, P < 0.01). Increase in serum total IgE levels correlated with decrease in incidence of sinusitis in both PAS and NAS groups. sinusitis incidence was significantly reduced in the PAS group in participants sensitized to allergens such as cockroaches, ragweed, ryegrass, Bermuda grass, oak, birch, and thistle. Conclusion Allergy is related to sinusitis incidence. It is likely that sensitization status could reduce the incidence of sinusitis, albeit in an antigen-specific manner.

Some features of hematological parameters and production of cytokines regulating inflammation in allergic rhinitis

Backgraund: Allergic rhinitis (AR) is a common IgE-mediated disease. Multiple mechanisms are involved in the regulation of IgE synthesis, and cytokines produced by immune cells play an important role in this process. In addition, the study of the features of immunological reactivity in seasonal AR (SAR) is of interest both getting of new data about pathogenesis of the disease and optimization of the treatment. Aims: To study the features of the cytokine status and hematological parameters in patients with SAR outside the period of exacerbation. Materials and methods: 43 adult patients with SAR (stage of remission) have been included in the study, and 47 conditionally healthy patients have formed the comparison group; perennial symptoms and/or sensitization to perennial allergens were considered as exclusion criteria. Complete blood cell count and serum IL-4, IL-5, IL-6, IL-8, IL-10, IL-18, MCP-1, total IgE, eosinophil cationic protein levels were measured. Results: The remission stage in patients with SAR is characterized by higher serum levels of total IgE and IL-8 compared with the group of healthy patients. Normal serum total IgE level in patients with SAR in remission is associated with activation of the monocyte-macrophage link (increased serum levels of MCP-1, IL-6, IL-8, absolute and relative numbers of monocytes). Increased serum total IgE level is associated with the predominant signs of the Th2-phenotype of the immune response (increased in the serum levels of IL-4, IL-5). Conclusions: Immune reactivity of patients with natural remission of SAR is characterized by Th1-phenotype features if serum level of IgE is normal and Th2-ones if IgE is increased.

Efficacy of Sublingual Immunotherapy in Allergic Rhinitis Children during Coronavirus Disease 2019

<b><i>Background:</i></b> Sublingual immunotherapy (SLIT) had good effectiveness for children with allergic rhinitis (AR). However, no studies explored the effect of persistent allergen exposure on SLIT treatment. Coronavirus disease 2019 (COVID-19) restricts outdoor activities of children significantly. We aimed to evaluate the effectiveness of SLIT during this special period. <b><i>Methods:</i></b> A total of 335 AR children who sensitize to house dust mite (HDM) undergoing SLIT were recruited in this study. The clinical effectiveness and safety were evaluated at different time points using symptom and medication scores. The serum total IgE and specific IgE (sIgE) at different time points were detected by using the Unicap system. <b><i>Results:</i></b> The total nasal symptoms score (TNSS) and total medication score (TMS) during the epidemic of COVID-19 increased significantly compared with the same period last year (<i>p</i> &#x3c; 0.05), despite that they were still significantly lower than baseline levels (<i>p</i> &#x3c; 0.05). The occurrence of adverse reactions at different time points had no significant differences. We also found that the family of the good response group had more frequent bedding cleaning. Both the tIgE and sIgE levels had no significant changes during SLIT treatment. <b><i>Conclusion:</i></b> Our results suggest that continuous HDM exposure reduced the effectiveness of SLIT, whereas effective reduction of HDM levels by frequent bed cleaning will be helpful during the SLIT treatment.

A randomised trial of prednisolone versus prednisolone and itraconazole in acute-stage allergic bronchopulmonary aspergillosis complicating asthma

Whether a combination of glucocorticoid and antifungal triazole is superior to glucocorticoid alone, in reducing exacerbations, in patients with allergic bronchopulmonary aspergillosis (ABPA) remains unknown. We aimed to compare the efficacy and safety of prednisolone-itraconazole combination versus prednisolone monotherapy in ABPA.We randomised subjects with treatment-naïve acute-stage ABPA complicating asthma to receive either prednisolone alone (four months) or a combination of prednisolone and itraconazole (four and six months, respectively). The primary outcomes were exacerbation rates at 12 months and glucocorticoid-dependent ABPA within 24 months of initiating treatment. The key secondary outcomes were response rates and percentage decline in serum total IgE at six weeks, time to first ABPA exacerbation, and treatment-emergent adverse effects (AE).We randomised 191 subjects to receive either prednisolone (n=94) or prednisolone-itraconazole combination (n=97). The one-year exacerbation rate was 33% and 20.6% in the prednisolone and the prednisolone-itraconazole arms, respectively (p=0.054). None of the participants progressed to glucocorticoid-dependent ABPA. All the subjects experienced a composite response at 6-weeks, along with a decline in serum total IgE (mean decline, 47.6% versus 45.5%). The mean time to first ABPA exacerbation (417 days) was not different between the groups. None of the participants required modification of therapy due to AE.There was a trend towards a decline in ABPA exacerbations at 1-year with the prednisolone-itraconazole combination than prednisolone monotherapy. A three-arm trial comparing itraconazole and prednisolone monotherapies with their combination, preferably in a multicentric design, is required to define the best treatment strategy for acute-stage ABPA.

Correlation between serum IL-23 and serum total IgE levels in allergic rhinitis patients

Background: Allergic rhinitis (AR) is an immunoglobulin E (IgE) mediated inflammatory chronic disorder of the nasal mucosa caused by contact to allergens which affects a significant percentage of population. Th17 cells might be involved in the acute phase of the allergic reaction. Th17 cells are regulated by IL-23, which is a member of the IL-12 cytokine family. IL-23 was suggested to be a pivotal cytokine involved in the pathogenesis of AR and may become a novel target in the treatment of AR. Objective: Here we investigate the role of serum IL-23 and its correlation with serum total IgE level in AR. Methodology: This case control study included the investigation of 48subjects. Blood samples were collected for measuring serum IL-23 and total IgE levels by ELISA. Results: positive correlation was found between IL-23 and total IgE serum level in AR patients. Conclusion: Positive correlation was found between serum IL-23 and serum total IgE levels in allergic rhinitis patients.

The role of rs_7927894 FLG gene polymorphism and total IgE in predicting clinical phenotypes of atopic dermatitis in children

Atopic dermatitis (AD) is the most common chronic allergic disease of childhood, the pathogenesis of which is based on endogenous genotype and which manifests by various clinical phenotypes — isolated or combined with other forms of atopy — allergic rhinitis/rhinoconjunctivitis (AR/ARC) and/or bronchial asthma (BA). Currently, one of the most studied genetic markers of AD developmental risk is the single nucleotide polymorphism of the filaggrin gene (SNP FLG), in particular, rs_7927894. The basic AD biomarker is total serum immunoglobulin E (IgE). But, so far, there has been no studies combining the mentioned predictors markers within different clinical AD phenotypes in children. Purpose — to detect the variants of SNP rs_7927894 of FLG gene and serum total IgE concentrations as personalized predictors panel for different AD clinical phenotypes developmental risk in children. Materials and methods. There were recruited 2 groups of patients into the study: the main comprised 39 children with phenotypes of AD isolated and combined with AR/ARC and/or BA; the control group comprised 47 children with disorders of digestive system (functional dyspepsia, chronic gastritis, peptic ulcer, functional biliary disorders) without clinical signs of atopy. The threshold level of statistical significance was set as p<0.05. Results. There were detected the predictor genotype and biomarker for the AD developmental risk as per AD isolated phenotype: 4.11 (95% CI 1.28; 13.18, p<0.05) within C/T SNP rs_7927894 of FLG gene variant and 8.98 (95% CI 2.53, 31.86, p<0.001) for total serum IgE>173 IU/ml. As well, predictor genotype and biomarker for the developmental risk of the AD combined with AR/ARC/BA phenotype were detected: 2.88 (95% 1.07; 8.54, p<0.05) within the C/T SNP rs_7927894 of FLG gene variant and 8.98 (95% CI 2.53; 31.86, p<0.001) for total serum IgE>213 IU/ml. Additionally, the developmental risk for the phenotype of AD combined with AR/ARC/ BA in comparison with AD isolated at a cut-off serum total IgE>1001 IU/ml was detected as 16.00 (95% CI 2.68; 95.44, p<0.01). Conclusions. The C/T SNP rs_7927894 of FLG gene variant and cut(off serum IgE concentrations are significantly associated with the developmental risk of AD clinical phenotypes in children. Total IgE remains a significant predictor biomarker of AD risk in children aged 3 to 18 years at serum concentrations >173 IU/ml for the AD isolated and at serum concentrations >213 IU/ml for the AD combined with AR/ARC/AD phenotypes. The level of total serum IgE>1001 IU/ml is a significant predictor biomarker for the developmental risk of AD phenotype combined with AR/ARC/BA in comparison to the AD isolated phenotype in children. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: atopic dermatitis, children, phenotype, filaggrin gene, single(nucleotide polymorphism, total immune globulin E.

Changes of Serum Bilirubin and Urine Peptides Related to Bilirubin Metabolism in Patients with Allergic Rhinitis

Background: The incidence rate of allergic rhinitis (AR) has been increasing, which has become a global health problem. As a kind of inflammatory airway disease, allergic rhinitis has a large number of inflammatory cells and inflammatory mediators that participate. Bilirubin is an effective endogenous antioxidant and anti-inflammatory molecule. This study aims to explore the relationship between bilirubin and allergic rhinitis, and to explore the potential value of bilirubin-related metabolites in blood and urine in the assessment of AR disease. Methods: A total of 63 allergic rhinitis (AR-S group) patients and 86 healthy controls (NC-S group) were enrolled. Venous blood was obtained for measurement of serum total IgE levels and bilirubin parameters. Patients were classified into normal IgE level group (AR2-S group) and elevated IgE level group (AR1-S group). Ten subjects were randomly selected from each group, which were AR2 group, AR1 group and NC group. Urine samples were measured with the nano UPLC-MS/MS system consisting of a Nanoflow HPLC system (EASY-nLC 1000 system from Thermo Scientific) and Orbitrap Fusion Lumos mass spectrometer (Thermo Scientific). Results: The mean total TBIL level (12.5 vs 15.7 μmol /L, p <0.001), median total DBIL level (4.4 vs 5.3 μmol /L, p <0.001) and mean total IBIL level (8.1 vs 10.3 μmol/L, p <0.001) in AR-S group were significantly lower than those in NC-S group. The mean total TBIL level (13.1 vs 15.7 μmol /L, p = 0.007), median total DBIL level (4.74 vs 5.3 μmol /L, p = 0.022), and mean total IBIL level (8.39 vs 10.3 μmol/L, p = 0.005) in AR2-S were significantly lower than those in NC-S group. The median total TBIL level (12.0 vs 15.7 μmol /L, p < 0.001), median total DBIL level (4.09 vs 5.3 μmol /L, p < 0.001), and median total IBIL level (7.91vs 10.3 μmol/L, p <0.001) in AR1-S were significantly lower than those in NC-S group. In addition, we found that there were 15 urine differential proteins related to bilirubin metabolism in AR2 and AR1. Their relative expression levels increased or decreased successively in NC group, normal IgE level group (AR2) and increased IgE level group (AR1). Conclusions: Compared with healthy people, the levels of bilirubin metabolites in patients with allergic rhinitis were decrease in the blood. The levels of bilirubin metabolites in urine of patients with allergic rhinitis have changed. This result suggests that bilirubin may be a new target for AR diagnosis and treatment.

Predictive factors for identifying macrolide responder in treating chronic rhinosinusitis

BACKGROUND: Low-dose macrolides (LDM) are anti-inflammatory agents with antineutrophilic activity, but patient selection for LDM therapy in treating chronic rhinosinusitis (CRS) is controversial. This study aimed to assess factors which predict LDM responders. METHODOLOGY: A prospective cohort study was performed. Patients with CRS received roxithromycin (150 mg) once daily for 12 weeks. Nasal secretions and serology were collected. Nine predictors for LDM response were assessed: nasal secretion IgE, nasal secretion IL-5, serum IgE, serum eosinophils, serum neutrophils, nasal polyps, asthma, allergy, and aspirin hypersensitivity, using receiver-operating curve analysis and multivariable logistic regression. Macrolide responders were those with sino-nasal outcome test-22 improvement, symptoms visual analogue scale decreased to ≤5, and no rescue medication. RESULTS: One hundred CRS patients (mean age 47.4±14.1 years, 45% male) were enrolled. Univariable logistic regression showed local total IgE less than 5.21; and serum eosinophils less than 2.2% associated with macrolide response. Multivariate models showed local total IgE maintained an independent association with macrolide response, with an ability to discriminate between responders and non-responders of 63%. Serum total IgE, nasal secretion IL-5, serum neutrophil, nasal polyp, asthma, allergy, and aspirin hypersensitivity showed no association with LDM response. CONCLUSIONS: Low total IgE level in the nasal secretion but not in the serum, predict LDM response.

Immunoinflammatory Biomarkers in Serum Are Associated with Disease Severity in Atopic Dermatitis

Background: A growing body of evidence links various biomarkers to atopic dermatitis (AD). Still, little is known about the association of specific biomarkers to disease characteristics and severity in AD. Objective: To explore the relationship between various immunological markers in the serum and disease severity in a hospital cohort of AD patients. Methods: Outpatients with AD referred to the Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark, were divided into groups based on disease severity (SCORAD). Serum levels of a preselected panel of immunoinflammatory biomarkers were tested for association with disease characteristics. Two machine learning models were developed to predict SCORAD from the measured biomarkers. Results: A total of 160 patients with AD were included; 53 (33.1%) with mild, 73 (45.6%) with moderate, and 34 (21.3%) with severe disease. Mean age was 29.2 years (range 6–70 years) and 84 (52.5%) were females. Numerous biomarkers showed a statistically significant correlation with SCORAD, with the strongest correlations seen for CCL17/thymus and activation-regulated chemokine (chemokine ligand-17/TARC) and CCL27/cutaneous T cell-attracting-chemokine (CTACK; Spearman R of 0.50 and 0.43, respectively, p < 0.001). Extrinsic AD patients were more likely to have higher mean SCORAD (p < 0.001), CCL17 (p < 0.001), CCL26/eotaxin-3 (p < 0.001), and eosinophil count (p < 0.001) than intrinsic AD patients. Predictive models for SCORAD identified CCL17, CCL27, serum total IgE, IL-33, and IL-5 as the most important predictors for SCORAD, but with weaker associations than single cytokines. Conclusions: Specific immunoinflammatory biomarkers in the serum, mainly of the Th2 pathway, are correlated with disease severity in patients with AD. Predictive models identified biomarkers associated with disease severity but this finding warrants further investigation.