Desequilíbrio imunológico periférico mediado por células Th17/Treg em pacientes com rinite alérgica / Peripheral Th17/Treg cell-mediated immunity imbalance in allergic rhinitis patients

Introdução: A rinite alérgica (RA) é uma doença não infecciosa da mucosa nasal mediada por IgE após o contato com alérgenos. Objetivo: Investigar as células Th17 periféricas e CD4 + CD25 + Foxp3 + células T reguladoras (Treg) e a expressão sérica de citocinas em pacientes com RA. Métodos: De março a maio de 2012, foi coletado o sangue periférico de 14 pacientes com RA (grupo RA) e seis indivíduos saudáveis (grupo controle). A detecção das células Th17 e células Treg foi realizada através da citometria de fluxo e os níveis séricos de IL -17 e TGF- β1. Foram medidos por ELISA. Resultados: A percentagem de células Th17 no grupo RA foi bem maior do que no grupo controle (p < 0,01). A proporção de células Treg no grupo RA também foi drasticamente menor quando comparada ao grupo controle (p < 0,01). No grupo RA, o nível sérico de IL-17 foi significativamente maior do que no grupo controle (p < 0,01). Conclusão: O desequilíbrio de células Th17/Treg periféricas desempenha um papel importante na patogênese da RA. .

Introduction: Allergic rhinitis (AR) is an IgE-mediated non-infectious disease of the nasal mucosa following contact with allergens. Objective: To investigate the peripheral Th17 cells and CD4 + CD25 + Foxp3 + regulatory T (Treg) cells and the expression of cytokines in the serum of AR patients. Methods: The peripheral blood of 14 patients with AR (AR group) and six healthy subjects (control group) was collected from March to May of 2012. Flow cytometry was performed to detect the Th17 cells and Treg cells, and enzyme-linked immunosorbent assay (ELISA) to measure the serum levels of IL-17 and TGF-β1. Results: The proportion of Th17 cells in the AR group was markedly higher than that in the control group (p < 0.01). The proportion of Treg cells in the AR group was also dramatically reduced when compared with the control group (p < 0.01). In the AR group, serum IL-17 levels were markedly higher than those in the control group (p < 0.01). In the AR group, serum TGF-β1 levels were significantly lower than those in the control group (p < 0.01). Conclusion: The imbalance of peripheral Th17/Treg cells plays an important role in the pathogenesis of AR. .

Respiratory allergy to moth: the importance of sensitization to Bombyx mori in children with asthma and rhinitis / Alergia respiratória à mariposa: importância da sensibilização à Bombyx mori em crianças com asma e rinite

OBJECTIVE: this study aimed to prepare a silkworm moth (Bombyx mori) antigenic extract and to perform skin prick tests with this extract in patients with allergic respiratory diseases; to evaluate serum specific immunoglobulin E (IgE) to Bombyx mori using ImmunoCAP(r) system and to report the frequency of positivity between the two methods and with clinical data. METHODS: this was a cross-sectional study with 99 children and adolescents diagnosed with asthma and/or allergic rhinitis, who had skin reactivity to at least one of the six aeroallergens tested. Clinical data were evaluated: skin prick tests with Bombyx mori in-house extract, and total and specific IgE analysis using ImmunoCAP(r) were performed. RESULTS: the frequency of Bombyx mori specific IgE was found to be 52.5% and 60% using the skin prick test and ImmunoCAP(r), respectively. An association between a positive skin test for Bombyx mori and the presence of allergic rhinitis, atopic dermatitis, and urticaria was observed, but the same was not true for asthma or allergic conjunctivitis. There was no relation with the severity of asthma or rhinitis symptoms. CONCLUSIONS: a high frequency of sensitization to Bombyx mori was observed in a selected population of patients with respiratory allergic diseases in the city of Curitiba, state of Paraná, Brazil. The extract prepared from the wings of this moth species is effective in demonstrating this sensitivity. .

OBJETIVO: preparar extrato antigênico da mariposa do bicho-da-seda (Bombyx mori) e realizar testes cutâneos com esse extrato em pacientes com doenças respiratórias alérgicas, avaliar IgE sérica específica para Bombyx mori usando o sistema ImmunoCAP(r) e comparar a frequência de positividade entre os dois métodos e com dados clínicos. MÉTODOS: Estudo transversal com 99 crianças e adolescentes com diagnóstico de asma e/ou rinite alérgica, que apresentaram reação cutânea a pelo menos um dos seis aeroalérgenos testados. Os dados clínicos foram avaliados; testes cutâneos com extrato de Bombyx mori e análise de IgE total e específica por ImmunoCAP(r) foram realizados. RESULTADOS: a frequência de IgE específica para Bombyx mori foi de 52,5% e 60%, respectivamente, pelo teste cutâneo e ImmunoCAP(r). Foi observada uma associação entre o teste cutâneo positivo para Bombyx mori e a presença de rinite alérgica, dermatite atópica e urticária, mas o mesmo não ocorreu para a asma ou conjuntivite alérgica. Não houve relação com a gravidade dos sintomas de asma ou rinite. CONCLUSÕES: alta frequência de sensibilização à Bombyx mori foi encontrada em uma população selecionada de pacientes com doenças alérgicas respiratórias na cidade de Curitiba, estado do Paraná, Brasil. O extrato preparado a partir das asas dessa espécie de mariposa é eficaz em demonstrar essa sensibilidade. .

Co-administration of Chenopodium album allergens and CpG oligodeoxy- nucleotides effects on peripheral blood mononuclear cells of patients with allergic rhinitis treated with intranasal corticosteroids and antihistamines

Allergic Rhinitis [AR] is one of the most common chronic diseases in the developed countries. This study was performed to investigate the effect of CpG-ODN in alteration of T-helper [Th]l/Th2 balance of patients with AR treated with intranasal corticosteroids [INCs] and antihistamines. Peripheral blood mononuclear cells [PBMCs] of 20 patients with AR were isolated before and after 45 days therapy. Cytokine production [IL-4, IL-10, IL-13, IFN-gamma] and specific Ch.a IgE in response to CpG co-administration of natural chenopodium album [CpG/Ch.a] or recombinant Ch.a [CpG/rCh.a] allergen were investigated in supernatants.of cultured PBMCs using ELISA Intracellular IL-10 was also assessed in CD4[+] cells using flow cytometry. Significant increase in production of IFN-y and IL-10 and decrease in production of IL-4 were found in supernatants of cultured PBMCs activated with CPG/ch.a and CPG/rch.a. of both CpG/Ch.a and CpG/rCh.a compared to allergens alone, before and after therapy. After therapy, IFN-gamma production with CpG/Ch.a was significantly increased in comparison with before [237 vs. 44 pg/ml, p=0.001]. IFN-gamma and IL-10 production with CpG/rCh.a was significantly increased after therapy compared to before [407.6 vs. 109 pg/ml, p=0.0l for IFN- gamma; 171.7 vs. 52.6 pg/ml, p=0.008 for IL-10], whilst IL-4 was significantly decreased [2.1 vs. 5.8 pg/ml, p=0.02]. Intracellular IL-10 expression was also significantly increased in response to either CpG/Ch.a or CpG/rCh.a that showed intracellular assay could be more sensitive than ELISA. Also, treatment with intranasal corticosteroids and antihistamines could enhance this CpG effect, in vitro

Clinical and immunological features of patients with atopy and concomitant HTLV-1 infection

Human T-cell lymphotropic virus type 1 (HTLV-1) induces an exacerbated type 1 immune response characterized by high spontaneous IFN-γ and TNF-α production. Allergic rhinitis and asthma are associated with the type 2 immune response, with elevated secretion of IL-4 and IL-5. The aim of this study was to characterize the immune response in atopic HTLV-1 carriers. The cytokine profile of atopic HTLV-1 carriers (N = 10; all females) was compared with that of non-atopic HTLV-1 carriers (N = 14; 9 females and 5 males). Mean patient age of atopic and non-atopic groups was 45 ± 8 and 38 ± 11 years, respectively. All atopic HTLV-1 carriers had rhinitis with or without asthma and a skin prick test positive for Dermatophagoides pteronyssinus antigen 1 (Derp-1). There was no difference in cytokine levels between the two groups in unstimulated peripheral blood mononuclear cell cultures. In cultures stimulated with Derp-1, IFN-γ levels tended to be higher (P = 0.06) and IL-5 levels were higher (P = 0.02) in atopic HTLV-1 patients than in non-atopic subjects. In contrast, IL-10 was lower (P = 0.004) in atopic than in non-atopic HTLV-1-infected subjects. This study shows that HTLV-1 infection with an exaggerated type 1 immune response does not prevent atopy. In this case, the exacerbated type 1 and type 2 immune responses were due to a lack of IL-10 production, a cytokine that plays an important role in down-modulating type 1 and type 2 immune responses and in preventing the development of chronic inflammatory diseases.

Rol de los receptores tipo toll en la patogénesis de la rinitis alérgica: [revisión] / Toll like receptors role in the allergic rhinitis: [review]

La rinitis alérgica afecta alrededor de seiscientos millones de personas alrededor del mundo, siendo actualmente la enfermedad recurrente con mayor prevalencia. En su patogénesis participa una compleja red de mediadores humorales y celulares participantes del perfil inmunológico Th2. Junto con el sistema inmune adaptativo, componentes de la inmunidad innata han mostrado jugar un importante rol en enfermedades alérgicas, tales como dermatitis atópica y asma bronquial. En el presente trabajo evaluamos el rol de los receptores tipo Toll en rinitis alérgica, realizando una revisión de avanzada con respecto a la expresión, función y modulación de estos receptores en esta enfermedad.

Allergic rhinitis (AR) affects about six hundred million people worldwide and is now considered the most prevalent recurrent disease. The pathogenesis of AR involves a complex network of cellular and humeral mediators involved in the Th2 immune profile. Together with the adaptive immune system, components of innate immunity have shown to play an important role in allergic diseases such as atopic dermatitis and bronchial asthma. The present review describes the role of Toll-like receptors in allergic rhinitis. We discuss the importance of the receptors expression, function and modulation in this disease.

IgE cross-reactivity between Lolium multiflorum and commercial grass pollen allergen extracts in Brazilian patients with pollinosis

Lolium multiflorum (Lm) grass pollen is the major cause of pollinosis in Southern Brazil. The objectives of this study were to investigate immunodominant components of Lm pollen allergens and the cross-reactivity of IgE with commercial grass pollen allergen extracts. Thirty-eight serum samples from patients with seasonal allergic rhinitis (SAR), 35 serum samples from patients with perennial allergic rhinitis (PAR) and 30 serum samples from non-atopic subjects were analyzed. Allergen sensitization was evaluated using skin prick test and serum IgE levels against Lm pollen extract were determined by ELISA. Inhibition ELISA and immunoblot were used to evaluate the cross-reactivity of IgE between allergens from Lm and commercial grass pollen extracts, including L. perenne (Lp), grass mix I (GI) and II (GII) extracts. IgE antibodies against Lm were detected in 100 percent of SAR patients and 8.6 percent of PAR patients. Inhibition ELISA demonstrated IgE cross-reactivity between homologous (Lm) and heterologous (Lp or GII) grass pollen extracts, but not for the GI extract. Fifteen IgE-binding Lm components were detected and immunoblot bands of 26, 28-30, and 32-35 kDa showed >90 percent recognition. Lm, Lp and GII extracts significantly inhibited IgE binding to the most immunodominant Lm components, particularly the 55 kDa band. The 26 kDa and 90-114 kDa bands presented the lowest amount of heterologous inhibition. We demonstrated that Lm extract contains both Lm-specific and cross-reactive IgE-binding components and therefore it is suitable for measuring quantitative IgE levels for diagnostic and therapeutic purposes in patients with pollinosis sensitized to Lm grass pollen rather than other phylogenetically related grass pollen extracts.

Potential Adjuvant Effects of Nigella sativa Seeds to Improve Specific Immunotherapy in Allergic Rhinitis Patients

To investigate the effects of Nigella sativa seed supplementation on symptom levels, polymorphonuclear leukocyte [PMN] functions, lymphocyte subsets and hematological parameters of allergic rhinitis. Twenty-four patients randomly selected from an experimental group of 31 [mean age 34 years] sensitive to house dust mites with allergic rhinitis and a control group of 8 healthy volunteers [mean age 23 years] were treated with allergen-specific immunotherapy in conventional doses for 30 days. After a month of immunotherapy, 12 of the 24 patients and the 8 healthy volunteers were given N. sativa seed supplementation [2 g/day orally] for 30 days. The remaining 12 patients continued only on immunotherapy during the same period. The other 7 patients were given 0.1 ml saline solution subcutaneously once a week as a placebo. The symptom scores, PMN functions, lymphocyte subsets and other hematological parameters were evaluated before and after all treatment periods. There was a statistically significant increase in the phagocytic and intracellular killing activities of PMNs of patients receiving specific immunotherapy, especially after the addition of N. sativa seed. The CDS counts of patients receiving specific immunotherapy plus N. sativa seed supplementation significantly increased compared to patients receiving only specific immunotherapy. PMN functions of healthy volunteers significantly increased after N. sativa seed supplementation compared to baseline. N. sativa seed supplementation during specific immunotherapy of allergic rhinitis may be considered a potential adjuvant therapy

Análise de citocinas pela RT-PCR em pacientes com rinite alérgica / RT-PCR cytokine study in patients with allergic rhinitis

Rinite alérgica é uma doença que decorre de um processo inflamatório da mucosa nasal conseqüente à reação de hipersensibilidade a alérgenos inalatórios e, eventualmente, alimentares. É mediada por IgE, envolvendo diferentes células, mediadores e citocinas. OBJETIVO: Avaliar as transcrições para as seguintes citocinas: IL-4, IL-5, IL-8 e IFN-gama, particularmente importantes no processo alérgico nasal, principalmente IL-4 e IL-5. Neste estudo, optou-se por avaliar os pacientes atópicos fora das crises alérgicas, com a finalidade de se conhecer as expressões das citocinas neste período. MATERIAL E MÉTODO: Realizou-se um estudo transversal e prospectivo, selecionando-se 30 pacientes, sendo 13 pacientes portadores de rinite alérgica paucissintomáticos e 17 pacientes não-atópicos. Os grupos foram selecionados através da história, do exame clínico otorrinolaringológico e do teste alérgico cutâneo - Prick Test. O perfil das citocinas foi pesquisado nos fragmentos de mucosa nasal, através da RT-PCR semiquantitativa, escolhida por apresentar boa reprodutibilidade e especificidade, utilizando-se como referência o gene da Beta-actina. RESULTADOS: Os valores de IL-5, IL-8, IFN-gama mantiveram-se homogêneos em relação ao grupo controle. A IL-4 apresentou diferença com significância estatística. CONCLUSÃO: Os pacientes alérgicos paucissintomáticos apresentaram normalização da expressão das citocinas na mucosa nasal à exceção de IL-4.

Allergic rhinitis is an inflammatory reaction of the nasal mucosa, in consequence of an IgE mediated hypersensitive reaction to inhaling allergens, involving different mediators and cytokine cells. AIM: The purpose of this study was to evaluate the transcriptions for IL-4, IL-5, IL-8 and IFN-gama, particularly important in the nasal allergy process, especially IL-4 and IL-5. For this study we decided to evaluate atopic patients who were free from allergic crises, with the purpose of knowing the cytokine expressions during this period. MATERIALS AND METHODS: Another prospective and transversal study was carried out, selecting 30 patients, 13 of these patients were pauci-symptomatic and 17 were non atopic. The groups were selected by means of a medical interview, an otolaryngologic clinical exam and allergy skin tests - Prick Test. The cytokines were investigated in fragments of the nasal mucosa, using RT-PCR - chosen because it has good reproducibility and specificity. RESULTS: IL-5, IL-8, IFN-gama cytokine values were kept homogeneous in relation to the control group. Only IL-4 presented significant statistic differences. CONCLUSION: Asymptomatic patients with allergic rhinitis presented with normalization of cytokine expression in the nasal mucosa, with exception of IL-4.

Humoral and cellular immune responses to Blomia tropicalis and concanavalin A-binding fractions in atopic patients

Blomia tropicalis, Dermatophagoides pteronyssinus and D. farinae are prevalent house dust mites. Concanavalin A-binding components derived from B. tropicalis (Bt-ConA extract) are highly immunogenic in allergic diseases. The aim of the present study was to evaluate the humoral and cellular immune responses to B. tropicalis in mite-sensitized patients. A total of 137 patients with allergic rhinitis with/without asthma and 109 non-atopic subjects were selected and analyzed by the skin prick test, and for total serum IgE and specific IgE levels to both Bt-total and Bt-ConA extracts, their proliferative response and cytokine (IFN-ã and IL-5) production by peripheral blood mononuclear cells (PBMC) stimulated with both extracts. Skin prick test showed that 70 percent of the patients were sensitized to Bt (Bt+) and similar levels of specific IgE to Bt-total and Bt-ConA extracts were demonstrable in Bt+ patients. Significant PBMC proliferation was observed in response to Bt-total extract in Bt+, but not in Bt- patients and non-atopic subjects (P < 0.001). Bt-ConA extract induced increased proliferative responses in all patient groups compared to medium alone (P < 0.05), but these responses were significantly decreased in the presence of the mannopyranoside ConA inhibitor (P < 0.05). Significant IFN-ã production was observed after Bt-ConA stimulation of Bt+ patients (P < 0.05), while Bt-total extract had no effect. IL-5 production was consistently detected in Bt+ patients after allergen-specific stimulation or with no stimulus, indicating that PBMC from allergic patients are prone to produce Th2 profile cytokines, spontaneously or inductively by allergen restimulation. These data showed that ConA-binding components isolated from B. tropicalis may contain relevant antigens that are involved in both humoral and cellular immune responses. However, without an additional purification procedure to eliminate the residual contamination with...

Evaluation of atopy among mouth-breathing pediatric patients referred for treatment to a tertiary care center

OBJETIVO: Respirador bucal é o indivíduo que utiliza a cavidade oral como principal via aérea durante a respiração. Trata-se de síndrome de múltiplas etiologias, dentre as quais a rinite alérgica merece destaque por sua alta prevalência. Este trabalho teve como objetivo avaliar a presença de atopia entre respiradores bucais encaminhados a serviço de referência da região metropolitana de Belo Horizonte. MÉTODOS: Estudo transversal e descritivo, realizado no Hospital das Clínicas da Universidade Federal de Minas Gerais. Foram incluídos pacientes de 2 a 12 anos de idade, com período de admissão entre novembro de 2002 e abril de 2004. Os responsáveis responderam a um questionário completo, e os pacientes foram submetidos a teste alérgico cutâneo para inalantes. Houve 140 participantes do estudo. Foram classificados como atópicos aqueles que apresentaram teste positivo para, no mínimo, um alérgeno. As análises estatísticas foram feitas no programa SPSS, usando análises univariadas seguidas pela regressão logística. RESULTADOS: Entre os 140 pacientes, 44,3 por cento (62/140) tiveram teste alérgico positivo. Acaros foram os alérgenos predominantes, apresentando positividade em 100 por cento dos atópicos. Em análise multivariada, atopia esteve significativamente associada ao sexo masculino (p = 0,05), presença de asma (p = 0,014), menor número de pessoas dormindo no mesmo cômodo que o paciente (p = 0,005), ausência de tabagismo passivo (p = 0,005) e ausência de apnéia noturna (p = 0,003). CONCLUSÃO: A alta prevalência de positividade no teste alérgico enfatiza a importância da investigação alergológica em respiradores bucais, pois a alergia tem formas específicas de tratamento que podem reduzir a morbidade desses pacientes quando adequadamente utilizadas.

OBJECTIVE: A mouth breather is someone who uses his/her oral cavity as main airway during breathing. This is a syndrome with several etiologies, but allergic rhinitis plays a key role due to its high prevalence. The aim of this study was to assess the presence of atopy among mouth-breathing patients referred to a tertiary care center in the metropolitan region of Belo Horizonte, Brazil. METHODS: Cross-sectional, descriptive study carried out at Hospital das Clínicas of Universidade Federal de Minas Gerais. Patients aged 2 to 12 years, admitted between November 2002 and April 2004, were included. Parents or surrogates completed a comprehensive questionnaire, and patients were submitted to a skin test for inhalant allergens. A total of 140 patients participated in the study. Those with a positive result for at least one allergen were regarded as atopic. The statistical analyses were made using SPSS, with univariate analyses followed by logistic regression. RESULTS: Of 140 patients, 44.3 percent (62/140) obtained positive results on the allergic test. Mites were the most predominant allergens, with a positive rate of 100 percent among atopic patients. In the multivariate analysis, atopy was significantly associated with the male sex (p = 0.05), presence of asthma (p = 0.014), lower number of people sleeping in the same room with the patient (p = 0.005), absence of passive smoking (p = 0.005) and absence of sleep apnea (p = 0.003). CONCLUSION:The high prevalence of positive results on the allergic test highlights the importance of allergologic investigation in mouth-breathers, since allergy has specific treatments that may reduce morbidity in these patients when properly used.

Responses of IgE, IgG1, and IgG4 to concanavalin A-binding Blomia tropicalis antigens in allergic patients

Blomia tropicalis (Bt) and Dermatophagoides pteronyssinus (Dp) are the prevalent house dust mites in tropical countries and are associated with allergic diseases. Glycosylated antigens are highly immunogenic and involved in different pathologies. We evaluated the presence of IgE, IgG1, and IgG4 to concanavalin A-binding antigens (Bt-Con-A) isolated from Bt-total extract in sera of allergic and non-allergic subjects. Bt-total and Bt-Con-A extracts were evaluated by SDS-PAGE and ELISA for reacting with IgE, IgG1, and IgG4 in sera of 121 patients with allergic rhinitis and 36 non-allergic individuals. All subjects were skin prick tested with Bt-total extract and inhibition tests were performed for IgE, IgG1, and IgG4 using both extracts (Bt-total and Bt-Con-A). Skin prick test showed that 58 percent of the patients were sensitized to Bt (Bt+), with 52 percent reactive to both mites (Bt and Dp) and 6 percent to Bt only. A broad spectrum of proteins (14-152 kDa) was visualized in Bt-total and components >27 kDa for the Bt-Con-A extract. ELISA showed a similar profile of IgE, IgG1 and IgG4 levels in response to Bt-total and Bt-Con-A extracts in different groups, although Bt+ patients showed a lower IgG4 reactivity to Bt-Con-A extract. Specific IgG1 levels were higher in Bt+ patients than in control subjects, and IgG4 levels showed no significant difference among groups. ELISA inhibition showed a partial IgE and total IgG1 and IgG4 cross-reactivity with Dp extract for Bt-total and Bt-Con-A extracts. We conclude that Con-A-binding components isolated from Bt constitute major allergens and are involved in both allergen sensitization (IgE response) and homeostasis maintenance (IgG1 and IgG4 responses).

Rinite, sinusite e asma: indissociáveis? / Rhinitis, Sinusitis and Asthma: hard to dissociate?

Este estudo tem como objetivo rever a literatura ressaltando aspectos epidemiológicos e fisiopatológicos relacionados à abordagem unificada de rinossinusite alérgica e da asma, com as respectivas implicações terapêuticas. O levantamento bibliográfico foi realizado a partir das informações disponibilizadas pelas bases de dados Medline, MD Consult, Highwire, Medscape, LILACS e por pesquisa direta, dos últimos trinta anos, utilizando-se os termos allergic rhinitis e asthma. Foram selecionados 55 artigos originais em revisão não sistemática abordando a questão da associação clínica entre rinossinusite alérgica e asma. Verifica-se que nos últimos anos, com o uso de medicamentos tópicos, para as vias aéreas superiores ou para as vias aéreas inferiores, a abordagem terapêutica tem sido distinta. Entretanto, inúmeros inquéritos epidemiológicos, estudos de imunopatologia e clínicos demonstram a inter-relação entre asma e rinossinusite alérgica evidenciados por: i) a rinite alérgica encontra-se associada à asma e constitui-se em fator de risco independente para o seu aparecimento; ii)as características imunopatológicas da rinite alérgica e da asma são semelhantes; iii)a rinite alérgica e a asma são manifestações de uma enfermidade sistêmica; iv)o controle da rinite favorece o controle da asma. A estreita associação entre a rinite alérgica e a asma requer a integração das abordagens diagnóstica, terapêutica e profilática dessas enfermidades. Opções terapêuticas que permitam o controle simultâneo de ambas oferecem vantagens relacionadas ao custo e à tolerabilidade.

The objective of this study was to review the literature and to discuss epidemiological and physiopathological aspects and therapeutical implications of an unified approach to allergic rhinosinusitis and asthma. The bibliographic survey was based on the information provided by the following databases: Medline, MD Consult, Highwire, Medscape, LILACS and through direct search over thirty years, using the terms allergic rhinitis and asthma. Fifty-five original articles were selected in the no systematically review addressing the issue of clinical association between allergic rhinusinusitis and asthma. It is noteworthy that in the late years, with the use of specific topical medications for the lower airways or else, to the upper airways, the therapeutical approach has been distinct. However, numerous epidemiological surveys, immunopatological and clinical studies demonstrate the inter-relationship between asthma and allergic rhinossinusitis, characterized by: i) allergic rhinitis is associated to asthma and constitute an independent risk factor for its occurrence; ii) the immunopathological characteristics of allergic rhinitis and asthma are similar; iii) allergic rhinitis and asthma are manifestations of a systemic disease; iv) control of rhinitis favors asthma control. taking into consideration the close inter-relationship between allergic rhinitis and asthma, the approach to diagnosis, treatment and prophylaxis of these illnesses should be integrated. Therapeutical options that allow for the simultaneous control of asthma and allergic rhinitis offer advantages related both to costs and tolerability.

Immunoblot analysis and comparative IgE responses of atopic patients to extracts of the domestic mite Blomia tropicalis

BACKGROUND: The domestic mite Blomia tropicalis is found in subtropical and tropical environments, and its clinical importance as a sensitizing agent in allergic disease is widely accepted. OBJECTIVE: To investigate the IgE reactivity to allergens present in extracts of the domestic mite B. tropicalis, and compare the IgE responses to these allergens by asthmatics, patients with atopic dermatitis and allergic rhinitis, as well as nonatopic controls. METHODS: Extracts from B. tropicalis were used for skin tests. The B. tropicalis specific IgE in the serum were measured using the FAST Plus Test and immunoblot analysis. RESULTS: A total of 199 volunteers participated in the study. The data show that 18 out of 29 polypeptide bands present in extracts of this mite species were recognized by the allergic and control sera. Of these allergens, four showed a high IgE binding frequency and had relative molecular weights of 104, 80, 68 and 14 kDa. The 14 kDa allergen demonstrated the highest IgE binding frequency. CONCLUSION: Sera from atopic patients reacted to more allergens than sera from patients controls. Extracts from pure bodies of B. tropicalis contain one immunodominant and three important allergens. A common characteristic between all of the sera tested was the high degree of serum IgE reactivity observed to the 14 kDa allergen.

La marcha atópica / The atopic march

Las enfermedades alérgicas presentan una alta prevalencia, lo que se ha explicado por diversas teorías. Una forma sencilla de abordar la evolución de las enfermedades que tienen una patogenia común es agruparlas en conjunto. En este artículo entregamos una visión actualizada de las enfermedades alérgicas mediadas por inmunoglobulina E, agrupadas según su evolución natural en el conjunto denominado “marcha atópica”.

Relationship between serum specific IgE and allergen skin test in allergic patients of Wuhan area / 华中科技大学学报（医学）（英德文版）

In order to study the relationship between serum specific IgE (sIgE) and allergen skin test, allergen skin tests and detections of sIgE in 220 allergic patients of Wuhan area were analyzed. The coherent rate of the two methods was beyond 70% (P < 0.01). It was concluded that the in vitro and in vivo detection methods of allergens have a high coherence and can be used as the effective ways to diagnose the allergic diseases in clinical practice.

Sensitization to common allergens, especially pollens, among children with respiratory allergy in the Trakya region of Turkey.

Asthma and allergic rhinitis are common problems in children and the causative pollen allergens vary according to the geographical area. The aim of this study was to investigate patterns of sensitization to common inhalant allergens, especially pollens, in Turkish children living in the Trakya region and to determine differences between rural and urban areas. Allergen skin testing was prospectively performed on 539 children aged between 4 and 17 years with respiratory allergy. The reaction was considered to be positive if the mean wheal diameter was at least 3 mm greater than that of the negative controls. We detected positive skin reactions in 420 (77.9%) children. Two hundred and eighty-one (52.1%) mite, 277 (51.4%) pollen, 174 (32.3%) mold, 65 (12.1%) animal dander, 12 (2.2%) cockroach and 6 (1.1%) latex skin sensitivities were detected. Among the pollen allergies 173 were cereal pollen (32.1%), 170 grass pollen (31.5%) and 144 tree pollen allergies (26.7%). The most common positive skin test among the pollens was to cultivated wheat (Titicum vulgare) (n = 116, 21,5%), followed by rye grass (Lolium perenne) and orchard grass (Dactylis glomerata). Positive skin reactions to Alternaria, to Candida albicans, and to all pollens except Ulmus competris, Pinus sylvetris, Platanus vulgaris and Tilia platyphyllos, were higher in children with allergic rhinitis than in those with asthma. In children from rural areas, allergic skin reactivity was found to be more common against Candida albicans, sheep dander and all pollens except Corylus avellana, Fraxinus excelsior, Populus alba, Pinus sylvetris, Platanus vulgaris and Chenopodium album, than in urban children. Although Trakya is close to Greece and other Mediterranean countries, this study suggests that the pollens, which sensitize children, are not similar.

House dust mite allergen levels in Chiang Mai homes.

The quantitative assays for house dust mite (HDM) allergens provide a valid index of exposure and can be used for risk evaluation. We assessed group I HDM allergen levels in mattress and living room floor dust from 35 Chiang Mai homes and identified factors associated with high allergen levels. One-third of mattress and living room floor dust had group I HDM allergen levels of between 2-10 microg/g. Two-thirds of mattress dust and a small amount of living room floor dust had group I HDM allergen levels of over 10 microg/g. The geometric means of Der p I, Der f I and total group I allergens in mattress and living room floor dust were 8.61, 2.88, and 15.81 microg/g and 1.61, 0.27 and 2.43 microg/g, respectively. Mattresses made of kapok and rugs kept in the living room were associated with high group I allergen levels.

Allergy to house dust mites and asthma

House dust mites have been shown to be important sources of indoor allergens associated with asthma and other allergic conditions. Asthma is a chronic respiratory disease that affects millions of people worldwide, and numerous scientific studies have shown that the prevalence of asthma is increasing. The most common dust mite species around the world include Dermatophagoides pteronyssinus (Dp), Dermatophagoides farinae (Df), Euroglyphus maynei (Em) and Blomia tropicalis (Bt). Over the past three decades, many important allergens from these species have been identified and characterized at the molecular level. The biological function of several house dust mite allergens has been elucidated, with many of them showing enzymatic activity. However, Bt allergens remain the least studied, even though this mite is very common in tropical and subtropical regions of the world, including Puerto Rico. Therefore, it is very important to include Bt in diagnostic and therapeutic strategies for house dust mite induced allergy and asthma, particularly in areas where Bt exposure and sensitization is high. Recombinant DNA technology, as well as other molecular biology and immunological techniques, have played a fundamental role in advances towards a better understanding of the biology of house dust mites and their role in allergic diseases. This kind of study also contributes to the understanding of the complex immunologic mechanisms involved in allergic reactions. The development of effective diagnostic and therapeutic approaches depends on the continuity of research of house dust mite allergens. The objectives of this review are to describe the most important aspects of house dust mite allergy and to acquaint the scientific community with the latest findings pertaining to house dust mite allergens, particularly those derived from Bt.

IgA deficiency: a report of three cases from Thailand.

Selective IgA deficiency has been reported to be the most common primary immunodeficiency disease in Western countries. A markedly lower frequency of this condition has been reported in the Japanese population. While most of the IgA deficient cases are healthy, some patients develop significant recurrent sinopulmonary infections, allergic disorders and autoimmune diseases. Herein, we report three cases of IgA deficiency among Thai patients, all of whom suffered from chronic sinopulmonary infections. Two of the three patients had absolute IgA deficiency while the third had a partial IgA deficiency. The associated conditions found in these three patients were deficiencies of an IgG subclass, allergic rhinitis and lupus nephritis. The youngest child (5 years old boy with lupus nephritis) expired from Pneumocystis carrinii pneumonia complicated with adult respiratory distress syndrome.

Determinacion serica de los niveles de ICAM-1s en pacientes con rinitis alergica / Serum levels of ICAM-1s in patient with allergic rhinitis

Se presume que la molécula de adhesión intercelular -1 (ICAM-1, CD54) está involucrada en la patogénesis del asma y se ha detectado una forma soluble de ICAM-1 (ICAM-1 s) en concentraciones elevadas en el suero de pacientes con ciertas condiciones inflamatorias. En este estudio, examinamos los niveles de ICAM-1 soluble en pacientes con rinitis alérgica de diversos grados: leve (8 pacientes), moderada (12 pacientes), severa (15 pacientes), del instituto de alergias, asma e inmunología. Los resultados fueron luego comparados con 10 sujetos saludables, como control negativo, sin diagnóstico de rinitis alérgica ni asma, y con 10 sujetos con asma de la unidad de neumología del Hospital La Samaritana, como control positivo. Todos los pacientes con edades entre 15 y 55 años. Utilizamos la técnica ELISA para medir ICAM-ls. Con anterioridad, todos los pacientes fueron sometidos a una prueba alérgica mediante el método Prick. Nuestro objetivo fue analizar si ICAM-1 s es un marcador de la severidad de la rinitis alérgica, y encontramos que los niveles de ICAM-1 soluble muestran un incremento a medida que la rinitis alérgica progresa. La comparación entre el grupo general de rinitis alérgica y el grupo de control negativo muestra resultados estadísticamente significativos (P < 0.05) y cada uno de los grupos de rinitis alérgica (leve, moderada y severa) en relación con el control negativo mostró que la expresión de ICAM-1 no incrementa y se mantiene baja, (Rinitis Leve p = 0.495, Moderada p = 0.0017, Severa p = 0.0014). Los anteriores resultados confirman nuestra hipótesis