Molecular diagnosis and immunotherapy selection in a Portuguese population sensitized to grass and olive pollens / Diagnóstico molecular e seleção de imunoterapia numa população portuguesa sensibilizada ao pólen de gramíneas e de oliveira

Introduction: Phleum pratense (Phl p) and Olea europaea (Ole e) are common allergenic pollen. Objectives: To describe the sensitization patterns to Phl p and Ole e allergens in a subset of allergic rhinitis patients with positive skin prick tests (SPTs) to these pollens and compare the allergen immunotherapy (AIT) choice before and after determination of molecular components. Methods: Candidates to pollen immunotherapy with positive SPTs to both Phl p and Ole e were recruited. All of them underwent an SPT with a panel of aeroallergens and measurements of serum specific IgE (sIgE) to Phl p, Ole e, Phl p1, Phl p5, Phl p7, Phl p12, Ole e1, Ole e7, and Bet v2. Results: Forty adults were included. Of these, 83% and 65% were sIgE-positive to Phl p and Ole e, using the 0.35 kUA/L and 0.70 kUA/L cut-offs, respectively. Moreover, 42.5% of patients had positive sIgE to Phl p1 and/or Phl p5, 2.5% only to Ole e1, and 47.5% to both (0.35 kUA/L cutoff). By increasing the cut-off to 0.7 kUA/L, 55% of patients were sensitized to Phl p1 and/or Phl p5, and no patient was sensitized only to Ole e1. After component-resolved diagnosis, AIT choice was changed in 15 (37.5%) patients, with a decrease in the number of prescriptions of AIT with both grass and olive pollens and with olive alone, together with an increase in the prescriptions of AIT with grass pollen alone. Conclusion: Genuine sensitization to Olea europaea was reduced, and the sensitization patterns were heterogeneous. Knowledge of pattern of sensitization to molecular components changed immunotherapy prescription in more than one third of the patients.

Introdução: Os polens de Phleum pratense (Phl p) e de Olea europaea (Ole e) são fontes alergênicas comuns. Objetivos: Descrever os padrões de sensibilização aos alergênios destes dois polens num subconjunto de pacientes com rinite alérgica polínica e comparar a escolha de imunoterapia, antes e depois da determinação de alergênios moleculares para Phl p e Ole e. Métodos: Foram recrutados candidatos para imunoterapia com polens, com testes cutâneos positivos para Phl p e Ole e. Todos realizaram um painel de testes em picada a aeroalergênios e determinação de IgE séricas específicas para Phl p, Ole e, rPhl p1, rPhl p5, rPhl p7, rPhl p 12, rOle e 1, nOle e 7, rBet v2. Resultados: Foram incluídos 40 adultos. Em relação à sIgE para Phl p e Ole e, 83% e 65% dos pacientes apresentaram positividade para ambos, usando o cut-off de 0,35 kUA/L e 0,70 kUA/L, respectivamente. A positividade para Phl p1 e/ou Phl p 5 foi encontrada em 42,5%, para Ole e 1 apenas em 2,5%, enquanto 47,5% apresentaram sIgE positivo para ambos (cut-off corte de 0,35 kUA/L). Aumentando o cut-off para 0,7 kUA/L, 55% foram sensibilizados para Phl p1 e/ou Phl p5, nenhum paciente foi sensibilizado apenas para Ole e 1. Após a determinação dos alergênios para os componentes moleculares, a escolha de imunoterapia foi alterada em 15 (37,5%) pacientes, com uma diminuição no número de vacinas para Phleum + Olea e apenas para Olea e um aumento na prescrição de vacinas para Phleum. Conclusão: A sensibilização genuína do Olea europaea foi reduzida e os padrões de sensibilização foram heterogêneos. O conhecimento da sensibilização aos componentes moleculares dos alergênios mudou a prescrição de imunoterapia em mais de um terço dos pacientes.

Determinação da potência relativa de extratos alergênicos de Phleum pratense por testes cutâneos / Establishing the relative potency of Phleum pratense allergenic extracts using skin prick tests

Objetivos: Comparar a potência de extratos europeus de Phleum pratense para imunoterapia sublingual (ITSL), em relação ao extrato referência norte-americano. Métodos: Foram selecionados 15 sujeitos, com idade entre 18 e 55 anos, histórico clínico sazonal compatível e teste cutâneo com alta reatividade a gramíneas. O delineamento de estudo foi transversal, triplo cego e randômico, e comparadas as potências dos seguintes extratos alergênicos para ITSL: (A) Soluprick® (30 HEP/mL) e (B) Grazax® 75.000 SQ-T, ambos os extratos da ALK-Abelló; (C) Oralair® e (D) Staloral®, com 300 IR/mL, Stallergènes, França. O extrato de origem norteamericana (E) foi o padrão, contendo 10.000 BAU/mL. Todos os extratos foram usados em forma de concentrados e nas diluições 1:3, 1:10, e 1:30. Os testes foram aplicados em quadruplicata em dois dias não consecutivos. Os diâmetros de pápula e eritema foram registrados após 15 minutos. Resultados: Não houve diferença significativa entre os testes realizados no primeiro e segundo dias (p = 0,37) com extratos concentrados, na diluição 1:3 e também 1:10 (p = 0,20 e p = 0,33, respectivamente). No segundo dia de testes, a média obtida das pápulas do extrato A foi de 16,7 mm na diluição 1:3; de 14,3 mm na diluição 1:10; e de 9,8 mm na diluição 1:30. Houve diferenças significativas entre os extratos A, B, C, D e E na comparação entre as médias das pápulas obtidas em todas as diluições, mostrando diferença de potência entre os extratos. O diâmetro das pápulas obtidas com o material concentrado, em ordem decrescente de potência, foram C > A > E > D > B. As reações observadas com extratos concentrados mostrou que o mais potente foi Staloral, e o menos potente Grazax. Conclusões: Houve variabilidade significativa de potência nos diversos extratos comparados. Isto reforça a necessidade de padronização de extratos alergênicos para ITSL.

Objectives: To compare the potency of European Phleum pratense pollen extracts for sublingual immunotherapy (SLIT) compared to the U.S. reference extract. Methods: Fifteen subjects aged between 18 and 55 years, with compatible seasonal clinical history and skin tests highly reactive to grass, were selected. The design was cross-sectional, blind, randomized. The following extracts were compared for SLIT: (A) Soluprick® (30 HEP/mL) and (B) Grazax® 75,000 SQ-T, both from ALK-Abelló; (C) Oralair® and (D) Staloral®, with 300 IR/mL, Stallergènes, France. The American extract (E) was the standard 10,000 BAU/mL. Extracts were used in concentrate form and also diluted in 1:3, 1:10, and 1:30 ratios. Tests were applied in quadruplicate on two nonconsecutive days. Skin test reading were done after 15 minutes. Results: There were no significant differences between the tests conducted on the first and second days with the extracts in concentrate form (p = 0.37) or diluted at 1:3 or 1:10 (p = 0.20, p = 0.33, respectively). On the second day of tests, mean wheal sizes obtained with extract A were 16.7 mm with the 1:3 dilution, 14.3 mm with the 1:10 dilution, and 9.8 mm with the 1:30 dilution. There were significant differences between extracts A, B, C, D and E when comparing mean wheal sizes obtained with all dilutions, demonstrating differences in the extracts' potency. Mean wheal diameters obtained with the concentrates, in decreasing order of potency, were C > A > E > D > B. The reactions showed that the most potent extract was Staloral, and the least potent, Grazax. Conclusions: There were significant potency variations in the different extracts assessed. These results reinforce the need for standardization of allergenic extracts used for SLIT.

The association between nasal eosinophilia and aeroallergen sensitization in children and adolescents with rhinitis

PURPOSE: To identify the correlation between nasal eosinophilia and aeroallergen sensitization in children and adolescents. METHODS: This is a retrospective study of patients below 18 years of age who had a history of rhinitis that lasted more than 2 weeks or had been repeated more than once a year, received nasal eosinophil examinations, and had serum specific IgE to aeroallergens measured at an Allergy Clinic in a single tertiary teaching hospital in Seoul, Korea. The percentage of nasal eosinophils was calculated by the number of eosinophils per total leukocytes in a high-power field of 1,000×. Data was analyzed to determine the association between nasal eosinophilia and 18 aeroallergens. RESULTS: Of the 245 patients included, 156 (63.7%) were male and the mean age (±standard deviation) was 7.9 years (±3.8). In total, 175 patients (71.4%) were sensitized to at least 1 of the 18 aeroallergens tested, and sensitization to house dust mite was most common. In addition, 118 (48.2%) and 69 patients (28.2%) had nasal eosinophilia of at least 1% and 5%, respectively. There were no significant correlations between serum total IgE or age and the percentage of nasal eosinophils. However, the percentage of nasal eosinophils in the group sensitized to any aeroallergens was significantly increased compared to the nonsensitized group (P=0.002). The percentage of nasal eosinophils was significantly higher in patients who were sensitized to Birch-Alder Mix, oak white, Bermuda grass, orchard grass, timothy grass, sweet vernal grass, rye, mugwort, short ragweed, Alternaria alternata, cats, dogs or Dermatophagoides farinae compared to those nonsensitized. CONCLUSION: Nasal eosinophilia was significantly associated with sensitization to aeroallergens.

Sensitization rates of airborne pollen and mold in children / 소아과

PURPOSE: Aeroallergens are important causative factors of allergic diseases. Previous studies on aeroallergen sensitization rates investigated patients groups that had visited pediatric allergy clinics. In contrast, we investigated sensitization rates in a general population group of elementary school to teenage students in Incheon, Jeju, and Ulsan. METHODS: After obtaining parental consent, skin-prick tests were performed on 5,094 students between March and June 2010. Elementary school students were tested for 18 common aeroallergens, whereas middle and high school students were tested for 25 allergens. The 25 allergens included Dermatophagoides pteronyssinus, Dermatophagoides farinae, pollen (birch, alder, oak, Japanese cedar, pine, willow, elm, maple, Bermuda grass, timothy grass, rye grass, orchard grass, meadow grass, vernal grass, mugwort, Japanese hop, fat hen, ragweed, and plantain), and mold (Penicillatum, Aspergillus, Cladosporium, and Alternaria). RESULTS: The sensitization rates in descending order were 25.79% (D. pteronyssinus), 18.66% (D. farinae), 6.20% (mugwort), and 4.07% (willow) in Incheon; 33.35% (D. pteronyssinus), 24.78% (D. farinae), 15.36% (Japanese cedar), and 7.33% (Alternaria) in Jeju; and 32.79% (D. pteronyssinus), 30.27% (D. farinae), 10.13% (alder), and 8.68% (birch) in Ulsan. The dust mite allergen showed the highest sensitization rate among the 3 regions. The sensitization rate of tree pollen was the highest in Ulsan, whereas that of Alternaria was the highest in Jeju. The ragweed sensitization rates were 0.99% in Incheon, 1.07% in Jeju, and 0.81% in Ulsan. CONCLUSION: The differences in sensitization rates were because of different regional environmental conditions and distinct surrounding biological species. Hence, subsequent nationwide studies are required.

Relationship between Sensitization to Outdoor Aeroallergen and Month of Birth / 소아알레르기및호흡기학회지

PURPOSE: Early sensitization to outdoor aeroallergens such as tree, grass and weed pollen in the early period of infancy is very important in the development of seasonal bronchial asthma or allergic rhinitis. There is a suggestion that pollen contact during the first 6 months of life increases the risk of pollen allergy for 20 years or later. The aim of our investigation was to identify the relationship between sensitization to outdoor aeroallergens and the month and season of birth in childhood respiratory allergic disorders. METHODS: One hundred three seasonal allergic rhinitis and bronchial asthmatic children were enrolled for this study, and skin prick tests done for each patient to detect the sensitized allergens. Ragweed, mugwort, alder, hazelnut, elm, willow, birch, beech, oak, plane tree, orchard and timothy grass were used for outdoor aeroallergens. The relative risk (RR) for development of hypersensitivity to outdoor aeroallergen in children born in certain months was calculated. RESULTS: We found that relative risk of immediate hypersensitivity to each outdoor aeroallergen was dependent on the season and month of birth. Tree pollen was the most common sensitizing allergen in children who were born in spring (RR=2.12, P< 0.001) and May (RR=1.83, P=0.042), grass pollen was most common in summer (RR=2.06, P=0.046) and June-born children (RR=3.69, P< 0.001) ; weed pollen was the in fall (ragweed RR=2.89; mugwort RR=2.23, P< 0.001) and September-born children. (ragweed RR=2.10, P=0.029; mugwort RR=1.98, P=0.026) CONCLUSION: Exposure in early infancy to outdoor aeroallergens is an important risk factor in the subsequent development of bronchial asthma and allergic rhinitis.

Clinical Statistical Study on Offending Allergens of Patients with Allergic Rhinitis: Prevalence of Multiple Sensitization / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The incidence of allergic rhinitis and the kinds of offending allergens in our environment are varying as the way of life changes with urbanization and industrialization. Therefore, knowledge of the relationship between allergic rhinitis and the offending allergen is crucial for therapeutic judgment. The purpose of this study was to find out the incidence and distribution of offending allergens and investigate the prevalence of multiple sensitization on patients with allergic rhinitis. MATERIALS AND METHOD: Allergic skin test and multiple allergosorbent chemiluminescent assay (MAST-CLA) was performed for 1, 705 allergic rhinitis patients from Jan. 1998 to Dec. 2001 at the allergy clinic, Kyung Hee university Hospital. and a retrospective study was done by reviewing the result. RESULTS: Common offending allergens were Dermatopgagoides farinae (D. farinae), Dermatophagoides pteronyssinus (D. pteronyssinus), various pollens, dog hair, cockroach, and cat hair. Common offending seasonal allergens were ragweed, mugwort, rye, timothy grass, and Bermuda grass. The most common combination of allergens was mites with animal danders. Nineteen point three percent of the patients were sensitized to both perennial and seasonal type of allergens. Thirty point eight percent of patients with PAR (perennial allergic rhinitis) and 66.7% of patients with SAR (seasonal allergic rhinitis) were sensitized to multiple allergen. The prevalence of mixed sensitization to both perennial and seasonal allergen is 19.3% in allergic rhinitis. CONCLUSION: The overall prevalence of multiple sensitization in allergic rhinitis is 52.7%.

A study on the production of allergen panels / 천식및알레르기

BACKGROUND AND OBJECTIVE: The selection of allergen panels is a prerequisite to effectively test for innumerable allergens scattered throughout the environment. However, the selection of the pre-existing panel has been vague and contains some allergens that have not been verified as being common in Korea. This study was aimed to produce allergen panels in Korea. METHODS: For 12 months in 1996, sera were tested by the chemiluminescent assay of Multiple allergen simultaneous test (MAST-CLA: Immunosystems, Mountain view, U.S.A.). A total of 2, 467 specimens that either tested positive or were negative but had high total IgE level were pooled together. The pooled ser a were assayed for 60 allergens supplied by Dexall Acti Tip System (Dexall biomedical Labs. Inc., Gaithersburg, U.S.A.), a recently developed enzyme immunoassay. According to the Allerg Ens Unit (Allergen Unit:AU), 12 of the most frequently encountered and 6 of the leaot frequent allergens with reactions between classes 3 and trace were selected. RESULTS: The 12 most frequently encountered allergens were : Dermatophagoides pteronyssinus, Dermatophagoides farinae, house dust, timothy grass, perennial rye, mugwort, birch, oak, hazel nut, common ragweed, alder and dog dander. The 6 least frequently encountered were : wheat, egg-white, cat epithelium, milk, cockroach and shrimp. CONCLUSION: The 12 allergens we chose proposed to be the minimally required panel of frequently encountered allergens in allergy testing. We conclude that the 12 most frequent allergens should be tested with the total IgE level as a major panel (panel-M) and that the 6 least frequently encountered allergens may be tested separately when needed, as a minor panel (panel-m).