The Prevalence of Allergic Diseases in Poland - the Results of the PMSEAD Study in Relation to Gender Differences.

BACKGROUND: Males and females exhibit different susceptibility to allergic diseases. OBJECTIVES: The aim of the study was to evaluate gender-related differences in the prevalence of allergic diseases in Poland. MATERIAL AND METHODS: To evaluate this problem, data from the Polish Multicenter Study of the Epidemiology of Allergic Diseases (PMSEAD) was analyzed. There were assessed 16,238 individuals, aged 3 to 80 years, among them 12,970 adults and 3,268 children. RESULTS: In adults the prevalence of asthma was 5.4%, seasonal allergic rhinitis 8.5%, persistent allergic rhinitis 3.0%, atopic dermatitis 1.6%, contact dermatitis 2.0%, and drug allergy 8.6%. In children asthma was diagnosed in 8.6% of the individuals assessed, seasonal allergic rhinitis in 8.6%, persistent allergic rhinitis in 2.1%, atopic dermatitis in 4.7%, contact dermatitis in 1.1% and drug allergy in 8.9%. Among the children in the sample, significantly higher prevalence rates were found in boys than in girls for asthma (10.9% vs. 6.3%; OR = 1.81; p < 0.001), seasonal allergic rhinitis (9.8% vs 7.4%; OR = 1.37, p = 0.018) and persistent allergic rhinitis (2.6% vs. 1.5%; OR = 1.74, p = 0.029). When comparing the differences by gender among adults, there was a lower proportion of male than female subjects suffering from asthma (4.9% vs. 5.8%; OR = 0.83, p = 0.018), seasonal allergic rhinitis (7.6% vs. 9.3%; OR = 0.81, p = 0.001), atopic dermatitis (1.1% vs. 2.0%; OR = 0.53, p < 0.001), contact dermatitis (1.1% vs. 2.8%; OR = 0.39; p < 0.001) and drug allergy (5.1% vs. 11.6%; OR = 0.41, p < 0.001). CONCLUSIONS: The opposite susceptibility to allergic diseases among children and adults may indicate that sex hormones play an important role in this phenomenon.

Are single nucleotide polymorphisms of the immunoglobulin A Fc receptor gene associated with allergic asthma?

BACKGROUND: Eosinophils are important components of allergic inflammation. The immunoglobulin A (IgA) Fc receptor (FcalphaRI), encoded by the FCAR gene, is a possible candidate for eosinophil activation at mucosal surfaces, where IgA is abundant. Both elevated cell surface expression of FcalphaRI and increased avidity for IgA were described on eosinophils from allergic subjects. The aim of our study was to examine the possible association of FCAR gene polymorphisms with allergic asthma. METHODS: We screened three regions of the FCAR gene: (1) the promoter region, (2) exon 3, encoding the first extracellular domain (EC1), and (3) exon 5, coding for the transmembrane and cytoplasmic domain, for new and published polymorphisms using a sensitive temperature gradient gel electrophoresis technique and compared their frequencies in 112 patients diagnosed with allergic asthma and 100 healthy controls. RESULTS: Six polymorphisms, including two novel ones, were detected. No differences between patients and controls were found in the distribution of any of these polymorphisms. CONCLUSION: FcalphaRI polymorphism does not seem to be a risk factor in allergic asthma. Nevertheless, this is the first report on the distribution of 6 single nucleotide polymorphisms of the FCAR gene in a human population and the first study on FCAR polymorphism in allergic asthma.

Skin reactivity to histamine and expression of histamine receptors mRNA in lymphocytes of healthy subjects and non-small-cell lung cancer patients before and after surgery.

Histamine modulates an immunological response through stimulation of appropriate receptor--H1R proinflammatory or H2R suppressive. The participation of histamine in regulation of an immunological response in the course of neoplastic disease is determined by the expression of particular receptor. The aim of our work was the investigation of the expression of mRNA of two types of histamine receptors in peripheral blood lymphocytes and the evaluation of skin-prick test with histamine in lung cancer patients before and after surgery. The investigation was performed on 15 patients qualified to surgery before and 7-10 days after treatment and on 12 healthy subjects. Reverse transcriptase polymerase chain reaction (RT-PCR) with primers labeled with fluorescent dyes was performed. Intensity of fluorescence was expressed as relative fluorescence units (RFU). The data were analysed using ABI Prism 310 GeneScan collection software Version 3.1. Skin-prick test with histamine was evaluated after 10 min by measuring the diameter of the weal. The expression of H1R and H2R mRNA in healthy subjects was not significantly different in contrast to the lung cancer patients in which a significant prevalence of H2R mRNA expression was observed before surgery and only slightly decreased after (P < 0.001). Skin-prick test--negative in one patient before surgery, after treatment was positive in all patients and the diameter of histamine weal was significantly increased (P < 0.001). One may assume that the prevalence of the expression of H2R mRNA in patients reflects the status of immunosuppression caused by cancer. Since histamine exerts its suppressive activity trough H2R it seems reasonably to include the antagonists of this receptor to the cancer therapy which may restore a relative balance between accessibility of both types of histamine receptors.

[Therapeutic management in severe and difficult asthma in adults]. / Postepowanie w ciezkiej i trudnej astmie u doroslych.

Classification of severity of bronchial asthma is a basic point for therapeutic management in adults. In the paper definitions of severe and difficult asthma are presented. The therapeutic possibilities are pointed according to new guidelines published in the recent period and own Author's clinical experience.

[Allergy to mould allergens as a risk factor for bronchial asthma in patients suffering from allergic rhinitis]. / Uczulenie na alergeny grzybów plesniowych jako czynnik ryzyka wystapienia astmy oskrzelowej u chorych z alergicznym niezytem nosa.

UNLABELLED: The ARIA study demonstrates the correlation between bronchial asthma (BA) and perennial rhinitis (PR) with mite or animal fur allergies. There are no reports concerning correlation between BA and PR with mould allergy. The authors of this study estimated the prevalence of BA in patients with PR, allergic to moulds in comparison with patients allergic to other aeroallergens. 460 patients suffering from PR were investigated: 102 were allergic to moulds (mono- or multisensitization type) and 358 were allergic to other allergens. The prevalence of BA in mould-sensitive and insensitive patients was 70.6% and 43.6%, respectively; it was significantly higher in the mould-sensitive group (p = 0.004) regardless of the type of mould hypersensitivity (mono- or multisensitization). The higher prevalence of BA in mould-sensitive patients was found to be valid only for adults. The adult PR patients with diagnosed BA were most frequently allergic to Alternaria (47.1%) and Cladosporium (30.8%). IN CONCLUSION: mould allergy may be a risk factor for BA development.

[Studies of the specificity of immediate allergic reactions to ampicillin]. / Badania nad swoistoscia natychmiastowych reakcji alergicznych wywolywanych przez ampicyline.

Ampicillin belongs to the drugs causing most frequently IgE-dependent allergic reactions, but the current specificity of these reactions is poorly known. Some experimental data suggest that the side chain of ampicillin may induce synthesis of drug-specific IgE antibodies. In our study we have decided to explain the specificity of ampicillin-induced allergic reactions type I appearing in patients after drug administration. Thirty-eight subjects developing an immediate response after administration of ampicillin entered the study. In all the patients skin tests with penicillin, ampicillin and amoxicillin determinants were performed. We have observed positive skin tests results with penicillin determinants in 23 subjects, in 32 subjects with ampicillin and in 17 cases with amoxicillin. Only in three persons the results were positive exclusively to ampicillin. The results of our study indicate that in the Polish population ampicillin induces an immediate IgE response with variable degree of cross-reactivity to other tested drugs, and selective response to ampicillin is uncommon.

[Blood and tissue eosinophilia in patient with angioedema caused by inhibitor of angiotensin converting enzyme (ACE)--case report and a view of literature]. / Eozynofilia obwodowa i tkankowa u pacjenta z obrzekiem naczynioruchowym wywolanym inhibitorem enzymu konwertujacego angiotensyne (ACE)--opis przypadku i przeglad pismiennictwa.

A case of angioedema caused by enalapril, undiagnosed for 5 years was presented. Enhanced blood and tissue eosinophilia shown in nasal smear was observed. In addition increased activity of coagulation system was shown manifested by enhance of concentration of Hageman factor and cardiolipin antibodies IgM and IgA isotype. The role of coagulation, complement and fibrinolysis systems in pathogenesis of ACE-inhibitors induced angioedema was discussed. The influence of bradykinin on activity of eosinophils was analyzed.

[Mechanisms of action of nebulized low molecular weights heparin in patients with bronchial asthma]. / Mechanizmy dzialania heparyny maloczasteczkowej nebulizowanej u chorych na astme oskrzelowa.

Bronchial asthma is a chronic disease of the respiratory tract. Search for alternative to presently used therapies seems to be the way to obtain a better control of asthma. Heparin is an acidic mucopolysaccharide and in the past years there has been a number of reports on the role of heparin and low-molecular-weight heparin (LMWH) in chronic inflammatory disorders of the respiratory tract. Our aim was to estimate the effect of long-time LMWH nebulization on selected parameters in asthmatic patients. Twenty-four patients entered the study. All of them were subjected to bronchoscopy with BAL, in 8 patients this procedure was performed twice: before and after heparin treatment. After 14 days of treatment we observed an increase in FEV1 (from 73.93 +/- 14.14% (in % of nominal value) to 89.62 +/- 10.08% (p = 0.0049). Additionally we noted a decrease in the percentage of eosinophils and lymphocytes in BAL sediments, from 4.86 +/- 3.48% to 1.25 +/- 2.76%; p = 0.0006 and from 5.39 +/- 2.25% to 2.94 +/- 1.23%; p = 0.0209, respectively. This changes were paralleled by a drop of EG2 in BAL supernatant from 1.00 +/- 0.99 to 0.13 +/- 0.35, p = 0.0256. In blood serum level of histamine 0.74 +/- 0.77 to 0.1 +/- 0.22; p = 0.0493. We did not observe significant changes in IL-5, sVCAM-1 or ECP concentrations in serum. Also different LMWH dosing (5-10 kUIC anti-Xa b.i.d.) did not produce any dose-response effect. We conclude, that LMWH in nebulization can be a valuable add-on treatment in bronchial asthma, and its most likely mechanisms of action are: prevention of mast cell degranulation (histamine decrease), decreased eosinophil activation (lower EG2), and modification of inflammatory cells influx (decreased percentages of eosinophils and lymphocytes in BAL).

Latex allergy and sensitization in children with spina bifida.

BACKGROUND: The purpose of this study was to investigate the prevalence rate of latex sensitization and latex allergy among children with spina bifida and to evaluate risk factors for natural rubber latex hypersensitivity. METHODS: A total of 34 children between 2.5 and 17 years of age participated in the study. Participants completed a questionnaire and underwent skin prick tests with latex, common aeroallergens and food allergens as well as measurements of specific IgE to latex and food allergens (RAST CAP). RESULTS: The prevalence of latex sensitization and latex allergy was estimated to be 32.4 and 18.8%, respectively. The most common reported clinical manifestation of latex allergy was urticaria. Three out of six symptomatic patients reported anaphylactic reactions. CONCLUSION: We found that major risk factors for latex sensitization were atopy and a history of numerous operations.

[Histamine receptors expression on lymphocytes and neutrophils in glucocorticosteroid sensitive and resistant asthma patients]. / Ekspresja receptorów histaminowych na limfocytach i neutrofilach u chorych na astme wrazliwa i oporna na glikokortykosteroidy.

Histamine is a physiological mediator which exerts both, effector and regulatory influence through its receptors on various cells. In the study we evaluated the expression of histamine receptors (HR) on inflammatory cells (lymphocytes and neutrophils) in glucocorticosteroid sensitive (n. = 17) and resistant (n. = 19) asthmatic patients and healthy subjects (n = 14). Moreover, we examined in vitro the influence of cortisol on HR expression in both studied groups with asthma and in a control group. We concluded that HR expression on lymphocytes was similar in all studied subjects. However, HR expression on neutrophils in both groups of asthmatic patients was significantly decreased compared to the control group. After the in vitro incubation with cortisol, we observed a significant decrease in HR expression on neutrophils (10(-8)-10(-5) M) and lymphocytes (10(-8)-10(-4) M) only in healthy subjects. Taking into consideration that histamine proinflammatory action is mediated by H1 receptor, and that in patients treated with long-time systemic GCS therapy we did not observe any decrease in HR expression in vitro, we suggest additional therapy with the second-generation antihistamines. These drugs not only block H1 receptors, but also have an anti-inflammatory effect.

[Studies on cross reactivity to penicillins in patients with immediate allergic reactions caused by amoxicillin]. / Badania nad krzyzowa nadwrazliwoscia na antybiotyki penicylinowe u chorych z natychmiastowymi reakcjami alergicznymi wywolywanymi przez amoksycyline.

In this study we have explored the presence of cross reactivity to penicillin and ampicillin in patients with immediate allergic reactions caused by amoxicillin. Skin test results with amoxicillin were positive in 66.66% and in the remaining 33.34% were negative. In 81.48% patients we observed positive results of skin tests with penicillin and/or ampicillin. Only in 14.48% of the patients we observed selective response to amoxicillin. On the basis of obtained results we conclude that sensitivity of skin tests with amoxicillin is rather moderate and confirmation of amoxicillin hypersensitivity can be obtained using skin tests with other penicillins. In our material selective amoxicillin hypersensitivity can be defined as a relatively rare phenomenon. These data should have the important implications in antibiotics' selection in patients with amoxicillin allergy.

[The influence of a three-year preseasonal specific immunotherapy on selected parameters of allergic inflammation in pollinosis patients]. / Wplyw trzyletniej przedsezonowej immunoterapii swoistej na wybrane parametry zapalenia alergicznego u chorych na pylkowice.

Specific immunotherapy (SIT) can in some cases influence the course of allergic inflammation (eosinophilia and ECP concentration in peripheral tissue). This study was set up to evaluate the efficacy of three-year pre-seasonal SIT with grass pollen allergoid. We measured NALf eosinophilia and ECP concentration both in NALf and blood serum after subsequent SITs. Twenty seven patients aged 26.7 +/- 7.4 (range 18-45) entered this study. They were randomly assigned to treatment with either Pollinex or Allergovit. We observed a progressive fall in NALf eosinophilia in subsequent years: 24.1 +/- 2.4%; 20.2 +/- 4.6%; 9.8 +/- 1.9% vs. 30.4 +/- 3.0% before treatment (p < 0.05, p < 0.05 and p < 0.001, respectively). Also ECP concentration fell after second and third SIT to 15.6 +/- 1.5 ng/ml i 12.96 +/- 1.75 ng/ml vs 23.3 +/- 3.7 ng/ml before SIT (p < 0.05). A significant drop in serum ECP concentration was recorded only after the third SIT season--2.5 +/- 1.23 micrograms/ml vs 5.8 +/- 1.3 micrograms/ml before treatment, p < 0.01. NALf eosinophilia correlated positively with NALf ECP concentration--R2 = 0.92, p < 0.05. Hence, SIT ameliorates allergic inflammation decreasing significantly activity of eosinophils in nasal mucosa measured as NALf eosinophilia and ECP concentration. This effect seems to be time-depended.

[Value of the leukotriene generation test in diagnosis of immediate hypersensitivity to penicillin]. / Wartosc testu wytwarzania leukotrienów w diagnostyce natychmiastowych reakcji alergicznych wywolywanych przez penicyline.

In this study we have decided to explore the diagnostic usefulness of CAST-ELISA test in patients with immediate allergic reactions caused by penicillin. Peripheral blood leukocytes were stimulated by commercially available penicillin allergens--Penicillin G, Benzyl-penicillin--Polylysine and specially performed Penicillin G conjugated to human serum albumin. Test was performed in 33 allergic persons and in 13 control healthy persons well tolerated penicillin antibiotics with negative skin tests results. CAST-ELISA test gave the positive results in 30.3% when unconjugated penicillin was used and in 18.18% with penicillin--polylysine. The best results were obtained when cells were stimulated with penicillin conjugated to human serum albumin--positive results were observed in 47.82%. Accumulate percentage of positive results was 73.91%. In our opinion CAST-ELISA test is reliable method in diagnosis of immediate allergic reactions caused by penicillin and inclusion of penicillin conjugated to human serum albumin seems to be justifiable.

Comparative study of cefaclor AF vs. cefuroxime axetil in acute exacerbations of chronic bronchitis.

BACKGROUND: Acute exacerbations of chronic bronchitis (AECB) are the most common complication of chronic bronchitis. The majority of AECB are caused by infection. The choice of appropriate antibacterial therapy for AECB is becoming more difficult and is usually empirically. Cefaclor and cefuroxime are used for ambulatory treatment of AECB. MATERIAL/METHODS: This multicenter, randomized, single blind study was undertaken in order to compare efficacy and safety of cefaclor AF (500 mg BID) and cefuroxime axetil (250 mg BID) in 10 days treatment of ambulatory patients with AECB. 170 adults were enrolled into the study. Clinical responses were assessed on 17th-24th day after randomization. RESULTS: Both antibiotics had high over 97% effectiveness in the treatment of AECB. There was statistically significant 1.7 times higher rate of patients with cough release after cefaclor treatment compared to cefuroxime (p<0.03). There was a significantly 2.25 higher rate of patients with AECB symptoms release like: increasing dyspnea, sputum volume and sputum purulence or cough in cefaclor group compared to cefuroxime (p<0.0187). Both treatments resulted in significant improvement of pulmonary peak expiratory flow (PEF). There were no differences between the rates of gastrointestinal and other side effects in both groups. CONCLUSIONS: 1. Cefaclor and cefuroxime have similar high efficacy and safety in 10 days treatment of patients with AECB. 2. Cefaclor treatment significantly higher 2.25 times reduces the rate of principle symptoms of AECB compared to cefuroxime. 3. Both antibiotics treatment significantly increase PEF, with higher tendency observed in after cefaclor treatment.