Oral and nasal provocation test in chicken egg allergy-case report.

INTRODUCTION: Allergy to chicken egg protein is a common form of food allergy. The most common clinical presentation includes gastrointestinal, skin, and respiratory symptoms. Differential diagnosis, including provocative tests, is critical in diagnosis. CASE DESCRIPTION: We present a case of a 21-year-old patient with egg allergy, who underwent a double-blind food provocation test with placebo (evaluating subjective complaints from the gastrointestinal tract) and a titrated nasal provocation test using dry chicken egg content. We assessed the response of the nasal mucosa in the provocation test using the visual analogue scale (VAS), acoustic and optical rhinometry, as well as measurements of nitric oxide concentration in the exhaled air. During the provocation test, we measured the changes in the transverse section of the nasal passages, which were accompanied by subjective complaints measured with the VAS scale, using objective techniques. In the nasal provocation test with a dose of 20 µg of chicken egg protein, we observed an increase in the reactivity of the nasal mucosa and a decrease in the level of nitric oxide in the exhaled air from the upper airways (920 ppb before the provocation test and up to 867 ppb during the early stage of the allergic reaction). During the provocation tests, we recorded typical symptoms associated with the early stage of the allergic reaction; including nasal obstruction (1.2 cm), leakage of watery discharge (0.8 cm) in the food test, and itchy nose (1.1 cm) in the food test vs. the nasal test: 4.6, 2.8, and 3.5 cm, respectively. CONCLUSIONS: The nasal mucosa provides convenient conditions for evaluation of the severity of allergy to common food allergens, including chicken egg allergens.

Effect of indoor air quality on the development of rhinitis in an urban population in Poland.

Background: Indoor air significantly impacts the incidence of rhinitis among residents of urban agglomerations. Objective: To assess the impact of indoor air pollution on rhinitis. Methods: Data were collected by using an European Community Respiratory Health Survey (ECRHS) and International Study of Asthma and Allergies in Childhood (ISAAC) standardized questionnaires (N = 18,617), and medical examinations were carried out (N = 4783) in selected Polish regions. For statistical analysis, the odds ratio (OR) was calculated with a 95% confidence interval to detect factors associated with rhinitis. The Wald test was performed to assess the significance of those factors. A value of p < 0.05 was considered statistically significant. Results: The most important factors associated with allergic rhinitis declared by adults, ages 20­44 years were the following: the age of the buildings (OR 1.34), presence of central heating system (OR 1.19), gas furnace used to heat the house (OR 1.19), solid-fuel stove (OR 1.92), and bottled-gas stove (OR 1.66). More frequent declarations of nonallergic rhinitis in the study group were associated with the use of a central heating system (children ages 6­7 years: OR 1.21; children ages 13­14 years: OR 1.22; and adults, ages 20­44 years: OR 1.27), solid-fuel stove (children ages 6­7 years: OR 2.95; children ages 13­14 years: OR 2.86; adults, ages 20­44 years: OR 2.02), and bottled-gas stove (children ages 6­7 years: OR 1.89; children ages 13­14 years: OR 1.88; adults, ages 20­44 years: OR 2.06). Diagnosed seasonal allergic rhinitis in adults, ages 20­44 years was associated with the year when the building was constructed (1970­1990) (OR 1.93) and the presence of a central heating system (OR 1.85). The year of construction of a building (1946­1969) (OR 4.84) as well as the use of central heating (OR 1.79) were causes of allergies to molds in the group of children ages 6­7 years, whereas sensitization to Dermatophagoides. pteronyssinus (OR 1.62) and Dermatophagoides farinae (OR 1.78) in children ages 6­7-years was associated with the presence of a central heating system. In children ages 13­14 years, the use of a solid-fuel stove was a cause of sensitization to D. farinae (OR 1.62). Conclusion: The age of the building, home heating systems, and pollution emitted by cooking appliances have a significant impact on the incidence of rhinitis. The highlights of the study included the following: (1) the age and condition of the building, the use of heating devices, stoves, and also mold allergens and house-dust mites contributed to a higher incidence of rhinitis, mainly among adults, ages 20­44 years; (2) gas-storage tanks and solid fuels contribute to rhinitis in the group of children ages 6­7 years and children ages 13­14 years.

Organic changes in the central nervous system in children on chronic inhaled corticosteroid therapy.

Treatment of asthma, the most common chronic respiratory disease in children, includes long-term inhaled corticosteroids (ICS). The purpose of this study was to analyze the impact of chronic inhaled steroids in children with asthma on changes in the central nervous system (CNS). Eleven children (8-17 years) on at least 4 years inhaled corticosteroid therapy were assessed with magnetic resonance imaging (MRI). All participants underwent a pediatric and neurological examination and spirometry. MRI data were obtained using a 1.5 T scanner with parallel imaging capability. Structural images consisted of axial T1, T2 using turbo spin echo, FLAIR and DWI sequences using typical parameters. Images were assessed in three planes (axial, coronal, and sagittal). Pediatric and neurological examination were normal in all children. In six, the MRI studies revealed small subcortical hyperintense foci. Three had more than five lesions, all of which were smaller than 3 mm. Features of mild supratentorial cortical atrophy were apparent in four. The cerebellum was unremarkable in all children imaged. In conclusion, patients receiving chronic inhaled corticosteroids had small subcortical hyperintense foci and features of mild supratentorial cortical atrophy. These findings suggest that ICS exposure may be associated with the development of organic changes in CNS. Further studies are needed to detail the extent of brain ICS-induced changes in children on chronic inhalative corticosteroid therapy as well as delayed impact of these changes on psychomotor functioning in adulthood.

Total and antigen-specific IGE levels in umbilical cord blood.

The present study was conducted to learn whether the perinatal and environmental factors could influence the total and antigen-specific IgE levels in umbilical cord blood. Retrospective data were obtained from 173 mother-infant pairs. Total and specific (for children's food, wheat/grass and house dust mite-HDM) cord blood IgE levels were determined using the immunoassay test. The total cord blood IgE was between 0.0-23.08 IU/ml (mean 0.55 +/-2.07 IU/ml; median 0.16 IU/ml). Total IgE levels were significantly higher in boys compared with girls (OR=2.2; P=0.007), and in newborns with complicated pregnancy (OR=2.7; P=0.003). A greater number of siblings correlated with increases in the total cord blood IgE (P<0.02). We detected specific IgE in 34 newborns (40 positive tests). A long-standing contact with a cat during pregnancy decreased the specific IgE level for wheat/grass (OR=3.2; P<0.07) and for children's food (OR=5.0; P<0.04), and the contact with a dog decreased the specific-IgE for wheat/grass (OR=0.3; P<0.05). Exposure to tobacco smoke correlated with the positive specific IgE toward house dust mite (OR=4.7; P=0.005).

Prediction of atopy in the first year of life using cord blood IgE levels and family history.

We assessed correlations of total and specific cord-blood IgE (cIgE) levels with allergic symptoms in the first year of life. cIgE levels were determined by an immunoassay test in full-term neonates. This is a prospective study in which a questionnaire was used after birth, and at 6 and 12 months of age. We used multiple logistic regression models to assess the association between the family history of atopy and the incidence of allergy. The infants were divided into groups based on the cIgE level (Group 1<0.1 IU/ml, n=65; Group 2 0.1-0.5 IU/ml, n=63; Group 3 >0.5 IU/ml, n=45). We found the symptoms of atopy in 26 children in Group 1 (40%), 30 (47.6%) in Group 2, and 17 (37.7%) in Group 3; the percentage of atopic diseases was insignificantly different among the three groups. No association between a high total cIgE and specific cIgE with atopy family history and the outcome of atopic diseases was discovered. We conclude that neither total nor specific cIgE level with atopy family history can be used as an indicator to single out high risk infants.