Different clinical allergological features of <Emphasis Type="Italic">Taenia solium</Emphasis> infestation

The tapeworm Taenia (T.) solium can be responsible for two different conditions: taeniasis and cysticercosis. Helminth infections in human host cause an immune response associated with elevated levels of IgE, tissue eosinophilia and mastocytosis, and with the presence of CD4+ T cells that preferentially produce IL-4, IL-5, and IL-13. Individuals exposed to helminth infections may have allergic inflammatory responses to parasites and parasite antigens. PubMed search of human cases of allergic reactions occurring during T. solium infestation was performed combining the terms (allergy, urticaria, angioedema, asthma, anaphylaxis) with T. solium. A study was considered eligible for inclusion in the review if it reported data on patients with T. solium infestation who had signs or symptoms of allergy. In literature we found six articles reporting the association between an allergic reaction and T. solium infestation: two cases of urticaria, two cases of relapsing angioedema, one case of asthma and two cases of anaphylaxis. Despite the large diffusion of T. solium infestation, we found only a few cases of concomitant allergic reaction and the presence of Taenia in the host. The association between T. solium infestation and allergic manifestations has never been clearly demonstrated, and in absence of a well-documented causality the hypotheses are merely speculative. Therefore, the association between Taenia infection and allergy needs to be thoroughly studied to better clarify if this association may really exist and which is the pathogenetic mechanism supported.     

The Problem of Allergy in Psychiatry

In recent years many authors have directed attention to allergic reactivity in mental disease. This problem has been studied with particular depth by O. V. Kerbikov (1) and his associates. (2) Clinical data, as well as, to some degree, laboratory research data demonstrate beyond all question that an allergic component often plays a substantial role in the genesis and shaping of various psychotic conditions. Also providing a basis for study of the problem of allergy in psychiatry are our data of pathophysiological studies in the field of allergy conducted in recent years (3-6), which demonstrate that the major role in the shaping of allergic reactions belongs to the central nervous system and that "nervous tissue may be the object in which the allergic reaction of antigen with antibody occurs" (A. D. Ado). Any pathological process modifies the immunological properties of the organism and causes adaptive defense reactions. Sometimes, under particular conditions, these defensive developments begin to play a pathogenic role. Under the influence of endogenic toxicosis, particularly in schizophrenia, autoantigens may be formed which acquire the nature of auto-or endo-allergens (A. D. Ado), which exercise a very pronounced effect upon the organism, including the central nervous system. In certain circumstances they facilitate the allergic genesis of psychopathological syndromes. The development of antibodies and auto-allergens in mental diseases may also be a consequence of the modification, under the influence of the pathological process and of various drugs, of the "normal flora" relationship characteristic of the given organism, and sometimes the result of this may be auto-infection.     

Difference in the Breast Milk Proteome between Allergic and Non-Allergic Mothers

Background

Breastfeeding has been linked to a reduction in the prevalence of allergy and asthma. However, studies on this relationship vary in outcome, which may partly be related to differences in breast milk composition. In particular breast milk composition may differ between allergic and non-allergic mothers. Important components that may be involved are breast milk proteins, as these are known to regulate immune development in the newborn. The objective of this study was therefore to explore differences in the proteins of breast milk from 20 allergic and non-allergic mothers. The results from this comparison may then be used to generate hypotheses on proteins associated with allergy in their offspring.

Methods

Milk samples from allergic and non-allergic mothers were obtained from the PIAMA project, a prospective birth cohort study on incidence, risk factors, and prevention of asthma and inhalant allergy. Non-targeted proteomics technology, based on liquid chromatography and mass spectrometry, was used to compare breast milk from allergic and non-allergic mothers.

Results

Nineteen proteins, out of a total of 364 proteins identified in both groups, differed significantly in concentration between the breast milk of allergic and non-allergic mothers. Protease inhibitors and apolipoproteins were present in much higher concentrations in breast milk of allergic than non-allergic mothers. These proteins have been suggested to be linked to allergy and asthma.

Conclusions

The non-targeted milk proteomic analysis employed has provided new targets for future studies on the relation between breast milk composition and allergy.     

Allergic rhinitis: evidence for impact on asthma

Background

This paper reviews the current evidence indicating that comorbid allergic rhinitis may have clinically relevant effects on asthma.

Discussion

Allergic rhinitis is very common in patients with asthma, with a reported prevalence of up to 100% in those with allergic asthma. While the temporal relation of allergic rhinitis and asthma diagnoses can be variable, the diagnosis of allergic rhinitis often precedes that of asthma. Rhinitis is an independent risk factor for the subsequent development of asthma in both atopic and nonatopic individuals. Controlled studies have provided conflicting results regarding the benefits for asthma symptoms of treating comorbid allergic rhinitis with intranasal corticosteroids. Effects of other treatments for comorbid allergic rhinitis, including antihistamines, allergen immunotherapy, systemic anti-IgE therapy, and antileukotriene agents, have been examined in a limited number of studies; anti-IgE therapy and antileukotriene agents such as the leukotriene receptor antagonists have benefits for treating both allergic rhinitis and asthma. Results of observational studies indicate that treating comorbid allergic rhinitis results in a lowered risk of asthma-related hospitalizations and emergency visits. Results of several retrospective database studies in the United States and in Europe indicate that, for patients with asthma, the presence of comorbid allergic rhinitis is associated with higher total annual medical costs, greater prescribing frequency of asthma-related medications, as well as increased likelihood of asthma-related hospital admissions and emergency visits. There is therefore evidence suggesting that comorbid allergic rhinitis is a marker for more difficult to control asthma and worsened asthma outcomes.

Conclusion

These findings highlight the potential for improving asthma outcomes by following a combined therapeutic approach to comorbid allergic rhinitis and asthma rather than targeting each condition separately.

     

Identification of a potent and nonpeptidyl ccr3 antagonist

CCR3 is expressed in a variety of leukocyte subsets, especially eosinophils, and may be involved in allergic disorders such as atopic asthma. To clarify the pathophysiological roles of CCR3 in allergic disorders, we developed a nonpeptidyl CCR3 antagonist. This antagonist, which is referred to as "Compound X," that inhibited the binding of [(125)I]Eotaxin to CHO cells transfected with human CCR3 with an IC(50) value of 2.3 nM. In human eosinophils, Compound X also inhibited Eotaxin-induced increases in intracellular Ca(2+) concentrations and chemotaxis. Thus, Compound X appears to be a highly potent CCR3 antagonist. These findings suggest that Compound X may be a useful tool for elucidating the pathophysiological roles of CCR3 in a variety of allergic disorders.     

GASTROINTESTINAL ALLERGIC DISEASE

Gastrointestinal allergic disease undoubtedly does exist, but its frequency has been tremendously overrated. It is believed that in many cases there is not sufficient evidence for attributing chronic, recurrent digestive disturbances to allergic reaction, and that skepticism is particularly important because such a diagnosis exposes the patient to an unwarranted type of dietary management that is complicated, frequently unwise, and not too infrequently used as a substitute for critical clinical thinking.The demonstration and subsequent elimination of allergic substances that may at times be productive of digestive symptoms is, of course, important, and when based on proper evaluation of a carefully taken history will undoubtedly yield brilliant results.     

THE SIGNIFICANCE OF INFECTION IN ALLERGIC DISEASE—Its Influence on Diagnosis and Management

The presence of infection in allergic disease produces a confused picture in which two different causative factors must be clearly separated by the physician if he is to treat the patient successfully. The effects of infection are not consistent. There are situations, as seen in infectious diseases, where symptoms of allergic disease are temporarily relieved and others where the infection may intensify or precipitate the allergic condition. It is likewise important to recognize the complications superimposed upon allergic disease by infection. In such cases, control of the infection is as dependent upon control of the allergy as it is upon antibiotics.     

THE SIGNIFICANCE OF INFECTION IN ALLERGIC DISEASE-Its Influence on Diagnosis and Management

The presence of infection in allergic disease produces a confused picture in which two different causative factors must be clearly separated by the physician if he is to treat the patient successfully. The effects of infection are not consistent. There are situations, as seen in infectious diseases, where symptoms of allergic disease are temporarily relieved and others where the infection may intensify or precipitate the allergic condition. It is likewise important to recognize the complications superimposed upon allergic disease by infection. In such cases, control of the infection is as dependent upon control of the allergy as it is upon antibiotics.     

Allergy testing: comparison of skin and in vitro tests of allergic reagin.

Skin tests have been used for many years to detect reaginic antibodies in the investigation of allergic patients. Recently in vitro assays of allergic reagins, including the radioallergosorbent test (RAST) and the rat mast cell test (RMCT) have become available. A comparison of the clinical usefulness of these tests suggested that skin tests and the RAST are of comparable diagnostic accuracy and reliability. The RMCT was found to be poorly reproducible and unreliable. For routine cases skin tests should continue to be the procedure of choice. The RAST may reasonably be used when skin tests are unreliable, impractical or contraindicated. The RAST may also be helpful in some cases in resolving discrepancies between skin test results and the clinical history.     

Lactobacillus rhamnosus HN001 attenuates allergy development in a pig model

Background

Probiotics have been studied as immunomodulatory agents of allergy. Several human probiotic trials tracking the development of eczema and other forms of allergy have yielded inconsistent results. A recent infant study demonstrated that pre and postnatal Lactobacillus rhamnosus HN001 (HN001) supplementation decreased the prevalence of eczema and IgE associated eczema. However, the influence of HN001 on the incidence of wheeze, asthma, and/or other allergic manifestations has yet to be reported.

Objective

This study was conducted to determine the effects of the probiotic HN001 on the development of allergic lung disease in a pig model.

Methods

Allergy was induced by a series of subcutaneous and intratracheal sensitizations with Ascaris suum allergen (ASA) during a six week time frame in post-weanling pigs supplemented daily with HN001, or without supplementation. One week following final sensitization intradermal skin tests and respiratory challenges were conducted.

Results

In response to intradermal and respiratory challenges, ASA-sensitized pigs fed HN001 had less severe skin flare reactions, smaller increases in pleural pressure, and trends towards lower changes in arterial oxygen and carbon dioxide partial pressure levels compared to control pigs. The frequency of ASA-specific IFN-γ-secreting peripheral blood mononuclear cells, as well as the amount of IL-10 produced by ASA-specific cells, was of greater magnitude in probiotic-fed pigs compared to control animals. These observations suggest that differences in clinical responses to the allergen challenges may be related to probiotic-induced modulation of Th1 (IFN-γ) and regulatory (IL-10) cytokine expression.

Conclusions

Probiotic supplementation decreased the severity of allergic skin and lung responses in allergen-sensitized pigs with a corresponding increase in IFN-γ expression. A similar correlation between certain allergic responses and increased IFN-γ expression has been reported in human clinical studies of allergy; this pig model of allergy may be indicative of potential probiotic modulation of allergic lung disease in humans.     

Regulation of IgE antibody production by serum molecules. V. Evidence that coincidental sensitization and imbalance in the normal damping mechanism results in "allergic breakthrough".

Experiments presented in this paper were designed to test a new concept concerning the possible pathogenesis of the allergic phenotype. This concept, termed "allergic breakthrough" considers that one of the avenues toward the allergic phenotype involves coincidental sensitization combined with an imbalance in the normal damping mechanism that serves to limit IgE antibody production. The three predictions of this concept that can be tested experimentally are: 1) manipulations that are effective in heightening or re-establishing the damping mechanism should manifest persistence insofar as IgE antibody synthesis to the relevant allergen is concerned; 2) once allergic breakthrough has occurred, the height of production of IgE antibodies specific for the sensitizing agent should remain elevated at levels characteristic of the allergic phenotype, even after the threshold of damping activity has returned to a normal level; and 3) allergic breakthrough should display specificity in that breakthrough would occur in response to subsequent exposure to the specific antigen to which coincidental sensitization initially occurred, but not for other unrelated antigens. The studies presented herein confirm each one of these predictions, thereby providing substantial support for the validity of this concept as one possible distinguishing feature between individuals manifesting the nonallergic and allergic phenotypes, respectively.     

Detection of monohydroxy "bile" acids in the brains of guinea pigs afflicted with experimental allergic encephalomyelitis

3alpha-Hydroxy-5-cholanoic acid (lithocholic acid) and some unidentified acids (one of them perhaps 3-hydroxy-cholest-5-en-26-oic acid) have been detected in the brains of guinea pigs afflicted with experimental "allergic" encephalomyelitis. None of the acids could be identified in comparable amounts of brain tissue from normal guinea pigs. Thin-layer chromatography of the free acids, and thin-layer and gas-liquid chromatography combined with mass spectrometry of the methyl esters were used for identification. The occurrence of these acids may possibly be the result of cholesterol oxidation in the brain. The acids, or compounds related to them, may play a role in development of demyelination in experimental allergic encephalomyelitis.     

Allergic fungal sinusitis. A report of two cases with diagnosis by intraoperative aspiration cytology

BACKGROUND: Allergic fungal sinusitis (AFS) is a newly recognized form of sinusitis characterized by opacification of the paranasal sinuses by "allergic mucin" (AM) admixed with scattered fungal organisms. AM consists of necrotic, or partially necrotic, eosinophils and Charcot-Leyden crystals suspended in lakes of laminated, mucinous material. AFS is characterized by the absence of bone or soft tissue invasion, purulent exudate or granulomatous inflammation. Clinically, it is important to differentiate AFS from both acute invasive fungal sinusitis and noninvasive mycetoma because the three diseases are treated with different modalities and have different prognoses. Although the radiologic features of AFS are often characteristic, occasionally it may be difficult to exclude neoplasia. CASES: Two cases of AFS, in which intraoperative diagnosis was made on the basis of the presence of both AM and fungal organisms, are reported. CONCLUSION: Cytologic diagnosis of AFS can be made from intraoperative sinus aspirates from the presence of AM and fungal elements. AM and fungi provide presumptive evidence for a noninvasive, allergic fungal disease and can help reassure clinicians intraoperatively and guide clinical management.     

A critical appraisal on AIT in childhood asthma

Abstract

Allergen immunotherapy (AIT) is the only disease-modifying treatment approved for allergic rhinitis and allergic asthma and represents a suitable therapeutic option, especially in childhood, to modify the progression of respiratory allergic diseases. Starting from the previous “generic class effect” evaluation, as testified by the numerous meta analyses, AIT is now considered a product-specific pathogenic-oriented treatment.

Background

AIT was empirically proposed more than one century ago in the subcutaneous form (SCIT), but the IgE-mediated mechanism of allergy was elucidated only after 50 years of clinical use of the treatment. The sublingual administration (SLIT) was developed during the 1980 ties, to achieve an improvement in safety and convenience. While SCIT is approved in the United States for the treatment of asthmatic patients with more than 12 years, so far few trials evaluated the clinical efficacy and safety of SLIT in children with allergic asthma, although the indications and some aspects remain unclear. Certainly, due to compliance problems, the age below 3 years may be reasonably considered a practical contraindication.

Conclusions

Given that some specific AIT products are effective and approved as drugs (AIFA, EMA, FDA), the use in children is still debated. Some aspects still need robust confirm: (a) the safety of AIT in asthma; (b) the optimal regimen of administration; (c) the role of AIT as preventative treatment for asthma development.

     

Investigating T cell activation and tolerance in vivo: peptide challenge in allergic asthmatics

In the atopic allergic individual, challenge with allergen elicits manifestations of both the humoral (IgE-mediated or early-phase reaction) and the cell-mediated immune response (late-phase reaction). Detailed study of late-phase cell-mediated events is confounded by the effects of the earlier IgE-mediated response which results in mast cell and basophil activation. Thus the relative contributions to allergic inflammation of individual cell types, such as T cells and eosinophils, are difficult to define. In this review we describe experiments, largely from our own group, in which we have attempted to dissociate early and late allergic reactions. To this end, cell-mediated responses were induced in the absence of preceding IgE-mediated events, by the delivery of synthetic peptides representing T cell epitopes of the allergen. Activation of T cells resulted in airway narrowing and an increase in airway reactivity to non-specific stimuli. Furthermore, we describe the induction of antigen-specific hyporesponsiveness or "tolerance" following intradermal, but not mucosal, peptide delivery. The induction of peptide-induced hyporesponsiveness could be temporally dissociated from the initial T cell activation resulting in bronchoconstriction and likely occurred through a different mechanism. Analysis of in vitro allergen responses of peripheral blood cells revealed that hyporesponsiveness was associated with reductions in both Th1 and Th2 cytokines, together with a concomitant increase in the regulatory cytokine IL-10. We conclude that activation of T cells in vivo may result in manifestations of chronic allergic inflammation including bronchoconstriction and hyperreactivity. Additionally, when administered systemically at low dose, peptides may induce long-lasting hyporesponsiveness in the T cell compartment, through a mechanism that is associated with induction of IL-10.     

IgE responses in human filariasis. IV. Parallel antigen recognition by IgE and IgG4 subclass antibodies

Immediate hypersensitivity responses are highly modulated in filariasis, and with few exceptions, the majority of infected individuals do not develop allergic manifestations. One possible mechanism for this modulated responsiveness could involve the high levels of IgG "blocking antibodies" shown to be present in filariasis and other chronic helminth infections. When immunoblot analyses were done to analyze the immunoglobulin (Ig) E and IgG antibody responses of patients simultaneously, remarkable similarity in the patterns of antigen binding was observed. In this study, the four IgG subclasses were analyzed in a similar manner in relation to IgE. The results clearly demonstrate that IgG4 was primarily responsible for this "parallel" recognition that was seen previously between IgG and IgE antibodies. These results lend additional support to the possibility that IgG4 may play an important role in modulating IgE-mediated allergic responses in vivo.     

<Emphasis Type="Italic">Aspergillus</Emphasis> Species in Bronchiectasis: Challenges in the Cystic Fibrosis and Non-cystic Fibrosis Airways

Bronchiectasis is a chronic irreversible airway abnormality associated with infectious agents that either cause or superinfect the airways. While the role of bacteria is well studied, much remains to be determined about fungi in both cystic fibrosis- and non-cystic fibrosis-related bronchiectasis. The airway is constantly exposed to inhaled ambient moulds of which Aspergillus represent the most ubiquitous. In a normal healthy host, this situation is of little consequence. The presence of anatomical or immunological abnormalities such as those in bronchiectasis leads to a range of fungal-related pathologies from asymptomatic airway colonization to fungal sensitization, allergic bronchopulmonary aspergillosis or chronic pulmonary aspergillosis. These entities are difficult to recognize, diagnose and treat due in part to a lack of validated biomarkers. Our true understanding of the complex relationships that regulate fungal–host interactions is still in its infancy and, several questions remain. This includes if fungal epidemiology in bronchiectasis is uniform across countries, and to what extent immunopathological mechanisms—related to fungal airway infections—occurs in different disease states. Specific triggers to allergic or infectious responses to Aspergillus require further exploration. How transition occurs between allergic and invasive phenotypes and their respective biomarkers is also important. Whether anti-fungal treatment is warranted in all cases and what the optimal management strategy is, particularly when treatment should commence and its expected duration remains unclear. Further research is clearly necessary and should be prioritized to better understand the clinical effects and impact of Aspergillus in the setting of bronchiectasis.     

Increase in the Incidence of Allergy to Prosthetic Materials and Local Anesthetics: Immunophysiology and Laboratory Diagnostics of Intolerance

Combined analysis of drug sensitivity in vitro and in vivo is necessary for reliable diagnosis of the intolerance to prosthetic materials and local anesthetics as an intrinsic allergic reaction, especially in the cases of generally weak allergic reactions. Changes in peroxidase release from granulocytes in response to a corresponding substance is an effective in vitro test, and the provocative mucosal-gingival test (MGT) is used in vivo. During the past decade, a growth was observed in the population developing allergies to prosthetic materials and local anesthetics, which is expressed in an increased number of patients with intolerance to these materials against the background of increasing hyperresponsiveness to the drugs which have usually been tolerated well, as well as an increased proportion of patients with a polyvalent allergy to many prosthetic materials and anesthetics. At the same time, the amount of weak responses to drugs in the in vitro test has increased. Some of these patients exhibit a pathologic response to the given drug, which can be detected using the MGT. In most cases, polyvalent allergies to prosthetic materials or anesthetics and a pathological response accompanied by a weak in vitro reaction are found in patients with bronchial asthma and other chronic allergies, chronic candidosis of the oral cavity, and chronic Helicobacter and Giardia lamblia infections.     

Detection of Charcot-Leyden crystals by fluorescence microscopy of Papanicolaou-stained smears of sputum, bronchoalveolar lavage fluid, and bronchial secretions

Fluorescence microscopy was used to examine Papanicolaou-stained smears of sputum and other secretions from the respiratory tract. Under these conditions Charcot-Leyden crystals (CLC) appear as bright yellow-green fluorescing needles. the study was performed to determine the value of this approach for the diagnosis of allergic lung diseases. the time taken to detect the crystals was recorded and the sensitivity of fluorescence microscopy for the detection of CLC was compared with light microscopy of the same samples. the data show that fluorescence microscopy is superior to light microscopy for the detection of CLC. the characteristic needle-shaped crystal can be recognized easily and fragments of crystals could be easily identified. In doubtful cases of allergic lung diseases, fluorescence microscopy may be used to supplement light microscopy for the detection of Charcot-Leyden crystals.