Recent advances in diagnosis and therapy of allergic rhinitis and asthma in childhood

European Annals of Allergy and Clinical Immunology Vol 44, No 6 (2012) > Calamelli

Recent advances in diagnosis and therapy of allergic rhinitis and asthma in childhood

E. Calamelli, G. Ricci, A. Pession

Abstract

Some of the most recent advances in the diagnosis and treatment of childhood asthma and allergies are here reviewed. New perspectives have been opened by in vitro diagnostic tests for allergies based on a molecular approach and novel approaches to in vivo tests (SPT or FEno). A better characterization of the patients is opening new classifications of allergic asthma and rhinitis phenotypes, which allow personalizing management disease programs and targeting pharmacotherapy. Educational programs and better communication are improving awareness and compliance with medical prescriptions and adherence to guidelines. Increasing information is being acquired on the mechanisms, efficacy and safety profiles of anti-asthma and anti-allergic drugs, including antihistamines, inhaled corticosteroids, long acting beta agonists, antibiotics, anti-IgE antibodies. Progress in biotechnologies is fostering new approaches to allergen-specific immunotherapy (subcutaneous, sublingual) concerning the quality, mechanisms, efficacy and safety of allergen products.

Keywords

Allergen-specific immunotherapy, allergic rhinitis, asthma, children, inhaled corticosteroids, IgE, longacting beta-2 agonists, nitric oxide, omalizumab, skin prick test.

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Pattern of airway inflammation and remodelling in mild persistent atopic asthma and in mild persistent asthma related to Gastroesophageal Reflux

European Annals of Allergy and Clinical Immunology Vol 44, No 6 (2012) 

Pattern of airway inflammation and remodelling in mild persistent atopic asthma and in mild persistent asthma related to Gastroesophageal Reflux

R.W. Dal Negro, M. Guerriero, C. Micheletto

Abstract

Background: The increase of basement membrane thickness (BMT) represents a structural feature described as commonly characterizing airway remodelling in asthma, even if the non-atopic condition had been investigated only episodically from this point of view. Gastroesophageal-reflux is a pathological condition which can frequently cause and/or sustain asthma in non-atopic individuals. Objectives: The aim of the study was to measure BMT; some inflammatory mediators in BAL; cys-leucotrienes (LTE4) in urine; e-NO, and BHR to Methacholine (MCh) in mild atopic and in mild non-atopic, GER-related asthma. Methods: After their informed consent, 25 mild atopic (40.9 years ± 13.1 sd, FEV1=95.9% pred. ± 12.9 sd) and 39 non-atopic, GER-related asthmatics (57.3 years ± 14.2 ds, FEV1=101.3% pred. ± 12.2 sd), nonsmoker and of a comparable asthma duration, underwent measurements of basal lung function and bronchial response to MCh (PD20 FEV1); endobronchial biopsies and BAL (in the right middle lobe), and a 24-h gastroesophageal pHmetry. Results: Atopic and GER-related asthma showed two distinct patterns of airway inflammation. The eosinophilic contribution to airway inflammation was systematically prevailing in the former group, such as: EOS=10.7% ± 13.4 sd vs 2.0% ± 2.8 sd, p=0.001; ECP=344.9 mcg/l ± 635.9 sd vs 59.2 mcg/l ± 75.1 sd, p=0.001. Conclusions: Data from the present study are suggesting that persistent mild atopic and mild GER-related asthma seem to represent two distinct phenotypes of asthma in terms of airway remodelling, and in particular of BMT involvement.

Keywords

Airway remodelling; atopic asthma; GER-related asthma; mild asthma

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Bioactive proteins in breast milk. Full text.

Review Article

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Bioactive proteins in breast milk

1. Bo Lönnerdal^*

Article first published online: 1 MAR 2013

DOI: 10.1111/jpc.12104

© 2013 The Author. Paediatrics and Child Health Division (Royal Australasian College of Physicians)

Issue

Journal of Paediatrics and Child Health

Special Issue: Bioactive proteins in breast milk

Volume 49, Issue Supplement S1, pages 1–7, March 2013

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Keywords:

• infant formula;
• milk;
• human;
• prebiotics;
• protein;
• bioactive;
• recombinant protein

Abstract

Human milk contains many proteins that have been shown to be bioactive, but it is still not known whether these activities are exerted in breast-fed infants. These bioactivities include enzyme activities, enhancement of nutrient absorption, growth stimulation, modulation of the immune system and defence against pathogens. The antimicrobial activities are very diverse, ranging from stimulation of beneficial microorganisms (i.e. prebiotic effects), killing or inhibition of growth of pathogens, to mechanisms preventing attachment or invasion of harmful microorganisms. Among the bioactive proteins are lactoferrin, lysozyme, secretory immunoglobulin A, haptocorrin, lactoperoxidase, α-lactalbumin, bile salt stimulated lipase, β- and κ-casein, and tumour growth factor β. Human milk proteins may be largely resistant against digestion in the gastrointestinal tract, be partially digested into bioactive peptides, or be more or less completely digested and utilised as a source of amino acids. These events can be studied using an in vitro digestion model, which is useful for predicting results in human infants. Some bovine milk proteins, for example, lactoferrin and tumour growth factor β, may also resist proteolysis and be capable of exerting bioactivities similar to those of human milk proteins.

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• PMC3574757

J Allergy (Cairo). 2013; 2013: 672381.

Published online 2013 January 31. doi:  10.1155/2013/672381

PMCID: PMC3574757

An Important Role of Blood and Lymphatic Vessels in Inflammation and Allergy

Silvana Zgraggen, Alexandra M. Ochsenbein, and Michael Detmar^*

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Abstract

Angiogenesis and lymphangiogenesis, the growth of new vessels from preexisting ones, have received increasing interest due to their role in tumor growth and metastatic spread. However, vascular remodeling, associated with vascular hyperpermeability, is also a key feature of many chronic inflammatory diseases including asthma, atopic dermatitis, psoriasis, and rheumatoid arthritis. The major drivers of angiogenesis and lymphangiogenesis are vascular endothelial growth factor- (VEGF-)A and VEGF-C, activating specific VEGF receptors on the lymphatic and blood vascular endothelium. Recent experimental studies found potent anti-inflammatory responses after targeted inhibition of activated blood vessels in models of chronic inflammatory diseases. Importantly, our recent results indicate that specific activation of lymphatic vessels reduces both acute and chronic skin inflammation. Thus, antiangiogenic and prolymphangiogenic therapies might represent a new approach to treat chronic inflammatory disorders, including those due to chronic allergic inflammation.

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Mast Cells and IgE: From History to Today

REVIEW ARTICLE

Mast Cells and IgE: From History to Today

doi:10.2332/allergolint.13-RAI-0537

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Hirohisa Saito, Teruko Ishizaka and Kimishige Ishizaka [About this authors]

ABSTRACT
Role of mast cells in allergy had remained undetermined until the discovery of IgE in 1966. Then, IgE purified from many Liters of plasma, which had been donated from a patient with fatal myeloma, was distributed to researchers all over the world, and thus accelerated exploring the mechanisms involved in allergic reactions, particularly about the role of mast cells and basophils in the IgE-mediated reactions. Identification of mast cells as a progeny of a bone marrow hematopoietic stem cell in 1977 led us to successful in vitroculture of human mast cells. Along with the development of molecular biological techniques, the structure of the high affinity IgE receptor (FcεRI) was determined in 1989. These findings and subsequent investigations brought deeper understanding of IgE-mediated allergic diseases in the past half century, especially where mast cells are involved. We have now even obtained the information about whole genome expression of FcεRI-dependently activated mast cells. In sharp contrast to our comprehension of allergic diseases where IgE and mast cells are involved, the mechanisms involved in non-IgE-mediated allergic diseases or non-IgE-mediated phase of IgE-mediated diseases are almost left unsolved and are waiting for devoted investigators to reveal it.

KEY WORDS:basophils, FcεRI, hematopoietic stem cells, histamine, mast cells

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Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care

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Discussion Paper

Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care

Pedro Azevedo¹, Jaime Correia de Sousa², Jean Bousquet³, António Bugalho-Almeida⁴, Stefano R Del Giacco⁵, Pascal Demoly⁶, Tari Haahtela⁷, Tiago Jacinto⁸, Vanessa Garcia-Larsen⁹, Thys van der Molen¹⁰, Mário Morais-Almeida¹¹, Luis Nogueira-Silva¹², Ana M Pereira¹³, Miguel Román Rodríguez¹⁴, Bárbara G Silva¹⁵, Ioanna G Tsiligianni¹⁶, Hakan Yaman¹⁷, Barbara Yawn¹⁸, ^*João A Fonseca¹⁹, in collaboration with the WHO Collaborative Center for Asthma and Rhinitis, Montpellier

Abstract
Asthma frequently occurs in association with allergic rhinitis and a combined management approach has been suggested. The Control of Allergic Rhinitis and Asthma Test (CARAT) is the first questionnaire to assess control of both diseases concurrently. However, to have an impact on healthcare it needs to be disseminated and adopted. In this paper we discuss the dissemination of CARAT in different countries and its possible applications in primary care. At present, the adaptation of CARAT for use in different languages and cultures is being led by volunteer researchers and clinicians in 15 countries. Website and smartphone applications have been developed, and a free open model of distribution was adopted to contribute to the dissemination of CARAT. Examples of dissemination activities include distribution of leaflets and posters, educational sessions on the use of the questionnaire in the follow-up of patients, development of clinical studies, collaborations with professional organisations and health authorities, and the inclusion of CARAT in clinical guidelines. The adoption of innovations is an important challenge in healthcare today, and research on the degree of success of dissemination strategies using suitable methods and metrics is much needed. We propose that CARAT can be used in a range of settings and circumstances in primary care for clinical, research and audit purposes, within the overall aim of increasing awareness of the level of disease control and strengthening the partnership between patients and doctors in the management of asthma and rhinitis. 

Cite as: Azevedo P, Correia de Sousa J, Bousquet J, Bugalho-Almeida A, Del Giacco SR, Demoly P, Haahtela T, Jacinto T, Garcia-Larsen V, van der Molen T, Morais-Almeida M, Nogueira-Silva L, Pereira AM, Rodríguez MR, Silva BG, Tsiligianni IG, Yaman H, Yawn B, Fonseca JA, in collaboration with the WHO Collaborative Center for Asthma and Rhinitis, Montpellier. Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care. Prim Care Respir J 2013; Available from: URL: http://dx.doi.org/10.4104/pcrj.2013.00012

Keywords
Asthma, rhinitis, control, questionnaire, dissemination, cultural adaptation

* Corresponding author. João A Fonseca Tel: +351914767661 Fax: +351914767661 Email:fonseca.ja@gmail.com

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