Clinical Predictors of Primary Immunodeficiency Diseases in Children

Original Article  Open Access

|  | Full Text    |    Allergy Asthma Immunol Res. 2013 Mar;5(2):88-95. English. Published online 2012 November 02.  http://dx.doi.org/10.4168/aair.2013.5.2.88  Copyright © 2013 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease Clinical Predictors of Primary Immunodeficiency Diseases in Children Shereen M. Reda,1 Dalia H. El-Ghoneimy,1 and Hanaa M. Afifi2 1Department of Pediatric Allergy and Immunology, Children's Hospital, Faculty of Medicine, Ain Shams University, Cairo, Egypt. 2Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.  Correspondence to: Shereen M. Reda, MD, PhD, Department of Pediatric Allergy and Immunology, Children's Hospital, Faculty of Medicine, Ain Shams University, 110 El-Merghany Street, Heliopolis, Cairo 11341, Egypt. Tel: +202-24187440; Fax: +202-22591561; Email: shereen.m.reda@gmail.com  Received May 10, 2012; Revised July 09, 2012; Accepted July 23, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose To promote awareness of primary immunodeficiency (PID), the "10 warning signs" of PID and an immunodeficiency-related (IDR) score were developed. However, their efficiency in identifying PID cases was not sufficiently evaluated in clinical practice. The objective of this study was to test the validity of the 10 warning signs and IDR score in identifying PID among children with recurrent infections at a tertiary pediatric hospital in Egypt. Methods A retrospective analysis of the medical records of 204 patients was performed. Of these patients, 92 had defined PID diseases and 112 were considered non-PID cases because investigations were inconclusive. Results Demonstrating two warning signs and an IDR score of 6 led to sensitivities of 94 and 66%, respectively, and specificities of 64 and 75%, respectively, in identifying PID cases. The strongest predictor of PID was family history that, if combined with the need for intravenous antibiotics, recurrent deep-seated infections, and failure to thrive, could identify 81% of PID patients. A family history of PID, sibling death, and/or parental consanguinity would predict 92% of combined immunodeficiencies, 92% of phagocyte defects, 87% of well-identified immunodeficiency syndromes, and 84% of antibody deficiency if the need for intravenous antibiotics is considered in the latter. Conclusions The 10 warning signs and IDR score do not aid in an early diagnosis of severe PID. Educational campaigns should target pediatricians aiming to increase PID awareness and to address family history of PID, parental consanguinity, and previous sibling death as key predictors of PID in communities with a high prevalence of consanguineous marriages.

The Influence of the Time and Temperature of Heat Treatment on the Allergenicity of Egg White Proteins

Original Article  Open Access

|  | Full Text    |    Allergy Asthma Immunol Res. 2013 Mar;5(2):96-101. English. Published online 2012 November 02.  http://dx.doi.org/10.4168/aair.2013.5.2.96  Copyright © 2013 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease The Influence of the Time and Temperature of Heat Treatment on the Allergenicity of Egg White Proteins Meeyong Shin,1 Youngshin Han,2 and Kangmo Ahn3 1Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea. 2Environmental Health Center for Atopic Dermatitis, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.  Correspondence to: Kangmo Ahn, MD, PhD, Department of Pediatrics, Sungkyunkwan University Samsung Medical Center, 80 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-3530; Fax: +82-2-3410-3669; Email:kmaped@skku.edu  Received July 27, 2012; Revised August 24, 2012; Accepted September 17, 2012. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose The present study was performed to determine the factor, either duration or the temperature of heat treatment, exerting maximal and significant influence on the composition and allergenicity of egg white (EW) proteins. Methods Raw EW and 4 kinds of heated EW (fried EW, boiled EW for 10 minutes, boiled EW for 30 minutes, and baked EW for 20 minutes at 170℃) were prepared, and subsequently protein extraction was carried out. The proteins were separated by SDS-PAGE, and then immunoglobulin E (IgE) immunoblots were performed with the sera of 7 egg-allergic patients. Furthermore, the antigenic activities of ovalbumin (OVA), ovomucoid (OM), and ovotransferrin (OT) in different EW samples were measured by inhibition enzyme-linked Immuno-sorbent assay (ELISA). Results In SDS-PAGE analysis, the intensity of the protein band at 45 kD (corresponding to OVA) decreased significantly in boiled EW (30 minutes) and baked EW, but no change was observed in the case of boiled EW for 10 minutes. In IgE immunoblots, the IgE response to 34-50 kD (OM and OVA) in boiled EW for 30 minutes decreased significantly, when compared with raw EW and other heated EWs. In inhibition ELISA, a significant decrease in the OVA antigenic activity was observed in boiled EW for 30 minutes amongst other heated EW samples. However, OM antigenic activity in all kinds of heated EW including boiled EW for 30 minutes did not reduce after heat treatment. The OT antigenic activity nearly disappeared in heated EWs except in the case of boiled EW for 10 minutes. Conclusions Amongst 4 kinds of heated EWs, the boiled EW for 30 minutes showed the most significant changes both in composition and reduction in allergenicity. Our results revealed that the duration of heat treatment had more influence on the composition and allergenicity of EW proteins than the temperature.

Intraoperative anaphylaxis: a case report of allergy to ranitidine

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

Intraoperative anaphylaxis: a case report of allergy to ranitidine

L. Antonicelli, G. Stagnozzi, C. Massaccesi, et al.

Abstract

We report the case of a 18-year old male who developed intraoperative anaphylaxis. The presence of specific IgE to ranitidine was documented. This case confirms the possibility of anaphylaxis at first exposure.

Keywords

Ranitidine, hypersensitivity, intraoperative anaphylaxis

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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.

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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)

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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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