Research

Inhaled corticosteroid use is associated with increased circulating T regulatory cells in children with asthma

Anne Marie Singh^1,5, Paul Dahlberg⁴, Kristjan Burmeister⁴, Michael D Evans², Ronald Gangnon^2,3, Kathy A Roberg¹, Christopher Tisler¹, Douglas DaSilva¹, Tressa Pappas¹,Lisa Salazar¹, Robert F Lemanske^1,4, James E Gern^1,4 and Christine M Seroogy^1*

• *Corresponding author: Christine M Seroogy cmseroogy@wisc.edu

Author Affiliations

¹Departments of Pediatrics, University of Wisconsin, 1111 Highland Avenue, 4139 WIMR, Madison, WI 53705-2275, USA

²Departments of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA

³Departments of Population Health Sciences, University of Wisconsin, Madison, WI, USA

⁴Departments of Medicine, University of Wisconsin, Madison, WI, USA

⁵Northwestern Feinberg School of Medicine, Chicago, IL, USA

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Clinical and Molecular Allergy 2013, 11:1 doi:10.1186/1476-7961-11-1

The electronic version of this article is the complete one and can be found online at:http://www.clinicalmolecularallergy.com/content/11/1/1

Received:	24 October 2012
Accepted:	22 January 2013
Published:	25 January 2013

© 2013 Singh et al; licensee BioMed Central Ltd. 

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

T regulatory (Treg) cells are important in balancing immune responses and dysregulation of Treg cells has been implicated in the pathogenesis of multiple disease states including asthma. In this study, our primary aim was to determine Treg cell frequency in the peripheral blood of children with and without asthma. The secondary aim was to explore the association between Treg cell frequency with allergen sensitization, disease severity and medication use.

Methods

Peripheral blood mononuclear cells from healthy control subjects (N = 93) and asthmatic children of varying disease severity (N = 66) were characterized by multi-parameter flow cytometry.

Results

Our findings demonstrate that children with asthma had a significantly increased frequency of Treg cells compared to children without asthma. Using a multivariate model, increased Treg cell frequency in children with asthma was most directly associated with inhaled corticosteroid use, and not asthma severity, allergic sensitization, or atopic status of the asthma.

Conclusion

We conclude that low dose, local airway administration of corticosteroids is sufficient to impact the frequency of Treg cells in the peripheral blood. These data highlight the importance of considering medication exposure when studying Treg cells and suggest inhaled corticosteroid use in asthmatics may improve disease control through increased Treg cell frequency.

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Allergic conjunctivitis: a comprehensive review of the literature

ReviewAllergic conjunctivitis: a comprehensive review of the literature

Mario La Rosa, Elena Lionetti, Michele Reibaldi, Andrea Russo, Antonio Longo, Salvatore Leonardi, Stefania Tomarchio,Teresio Avitabile and Alfredo Reibaldi

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Italian Journal of Pediatrics 2013, 39:18 doi:10.1186/1824-7288-39-18

Published: 14 March 2013

Abstract (provisional)

Ocular allergy represents one of the most common conditions encountered by allergists and ophthalmologists. Allergic conjunctivitis is often underdiagnosed and consequently undertreated. Basic and clinical research has provided a better understanding of the cells, mediators, and immunologic events, which occur in ocular allergy. New pharmacological agents have improved the efficacy and safety of ocular allergy treatment. An understanding of the immunologic mechanisms, clinical features, differential diagnosis, and treatment of ocular allergy may be useful to all specialists who deal with these patients. The purpose of this review is to systematically review literature underlining all the forms classified as ocular allergy: seasonal allergic conjunctivitis, perennial allergic conjunctivitis, vernal keratoconjunctivitis, atopic keratocongiuntivitis, contact allergy, and giant papillary conjunctivitis.

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PLoS One. 2013; 8(3): e58484.

Published online 2013 March 11. doi:  10.1371/journal.pone.0058484

PMCID: PMC3594299

Mapping Systematic Reviews on Atopic Eczema—An Essential Resource for Dermatology Professionals and Researchers

Masaki Futamura,^1,2,* Kim S. Thomas,¹ Douglas J. C. Grindlay,³ Elizabeth J. Doney,¹ Donna Torley,⁴ and Hywel C. Williams¹

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Abstract

Background

Many research studies have been published on atopic eczema and these are often summarised in systematic reviews (SRs). Identifying SRs can be time-consuming for health professionals, and researchers. In order to facilitate the identification of important research, we have compiled an on-line resource that includes all relevant eczema reviews published since 2000.

Methods

SRs were searched for in MEDLINE (Ovid), EMBASE (Ovid), PubMed, the Cochrane Database of Systematic Reviews, DARE and NHS Evidence. Selected SRs were assessed against the pre-defined eligibility criteria and relevant articles were grouped by treatment category for the included interventions. All identified systematic reviews are included in the Global Resource of EczemA Trials (GREAT) database (www.greatdatabase.org.uk) and key clinical messages are summarised here.

Results

A total of 128 SRs reviews were identified, including three clinical guidelines. Of these, 46 (36%) were found in the Cochrane Library. No single database contained all of the SRs found. The number of SRs published per year has increased substantially over the last thirteen years, and reviews were published in a variety of clinical journals. Of the 128 SRs, 1 (1%) was on mechanism, 37 (29%) were on epidemiology, 40 (31%) were on eczema prevention, 29 (23%) were on topical treatments, 31 (24%) were on systemic treatments, and 24 (19%) were on other treatments. All SRs included searches of MEDLINE in their search methods. One hundred six SRs (83%) searched more than one electronic database. There were no language restrictions reported in the search methods of 52 of the SRs (41%).

Conclusions

This mapping of atopic eczema reviews is a valuable resource. It will help healthcare practitioners, guideline writers, information specialists, and researchers to quickly identify relevant up-to-date evidence in the field for improving patient care.

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PLoS One. 2013; 8(2): e56452.

Published online 2013 February 28. doi:  10.1371/journal.pone.0056452

PMCID: PMC3585340

Measuring Hordein (Gluten) in Beer – A Comparison of ELISA and Mass Spectrometry

Gregory J. Tanner,^#1,2,* Michelle L. Colgrave,^#2,3 Malcolm J. Blundell,^1,2 Hareshwar P. Goswami,^2,3 and Crispin A. Howitt^1,2

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Abstract

Background

Subjects suffering from coeliac disease, gluten allergy/intolerance must adopt a lifelong avoidance of gluten. Beer contains trace levels of hordeins (gluten) which are too high to be safely consumed by most coeliacs. Accurate measurement of trace hordeins by ELISA is problematic.

Methods

We have compared hordein levels in sixty beers, by sandwich ELISA, with the level determined using multiple reaction monitoring mass spectrometry (MRM-MS).

Results

Hordein levels measured by ELISA varied by four orders of magnitude, from zero (for known gluten-free beers) to 47,000 µg/mL (ppm; for a wheat-based beer). Half the commercial gluten-free beers were free of hordein by MS and ELISA. Two gluten-free and two low-gluten beers had zero ELISA readings, but contained significant hordein levels (p<0 .05="" 1="" 20="" a="" also="" approximately="" average="" barley="" beers="" but="" by="" commercial="" contained="" content="" elisa="" false="" gave="" had="" hordein="" less="" levels="" ms.="" ms="" near="" negatives="" of="" or="" p="" ppm="" proteins.="" readings="" respectively.="" several="" six="" than="" undeclared="" wheat="" with="" zero="">

Conclusions

ELISA results did not correlate with the relative content of hordein peptides determined by MS, with all barley based beers containing hordein. We suggest that mass spectrometry is more reliable than ELISA, as ELISA enumerates only the concentration of particular amino-acid epitopes; this may vary between different hordeins and may not be related to the absolute hordein concentration. MS quantification is undertaken using peptides that are specific and unique, enabling the quantification of individual hordein isoforms. This outlines the problem of relying solely on ELISA determination of gluten in beverages such as beer and highlights the need for the development of new sensitive and selective quantitative assay such as MS.

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Case report

Proposed new mechanism for food and exercise induced anaphylaxis based on case studies

Jennifer Yan Chen, Jaclyn Quirt and Jason Kihyuk Lee

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Allergy, Asthma & Clinical Immunology 2013, 9:11 doi:10.1186/1710-1492-9-11

Published: 20 March 2013

Abstract (provisional)

We present two cases of food and exercise-induced anaphylaxis (FEIA) in patients with a diagnosis of oral allergy syndrome (OAS) to the implicated foods. Patient A had FEIA attributed to fresh coriander and tomato and Patient B to fresh celery. These food allergens have been implicated in OAS and have structural antigenic similarity to that of birch and/or grass. Both patients? allergies were confirmed by fresh skin prick tests. In both cases, strenuous exercise was antecedent to the systemic anaphylaxis reaction and subsequent ingestion without exercise produced only local symptoms of perioral pruritus. We review the current proposed mechanisms for food and exercise induced anaphylaxis to oral allergens and propose a novel and more biologically plausible mechanism. We hypothesize that the inhibitory effects of exercise on gastric acid secretion decreases the digestion of oral allergens and preserves structural integrity, thereby allowing continued systemic absorption of the allergen whether it be profilins, lipid transfer proteins, or other antigenic determinants.

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Correlation between skin prick test and MAST-immunoblot results in patients with chronic rhinitis

Correlation between skin prick test and MAST-immunoblot results in patients with chronic rhinitis

Young Ha Kim, Byung Jae Yu, Woo Jin Kim, Ju Eun Kim, Guen-Ho Lee, Kyeong-Ah Lee, Jin Hee Cho

Abstract

Background and Objectives: The most reliable method for confirming the causative allergens of allergic rhinitis is the skin prick test, followed by the multiple allergen simultaneous test (MAST), which reportedly has acceptable sensitivity and specificity. This study was designed to confirm whether a novel MAST-immunoblot assay can reliably diagnose allergic rhinitis.

Methods: A retrospective chart review was conducted of chronic rhinitis patients who visited Yeouido St. Mary’s Hospital between January 2010 and June 2011.

Results: In total, 193 subjects (111 male, 82 female) were included, with a mean age of 30.08 years (range 6–77). The skin prick test detected 132 subjects as having one or more positive responses to allergens, and MAST detected 105 subjects as having one or more positive response. The sensitivity, specificity, and efficiency of the MAST assay were 63.16%, 65.57%, and 63.92%, respectively. Sensitivity, specificity and efficacy for common allergens were not high enough for MAST to replace skin prick test in detecting causative allergens. When correlation was defined as a difference between the classes of MAST and SPT of less than 2, the correlation rates for Dermatophagoides farina and Dermatophagoides pteronyssinus were 65.80% and 59.07%, respectively.

Conclusion: The correlation between MAST and the skin prick test is not sufficiently strong to use MAST as a diagnostic test to confirm the causative allergen in allergic rhinitis. Further studies to confirm the reliability of MAST should be conducted. 

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Severe and uncontrolled adult asthma is associated with vitamin D insufficiency and deficiency

Research

Severe and uncontrolled adult asthma is associated with vitamin D insufficiency and deficiency

Stephanie Korn, Marisa Hübner, Matthias Jung, Maria Blettner and Roland Buhl

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Respiratory Research 2013, 14:25 doi:10.1186/1465-9921-14-25

Published: 22 February 2013

Abstract (provisional)

Background

Vitamin D has effects on the innate and adaptive immune system. In asthmatic children low vitamin D levels are associated with poor asthma control, reduced lung function, increased medication intake, and exacerbations. Little is known about vitamin D in adult asthma patients or its association with asthma severity and control.

Methods

Clinical parameters of asthma control and 25-hydroxyvitamin D (25(OH)D) serum concentrations were evaluated in 280 adult asthma patients (mean +/- SD: 45.0 +/- 13.8 yrs., 40% male, FEV1 74.9 +/- 23.4%, 55% severe, 51% uncontrolled).

Conclusions

25(OH)D levels below 30 ng/ml are common in adult asthma and most pronounced in patients with severe and/or uncontrolled asthma, supporting the hypothesis that improving suboptimal vitamin D status might be effective in prevention and treatment of asthma.

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Is asthma a vanishing disease? A study to forecast the burden of asthma in 2022

Research article

Is asthma a vanishing disease? A study to forecast the burden of asthma in 2022

Teresa To, Sanja Stanojevic, Rachel Feldman, Rahim Moineddin, Eshetu G Atenafu, Jun Guan and Andrea S Gershon

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BMC Public Health 2013, 13:254 doi:10.1186/1471-2458-13-254

Published: 21 March 2013

Abstract (provisional)

Background

Recent evidence regarding temporal trends of asthma burden has not been consistent, with some countries reporting decreases in prevalence of asthma. In Ontario, the province in Canada with the highest population, the prevalence of asthma rose at a rate of 0.5% per year between 1996 and 2005. These estimates were based on population-based health services use data spanning more than a decade and provide a powerful source to forecast the trends of asthma burden. The objective of this study was to use observed population trends data of asthma incidence and prevalence to forecast future disease burden.

Methods

The Ontario Asthma Surveillance Information System (OASIS) used health administrative databases to identify and track all individuals in the province with asthma. Individuals with asthma identified between April 1, 1996 and March 31, 2010 were included. Exponential smoothing models were applied to annual data to project incidence to the year 2022, prevalence was estimated by applying the cumulative projected incidence to the projected population.

Results

While asthma incidence is falling, the absolute number of prevalent cases will continue to rise. We projected that almost 1 in 8 individuals in Ontario will have asthma by the year 2022, suggesting that asthma will continue to be a major burden on individuals and the health care system.

Conclusions

These projections will help inform health care planners and decision-makers regarding resource allocation to optimize asthma outcomes.

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