April 17, 2013

Anaphylaxis to Topically Applied Sodium Fusidate


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Allergy Asthma Immunol Res. 2013 March; 5(2): 110–112.
Published online 2012 November 2. doi:  10.4168/aair.2013.5.2.110
PMCID: PMC3579090

Anaphylaxis to Topically Applied Sodium Fusidate

Mi-Ran Park,1,2 Do-Soo Kim,1,2 Jihyun Kim,1,2 and Kangmo Ahncorresponding author1,2
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Abstract

Fusidic acid is a bacteriostatic antibiotic that is effective primarily on gram-positive bacteria, such asStaphylococcus and Corynebacterium species. It is often topically applied to the skin, but is also given systemically as a tablet or injection. Allergic contact dermatitis, or urticaria, has been reported as a side effect of fusidic acid treatment, whereas anaphylaxis to topically administered fusidic acid has not been reported previously. A 16-year-old boy visited an outpatient clinic for further evaluation of anaphylaxis. He suffered abrasions on his arms during exercise, which were treated with a topical ointment containing sodium fusidate. Within 30 minutes, he developed urticaria and eyelid swelling, followed by a cough and respiratory difficulty. His symptoms were relieved by emergency treatment in a nearby hospital. To investigate the etiology, oral provocation with fusidate was performed. After 125 mg (1/2 tablet) of sodium fusidate was administered, he developed a cough and itching of the throat within 30 minutes, which was followed by chest discomfort and urticaria. Forced expiratory volume in 1 second (FEV1) dropped from 4.09 L at baseline to 3.50 L after challenge, although wheezing was not heard in his chest. After management with an inhaled bronchodilator using a nebulizer, chest discomfort was relieved and FEV1 rose to 3.86 L. The patient was directed not to use fusidate, especially on abrasions. Here we report the first case of anaphylaxis resulting from topical fusidic acid application to abrasions.
Keywords: Anaphylaxis, fusidic acid, ointment
Articles from Allergy, Asthma & Immunology Research are provided here courtesy of Korean Academy of Asthma, Allergy and Clinical Immunology and Korean Academy of Pediatric Allergy and Respiratory Disease

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Effect of In Vitro and In Vivo Anakinra on Cytokines Production in Schnitzler Syndrome


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PLoS One. 2013; 8(3): e59327.
Published online 2013 March 19. doi:  10.1371/journal.pone.0059327
PMCID: PMC3602040

Effect of In Vitro and In Vivo Anakinra on Cytokines Production in Schnitzler Syndrome

David Launay,1,2,* Virginie Dutoit-Lefevre,2,3 Emmanuel Faure,4 Olivier Robineau,1 Carine Hauspie,2,3 Vincent Sobanski,1,2 Eric Hachulla,1,2 Myriam Labalette,2,3 Pierre-Yves Hatron,1 and Sylvain Dubucquoi2,3
Emma H. Wilson, Editor
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Abstract

IL-1 receptor antagonist anakinra is usually highly efficient in Schnitzler syndrome (SS), a rare inflammatory condition associating urticaria, fever, and IgM monoclonal gammopathy. In this study, we aimed to assess lipopolysaccharide (LPS)-induced production of inflammatory cytokines by peripheral blood mononuclear cells (PBMCs) before and after 1 month of anakinra in patients with SS. LPS-induced production of IL-1β, IL-6 and TNFα was assessed by enzyme-linked immunosorbent assay with and without anakinra in vitro, and before and after 1 month (in vivo condition) of treatment in 2 patients with SS. Spontaneous production of IL-1β, IL-6 and TNF-α by PBMCs was similar in the patients and the healthy controls and was almost undetectable. Stimulation with LPS caused a higher release of cytokines from the patients than from the healthy controls. Before in vivo anakinra start, in vitro adjunction of anakinra reduced the high LPS-induced production of IL-1β and TNFα in both patients and of IL-6 in one patient. After 1 month of treatment with anakinra, while the patients had dramatically improved, there was also a marked reduction in LPS-induced cytokines production, which was almost normalized in one patient. This study shows an abnormal LPS-induced inflammatory cytokines production in SS, which can be decreased or even normalized by in vitro and in vivo anakinra.
Articles from PLoS ONE are provided here courtesy of Public Library of Science

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April 15, 2013

Influenza vaccine safety in patients with egg allergy



Vaccine Update
Influenza vaccine safety in patients with egg allergy 
Katie A. Croegaert, BS; Marwa M. Ithman, BA; Andrew L. Spurgin, BA; Susan S. Vos, BS, PharmD; Gary Milavetz, BS, PharmD
J Am Pharm Assoc. 2013;53:214-216. doi:10.1331/JAPhA.2013.13511
Article
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References
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Egg allergy is one of the most common food allergies in pediatric patients, with a parent-reported prevalence ranging from 1.6% to 2.6% of children in the general population. 1 An egg allergy early in life has been correlated with respiratory allergic symptoms (asthma and/or rhinitis). 2 In addition, adult patients with asthma are at a high risk for complications from influenza. 3 Until recently, all influenza vaccines had been prepared by inoculation of virus into chicken eggs. 4 In 2012, the Food and Drug Administration announced the approval of Flucelvax (Novartis), the first influenza vaccine produced using cultured animal cells instead of fertilized chicken eggs. 5 Therefore, understanding the current recommendations and concerns for influenza vaccination in patients with egg allergy is important.
Egg intolerance occurs when the body is not able to properly digest or reacts adversely to certain components of the egg. This happens if a person lacks specific enzymes or if he/she has a gastrointestinal reaction to a component of the egg product. People with egg intolerance usually can eat small amounts of egg without having a serious reaction. Individuals with food intolerance to egg typically can get the influenza vaccine without any risks or harm. 6
A true egg allergy is a systemic immune response and occurs when the body produces immunoglobulin E (IgE) antibodies to a protein in the egg. The individual must have been exposed to the substance causing the allergic reaction previously. The exposure could have been through diet or previous vaccination. IgE recognizes and binds an egg protein. With the allergen bound, the IgE crosslinks on the mast cell, releasing potent chemicals such as histamine and cytokines. 6 These chemicals mediate an allergic reaction in the body that can present as a variety of symptoms (e.g., urticaria, angioedema, pruritus, vomiting, diarrhea, dyspnea, wheezing, swelling of the mouth and throat). Although some symptoms of egg intolerance and allergy overlap, an egg allergy is much more serious. 6
The allergic response to exposure to the allergy-causing food usually occurs within minutes. Individuals react at varying levels of severity during a food allergy reaction. Classification of the allergic reaction is important when considering vaccination. Mild symptoms of egg allergy are defined as hives only. Severe symptoms (e.g., anaphylaxis) generally require epinephrine or emergency treatment and involve cardiovascular changes (e.g., hypotension), respiratory symptoms (e.g., wheezing, dyspnea), and gastrointestinal symptoms (e.g., nausea, vomiting). Individuals requiring epinephrine must be sent for further medical evaluation.
The Advisory Committee on Immunization Practices recommends administering the influenza vaccine with caution to patients with mild egg allergy; it is no longer contraindicated. Patients with a mild allergic reaction to egg can receive the injectable influenza vaccine with careful observation for 30 minutes after vaccination. Patients with a history of a severe allergic reaction to egg should be referred to a physician with expertise in managing allergic conditions. 4 The safety of live attenuated influenza vaccine (LAIV; FluMist—MedImmune) in patients with egg allergy has not been established; therefore, LAIV should not be used in this population at this time ( Figure 1). 7 In addition, procedures such as skin prick testing and dividing the injectable vaccine into a two-step dose have been found to be unnecessary. 4
VaccUpdateFigure1.jpeg
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Figure 1. Pharmacists' algorithm for patients with suspected egg allergy
aBased on state laws, employer policy, and/or protocol.
bPrecautions when administering influenza vaccine to a patient with presumed egg allergy include observation for 30 minutes and appropriate resuscitative equipment available.
Modified from: Centers for Disease Control and Prevention. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2011.www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a3.htm. Accessed January 24, 2013.
Ovalbumin is used as a marker for the egg protein content in influenza vaccines. A number of studies have reported the content of ovalbumin safely administered to egg-allergic patients to be as high as 1.4 µg/mL (0.7 µg/0.5 mL dose). Ovalbumin content in vaccines can vary among seasons, manufacturers, and lots. 4However, the maximum threshold of safe ovalbumin concentration is unknown. 8, 9
Unfortunately, a single source of information regarding ovalbumin content does not exist. Currently, three sources of information on ovalbumin content are available. The most readily available sources are the various package inserts. However, some manufacturers do not include ovalbumin content on the package insert. Second, pharmacists can contact the vaccine manufacturer and request ovalbumin content of the product. Third, the Centers for Disease Control and Prevention publishes vaccination recommendations each summer/fall with updated information for individuals with egg allergy. 4
Patients with mild egg allergy may be vaccinated by a pharmacist familiar with the potential manifestations of egg allergy and trained to manage an anaphylactic reaction. 4 Before administering the vaccine, a thorough medical history should be taken, with special attention focused on previous vaccines and the patient's response. Patients should be observed on site for at least 30 minutes following administration of the vaccine dose for signs and symptoms of allergic reaction. The pharmacist should be able to recognize a severe allergic reaction at its early stages and must have emergency resuscitative equipment available for immediate treatment in case of anaphylaxis. This should include injectable epinephrine and an oral antihistamine, such as diphenhydramine or hydroxyzine. 10 Because of the severe nature of the reaction, some community pharmacies may not be appropriate sites for this approach. Pharmacists should offer advice and refer patients with an egg allergy who may benefit from influenza immunization.
1
Eggesbø M, Botten G, Halvorsen R, Magnus P.  The prevalence of allergy to egg: a population-based study in young children.  Allergy.  2001; 56( 5): 403– 11. [CrossRef]
 
2
Tariq SM, Matthews SM, Hakim EA, Arshad SH.  Egg allergy in infancy predicts respiratory allergic disease by 4 years of age.  Pediatr Allergy Immunol.  2000; 11( 3): 162– 7. [CrossRef]
 
3
Ford ES, Mannino DM, Williams SG.  Asthma and influenza vaccination: findings from the 1999-2001 National Health Interview Surveys.  Chest.  2003; 124( 3): 783– 9. [CrossRef]
 
4
Centers for Disease Control and Prevention.  Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP): United States, 2012-13 influenza season. www.cdc.gov/mmwr/preview/mmwrhtml/mm6132a3.htm. Accessed January 24,  2013. 
 
5
Food and Drug Administration.  FDA approves first seasonal influenza vaccine manufactured using cell culture technology.www.fda.gov/newsevents/newsroom/pressannouncements/ucm328982.htm. Accessed January 24,  2013. 
 
6
NIAID-Sponsored Expert Panel.  Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-Sponsored Expert Panel.  J Allergy Clin Immunol.  2010; 126( 6 suppl): S1– 58. 
 
7
Vasu N, Ghaffari G, Craig ET, Craig TJ.  Adverse events associated with intranasal influenza vaccine in the United States.  Ther Adv Respir Dis.  2008; 2( 4): 193– 8. [CrossRef]
 
8
Howe LE, Conlon AS, Greenhawt MJ, Sanders GM.  Safe administration of seasonal influenza vaccine to children with egg allergy of all severities.  Ann Allergy Asthma Immunol.  2011; 106( 5): 446– 7.[CrossRef]
 
9
Upton JE, Hummel DB, Kasprzak A, Atkinson AR.  No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients.  Allergy Asthma Clin Immunol.  2012; 8:2. 
 
10
Greenhawt MJ, Li JT, Bernstein DI, et al. Administering influenza vaccine to egg allergic recipients: a focused practice parameter update.  Ann Allergy Asthma Immunol.  2011; 106( 1): 11– 6.[CrossRef]
 
Send your immunization questions to the JAPhA Contributing Editors who coordinate the Vaccine Update column:
This article is supported by a Cooperative Agreement provided by the Centers for Disease Control and Prevention (CDC) entitled “Pharmacists: Connecting, Communicating and Collaborating for Improved Community Health” (1U66 IP000114). The opinions expressed in this article do not represent the viewpoints of the CDC.

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April 14, 2013

An Intelligent System Approach for Asthma Prediction in Symptomatic Preschool Children


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Comput Math Methods Med. 2013; 2013: 240182.
Published online 2013 March 14. doi:  10.1155/2013/240182
PMCID: PMC3612481

An Intelligent System Approach for Asthma Prediction in Symptomatic Preschool Children

E. Chatzimichail, 1 ,* E. Paraskakis, 2 M. Sitzimi, 2 and A. Rigas 1
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Abstract

Objectives. In this study a new method for asthma outcome prediction, which is based on Principal Component Analysis and Least Square Support Vector Machine Classifier, is presented. Most of the asthma cases appear during the first years of life. Thus, the early identification of young children being at high risk of developing persistent symptoms of the disease throughout childhood is an important public health priority. Methods. The proposed intelligent system consists of three stages. At the first stage, Principal Component Analysis is used for feature extraction and dimension reduction. At the second stage, the pattern classification is achieved by using Least Square Support Vector Machine Classifier. Finally, at the third stage the performance evaluation of the system is estimated by using classification accuracy and 10-fold cross-validation. Results. The proposed prediction system can be used in asthma outcome prediction with 95.54 % success as shown in the experimental results.Conclusions. This study indicates that the proposed system is a potentially useful decision support tool for predicting asthma outcome and that some risk factors enhance its predictive ability.

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Effect of budesonide on fibroblast-mediated collagen gel contraction and degradation.


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J Inflamm Res. 2013; 6: 25–33.
Published online 2013 February 27. doi:  10.2147/JIR.S35136
PMCID: PMC3617814

Effect of budesonide on fibroblast-mediated collagen gel contraction and degradation

Qiuhong Fang,1,2 Nancy A Schulte,3 Huijung Kim,4 Tetsu Kobayashi,5 Xingqi Wang,2 Anna Miller-Larsson,6 Elisabet Wieslander,6 Myron L Toews,3 Xiangde Liu,2 and Stephen I Rennard2
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Abstract

Background

The balance between production and degradation of extracellular matrix is crucial in maintaining normal tissue structure. This study was designed to investigate the effect of budesonide on fibroblast-mediated tissue repair and remodeling.

Methods

Using human fetal lung fibroblasts in a three-dimensional collagen gel culture system, we investigated the effect of budesonide (1-1000 nM) on collagen gel contraction and degradation in the presence or absence of Inflammatory cytokines (interleukin-1β and tumor necrosis factor α; 5 ng/mL each) and, in order to activate latent proteases, serine protease trypsin 0.25 μg/mL. The effects of budesonide on metalloproteinase production and activation were also investigated.

Results

Inflammatory cytokines significantly inhibited collagen gel contraction mediated by lung fibroblasts. Budesonide counteracted the effect of cytokines in a concentration-dependent manner (to 50%, P<0.01). Budesonide 100 nM almost completely inhibited the release and mRNA expression of metalloproteinase-1, metalloproteinase-3, and metalloproteinase-9 induced by the cytokines (P< 0.05). Exposure to the cytokines plus trypsin increased collagen degradation and conversion of the metalloproteinases to lower molecular weight forms corresponding to their active forms. Budesonide blocked both enhanced collagen degradation (P< 0.01) and suppressed trypsin-mediated conversion of cytokine-induced metalloproteinase-9 and metalloproteinase-3 to lower molecular weight forms. Similar effects were observed with dexamethasone 1 μM, suggesting a class effect.

Conclusion

These findings demonstrate that budesonide directly modulates contraction of collagen gels and can decrease collagen degradation under Inflammatory conditions. The mechanism of this effect is through suppressing gene expression, release, and activation of metalloproteinases. By modulating the release and activity of metalloproteinases, inhaled budesonide may be able to modify airway tissue repair and remodeling.
Keywords: metalloproteinase, budesonide, tissue remodeling

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Roles of IL-22 in Allergic Airway Inflammation


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J Allergy (Cairo). 2013; 2013: 260518.
Published online 2013 February 21. doi:  10.1155/2013/260518
PMCID: PMC3594983

Roles of IL-22 in Allergic Airway Inflammation

Koichi Hirose,* Kentaro Takahashi, and Hiroshi Nakajima
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Abstract

IL-23- and IL-17A-producing CD4+ T cell (Th17 cell) axis plays a crucial role in the development of chronic inflammatory diseases. In addition, it has been demonstrated that Th17 cells and their cytokines such as IL-17A and IL-17F are involved in the pathogenesis of severe asthma. Recently, IL-22, an IL-10 family cytokine that is produced by Th17 cells, has been shown to be expressed at the site of allergic airway inflammation and to inhibit allergic inflammation in mice. In addition to Th17 cells, innate lymphoid cells also produce IL-22 in response to allergen challenge. Functional IL-22 receptor complex is expressed on lung epithelial cells, and IL-22 inhibits cytokine and chemokine production from lung epithelial cells. In this paper, we summarize the recent progress on the roles of IL-22 in the regulation of allergic airway inflammation and discuss its therapeutic potential in asthma.

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Swimming and Asthma: Differences between Women and Men


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J Allergy (Cairo). 2013; 2013: 520913.
Published online 2013 February 20. doi:  10.1155/2013/520913
PMCID: PMC3590744

Swimming and Asthma: Differences between Women and Men

Marja Kristiina Päivinen, 1 , 2 ,* Kari Lasse Keskinen, 3 and Heikki Olavi Tikkanen 1 , 2
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Abstract

Background and Aim. Asthma is common in endurance athletes including swimmers. Our aim was to study gender differences in asthma, allergy, and asthmatic symptoms in swimmers and investigate the effects of varying intensities of physical exercise on competitive swimmers with asthma. Methods. Three hundred highly trained swimmers (156 females and 144 males) were studied by a questionnaire. Their mean (±SD) ages were 17 ± 3 and 19 ± 3 years, and they had training history of 7 ± 2 and 7 ± 3 years in females and males, respectively. Gender differences in asthma, allergy, and respiratory symptoms were examined. Special attention was focused on asthmatic swimmers, their allergies and respiratory symptoms during swimming at different intensities. Results. The prevalence of physician-diagnosed asthma was 19% for females and males. No gender differences in asthma or respiratory symptoms were found. Males reported allergies significantly more often than females (P = 0.007). Gender difference was found in respiratory symptoms among swimmers with physician-diagnosed asthma because females reported symptoms significantly more often (P = 0.017) than males. Asthmatic females also reported symptoms significantly more often at moderate intensity swimming (P = 0.003) than males especially for coughing. Discussion. Gender difference in prevalence of asthma was not found in swimmers. However, allergy was reported significantly more by male swimmers. Male swimmers with asthma reported significantly more cases having family history of asthma, which may be a sign of selection of asthma-friendly sport. Moderate intensity swimming seemed to induce significantly more symptoms especially coughing in asthmatic females.

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