Research article

Increased incidence of autoimmune markers in patients with combined pulmonary fibrosis and emphysema

Argyris Tzouvelekis, George Zacharis, Anastasia Oikonomou, Dimitrios Mikroulis, George Margaritopoulos, Anastasios Koutsopoulos, Antonis Antoniadis, Andreas Koulelidis, Paschalis Steiropoulos, Panagiotis Boglou, Matina Bakali,Marios Froudarakis and Demosthenes Bouros

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BMC Pulmonary Medicine 2013, 13:31 doi:10.1186/1471-2466-13-31

Published: 22 May 2013

Abstract (provisional)

Background

Combined pulmonary fibrosis and emphysema (CPFE) is an umbrella term encompassing upper lobe emphysema and lower lobe pulmonary fibrosis with pathogenesis elusive. The aim of our study was to investigate the incidence of autoimmune markers in patients with CPFE.

Methods

In this multicenter study we retrospectively evaluated records from patients with CPFE and IPF without emphysema. Baseline demographic characteristics, high-resolution computed tomography (HRCT), spirometry, histopathological, treatment, serum immunologic and survival data were investigated. B cell presence was estimated with CD20 immunostaining in representative lung biopsy samples from CPFE patients and control subjects.

Results

A statistically significant increased number of CPFE patients with elevated serum ANA with or without positive p-ANCA titers compared to patients with IPF without emphysema was observed. Patients with CPFE and positive autoimmune markers exhibited improved survival compared to patients with a negative autoimmune profile. A massive infiltration of clusters of CD20+ B cells forming lymphoid follicles within the fibrotic lung in CPFE patients with positive serum immunologic profile compared to patients with negative profile, was noted and positively correlated with improved survival.

Conclusions

A significant proportion of patients with CPFE may present with underlying auto-immune disorders that may reside insidiously and be associated with favorable prognosis. Early identification of these patients using a panel of auto-antibodies may lead to more targeted and effective therapeutic applications.

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Early fish introduction and neonatal antibiotics affect the risk of asthma into school age

Original Article

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1. Emma Goksör^*, 
2. Bernt Alm, 
3. Rolf Pettersson, 
4. Per Möllborg, 
5. Laslo Erdes,
6. Nils Åberg, 
7. Göran Wennergren

Article first published online: 11 APR 2013

DOI: 10.1111/pai.12078

© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd

Issue

Pediatric Allergy and Immunology

Volume 24, Issue 4, pages 339–344, June 2013

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Keywords:

• antibiotics;
• asthma;
• atopic asthma;
• cohort study;
• fish

Abstract

Background

The early introduction of fish has been reported to reduce the risk of wheezing disorder in early childhood, while broad-spectrum antibiotics in the first week have been associated with an increased risk. However, it is uncertain whether the effects remain into school age. The aim was to explore these risk factors for doctor-diagnosed asthma at 8 years.

Methods

Data were obtained from a prospective, longitudinal study of a cohort of children born in western Sweden. The parents answered questionnaires at 6 months and 1, 4.5 and 8 years of age. The response rate at 8 years was 80% of the questionnaires distributed (4051/5044), that is, 71% of the families entering the study (4051/5654).

Results

At 8 years, 5.7% reported current doctor-diagnosed asthma. Of these, 65% had atopic asthma and 35% non-atopic asthma. In the multivariate analysis, atopic heredity, male gender and own allergic disease during infancy were risk factors for doctor-diagnosed asthma at 8 years. In addition, the introduction of fish before the age of 9 months independently reduced the risk (adjusted OR 0.6; 95% CI 0.4–0.96), while broad-spectrum antibiotics in the first week independently increased the risk of current asthma at school age (aOR 2.3; 1.2–4.2). Regarding types of asthma, the effects were significant in atopic asthma but not in non-atopic asthma.

Conclusion

The early introduction of fish and neonatal antibiotic treatment influence the risk of asthma into school age. The significant effect on atopic asthma is of particular importance, as this phenotype is of major clinical significance.

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• PLoS One
• v.8(2); 2013
• PMC3579929

PLoS One. 2013; 8(2): e56773.

Published online 2013 February 22. doi:  10.1371/journal.pone.0056773

PMCID: PMC3579929

Mast Cell Dependent Vascular Changes Associated with an Acute Response to Cold Immersion in Primary Contact Urticaria

Joseph Meyer,¹ Alexander M. Gorbach,¹ Wei-Min Liu,¹ Nevenka Medic,² Michael Young,³ Celeste Nelson,² Sarah Arceo,² Avanti Desai,² Dean D. Metcalfe,² and Hirsh D. Komarow^2,*

Christian Schulz, Editor

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Abstract

Background

While a number of the consequences of mast cell degranulation within tissues have been documented including tissue-specific changes such as bronchospasm and the subsequent cellular infiltrate, there is little known about the immediate effects of mast cell degranulation on the associated vasculature, critical to understanding the evolution of mast cell dependent inflammation.

Objective

To characterize the microcirculatory events that follow mast cell degranulation.

Methodology/Principal Findings

Perturbations in dermal blood flow, temperature and skin color were analyzed using laser-speckle contrast imaging, infrared and polarized-light colorimetry following cold-hand immersion (CHI) challenge in patients with cold-induced urticaria compared to the response in healthy controls. Evidence for mast cell degranulation was established by documentation of serum histamine levels and the localized release of tryptase in post-challenge urticarial biopsies. Laser-speckle contrast imaging quantified the attenuated response to cold challenge in patients on cetirizine. We found that the histamine-associated vascular response accompanying mast cell degranulation is rapid and extensive. At the tissue level, it is characterized by a uniform pattern of increased blood flow, thermal warming, vasodilation, and recruitment of collateral circulation. These vascular responses are modified by the administration of an antihistamine.

Conclusions/Significance

Monitoring the hemodynamic responses within tissues that are associated with mast cell degranulation provides additional insight into the evolution of the acute inflammatory response and offers a unique approach to assess the effectiveness of treatment intervention.

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• The Annals of Occupational Hygiene
• Advance Access
• 10.1093/annhyg/mes110

Isocyanate Exposure Assessment Combining Industrial Hygiene Methods with Biomonitoring for End Users of Orthopedic Casting Products

1. RonALD L. Pearson¹,*, 
2. Perry W. Logan², 
3. Anita M. Kore², 
4. Constance M. Strom²,
5. Lisa M. Brosseau³ and 
6. Richard L. Kingston³,⁴

+Author Affiliations

1. ¹Environmental Health & Safety, Inc., St Paul, MN 55116, USA;
2. ²3M Company, 3M Center, St Paul, MN 55144-1000, USA;
3. ³University of Minnesota, Minneapolis, MN 55455, USA;
4. ⁴SafetyCall International, PLLC, Bloomington, MN 55425, USA

1. ↵*Author to whom correspondence should be addressed. Tel: +1-651-698-5852; fax: +1-651-698-2376; e-mail: rpearson@ehsinconline.com

• Received June 14, 2012.
• Accepted December 10, 2012.

Abstract

Previous studies have suggested a potential risk to healthcare workers applying isocyanate-containing casts, but the authors reached their conclusions based on immunological or clinical pulmonology test results alone. We designed a study to assess potential exposure to methylene diphenyl diisocyanate (MDI) among medical personnel applying orthopedic casts using two different application methods. Air, dermal, surface, and glove permeation sampling methods were combined with urinary biomonitoring to assess the overall risk of occupational asthma to workers handling these materials. No MDI was detected in any of the personal and area air samples obtained. No glove permeation of MDI was detected. A small proportion of surface (3/45) and dermal wipe (1/60) samples were positive for MDI, but were all from inexperienced technicians. Urinary metabolites of MDI [methylenedianiline (MDA)] were detected in three of six study participants prior to both a ‘dry’ and ‘wet’ application method, five of six after the dry method, and three of six after the wet method. All MDA results were below levels noted in worker or general populations. Our conclusion is that the risk of MDI exposure is small, but unquantifiable. Because there is some potential risk of dermal exposure, medical personnel are instructed to wear a minimum of 5-mil-thick (5 mil = 0.005 inches) nitrile gloves and avoid contact to unprotected skin. This could include gauntlets, long sleeves, and/or a laboratory coat.

1. Ann Occup Hyg (2013)
   doi: 10.1093/annhyg/mes110
   First published online: May 16, 2013

1. This article is Open Access
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5. Supplementary Data

Utility of penicillin allergy testing in patients presenting with a history of penicillin allergy

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Original Article  Open Access

|    Asia Pac Allergy. 2013 Apr;3(2):115-119. English. Published online 2013 April 26.  http://dx.doi.org/10.5415/apallergy.2013.3.2.115  Copyright © 2013. Asia Pacific Association of Allergy, Asthma and Clinical Immunology. Utility of penicillin allergy testing in patients presenting with a history of penicillin allergy Priyanka S Sagar,1 and Constance H Katelaris1,2 1School of Medicine, University of Western Sydney, Campbelltown, NSW 2560, Australia. 2Immunology Department, Campbelltown Hospital, Campbelltown, NSW 2560, Australia.  Correspondence: Priyanka S Sagar. School of Medicine, University of Western Sydney, Campbelltown, NSW 2560, Australia. Tel: +61-4-2565-3822, Fax: +61-2-9633-4108, Email: priyanka.s.sagar@gmail.com  Received January 09, 2013; Accepted March 23, 2013. 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 Background Current statistics show that approximately 10% of patients claim to be allergic to penicillin yet only 10% of these have demonstrable allergy. The most appropriate and cost-effective antibiotics are sometimes withheld on the basis of patient history of drug allergy. Objective Investigation of IgE hypersensitivity and delayed hypersensitivity in patients with a history of penicillin allergy to a teaching hospital allergy clinic. Methods Patients underwent skin prick and intradermal testing (IDT) with major and minor penicillin determinants. Those with negative skin tests were administered a three-day oral challenge. Demographic and clinical details about the reactions were noted. Results One hundred twenty eight patients underwent testing, of these, one hundred and ten had self-reported histories of penicillin allergy and eighteen were referred because of other antibiotic allergies. Seventeen patients with self-reported penicillin allergy had either positive skin tests or oral challenge results, corresponding to 15% of patients having proven allergy. None reacted on skin prick testing, four reacted to IDT, thirteen reacted to oral challenge (five immediate and eight delayed). Analysis of clinical histories showed that patients with a well-defined history of allergy and a history of anaphylaxis were more likely to have a positive test compared to patients with vague histories. Skin testing proved to be less sensitive than oral challenge. Conclusion A minority of patients presenting with a history of penicillin allergy have evidence of immune-mediated hypersensitivity (17/110, 15%) in this study. Of these, eight out of seventeen (47%) had delayed reactions, demonstrating the usefulness and discriminating power of objective testing, which must include three-day oral challenge. Discriminating factors for immune-mediated allergy from patient history were a clear description of the original reaction and a history of anaphylaxis. Negative allergy testing enables the use of penicillin as first-line treatment when necessary and this can significantly reduce costs of antibiotics. Keywords: Penicillin allergy, Skin prick testing, Oral challenge.  Full Text