The airport atmospheric environment: respiratory health at work

1. Léa Touri*, 
2. Hélène Marchetti*, 
3. Irène Sari-Minodier*,#¶,
4. Nicolas Molinari+ and 
5. Pascal Chanez§,f⇑

+Author Affiliations

1. ^*Aix-Marseille Université, Faculté de médecine de la Timone, Service de santé au travail, Marseille, ^#Aix-Marseille Université, UMR CNRS 7263 IMBE, Marseille, ^¶FR CNRS 3098 ECCOREV, Europôle de l’Arbois, Aix-en-Provence, and ⁺Service DIM, UMR 729 mistea, Hopital La Colombière, CHRU Montpellier, Montpellier, ^§Département des maladies respiratoires, Assistance Publique – Hôpitaux de Marseille, Marseille, and ^fLaboratoire d’immunologie INSERM CNRS U 1067, UMR7733, Aix-Marseille Université, Marseille, France.

1. P. Chanez, Département des maladies respiratoires, AP-HM, CNRS U 600, UMR6212, Boulevard de Sainte Marguerite, Marseille 13008, France. E-mail:Pascal.chanez@univ-med.fr

Abstract

Air traffic is increasing, raising concern about local pollution and its adverse health effects on the people living in the vicinity of large airports. However, the highest risk is probably occupational exposure due to proximity. Jet exhaust is one of the main concerns at an airport and may have a health impact, particularly on the respiratory tract. Current studies are neither numerous enough nor strong enough to prove this kind of association. Yet, more and more people work in airports, and occupational exposure to jet exhaust is a fact. The aim of this review was to evaluate the existing knowledge regarding the impact of airport pollution on respiratory health. We conducted systematic literature searches to examine workplace exposures.

• Airport
 
• air traffic
 
• jet exhaust
 
• occupational exposure
• respiratory problems
 
• respiratory tract

1. doi:10.1183/09059180.00005712
   
   Eur Respir Rev June 1, 2013 vol. 22 no. 128 124-130

1. » Abstract
2. Full Text
3. Full Text (PDF)
4. Disclosures

Footnotes

• Provenance
  Submitted article, peer reviewed.
• Statement of Interest
  Conflict of interest information can be found alongside the online version of the article at err.ersjournals.com

• Received September 21, 2012.
• Accepted October 7, 2012.

• ©ERS 2013

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What's this?

Study protocol

The diagnosis of food allergy: protocol for a systematic review

Karla Soares-Weiser, Sukhmeet S Panesar, Tamara Rader, Yemisi Takwoingi, Thomas Werfel, Antonella Muraro, Karin Hoffmann-Sommergruber, Graham Roberts and Aziz Sheikh

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Clinical and Translational Allergy 2013, 3:18 doi:10.1186/2045-7022-3-18

Published: 7 June 2013

Abstract (provisional)

Background

The literature on diagnostic tests for food allergy currently lacks clear consensus regarding the accuracy and safety of different investigative approaches. The European Academy of Allergy and Clinical Immunology is in the process of developing its Guideline for Food Allergy and Anaphylaxis, and this systematic review is one of seven inter-linked evidence syntheses that are being undertaken in order to provide a state-of-the-art synopsis of the current evidence base in relation to epidemiology, prevention, diagnosis and clinical management, and impact on quality of life, which will be used to inform the formulation of clinical recommendations. The aim of this systematic review will be to assess the diagnostic accuracy of tests aimed at supporting the clinical diagnosis of IgE-mediated food allergy.

Methods

The following databases from inception to September 30, 2012 will be searched for studies of diagnostic tests: Cochrane Library (Wiley&Sons); MEDLINE (OVID); Embase (OVID); CINAHL (Ebscohost); ISI Web of Science (Thomson Web of Knowledge); TRIP Database (web www.tripdatabase.com); and Clinicaltrials.gov (NIH web). These database searches will be supplemented by contacting an international panel of experts. Studies evaluating APT, SPT, specific-IgE, and component specific-IgE in participants of any age with suspected food allergy will be included. The reference standard will be DBPCFC in at least 50% of the participants. Studies will be quality assessed by using the QUADAS-2 instrument. We will report summary statistics such as sensitivity, specificity, and/or likelihood ratios. We will use the hierarchical summary ROC (HSROC) model to summarize the accuracy of each test and to compare the accuracy of two or more tests.

Discussion

Decisions on which tests to use need to be guided by availability of tests, populations being cared for, risks, financial considerations and test properties. This review will examine papers from around the world, covering children and adults with suspected food allergy in varying populations and concentrated on four type of tests: APT, SPT, specific-IgEs, and component specific-IgEs.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Research

Novel birch pollen specific immunotherapy formulation based on contiguous overlapping peptides

Céline Pellaton¹, Yannick Perrin¹, Caroline Boudousquié¹, Nathalie Barbier¹, Jacqueline Wassenberg¹, Giampietro Corradin³, Anne-Christine Thierry¹, Régine Audran¹, Christophe Reymond^1,2 and François Spertini^1*

• *Corresponding author: François Spertini francois.spertini@chuv.ch

Author Affiliations

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Clinical and Translational Allergy 2013, 3:17 doi:10.1186/2045-7022-3-17

Published: 1 June 2013

Abstract

Background

Synthetic contiguous overlapping peptides (COPs) may represent an alternative to allergen extracts or recombinant allergens for allergen specific immunotherapy. In combination, COPs encompass the entire allergen sequence, providing all potential T cell epitopes, while preventing IgE conformational epitopes of the native allergen.

Methods

Individual COPs were derived from the sequence of Bet v 1, the major allergen of birch pollen, and its known crystal structure, and designed to avoid IgE binding. Three sets of COPs were tested in vitro in competition ELISA and basophil degranulation assays. Their in vivo reactivity was determined by intraperitoneal challenge in rBet v 1 sensitized mice as well as by skin prick tests in volunteers with allergic rhinoconjunctivitis to birch pollen.

Results

The combination, named AllerT, of three COPs selected for undetectable IgE binding in competition assays and for the absence of basophil activation in vitro was unable to induce anaphylaxis in sensitized mice in contrast to rBet v 1. In addition no positive reactivity to AllerT was observed in skin prick tests in human volunteers allergic to birch pollen. In contrast, a second set of COPs, AllerT4-T5 displayed some residual IgE binding in competition ELISA and a weak subliminal reactivity to skin prick testing.

Conclusions

The hypoallergenicity of contiguous overlapping peptides was confirmed by low, if any, IgE binding activity in vitro, by the absence of basophil activation and the absence of in vivo induction of allergic reactions in mouse and human.

Trial registration

ClinicalTrials.gov NCT01719133

Keywords: 

IgE; Peptides; Immunotherapy; Birch; Pollen

Research

A phase 3 trial assessing the efficacy and safety of grass allergy immunotherapy tablet in subjects with grass pollen-induced allergic rhinitis with or without conjunctivitis, with or without asthma

Kevin Murphy, Sandra Gawchik, David Bernstein, Jens Andersen and Martin Rud Pedersen

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Journal of Negative Results in BioMedicine 2013, 12:10 doi:10.1186/1477-5751-12-10

Published: 1 June 2013

Abstract (provisional)

Background

Design and execution of immunotherapy trials for seasonal allergies may be complicated by numerous factors including variable allergy testing methods, pollen levels, and timing and intensity of other seasonal allergens. We evaluated grass allergy immunotherapy tablet (AIT) treatment in North American adults with grass pollen-induced allergic rhinitis with or without conjunctivitis (AR/C), with/without asthma.

Methods

Subjects age 18--65 with clinical history of grass pollen--induced AR/C, with/without asthma were randomized 1:1 to once-daily 2800 BAU Timothy grass AIT (oral lyophilisate, Phleum pratense, 75,000 SQ-T, containing approximately 15 mug of Phl p 5) or placebo. The AR/C symptom and medication scores were recorded daily. The primary end point was the average AR/C daily symptom score (DSS) during the entire grass pollen season (GPS). Ranked key secondary end points were Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, daily medication score (DMS), and percentage of well days, all over entire GPS. Safety was monitored through adverse event reporting.

Results

Efficacy analysis included 289 subjects. Over the entire GPS, mean DSS was 6% lower with AIT versus placebo (5.69 vs. 6.06), but this difference was not statistically significant (p = 0.3475) despite significantly higher immunological response in the grass AIT group. No significant between-group differences were seen for key secondary end points. In general, DSS was high before GPS began and no clear relationship between DSS and grass pollen counts was seen during GPS. In post hoc analysis of subjects with pre-seasonal DSS <=3, mean DSS and DMS were both significantly lower with grass AIT versus placebo (27%; p = 0.0327 and 68%; p = 0.0060, respectively). In this subgroup a relationship between DSS and grass pollen counts was observed. Grass AIT was generally well tolerated, with no events of anaphylactic shock or respiratory compromise.

Conclusions

In this trial, 2800 BAU grass AIT did not demonstrate significant symptom improvement versus placebo. Lack of relationship between pollen count and symptom score in the study population, and post hoc findings among subjects with low pre-seasonal symptoms, suggest that the symptoms reported in this study were not primarily reflective of the effects of grass pollen exposure.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Low dose intravenous immunoglobulins and steroids in toxic epidermal necrolysis

ORIGINAL ARTICLE
Year : 2013  |  Volume : 79  |  Issue : 4  |  Page : 506-511

Low dose intravenous immunoglobulins and steroids in toxic epidermal necrolysis: A prospective comparative open-labelled study of 36 cases

Soumya Jagadeesan¹, K Sobhanakumari¹, Sadeep Melethil Sadanandan¹, Sheeba Ravindran¹, Manjula Velikkakathu Divakaran², Lissy Skaria¹, George Kurien^1
1 Department of Dermatology and Venereology, Government Medical College, Kottayam, Kerala, India
² Department of Community Medicine, Government Medical College, Kottayam, Kerala, India

Date of Web Publication

5-Jun-2013

Correspondence Address:
K Sobhanakumari
Department of Dermatology, Government Medical College, Kottayam, Kerala - 686008
India

DOI: 10.4103/0378-6323.113080

Abstract

Background: Toxic epidermal necrolysis (TEN) is a severe adverse drug reaction associated with high mortality. Though different modalities of treatment are advocated, there is no consensus regarding specific therapy. Corticosteroids have shown conflicting results and for high dose intravenous immunoglobulins (IVIG), cost is a limiting factor. Aim: To find out the effectiveness of combination therapy with low-dose IVIG and steroids versus steroids alone in our TEN patients. Methods: After obtaining Ethical Committee approval, 36 consecutive TEN patients (2008-2012) were alternately allocated to 2 groups - Group A was given combination of low-dose IVIG (0.2-0.5 g/kg) and rapidly tapering course of steroids (intravenous dexamethasone 0.1- 0.3 mg/kg/day tapered in 1-2 weeks) while Group B was given same dose of steroids alone. Outcome parameters assessed were time taken for arrest of disease progression, time taken for re-epithelization, duration of hospital stay and mortality rates. Results: Both groups had 18 patients. Baseline characteristics like age, sex ratio, SCORTEN, body surface area involvement and treatment interval were comparable. Time for arrest of disease progression and for re-epithelization was significantly lowered in Group A (P = 0.0001, P = 0.0009 respectively). Though duration of hospital stay and deaths were less in Group A, difference was not statistically significant. SCORTEN based standardized mortality ratio (SMR) analysis revealed that combination therapy reduced the probability of dying by 82% (SMR = 0.18 ± 0.36) and steroids by 37% (SMR = 0.63 ± 0.71). Difference in SMR was statistically significant (P = 0.00001). No significant side effects due to either modality were found in any of the patients. Conclusion: Combination therapy with low-dose IVIG and steroids is more effective in terms of reduced mortality and faster disease resolution when compared to steroids alone in TEN.

Keywords: Combination therapy, low dose intravenous immunoglobulins, toxic epidermal necrolysis

How to cite this article: Jagadeesan S, Sobhanakumari K, Sadanandan SM, Ravindran S, Divakaran MV, Skaria L, Kurien G. Low dose intravenous immunoglobulins and steroids in toxic epidermal necrolysis: A prospective comparative open-labelled study of 36 cases. Indian J Dermatol Venereol Leprol 2013;79:506-11

How to cite this URL: Jagadeesan S, Sobhanakumari K, Sadanandan SM, Ravindran S, Divakaran MV, Skaria L, Kurien G. Low dose intravenous immunoglobulins and steroids in toxic epidermal necrolysis: A prospective comparative open-labelled study of 36 cases. Indian J Dermatol Venereol Leprol [serial online] 2013 [cited 2013 Jun 6];79:506-11. Available from: http://www.ijdvl.com/text.asp?2013/79/4/506/113080   Article in PDF (959 KB)    Citation Manager    Access Statistics    Reader Comments