Knowledge of Their Own Allergic Sensitizations in Asthmatic Patients and Its Impact on the Level of Asthma Control

Arch Bronconeumol. 2013 Jul;49(7):289-96. doi: 10.1016/j.arbres.2013.02.004.

Àlex Roger^a,, Rosa Vázquez^b, Carlos Almonacid^c, Alicia Padilla^d, José Serrano^e, Mercedes García-Salmones^f, Fernando Molina^g, Celia Pinedo^h, Montserrat Torrejónⁱ, César Picado^j, Antolín López-Viña^k, Vicente Plazaⁱ

^a Servicio de Neumología, Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain
^b Unidad de Neumología, Hospital Infanta Elena, Huelva, Spain
^c Sección de Neumología, Hospital Universitario de Guadalajara, Guadalajara, Spain
^d Unidad de Neumología, Hospital Costa del Sol, Marbella, Málaga, Spain
^e Unidad de Neumología, Hospital Comarcal de Inca, Inca, Mallorca, Islas Baleares, Spain
^f Unidad de Neumología, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
^g Servicio de Neumología, Hospital Modelo, A Coruña, Spain
^h Servicio de Neumología, Hospital Clínico San Carlos, Madrid, Spain
ⁱ Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
^j Servicio de Neumología, Hospital Clínic i Provincial, Barcelona, Spain
^k Servicio de Neumología, Hospital Universitario Puerta de Hierro, Madrid, Spain

Keywords

Asthma. Asthma/prevention and control. Asthma/immunology. Allergy and immunology. Allergens/diagnostic use. Air pollutants/immunology. Skin tests. Environmental medicine. Health education.

Abstract

Background

Asthma guidelines recommend the adoption of allergen avoidance measures (AAM). To do so, patients need to know their own allergies. However, this degree of knowledge has not yet been assessed. The aims of this study were to determine, in allergic asthma patients: (i) the degree of knowledge of their own allergic sensitizations; (ii) the percentage of those who knew all their allergies and, in addition, adopted AAM against all of them, and (iii) the possible impact of this degree of knowledge on the level of asthma control.

Patients and methods

Descriptive, prospective and multicentre study, including 147 patients from 9 Respiratory Medicine outpatient clinics. After confirming the previous allergic asthma diagnosis, a questionnaire was completed. It included asthma control and severity levels, results of previous allergy tests, and the description and number of allergic sensitizations known by the patients and AAM followed.

Results

Only 72 (49%) patients knew all their allergic sensitizations and only 48 (33%) were also following AAM against all the allergens to which they were allergic. No relationship was established between the degree of knowledge of their own allergies and the level of asthma control (P=.544).

Conclusions

Overall knowledge about the allergic nature of their disease among asthmatic patients attending Spanish Respiratory Medicine Departments is inadequate. Furthermore, a higher degree of knowledge of their allergies does not seem to lead, by itself, to better asthma control. Both findings seem to question the effectiveness of current educational strategies in this field and consequently, and they should be revised.

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• PLoS One
• v.8(7); 2013
• PMC3722239

PLoS One. 2013; 8(7): e69900.

Published online 2013 July 24. doi:  10.1371/journal.pone.0069900

PMCID: PMC3722239

Most Personal Exposure to House Dust Mite Aeroallergen Occurs during the Day

Euan R. Tovey,1,2,* Christiana M. Willenborg,3 Daniele A. Crisafulli,1 Janet Rimmer,1,2 and Guy B. Marks2,4

Qinghua Sun, Editor

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Abstract

Background

The bed is commonly regarded as the main site of house dust mite exposure; however this has not been directly established by continuous measurements. The objective of this study was to determine the pattern of personal exposure to mite aeroallergen over 24 hours.

Methods

12 adults each collected 9 sequential samples (8 during the day, mean 115 mins, and one overnight, mean 514 mins) over 24 hours using a portable air-pump (2L/min) connected to an IOM filter located on the shoulder during the day and on the bed head overnight. Samples were analysed for mite allergen Der p 1 by ELISA. Location and activity were recorded. A mixed model analysis was performed to determine exposure as a function of 14 categories of activity.

Results

Personal aeroallergen exposure differed widely over time, both within and between subjects. The highest average exposure (1117 pg/m3, 95% CI: 289-4314) occurred on public transport and the lowest overnight in bed (45 pg/m3, 95% CI: 17-17), which contributed only 9.8% (95% CI: 4.4%-15.1%) of total daily exposure. Aeroallergens were not related to bed reservoirs.

Conclusion

The study challenges the current paradigm that the bed is the main site of HDM exposure and instead suggests most exposure occurs in association with domestic activity and proximity to other people. Effective mite interventions, designed to improve asthma outcomes, need to first identify and then address the multiple sources of aeroallergen exposure.

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Abstract

Background

The bed is commonly regarded as the main site of house dust mite exposure; however this has not been directly established by continuous measurements. The objective of this study was to determine the pattern of personal exposure to mite aeroallergen over 24 hours.

Methods

12 adults each collected 9 sequential samples (8 during the day, mean 115 mins, and one overnight, mean 514 mins) over 24 hours using a portable air-pump (2L/min) connected to an IOM filter located on the shoulder during the day and on the bed head overnight. Samples were analysed for mite allergen Der p 1 by ELISA. Location and activity were recorded. A mixed model analysis was performed to determine exposure as a function of 14 categories of activity.

Results

Personal aeroallergen exposure differed widely over time, both within and between subjects. The highest average exposure (1117 pg/m3, 95% CI: 289-4314) occurred on public transport and the lowest overnight in bed (45 pg/m3, 95% CI: 17-17), which contributed only 9.8% (95% CI: 4.4%-15.1%) of total daily exposure. Aeroallergens were not related to bed reservoirs.

Conclusion

Regulatory T cells use “Itch” to control asthma

Published in Volume 123, Issue 11 (November 1, 2013)
J Clin Invest. 2013;123(11):4576–4578. doi:10.1172/JCI72477. 
Copyright © 2013, American Society for Clinical Investigation

Commentary

WanJun Chen

Mucosal Immunology Section, OPCB, NIDCR, NIH, Bethesda, Maryland, USA.

Address correspondence to: WanJun Chen, Mucosal Immunology Section, NIDCR, NIH, 30 Convent Dr., Bethesda, Maryland 20892, USA. Phone: 301.435.7168; Fax: 301.402.1064; E-mail: wchen@dir.nidcr.nih.gov.

First published October 25, 2013

Regulatory T cells (Tregs) control type 2 T helper cell–mediated (Th2-mediated) lung inflammation, but the molecular mechanisms by which Tregs execute this activity remain elusive. In this issue of the JCI, Jin et al. reveal that Itch, a HECT-type E3 ubiquitin ligase in Tregs, plays a specific role in restraining Th2 cell responses. This finding has important implications for understanding the pathogenesis of allergy and asthma.

See the related article beginning on page 4923.

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• J Clin Diagn Res
• v.7(12); Dec 2013
• PMC3919411

J Clin Diagn Res. 2013 December; 7(12): 2683–2685.

Published online 2013 December 15. doi:  10.7860/JCDR/2013/6635.3732

PMCID: PMC3919411

Role of Reactive Oxygen Species and Antioxidants in Atopic Dermatitis

N. Sivaranjani,1 S. Venkata Rao,2 and G. Rajeev3

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Abstract

Background: In humans, oxidative stress is involved in many diseases such as atherosclerosis, Parkinson’s disease, heart failure, myocardial infarction, Alzheimer’s disease, Fragile X syndrome and chronic fatigue syndrome. Atopic dermatitis (AD), also known as atopic eczema, is a non-contagious, relapsing inflammatory skin disease which is characterized by eczema and pruritus. The skin reacts abnormally to irritants, food and environmental allergens and it becomes very itchy, which leads to scratching, redness and flaky skin. Very little study has been done to find out the relationship between oxidative stress and Atopic dermatitis.

Aim: The aim of our work was to evaluate the status of oxidative stress in patients of Atopic dermatitis in comparison with healthy control subjects.

Material and Methods: Twenty five patients of known Atopic dermatitis and 25 normal healthy controls of same age group were included in the study. Estimations of oxidants like Malondialdehyde (MDA), enzymatic antioxidants like Superoxide dismutase (SOD), Catalase, Glutathione peroxidase (GPX) and non-enzymatic antioxidants like reduced Glutathione (GSH), Vitamin A, Vitamin E and Vitamin C were done to assess the oxidative stress.

Results: Atopic dermatitis patients were more prone to damage caused by Reactive Oxygen Species (ROS) or Oxidants, than controls, which was evident from an increase of Malondialdehyde and a decrease of enzymatic and non enzymatic Antioxidants.

Conclusion: Antioxidants may possibly be beneficial in the treatment of Atopic dermatitis, which must be substantiated by further studies.

Keywords: Reactive oxygen species (ROS), Oxidative stress, Antioxidants, Atopic dermatitis

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Abstract

Background: In humans, oxidative stress is involved in many diseases such as atherosclerosis, Parkinson’s disease, heart failure, myocardial infarction, Alzheimer’s disease, Fragile X syndrome and chronic fatigue syndrome. Atopic dermatitis (AD), also known as atopic eczema, is a non-contagious, relapsing inflammatory skin disease which is characterized by eczema and pruritus. The skin reacts abnormally to irritants, food and environmental allergens and it becomes very itchy, which leads to scratching, redness and flaky skin. Very little study has been done to find out the relationship between oxidative stress and Atopic dermatitis.

Aim: The aim of our work was to evaluate the status of oxidative stress in patients of Atopic dermatitis in comparison with healthy control subjects.

Material and Methods: Twenty five patients of known Atopic dermatitis and 25 normal healthy controls of same age group were included in the study. Estimations of oxidants like Malondialdehyde (MDA), enzymatic antioxidants like Superoxide dismutase (SOD), Catalase, Glutathione peroxidase (GPX) and non-enzymatic antioxidants like reduced Glutathione (GSH), Vitamin A, Vitamin E and Vitamin C were done to assess the oxidative stress.

Results: Atopic dermatitis patients were more prone to damage caused by Reactive Oxygen Species (ROS) or Oxidants, than controls, which was evident from an increase of Malondialdehyde and a decrease of enzymatic and non enzymatic Antioxidants.

Conclusion: Antioxidants may possibly be beneficial in the treatment of Atopic dermatitis, which must be substantiated by further studies.

Keywords: 

• Sci Rep
• v.3; 2013
• PMC3725475

Sci Rep. 2013; 3: 2301.

Published online 2013 July 29. doi:  10.1038/srep02301

PMCID: PMC3725475

Thymic Stromal Lymphopoietin Induces Migration in Human Airway Smooth Muscle Cells

Naresh Singh Redhu,1,2,3 Lianyu Shan,1,2 Hesam Movassagh,1 and Abdelilah S. Gounnia,1

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Abstract

Airway remodeling due to increased airway smooth muscle (ASM) mass, likely due to enhanced migration and proliferation, has been shown to be highly associated with decline in lung function in asthma. Thymic stromal lymphopoietin (TSLP) is an IL-7-like, pro-allergic cytokine that has been shown to be necessary and sufficient for the development of allergic asthma. Human ASM (HASM) cells express TSLP receptor (TSLPR), the activation of which leads to enhanced release of proinflammatory mediators such as IL-6, CCL11/eotaxin-1, and CXCL8/IL-8. We show here that TSLP induces HASM cell migration through STAT3 activation since lentiviral-shRNA inhibition of STAT3 abrogated the TSLP-induced cell migration. Moreover, TSLP induced multiple cytoskeleton changes in HASM cells such as actin polymerization, cell polarization, and activation of small GTPase Rac1. Collectively, our data suggest a pro-migratory function of TSLP in ASM remodeling and provides better rationale for targeting TSLP/TSLPR pathway for therapeutic approaches in allergic asthma.

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• Drug Des Devel Ther
• v.8; 2014
• PMC3923619

Drug Des Devel Ther. 2014; 8: 197–207.

Published online 2014 February 7. doi:  10.2147/DDDT.S49409

PMCID: PMC3923619

Omalizumab, an anti-immunoglobulin E antibody: state of the art

Cristoforo Incorvaia,1 Marina Mauro,2 Marina Russello,2 Chiara Formigoni,3 Gian Galeazzo Riario-Sforza,1 and Erminia Ridolo4

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Abstract

A large number of trials show that the anti-immunoglobulin (Ig) E antibody omalizumab is very effective in patients with severe allergic asthma. This is acknowledged in consensus documents. The drug also has a good safety profile and a pharmacoeconomic advantage due to a reduction in the number of hospitalizations for asthma attacks. In recent years, some studies have shown that omalizumab is effective also in nonallergic asthma. Effects on the complex signaling mechanisms leading to activation of effector cells and to mediator release may account for this outcome. Indeed, omalizumab has been reported to be effective in a number of IgE-mediated and non-IgE-mediated disorders. Concerning the former, clinical efficacy has been observed in rhinitis, allergic bronchopulmonary aspergillosis, latex allergy, atopic dermatitis, allergic urticaria, and anaphylaxis. In addition, omalizumab has been demonstrated to be able to prevent systemic reactions to allergen immunotherapy, thus enabling completion of treatment in patients who otherwise would have to stop it. Concerning non-IgE-mediated disorders, omalizumab has been reported to be effective in nasal polyposis, autoimmune urticaria, chronic idiopathic urticaria, physical urticaria, idiopathic angioedema, and mastocytosis. Current indications for treatment with omalizumab are confined to severe allergic asthma. Consequently, any other prescription can only be off-label. However, it is reasonable to expect that the use of omalizumab will be approved for particularly important indications, such as anaphylaxis, in the near future.

Keywords: hypersensitivity, immunoglobulin E, anti-IgE, omalizumab, asthma, atopic dermatitis, anaphylaxis, urticaria, mastocytosis

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Abstract

A large number of trials show that the anti-immunoglobulin (Ig) E antibody omalizumab is very effective in patients with severe allergic asthma. This is acknowledged in consensus documents. The drug also has a good safety profile and a pharmacoeconomic advantage due to a reduction in the number of hospitalizations for asthma attacks. In recent years, some studies have shown that omalizumab is effective also in nonallergic asthma. Effects on the complex signaling mechanisms leading to activation of effector cells and to mediator release may account for this outcome. Indeed, omalizumab has been reported to be effective in a number of IgE-mediated and non-IgE-mediated disorders. Concerning the former, clinical efficacy has been observed in rhinitis, allergic bronchopulmonary aspergillosis, latex allergy, atopic dermatitis, allergic urticaria, and anaphylaxis. In addition, omalizumab has been demonstrated to be able to prevent systemic reactions to allergen immunotherapy, thus enabling completion of treatment in patients who otherwise would have to stop it. Concerning non-IgE-mediated disorders, omalizumab has been reported to be effective in nasal polyposis, autoimmune urticaria, chronic idiopathic urticaria, physical urticaria, idiopathic angioedema, and mastocytosis. Current indications for treatment with omalizumab are confined to severe allergic asthma. Consequently, any other prescription can only be off-label. However, it is reasonable to expect that the use of omalizumab will be approved for particularly important indications, such as anaphylaxis, in the near future.

Keywords: 

Variably severe systemic allergic reactions after consuming foods with unlabelled lupin flour: a case series

Case report

Amolak AS Bansal, Mihir M Sanghvi, Rhea A Bansal and Grant R Hayman

Author Affiliations

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Journal of Medical Case Reports 2014, 8:55  doi:10.1186/1752-1947-8-55

Published: 16 February 2014

Abstract (provisional)

Introduction

Lupin allergy remains a significant cause of food-induced allergic reactivity and anaphylaxis. Previous work suggests a strong association with legume allergy and peanut allergy in particular. Both doctors and the public have little awareness of lupin as an allergen.

Case presentation

Case 1 was a 41-year-old Caucasian woman without previous atopy who developed facial swelling, widespread urticaria with asthma and hypotension within minutes of eating a quiche. Her lupin allergy was confirmed by both blood and skin tests. Her lupin sensitivity was so severe that even the miniscule amount of lupin allergen in the skin testing reagent produced a mild reaction.

Case 2 was a 42-year-old mildly atopic Caucasian woman with three episodes of worsening urticaria and asthma symptoms over 6 years occurring after the consumption of foods containing lupin flour. Blood and skin tests were positive for lupin allergy.

Case 3 was a 38-year-old Caucasian woman with known oral allergy syndrome who had two reactions associated with urticaria and vomiting after consuming foods containing lupin flour. Skin testing confirmed significant responses to a lupin flour extract and to one of the foods inducing her reaction.

Case 4 was a 54-year-old mildly atopic Caucasian woman with a 7 year history of three to four episodes each year of unpredictable oral tingling followed by urticaria after consuming a variety of foods. The most recent episode had been associated with vomiting. She had developed oral tingling with lentil and chickpeas over the previous year. Skin and blood tests confirmed lupin allergy with associated sensitivity to several legumes.

Conclusions

Lupin allergy can occur for the first time in adults without previous atopy or legume sensitivity. Although asymptomatic sensitisation is frequent, clinical reactivity can vary in severity from severe anaphylaxis to urticaria and vomiting. Lupin allergy may be confirmed by skin and specific immunoglobulin E estimation. Even skin testing can cause symptoms in some highly sensitive individuals. The diagnosis of lupin allergy in adults may be difficult because it is frequently included as an undeclared ingredient. Better food labelling and medical awareness of lupin as a cause of serious allergic reactions is suggested.

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

• Clin Med Res
• v.11(2); Jun 2013
• PMC3692389

Clin Med Res. 2013 June; 11(2): 54–65.

Published online 2013 April 11. doi:  10.3121/cmr.2013.1113

PMCID: PMC3692389

Patient Characteristics Associated with Medication Adherence

Sharon J Rolnick, PhD, MPH,* Pamala A. Pawloski, PharmD,* Brita D. Hedblom, BS,* Stephen E. Asche, MA,* andRichard J. Bruzek, PharmD†

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ABSTRACT

Objective

Despite evidence indicating therapeutic benefit for adhering to a prescribed regimen, many patients do not take their medications as prescribed. Non-adherence often leads to morbidity and to higher health care costs. The objective of the study was to assess patient characteristics associated with medication adherence across eight diseases.

Design

Retrospective data from a repository within an integrated health system was used to identify patients ≥18 years of age with ICD-9-CM codes for primary or secondary diagnoses for any of eight conditions (depression, hypertension, hyperlipidemia, diabetes, asthma or chronic obstructive pulmonary disease, multiple sclerosis, cancer, or osteoporosis). Electronic pharmacy data was then obtained for 128 medications used for treatment.

Methods

Medication possession ratios (MPR) were calculated for those with one condition and one drug (n=15,334) and then for the total population having any of the eight diseases (n=31,636). The proportion of patients adherent (MPR ≥80%) was summarized by patient and living-area (census) characteristics. Bivariate associations between drug adherence and patient characteristics (age, sex, race, education, and comorbidity) were tested using contingency tables and chi-square tests. Logistic regression analysis examined predictors of adherence from patient and living area characteristics.

Results

Medication adherence for those with one condition was higher in males, Caucasians, older patients, and those living in areas with higher education rates and higher income. In the total population, adherence increased with lower comorbidity and increased number of medications. Substantial variation in adherence was found by condition with the lowest adherence for diabetes (51%) and asthma (33%).

Conclusions

The expectation of high adherence due to a covered pharmacy benefit, and to enhanced medication access did not hold. Differences in medication adherence were found across condition and by patient characteristics. Great room for improvement remains, specifically for diabetes and asthma.

Keywords: Medication Adherence, Patient Compliance, Pharmacy Benefits

This article has been cited by other articles in PMC.

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ABSTRACT

Objective

Despite evidence indicating therapeutic benefit for adhering to a prescribed regimen, many patients do not take their medications as prescribed. Non-adherence often leads to morbidity and to higher health care costs. The objective of the study was to assess patient characteristics associated with medication adherence across eight diseases.

Design

Retrospective data from a repository within an integrated health system was used to identify patients ≥18 years of age with ICD-9-CM codes for primary or secondary diagnoses for any of eight conditions (depression, hypertension, hyperlipidemia, diabetes, asthma or chronic obstructive pulmonary disease, multiple sclerosis, cancer, or osteoporosis). Electronic pharmacy data was then obtained for 128 medications used for treatment.

Methods

Medication possession ratios (MPR) were calculated for those with one condition and one drug (n=15,334) and then for the total population having any of the eight diseases (n=31,636). The proportion of patients adherent (MPR ≥80%) was summarized by patient and living-area (census) characteristics. Bivariate associations between drug adherence and patient characteristics (age, sex, race, education, and comorbidity) were tested using contingency tables and chi-square tests. Logistic regression analysis examined predictors of adherence from patient and living area characteristics.

Results

Medication adherence for those with one condition was higher in males, Caucasians, older patients, and those living in areas with higher education rates and higher income. In the total population, adherence increased with lower comorbidity and increased number of medications. Substantial variation in adherence was found by condition with the lowest adherence for diabetes (51%) and asthma (33%).

Conclusions

The expectation of high adherence due to a covered pharmacy benefit, and to enhanced medication access did not hold. Differences in medication adherence were found across condition and by patient characteristics. Great room for improvement remains, specifically for diabetes and asthma.

Keywords: