March 26, 2013

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

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.

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

March 24, 2013

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.

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

March 23, 2013

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.

Allergy, Asthma and Immunology

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March 26, 2013