Allergy Notes: 08/2009

Video: Food Allergies: A Personal Story

"Sarah Gitlin talks about her lifetime of dealing with food allergies. Diagnosed at 10 months old, Sarah spent her childhood unlike most other children, but very like much like other food allergy sufferers. Now 18, Sarah is among those leading the charge for a cure.

Children growing up with food allergies must avoid foods the rest of us take for granted, such as peanuts, milk, wheat, eggs, and more. Luckily, through existing science a cure is possible." From the Food Allergy Initiative.

Related:

Videos from the KFA channel on YouTube -"Kids With Food Allergies"

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Higher incidence of pediatric anaphylaxis in northern areas of the United States. http://bit.ly/1oEyaz
Childhood Asthma Control Test cannot substitute for FEV1 and fractional exhaled nitric oxide (FeNO) during follow-up http://bit.ly/2dQEjx
Cross reactions between birch pollen and peanut explain high sensitization rate to peanut where birch trees are common http://bit.ly/ZUm1Q
The FDA is reviewing the combination of mometasone and formoterol for the maintenance treatment of asthma http://bit.ly/2qp9Gg
Does nasal rinsing help against allergies? Yes, if your patient is willing to use it. Many patients dislike the method. http://bit.ly/34PyYD
Rhinosinusitis: Saline sinus rinse recipe by AAAAI http://bit.ly/tnrxX - PDF: http://bit.ly/ol5BL
The concept of distinct types of helper T cells - Th1 and Th2 - was introduced in 1986. Interleukin-17 and Type 17 Helper T Cells - NEJM review http://bit.ly/467g9
A nosebleed for 7 days. What is the cause? http://bit.ly/19W9a0 - A living leech!?
Intradermal skin testing on Flickr: http://bit.ly/B8ZXJ

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Increased eosinophils in descending and sigmoid colon are an important clue towards a diagnosis of drug-related colitis. Drug-related colitis caused by NSAIDs (70%), antiplatelet agents (19%) and oestroprogestinic agents (11%) http://bit.ly/QpjWT
Budesonide treatment for 12 months does not increase the risk of pneumonia in patients with COPD http://bit.ly/1PntiS
Asthma prevalence in Bavaria was 4.8% in F and 4.5% in M; only 61.4% received any anti-asthmatic pharmacotherapy. Only 52.8% of asthma patients in Bavaria were treated in accordance with guidelines. http://bit.ly/CSQMK
Children's Hospital Boston blogs about its first patient to enter its milk desensitization study http://bit.ly/1ORbvO
TV report promotes SLIT: Doctors Seek More Convenient Way To Fight Allergies http://bit.ly/rdeJS
Oral medications led to better asthma outcomes compared with inhaled steroids because patients were more likely to take them http://bit.ly/20qI7g -- WellPoint (insurer)-funded study shows that montelukast "may be a reasonable alternative to ICS" when patients don't use ICS http://bit.ly/3l0PKQ

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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More Allergy Textbooks Searchable on Google Books

Pediatric allergy By Donald Y. M. Leung:

Food allergy and intolerance By Jonathan Brostoff, Stephen J. Challacombe:

In-utero exposures (diet, microbial products, smoking) may program the susceptibility to asthma and allergic disease

The term epigenetics refers to changes in phenotype (appearance) or gene expression caused by mechanisms other than changes in the underlying DNA sequence, hence the name epi- (Greek: over; above) -genetics.

There is no change in the underlying DNA sequence of the organism; the phenotype is expressed by activating some genes while inhibiting others. Epigenetics includes changes in gene function that occur without a change in the sequence of DNA. These changes occur as a result of the interaction of the environment with the genome.

Pregnancy is arguably the most critical period of developmental programming. New studies reinforce the importance of in-utero exposures (including dietary nutrients, microbial products, cigarette smoking, and certain maternal mediations) in fetal immune development and in programming the susceptibility to asthma and allergic disease.

Epigenetic determinants activate or silence fetal genes through alterations in DNA, histone methylation and acetylation.

DNA associates with histone proteins to form chromatin. Image source: Wikipedia, GNU Free Documentation License.

Histones are the chief protein components of chromatin. They act as spools around which DNA winds, and they play a role in gene regulation. Without histones, the unwound DNA in chromosomes would be very long. For example, each human cell has about 1.8 meters of DNA, but wound on the histones it has about 90 millimeters of chromatin.

Histone acetylation opens the chromatin to allow transcription of DNA. Histone deacetylation decreases gene expression. Deacetylation is reduced in chronic obstructive pulmonary disease (COPD).

From the NYTimes:

Genes as Mirrors of Life Experiences - Genes are far more than protein machines, pumping out their product like a popcorn maker.

References:

Asthma and pregnancy: emerging evidence of epigenetic interactions in utero. Prescott SL, Clifton V. Curr Opin Allergy Clin Immunol. 2009 Oct;9(5):417-26.
Epigenetics, Wikipedia.
Redon C, Pilch D, Rogakou E, Sedelnikova O, Newrock K, Bonner W (April 2002). "Histone H2A variants H2AX and H2AZ". Curr. Opin. Genet. Dev. 12 (2): 162–9.
In Scotland, passage of smoke-free legislation was associated with 18% decrease in asthma hospitalizations per year http://goo.gl/6LdK
Image source: Wikipedia, GNU Free Documentation License.

Video: Kids and Parents Talk About Living With Food Allergies

Learn about the realities faced by children who suffer from food allergies - and their parents. From the Food Allergy Initiative.

Related:

Videos from the KFA channel on YouTube -"Kids With Food Allergies"

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Combination of new freedoms and unhealthy conditions can be "incendiary" when children go to college - USA Today http://bit.ly/fXvwf
"Case report of a woman who alleviated her severe allergic rhinitis by drinking lemon juice daily" http://is.gd/2wyu7
Improvement and standardization of SPT solutions used for the diagnosis of baker's asthma are highly recommended http://www3.interscienc ...
Antihistamine Xyzal (levocetirizine) has been FDA-approved for children as young as 6 months http://bit.ly/zIWNU
Angioedema of the lip on Flickr: http://bit.ly/1XX2AV
The first dry powder inhalable measles vaccine will soon be ready for testing in humans http://bit.ly/PgqjG
A delayed reaction to a skin prick test on Flickr: http://bit.ly/h88O0
Rush immunotherapy in the news: Patient spends an entire day at the office, gets a series of shots throughout the day. "In one day, they can take off about four months of shots" http://bit.ly/s1bdu
Allergy and Asthma Videos by AAAAI experts http://bit.ly/Gaa4H

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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Survey reveals widespread lack of knowledge about food allergy among general public

From Forbes.com:

Online survey of 2,148 adults found that 50% of respondents incorrectly believed that there is a cure for food allergy.

The survey reveals widespread lack of knowledge and awareness about food allergy among the general public.

More than 2/3 of U.S. adults mistakenly believe that daily medicine can be taken to prevent a food allergy reaction.

76% of food allergy-related deaths follow consumption of foods outside of the home.

Eight top allergens account for 90 percent of all food allergies. See more Allergy and Immunology mind maps here.

References:
Food Allergy: A Short Review
Food Allergen Avoidance
Food Challenges
Mind Maps: Food Allergy
Mnemonics: Food Allergy
Blog articles from AllergyNotes
Images source: Wikipedia, public domain.

Asthma video: "Are you using your inhaler right?" - "Do I look like an idiot?!"

Dr. House tries his best.

The correct way to use your metered dose inhaler (MDI).

References:
Videos: How to use your asthma inhalers
Video: How to Use Asthma Devices -- Inhalers, Spacers, Peak Flow Meters
Inhaler Technique Videos. Asthma Foundation http://goo.gl/5H5i
Medications reference chart. Asthma Foundation http://goo.gl/ourq

Proper techniques for the administration of inhaled medications to treat asthma - AAAAI - Ask the Expert, 2011.

"Mysterious cytokine" activin eases asthma (in mice)

Activin and inhibin are 2 closely related protein complexes that have opposing biological effects.

Activin enhances FSH biosynthesis and secretion, and participates in the regulation of the menstrual cycle. Conversely, inhibin downregulates FSH synthesis and inhibits FSH secretion. Inhibin A is part of the prenatal quad screen administered during pregnancy at a gestational age of 16-18 weeks. An elevated inhibin A (along with an increased beta-hCG, decreased AFP, and a decreased estriol) is suggestive of the presence of a fetus with Down syndrome.

Many other functions have been found to be exerted by activin, including roles in cell proliferation, differentiation, apoptosis, immune responses, and wound repair.

Activin is a dimer composed of 2 identical or very similar beta subunits. Inhibin is also a dimer wherein the first component is a beta subunit similar or identical to the beta subunit in activin.

Schematic diagram of the structures of inhibin and activin. The black line between the monomers represents a disulfide bond. Image source: Wikipedia, public domain.

How does this relate to asthma?

Like many cytokines, activin-A triggers different effects in different situations. It incites inflammation but it can inhibit it as well.

Injections of activin-A helped mice breathe easier: Activin-A exerted its effects by boosting the number of T reg cells.

T reg cells work by releasing soothing cytokines IL-10, TGF-1 & blocking maturation of dendritic cells, essential for Th2 specialization.

References:
Activin eases asthma: Mysterious cytokine quells asthma, triggers T reg cells to prevent dendritic cells from growing up http://is.gd/26Pu0
Activin and inhibin, from Wikipedia, the free encyclopedia.Activin-A - a new critical regulator of allergic asthma http://goo.gl/5Pm9I - Potential therapeutic target.

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Asthma, food allergies and anaphylaxis are more frequently diagnosed in females http://bit.ly/5SKwx
Food avoiders in infancy have a higher risk of 'atopic march' and allergy to other foods ('food allergen march') http://bit.ly/UQidb
Asthma hospitalization rates increased with SABA prescription rates but fell with LABA prescription rates. African Americans were 6 times more likely to be hospitalized for asthma, greater risk with SABA, but lower with LABA http://bit.ly/IZ6bj
Immunotherapy in the Treatment of Food Allergy: Focus on Oral Tolerance - Medscape http://bit.ly/10RkLb. Food allergy affects 6% of children younger than 3 years of age and approximately 4% of adults in the United States. Food-induced anaphylaxis is the most common cause of anaphylaxis treated in hospital emergency departments.
Diuretics without a sulfonamide group (amiloride, eplerenone, ethacrynic, spironol., triamterene) safe in sulfa allergy http://bit.ly/yoyBk
eNO measurement covered for asthma by BlueCross BlueShield, a health care insurer in Mid-Atlantic region USA http://pi5kn.tk

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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Genetic etiologies of leukocyte adhesion defects

In LAD I the firm adhesion of leukocyte to the endothelium is defective, because of mutations in the gene encoding the beta(2)-integrin.

LAD II involved the first phase, rolling phase, and is caused by mutations in the specific fucose transporter to the Golgi apparatus.

LAD III is the last syndrome to be described and a primary activation defect in all three beta-integrins 1, 2, and 3 is detected.

The most recent discovery is mutations in kindlin 3, a newly recognized component, which binds the cytoplasmic tail of integrin.

Rolling Adhesion. This video describes the way in which leukocytes bind to the blood vessel endothelium. This video is from: Janeway's Immunobiology, 7th Edition Murphy, Travers, & Walport. Source: Garland Science.

Leukocyte adhesion defects in Oxford handbook of clinical immunology and allergy By Gavin Spickett:

References:
Updates on genetic etiologies of leukocyte adhesion defects. http://bit.ly/sygq6
Leukocyte adhesion deficiency (LAD)
Adhesion Molecules
CD11
CD18
CD15, Sialyl LewisX (SLeX)

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Tips to allergy-proof your home for fall: Wash bedding in 130-degree water to kill dust mites. Fight mold with a dehumidifier set between 35 and 45 percent humidity. Your potted plants can harbor sneeze-producing mold on their leaves. Keep windows shut between the high-pollen-count hours of 10 a.m. and 3 p.m. http://bit.ly/OLAAL
AAAAI Plant and Pollen Photo Gallery http://bit.ly/qXapf

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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What is IgE-Facilitated Allergen Binding (IgE-FAB)?

Example: Clinical efficacy and immune regulation with peanut oral immunotherapy. Jones SM et al. J Allergy Clin Immunol. 2009 Jul 2.

IgE-Facilitated Allergen Binding (IgE-FAB) assay is an in vitro model of facilitated allergen presentation. Omalizumab binds to Cε3 region of IgE.

The addition of serum from patients who have received SCIT inhibits allergen-IgE complex binding to CD23 on B cells. CD23, also known as Fc epsilon RII, or FcεRII, is the low affinity receptor for IgE. CD23 is present on mature B cells, activated macrophages, eosinophils, dendritic cells and platelets. http://bit.ly/C2Nrh - CD23 is the low affinity IgE receptor (FceRII). CD21 (CR2) binds EBV, HHV8, C3d, and CD23 (low affinity IgE receptor (FceRII).

IgG4 antibodies from patients who received grass SCIT inhibit IgE–FAB binding to B cells -- IgG4 inhibits IgE–FAB http://bit.ly/YwpdR

IgE-Facilitated Allergen Binding (IgE-FAB) in Science in Medicine: The Jci Textbook of Molecular Medicine By Andrew R. Marks, Ushma S. Neill:

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

7 Chinese women suffered permanent lung damage, 2 died after working in a paint factory using nanoparticles. One nanometer is one-billionth of a meter (yard) and nanoparticles measure between 1 to 100 nanometers. They are used in products like sporting goods, tires, electronics, cosmetics and surface coatings http://bit.ly/1U8NT
Paraffin wax candles, used for romantic ambiance, fragrance and light, contribute to air pollution inside homes http://bit.ly/4jjCcT
Eating out: tips for customers and restaurant professionals by Food Allergy Initiative http://bit.ly/FWf6W
Patient story on Flickr: "So a funny thing happened at lunch...." http://bit.ly/RhROU - Allergy to Linum (flax seed) http://bit.ly/9Lmaz

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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What is TaqMan?

Example: Clinical efficacy and immune regulation with peanut oral immunotherapy. Jones SM et al. J Allergy Clin Immunol. 2009 Jul 2.

JAK-STAT (Janus kinase-signal transducer and activator of transcription) path transmits signals directly to target gene. JAK-STAT signaling is evolutionarily conserved in eukaryotic organisms from slime molds to humans http://bit.ly/16yaNe

cDNA is a complementary DNA synthesized from a mature mRNA template by the enzyme reverse transcriptase http://bit.ly/V5Jmv

TaqMan are hydrolysis probes used to increase the specificity of real-time PCR assays. TaqMan principle relies on the 5´–3´ nuclease activity of Taq polymerase and fluorophore-based detection. TaqMan probes were named after the videogame PacMan (Taq Polymerase + PacMan = TaqMan) http://bit.ly/15UwMT

Taq polymerase is a DNA polymerase named after thermophilic bacterium Thermus aquaticus from which it was isolated http://bit.ly/52a2b

Taqman in Molecular diagnostic PCR handbook By Gerrit J. Viljoen, L. H. Nel, J. R. Crowther:

Do prostaglandin analogue-based eye drops (Latanoprost/Xalatan, etc.) used for glaucoma help patients who have a concurrent allergic conjunctivitis?

Not likely.

Latanoprost is a prostaglandin analogue and we already know that anti-prostaglandin therapy is effective in vernal conjunctivitis in particular: http://www.ncbi.nlm.nih.gov/pubmed/3115287

One would expect some worsening of allergic conjunctivitis in patients treated with prostaglandin analogues for glaucoma but the evidence is not very convincing: http://www.ncbi.nlm.nih.gov/pubmed/11789860

However, ocular allergic reactions induced by prostaglandin analogues themselves are well-described in the literature: http://www.ncbi.nlm.nih.gov/pubmed/16750448

Bottom line: Prostaglandin analogue eye drops used in glaucoma do not help in allergic conjunctivitis and are possibly harmful.

Ocular antihistamines (eye drops) (click to enlarge the image)

Image source: OpenClipArt.org.

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Parents of children with suspected peanut or hazelnut allergy show high levels of anxiety about an allergic reaction. After food challenge (DBPCFC), parental anxiety was significantly lower, regardless of a positive or negative outcome http://bit.ly/EwFH8
Basophil responsiveness (CD63) useful in insect sting allergy and negative specific IgE and skin prick test http://bit.ly/4qr11m
Fungal sensitization is common in patients with severe asthma: 66% have severe asthma with fungal sensitization (SAFS). SAFS: A. fumigatus 45%, C. albicans 36, P. notatum 29, C. herbarum 24, A. alternata 22, B. cineria 18, Trichophyton 17. It is necessary to undertake both SPT and specific serum IgE testing to identify all cases of fungal sensitization. http://bit.ly/qEQiC
Statins inhibit of eosinophil adhesion to ICAM-1 - a novel actions that may be used to treat allergic disease. http://bit.ly/nb0R9
Psychological stress can heighten and possibly prolong allergic responses. http://bit.ly/1Z3Xk
CNN Q&A: Is my daughter's violent reaction to a drug an allergy? http://bit.ly/1h98U1
Toothpaste Allergy as a Cause of Cheilitis in Israeli Patients http://bit.ly/IZchY
Comèl-Netherton syndrome defined as primary immunodeficiency. Mutations in serine protease inhibitor Kazal-type 5 (SPINK5) for lympho-epithelial Kazal-type 5 related inh. (LEKTI) cause Comèl-Netherton. Comèl-Netherton syndrome is an autosomal-recessive disease characterized by congenital ichthyosis, bamboo hair, and atopic diathesis. http://bit.ly/mt8qb
How to cut mold allergies - advice from The Miami Herald http://bit.ly/e4UNS

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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Update on Seafood Allergy

From Medscape:

Prevalence data from Asia highlight seafood as a significant sensitizer in up to 40% of children and 33% of adults http://bit.ly/1vFgR4

Fish allergens can be detected in serum samples of people as early as 10 min after ingestion.

Inhaled airborne seafood allergens seem to induce sensitization and reactions. Major allergen of shellfish is the muscle protein, tropomyosin, in crustacean and mollusks.

Patients with seafood allergy are frequently reported to also have allergic reactions to mites and insects. Cross-reactivity between crustacean and HDM allergens is due to amino acid homology of these invertebrate tropomyosins.

Seafood hypersensitivity in mite sensitized individuals: is tropomyosin the only responsible allergen?

Tropomyosin does not seem to be the main allergen involved in mite-seafood sensitization in mite sensitized individuals. However, high levels of sIgE to tropomyosin seem to be related to severity of symptoms. http://goo.gl/Wj9xW

A 20-year-old man with a known dust mite-related allergic rhinitis develops rash, dyspnea, bradycardia, dizziness 30 minuts after eating oysters. What is the cause?

(A) Shigella

(B) Cholera

(C) Scrombroid

(D) Tropomyosin

(E) Parvalbumin

Answer: Tropomyosin. Shrimp Allergy in Italian Adults: Skin reactivity to house dust mite (HDM) was found 70% (Int Arch Allergy Immunol. 2011),

Related:
A puzzle: an Orthodox Jewish patient with an allergy to shellfish. How is that possible?

Seafood hypersensitivity in mite sensitized individuals: is tropomyosin the only responsible allergen? http://goo.gl/A30fZ
Exposure to cockroach is linked to high shrimp IgE with questionable clinical reactivity - food challenge is needed for diagnosis (JACI, 2011).

Cross Reactions Among Foods (PDF).

Shellfish allergy is a frequent, long-lasting, life-threatening disorder. As shellfish consumption increases, the number of allergic reactions to shellfish is expected to continue to rise too http://goo.gl/D2PRx
Image source: A steamed tail-on shrimp, Wikipedia, public domain.

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Hypersensitivity to mosquito bites manifests primarily as local reactions with anaphylaxis being a very rare event. Necrotic skin reactions to mosquito bites have been associated with a newly recognized hemophagocytic syndrome. Three proteins (rAed a 1, rAed a 2, rAed a 3) shared by several mosquito species may be used as skin test antigens for the future http://bit.ly/Lijkn

In numbers: 0.001 = Fraction of a peanut given to children with peanut allergy at start of a trial designed to build up tolerance. 19,000 = Maximum number of dust mites found in a gram of household dust. 1 billion = Approximate number of pollen grains produced by a single ragweed plant each year. Each ragweed plant produces 1 billion pollen grains in a season that can travel up to 400 miles in the wind http://bit.ly/jOXHJ

Passive exposure of pregnant women to tobacco smoke associated with asthma- and allergy-related symptoms in children http://bit.ly/e2YVf

CNN: What to do if you're allergic to your pet http://bit.ly/Eu74n

CNN: Skateboarder's death underscores insect allergy risks. 5 percent of Americans are at risk for a severe, potentially life-threatening allergic reaction from insect stings http://bit.ly/3PEVtK -- TV report: Insect Bites (4-min video) http://bit.ly/2ezQNZ

Video: Understanding Your Child's Asthma Plan http://bit.ly/3WhN67

Image: Cold-Induced Urticaria http://twitpic.com/e8lh2 - via @MatthewBowdish

Contact Dermatitis: A Learning Module by AAMC http://bit.ly/A1dnc

Anaphylaxis: 36 Common Sense Ways to Reduce the Risk http://bit.ly/164x8D

August is officially the beginning of ragweed season http://bit.ly/KAZlq

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

IL-17A plays an important role in the eosinophil accumulation and remodeling in the nasal polyps http://bit.ly/12sLbv
The enzyme aldose reductase could be the base for powerful new therapy for asthma http://bit.ly/tFev9
Immunotherapy produced more CD14, IL-10, and TGF- beta, FEV1improvement, and Foxp3+ CD4+ Treg cells. Induction of IL-10+ CD4+ CD25+ regulatory T cells with decreased NF-B expression during immunotherapy. MyD88 is a toll-like receptor (TLR) adaptor to activate NF-kB - NF-kB is a master switch for allergic inflammation http://bit.ly/LebkG
Ready for Ragweed Allergy Season? These 8 Tips Can Help Fight Pollen Allergy http://bit.ly/1aCHFH
Passive exposure of pregnant women to tobacco smoke associated with asthma- and allergy-related symptoms in children http://bit.ly/e2YVf
CNN: What to do if you're allergic to your pet http://bit.ly/Eu74n
CNN: Skateboarder's death underscores insect allergy risks. 5 percent of Americans are at risk for a severe, potentially life-threatening allergic reaction from insect stings http://bit.ly/3PEVtK

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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Photo: Large Local Reaction to a Wasp Sting

Photo: Wasp Sting Reaction on Flickr http://bit.ly/TEepT. Author: cdresz. All sizes of this photo are available for download under a Creative Commons license.

Large local reactions occur in 17-56% of stung people. Edema may extend to 10 cm from site of the sting. The localized reaction may last 12-24 hours to 7 days.

Large local reactions to stings have a 4-10% chance of a future systemic reaction.

According to more recent studies, large local reactions (LLRs) from stinging insects are followed by a systemic reaction in 10-15% of patients. Prescription of autoinjectable adrenaline is advisable in large LLRs due to insects, immunotherapy studies needed http://bit.ly/HhmUo

Large local reactions can be mistakenly diagnosed as cellulitis.

Local reactions may be life threatening if local swelling at the sting site compromises the airway.

Topical antihistamines should not be used because they may penetrate the wounded skin, bind to proteins and cause sensitization through haptenization.

Mind map of insect venom allergy.

Children generally have a more benign course after insect stings because they usually have only cutaneous systemic reactions. Remember:

C
Children
Cutaneous only

A
Adults
Airway
Anaphylaxis

Selection of patients for SPT and SCIT, from Atlas of allergies and clinical immunology By Philip Fireman:

Hymenoptera venom allergen components from Allergy and Asthma By Massoud Mahmoudi:

Insect allergy from Manual of allergy and immunology By Daniel C. Adelman, Thomas B. Casale, Jonathan Corren:

Related:
Large Skin Reaction to Insect Bites and Stings: Is it Dangerous and What to Do?
Venom immunotherapy reduces large local reactions to insect stings
Anaphylactic Shock Due to Bee Sting
Venom Allergy: A Short Review. V. Dimov, 08/2007.

Beebearding is thought to date back to the 1700s http://goo.gl/j4nE

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

People who clean their homes with hypochlorite bleach less likely to be atopic, more likely to have respiratory symptoms http://bit.ly/L1A0X
Lipid transfer protein (Ara h 9) is a new peanut allergen relevant for a Mediterranean allergic population. http://bit.ly/17q2J3
Gastrointestinal tract is the largest lymphoid organ in the body. 4 major GI problems in antibody deficiency: infection, malignancy, inflammatory, autoimmune. May mimic IBD, celiac. http://bit.ly/87MrW
Another asthma predictive index: Clinical asthma prediction score for preschool children who have asthma-like symptoms for the first time. Risk score based on 8 clinical parameters predicts asthma in preschool children who first reported asthma-like symptoms http://bit.ly/d6K6c
In ICS users, chronic cough or phlegm and female sex were related to uncontrolled asthma. In non-ICS users, high total IgE and sensitization to molds were associated with uncontrolled asthma http://bit.ly/x7GtG
Guardian.co.uk: MSG allergy is fake science http://bit.ly/7X183
Expanding snow crab-processing industry may increase risk of occupational allergy, 4 IgE-reactive proteins identified http://bit.ly/i2dma
Recent Advances in Childhood Asthma: An Expert Interview With Bradley E. Chipps, MD - Medscape http://bit.ly/VcnhY

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support.

Image source: OpenClipArt.org, public domain.

What is behind the names of food allergens?

From the New Scientist magazine:

"Hazelnuts and apples are the most common triggers of food allergies in Europeans - not peanuts, as many might expect." Regional differences: "Peach and melon allergy is common in the Mediterranean - in Spain and Greece. Iceland is a hotspot for fish allergy."

Crossreaction between birch (Bet v 1), apple (Mal d 3) and peach ( Pru p 3) http://bit.ly/24Yh6G

Bet v 1 cross-reactions: people who have birch pollen allergy often react to apple, celery, plums and several other common foods.

Behind the names of food allergens: Pru p 3, a major peach allergen - from peach (Prunus persica) http://bit.ly/140g0j

Behind the names of food allergens: Mal d 3 (Lipid-transfer Protein) apple allergen - from apple (Malus domestica) http://bit.ly/Rh2mF

Behind the names of allergens: Bet v 1, the major birch pollen allergen - from birch, Betula verrucosa http://bit.ly/1nT0vT

Oral allergy syndrome (OAS, pollen-food allergy syndrome) is contact urticaria of the oropharynx. OAS is caused by allergens in fruits, vegetables, tree nuts, and peanuts that are homologous to pollen allergens.

Related reading:

What is oral allergy syndrome?
Unfolding of Pru p3 (peach) reduces resistance to GI proteolysis, almost completely abrogated IgE allergenic potency. JACI, 2011.
Image source: Silver Birch, Wikipedia, GNU Free Documentation License.

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Inner-city asthmatic patients: 70% of patients saying that they used ICS all or most of the time when asymptomatic, 49% worried about side effects and 37% worried about becoming addicted. http://bit.ly/2lJXho
Inhaled corticosteroids, lung function and bronchial hyperresponsiveness in asthma: effect starts as early as 8 weeks http://bit.ly/5M7Wf
Mold was detected in 93% of the homes. The most common molds were Cladosporium in 72% and Penicillium in 42%. Exposure to airborne Penicillium is associated with increased peak expiratory flow variability in asthmatic children. http://bit.ly/13ehOE
Both allergic and nonallergic rhinitis are risk factors for a high apnea-hypopnea index, predispose to sleep apnea. Patients with rhinitis should be treated not only for nasal symptoms but also for a better quality of sleep. http://bit.ly/x4RCc
Immunization with mRNA induces TH1-biased immune responses similar to DNA-based vaccination but safer (in mice) http://bit.ly/1abZcT
Bronchial provocation with inhaled dry-powder mannitol had a high diagnostic specificity for the diagnosis of asthma. http://bit.ly/E03YH
Methacholine is more sensitive than mannitol for evaluation of bronchial hyperresponsiveness in children with asthma http://goo.gl/Dh0m

Survey: Increased food allergy knowledge among the general public is needed. http://bit.ly/2FIx87

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support.

Image source: OpenClipArt.org, public domain.

A puzzle: an Orthodox Jewish patient with an allergy to shellfish. How is that possible?

Jewish cuisine is a collection of cookery traditions linked by Jewish dietary laws and holiday traditions. Certain foods, notably pork and shellfish, are forbidden.

A question from Twitter:

@kidneynotes A puzzle: an Orthodox Jewish patient with an allergy to shellfish. about 1 hour ago from Ping.fm

Answer:

Patients with seafood allergy are frequently reported to also have allergic reactions to mites and insects. This cross-reactivity is probably due to the high amino acid homology of these invertebrate tropomyosins and may have significant clinical implications.

A recent study demonstrated sensitization to shrimp tropomyosin in orthodox Jews who are prohibited by religious dietary laws from eating shellfish; however, as they were never exposed to crustacean allergens, this sensitization to tropomyosin is probably due to a noncrustacean source, such as house dust mites (HDM), cockroaches or both, via inhalation.

Seafood hypersensitivity in mite sensitized individuals: is tropomyosin the only responsible allergen?

Tropomyosin does not seem to be the main allergen involved in mite-seafood sensitization in mite sensitized individuals. However, high levels of sIgE to tropomyosin seem to be related to severity of symptoms. http://goo.gl/Wj9xW

A 20-year-old man with a known dust mite-related allergic rhinitis develops rash, dyspnea, bradycardia, dizziness 30 minuts after eating oysters. What is the cause?

(A) Shigella

(B) Cholera

(C) Scrombroid

(D) Tropomyosin

(E) Parvalbumin

Answer: Tropomyosin. Shrimp Allergy in Italian Adults: Skin reactivity to house dust mite (HDM) was found 70% (Int Arch Allergy Immunol. 2011),

References:
Immunoglobulin E antibody reactivity to the major shrimp allergen, tropomyosin, in unexposed Orthodox Jews. Fernandes J, Reshef A, Patton L, Ayuso R, Reese G, Lehrer SB. Clin Exp Allergy. 2003 Jul;33(7):956-61.
New Insights Into Seafood Allergy. Andreas L. Lopata; Samuel B. Lehrer. From Current Opinion in Allergy and Clinical Immunology.
Exposure to cockroach is linked to high shrimp IgE with questionable clinical reactivity - food challenge is needed for diagnosis (JACI, 2011).

Cross Reactions Among Foods (PDF).

Shellfish allergy is a frequent, long-lasting, life-threatening disorder. As shellfish consumption increases, the number of allergic reactions to shellfish is expected to continue to rise too http://goo.gl/D2PRx

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Allergic rhinitis was significantly associated with nasal eosinophilia and irreversible nasal airway obstruction. Chronic inflammation and structural remodeling of the nasal mucosa occurs in allergic rhinitis n children at age 6. Allergic rhinitis associated with irreversible nasal airway obstruction, whereas nonallergic rhinitis was not. http://bit.ly/1kVGuV
Ozone concentrations below the current U.S. clean-air standard may still temporarily impair lung function http://bit.ly/3wu6Mu
120 people die each year in the United States from peanut allergies. Food allergies are becoming more prevalent http://bit.ly/4vi0V
T-cell epitope mapping identified several major T-cell allergens, may offer peptide therapy in the future http://bit.ly/tg6f4
In honeybee or yellow jacket venom allergy, VIT with purified extracts had a lower rate of severe local reactions http://bit.ly/3dO7H
Lower vascular endothelial growth factor (VEGF) levels in the airway as a marker for emphysematous changes in the lungs http://bit.ly/2uSUWp
Google "wonder wheel" for asthma - a rudimentary mind map: http://bit.ly/4tOOF

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support.

Image source: OpenClipArt.org, public domain.

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

When used with ICS and LABA, tiotropium decreases risk of mortality in COPD http://bit.ly/11hnBt
Asthma is the 5th most costly disease in the US from 1996-2006, Medical Expenditure Panel Survey (MEPS) http://37hsp.tk
Double-blind, placebo-controlled food challenge (DBPCFC) as an office procedure: a manual - from JACI 1988 http://bit.ly/asPP5
How To Get Featured By the Press (Repeatedly) Even If Your Blog is New http://bit.ly/9kiKl
Video: Kids and Parents Talk About Living With Food Allergies http://bit.ly/5lmcz

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support.

Image source: OpenClipArt.org, public domain.

What is oral allergy syndrome?

Oral allergy syndrome (OAS, pollen-food allergy syndrome) is contact urticaria of the oropharynx http://bit.ly/HVvXf

OAS is caused by allergens in fruits, vegetables, tree nuts, and peanuts that are homologous to pollen allergens.

Cross-reactivity in Pollen-Food Allergy Syndrome (PFAS) or Oral Allergy Syndrome (OAS) (click to enlarge the image).

Cross-reactivity list in oral allergy syndrome (pollen-food allergy syndrome): http://bit.ly/dFuk1

Flavored Coffee May Trigger Seasonal Allergies - due to oral allergy syndrome. Fox News, 2011.

Which allergen cross-reacts with Bet v1 (birch)?

(A) Ara h1 (peanut)

(B) Mal d 1 (apple)

(C) Ara h3 (peanut)

(D) Bos d (milk)

(E) Gal d (egg)

(F) Hev b2 (latex)

Answer: B, apple. Pollen sensitizations linked to food allergies was first reported with birch pollen and apples 50 years ago.

Related:

Profilin may be a pan-allergen among plants that crossreacts between pollen, fruits, vegetables and latex http://goo.gl/ZUPRQ

Cross Reactions Among Foods (PDF).

Oral symptoms from the ingestion of food in a patient with allergic rhinitis - AAAAI Ask the Expert, 2011.
In birch-apple syndrome (oral allergy syndrome), eating apple does not affect the respiratory tract. Annals of Allergy, Asthma and Immunology, 2011.

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Chronic urticaria is a common skin disease without an etiology in the majority of cases. In chronic urticaria, blood basophils display altered IgE receptor-mediated degranulation, reverts in disease remission http://bit.ly/gLZ6W
Two subtypes of cholinergic urticaria are proposed: sweat-hypersensitivity type and follicular type http://bit.ly/11Yz4
Intranasal corticosteroids improve ocular allergy through the naso-ocular reflex, a class effect http://bit.ly/7RuIr
Some studies suggest a relationship between intranasal steroids and increased IOP. Large prospective studies are lacking http://bit.ly/3GMlH3
Methotrexate helpful in moderate to severe adult atopic eczema, mean effective dose was 15 mg http://bit.ly/9qeOI
Obesity predisposes to Th17 bias - a T-cell lineage subset with prominent pro-inflammatory roles http://bit.ly/IBaH9
Increased urine IgM excretion predicts cardiovascular events in patients with type 1 diabetes nephropathy http://bit.ly/ZJLiH
Severe chronic upper airway disease (SCUAD) = uncontrolled allergic rhinitis, NAR, chronic rhinosinusitis, AERD, etc. http://bit.ly/FUjrI

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support.

Image source: OpenClipArt.org, public domain.

Does honey relieve allergy symptoms?

From Fort Worth Weekly:

"If you Google "local honey allergies" about 450,000 results appear. Publications like Self magazine, Consumer Health Digest, and the Sacramento Press all report the stories of people whose allergies have disappeared after eating the natural sweetener.

But "The bees don't know what you're allergic to," he said. Most people are allergic to windborne pollens that come from grass and trees, but bees mostly gather flower pollens, he said. Another problem: You'd have to eat dozens of pounds of honey for it to be beneficial, the allergist said. There isn't enough pollen in the natural sweetener to make a big impact."

Does honey relieve allergic symptoms?

The answer is "no."

A 2002 study examined the effect of ingestion of honey on symptoms of rhinoconjunctivitis.

Thirty-six participants who complained of allergic rhinoconjunctivitis were recruited. All recruits were scratch-tested at entry for common aeroallergens.

The cohort was randomly assigned to one of three groups receiving:

1. locally collected, unpasteurized, unfiltered honey
2. nationally collected, filtered, pasteurized honey
3. corn syrup with synthetic honey flavoring

They were asked to consume one tablespoonful a day of the honey or substitute and to follow their usual standard care for the management of their symptoms. All participants were instructed to maintain a diary tracking 10 subjective allergy symptoms, and noting the days on which their symptoms were severe enough to require their usual antiallergy medication.

Neither honey group experienced relief from their symptoms in excess of that seen in the placebo group.

This study does not confirm the widely held belief that honey relieves the symptoms of allergic rhinoconjunctivitis.

References:
Effect of ingestion of honey on symptoms of rhinoconjunctivitis. Rajan TV, Tennen H, Lindquist RL, Cohen L, Clive J. Ann Allergy Asthma Immunol. 2002 Feb;88(2):198-203.
Image source: A jar of honey with honey dipper, Wikipedia, public domain.

Related:
Can Locally Produced Honey Reduce Your Allergy Symptoms? Dr. Neil Kao ("The Allergy Dude's") Allergy and Asthma Website, 2010.

Can Eating Local Honey Cure Allergies? No, in most cases. NYTimes, 2011.

Allergy and Immunology News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

4-year-old children diagnosed with asthma appear to have increased risk of injury over their peers http://bit.ly/s0MOS
Hereditary angioedema with normal C1 inhibition: mutations in coagulation factor XII (Hageman factor) gene detected http://bit.ly/19m1n
Urticaria caused by antihistamines: report of 5 cases. http://bit.ly/4usCgB
Perception of Breathlessness by a 3-Minute Respiratory Exerciser Test Predicts Asthma Exacerbations. Asthmatic patients with over-perception of dyspnea are at increased risks of unscheduled visits and hospital admissions http://bit.ly/DGuPp
School staff more inclined to act based on perceptions of a child's asthma or children's reports rather than peak flow http://bit.ly/KhhRK
How air pollutants act as an adjuvant for allergic sensitization and asthma. Particulate matter generate oxygen radicals capable of perturbing the redox equilibrium mucosal immune cells. Particulate matter exposure induces proinflammatory changes and proallergic effects in the respiratory tract. http://bit.ly/ds647

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. The inclusion of a Twitter update (tweet) is not an endorsement or agreement of any kind. Tweets and links do not represent endorsement, approval or support.

Image source: OpenClipArt.org, public domain.

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