Allergy Notes: 11/2009

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.

ICS/LABA in COPD increase risk of pneumonia by 63%, viral respiratory infections by 22%, oral fungal infections by 59%. ICS/LABA did not reduce overall death rates in COPD compared to LABA alone http://bit.ly/4sDzI9

Minority children less likely to take ICS for asthma, leading to more ER visits http://bit.ly/4jYelC

Subcutaneous heparin will induce skin lesions in about one in 13 patients, usually as a result of an allergic reaction http://bit.ly/VkKlb

Converting Advair to the equivalent Symbicort dosage - conversion table http://bit.ly/2fBQCr

Videos show T cells breaching the central nervous system's defences. http://bit.ly/EkC3N

Immunology flashcards http://bit.ly/2DanMh

CNN: "Are there any treatments for hyperthyroidism when patient is allergic to iodine?" http://bit.ly/3I2NSN - There's no true iodine allergy. "Asking a patient if he/she is "allergic to iodine" should be avoided because its significance is null" http://bit.ly/4Cu59e -- Allergic contact dermatitis from povidone-iodine: it is important to rule out false-positive patch test reactions http://bit.ly/20Y2Kf

Study tries to explain the relative immunity to H1N1 in people older than 60 http://bit.ly/3s2Kxg

Acetaminophen, the active ingredient in Tylenol, weakens infants' immune responses to vaccines http://bit.ly/4CzhTU

Medical news tweets are not research articles - they are 140-character messages - please always go to the original source, links, etc. Tweets and links do not represent endorsement, approval or support. Image source: OpenClipArt.org, public domain.

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Food-Dependent Exercise-Induced Anaphylaxis (FDEIA)

Food-dependent exercise-induced anaphylaxis (FDEIA) is a special form of food allergy where a food-intake alone does not induce any symptoms. Anaphylaxis occurs only when triggering factors such as exercise or aspirin-intake are added after ingestion of the causative food.

The most frequent causative food in FDEIA in Japan is wheat. Both exercise and aspirin-intake facilitate allergen absorption from the gastrointestinal tract.

80% of the patients with wheat-induced FDEIA have IgE reacting to omega-5 gliadin and the remaining of the patients to high molecular weight glutenin (HMW-glutenin).

References:

Food-dependent exercise-induced anaphylaxis (FDEIA)
Food-Dependent Exercise-Induced Anaphylaxis-Importance of Omega-5 Gliadin and HMW-Glutenin as Causative Antigens for Wheat-Dependent Exercise-Induced Anaphylaxis. Morita E, Matsuo H, Chinuki Y, Takahashi H, Dahlström J, Tanaka A. Allergol Int. 2009 Oct 25;58(4).

Image source: OpenClipart.org, public domain.

Exercise-induced anaphylaxis http://goo.gl/d5YYM

Anaphylaxis guidelines by World Allergy Organization. JACI, 2011.

Allergy and Immunology News of the Day

Among children diagnosed with multiple allergic diseases there is a number of variants of 'the allergic march'. Eczema followed by asthma, which is in turn followed by rhinitis, is the most common trajectory of the allergic march http://bit.ly/GD7wK

Treating pregnant mothers, and then their infants, with probiotics may help prevent eczema in children http://bit.ly/XcTk4

Bee venom immunotherapy is effective in most patients immediately after the maintenance dose has been reached http://bit.ly/3so0zT

Researchers trying to create "mutant" allergens that one day may be used to treat allergy sufferers - WSJ http://bit.ly/SE6ml

Risk of Afib may double with systemic steroids taken for chronic diseases http://bit.ly/QCL1V

IgE-independent hypersensitivity mediated by immunoglobulin free light chains (FLCs) http://bit.ly/4lyCdU

An adverse reaction seemingly associated with a vaccine should not preclude receiving that same vaccine in the future http://bit.ly/Z1UwP

Kyle and family document their trip to The Hill where they lobby for laws to manage food allergies in school - CNN http://bit.ly/3fjVWA

Allergy and Immunology News of the Day

Deficiency of circulating plasmacytoid dendritic cells (pDC) during infancy appears to be a risk factor for asthma. Infants with higher numbers of circulating plasmacytoid dendritic cells (pDC) appear "protected" against asthma http://bit.ly/2xUexA

The minimally important difference in Asthma Control Test (ACT) used for comparison between test samples is 3 points http://bit.ly/hv04A

Inhibition of IL-4–STAT6 might explain the mechanism of aspirin desensitization http://bit.ly/13A9v2

People who clean their homes with bleach are less likely to be atopic but more likely to have respiratory symptoms. http://bit.ly/nMAAj

Immunotherapy studies have demonstrated that a local reaction does not predict a systemic reaction. Local reactions to immunotherapy do not predict local reactions at the next immunotherapy injection. http://bit.ly/WYTgN

Factors associated with uncontrolled asthma were different in ICS users and non-ICS users. In ICS users: chronic cough/phlegm, female sex. Factors associated with uncontrolled asthma in non-ICS users: high total IgE and sensitization to molds http://bit.ly/unKon

There is a need for better designed sublingual immunotherapy (SLIT) clinical trials. Several unpublished oral and sublingual immunotherapy studies in the United States failed to meet primary endpoints. http://bit.ly/ttaIB

Environmental exposure chamber determines triggers in non-allergic rhinitis

From MedPage Today:

In a study of 41 patients with non-allergic rhinitis exposed sequentially to a range of triggers, researchers found:

- 51% responded to cold dry air
- 70% reacted to a change from warm humid air to cold and dry air
- 47% responded to a two-hour exposure to ozone
- 32% responded to a 15-minute exposure to acetic acid, described as "smelling like a fish and chip shop"
- 43% responded to a potpourri fragrance

References:
ACAAI: New Method Tackles Nonallergic Rhinitis. Michael Smith, North American Correspondent, MedPage Today.

Allergy and Immunology News of the Day

Being overweight, especially around the middle, linked to risk for developing asthma http://bit.ly/pEmSZ

Normal reference values for serum mast cell tryptase are 1-15 ng/mL, with an average of approximately 5 ng/mL http://bit.ly/cTSYL

Incidence of anaphylaxis has increased over the past few decades, lifetime prevalence is 0.05% to 2.0%. Higher incidence of pediatric anaphylaxis in northern areas of the United States http://bit.ly/3lxAhd

C1 esterase inhibitor 20 U/kg IV is effective, rapid and safe treatment for acute abdominal and facial attacks in HAE http://bit.ly/ag64n

IL-2, IL-6, IL-10, TNF receptor I, MCT, and histamine were significantly elevated in patients with severe anaphylaxis. Levels of IL-6, IL-10, TNF receptor I, MCT, and histamine correlated with hypotension in anaphylaxis http://bit.ly/vKHI

Lipid transfer protein (Ara h 9) as a new peanut allergen relevant for a Mediterranean allergic population http://bit.ly/mLA4m

Expression of CCR5 and CCR6 of Langerin-negative CD1a+ dendritic cells was characteristic for acute atopic dermatitis http://bit.ly/1QuOCo

A wasp in a sticky situation in Milton Keynes. http://bit.ly/4cBJTx

ACP has created a COPD Portal http://bit.ly/2X7jC

Adherence to allergen-specific immunotherapy is better for SLIT than SCIT

Allergen-specific immunotherapy can modify the natural history of the allergic diseases, reducing the development of asthma and new sensitizations after 3-4 years of treatment. In order for immunoterapy to work however, adherence to the therapy is mandatory.

Rate of adherence to subcutaneous immunotherapy (SCIT) is low, at less than 70%. The possible explanations for that fact include the following factors:

- inconvenience
- lack of perceived efficacy
- costs and loss of working hours

In comparison, local nasal immunotherapy has a even lower adherence rate (27%), due to the local nasal side effects.

For sublingual immunotherapy (SLIT), the rates of compliance are greater than 75%.

The reasons for discontinuation of SLIT are:

- costs
- inconvenience
- feeling of inefficacy
- side effects

In real life, costs and patient education are crucial issues in adherence to this SCIT and SLIT. Reduction of costs and more efforts in education of patients may improve the adherence to immunotherapy.

References:
Evidence of adherence to allergen-specific immunotherapy. Senna G, Ridolo E, Calderon M, Lombardi C, Canonica GW, Passalacqua G. Curr Opin Allergy Clin Immunol. 2009 Dec;9(6):544-8.

SCIT ("allergy shots") is at least as potent as pharmacotherapy in controlling the symptoms of allergic rhintis as early as the first season of therapy. JACI, 2011.
Image source: OpenClipArt.org, public domain.

Allergy and Immunology News of the Day

The Claim: With a Runny Nose, Green Calls for an Antibiotic. http://bit.ly/1gD5ka - Answer: Not really.

Arg16 genotype associated with exacerbations in asthmatic children and young adults exposed daily to beta(2)-agonists http://bit.ly/2lvW7A

Alarmin - Alarmin(g) news about danger - cells release high-mobility-group box (HMGB) proteins that signal tissue damage http://bit.ly/uw725

Mammalian target of rapamycin (mTOR) is a serine–threonine kinase that senses nutrition status to control cell growth http://bit.ly/BSgjs

Pulmonary alveolar proteinosis (PAP) is rare: accumulation of pulmonary surfactant, respiratory failure, infections. Pulmonary alveolar proteinosis is a primary immunodeficiency of impaired GM-CSF stimulation of macrophages http://bit.ly/WgJe9

Regulatory T Cells in Asthma: ability to enhance regulatory function may represent a treatment for asthma http://bit.ly/SwUlc

New research: Forkhead box transcription factor Foxo and the cycle of life and death http://bit.ly/r27nr

Properdin, a plasma component, is critical in the stabilization of alternative complement pathway convertases. Properdin is a pattern recognition molecule that binds to certain microbial surfaces, apoptotic and necrotic cells http://bit.ly/2lSfaY

Dogs are getting food allergies too http://bit.ly/iVOjM

Patients who are allergic to eggs may still receive the flu shot after an allergist evaluation

From MedPage Today:

"Egg-allergic patients can get a flu shot if its egg protein content is 1.2 mcg/mL or less. It should, however, be given in graded doses -- an initial 10% of the full dose, then the remaining 90% a half-hour later if no reaction occurs.

Unlike MMR vaccine, which is made in chick embryo fibroblast cell cultures, influenza viruses are grown directly in eggs, so by the time it turns into the 'flu shot,' there is a little egg protein left over."

Egg-allergic patients without anaphylaxis to egg may safely receive the influenza vaccine in a 2-dose, graded fashion without a vaccine skin test. Safety of Influenza Vaccine Administration in Egg-Allergic Patients. Pediatrics, Vol. 125 No. 5 May 2010, pp. e1024-e1030.

References:
ACAAI: Egg Allergy No Excuse for Skipping Flu Shot. Kristina Fiore, Staff Writer, MedPage Today.

Tolerance to egg-containing baked foods (cake, bread) does not exclude the possibility of egg allergy (AAAAI Ask The Expert).

Allergy and Immunology News of the Day

Intralymphatic immunotherapy (ILIT) reduces the dose and the number of allergen injections http://bit.ly/QXzz9

Allergic disorders may be associated with microalbuminuria in men with type 2 diabetes. Blood eosinophil count is a better predictor of microalbuminuria than blood pressure, HbA1c, or duration of diabetes http://bit.ly/qeQN2

T cells require Foxo1 transcription factor to populate the peripheral lymphoid organs http://bit.ly/r5s26

Thymic stromal lymphopoietin (TSLP) is a critical mediator of IL-13-driven allergic inflammationhttp://bit.ly/4DzZvL

The occupant as a source of house dust bacteria: human-derived bacteria account for 69-88% of mattress dust samples http://bit.ly/10lJDF

Interleukin-33 – cytokine of dual function or novel alarmin? IL-33 is a ligand for the Th2-associated ST2 receptor http://bit.ly/kblld

New and Existing Therapeutic Options for Hand Eczema - Medscape Skin Therapy Letter http://bit.ly/rYzVx

Allergic rhinitis with negative skin tests: Does it exist? Is localized IgE-mediated allergy in play? http://bit.ly/FfKdF

Allergy and Immunology News of the Day

Levalbuterol versus albuterol: no clinical superiority was proven http://bit.ly/1UzHLo

Registration for the 2010 ABAI exams starts January 1st via the web portal http://bit.ly/4ynXRS

High-dose SLIT with 5 grasses (Oralair Grasses) decreases rhinitis symptoms from the first month of treatment forward. Oralair Grasses by Stallergenes includes 5 grasses: orchard, meadow, perennial rye, sweet vernal and timothy http://bit.ly/soFU0

Unilateral Rhinorrhea in Allergic Rhinitis Due to... Cerebrospinal Fluid Leak http://bit.ly/3WycEP

Antismoking drug Chantix has been linked to suicide but a new study shows that such risk is nonexistent or small http://bit.ly/Pijaf

ABAI Board Review Course online http://bit.ly/cukSf and PDFs http://bit.ly/183QYt

100 Worst Cities for Fall Allergies http://bit.ly/2SrIir

RT @AllergyZoneCEO: "Projected 20% growth in out-patient visits in next 10 years. 500M will be eVisits. Can Twitter play a role?"

In children with a cough that lasts more than 8 weeks, the most likely causes are allergy (?), reflux, and asthma http://bit.ly/3vAk8B

Allergy and Immunology News of the Day

Combined Immunodeficiency Associated with DOCK8 Mutations http://bit.ly/RzeJ3

Anaphylaxis after ingesting an omeprazole capsule - not due to omeprazole allergy but soybean oil hypersensitivity http://bit.ly/1hndk1

A diagnosis of soy allergy should not be overlooked in cases of drug hypersensitivity http://bit.ly/1hndk1

Large waist was associated with increased asthma prevalence even among women considered to have normal body weight http://bit.ly/ppaCW

Intal Inhaler (cromolyn sodium inhalation aerosol) is discontinued, the company has not found a HFA MDI manufacturer http://bit.ly/z1oBa

Urticaria pigmentosa on Flickr http://bit.ly/1jk23 via @MatthewBowdish

Mother of a boy with food allergy is fighting the city's decision that park officials can't use EpiPen in emergencies http://bit.ly/I94pe

Allergen rules may alter scents of great perfumes http://bit.ly/14kuFz

Contact dermatitis on Flickr: http://bit.ly/3AqI29

Subcutaneous kallikrein inhibitor ecallantide as a treatment for hereditary angioedema (HAE)

From MedPage Today:

Between 8,000 and 10,000 people in the U.S. are affected by the most common form of HAE which is caused by an autosomal dominant mutation that decreases C1 inhibitor levels.

Plasma kallikrein plays a major role in the contact (kallikrein-kinin) cascade producing bradykinin. Bradykinin is a vasodilator, which increases vascular permeability, activates inflammation and produces pain.

New therapies for hereditary angioedema (HAE) (click to enlarge the image).

Ecallantide (DX-88) is a subcutaneous kallikrein inhibitor which is under investigation for treatment of hereditary angioedema (HAE).

In the clinical trials, the proportion of patients who said they had complete or near-complete resolution varied by attack site:

- For abdominal attacks, 65.2% of those on the drug reported such an outcome, compared with 31.7% for those on placebo (P=0.01).

- For laryngeal attacks, the comparable proportion were 60% versus 11.1% (P=0.03).

- For peripheral attacks, there was no significant difference within the first four hours.

However, the median times -- 67 minutes for the drug versus 105 minutes for placebo -- were not significantly different.

References:

ACAAI: HAE Drug Offers Faster Relief. Michael Smith, North American Correspondent, MedPage Today.

Ecallantide (DX-88), a plasma kallikrein inhibitor for the treatment of hereditary angioedema and the prevention of blood loss in on-pump cardiothoracic surgery. Lehmann A. Expert Opin Biol Ther. 2008 Aug;8(8):1187-99.

Virtually No Relapses After Ecallantide for Acute HAE attacks, despite short half-life. Medscape, 2011.

Allergy and Immunology News of the Day

Rising Heat, Humidity Raise Risk of Asthma Exacerbations. 10% increase in humidity 2 days before the admission day was associated with one additional visit to ER for asthma. Temperature: an interday change of 10 degrees one day before the admission resulted in two additional visits for asthma http://bit.ly/VFuFU

Does food allergy cause atopic dermatitis? Diagnosis of food-induced eczema cannot be made w/o food challenge testing http://bit.ly/14x0tE

Case report: Presumed pizza allergy disproven, cause of the patient’s initial reaction remains unknown. The best skin testing method to test for allergy to fresh fruits and vegetables is the "prick prick" method http://bit.ly/CTrgv

World Allergy Organization's Online Food Allergy Learning Program http://bit.ly/3XrbZc

Angioedema: Interactive case report by WAO http://bit.ly/18Q2k2

Exercise-induced anaphylaxis: a case report. WAO. http://bit.ly/hA8tK

FPIES: Food Protein Induced Enterocolitis Syndrome. Patient Information: http://bit.ly/qad8q

Adverse reactions to vaccines do not make future vaccinations impossible

From MedPage Today:

Many people -- even some healthcare providers -- incorrectly think such reactions preclude a future vaccination. John Kelso, MD, of the Scripps Clinic in San Diego, briefly reviews the topic.

References:
ACAAI: Most Can Take Vaccines Even after Reactions. Michael Smith, North American Correspondent, MedPage Today.

Allergy and Immunology News of the Day

Definition of asthma has evolved - is it time to to move beyond FEV1? http://bit.ly/12rkNQ

Flu vaccine guidance for patients with immune deficiency by AAAAI http://bit.ly/7Lh06

Is intranasal FluMist safe in patients with egg allergy? http://bit.ly/7TSEl - No. FluMist must not be given to people with egg allergy.

Generic Alternative to EpiPen and TwinJect? http://bit.ly/19RMvu

Regulatory T cells become autoaggressive when Foxp3 is extinguished http://bit.ly/rZBl5

A patient chronicles their anaphylactic reaction to a wasp sting on Flickr http://bit.ly/fne4G - Not safe and not a recommended thing to do.

Mouse allergen associated with asthma in the community http://bit.ly/8NNCB

Defects of structural protein filaggrin as a risk factor for atopic dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease that is characterized by a defective skin barrier function. Recent studies have reported mutations of the skin barrier gene encoding filaggrin in a subset of patients with AD.

The filaggrin gene (FLG) mutation leads an epithelial barrier defect. This epidermal defect leads to:

- compromised barrier against allergens and microbes
- polarized T(H)2 lymphocyte response
- chronic inflammation, including autoimmune mechanisms

Patients with atopic dermatitis have an acquired decrease in filaggrin expression that is further decreased by IL-4 and IL-13.

Compared with normal skin, filaggrin expression was reduced in acute AD skin.

AD skin is characterized by the overexpression of IL-4 and IL-13. Keratinocytes differentiated in the presence of IL-4 and IL-13 exhibited reduced filaggrin gene expression.

Patients with AD have an acquired decrease in filaggrin expression that is further decreased by IL-4 and IL-13. Medications that block of IL-4 and IL-13 could improve skin barrier integrity.

SNPs associated with atopic diseases

Filaggrin gene

Filaggrin is essential for epidermal barrier function. SNP associated with eczema and asthma. Gene defect can triple risk of peanut allergy - filaggrin has already been shown to be a factor in eczema and asthma. BBC, 2011.

17q12-21 gene

ORMDL3 protein defects associated with asthma.

5q22-32 gene

CD14 is a lipopolysaccharide (LPS) receptor. SNPs associated with asthma and atopy.

3p21-22 gene

CCR5 is a chemokine receptor. SNP can be protective against asthma.

Xp22 gene

TLR7 and TLR8 are recognition receptors for viral ssRNA. SNPs assciated with asthma, rhinitis, atopic dermatitis.

5q31 gene

IL-13 is a cytokine that induces IgE secretion, mucus production, and collagen synthesis (fibrosis). SNPs associated with asthma.

ADRB2 gene

ADRB2 gene encodes β2-adrenergic receptor. Argenteum (Arg) or Arg/Arg phenotype associated with decreased albuterol response compared to Gly/Gly phenotype at residue 16.

ADAM33 gene

Type 1 transmembrane protein involved in cell-to-cell interactions. SNPs associated with asthma.

References:

Filaggrin in atopic dermatitis. O'Regan GM, Sandilands A, McLean WH, Irvine AD. J Allergy Clin Immunol. 2009 Sep;124(3S2):R2-R6.
Cytokine modulation of atopic dermatitis filaggrin skin expression. Howell MD, Kim BE, Gao P, Grant AV, Boguniewicz M, Debenedetto A, Schneider L, Beck LA, Barnes KC, Leung DY. J Allergy Clin Immunol. 2009 Sep;124(3S2):R7-R12.

Loss-of-function mutations in filaggrin gene are associated with atopic dermatitis, and now with peanut allergy too. JACI, 2011.

Gene defect can triple risk of peanut allergy - filaggrin has already been shown to be a factor in eczema and asthma. BBC, 2011.
Filaggrin gene mutations are associated with atopic asthma http://goo.gl/5mQlj

Early food sensitization and presence of FLG mutation in infants with eczema increase the risk for later asthma. JACI, 2011.
Image source: Atopic dermatitis. Wikipedia, GNU Free Documentation License.

Frequent Nasal Saline Irrigation May Lead to More Sinus Infections

From MedPage Today:

"Contrary to popular belief, irrigating the nose every day with the help of a Neti pot may actually make patients more susceptible to sinus infections. Those who stopped using the nasal saline wash on a regular basis had a 62% decrease in the frequency of acute rhinosinusitis, Talal M. Nsouli, MD and colleagues reported at the 2009 American College of Allergy, Asthma, & Immunology meeting.

"I don't have anything against short-term nasal saline irrigation -- even aggressive nasal saline irrigation for three, four days or one week is totally fine," Nsouli said. "But when we are doing it on a daily basis, we are modifying the immunological biochemistry of the nose."

Video discussion: "Nasal Saline Blown Out of Proportion":

References:

ACAAI: Frequent Nose Irrigation May Lead to More Sinus Infections. Kristina Fiore, Staff Writer, MedPage Today.

Nasal Irrigation as part of daily hygiene routine? "They brush their teeth, they wash their face, they rinse their nose" http://goo.gl/F0N11
Neti Pot, Nasal Irrigation - Pros and Cons and Slideshow. WebMD, 2011.

Predictors of severe anaphylaxis in Hymenoptera venom allergy

Severe anaphylaxis to honeybee or vespid (wasp) stings is associated with a variety of risk factors, which are poorly defined.

This study of 962 patients evaluated the association of baseline serum tryptase and other variables routinely recorded during patient evaluation with the frequency of past severe anaphylaxis after a field sting.

21.4% of patients had a severe anaphylactic reaction after a field sting.

Factors associated with severe reactions after a field sting were:

- higher tryptase concentrations
- vespid (wasp) venom allergy
- older age, male sex
- angiotensin-converting enzyme inhibitor medication

In patients with honeybee or vespid (wasp) venom allergy, baseline serum tryptase concentrations are associated with the risk for severe anaphylactic reactions. Preventive measures should include replacing angiotensin-converting enzyme inhibitors with other BP medications.

References:
Predictors of severe systemic anaphylactic reactions in patients with Hymenoptera venom allergy: importance of baseline serum tryptase-a study of the European Academy of Allergology and Clinical Immunology Interest Group on Insect Venom Hypersensitivity. Ruëff F, Przybilla B, Biló MB, Müller U, Scheipl F, Aberer W, Birnbaum J, Bodzenta-Lukaszyk A, Bonifazi F, Bucher C, Campi P, Darsow U, Egger C, Haeberli G, Hawranek T, Körner M, Kucharewicz I, Küchenhoff H, Lang R, Quercia O, Reider N, Severino M, Sticherling M, Sturm GJ, Wüthrich B. J Allergy Clin Immunol. 2009 Nov;124(5):1047-54.

Anaphylaxis guidelines by World Allergy Organization. JACI, 2011.
Image source: Vespula germanica, Wikipedia, Richard Bartz, Creative Commons Attribution ShareAlike 2.5 License.

B1 and gC1q receptors involved in vascular leakage induced by angioedema

Activation of bradykinin-mediated B2 receptor plays an important role in angioedema associated with C1 inhibitor deficiency. Icatibant is a B2 receptor antagonist.

It is unclear if other receptors expressed on endothelial cells contribute to the release of kinins and vascular leakage in these patients. The recognition of their role may have obvious therapeutic implications.

In a new study, both B1 receptor and gC1q receptor were involved in the vascular leakage induced by hereditary and acquired angioedema plasma.

References:
Novel pathogenic mechanism and therapeutic approaches to angioedema associated with C1 inhibitor deficiency. Bossi F, Fischetti F, Regoli D, Durigutto P, Frossi B, Gobeil F, Ghebrehiwet B, Peerschke EI, Cicardi M, Tedesco F. J Allergy Clin Immunol. 2009 Sep 29.
Image source: Bradykinin. Wikipedia, public domain.

SABAs downregulate anti-inflammatory effects of inhaled corticosteroids as shown by higher bromotyrosine levels

Previous research suggests that short-acting beta2-agonists (SABAs) may downregulate the anti-inflammatory effects of inhaled corticosteroids, thereby increasing asthma morbidity.

3-bromotyrosine and 3,5-dibromotyrosine levels are markers of eosinophil activation. 3-Bromotyrosine levels correlate with eosinophil cationic protein levels. These modified tyrosine residues provide useful information about the inflammatory state of the airways.

In this study, levels of 3-bromotyrosine and 3,5-dibromotyrosine were measured in sputum during treatment with terbutaline, budesonide, and their combination in 28 patients with persistent asthma.

Treatment with budesonide lowered 3-bromotyrosine levels compared with placebo and terbutaline. Budesonide-terbutaline lowered 3,5-dibromotyrosine levels compared with placebo and terbutaline treatments.

3-bromotyrosine and 3,5-dibromotyrosine were significantly raised when terbutaline was added to budesonide treatment.

The authors concluded that 3-Bromotyrosine and 3,5-dibromotyrosine reflect treatment effects in asthma and support previous findings that SABAs impair the anti-inflammatory effects of inhaled corticosteroids.

References:
Bromotyrosines in sputum proteins and treatment effects of terbutaline and budesonide in asthma. van Dalen CJ, Aldridge RE, Chan T, Senthilmohan R, Hancox RJ, Cowan JO, Taylor DR, Town GI, Kettle AJ. Ann Allergy Asthma Immunol. 2009 Oct;103(4):348-53.
Image source: Terbutaline. Wikipedia, public domain.

Inhaled pitrakinra (dual IL-4/IL-13 antagonist) inhibits airway hyperresponsiveness in asthma (in monkeys)

Pitrakinra is a recombinant protein derived from IL-4 that binds to IL-4R[alpha] and acts as an antagonist of IL-4 and IL-13.

Local administration of pitrakinra to the lung of monkeys inhibited allergen-induced airway hyperresponsiveness (AHR), one of the cardinal features of asthma, indicating the therapeutic potential of inhaled pitrakinra in the treatment of atopic asthma.

References:
Inhaled vs subcutaneous effects of a dual IL-4/IL-13 antagonist in a monkey model of asthma. A. Tomkinson, J. Tepper, M. Morton, A. Bowden, L. Stevens, P. Harris, D. Lindell, N. Fitch, R. Gundel, E. B. Getz. Allergy, 2009.
Image source: Crystal structure of human IL-4. Wikipedia, public domain.

Anaphylaxis to Patent Blue V dye used used for staging procedures in breast cancer

The dye Patent Blue V (PBV) is increasingly used for staging procedures in breast cancer but is reported to cause adverse reactions.

9 patients with hypersensitivity reactions to PBV who were identified through the Norwegian network for reporting allergic reactions during anesthesia.

There was an incidences of 0.5% for all kinds of PBV reactions and 0.4% for anaphylaxis.

Typical clinical features included:

- cardiovascular and/or cutaneous symptoms
- a delay in symptoms, compared to the time of dye injection
- poor response to ephedrine and intravenous fluid
- need for adrenaline administration, sometimes prolonged, for circulatory stabilization

During anaphylactic reactions, serum tryptase was increased in 6 patients and normal in one.

Skin prick tests to PBV were positive in all 8 patients tested.

The clinical features and the results of follow-up studies strongly suggest that these reactions are IgE mediated.

References:
Anaphylaxis to Patent Blue V. Clinical aspects. A. S. Hunting, A. Nopp, S. G. O. Johansson, F. Andersen, V. Wilhelmsen, A. B. Guttormsen. Allergy. 2009.
Image source: Blue. Wikipedia, public domain.

Fibrin degradation products, D-dimer and CRP for assessment of disease activity of chronic urticaria

Currently, there is no reliable biomarker for evaluation of disease severity and activity of chronic urticaria (CU).

Markers of blood coagulation and fibrinolysis are elevated in severe cases of CU.

Plasma fibrin degradation products (FDP), d-dimer and serum C-reactive protein (CRP) were measured in 82 patients with CU and 37 patients with acute urticaria, idiopathic angioedema (AE) or inducible types of urticaria (IU).

The levels of FDP in patients with CU were higher than those in patients with IU, but no other differences in FDP, d-dimer and CRP were observed among patients with different types of urticaria.

In 37 patients with CU, levels of all these parameters reduced as their disease condition improved, while they increased when the disease became aggravated.

The study authors concluded that the measurement of plasma FDP, d-dimer and serum CRP may be useful for the assessment of disease activity of CU. Asthma is also associated with a procoagulant state in the bronchoalveolar space (Blood, 01/2012).

References:

Coagulation/fibrinolysis and inflammation markers are associated with disease activity in patients with chronic urticaria. S. Takahagi et al. Allergy, 2009.
Image source: Urticaria, Wikipedia, public domain.

Triggers of asthma attacks in adults

131 adult asthma patients were enrolled into a study that assessed asthma triggers via a questionnaire.

Regardless of asthma severity, 59.5 % of the subjects reported to be triggered by more than 10 factors.

The most common triggers were air pollutants (89%) and weather changes (82%).

In the severe group, more frequently mentioned triggers were medications, emotional stress, weather changes and indoor pollutants. Stress was reported more frequently by females than males.

References:
Triggers in adult asthma: are patients aware of triggers and doing right? Göksel O, Celik GE, Oner Erkekol F, Güllü E, Mungan D, Misirligil Z. Allergol Immunopathol (Madr). 2009 May-Jun;37(3):122-8.
Air pollution near the home increases asthma severity in children
Traffic exposure associated with decreased lung function in asthma

The burden of adult asthma in the United States: patients with asthma less likely to be employed (odds ratio, 0.78) http://goo.gl/eCNuu
Image source: Interstate 80, seen here in Berkeley, California, is a freeway with many lanes and heavy traffic, Wikipedia, GNU Free Documentation License.

CNN video: Peanut-free game highlights food allergy

At least 120 people die each year in the United States from peanut allergies. Food allergies are becoming more prevalent worldwide.

References:
Peanut-free ballgame highlights food allergy dangers. CNN.

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CNN video: Peanut-free game highlights food allergy

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