Two-thirds of patients with allergic rhinitis may be at risk of becoming asthmatic

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Allergic rhinitis (AR) may be considered a risk factor for the onset of asthma. Recently, it has been reported that forced expiratory flow between 25% and 75% of vital capacity (FEF(25-75) ) may predict a positive response to bronchodilation test in asthmatic children.

1,500 adult patients suffering from persistent AR were evaluated in this study from Italy.

63% of patients had reversibility to bronchodilation test and 18% had impaired FEF(25-75) values (lower than 65% of predicted).

This study highlights that about two-thirds of patients with persistent AR may be considered at risk of becoming asthmatic. Spirometry may allow the early detection of patients prone to develop asthma.

References:
Bronchodilation test in patients with allergic rhinitis. Ciprandi G, Signori A, Tosca MA, Cirillo I. Allergy. 2011 Jan 25. doi: 10.1111/j.1398-9995.2011.02544.x.

Image source: Wikipedia, a Creative Commons license.

Nasal cleansing - Mayo Clinic video

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Mayo Clinic: What can you do about that runny nose and nasal congestion? Medications are one option, but so is nasal cleansing.



Treatment Options for Allergic Rhinitis (click to enlarge the image).

Related:

SinuSurf (nasal saline rinse with surfactant) associated with loss of smell "for months to years". Discontinue use (PDF) http://goo.gl/awQUP

Patients with nut allergy have increased basophil CD203c levels

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Basophils contribute to anaphylaxis and allergies. The researchers examined the utility of assessing basophil-associated surface antigens (CD11b/CD63/CD123/CD203c/CD294) in characterizing and monitoring subjects with nut allergy.


Basophil granulocyte. Image source: Wikipedia.

CD203c levels increased in nut allergy

Basophil CD203c levels were increased at baseline in subjects with nut allergy compared to healthy controls.

Increased expression of CD203c occurred when basophils were stimulated with the allergen.

CD203c expression was decreased after 4 and 8 weeks of omalizumab (anti-IgE, Xolair) treatment but returned to baseline after treatment was stopped.

Subjects with nut allergy showed an increased CD203c level at baseline, and following stimulation with nut allergen. Both can be reduced by omalizumab therapy.

These results highlight the potential of using basophil CD203c levels for diagnosis and therapeutic monitoring in subjects with nut allergy.

Application of CD203c testing beyond food allergy

The same CD marker, CD203c, is used to test for Anti-FceR1 Autoantibodies in Chronic Urticaria.



Anti-FceR1 autoantibodies in chronic autoimmune urticaria: IgG against FceRI (receptor for IgE) (click to enlarge the image).

Basophil expression levels of CD203c might be used to monitor asthma control.

References:

Basophil CD203c levels are increased at baseline and can be used to monitor omalizumab treatment in subjects with nut allergy. Gernez Y, Tirouvanziam R, Yu G, Ghosn EE, Reshamwala N, Nguyen T, Tsai M, Galli SJ, Herzenberg LA, Herzenberg LA, Nadeau KC. Int Arch Allergy Immunol. 2011;154(4):318-27. Epub 2010 Oct 25.

F-PIGS? Wasn't there a better acronym for Food Protein-Induced Gastrointestinal Syndrome?

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It has been suggested that gene-environmental interactions (epigenomics) play a role in allergy in early life.

This Japanese study included two pairs of identical and fraternal twins with Food Protein-Induced Gastrointestinal Syndrome (FPIGS).

The identical twins developed vomiting and bloody stool simultaneously.

The fraternal twins developed prolonged vomiting and loose stools at different times.

Their symptoms resolved when formula feeding was stopped, and the symptoms were thought to indicate an allergy to cow's milk. However, the researchers concluded that the most likely diagnosis was FPIGS. Since the symptoms developed at different times, the genetics may play a role.

I am not sure that one can make any firm conclusions from these cases though. It is also worth mentioning that FPIGS is not considered a "true" IgE-mediated allergy.

References:

Food Protein-Induced Gastrointestinal Syndromes in Identical and Fraternal Twins. Shoda T, Isozaki A, Kawano Y. Allergol Int. 2011 Jan 25;60(1).
Image source: Wikipedia, GNU Free Documentation License.

Related reading

Understanding FPIES Through Moms Sharing Their Stories. Nutricia Neocate blog, 2011.
100% of Greek philosopher named trials showed reduction in mortality, compared with 12% of trials with other acronyms. Lancet, 2011.
International Association for Food Protein Enterocolitis (IAFFPE)

Twitter comments:

@kfatweets: Worse than iPad. RT @Allergy: Wasn't there a better acronym for Food Protein-Induced Gastrointestinal Syndrome (FPIGS)? http://goo.gl/yVwLq

@MatthewBowdish (Matthew Bowdish MD): FPIES is bad enough!

Vitamins A, D, and E, zinc, fruits and vegetables, and Mediterranean diet may prevent asthma

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Epidemiologic studies suggest that deficiencies of the nutrients selenium; zinc; vitamins A, C, D, and E; and low fruit and vegetable intake may be associated with the development of asthma and allergic disorders.

This meta-analysis included 62 study reports. There were no randomized controlled trials among them.

Serum vitamin A was lower in children with asthma compared with controls (odds ratio [OR], 0.25).

High maternal dietary vitamin D and E intakes during pregnancy were protective for the development of wheezing outcomes (OR, 0.56, and OR, 0.68, respectively).

Adherence to a Mediterranean diet was protective for persistent wheeze (OR, 0.22) and atopy (OR, 0.55).

Most fruit and vegetable studies reported beneficial associations with asthma and allergic outcomes.

The available epidemiologic evidence is weak but nonetheless supportive with respect to vitamins A, D, and E; zinc; fruits and vegetables; and a Mediterranean diet for the prevention of asthma. Experimental studies of these exposures are now warranted.

References:
Nutrients and foods for the primary prevention of asthma and allergy: Systematic review and meta-analysis. Nurmatov U, Devereux G, Sheikh A. J Allergy Clin Immunol. 2010 Dec 23.

Fruity Vegetables May Protect Against Atopy

Intravenous immune globulin (IVIG) in autoimmune and inflammatory disorders: how does it work?

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Intravenous immune globulin (IVIG) is an important treatment modality in patients with humoral or B-cell immune deficiency as replacement therapy. Soon after its introduction in 1980s for treatment of patients with immune deficiency, IVIG was used in the treatment of children with idiopathic thrombocytopenia purpura (ITP).

A lot more IVIG is used for the treatment of autoimmune and inflammatory disorders than as replacement therapy in patients with immune deficiency.


An antibody has Fab (fragment, antigen-binding) and Fc (fragment, crystalizable) regions. Fc receptors bind to the Fc region. Image source: Wikipedia, public domain.


Fc receptor interaction with an antibody-coated microbial pathogen. Image source: Wikipedia, public domain.

A number of mechanisms for the immune modulation and anti-inflammatory actions of IVIG have been described:

- Fc receptor blockade
- inhibition of complement deposition
- enhancement of regulatory T cells (T regs)
- inhibition or neutralization of cytokines and growth factors
- accelerated clearance of autoantibodies
- modulation of adhesion molecules and cell receptors
- activation of regulatory macrophages through the FcγRIIb receptor

IVIG affects many different pathways to modulate the immune and inflammatory response.

References:
The IgG molecule as a biological immune response modifier: Mechanisms of action of intravenous immune serum globulin in autoimmune and inflammatory disorders. Ballow M. J Allergy Clin Immunol. 2010 Dec 23.

Food Allergy: Is Sesame Seed the “Middle Eastern Peanut"?

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A survey of 1800 patients with suspected IgE-mediated food allergic reactions was conducted in Lebanon. Clinical correlation was done in 93 patients.

21% patients had positive specific IgE to food allergens.

The major causes of food allergy were:

- cow's milk in infants and young children
- hazelnut and wheat flour in adults

Although specific IgE to peanut were higher than for sesame, peanut-induced allergic reactions were mild, in contrary to sesame where anaphylaxis was the only clinical manifestation.

Recently, sesame has been recognized as an increasingly frequent and potentially severe allergen. Sesame allergy is probably related to the nutritional habits of the local population.

References:
Food Allergy in Lebanon: Is Sesame Seed the “Middle Eastern” Peanut. World Allergy Organization Journal: January 2011 - Volume 4 - Issue 1 - pp 1-3.

Diagnosing sesame allergy by an immediate-reading “contact test” with sesame oil. JACI, 2011.

Image sources: Wikipedia, public domain.

Managing Food Allergies in the School Setting (video)

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Managing Food Allergies in the School Setting is a 20-minute educational video created by the Food Allergy and Anaphylaxis Network (FAAN), in collaboration with the Centers for Disease Control and Prevention's Division of Adolescent and School Health, the National Association of School Nurses, and the National School Boards Association. In the video, children, parents, school nurses, school principals, and others offer guidance to help schools better manage this emerging school health issue.

Related reading:

Helping Families Manage Food Allergy in Schools - Medscape http://goo.gl/kCsTs
Management of food allergy in schools - AAAAI Ask the Expert, 2011.
Overhyped Panics - WSJ, 2011.

Latest U.S. Asthma Statistics by CDC (video)

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CDC: What does living with asthma mean to you? About 25 million people are living with asthma in the U.S. Learn what you can do to control your asthma at http://cdc.gov/VitalSigns/asthma

Asthma in the US is growing every year. Asthma rates rose the most among black children, almost a 50% increase. Asthma was linked to 3,447 deaths (about 9 per day) in 2007. Asthma costs in the US grew from about $53 billion in 2002 to about $56 billion in 2007, about a 6% increase.

One in 12 people (about 25 million, or 8% of the population) had asthma in 2009, compared with 1 in 14 (about 20 million, or 7%) in 2001.

More than half (53%) of people with asthma had an asthma attack in 2008. 185 children and 3,262 adults died from asthma in 2007.

Better asthma education is needed: less than half of people with asthma reported being taught how to avoid triggers.

Postorgasmic illness syndrome (POIS) - local allergic symptoms and transient flu-like illness in men

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Postorgasmic illness syndrome (POIS) is a combination of local allergic symptoms and transient flu-like illness. This post-ejaculatory complex of local and/or systemic symptoms occurs within seconds, minutes, or hours post-masturbation, coitus, or spontaneous ejaculation. Recent data may suggest an autoimmunogenic/allergic underlying mechanism.

Baseline characteristics of the study group

This Dutch study included 45 males suspected of having POIS:

- 58% of them had an atopic constitution

- 56% had a lifelong premature ejaculation, defined as self-perceived intravaginal ejaculation latency time (IELT) of less than 1 minute.

Clinical features

In 87% of men, POIS symptoms started within 30 minutes after ejaculation.

Complaints of POIS were categorized in seven clusters of symptoms, e.g., general, flu-like, head, eyes, nose, throat, and muscles.

Local allergic reactions of eyes and nose were reported in 44% and 33% of subjects, a flu-like syndrome in 78% of subjects, exhaustion and concentration difficulties in 80% and 87% of subjects.

Skin prick tests

Of the 45 included men, 33 subjects consented to skin-prick testing with autologous diluted semen. 88% of the 33 men had a positive skin-prick test with their own (autologous) semen.

Diagnosis and conclusion

The combination of allergic and systemic flu-like reactions post-ejaculation together with a positive skin-prick test in the majority of males underscores the hypothesis of an "immunogenic" etiology of POIS. POIS could be caused by Type-1 and/or Type-IV allergy to the males' own semen, as soon it is triggered by ejaculation.

Treatment

Two males with POIS were successfully treated by hyposensitization with autologous semen, which supports an immunogenic/allergic etiology and underscores the clinical implication for immunological sexual medicine.

References:

Postorgasmic Illness Syndrome (POIS) in 45 Dutch Caucasian Males: Clinical Characteristics and Evidence for an Immunogenic Pathogenesis (Part 1). Waldinger MD, Meinardi MM, Zwinderman AH, Schweitzer DH. J Sex Med. 2011 Jan 17. doi: 10.1111/j.1743-6109.2010.02166.x. [Epub ahead of print].

Hyposensitization Therapy with Autologous Semen in Two Dutch Caucasian Males: Beneficial Effects in Postorgasmic Illness Syndrome (POIS; Part 2). Waldinger MD, Meinardi MM, Schweitzer DH. J Sex Med. 2011 Jan 17. doi: 10.1111/j.1743-6109.2010.02167.x. [Epub ahead of print].

Semen Allergy Suspected in Rare Post-Orgasm Illness. Reuters.

Some poor men are apparently allergic to their own semen. LA Times.

Men, do you suffer from flu symptoms after sex? You could be allergic to your own semen. Daily Mail.

Food Allergy on NBC News (video)

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Visit msnbc.com for breaking news, world news, and news about the economy

Food Allergy on NBC Nightly News, May 8, 2011.

Food Allergy Awareness Week 2011

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Mark your calendars for the 14th annual Food Allergy Awareness Week, May 8-14, 2011. This is a video by the Food Allergy and Anaphylaxis Network.

8 foods cause 90 percent of food allergies (TEMPS WFS) (click to enlarge the image)

Related reading:

Food Allergy Cases, Clinical Notes, Mind Maps and Mnemonics at AllergyCases.org

News About Food Allergy at Allergy Notes

Omalizumab safe and effective as add-on therapy to corticosteroids in asthma (meta-analysis)

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Omalizumab is a humanized monoclonal anti-IgE for the treatment of severe allergic asthma. Because omalizumab targets an immune system molecule (IgE and its receptors), there has been particular interest in the drug's safety.

This meta-analysis included 8 trials with 3,400 participants.

At the end of the steroid-reduction phase, patients taking omalizumab were more likely to be able to withdraw from corticosteroids completely compared with those taking placebo (relative risk [RR] = 1.80).

Omalizumab patients showed a decreased risk of asthma exacerbations (RR = 0.56).

The frequency of serious adverse effects was similar in the omalizumab (3.8%) and placebo (5.3%) groups. However, injection site reactions were more frequent in the omalizumab patients (20% vs. 13%).

There were no indications of increased risk of hypersensitivity reactions, cardiovascular effects, or malignant neoplasms.

In school-aged children, adolescents, and adults with moderate-to- severe persistent allergic asthma, subcutaneous injection of omalizumab (0.016 mg/kg/international units/mL every 2 to 4 weeks depending on body weight) was superior to placebo in preventing asthma exacerbations.

Limitations of the systematic review include identification of only 2 trials that recruited pediatric participants. Also the study period was not long enough, for example, no significant adverse effects were seen among patients taking omalizumab in studies shorter than 1 year.

References:
Efficacy and Safety of Subcutaneous Omalizumab vs Placebo as Add-on Therapy to Corticosteroids for Children and Adults With Asthma: A Systematic Review. Rodrigo GJ, Neffen H, Castro-Rodriguez JA. Chest. 2011 Jan;139(1):28-35. Epub 2010 Aug 5.
Humanized Monoclonal Antibody May Be Effective, Safe in Asthma Patients. Medscape, 2011.

Omalizumab in Severe Asthma Inadequately Controlled With Standard Therapy reduces asthma exacerbations by 25% (RR), Annals of Int Medicine, 2011.

Image source: Wikipedia, public domain.