IgE antibodies to alpha-gal in the general adult population: relationship with tick bites, atopy, and cat ownership

BACKGROUND

The carbohydrate alpha-gal epitope is present in many animal proteins, including those of red meat and animal immunoglobulins, such as cat IgA. Systemic anaphylaxis to the alpha-gal epitope has recently been described.

OBJECTIVE

To investigate and compare the prevalence of alpha-gal-specific (s)IgE and its associated factors in the general adult population from two separated (Northern and Southern) European regions (Denmark and Spain, respectively).

METHODS

Cross-sectional study of 2297 and 444 randomly selected adults from 11 municipalities in Denmark and one in Spain. Alpha-gal sIgE was assessed by ImmunoCAP to bovine thyroglobulin. Additional assessments included a panel of skin prick test (SPT) to common aeroallergens and epidemiological factors, including the history of tick bites in the Danish series.

RESULTS

The prevalence of positive (≥ 0.1 kUA /L) sIgE to alpha-gal was 5.5% and 8.1% in the Danish and Spanish series, respectively. The prevalence of sIgE ≥ 0.35 kUA /L was 1.8% and 2.2% in Denmark and Spain, respectively. Alpha-gal sIgE positivity was associated with pet ownership in both series and, particularly, cat ownership (data available in the Danish series). Alpha-gal sIgE positivity was associated with atopy (SPT positivity) in both series, although it was not associated with SPT positivity to cat or dog dander. Alpha-gal sIgE positivity was strongly associated with a history of tick bites.

CONCLUSIONS AND CLINICAL RELEVANCE

The prevalence of alpha-gal sIgE antibodies in these general adult European populations is similarly low. The presence of alpha-gal sIgE antibodies is associated with a history of tick bites, atopy, and cat ownership.

Stroke volume variation and indexed stroke volume measured using bioreactance predict fluid responsiveness in postoperative children

BACKGROUND

Postoperative fluid management can be challenging in children after haemorrhagic surgery. The goal of this study was to assess the ability of dynamic cardiovascular variables measured using bioreactance (NICOM®, Cheetah Medical, Tel Aviv, Israel) to predict fluid responsiveness in postoperative children.

METHODS

Children sedated and mechanically ventilated, who require volume expansion (VE) during the immediate postoperative period, were included. Indexed stroke volume (SVi), cardiac index, and stroke volume variation (SVV) were measured using the NICOM® device. Responders (Rs) to VE were patients showing an increase in SV measured using transthoracic echocardiography of at least 15% after VE. Data are median [95% confidence interval (CI)].

RESULTS

Thirty-one patients were included, but one patient was excluded because of the lack of calibration of the NICOM® device. Before VE, SVi [33 (95% CI 31-36) vs 24 (95% CI 21-28) ml m(-2); P=0.006] and SVV [8 (95% CI 4-11) vs 13 (95% CI 11-15)%; P=0.004] were significantly different between non-responders and Rs. The areas under the receiver operating characteristic curves of SVi and SVV for predicting fluid responsiveness were 0.88 (95% CI 0.71-0.97) and 0.81 (95% CI 0.66-0.96), for a cut-off value of 29 ml m(-2) (grey zone 27-29 ml m(-2)) and 10% (grey zone 9-15%), respectively.

CONCLUSIONS

The results of this study show that SVi and SVV non-invasively measured by bioreactance are predictive of fluid responsiveness in sedated and mechanically ventilated children after surgery.

Use of text-message reminders to improve participation in a population-based breast cancer screening program

To analyze the effect of a cell text message reminder service on participation in a mammogram screening program in Catalonia, Spain. A quasi-experimental design was used with women aged 50 to 69 years who had been scheduled mammogram appointments in June or July 2011. Women were personally invited by letter to attend to the breast cancer screening program (n = 12,786). Prior to the invitation, 3,719 (29.1 %) of them had provided their cell telephone number to the National Health Service. These women received a text message reminder 3 days before their scheduled appointment. Logistic regression models were used to analyze whether the text message reminder was associated with participation in screening. Cost-effectiveness of adding a text message reminder to the invitation letter was also analyzed. The overall rate of participation in breast cancer screening was 68.4 %. The participation rate was significantly higher in the text messaging group, with an age-adjusted OR of 1.56 (95 %CI: 1.43-1.70). A detailed analysis showed that the increase in participation related to the text message reminder was higher among women without previous screening who lived in areas where access to postal mail was limited (OR=2.85; 95 %CI: 2.31-3.53) compared to those who lived in areas of easier postal mail access (OR=1.66; 95 %CI: 1.36-2.02). The invitation letter+text message reminder was a cost-effective strategy. Text message reminders are an efficient cost-effective approach to improve participation in difficult-to-reach populations, such as rural areas and newly developed suburbs.

The association of the 'additional height index' with atopic diseases, non-atopic asthma, ischaemic heart disease and mortality: a population-based study

OBJECTIVE

Intrauterine growth has been associated with atopic conditions. Growth and adult height have been associated with cardiovascular disease, cancers and mortality but are highly genetic traits. The objectives of the study were as follows: first, to define a height measure indicating an individual's height below or above that which could be expected based on parental height (genetic inheritance) and growth charts. It was named 'the additional height index' (AHI), defined as (attained-expected) height; second, to investigate possible associations of AHI with atopic versus non-atopic health outcomes and with ischaemic heart disease (IHD) and IHD mortality.

DESIGN

General population-based study.

SETTING

Research centre.

PARTICIPANTS

A random sample of 2656 men and women living in greater Copenhagen took part in the MONICA10 study (the Danish monitoring trends and determinants of cardiovascular disease). In total, 1900 participants with information of parental height were selected.

OUTCOME MEASURES

Atopic sensitisation (serum IgE), questionnaire information of atopic dermatitis, rhinoconjunctivitis, asthma or wheezing, and registry-based diagnoses of IHD/IHD mortality from National Registries.

RESULTS

Increasing levels of AHI were inversely associated with non-atopic asthma, non-atopic wheezing, IHD and IHD mortality (IHD-all). For one SD increase of AHI, the OR or HR with CI in adjusted analyses was non-atopic asthma OR=0.52 (0.36 to 0.74), non-atopic wheezing OR=0.67 (0.51 to 0.89), and IHD-all HR=0.89 (0.78 to 1.01). The level of AHI was higher among individuals with atopic dermatitis, allergic rhinoconjunctivitis and atopic sensitisation (all p values <0.001) compared with individuals without those conditions; however, the associations were not confirmed in adjusted analyses.

CONCLUSIONS

Individuals with childhood conditions that led them to attain tallness higher than expected from their parents' height may be at lower risk of non-atopic asthma/wheeze and IHD/IHD mortality but possibly at higher risk of atopic conditions. The measure of tallness below or above the expected height could be a sensitive alternative to normal height in epidemiological analyses.

The relationship of serum triglycerides, serum HDL, and obesity to the risk of wheezing in 85,555 adults

BACKGROUND

Asthma has been linked to obesity and the presence of the metabolic syndrome.

OBJECTIVE

To explore which components of the metabolic syndrome that were associated with wheezing, a main symptom of asthma. Further, to explore whether these associations were different in individuals with and without rhinitis symptoms.

METHODS

We used data from the Ibermutuamur Cardiovascular Risk Assessment Plan (ICARIA) including 85,555 Spanish workers (median age = 34, range = 16-75 years) with assessments of self reported wheezing and rhinitis symptoms. Fasting blood samples were analysed for serum triglyceride (s-TG), HDL (s-HDL) and glucose; blood pressure, waist circumference (WC) and body mass index (BMI) were measured.

RESULTS

In mutually adjusted analyses including all components of the metabolic syndrome and possible confounders, elevated WC (or BMI), elevated s-TG and low s-HDL were significantly associated with wheezing. Odds ratio (OR) with confidence interval (CI) were: elevated WC = 1.54 (1.46-1.62), elevated s-TG = 1.24 (1.18-1.30), low s-HDL = 1.17 (1.12-1.22). These associations were stronger in individuals without than in those with rhinitis symptoms, OR's (CI's) were WC = without rhinitis 1.70 (1.57-1.85) vs. with rhinitis 1.47 (1.37-1.58). Elevated s-TG = without rhinitis 1.36 (1.26-1.46) vs. with rhinitis 1.21 (1.13-1.29). Low s-HDL = without rhinitis 1.24 (1.15-1.34) vs. with rhinitis 1.11 (1.04-1.18).

CONCLUSIONS

High s-TG and low s-HDL were associated with wheezing after adjustment for adiposity. This may substantiate elevated s-TG and lowered s-HDL as markers or inducers of inflammation associated disease. The study supports the notion that these biochemical markers have differential effects on different types of wheezing.

Serum tryptase concentrations in beekeepers with and without Hymenoptera venom allergy

BACKGROUND

Increased tryptase concentrations are a risk marker for the severity of reactions to Hymenoptera stings or venom immunotherapy

OBJECTIVE

To investigate serum tryptase concentrations in beekeepers with and without Hymenoptera venom allergy (HVA).

METHODS

Serum tryptase concentrations were measured in adult patients with HVA (n = 91, 37 of whom were beekeepers), beekeepers without HVA (n = 152), and control individuals from the general adult population (n = 246).

RESULTS

Multivariate analyses revealed that serum tryptase levels were positively associated with beekeeping activities (P < .001) and HVA (P < .001). Tryptase levels were also positively associated with age (P < .001) and male'sex (P = .02), and negatively associated with alcoho consumption (P = .002).

CONCLUSIONS

Beekeeping and HVA are independently associated with increased concentrations of serum tryptase.

Olfactory dysfunction in multiple sclerosis: evidence of a decrease in different aspects of olfactory function

BACKGROUND/AIMS

Numerous authors have described olfactory dysfunction in multiple sclerosis (MS) in recent years. The aim of this study was to specify the aspects of olfactory perception that are most affected and to identify any correlations with clinical, anatomical and functional data.

METHODS

50 patients with remitting or secondary progressive MS were included. Personal data were collected (medical history, characteristics of their disease, depression and disability scores and number of lesions on cerebral imaging). An olfactory test (Sniffin Sticks®) was used to evaluate subjects' olfactory function.

RESULTS

The odor detection threshold is the most sensitive marker, with 40% of patients presenting hyposmia. The ability to identify odors is affected later on, and is inversely correlated with the level of disability.

CONCLUSION

Our results confirm that several aspects of olfactory function are altered in MS, particularly those aspects requiring greater cognitive involvement, such as discrimination and identification of odors.

Influence of experimental alcohol administration on serum immunoglobulin levels: contrasting effects on IgE and other immunoglobulin classes

In humans, alcoholic liver disease is associated with hypergammaglobulinemia, particularly with high serum concentrations of IgA. Furthermore, alcohol consumption is associated with high concentrations of IgE and low concentrations of IgG. However, there is little experimental evidence to corroborate these observational findings. The objective of the present study was to investigate the potential short-term effects of alcohol administration on serum immunoglobulin concentrations in mice, and the potential influence of sex and strain on these effects. Eight mouse groups were defined by strain (Swiss vs C57BL/6), sex (male vs female), and experimental procedure (alcohol administration vs control diet). Alcohol was administered in a semi-liquid diet (6.5%v/v); control animals received an isocaloric semi-liquid diet. Immunoglobulin concentrations (IgE, IgA, IgM, IgG1, IgG2a, IgG2b, and IgG3) were measured at baseline and weekly thereafter for 4 weeks. Serum Th1 (interferon-gamma) and Th2 (IL-4 and IL-13) cytokines were measured at week 4. We found significant variations in baseline immunoglobulin concentrations depending upon mouse sex and strain. Alcohol administration was quickly followed by an increase in serum IgE concentrations in all experimental groups. IgE increase was correlated with serum IL-13 increase. In contrast, alcohol administration was not associated with significant changes in serum IgA and IgM concentration, and appeared to decrease IgG subclass concentrations. Alcohol effects on immunoglobulin concentrations were independent of mouse strain and sex. In conclusion, alcohol administration in mice had contrasting effects on IgE and other immunoglobulin classes. This experimental evidence confirms observational results in humans.

Exploring the obesity-asthma link: do all types of adiposity increase the risk of asthma?

BACKGROUND

Obesity and risk of asthma are linked. Different distributions of adiposity, such as visceral, subcutaneous or ectopic adiposity, may affect asthma risk differently.

OBJECTIVE

To explore the association of different adiposity types with self-reported asthma, bronchial inflammation and lung function, accounting for possible effect modifiers, such as atopy and gender.

METHODS

In a general population sample of 3471 persons aged 19-72, visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were measured by ultrasound, and fat percentage by bio-impedance. Body mass index, waist circumference, waist-to-hip ratio (WHR), bronchial inflammation as fractional expiratory nitric oxide (FeNO), lung function [FEV(1) and forced vital capacity (FVC)], and atopy (specific IgE) were measured.

RESULTS

All adiposity measures were associated with a higher risk of asthma. The risk estimates (odds ratios, OR, with 95% confidence interval, CI) of current asthma were of similar magnitude for all six adiposity measures ranging between 1.17, CI = 0.98-1.40 (SAT) and 1.51, CI = 1.17-1.95 (WHR). The adiposity-asthma associations were significantly stronger in non-atopics than in atopics. In non-atopics the risk estimates of current asthma ranged between 1.35 CI = 1.08-1.72 and 1.82 CI = 1.34-2.46 for SAT and WHR respectively. Consistent results were obtained using dichothomized adiposity measures (obese vs. non-obsese). The FVC and FEV(1) decreased significantly with increasing adiposity in both atopics and non-atopics, e.g. FVC decreased between 36 mL (CI = 10, 62 mL) and 155 mL (CI = 124, 186 mL) for one unit (standard error) increase of SAT and VAT respectively. Adiposity measures were not associated with atopy and not consistently associated with FeNO levels.

CONCLUSIONS AND CLINICAL RELEVANCE

The effect of adiposity on asthma was mainly seen in non-atopics and did not appear to depend on the distribution of adiposity as reflected by the adiposity measures used in the present study. Increasing adiposity was associated with lower lung function independent of atopic status.

Analysis of mite allergic patients in a diverse territory by improved diagnostic tools

BACKGROUND

There are few studies comparing the sensitization with mite allergens from different mite species which could potentially be the cause of allergy.

OBJECTIVE

To improve the diagnosis of mite allergic patients from a diverse territory in which D. pteronyssinus/D. farinae mites together with storage mites could be present in the environment.

METHODS

Four hundred and seventy-seven patients (both children and adults) from different regions, covering the main mite prevalent areas of Spain, were recruited. sIgE to eight allergens was measured together with SPT to whole mite extracts, level of mite allergen exposure, and specific IgG(4) . BAT and CAST was performed in a subgroup of patients.

RESULTS

D. pteronyssinus and L. destructor were more prevalent in Atlantic areas, whereas D. farinae predominate in Mediterranean areas. About 90% of patients were sensitized to group 1 and/or group 2 allergens. Group 2 was the most prevalent, and the IgE response/intensity of sensitization in BAT was higher. sIgE to Der p 2/Der f 2 was almost fully cross-reactive, but no cross-reactivity was detected with Lep d 2. Group 1 allergens were also cross-reactive, but in some patients a species-specific response was observed. sIgE to Lep d 2 was associated with SPT results to storage mites. Sensitization to Der p 1 was more frequent in children, whereas Lep d 2 sensitization was more frequent in adults. A higher ratio IgE/IgG(4) to Der p 2 was associated with the presence of allergic asthma.

CONCLUSION

An improved diagnosis algorithm has been established. Group 2 allergens seem to have a leading role in mite allergy, but as group 1 sensitization could be species-specific in some patients and its prevalence is higher in children, an adequate balance on major mite species and major allergens must be consider in the design of mite allergy vaccines.

Painful patellofemoral instability secondary to peroperative patellar fracture during bone-patellar tendon-bone autograft harvesting for anterior cruciate ligament reconstruction

Reconstructive surgery of the anterior cruciate ligament (ACL) of the knee in young active patients is a routine procedure, but with certain risks that need to be taken into account. Peroperative patellar fracture after bone-patellar tendon-bone autograft harvesting is a rare complication, which can significantly impair the functional outcome of ACL single-bundle reconstruction. We report the case of a patient presenting with disabling patellofemoral syndrome 3 years after arthroscopic ACL reconstruction by bone-tendon-bone autograft, revealing unnoticed mal-union of a iatrogenic sagittal patellar fracture. Patellar osteotomy corrected this painful iatrogenic patellar instability.