Novel treatments of asthma and allergic diseases

Childhood Allergy Disease, Early Diagnosis, and the Potential of Salivary Protein Biomarkers

Allergic disease has risen to epidemic proportions since the last decade and is among the most common noncommunicable, chronic diseases in children and adolescents worldwide. Allergic disease usually occurs in early life; thus, early biomarkers of allergic susceptibility are required for preventive measures to high-risk infants which enable early interventions to decrease allergic severity. However, to date, there is no reliable general or specific allergy phenotype detection method that is easy and noninvasive for children. Most reported allergic phenotype detection methods are invasive, such as the skin prick test (SPT), oral food challenge (OFC), and blood test, and many involve not readily accessible biological samples, such as cord blood (CB), maternal blood, or newborn vernix. Saliva is a biological sample that has great potential as a biomarker measurement as it consists of an abundance of biomarkers, such as genetic material and proteins. It is easily accessible, noninvasive, collected via a painless procedure, and an easy bedside screening for real-time measurement of the ongoing human physiological system. All these advantages emphasise saliva as a very promising diagnostic candidate for the detection and monitoring of disease biomarkers, especially in children. Furthermore, protein biomarkers have the advantages as modifiable influencing factors rather than genetic and epigenetic factors that are mostly nonmodifiable factors for allergic disease susceptibility in childhood. Saliva has great potential to replace serum as a biological fluid biomarker in diagnosing clinical allergy. However, to date, saliva is not considered as an established medically acceptable biomarker. This review considers whether the saliva could be suitable biological samples for early detection of allergic risk. Such tools may be used as justification for targeted interventions in early childhood for disease prevention and assisting in reducing morbidity and mortality caused by childhood allergy.

Correlation between use of immunosuppressive agents and transplant-acquired allergies in renal transplant recipients

Background

Although immunosuppressive agents used in recipients of organ transplants can suppress T cell immune responses, type I allergy to ingested or inhaled allergens after organ transplantation have frequently been reported in pediatric patients. This study aims to investigate the relationship between the use of immunosuppressive agents and the transplant-acquired allergy (TAA) in adult renal transplant recipients (RTRs).

Methods

Seventy-nine RTRs treated in our hospital from February 2015 to February 2016 were interviewed for allergic diseases by using a standard questionnaire. UniCAP allergen screening tests were performed to detect total IgE and specific IgE levels before and after renal transplantation after the use of calcineurin inhibitor tacrolimus (FK506) or cyclosporin A (CsA). The follow-up visits were scheduled for 6 months, 1 year, 2 years, and 3 years after transplantation.

Results

Allergen sensitization occurred in 9 of 79 patients. Among them, the sensitization occurred in 2 cases within 6 months after renal transplantation, in 1 case from 6 months to 1 year, in 3 cases from 1 to 2 years, and in 3 cases from 2 to 3 years. The majority of sensitization was induced by inhaled allergens (n=7), among whom 3 patients (3/79, 3.8%) had a history of type I allergy, which occurred within 6 months after transplantation in 2 cases (allergic dermatitis) and from 2 to 3 years in 1 case (diarrhea after peanut allergy). The total IgE levels of RTRs using immunosuppressive agents at different time points including 6 months, 1 year, 2 years, and 3 years after renal transplantation were significantly lower than that before surgery (all P<0.05). Sensitization occurred in 8 RTRs using FK506 and in 1 patient treated with CsA (P=0.432), and allergies occurred in 3 RTRs using FK506 and were not found among CsA users (P=0.561).

Conclusions

Administration of immunosuppressive agents in adult RTRs cannot wholly prevent allergy or sensitization. Studies with larger sample sizes and more extended follow-up periods are still required to further explore the potential association between the use of FK506 and CSA and the allergies or sensitization.

Shuang-Huang-Lian Attenuates Airway Hyperresponsiveness and Inflammation in a Shrimp Protein-Induced Murine Asthma Model

Shuang-Huang-Lian (SHL), an herbal formula of traditional Chinese medicine, is clinically used for bronchial asthma treatment. Our previous study found that SHL prevented basophil activation to suppress Th2 immunity and stabilized mast cells through activating its mitochondrial calcium uniporter. Sporadic clinical reports that SHL was used for the treatment of bronchial asthma can be found. Thus, in this study, we systematically investigated the effects of SHL on asthmatic responses using a shrimp protein (SP)- induced mouse model. SHL significantly inhibited airway inspiratory and expiratory resistance, and histological studies suggested it reduced thickness of airway smooth muscle and infiltration of inflammation cells. It also could alleviate eosinophilic airway inflammation (EAI), including reducing the number of eosinophils and decreasing eotaxin and eosinophil peroxidase levels in the bronchoalveolar lavage fluid (BALF). Further studies indicated that SHL suppressed SP-elevated mouse mast cell protease-1 and IgE levels, prevented Th2 differentiation in mediastinal lymph nodes, and lowered Th2 cytokine (e.g., IL-4, IL-5, and IL-13) production in BALF. In conclusion, SHL attenuates airway hyperresponsiveness and EAI mainly via the inhibition of mast cell activation and Th2 immunity, which may help to elucidate the underlying mechanism of SHL on asthma treatment and support its clinical use.

Glycomacropeptide administration attenuates airway inflammation and remodeling associated to allergic asthma in rat

OBJECTIVE

Glycomacropeptide (GMP) is a bioactive peptide derived from milk that has been reported to exhibit a range of anti-inflammatory and immunomodulatory properties. The aim of this study was to analyze the prophylactic effect of GMP administration on airway inflammation and remodeling in an experimental model of asthmatic rat.

METHODS

Animals treated orally with or without GMP (500 mg/kg/day) were ovalbumin-sensitized and -nebulized and several indicators of Th2 response, airway structural changes and inflammatory cells recruitment were evaluated.

RESULTS

Treatment with GMP prior and during asthma development resulted in reduction of allergen-specific IgE titers in serum and blood eosinophilia. Also, GMP substantially suppressed the recruitment of inflammatory cells to bronchoalveolar compartment. Histological studies demonstrated that GMP markedly inhibits eosinophils infiltration, goblet cells hyperplasia and collagen deposit in lung tissue. The latter effect was related with an inhibition in transforming growth factor-β expression. In addition, expression of interleukin-5 and -13 were substantially inhibited in lung while that of interleukin-10 was increased.

CONCLUSION

Our results suggest that administration of GMP may prevent the development of an excessive Th2 response in asthma and effectively ameliorates the progression of the disease.

Acupuncture Attenuated Inflammation and Inhibited Th17 and Treg Activity in Experimental Asthma

Acupuncture is an effective therapeutic method in asthma treatment in traditional Chinese medicine. Here, we evaluated the effect of acupuncture on airway hyperresponsiveness (AHR) and the associated inflammatory changes as well as Th17 and Treg activity in ovalbumin- (OVA-) induced experimental asthma. Our results revealed that acupuncture treatment significantly inhibited AHR, lung inflammation, and mucus secretion of experimental asthma mice. Furthermore, a decrease in lymphocytes and eosinophils as well as neutrophils was observed in bronchoalveolar lavage fluid (BALF) of mice treated with acupuncture. Acupuncture reduced the OVA specific IgE level as well as the Th17 cytokine levels including IL-17A, IL-17F, and IL-22 in the serum of the experimental asthma mice. Acupuncture treatment group also had reduced CD4+IL-17A+ cell numbers and increased CD4+Foxp3+ cell numbers in BALF. In addition, acupuncture could inhibit IL-17R, RORγt, p65, and the inhibitor of NF-κB kinase-α (IKKα) protein expression. Our results indicated that acupuncture was effective in inhibiting AHR and inflammation in OVA-induced experimental asthma, which may be associated with the regulation of Th17 and Treg activity and NF-κB pathway.

A, Canales M, Morales S. RGE, Mardones P. P, Leiva G. MA. Trends and threshold exceedances analysis of airborne pollen concentrations in Metropolitan Santiago Chile

Pollen is one of the primary causes of allergic rhinoconjunctivitis in urban centers. In the present study, the concentrations of 39 different pollens in the Santiago de Chile metropolitan area over the period 2009–2013 are characterized. The pollen was monitored daily using Burkard volumetric equipment. The contribution of each type of pollen and the corresponding time trends are evaluated. The concentrations of the pollens are compared with the established threshold levels for the protection of human health. The results show that the total amount of pollen grains originating from trees, grasses, weeds and indeterminate sources throughout the period of the study was 258,496 grains m-3, with an annual average of 51,699 ± 3,906 grains m-3 year-1. The primary source of pollen is Platanus orientalis, which produces 61.8% of the analyzed pollen. Grass pollen is the third primary component of the analyzed pollen, with a contribution of 5.82%. Among the weeds, the presence of Urticacea (3.74%) is remarkable. The pollination pattern of the trees is monophasic, and the grasses have a biphasic pattern. The trends indicate that the total pollen and tree pollen do not present a time trend that is statistically significant throughout the period of the study, whereas the grass pollen and weed pollen concentrations in the environment present a statistically significant decreasing trend. The cause of this decrease is unclear. The pollen load has doubled over the past decade. When the observed concentrations of the pollens were compared with the corresponding threshold levels, the results indicated that over the period of the study, the pollen concentrations were at moderate, high and very high levels for an average of 293 days per year. Systematic counts of the pollen grains are an essential method for diagnosing and treating patients with pollinosis and for developing forestation and urban planning strategies.

Immunotherapy in allergy and cellular tests: state of art

The basophil activation test (BAT) is an in vitro assay where the activation of basophils upon exposure to various IgE-challenging molecules is measured by flow cytometry. It is a cellular test able to investigate basophil behavior during allergy and allergy immunotherapy. A panoply of critical issues and suggestive advances have rendered this assay a promising yet puzzling tool to endeavor a full comprehension of innate immunity of allergy desensitization and manage allergen or monoclonal anti-IgE therapy. In this review a brief state of art of BAT in immunotherapy is described focusing onto the analytical issue pertaining BAT performance in allergy specific therapy.