The link between helminthic infection and atopy

Food Allergies and Parasites in Children

The dynamically growing incidence of food allergies forces the scientific community to develop new methods for their diagnosis, differentiation, and effective treatment. Parasitoses appear much less frequently in the scientific literature, as well as among the presumed causes of numerous conditions. The similarity of inflammatory mechanisms in allergies and parasitosis necessitates a revision of current diagnostic standards. A lack of specificity and the coincidence of symptoms at an early stage of disease can lead to misdiagnosis. In this paper, we attempted to perform a comparative analysis of the similarities and differences in symptoms for these two types of diseases. We described the molecular mechanisms and metabolic pathways of food allergy and parasitosis. We presented the available research methods and directions of ongoing studies aimed at implementing precise medical techniques for differential diagnosis. We discussed the allergenic properties of certain parasite proteins, using the example of myofibrillar tropomyosins from the nematode Anisakis simplex. The literature in the fields of allergology and parasitology leads to the conclusion that it is reasonable to run parallel allergological and parasitological diagnostics in patients with non-specific symptoms. This approach will facilitate accurate and early diagnosis and implementation of effective therapy.

Effects of Maternal Fenbendazole on Litter Size, Survival Rate, and Weaning Weight in C57BL/6J Mice

Fenbendazole is a broad-spectrum benzimidazole commonly used in laboratory animal medicine as an anthelmintic for elimination of pinworms. This drug is generally regarded as safe, with minimal side effects. Some data in rodent species indicate multiple physiologic effects of fenbendazole, including changes in immune parameters and behavior, but no studies to date have evaluated possible effects on reproduction in mice. The purpose of the current study was to determine the effects of several treatment regimens of fenbendazole on reproductive parameters in C57BL/6J mice. Uninfected mice were given fenbendazole-treated feed continuously or every other week until pups were born or weaned. This treatment also was combined with environmental decontamination. No significant differences in litter size, survival rate, or weaning weight were detected between groups. Under the conditions of this study, fenbendazole treatment does not affect reproduction in C57BL/6J mice.

Association between exercise-induced asthma and parental socio-economic status among school-aged adolescents in a semiurban community in Nigeria

This study investigated the prevalence and association between exercise-induced asthma (EIA) and parental socio-economic status (PSES) among school-aged adolescents in a semiurban community in Nigeria. Three hundred and eighty-five adolescents (185 male and 200 female adolescents) whose ages ranged between 10 and 19 years participated in this cross-sectional study. Participants were recruited from four government approved secondary schools in Ido-Ekiti using a multistage sampling technique. Peak expiratory flow rate (PEFR) was assessed at baseline and after 6-min run test (6-MRT) on a level playing ground using a standard peak flow meter. PEFR measurements were repeated at 5th, 10th, 15th, and 20th min post 6-MRT. Participants who had >15.0% PEFR fall were considered to have EIA. PSES was assessed using a validated socio-economic status questionnaire. Descriptive and inferential statistics were used to analyze data. Alpha level was set at P<0.05. The mean ages of males and females were 13.9±2.0 and 13.8±1.6 years, respectively. More than half of the participants, 58.2% had EIA (>15.0% PEFR scores) while 53.5% belonged to middle PSES class. There was no significant difference between PEFR scores of male and female participants at baseline and 5th min post 6-MRT. However, male participants had significant higher PEFR than the female counterparts at 10th (t=2.090, P=0.037), 15th (t=2.162, P=0.031), and 20th min (t=2.978, P=0.003). There was significant association between EIA and PSES (χ²=152.4; P=0.001). The prevalence of EIA is very high among school-aged adolescents in Nigeria and was significantly associated with PSES.

Clonorchis sinensis infection is positively associated with atopy in endemic area

BACKGROUND

Epidemiologic studies have suggested that helminth infections play a protective role against allergy; this inverse association, however, has not been consistent. Clonorchis sinensis, the liver fluke of human, is prevalent in the Far East. The association between C. sinensis infection and allergy has not yet been reported.

OBJECTIVE

We evaluated the association between clonorchiasis and atopy or allergic diseases in adults in endemic areas of clonorchiasis.

METHODS

A total of 1116 subjects (males 419, females 697; age range, 30-86; mean age=61 years) were recruited from two endemic areas of C. sinensis in Korea. Clonorchiasis was confirmed by stool examination. Allergic symptoms were evaluated with a modified ISAAC questionnaire, and atopy was defined by skin prick test for common inhalant allergens. Total serum IgE and C. sinensis-specific IgE level was measured by ELISA and methacholine bronchial provocation test was performed to evaluate airway hyperresponsiveness (AHR).

RESULTS

Clonorchiasis was positively associated with atopy [odds ratio (OR), 1.856; 95% confidence interval (CI), 1.199-2.873] and high levels of total serum IgE (OR, 1.455; 95% CI, 1.050-2.016). Higher association with clonorchiasis was shown in subjects who showed both atopy and high total serum IgE levels (OR, 2.540; 95% CI, 1.448-4.455). Clonorchiasis had no association with wheezing, AHR, asthma or allergic rhinitis.

CONCLUSION AND CLINICAL RELEVANCE

Clonorchiasis was positively associated with atopy in adults in endemic area.

High body mass index is not associated with atopy in schoolchildren living in rural and urban areas of Ghana

Background

Factors which determine the development of atopy and the observed rural-urban gradient in its prevalence are not fully understood. High body mass index (BMI) has been associated with asthma and potentially atopy in industrialized countries. In developing countries, the transition from rural to urban areas has been associated with lifestyle changes and an increased prevalence of high BMI; however, the effect of high BMI on atopy remains unknown in this population. We therefore investigated the association between high BMI and atopy among schoolchildren living in rural and urban areas of Ghana.

Methods

Data on skin prick testing, anthropometric, parasitological, demographic and lifestyle information for 1,482 schoolchildren aged 6-15 years was collected. Atopy was defined as sensitization to at least one tested allergen whilst the Centres for Disease Control and Prevention (CDC, Atlanta) growth reference charts were used in defining high BMI as BMI ≥ the 85^th percentile. Logistic regression was performed to investigate the association between high BMI and atopy whilst adjusting for potential confounding factors.

Results

The following prevalences were observed for high BMI [Rural: 16%, Urban: 10.8%, p < 0.001] and atopy [Rural: 25.1%, Urban: 17.8%, p < 0.001]. High BMI was not associated with atopy; but an inverse association was observed between underweight and atopy [OR: 0.57, 95% CI: 0.33-0.99]. Significant associations were also observed with male sex [Rural: OR: 1.49, 95% CI: 1.06-2.08; Urban: OR: 1.90, 95% CI: 1.30-2.79], and in the urban site with older age [OR: 1.76, 95% CI: 1.00-3.07], family history of asthma [OR: 1.58, 95% CI: 1.01-2.47] and occupational status of parent [OR: 0.33, 95% CI: 0.12-0.93]; whilst co-infection with intestinal parasites [OR: 2.47, 95% CI: 1.01-6.04] was associated with atopy in the rural site. After multivariate adjustment, male sex, older age and family history of asthma remained significant.

Conclusions

In Ghanaian schoolchildren, high BMI was not associated with atopy. Further studies are warranted to clarify the relationship between body weight and atopy in children subjected to rapid life-style changes associated with urbanization of their environments.

Helminth infection inhibits airway allergic reaction and dendritic cells are involved in the modulation process

Several previous studies have demonstrated that some helminth infections can inhibit allergic reactions, but the examination on the effect of live Schistosoma japonicum (SJ) infection on allergic inflammation remains limited. The aim of this study was to examine the effect and mechanism of chronic SJ infection on airway allergic inflammation in a murine model. The data showed that chronic SJ infection suppressed airway eosinophilia, mucus production and antigen-specific IgE responses induced by ovalbumin (OVA) sensitization and challenge. Cytokine production analysis showed that chronic SJ infection reduced allergen-driven interleukin (IL)-4 and IL-5 production, but had no significant effect on IFN-gamma production. More importantly, we found that the adoptive transfer of dendritic cells (DCs) from SJ-infected mice dramatically decreased airway allergic inflammation in the recipients, which was associated with significant decrease of IL-4/IL-5 production and increase of IL-10 production. The results suggest that SJ infection may inhibit the development of allergy and that DCs may be involved in the process of helminth infection-mediated modulation of allergic inflammation.

Towards a differential definition of atopy: Anisakis simplex and the relationship between parasites and arthropods in respiratory allergy

Protective as well as enhancing effects of parasite infections on allergic disease have been postulated. Previous studies on this relationship focused frequently on skin test reactivity against aeroallergens, being house dust mites (HDM) the main agents responsible for a positive atopy outcome. We aimed to analyse the possible relationship between human parasite infection induced Anisakis simplex urticaria and respiratory allergy. A total of 86 patients with gastro-allergic Anisakiasis and 203 patients with chronic urticaria sensitized against A. simplex were studied for sensitization against aeroallergens and evaluated for rhinoconjunctivitis or bronchial asthma (RCBA). We compared the results with a control group of 250 consecutive patients referred for evaluation of allergic RCBA and atopy prevalence data of our region. Whereas no effect of A. simplex related disease on the overall allergic respiratory disease could be detected, a highly significant higher prevalence of RCBA associated HDM sensitization, but diminished allergy against other common aeroallergens (pollen, mould or dander) was observed in these groups. The relationship between A. simplex parasitism-associated acute or chronic urticaria on one side and allergic respiratory disease on the other side depends on the definition of atopy. We propose a differential definition of atopy, with a special emphasis on arthropod related sensitization.

Old enemies, still with us after all these years

Although some previously common infections, such as Sendai virus and Mycoplasma pulmonis, have become rare in laboratory rodents in North American research facilities, others continue to plague researchers and those responsible for providing biomedical scientists with animals free of adventitious disease. Long-recognized agents that remain in research facilities in the 21st century include parvoviruses of rats and mice, mouse rotavirus, Theilers murine encephalomyelitis virus (TMEV), mouse hepatitis virus (MHV), and pinworms. The reasons for their persistence vary with the agent. The resilience of parvoviruses, for example, is due to their resistance to inactivation, their prolonged shedding, and difficulties with detection, especially in C57BL/6 mice. Rotavirus also has marked environmental resistance, but periodic reintroduction into facilities, possibly on bags of feed, bedding, or other supplies or equipment, also seems likely. TMEV is characterized by resistance to inactivation, periodic reintroduction, and relatively long shedding periods. Although MHV remains active in the environment at most a few days, currently prevalent strains are shed in massive quantities and likely transmitted by fomites. Pinworm infestations continue because of prolonged infections, inefficient diagnosis, and the survivability of eggs of some species in the environment. For all of these agents, increases in both interinstitutional shipping and the use of immunodeficient or genetically modified rodents of unknown immune status may contribute to the problem, as might incursions by wild or feral rodents. Elimination of these old enemies will require improved detection, strict adherence to protocols designed to limit the spread of infections, and comprehensive eradication programs.

Effect of parasitosis on allergic sensitization in rats sensitized with ovalbumin: interaction between parasitosis and allergic sensitization

Some helminthic infections, especially nematode infections, may behave as allergens and induce allergic sensitization. In this study, the investigators explored whether infections with Syphacia muris and Aspiculuris tetraptera have any effect on the development of allergen-induced cytokine responses and serum total immunoglobulin E (IgE) levels in ovalbumin (OVA)-sensitized rats. Four groups of male Wistar rats were studied. OVA sensitization was generated in 2 groups of rats; the rats in 1 group were infected and those in the other group were not. On day 21 after sensitization, tumor necrosis factor-alpha, interleukin-10, and total IgE levels in serum samples of rats were measured by enzyme-linked immunosorbent assay. The results showed that average concentrations of tumor necrosis factor-a and interleukin-10 were significantly greater in the group of rats infected with parasites and sensitized to OVA compared with the group uninfected with parasites and sensitized to OVA (P=.043 and P=.046, respectively). Upon comparison of total IgE concentrations, the group of rats infected with parasites and given saline solution showed higher levels compared with the group uninfected with parasites and given saline (P=.004). In conclusion, the investigators were unable to show a protective effect of an existing parasitic infection against the development of allergic sensitization upon exposure to OVA.

A pilot screening of prevalence of atopic states and opisthorchosis and their relationship in people of Tomsk Oblast

The study was aimed to estimate the relationship between the prevalence of allergic disease and helminth invasion by the trematode Opisthorchis felineus in rural and urban populations of Tomsk Oblast (West Siberia, Russia). Two hundred and one people from Kargasok village of Tomsk Oblast and 196 from the city of Tomsk were screened for the presence of atopy and O. felineus invasion. Opisthorchosis was found in 66 participants (32.8%) from Kargasok and in 22 people (11.2%) from Tomsk. Atopic diseases were more common in the urban population than in the rural: 52.8 and 31.4%, respectively. Positive skin-prick tests were significantly higher in the urban population than in rural people: 83.2 vs 24.4%, respectively. It was found that in the city, the presence of antibodies to O. felineus negatively correlates with the atopic sensitization by skin-prick tests. However, in the village, opisthorchosis was positively associated with atopic diseases. The data obtained confirm the negative association of rural lifestyle and atopic diseases prevalence and indicate that O. felineus invasion might be a modifying factor of this relationship in Tomsk Oblast.

Microarray-based identification of novel biomarkers in asthma

Bronchial asthma is a complicated and diverse disorder affected by genetic and environmental factors. It is widely accepted that it is a Th2-type inflammation originating in lung and caused by inhalation of ubiquitous allergens. The complicated and diverse pathogenesis of this disease yet to be clarified. Functional genomics is the analysis of whole gene expression profiling under given condition, and microarray technology is now the most powerful tool for functional genomics. Several attempts to clarify the pathogenesis of bronchial asthma have been carried out using microarray technology, providing us some novel biomarkers for diagnosis, therapeutic targets or understanding pathogenic mechanisms of bronchial asthma. In this article, we review the outcomes of these analyses by the microarray approach as applied to this disease by focusing on the identification of novel biomarkers.

Infection with Syphacia obvelata (pinworm) induces protective Th2 immune responses and influences ovalbumin-induced allergic reactions

Infections with pinworms are common in rodent animal facilities. In this study, we show the consequence of an outbreak in a transgenic barrier facility of infection by Syphacia obvelata, a murine pinworm gastrointestinal nematode. Immune responses were defined in experimental infection studies with BALB/c mice. Infection with S. obvelata induced a transient Th2-type immune response with elevated interleukin 4 (IL-4), IL-5, and IL-13 cytokine production and parasite-specific immunoglobulin G1 (IgG1). In contrast, BALB/c mice deficient in IL-13, IL-4/13, or the IL-4 receptor alpha chain showed chronic disease, with a >100-fold higher parasite burden, increased gamma interferon production, parasite-specific IgG2b, and a default Th2 response. Interestingly, infected IL-4-/- BALB/c mice showed only slightly elevated parasite burdens compared to the control mice, suggesting that IL-13 plays the dominant role in the control of S. obvelata. The influence that pinworm infection has on the allergic response to a dietary antigen was found to be important. Helminth-infected mice immunized against ovalbumin (Ova) elicited more severe anaphylactic shock with reduced Ova-specific IL-4 and IL-5 than did noninfected controls, demonstrating that S. obvelata infection is able to influence nonrelated laboratory experiments. The latter outcome highlights the importance of maintaining mice for use as experimental models under pinworm-free conditions.

Schistosoma japonicum egg antigens stimulate CD4 CD25 T cells and modulate airway inflammation in a murine model of asthma

A number of epidemiological and clinical studies have suggested an inverse association between allergy and helminth infection, such as Schistosomiasis. Therefore, we hypothesize that Schistosoma japonicum egg antigens, a type of native antigen, can induce production of CD4(+) CD25(+) T cells with regulatory activity, modulating airway inflammation and inhibiting asthma development. The frequency of CD4(+) CD25(+) T cells was determined by flow cytometry for mice treated with ovalbumin (OVA), CD25(+) depletion/OVA, schistosome egg antigens, schistosome egg antigens/OVA and for control mice. The ability of CD25(+) T cells from these mice to suppress T-cell proliferation and cytokine production was investigated both in vivo and in vitro. Results showed that the CD4(+) CD25(+) T cells of OVA-treated mice exhibited impaired control of dysregulated mucosal T helper 2 responses compared to the controls (P < 0.05). Depletion of CD25(+) cells accelerated OVA-induced airway inflammation and increased the expression of interleukin (IL)-5 and IL-4. Treatment with schistosome egg antigens increased the number and suppressive activity of CD4(+) CD25(+) T cells, which made IL-10, but little IL-4. In a murine model of asthma, S. japonicum egg antigens decreased the expression of Th2 cytokines, relieved antigen-induced airway inflammation, and inhibited asthma development. Thus, we provided evidence that S. japonicum egg antigens induced the production of CD4(+) CD25(+) T cells, resulting in constitutive immunosuppressive activity and inhibition of asthma development. These results reveal a novel form of protection against asthma and suggest a mechanistic explanation for the protective effect of helminth infection on the development of allergy.

Early stages of Ascaris suum induce airway inflammation and hyperreactivity in a mouse model

The inflammatory and functional changes that occur in murine lung after infection with 2500 infective Ascaris suum eggs were studied in this work. A sequential influx of neutrophils, mononuclear cells and eosinophils occurred into airways concomitantly with migration of larvae from liver to the lungs. Histological analysis of the lung showed a severe intra-alveolar haemorrhage at the peak of larval migration (day 8) and the most intense inflammatory cell infiltrate on day 14. Ascaris L3 were found in alveolar spaces and inside bronchioles on day 8. The number of eosinophils was elevated in the blood on days 8 and 14. The peak of eosinophil influx into the lung was at day 14, as indicated by the high levels of eosinophil peroxidase activity, followed by their migration into the airways. The antibody response against egg and larval antigens consisted mainly of IgG1 and IgM, and also of IgE and anaphylactic IgG1, that cross-reacted with adult worm antigens. Total IgE levels were substantially elevated during the infection. Measurement of lung mechanical parameters showed airway hyperreactivity in infected mice. In conclusion, the murine model of A. suum infection mimics the Th2-induced parameters observed in pigs and humans and can be used to analyse the immunoregulatory properties of this helminth.

Regulation of allergy and autoimmunity in helminth infection

Parasitic infections are a major theme in the "hygiene hypothesis", as allergies and autoimmune diseases are less prevalent in countries with higher burdens of helminths and other parasitic organisms. Helminths"-the grouping of multicellular worm parasites including nematodes, cestodes and trematodes-tend to establish long-lived, chronic infections indicating successful down-modulation of the host immune system. In this review, we describe the intricate immunology of host-helminth interactions and how parasites manipulate immune responses to enhance their survival. In so doing, they often minimise immunopathology and, it is suggested, reduce host susceptibility to, and severity of allergic and autoimmune diseases. Studies on helminth-infected communities and individuals support the hypothesis that an immuno-regulatory network promoted by parasites extends its influence to limiting allergies. Experimental models are now probing more deeply into the area of immune modulation by helminths, and we discuss the likely mechanisms by which helminths could be establishing a strongly regulatory environment. Understanding and harnessing the modulatory capacity of helminths may uncover novel therapeutic interventions, mimicking and exploiting their evolution for our benefit. Parasitic infections are a major theme in the "hygiene hypothesis", as allergies and autoimmune diseases are less prevalent in countries with higher burdens of helminths and other parasitic organisms. Helminths"-the grouping of multicellular worm parasites including nematodes, cestodes and trematodes-tend to establish long-lived, chronic infections indicating successful down-modulation of the host immune system. In this review, we describe the intricate immunology of host-helminth interactions and how parasites manipulate immune responses to enhance their survival. In so doing, they often minimise immunopathology and, it is suggested, reduce host susceptibility to, and severity of allergic and autoimmune diseases. Studies on helminth-infected communities and individuals support the hypothesis that an immuno-regulatory network promoted by parasites extends its influence to limiting allergies. Experimental models are now probing more deeply into the area of immune modulation by helminths, and we discuss the likely mechanisms by which helminths could be establishing a strongly regulatory environment. Understanding and harnessing the modulatory capacity of helminths may uncover novel therapeutic interventions, mimicking and exploiting their evolution for our benefit.

Structural, biological, and evolutionary relationships of plant food allergens sensitizing via the gastrointestinal tract

The recently completed genome sequence of the model plant species Arabidopsis has been estimated to encode over 25,000 proteins, which, on the basis of their function, can be classified into structural and metabolic (the vast majority of plant proteins), protective proteins, which defend a plant against invasion by pathogens or feeding by pests, and storage proteins, which proved a nutrient store to support germination in seeds. It is now clear that almost all plant food allergens are either protective or storage proteins. It is also becoming evident that those proteins that trigger the development of an allergic response through the gastrointestinal tract belong primarily to two large protein superfamilies: (1) The cereal prolamin superfamily, comprising three major groups of plant food allergens, the 2S albumins, lipid transfer proteins, and cereal alpha-amylase/trypsin inhibitors, which have related structures, and are stable to thermal processing and proteolysis. They include major allergens from Brazil nut, peanuts, fruits, such as peaches, and cereals, such as rice and wheat; (2) The cupin superfamily, comprising the major globulin storage proteins from a number of plant species. The globulins have been found to be allergens in plant foods, such as peanuts, soya bean, and walnut; (3) The cyteine protease C1 family, comprising the papain-like proteases from microbes, plants, and animals. This family contains two notable allergens that sensitize via the GI tract, namely actinidin from kiwi fruit and the soybean allergen, Gly m Bd 30k/P34. This study describes the properties, structures, and evolutionary relationships of these protein families, the allergens that belong to them, and discusses them in relation to the role protein structure may play in determining protein allergenicity.

Limited Ability of Antigen-Specific Th1 Responses to Inhibit Th2 Cell Development In Vivo

Th1 and Th2 cells mutually antagonize each other's differentiation. Consequently, allergen-specific Th1 cells are believed to be able to suppress the development of Th2 cells and to prevent the development of atopic disorders. To determine whether a pre-existing Ag-specific Th1 response can affect the development of Th2 cells in vivo, we used an immunization model of Ag-pulsed murine dendritic cell (DC) transfer to induce distinct Th responses. When transferred into naive mice, Ag-pulsed CD8alpha(+) DCs induced a Th1 response and the production of IgG2a, whereas CD8alpha(-) DCs primed a Th2 response and the production of IgE. In the presence of a pre-existing Ag-specific Th2 environment due to Ag-pulsed CD8alpha(-) DC transfer, CD8alpha(+) DCs failed to prime Th1 cells. In contrast, CD8alpha(-) DCs could prime a Th2 response in the presence of a pre-existing Ag-specific Th1 environment. Moreover, exogenous IL-4 abolished the Th1-inducing potential of CD8alpha(+) DCs in vitro, but the addition of IFN-gamma did not effectively inhibit the potential of CD8alpha(-) DCs to prime IL-4-producing cells. Thus, Th1 and Th2 cells differ in their potential to inhibit the development of the other. This suggests that the early induction of allergen-specific Th1 cells before allergy sensitization will not prevent the development of atopic disorders.

The role of interleukin-4 and interleukin-13 in the non-immunologic aspects of asthma pathogenesis

Bronchial asthma is a complex disease characterized by airway inflammation involving a Th2-cytokine, interleukin (IL)-13. A substantial body of evidence has accumulated pointing to the pivotal role of IL-13 in the pathogenesis of bronchial asthma. The evidence is categorized as (i) analyses of mouse models, (ii) expression of these cytokines in the bronchial lesions, and (iii) genetic association of the signaling molecules of these cytokines. In addition, the molecular mechanism of the signal transduction of IL-13 has also been well characterized. We have applied microarray analyses to human bronchial epithelial cultures to search for genes regulated by IL-13 and have identified a subset of disease-relevant genes by comparison with cDNA libraries derived from normal and asthmatic bronchial biopsies. Expression of squamous cell carcinoma antigen-1 (SCCA1) and SCCA2, the cysteine and serine protease inhibitors, respectively, was the highest in the bronchial epithelial cells stimulated by IL-4 and IL-13 and was augmented in the asthmatic cDNA library. Furthermore, serum levels of SCCA were also elevated in asthmatic patients. Taken together, it was supposed that SCCA may play some role in the pathogenesis of bronchial asthma, and measuring its serum level may be relevant for diagnosing or monitoring the status of bronchial asthma.

Changes in pulmonary function and parasite burden in rats infected with Strongyloides venezuelensis concomitant with induction of allergic airway inflammation

The prevalence of allergic diseases such as asthma has increased markedly over the past few decades. To evaluate the possible mutual influence of helminth infection and allergy, the combined effects of experimental allergic airway inflammation and infection with Strongyloides venezuelensis on various parasitological and inflammatory indices were evaluated in the rat. A challenge of immunized rats with aerosolized ovalbumin (OVA) resulted in eosinophilic inflammation that peaked 48 h after the challenge and was accompanied by airway hyperresponsiveness (AHR) to an intravenous acetylcholine challenge. S. venezuelensis infection concomitant with an OVA challenge of immunized rats resulted in prolonged pulmonary inflammation with increased eosinophil infiltration in bronchoalveolar lavage fluid but not in the lung tissue. These rats also showed a significant parasite burden reduction, especially during parasite migration through the lungs. However, the fecundity rates of worms that reached the intestine were similar in allergic and nonallergic animals. Despite airway inflammation, the increased responsiveness of the airways in the experimental asthma model was suppressed during parasite migration through the lungs (2 days). In contrast, parasite-induced AHR was unchanged 5 days after infection in immunized and challenged rats. In conclusion, infection with S. venezuelensis interfered with the onset of AHR following an antigen challenge of immunized rats. The ability of parasites to switch off functional airway responses is therapeutically relevant because we may learn from parasites how to modulate lung function and, hence, the AHR characteristic of asthmatic patients.

Could control of soil-transmitted helminthic infection influence the HIV/AIDS pandemic

In May 2001, the World Health Assembly (WHA) estimated that two billion people were infected by soil-transmitted helminths (S-THs) and schistosomiasis, worldwide. The WHA urged member states to recognise that there can be synergy between public health control programmes for S-THs, schistosomiasis and other diseases. This is particularly relevant to the new dimension created by the HIV/AIDS epidemics in the same impoverished communities and countries where helminthiasis is hyperendemic. Immunological adaptation between humans and parasitic helminths has developed during evolution. Review of 109 research papers, 76% (83/109) of which, were published between 1995 and February 2002, revealed increasing evidence that this relationship may have created an opportunity for more rapid infection by the human immunodeficiency virus (HIV), as well as quicker progression to AIDS. Moreover, the efficacy of some vaccines against HIV is likely to be impaired by chronic helminthiasis. For this, there is strong, indirect evidence. There is an urgent need for parasitologists, epidemiologists, immunologists and virologists to undertake comprehensive, transdisciplinary research. On the other hand, there is no current evidence that immunosuppression by HIV facilitates helminthic infection. The situation in regard to strongyloidiasis, however, is not yet clear.

Is the hygiene hypothesis an example of hormesis?

The "hygiene hypothesis" has been suggested to explain the rising incidence of allergic disorders in developed countries. The postulated mechanism is that infectious and/or microbial agents stimulate the immune system toward Th1 (allergy fighting) rather than Th2 (allergy promoting) response. This paper reviews the evidence related to early life infectious/microbial exposures and subsequent atopic disorders and evaluates whether these data suggest a hormetic effect. Our review indicates an insufficient and contradictory association for bacterial/viral infections, with protective effects being either absent or specific to certain infections and/or populations. Chronic, heavy parasitic burdens appear to confer protection against atopic disorders, but are associated with considerable pathology. Moreover, light parasitic burden may increase allergic responses (i.e., no "low dose" beneficial effect). In contrast, there is consistent evidence that general microbial exposures, particularly gut commensals, may be protective against allergy development, which is consistent with a hormetic effect (i.e., potentially beneficial effects at low doses and detrimental effects at high levels).

CONCLUSION

General microbial exposures in relation to the "hygiene hypothesis" may represent a hormetic effect, although further research with more rigorous study methods (i.e., prospective designs and measurement of exposure timing, dose, route, etc.) are needed.

Eosinophilic inflammation and airway hyper-responsiveness are profoundly inhibited by a helminth (Ascaris suum) extract in a murine model of asthma

BACKGROUND

The increase of atopic disorders in developed countries has been associated with the decline of infectious diseases, including helminthic infections. We have already demonstrated that adult worm extracts from Ascaris suum (ASC) suppress the IgE antibody production against unrelated antigens.

OBJECTIVE

Here we investigated the influence of ASC on the development of pulmonary eosinophilic inflammation in a murine model of asthma.

METHODS

Heat-coagulated egg white alone (EWI) or mixed with ASC (EWI + ASC) was implanted subcutaneously in B10.A or C57BL/6 mice, and 14 days later they were challenged intratracheally with OVA or exposed to aerosolized OVA for 4 days.

RESULTS

The suppressive effect of ASC was demonstrated on the accumulation of cells into airways, with reduction of eosinophil numbers and of eosinophil peroxidase activity in EWI + ASC-immunized mice. This effect correlated with a marked reduction of IL-5 and IL-4 levels in the BAL from C57BL/6 and B10. A mice, respectively, and of eotaxin in BAL and lung tissue from both strains. OVA-specific IgG1 and IgE levels were also impaired in serum and BAL from these mice. Airway hyper-reactivity to methacholine was obtained in B10. A mice sensitized with EWI, but the respiratory mechanical parameters returned to normal levels in EWI + ASC-immunized mice.

CONCLUSION

These results indicate that ASC has a profound inhibitory effect on lung inflammation and hyper-responsiveness and that suppression of IL-5 or IL-4 and of eotaxin contributes to this effect.

An enteric helminth infection protects against an allergic response to dietary antigen

Although helminths induce a polarized Th2 response they have been shown, in clinical studies, to confer protection against allergies. To elucidate the basis for this paradox, we have examined the influence of an enteric helminth infection on a model of food allergy. Upon Ag challenge, mice fed peanut (PN) extract plus the mucosal adjuvant cholera toxin (CT) produced PN-specific IgE that correlated with systemic anaphylactic symptoms and elevated plasma histamine. PN-specific IgE was not induced in helminth-infected mice fed PN without CT. Moreover, when PN plus CT was fed to helminth-infected mice, both PN-specific IgE and anaphylactic symptoms were greatly diminished. The down-regulation of PN-specific IgE was associated with a marked reduction in the secretion of IL-13 by PN-specific T cells. When helminth-infected PN plus CT-sensitized mice were treated with neutralizing Abs to IL-10, the PN-specific IgE response and anaphylactic symptoms were similar to, or greater than, those seen in mice that receive PN and CT alone. Taken together, these results suggest that helminth-dependent protection against allergic disease involves immunoregulatory mechanisms that block production of allergen-specific IgE.

Th2 responses without atopy: immunoregulation in chronic helminth infections and reduced allergic disease

The immune response to helminth infections has long been known to share key features with the allergic response. In particular, both are typified by enhanced T helper 2 (Th2) responses with high levels of interleukin-4 (IL-4), IL-5 and IL-13, accompanied by eosinophilia and abundant IgE production. Paradoxically, the geographical distribution of helminth parasitism and allergic disease is complementary rather than coincident. Thus, the question arises does the Th2 response to parasites protect or pre-empt the host from developing Th2-linked allergic manifestations? It is suggested that downregulatory immune mechanisms, which dampen the anti-parasite response, might benefit the host by blocking progression to atopic reactions. This is of relevance in explaining how the "hygiene hypothesis" might operate immunologically and in the design of therapeutics.

Infection of mice with the helminth Strongyloides stercoralis suppresses pulmonary allergic responses to ovalbumin

Asthma and helminth infections induce similar immune responses characterized by the presence of peripheral blood eosinophilia and elevated serum IgE levels. Epidemiological surveys have reported either increases or decreases in the development of atopic diseases and asthma based on the prevalence of helminth infections in the population. The aim of this study was to determine if a pre-existing helminth infection would increase or decrease subsequent allergic responses to an unrelated allergen in the lungs. BALB/cByJ mice were infected with the nematode parasite Strongyloides stercoralis prior to ovalbumin (OVA) immunization and intratracheal challenge. Bronchoalveolar lavage (BAL) and fluid (BALF) were collected 3 days post-challenge and cellular and humoral immune responses were measured. Intracellular cytokine staining revealed increased IL-4 and IL-5 producing cells in BAL from mice infected with S. stercoralis before OVA sensitization. Increased IL-5 protein levels and decreased IFN-gamma protein levels were also observed in the BALF. There was, however, no increase in airway eosinophil accumulation in mice infectd with parasites before sensitization with OVA as compared to mice exposed to OVA alone. Furthermore, eotaxin levels in the lungs induced by OVA was suppressed in mice infected with the parasite before OVA sensitization. The development of OVA specific IgE responses in BALF was also impaired in mice infected with the parasite before sensitization with OVA. These results suggest that a pre-existing helminth infection may potentiate a systemic Type 2-type response yet simultaneously suppress in the lungs allergen-specific IgE responses and eotaxin levels in response to subsequent exposure to allergens.