1
|
Ren C, Carrillo ND, Cryns VL, Anderson RA, Chen M. Environmental pollutants and phosphoinositide signaling in autoimmunity. JOURNAL OF HAZARDOUS MATERIALS 2024; 465:133080. [PMID: 38091799 PMCID: PMC10923067 DOI: 10.1016/j.jhazmat.2023.133080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 02/08/2024]
Abstract
Environmental pollution stands as one of the most critical challenges affecting human health, with an estimated mortality rate linked to pollution-induced non-communicable diseases projected to range from 20% to 25%. These pollutants not only disrupt immune responses but can also trigger immunotoxicity. Phosphoinositide signaling, a pivotal regulator of immune responses, plays a central role in the development of autoimmune diseases and exhibits high sensitivity to environmental stressors. Among these stressors, environmental pollutants have become increasingly prevalent in our society, contributing to the initiation and exacerbation of autoimmune conditions. In this review, we summarize the intricate interplay between phosphoinositide signaling and autoimmune diseases within the context of environmental pollutants and contaminants. We provide an up-to-date overview of stress-induced phosphoinositide signaling, discuss 14 selected examples categorized into three groups of environmental pollutants and their connections to immune diseases, and shed light on the associated phosphoinositide signaling pathways. Through these discussions, this review advances our understanding of how phosphoinositide signaling influences the coordinated immune response to environmental stressors at a biological level. Furthermore, it offers valuable insights into potential research directions and therapeutic targets aimed at mitigating the impact of environmental pollutants on the pathogenesis of autoimmune diseases. SYNOPSIS: Phosphoinositide signaling at the intersection of environmental pollutants and autoimmunity provides novel insights for managing autoimmune diseases aggravated by pollutants.
Collapse
Affiliation(s)
- Chang Ren
- Department of Pharmacology, Joint Laboratory of Guangdong-Hong Kong Universities for Vascular Homeostasis and Diseases, School of Medicine, Southern University of Science and Technology, Shenzhen 518055, China
| | - Noah D Carrillo
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Vincent L Cryns
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA; University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Richard A Anderson
- University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Mo Chen
- Department of Pharmacology, Joint Laboratory of Guangdong-Hong Kong Universities for Vascular Homeostasis and Diseases, School of Medicine, Southern University of Science and Technology, Shenzhen 518055, China.
| |
Collapse
|
2
|
Fukutomi Y, Tanaka H, Sekiya K, Watai K, Hamada Y, Iwata M, Saito A, Okabe K, Sugiyama A, Fukushima T, Oshikawa C, Uetake H, Yoshisue H, Irie T, Kishikawa R. Uncovering Severe Patient Group With Pollen-Related Extrarespiratory Allergic Symptoms: A Year-Long Diary Survey in Japan. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00167-3. [PMID: 38382879 DOI: 10.1016/j.jaip.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The most common symptoms of pollen allergy are rhinitis and conjunctivitis. However, in real-world clinical practice, we sometimes encounter patients with pollen allergy suffering from severe extrarespiratory symptoms including skin, gastrointestinal, or flu-like symptoms in relation to exposure to sensitized pollen. OBJECTIVE To elucidate the extrarespiratory symptoms in patients with pollen allergy. METHODS We performed a non-drug-focused prospective study of patients with pollen allergy (n = 384). During the 1-year observational period, they were asked to complete a weekly electronic diary consisting of visual analog scale (VAS) scores to assess all symptoms experienced in various organs over the past week. An association between seasonal pollen levels and seasonal increase in VAS scores was evaluated using a mixed-effects model for repeated measures. A k-means cluster analysis was performed to identify a group of patients experiencing stronger extrarespiratory symptoms. RESULTS In patients sensitized to grass or birch pollen, higher seasonal levels of these pollen grains were associated with higher VAS scores for headache, gastrointestinal symptoms, skin symptoms, and fatigue. A cluster analysis identified a group of severe pollen-allergic patients with higher extrarespiratory symptoms (n = 42). This group was characterized by a higher frequency of comorbid food allergy/atopic dermatitis, higher rate of IgE sensitization to pollens, and higher impaired activity and work productivity. CONCLUSIONS This 1-year survey identified a small but nonnegligible group of patients with pollen-related extrarespiratory symptoms. More attention should be paid to this patient group considering their impaired activity and work productivity.
Collapse
Affiliation(s)
- Yuma Fukutomi
- NHO Sagamihara National Hospital, Sagamihara, Japan.
| | | | | | | | - Yuto Hamada
- NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Maki Iwata
- NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Akemi Saito
- NHO Sagamihara National Hospital, Sagamihara, Japan
| | - Koki Okabe
- NHO Fukuoka National Hospital, Fukuoka, Japan
| | | | | | | | | | | | | | | |
Collapse
|
3
|
Briceno Noriega D, Savelkoul HFJ, Jansen A, Teodorowicz M, Ruinemans-Koerts J. Pollen Sensitization Can Increase the Allergic Reaction to Non-Cross-Reactive Allergens in a Soy-Allergic Patient. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6045. [PMID: 37297649 PMCID: PMC10252215 DOI: 10.3390/ijerph20116045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
During and after the pollen season, an increase in food-triggered allergic symptoms has been observed in pollen-food syndrome patients, possibly due to seasonal boosting of pollen-IgE levels. It has been suggested that consumption of birch-pollen-related foods plays a role in seasonal allergenic inflammation. However, whether this increased pollen sensitization during the pollen season can also affect the allergenicity of allergens that are non-cross-reactive with birch pollen remains in question. This study presents the case of a patient with soy allergy and pollinosis, who experiences worsening of gastrointestinal (GI) symptoms during the birch pollen season even though the eliciting food factor does not cross-react with birch pollen allergens and their homologs (e.g., Bet v 1 and Gly m 4). The results showed a notable increase in sIgE for Gly m 4 (3.3 fold) and Bet v 1 (2.6 fold) during the birch pollen season compared to outside the birch pollen season, while Gly m 5 and Gly m 6 showed only a slight increase (1.5 fold). The basophil activation test (BAT) showed that in this patient Gly m 5 and Gly m 6 are clinically relevant soy allergens, which correlates with the reported clinical symptoms to processed soy. Moreover, the BAT against raw soy shows an increase in basophil activation during the birch pollen season and a negative basophil activation result outside the birch pollen season. Thus, the worsening of GI symptoms could possibly be due to an increase in IgE receptors, an over-reactive immune system, and/or significant intestinal allergic inflammation. This case highlights the importance of including allergens that do not cross-react with birch pollen and using a functional assay such as the BAT to evaluate clinical relevance when assessing birch pollen seasonal influence on soy allergenicity.
Collapse
Affiliation(s)
- Daniela Briceno Noriega
- Cell Biology and Immunology Group, Wageningen University and Research Centre, 6708 WD Wageningen, The Netherlands
| | - Huub F. J. Savelkoul
- Cell Biology and Immunology Group, Wageningen University and Research Centre, 6708 WD Wageningen, The Netherlands
| | - Ad Jansen
- Department of Otorhinolaryngology, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands
| | - Malgorzata Teodorowicz
- Cell Biology and Immunology Group, Wageningen University and Research Centre, 6708 WD Wageningen, The Netherlands
| | - Janneke Ruinemans-Koerts
- Cell Biology and Immunology Group, Wageningen University and Research Centre, 6708 WD Wageningen, The Netherlands
- Department of Clinical Chemistry and Hematology, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
| |
Collapse
|
4
|
Buhner S, Schäuffele S, Giesbertz P, Demir IE, Zeller F, Traidl-Hoffmann C, Schemann M, Gilles S. Allergen-free extracts from birch, ragweed, and hazel pollen activate human and guinea-pig submucous and spinal sensory neurons. Neurogastroenterol Motil 2023:e14559. [PMID: 36989179 DOI: 10.1111/nmo.14559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 01/16/2023] [Accepted: 02/24/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Non-allergenic, low molecular weight components of pollen grains are suspected to trigger changes in gut functions, sometimes leading to inflammatory conditions. Based on extensive neuroimmune communication in the gut wall, we investigated the effects of aqueous pollen extracts (APE) on enteric and spinal sensory neurons. METHODS Using Ca2+ and fast potentiometric imaging, we recorded the responses of guinea-pig and human submucous and guinea-pig dorsal root ganglion (DRG) neurons to microejection of low (<3 kDa) and high (≥3 kDa) molecular weight APEs of birch, ragweed, and hazel. Histamine was determined pharmacologically and by mass spectrometry (LC-MS/MS). KEY RESULTS Birch APE<3kDa evoked strong [Ca+2 ]i signals in the vast majority of guinea-pig DRG neurons, and in guinea-pig and human enteric neurons. The effect of birch APE≥3kDa was much weaker. Fast neuroimaging in human enteric neurons revealed an instantaneous spike discharge after microejection of birch, ragweed, and hazel APE<3kDa [median (interquartile range) at 7.0 Hz (6.2/9.8), 5.7 Hz (4.4/7.1), and 8.4 Hz (4.3/12.5), respectively]. The percentage of responding neurons per ganglion were similar [birch 40.0% (33.3/100.0), ragweed 50.8% (34.4/85.6), and hazel 83.3% (57.1/100.0)]. A mixture of histamine receptor (H1-H3) blockers significantly reduced nerve activation evoked by birch and ragweed APEs<3kDa , but was ineffective on hazel. Histamine concentrations in ragweed, birch and hazel APE's < 3 kDa were 0.764, 0.047, and 0.013 μM, respectively. CONCLUSIONS Allergen-free APEs from birch, ragweed, and hazel evoked strong nerve activation. Altered nerve-immune signaling as a result of severe pollen exposure could be a pathophysiological feature of allergic and non-allergic gut inflammation.
Collapse
Affiliation(s)
- Sabine Buhner
- Chair of Human Biology, Technical University Munich, Freising, Germany
| | | | - Pieter Giesbertz
- Molecular Nutrition Unit, Technical University Munich, Freising, Germany
| | - Ihsan Ekin Demir
- University Hospital Rechts der Isar, Technical University Munich, Munich, Germany
| | - Florian Zeller
- Department of Surgery, Academic Hospital Freising, Freising, Germany
| | - Claudia Traidl-Hoffmann
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Christine Kühne Center for Allergy Research and Education (CK-Care), Davos, Switzerland
| | - Michael Schemann
- Chair of Human Biology, Technical University Munich, Freising, Germany
| | - Stefanie Gilles
- Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- Institute of Environmental Medicine, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| |
Collapse
|
5
|
Herman SM, Zaborniak K, Bernstein CN. Insight into Inflammatory Bowel Disease Pathogenesis: Is the Answer Blowing in the Wind? Inflamm Bowel Dis 2022; 28:486-491. [PMID: 34473278 DOI: 10.1093/ibd/izab183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Indexed: 12/30/2022]
Abstract
Inflammatory bowel diseases (IBD) including Crohn's disease and ulcerative colitis are conditions characterized by immune dysregulation to a trigger in those with a genetic predisposition. Environmental factors are thought to contribute to IBD, but no definite trigger has been identified. Aeroallergens have not been thoroughly investigated in their potential contribution to the pathogenesis to IBD. The geographic distribution of aeroallergens and IBD, the association of atopic disease with IBD, seasonality and IBD, and cross-reactive food allergens require further study with implications for targeted dietary and immunomodulatory therapies.
Collapse
Affiliation(s)
- Sari M Herman
- Division of Clinical Immunology and Allergy, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karver Zaborniak
- Section of Clinical Immunology and Allergy, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- Section of Clinical Immunology and Allergy, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba Inflammatory Bowel Disease Clinical and Research Centre, Winnipeg, Manitoba, Canada
| |
Collapse
|
6
|
Kim S, Keum B, Byun J, Kim B, Lee K, Yeon J, Lee J, Choi H, Kim E, Jeen Y, Lee H, Chun H, Kim T. Colonic Mucosal Immune Activation in Mice with Ovalbumin-Induced Allergic Airway Disease: Association between Allergic Airway Disease and Irritable Bowel Syndrome. Int J Mol Sci 2021; 23:ijms23010181. [PMID: 35008607 PMCID: PMC8745416 DOI: 10.3390/ijms23010181] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/12/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022] Open
Abstract
Recent studies on the pathophysiology of irritable bowel syndrome (IBS) have focused on the role of mast cells (MCs) in intestinal mucosal immunity. A link between allergic airway diseases (AADs) and IBS has been suggested because both diseases have similar pathophysiology. We aimed to investigate whether the induction of AAD in mice could lead to inflammation of the colonic mucosa, similar to IBS. We also evaluated whether this inflammatory response could be suppressed by administering a therapeutic agent. Mice were divided into three groups: control, AAD-induced, and salbutamol-treated. An AAD mouse model was established by intraperitoneal injection and nasal challenge with ovalbumin. Mice with AAD were intranasally administered salbutamol. Analyses of cytokine levels, MC count, and tryptase levels in the intestinal mucosa were performed to compare the changes in inflammatory responses among the three groups. Inflammation was observed in the intestinal mucosa of mice in the AAD group. This inflammation in AAD mice was suppressed after salbutamol treatment. Our study demonstrates that AAD induces an inflammatory response similar to that in IBS, suggesting a possible association between IBS and AADs. In patients with IBS with such allergic components, salbutamol may have the potential to alleviate the inflammatory response.
Collapse
Affiliation(s)
- Sanghyun Kim
- Department of Internal Medicine, College of Medicine, Korea University, Seoul 02841, Korea; (S.K.); (B.K.); (J.L.); (H.C.); (E.K.); (Y.J.); (H.L.)
| | - Bora Keum
- Department of Internal Medicine, College of Medicine, Korea University, Seoul 02841, Korea; (S.K.); (B.K.); (J.L.); (H.C.); (E.K.); (Y.J.); (H.L.)
| | - Junhyoung Byun
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea; (J.B.); (B.K.); (K.L.); (J.Y.)
| | - Byoungjae Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea; (J.B.); (B.K.); (K.L.); (J.Y.)
| | - Kijeong Lee
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea; (J.B.); (B.K.); (K.L.); (J.Y.)
| | - Jiwoo Yeon
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea; (J.B.); (B.K.); (K.L.); (J.Y.)
| | - Jaemin Lee
- Department of Internal Medicine, College of Medicine, Korea University, Seoul 02841, Korea; (S.K.); (B.K.); (J.L.); (H.C.); (E.K.); (Y.J.); (H.L.)
| | - Hyuksoon Choi
- Department of Internal Medicine, College of Medicine, Korea University, Seoul 02841, Korea; (S.K.); (B.K.); (J.L.); (H.C.); (E.K.); (Y.J.); (H.L.)
| | - Eunsun Kim
- Department of Internal Medicine, College of Medicine, Korea University, Seoul 02841, Korea; (S.K.); (B.K.); (J.L.); (H.C.); (E.K.); (Y.J.); (H.L.)
| | - Yoontae Jeen
- Department of Internal Medicine, College of Medicine, Korea University, Seoul 02841, Korea; (S.K.); (B.K.); (J.L.); (H.C.); (E.K.); (Y.J.); (H.L.)
| | - Hongsik Lee
- Department of Internal Medicine, College of Medicine, Korea University, Seoul 02841, Korea; (S.K.); (B.K.); (J.L.); (H.C.); (E.K.); (Y.J.); (H.L.)
| | - Hoonjai Chun
- Department of Internal Medicine, College of Medicine, Korea University, Seoul 02841, Korea; (S.K.); (B.K.); (J.L.); (H.C.); (E.K.); (Y.J.); (H.L.)
- Correspondence: (H.C.); (T.K.)
| | - Taehoon Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, College of Medicine, Korea University, Seoul 02841, Korea; (J.B.); (B.K.); (K.L.); (J.Y.)
- Correspondence: (H.C.); (T.K.)
| |
Collapse
|
7
|
Friesen C, Colombo JM, Deacy A, Schurman JV. An Update on the Assessment and Management of Pediatric Abdominal Pain. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:373-393. [PMID: 34393542 PMCID: PMC8354769 DOI: 10.2147/phmt.s287719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/15/2021] [Indexed: 12/12/2022]
Abstract
Chronic abdominal pain is very common in children and adolescent and results in high personal and social costs. Most youth with chronic abdominal pain fulfill criteria for a functional abdominal pain disorder (FAPD) as defined by Rome criteria. These are complex conditions with a wide array of biological, psychological, and social factors contributing to the experience of pain. The purpose of the current review is to provide an overview of the pathophysiology of FAPDs and an up-to-date summary of the literature related to FAPDs in children and adolescents, with additional focus on several areas (eg, diet and probiotics) where patients and families frequently have questions or implement self-directed care. We also provide an approach to the assessment and treatment of pediatric FAPDs focusing on the robust literature regarding psychological interventions and much sparser literature regarding medication treatment.
Collapse
Affiliation(s)
- Craig Friesen
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jennifer M Colombo
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Amanda Deacy
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| | - Jennifer V Schurman
- Division of Gastroenterology, Hepatology, and Nutrition; Children's Mercy Kansas City, Kansas City, MO, USA
| |
Collapse
|
8
|
Friesen C, Colombo J, Schurman J. Update on the Role of Allergy in Pediatric Functional Abdominal Pain Disorders: A Clinical Perspective. Nutrients 2021; 13:2056. [PMID: 34208479 PMCID: PMC8235503 DOI: 10.3390/nu13062056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022] Open
Abstract
Both functional abdominal pain disorders (FAPDs) and food allergies are relatively common in children and adolescents, and most studies report an association between FAPDs and allergic conditions. FAPDs share pathophysiologic processes with allergies, including both immune and psychological processes interacting with the microbiome. No conclusive data are implicating IgE-mediated reactions to foods in FAPDs; however, there may be patients who have IgE reactions localized to the gastrointestinal mucosa without systemic symptoms that are not identified by common tests. In FAPDs, the data appears stronger for aeroallergens than for foods. It also remains possible that food antigens initiate an IgG reaction that promotes mast cell activation. If a food allergen is identified, the management involves eliminating the specific food from the diet. In the absence of systemic allergic symptoms or oral allergy syndrome, it appears unlikely that allergic triggers for FAPDs can be reliably identified by standard testing. Medications used to blunt allergic reactions or symptomatically treat allergic reactions may be useful in FAPDs. The purpose of the current manuscript is to review the current literature regarding the role of allergy in FAPDs from a clinical perspective, including how allergy may fit in the current model of FAPDs.
Collapse
Affiliation(s)
- Craig Friesen
- Division of Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (J.C.); (J.S.)
| | | | | |
Collapse
|
9
|
Siah KTH, Santosa A, Cheung CKY, Soh AYS, Bigliardi PL. Atopic Patients Who Fulfilled Rome III Criteria for Irritable Bowel Syndrome Had Higher Animal Danders Sensitization. J Neurogastroenterol Motil 2020; 26:267-273. [PMID: 32235034 PMCID: PMC7176502 DOI: 10.5056/jnm19181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 12/12/2022] Open
Abstract
Background/Aims The relationship between animal exposure and irritable bowel syndrome (IBS) is debated. Epidemiological studies have shown that atopy is more prevalent in IBS patients and vice versa. We set out to examine the association between animal danders sensitization and IBS-like symptoms in atopic patients. Methods We recruited 69 consecutive atopic patients from the allergy clinic of a tertiary hospital. Subjects completed validated bowel questionnaires, underwent skin prick test, blood was collected for serum total immunoglobulin E, and ImmunoCAP immune solid-phase allergen chip (ISAC) IgE multiplex assay. Results Twenty-eight (41.0%) atopic patients fulfilled the Rome III IBS criteria (atopy-IBS). There were no differences in gender, age, pet ownership, total serum IgE, or food allergen sensitization between atopy-IBS group and atopy-non-IBS group. We found that atopy-IBS group had significantly higher number of positive skin prick test for cat dander (64.3% vs 24.4%, P < 0.001), dog dander (64.3% vs 41.5%, P = 0.015) and weed pollens (32.1% vs 14.6%, P = 0.050) compared to atopy-non-IBS group. Out of 112 components from 51 allergen sources (both aeroallergen and food allergens), only Fel d1 (a major cat dander antigen) IgE is significantly higher in atopy-IBS group than atopy-non-IBS group (21.4% vs 2.4%, P = 0.029). Majority of atopy-IBS patients had mixed-type IBS. Conclusions We demonstrated an association between animal danders sensitization, in particular cat dander sensitization, and IBS-like symptoms in atopic patients. Future studies are needed to explore the relationship between aeroallergen and functional gastrointestinal disorders. Sensitization may be related to the pathophysiology of IBS or it could be that we are missing aeroallergen-induced gut allergy.
Collapse
Affiliation(s)
- Kewin T H Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Amelia Santosa
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Rheumatology, University Medicine Cluster, National University Health System, Singapore
| | | | - Alex Y S Soh
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul L Bigliardi
- Department of Dermatology, Division of Dermato-Allergy, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
10
|
Loo EXL, Wang DY, Siah KTH. Association between Irritable Bowel Syndrome and Allergic Diseases: To Make a Case for Aeroallergen. Int Arch Allergy Immunol 2019; 181:31-42. [PMID: 31694023 DOI: 10.1159/000503629] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/21/2019] [Indexed: 11/19/2022] Open
Abstract
Irritable bowel syndrome (IBS) is a functional gastrointestinal disease and the most common cause of prolonged abdominal pain and bowel disturbances in the developed world. While initially thought to be functional or psychosomatic in nature, IBS is now recognized as a heterogeneous group of conditions. A subset of IBS patients and patients with allergic diseases share some characteristic inflammatory features. In fact, atopic children show an increased likelihood of developing IBS as adults. Given these findings, a subset of IBS may be suffering from allergy-related gut diseases. In this review, we present the allergy-related comorbidities of IBS, including genetic, environmental, and immunologic factors. We discuss studies demonstrating an increased sensitization of IBS patients to aeroallergens compared to food allergens. We then postulate potential pathophysiological mechanisms underlying both IBS and aeroallergens in the gut, followed by potential implications in the screening and treatment of allergies in IBS patients.
Collapse
Affiliation(s)
- Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Department of Pediatrics, Yong Loo School of Medicine, National University of Singapore, Singapore, Singapore
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kewin Tien Ho Siah
- Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore, Singapore, .,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore,
| |
Collapse
|
11
|
Friesen C, Singh M, Singh V, Schurman JV. An observational study of headaches in children and adolescents with functional abdominal pain: Relationship to mucosal inflammation and gastrointestinal and somatic symptoms. Medicine (Baltimore) 2018; 97:e11395. [PMID: 30045261 PMCID: PMC6078717 DOI: 10.1097/md.0000000000011395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 06/12/2018] [Indexed: 01/28/2023] Open
Abstract
Headaches and abdominal pain are among the most common pediatric pain conditions. Mast cells have been implicated in the pathophysiology of migraines, as well as functional dyspepsia (FD) and irritable bowel syndrome (IBS). The primary aims of the current study were to assess headache prevalence in patients with FD and to assess the association between headaches and mucosal mast cells and eosinophils. An additional aim was to explore associations of headache with other symptoms.We conducted a cross-sectional retrospective chart review of 235 consecutive patients with chronic abdominal pain. All patients had completed a standardized questionnaire as part of their routine clinical evaluation. Both gastrointestinal and non-gastrointestinal somatic symptoms were included in the analysis. All patients diagnosed with FD had undergone upper endoscopy with biopsies obtained from the gastric antrum and duodenum and these specimens were utilized to assess eosinophil and mast cell densities, respectively.Overall, 86% of patients fulfilled Rome IV criteria for FD. Headache was reported by 73.8% of FD patients versus 45.2% of non-FD patients (P = .001). Duodenal mast cell densities were significantly increased in those reporting headaches. Headache was not associated with any specific gastrointestinal symptoms but was associated with a wide array of non-gastrointestinal symptoms including fatigue, dizziness, muscle pain, joint pain, and chest pain.Headaches are common in children and adolescents with abdominal pain and, utilizing Rome IV criteria, are specifically associated with FD. In patients with FD, headaches are associated with increased duodenal mast cell density and a variety of somatic symptoms, all of which are possibly the result of mast cell activation.
Collapse
Affiliation(s)
- Craig Friesen
- Division of Gastroenterology, Hepatology, and Nutrition
| | - Meenal Singh
- Division of Gastroenterology, Hepatology, and Nutrition
| | | | - Jennifer V. Schurman
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO
| |
Collapse
|
12
|
Tsai JD, Wang IC, Shen TC, Lin CL, Wei CC. A 8-year population-based cohort study of irritable bowel syndrome in childhood with history of atopic dermatitis. J Investig Med 2018; 66:755-761. [DOI: 10.1136/jim-2017-000631] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2017] [Indexed: 12/15/2022]
Abstract
Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder affecting a large number of people worldwide. Based on the concept of central sensitization, we conducted a population-based cohort analysis to investigate the risk of IBS in children with atopic dermatitis (AD) as one of the first steps in the atopic march. From 2000 to 2007, 1 20 014 children with newly diagnosed AD and 1 20 014 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of IBS in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and CIs were measured. The incidence of IBS during the study period was 1.45-fold greater (95% CI: 1.32 to 1.59) in the AD cohort than in the non-AD cohort (18.8 vs 12.9 per 10 000 person-years). The AD to non-AD HR of IBS was greater for girls (1.60, 95% CI: 1.39 to 1.85) and children≥12 years (1.59, 95% CI: 1.23 to 2.05). The HR of IBS in AD children increased from 0.84 (95% CI: 0.75 to 0.94) for those with ≤3 AD related visits to 16.7 (95% CI: 14.7 to 18.9) for those with >5 visits (P<0.0001, by the trend test). AD children had a greater risk of developing IBS. Further research is needed to clarify the role of allergy in the pathogenesis of IBS.
Collapse
|
13
|
Siah KTH, Wong RK, Chan YH, Ho KY, Gwee KA. Prevalence of Irritable Bowel Syndrome in Singapore and Its Association with Dietary, Lifestyle, and Environmental Factors. J Neurogastroenterol Motil 2016; 22:670-676. [PMID: 26951047 PMCID: PMC5056577 DOI: 10.5056/jnm15148] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/21/2016] [Accepted: 02/10/2016] [Indexed: 12/13/2022] Open
Abstract
Background/Aims The prevalence of irritable bowel syndrome (IBS) has risen considerably over the past decade in Singapore. We aim to explore the contribution of changes in diet, lifestyle and habits that may contribute to the increased prevalence and development of IBS. Methods This is a survey-based cross-sectional population study aimed to gather demographic, socio-economical, lifestyle, dietary, antibiotic usage and other related information. Subjects were adult male or female Singaporeans aged 21 years or above. Association of the factors gathered with the presence or absence of IBS (by Rome III criteria) was assessed using chi-square or Fisher's exact test. Variables with a level of statistical significance of 0.1 or less in the univariate analysis were entered into a stepwise logistic regression model. Results A total of 297 subjects participated in the study (female 60.3%). Overall, 20.9% subjects fulfilled the Rome III IBS criteria. Univariate analysis showed that IBS was associated with pet ownership, antibiotic usage, late dinner, (> 9 PM) and consumption of Western meals, coffee, and bread. The multivariate logistic regression analyses showed that IBS was independently associated with being a pet owner (P = 0.008; OR, 2.5; 95% CI, 1.278-5.037). Conclusions The prevalence of IBS was 20.9% using the Rome III criteria in our study. The association between IBS and pet ownership will need further investigation.
Collapse
Affiliation(s)
- Kewin T H Siah
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Reuben K Wong
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yiong H Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, NUHS, Singapore
| | - Khek Y Ho
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kok-Ann Gwee
- Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
14
|
Shen TC, Lin CL, Wei CC, Chen CH, Tu CY, Hsia TC, Shih CM, Hsu WH, Sung FC, Kao CH. Bidirectional Association between Asthma and Irritable Bowel Syndrome: Two Population-Based Retrospective Cohort Studies. PLoS One 2016; 11:e0153911. [PMID: 27093172 PMCID: PMC4836663 DOI: 10.1371/journal.pone.0153911] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 04/06/2016] [Indexed: 12/13/2022] Open
Abstract
Background There is a demonstrated association between asthma and irritable bowel syndrome (IBS). In this study, we examined the bidirectional association between asthma and IBS using a nationwide database. Methods We conducted two retrospective cohort studies using data obtained from the National Health Insurance of Taiwan. Study 1 included 29,648 asthma patients newly diagnosed between 2000 and 2010. Study 2 included 29,875 IBS patient newly diagnosed between 2000 and 2010. For each study, four subjects without asthma and IBS were selected, respectively, frequency-matched by sex, age, and the diagnosis date. All four cohorts were followed up until the end of 2011 to estimate incident IBS for Study 1 and incident asthma for study 2. Adjusted hazard ratios (aHRs) were estimated using the Cox proportional hazards model after controlling for sex, age and comorbidities. Results The incidence of IBS was 1.89 times higher in the asthma cohort than in the comparison cohort (8.26 vs. 4.36 per 1,000 person-years), with an aHR of 1.57 [95% confidence interval (CI) = 1.47–1.68]. The aHRs remained significant in all subgroups measured by sex, age and the presence of comorbidities. In contrast, the incidence of asthma was 1.76 times higher in the IBS cohort than the comparison cohort (7.09 vs. 4.03 per 1,000 person-years), with an aHR of 1.54 (95% CI = 1.44−1.64). Similarly, aHRs remained significant in all subgroups measured by sex, age and the presence of comorbidities. Conclusion The present study suggests a bidirectional association between asthma and IBS. Atopy could be a shared pathophysiology underlying this association, deserving a further investigation.
Collapse
Affiliation(s)
- Te-Chun Shen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chang-Ching Wei
- Children’s Hospital, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chia-Hung Chen
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chuen-Ming Shih
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wu-Huei Hsu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
- * E-mail: (CHK); (FCS)
| | - Chia-Hung Kao
- Graduate Institute of Clinical Medicine Science, College of Medicine, China Medical University, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
- * E-mail: (CHK); (FCS)
| |
Collapse
|
15
|
Vicario M, González-Castro AM, Martínez C, Lobo B, Pigrau M, Guilarte M, de Torres I, Mosquera JL, Fortea M, Sevillano-Aguilera C, Salvo-Romero E, Alonso C, Rodiño-Janeiro BK, Söderholm JD, Azpiroz F, Santos J. Increased humoral immunity in the jejunum of diarrhoea-predominant irritable bowel syndrome associated with clinical manifestations. Gut 2015; 64:1379-88. [PMID: 25209656 DOI: 10.1136/gutjnl-2013-306236] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 08/14/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Altered intestinal barrier is associated with immune activation and clinical symptoms in diarrhoea-predominant IBS (IBS-D). Increased mucosal antigen load may induce specific responses; however, local antibody production and its contribution to IBS aetiopathogenesis remain undefined. This study evaluated the role of humoral activity in IBS-D. METHODS A single mucosal jejunal biopsy, luminal content and blood were obtained from healthy volunteers (H; n=30) and IBS-D (n=49; Rome III criteria) participants. Intraepithelial lymphocytes, mast cells, B lymphocytes and plasma cells were studied by imaging techniques. Differential gene expression and pathway analysis were assessed by microarray and PCR techniques. Blood and luminal immunoglobulins (Igs) were quantified. Gastrointestinal symptoms, respiratory atopy and stress and depression were also recorded. RESULTS Patients with IBS-D showed a higher number and activation of mucosal B lymphocytes and plasma cells (p<0.05). Mast cell density was increased in patients with IBS-D (non-atopic) and in close proximity to plasma cells (p<0.05). Microarray profiling identified differential humoral activity in IBS-D, involving proliferation and activation of B lymphocytes and Igs production (p<0.001). Mucosal humoral activity was higher in IBS-D, with upregulation of germline transcripts and Ig genes (1.3-fold-1.7-fold increase; p<0.05), and increased IgG(+) cells and luminal IgG compared with H (p<0.05), with no differences in blood. Biological markers of humoral activity correlated positively with bowel movements, stool form and depression. CONCLUSIONS Enhanced small bowel humoral immunity is a distinctive feature of IBS-D. Mucosal Ig production contributes to local inflammation and clinical manifestations in IBS-D.
Collapse
Affiliation(s)
- Maria Vicario
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Ana M González-Castro
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Martínez
- Department of Human Molecular Genetics, Institute of Human Genetics, University of Heidelberg, Heidelberg, Germany
| | - Beatriz Lobo
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marc Pigrau
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Guilarte
- Department of Allergy, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Inés de Torres
- Department of Pathology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose L Mosquera
- Department of Statistics, University of Barcelona, Barcelona, Spain
| | - Marina Fortea
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - César Sevillano-Aguilera
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eloisa Salvo-Romero
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carmen Alonso
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Bruno K Rodiño-Janeiro
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Johan D Söderholm
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Fernando Azpiroz
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Javier Santos
- Neuro-immuno-gastroenterology Laboratory, Digestive Diseases Research Unit, Vall d'Hebron Institut de Recerca, Barcelona, Spain Department of Gastroenterology, Hospital Universitari Vall d'Hebron & Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| |
Collapse
|
16
|
Rentzos G, Johanson L, Sjölander S, Telemo E, Ekerljung L. Self-reported adverse reactions and IgE sensitization to common foods in adults with asthma. Clin Transl Allergy 2015; 5:25. [PMID: 26191401 PMCID: PMC4506426 DOI: 10.1186/s13601-015-0067-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 05/25/2015] [Indexed: 01/24/2023] Open
Abstract
Background There is very few data available on the prevalence of food hypersensitivity among adults with asthma. The aim of this study was to explore the prevalence of self-reported adverse reactions and IgE sensitization to the different foods and to determine the spectrum and the prevalence of food-related gastrointestinal symptoms in adults with and with no asthma. Methods A cross sectional study based on interviews and questionnaire responses from 1527 subjects, aged 18–75 years of age, from Västra Götaland in Sweden, as part of the larger West Sweden Asthma Study. IgE analyses were performed in sera from all subjects. Results Fifty three percent of adults with asthma reported adverse reactions to foods compared to 30 % of non-asthmatics. Most asthmatics reported symptoms from eating hazelnut, followed by other nuts, birch-related foods, milk, peanut and shellfish. Furthermore, adults with asthma experienced significantly more often gastrointestinal symptoms from hazelnut, apple and milk and were found to significantly more often be sensitized to the most common foods compared to the non-asthmatic subjects. The asthmatics showed a significant correlation between IgE to both hazelnut and birch and self-reported symptoms after ingestion of hazelnut and to a lesser extent to almonds. Conclusions The prevalence of self-reported adverse reactions and sensitization to the most common foods was much higher among the asthmatic subjects. Hazelnut was the food that asthmatics most frequently experienced adverse reactions from, and the strong correlation between IgE to hazelnut and birch indicate that the observed adverse reactions are partly due to sensitization to allergens from the PR-10 family. Electronic supplementary material The online version of this article (doi:10.1186/s13601-015-0067-6) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- G Rentzos
- Section of Allergology, University Hospital of Sahlgrenska, 413 45 Gothenburg, Sweden
| | - L Johanson
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden
| | - S Sjölander
- R&D, ImmunoDiagnostics, Thermofischer Scientific, Uppsala, Sweden
| | - E Telemo
- Department for Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L Ekerljung
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
17
|
Rentzos G, Lundberg V, Stotzer PO, Pullerits T, Telemo E. Intestinal allergic inflammation in birch pollen allergic patients in relation to pollen season, IgE sensitization profile and gastrointestinal symptoms. Clin Transl Allergy 2014; 4:19. [PMID: 24910772 PMCID: PMC4048541 DOI: 10.1186/2045-7022-4-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 05/20/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Birch pollen allergic patients frequently experience gastrointestinal upset accompanied by a local allergic inflammation in the small intestine especially during the pollen season. However, it is not known if the GI pathology is connected to the subjective symptoms of the patient. The objective of this study was to evaluate the immune pathology of the duodenal mucosa and the serum IgE antibody profiles in birch pollen allergic patients in relation to their gastrointestinal symptoms, during and outside the birch pollen season. METHODS Thirty-two patients with birch pollen allergy and sixteen healthy controls were enrolled in the study. Twenty allergic patients had gastrointestinal symptoms and twelve did not. All participants underwent an allergy investigation and gastroscopy with duodenal biopsy. The duodenal biopsies were retrieved during the pollen season (May-June) and off-season (November-March). The biopsies were immunostained for mast cells (IgE and tryptase), eosinophils, T cells (CD3), and dendritic cells (CD11c). Pollen-specific IgE antibodies were determined by ImmunoCAP and component microarray (ISAC). RESULTS Patients in both pollen allergic groups showed similar degree of intestinal allergic inflammation during the pollen season regardless of gastrointestinal symptoms. The eosinophils, mast cells and dendritic cells were increased in the mucosa. Patients with gastrointestinal symptoms had significantly elevated IgE antibodies to birch (rBet v 1), hazelnut (rCor a 1), and apple (rMal d1) during the pollen season. CONCLUSIONS Patients allergic to birch pollen have clear signs of an ongoing allergic inflammation in their intestinal mucosa, which is aggravated during the pollen season. The magnitude of the allergic intestinal inflammation is not associated with subjective gastrointestinal symptoms of the individual patient.
Collapse
Affiliation(s)
- Georgios Rentzos
- Section of Allergology, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Vanja Lundberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Ove Stotzer
- Department of Internal Medicine, Section of Gastroenterology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Teet Pullerits
- Section of Allergology, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden
| | - Esbjörn Telemo
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
18
|
Abstract
BACKGROUND Eosinophilic enterocolitis (EEC) is an emerging distinct inflammatory bowel disease of unknown etiology. There are no published data on the effect of infliximab (IFX) or adalimumab (ADA) for the treatment of refractory cases. METHODS A report of all pediatric cases with EEC treated with anti-tumor necrosis factor, identified after an open international call. RESULTS We describe here the first 8 children with refractory EEC who were treated with IFX (75% boys; mean age at diagnosis 8.6 ± 4.03 [range 1.6-14 years]; mean age at IFX treatment 11.7 ± 4.4 [range 4.2-16 years]). Allergic and infectious causes of EEC were excluded in all cases. Rapid and complete clinical remission was documented in 6 (75%) children following the induction infusions: 3 (38%) with endoscopic remission, 2 (25%) with endoscopic improvement, and 1 unknown. Four of the 6 responders had secondary loss of response and were switched to ADA, 3 of whom with sustained remission using high doses. Overall, the 6 responders were followed for a median of 7 years (range 4-12; interquartile range 6.4-8.8 years) without evidence of developing Crohn disease or ulcerative colitis. The only case with macroscopic findings on endoscopy was a primary nonresponder. CONCLUSIONS IFX and ADA may be effective in cases of refractory idiopathic EEC; however, because this is an uncontrolled report, further prospective studies are warranted.
Collapse
|
19
|
Lied GA, Lillestøl K, Lind R, Valeur J, Morken MH, Vaali K, Gregersen K, Florvaag E, Tangen T, Berstad A. Perceived food hypersensitivity: a review of 10 years of interdisciplinary research at a reference center. Scand J Gastroenterol 2011; 46:1169-78. [PMID: 21679125 DOI: 10.3109/00365521.2011.591428] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Perceived food hypersensitivity is a prevalent, but poorly understood condition. In this review article, we summarize narratively recent literature including results of our 10 years' interdisciplinary research program dealing with such patients. The patients (more than 400) included in our studies were all adults referred to a university hospital because of gastrointestinal complaints self-attributed to food hypersensitivity. Despite extensive examinations, food allergy was seldom diagnosed. The majority of the patients fulfilled the diagnostic criteria for irritable bowel syndrome. In addition, most suffered from several extra-intestinal health complaints and had considerably impaired quality of life. However, psychological factors could explain only approximately 10% of the variance in the patients' symptom severity and 90% of the variance thus remained unexplained. Intolerance to low-digestible carbohydrates was a common problem and abdominal symptoms were replicated by carbohydrate ingestion. A considerable number of patients showed evidence of immune activation by analyses of B-cell activating factor, dendritic cells and "IgE-armed" mast cells. Multiple factors such as immune activation, disturbed intestinal fermentation, enteric dysmotility, post-infectious changes and "local" allergy in the gut as well as psychological disturbances may play a role in the pathophysiology of perceived food hypersensitivity. Hence, our results support the view that management of these patients should be interdisciplinary.
Collapse
|
20
|
Implications of eosinophilia in the normal duodenal biopsy - an association with allergy and functional dyspepsia. Aliment Pharmacol Ther 2010; 31:1229-36. [PMID: 20222916 DOI: 10.1111/j.1365-2036.2010.04282.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Allergy and functional gastrointestinal disorders have been associated with eosinophilia in duodenal mucosa. AIM To assess the prevalence of eosinophilia in duodenal biopsies of patients attending for oesophogastroduodenoscopy and delineate associated clinical conditions. METHODS A total of 155 patients (mean age 55 years, 59% women) with normal duodenal biopsies were randomly selected for audit from histopathology files. Eosinophil counts in five high power fields (HPFs) were assessed. Records were analysed for symptoms, diagnosis and medications; patients were divided into five groups based on upper gastrointestinal (UGI) symptom profiles, including a control group of those without predominant UGI symptoms. The prevalence of duodenal eosinophilia (defined as >22/5HPFs a priori) was calculated. RESULTS In the control group, the mean duodenal eosinophil count was 15/5HPFs; prevalence of duodenal eosinophilia was 22.5%. In postprandial distress syndrome (PDS), both mean eosinophil counts (20.2/5HPF, P < 0.04) and prevalence of duodenal eosinophilia (47.3%, P < 0.04) were significantly higher. Duodenal eosinophilia was significantly associated with allergy (OR 5.04, 95% CI 2.12-11.95, P < 0.001). There was no association with irritable bowel syndrome or medications. CONCLUSIONS Subtle duodenal eosinophilia is relatively common in routine oesophogastroduodenoscopy and previously overlooked; it is associated with allergy and may indicate a hypersensitivity mechanism in some patients with PDS including early satiety.
Collapse
|
21
|
Jyonouchi S, Brown-Whitehorn TA, Spergel JM. Association of eosinophilic gastrointestinal disorders with other atopic disorders. Immunol Allergy Clin North Am 2009; 29:85-97, x. [PMID: 19141344 DOI: 10.1016/j.iac.2008.09.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Eosinophilic esophagitis is a chronic disease that leads to either persistent symptoms or, at times, intermittent "flares." It shares many features with other atopic diseases (asthma, allergic rhinitis, and atopic dermatitis), including the following: T helper 2 cells and eosinophils play a critical role in the pathogenesis of the disease; avoidance of allergens promotes remission of disease and symptom control; and locally applied corticosteroids provide control. Finally, most patients who have eosinophilic gastrointestinal disorders have an associated atopic disease.
Collapse
Affiliation(s)
- Soma Jyonouchi
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | | | | |
Collapse
|
22
|
The role of the high-affinity IgE receptor, FcepsilonRI, in eosinophilic gastrointestinal diseases. Immunol Allergy Clin North Am 2009; 29:159-70, xii. [PMID: 19141351 DOI: 10.1016/j.iac.2008.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Primary eosinophilic gastrointestinal diseases (EGIDs) are a heterogeneous group of diseases including eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, eosinophilic enteritis, and eosinophilic colitis. The unifying hallmark and diagnostic marker of EGIDs is an eosinophil-rich inflammatory infiltrate of the GI mucosa, in the absence of known causes for eosinophilia. The etiology of EGIDs is not yet fully understood. The pathogenesis however seems to involve a complex interplay of genetic predisposition, exposure to food- and environmental allergens and IgE-mediated activation of the immune system. Accumulating evidence relates EGIDs to the group of T-helper (Th) 2 mediated immune disorders, like IgE-mediated allergy. In this article we discuss a possible role of IgE-mediated immune-activation via the high affinity receptor for IgE, FcepsilonRI, in the pathogenesis of primary EGIDs. Beyond its defined role in type I allergic reactions, we here hypothesize that activation of tetrameric FcepsilonRI on mast cells and basophils as well as trimeric FcepsilonRI on human eosinophils and antigen presenting cells in the gastrointestinal mucosa is critically involved in the pathology of EGIDs. We also discuss how IgE-independent triggering of FcepsilonRI could be a mechanisms responsible for activation of the immune system in patients with EGID.
Collapse
|
23
|
Tobin MC, Keshavazian A, Farhardi A. Atopic irritable bowel syndrome: same old hat or a new entity? Expert Rev Gastroenterol Hepatol 2008; 2:457-9. [PMID: 19072394 DOI: 10.1586/17474124.2.4.457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
24
|
Atopy is a risk factor for acute appendicitis? A prospective clinical study. J Gastrointest Surg 2008; 12:1251-6. [PMID: 18350341 DOI: 10.1007/s11605-008-0511-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 02/28/2008] [Indexed: 01/31/2023]
Abstract
PURPOSE The purpose of the study was to assess the role of atopy on the development of appendicitis. Acute appendicitis is the most common indication for emergent laparotomy especially in the late teens and early 20s. The pathogenesis generally begins with luminal obstruction caused by fecal mass, seeds, stricture, and bacterial, parasitic, or viral infections. The present study was designed to evaluate whether allergic reaction is indeed an undefined leading factor for luminal obstruction. MATERIAL AND METHODS Mix inhalant and food prick tests were performed in 111 patients who underwent appendectomy for acute appendicitis and in 100 control patients. The material of appendectomy was examined, acute appendicitis was verified and graded according to the severity of inflammation and eosinophilic infiltration rate in the wall of appendix by a pathologist. Demographic data were recorded, and peripheral eosinophil count was also performed. RESULTS Mix prick test of 33 patients (29.7%) and food prick test of 14 patients (12.6%) were positive in study group when compared with 7 patients (7%) and 1 patient (1%) in control group (p < 0.001). A total of 38 patients (34.2%) in the study group were reactive with mix or food prick test when compared with 8 patients (8%) in control group. There was no significant difference between eosinophilic infiltration rate, peripheral eosinophil count, severity of inflammation, and Alvarado score of mix prick test positive and negative patients in study group. CONCLUSION Atopy incidence in patients with acute appendicitis was significantly higher when compared with control group. However, eosinophilic infiltration rate, inflammation grade, and peripheral eosinophil count were not able to explain the relationship between the two conditions. Atopy is a risk factor for acute appendicitis.
Collapse
|
25
|
Tobin MC, Moparty B, Farhadi A, DeMeo MT, Bansal PJ, Keshavarzian A. Atopic irritable bowel syndrome: a novel subgroup of irritable bowel syndrome with allergic manifestations. Ann Allergy Asthma Immunol 2008; 100:49-53. [PMID: 18254482 DOI: 10.1016/s1081-1206(10)60404-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mast cells have a primary role in atopy. Mast cells may play a unique role in a subgroup of patients with irritable bowel syndrome (IBS). This observation suggests a link between atopic disorders and IBS. OBJECTIVE To determine whether there is an association between atopic disorders and IBS. METHODS We undertook a prospective study using structured questionnaires. We administered questionnaires to 125 consecutive patients seen in the following clinics from July 1 through October 31, 2001: allergy/immunology (AI) (n = 39), gastroenterology (n = 36), and general medicine (n = 50). The survey included questions detailing gastrointestinal and allergic symptoms. Diagnosis of IBS was based on Rome II criteria. Diagnosis of atopy was based on clinical parameters. RESULTS The AI clinic reported a significantly (P = .015) higher rate of IBS than the general medicine clinic. The IBS incidence reported in the AI clinic was similar to that reported in the gastroenterology clinic. The likelihood of IBS was significantly higher in patients with seasonal allergic rhinitis (2.67 times; 95% confidence interval [CI], 1.10-6.49; P = .03), patients with allergic eczema (3.85 times; 95% CI, 1.72-8.60; P = .001), and patients with depression (2.56 times; 95% CI, 1.05-6.14; P = .04). Patients reporting atopic symptoms (seasonal allergic rhinitis, allergic eczema, and asthma) were 3.20 times (95% CI, 1.20-8.50) (P = .02) more likely to fulfill the criteria for IBS. CONCLUSIONS Adults with atopic symptoms report a high incidence of IBS, suggesting a link between atopy and IBS. We proposed a subgroup of patients with IBS (atopic IBS) who have typical IBS symptoms in association with atopic manifestations. Identifying atopic vs nonatopic IBS may help in identifyingthe underlying pathophysiologic mechanisms and therapeutic options.
Collapse
Affiliation(s)
- Mary C Tobin
- Department of Immunology/Microbiology, Rush University Medical Center, John H. Stoger, Jr Hospital, Chicago, Illinois 60612, USA.
| | | | | | | | | | | |
Collapse
|
26
|
TSUNEMATSU M, YAMAJI T, KOZUTSUMI D, MURAKAMI R, NAGAI H, KINO K. A new murine model of allergic rhinitis by repeated intranasal Cry j 1 challenge. Biomed Res 2008; 29:119-23. [DOI: 10.2220/biomedres.29.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
27
|
Kämpe M, Stålenheim G, Janson C, Stolt I, Carlson M. Systemic and local eosinophil inflammation during the birch pollen season in allergic patients with predominant rhinitis or asthma. Clin Mol Allergy 2007; 5:4. [PMID: 17967188 PMCID: PMC2174506 DOI: 10.1186/1476-7961-5-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Accepted: 10/29/2007] [Indexed: 12/20/2022] Open
Abstract
Background The aim of the study was to investigate inflammation during the birch pollen season in patients with rhinitis or asthma. Methods Subjects with birch pollen asthma (n = 7) or rhinitis (n = 9) and controls (n = 5) were studied before and during pollen seasons. Eosinophils (Eos), eosinophil cationic protein (ECP) and human neutrophil lipocalin were analysed. Results Allergic asthmatics had a larger decline in FEV1 after inhaling hypertonic saline than patients with rhinitis (median) (-7.0 vs.-0.4%, p = 0.02). The asthmatics had a lower sesonal PEFR than the rhinitis group. The seasonal increase in B-Eos was higher among patients with asthma (+0.17 × 109/L) and rhinitis (+0.27 × 109/L) than among controls (+0.01 × 109/L, p = 0.01). Allergic asthmatics and patients with rhinitis had a larger increase in sputum ECP (+2180 and +310 μg/L) than the controls (-146 μg/L, p = 0.02). No significant differences in inflammatory parameters were found between the two groups of allergic patients. Conclusion Patients with allergic asthma and rhinitis have the same degree of eosinophil inflammation. Despite this, only the asthmatic group experienced an impairment in lung function during the pollen season.
Collapse
Affiliation(s)
- Mary Kämpe
- Department of Medical Sciences, Respiratory Medicine and Allergology; University Hospital, Uppsala, Sweden.
| | | | | | | | | |
Collapse
|
28
|
Onbasi K, Sin AZ, Doganavsargil B, Onder GF, Bor S, Sebik F. Eosinophil infiltration of the oesophageal mucosa in patients with pollen allergy during the season. Clin Exp Allergy 2006; 35:1423-31. [PMID: 16297137 DOI: 10.1111/j.1365-2222.2005.02351.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND The oesophagus is normally devoid of eosinophils. There are some disorders accompanying with eosinophil infiltration. Food allergy has been reported as a common reason, especially in children but some other studies have also indicated that aeroallergens might have a role in oesophageal eosinophil accumulation. OBJECTIVE In this study we investigated whether there is any eosinophil recruitment in the oesophagus of pollen-allergic patients who had respiratory symptoms during the season. METHODS Thirty-eight symptomatic patients (allergic rhinitis (AR) with or without asthma) who had sensitization to grass pollen were included in the study during the pollen season. Controls were composed of 25 healthy non-atopics and 24 patients diagnosed as having gastro-oesophageal reflux disease. Reflux was excluded in allergic and non-atopic groups, whereas the presence of allergy was eliminated in control groups. Gastrointestinal endoscopy was performed in all participants, and biopsy specimens were taken from both the proximal and the distal oesophagus to evaluate eosinophil accumulation. At the same time, blood eosinophil numbers were counted. Results Oesophageal eosinophil accumulation was found in 10 allergic patients (26%) and in five patients (21%) with gastro-oesophageal reflux disease but none of the healthy controls had eosinophils (0%) (P<0.05). Blood eosinophils were higher in these 10 patients than the rest of the 28 patients without infiltration. In this group, blood eosinophils were also correlated with the number of accumulated eosinophils in the oesophagus (P<0.001). There was more intense eosinophil infiltration at the distal part of the oesophagus in the reflux group when compared with the allergic group (mean 7.6+/-5.6 vs. 3.2+/-3.7). Nevertheless, eosinophils were found to be concentrated (mean 5.5+/-7.3) in the proximal oesophagus of allergic patients, although it was 1.7+/-1.5 in reflux patients (P>0.05). Conclusion Our results showed that eosinophil infiltration might be observed in oesophageal tissue of patients with respiratory tract allergy during the symptomatic period. This finding may possibly reflect the systemic and common mucosal aspects of allergic inflammation.
Collapse
Affiliation(s)
- K Onbasi
- Department of Internal Medicine, Division of Immunology and Allergy, Ege University School of Medicine, Izmir, Turkey
| | | | | | | | | | | |
Collapse
|
29
|
Affiliation(s)
- C Serrano
- Servicio de Neumología y Alergia Respiratoria, ICPCT, Hospital Clínic, Barcelona, Spain
| | | | | |
Collapse
|
30
|
Abstract
The prevalence of food allergy reaches 3% in the adult population. Chronic gastrointestinal allergy is a rare entity: 4.2% of food allergies in adults, and represents 3.2% of all intestinal disorders. Non-specific symptoms are the rule but eosinophilic gastrointestinal disorders are the subject of much interest. Endoscopy and biopsies of the gastrointestinal tract help the differential diagnoses. Food allergy is suspected from the patient's history leading to skin tests and laboratory tests identifying a sensitization but allergy is only confirmed by standardized challenges or eviction diets over a sufficiently long period. New types of investigations coupling oral challenges to foods to gastroenterological techniques should be studied further.
Collapse
|
31
|
Serrano C, Valero A, Picado C. Rinitis y asma: una vía respiratoria, una enfermedad. Arch Bronconeumol 2005. [DOI: 10.1157/13079841] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
32
|
Abstract
Adult food allergy is estimated at approximately 3.2% worldwide. The persistence of childhood food allergy is unusual, peanut allergies excepted. Once established in adults, food allergy is rarely cured. Factors favoring the acquisition of allergy could be sensitization to pollens, occupational sensitization by inhalation, drugs (such as tacrolimus), and sudden dietary changes. Severe anaphylaxis and oral allergy syndrome are frequent. The fatality risk is estimated at 1% in severe anaphylaxis. Risk factors for severe anaphylaxis are agents causing increased intestinal permeability, such as alcohol and aspirin. b-blockers, angiotensin-converting enzyme (ACE) inhibitors, and exercise are other factors. Gastrointestinal food allergy remains, to a large extent, undiagnosed in adults. Food allergens are mainly fruit and vegetable, related to pollen sensitizations, or to latex allergy. Wheat flour allergy is increasing. The diagnosis relies on prick skin tests, detection of specific IgEs, and standardized oral challenges. Strict avoidance diets are necessary. Specific immunotherapy to pollens may be efficient for cross-reactive food allergies.
Collapse
Affiliation(s)
- Denise A Moneret-Vautrin
- Department of Internal Medicine, Clinical Immunology and Allergology, University Hospital, 29 Avenue de Lattre de Tassigny, 54035 Nancy, France.
| | | |
Collapse
|
33
|
Ngo P, Furuta G, Burks W. The pathobiology of eosinophilic gastroenteritis of childhood: is it really the eosinophil, allergic mediated, or something else? Curr Gastroenterol Rep 2004; 6:436-40. [PMID: 15527672 DOI: 10.1007/s11894-004-0064-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Over the past decade clinicians have witnessed a dramatic rise in the prevalence of eosinophilic gastrointestinal diseases. Diverse symptoms, a broad range of endoscopic findings, and varying histopathologic features pose several questions: Do eosinophils represent an allergic response? What mechanisms drive eosinophils to specific mucosal targets? How do eosinophils affect the gastrointestinal tissues? Recent clinical and basic studies are investigating the pathogenesis of eosinophilic gastrointestinal diseases. This review highlights the literature concerning the mechanisms that govern these diseases, with a specific focus on diseases of gastrointestinal columnar epithelia (eosinophilic gastroenteritis and eosinophilic colitis). The roles of specific chemokines, such as eotaxin, and the data supporting the involvement of eosinophil granule proteins in disease states, are discussed.
Collapse
Affiliation(s)
- Peter Ngo
- Division of Pediatric Gastroenterology, Children's Hospital of Boston, 300 Longwood Avenue, Hunnewell, Ground Floor, Boston, MA 02115, USA
| | | | | |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW The present review addresses the current literature regarding the impact of diet and the development of atopic disease. A search of the literature was carried out covering the following topics: diet and nutrition combined with immediate hypersensitivity, atopy, atopic disease, atopic dermatitis, and food allergy. RECENT FINDINGS The search results identified a significant contribution in the form of reviews considering this important topic, which ultimately led to the author's recommendation of these reviews to impress upon readers the impact of the atopy triad: atopic dermatitis to allergic rhinitis and asthma. SUMMARY A great deal of information exists in the pathomechanisms of atopic disease that will affect the classification of allergic and non-allergic atopic diseases. Increasing data on the genetic, humoral and cellular forms associated with these diseases will provide more clear-cut diagnostic criteria, treatment regimens and a more strict definition of the disease variants.
Collapse
Affiliation(s)
- Ricki M Helm
- Department of Microbiology/Immunology, Arkansas Children's Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| |
Collapse
|
35
|
Heine RG. Pathophysiology, diagnosis and treatment of food protein-induced gastrointestinal diseases. Curr Opin Allergy Clin Immunol 2004; 4:221-9. [PMID: 15126946 DOI: 10.1097/00130832-200406000-00015] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Although our general understanding of food hypersensitivity has improved in recent years, gastrointestinal food protein-induced diseases still pose diagnostic and therapeutic dilemmas. RECENT FINDINGS Food allergy in children and adults may involve any part of the gastrointestinal tract. Clinical presentations include protein-induced enterocolitis syndrome, enteropathy and proctocolitis, as well as eosinophilic gastroenteritis and related disorders. For many of these conditions, our understanding of the pathophysiology is incomplete. Manifestations are mostly non-IgE mediated, and skin prick testing and measurement of food-specific IgE antibody levels are of limited diagnostic value. Atopy patch testing may be of benefit in identifying food items associated with late-onset gastrointestinal reactions. A definitive diagnosis of gastrointestinal food allergy, however, still relies on formal food challenges. Depending on the clinical presentation, gastrointestinal biopsies may be required. In infancy, hypoallergenic formula or maternal elimination diets have been shown to effectively control the gastrointestinal manifestations of food allergies. Growth parameters and micronutrient levels need to be carefully monitored while on elimination diets for prolonged periods. In older children and adults with eosinophilic gastrointestinal disorders, the response to dietary restriction is variable. Corticosteroids may be required to control symptoms in those who failed to respond to hypoallergenic diets. In eosinophilic esophagitis, steroids can be administered topically in the form of swallowed aerosols. Leukotriene receptor antagonists and other novel therapies may be useful as steroid-sparing agents. SUMMARY Early diagnosis and treatment of food protein-induced gastrointestinal diseases may prevent significant nutritional complications. Further research is needed to develop diagnostic tools for these mainly cell-mediated disorders.
Collapse
Affiliation(s)
- Ralf G Heine
- Department of Allergy, Royal Children's Hospital, and Department of Paediatrics, University of Melbourne, Victoria, Australia.
| |
Collapse
|
36
|
Abstract
Evidence for one airway continues to accumulate. Nasal allergen challenges increase lower airway inflammation, and nasal corticosteroid treatment reduces lower airway inflammation. Allergic respiratory inflammation might even spread systemically to involve nonrespiratory organs. Eosinophilic enteritis and eosinophilic esophagitis are reported during pollen seasons in patients with seasonal allergic rhinitis. Chronic hypertrophic sinusitis (CHS) is found in the majority of patients with asthma. Like asthma, the histology of CHS is characterized by epithelial damage, basement membrane thickening, and eosinophilic inflammation. The damaged epithelium might explain the acute bacterial exacerbations seen in patients with CHS. Studies have extended evidence of the safety and efficacy of the second- and third-generation antihistamines to younger children and to patients with perennial rhinitis but continue to show improvement of symptom scores over that seen with placebo of less than 20%. Studies on antihistamine use in the first trimester in nearly 500 women (65% taking loratadine) revealed no increase in the complications of pregnancy or congenital anomalies. Positive skin prick test responses to birch in asymptomatic young adults predicted later development of clinical allergic rhinitis. A dose response was demonstrated for immunotherapy with cat dander extract. The best results were in subjects receiving a dose containing 15 microg of the major cat allergen Fel d 1 (equivalent to approximately 2500 bioequivalent allergen units). Both topical intranasal immunotherapy and high-dose sublingual immunotherapy have been repeatedly proved to be safe and effective in double-blind, placebo-controlled studies. CD4+CD25+ regulatory T cells secreting IL-10, TGF-beta, or both appear important in normal individuals and in patients treated with allergen immunotherapy in maintaining or restoring normal T(H)1/T(H)2 balance and overall suppression of both phenotypes.
Collapse
Affiliation(s)
- Harold S Nelson
- National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA
| |
Collapse
|