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Lam K, Au E, Ip WK, Tam JK, Leung PSC. Inhalant Mediated Allergy: Immunobiology, Clinical Manifestations and Diagnosis. Clin Rev Allergy Immunol 2025; 68:43. [PMID: 40234356 PMCID: PMC12000167 DOI: 10.1007/s12016-025-09053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2025] [Indexed: 04/17/2025]
Abstract
Inhalant allergen-mediated respiratory diseases, including asthma and allergic rhinitis, have become increasing global health issues. While air pollution is believed to favor allergic sensitization and intensify clinical symptoms of allergy, allergen sensitization can vary highly with geographical location, climate, and lifestyle differences. Pollen sensitization is higher in European countries, while dust mite is more common in regions with high humidity. Domestic pet sensitization is on the rising trend in industrialized nations, but the paradoxical effect of intensive cat exposure in early childhood is also observed. Clinical management of inhalant allergic diseases has greatly benefited from the immunological and mechanistic understanding of pathophysiology. In this review, we discuss the current knowledge on inhalant mediated allergic disorders with emphasis on (1) the major immune cells and relevant chemokines and cytokines in the sensitization and effector phase with aeroallergen exposure, (2) their manifestation in asthma and allergic rhinitis, (3) characterization of inhalant allergens, (4) chemical contributions to the development of allergic diseases, and (5) clinical diagnosis of aeroallergen sensitization and management of inhalant allergy. Knowledge on the role of Th2 skewing, IgE, basophil, mast cells, and eosinophils in respiratory allergic diseases are fundamental in the diagnosis and management of these disorders. Skin test, basophil activation test, and specific IgE component-resolved diagnostics are used for diagnosis and facilitate further management. Advances in the development of biologics and allergen-specific immunotherapy will strategize the future approaches in the clinical care of respiratory allergic diseases.
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Affiliation(s)
- Ki Lam
- Division of Clinical Immunology, Department of Pathology, Special Administrative Region, Queen Mary Hospital, Hong Kong, China
| | - Elaine Au
- Division of Clinical Immunology, Department of Pathology, Special Administrative Region, Queen Mary Hospital, Hong Kong, China
| | - W K Ip
- Division of Clinical Immunology, Department of Pathology, Special Administrative Region, Queen Mary Hospital, Hong Kong, China
| | - Jenna K Tam
- Institute of Society and Genetics, University of California, Los Angeles, CA, 90095, USA
| | - Patrick S C Leung
- Division of Rheumatology/Allergy and Clinical Immunology, University of California, Davis, CA, 95616, USA.
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Brazhnikov G, Smolnikov E, Litovkina A, Jiang T, Shatilov A, Tulaeva I, Tulaev M, Karaulov A, Poroshina A, Zhernov Y, Focke‐Tejkl M, Weber M, Akinfenwa O, Elisyutina O, Andreev S, Shilovskiy I, Shershakova N, Smirnov V, Fedenko E, Lepeshkova TS, Beltyukov EC, Naumova VV, Kundi M, Khaitov M, Wiedermann U, Valenta R, Campana R. Natural human Bet v 1-specific IgG antibodies recognize non-conformational epitopes whereas IgE reacts with conformational epitopes. Allergy 2023; 78:3136-3153. [PMID: 37701941 PMCID: PMC10952721 DOI: 10.1111/all.15865] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND The nature of epitopes on Bet v 1 recognized by natural IgG antibodies of birch pollen allergic patients and birch pollen-exposed but non-sensitized subjects has not been studied in detail. OBJECTIVE To investigate IgE and IgG recognition of Bet v 1 and to study the effects of natural Bet v 1-specific IgG antibodies on IgE recognition of Bet v 1 and Bet v 1-induced basophil activation. METHODS Sera from birch pollen allergic patients (BPA, n = 76), allergic patients without birch pollen allergy (NBPA, n = 40) and non-allergic individuals (NA, n = 48) were tested for IgE, IgG as well as IgG1 and IgG4 reactivity to folded recombinant Bet v 1, two unfolded recombinant Bet v 1 fragments comprising the N-terminal (F1) and C-terminal half of Bet v 1 (F2) and unfolded peptides spanning the corresponding sequences of Bet v 1 and the apple allergen Mal d 1 by ELISA or micro-array analysis. The ability of Bet v 1-specific serum antibodies from non-allergic subjects to inhibit allergic patients IgE or IgG binding to rBet v 1 or to unfolded Bet v 1-derivatives was assessed by competition ELISAs. Furthermore, the ability of serum antibodies from allergic and non-allergic subjects to modulate Bet v 1-induced basophil activation was investigated using rat basophilic leukaemia cells expressing the human FcεRI which had been loaded with IgE from BPA patients. RESULTS IgE antibodies from BPA patients react almost exclusively with conformational epitopes whereas IgG, IgG1 and IgG4 antibodies from BPA, NBPA and NA subjects recognize mainly unfolded and sequential epitopes. IgG competition studies show that IgG specific for unfolded/sequential Bet v 1 epitopes is not inhibited by folded Bet v 1 and hence the latter seem to represent cryptic epitopes. IgG reactivity to Bet v 1 peptides did not correlate with IgG reactivity to the corresponding Mal d 1 peptides and therefore does not seem to be a result of primary sensitization to PR10 allergen-containing food. Natural Bet v 1-specific IgG antibodies inhibited IgE binding to Bet v 1 only poorly and could even enhance Bet v 1-specific basophil activation. CONCLUSION IgE and IgG antibodies from BPA patients and birch pollen-exposed non-sensitized subjects recognize different epitopes. These findings explain why natural allergen-specific IgG do not protect against allergic symptoms and suggest that allergen-specific IgE and IgG have different clonal origin.
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Affiliation(s)
- Georgii Brazhnikov
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
- Institute for Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Evgenii Smolnikov
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
- Department of Immunology, Institute of MedicineRUDN UniversityMoscowRussia
| | - Alla Litovkina
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
- Department of Immunology, Institute of MedicineRUDN UniversityMoscowRussia
| | - Tianchi Jiang
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Artem Shatilov
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
| | - Inna Tulaeva
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
- Laboratory of Immunopathology, Department of Clinical Immunology and AllergologyI.M. Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Mikhail Tulaev
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and AllergologyI.M. Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Alina Poroshina
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
| | - Yury Zhernov
- F. Erismann Institute of Public HealthI.M. Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Margarete Focke‐Tejkl
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
- Karl Landsteiner University of Health SciencesKremsAustria
| | - Milena Weber
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Oluwatoyin Akinfenwa
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Olga Elisyutina
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
- Department of Immunology, Institute of MedicineRUDN UniversityMoscowRussia
| | - Sergey Andreev
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
| | - Igor Shilovskiy
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
| | - Nadezhda Shershakova
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
| | - Valeriy Smirnov
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
| | - Elena Fedenko
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
| | | | - Evgeny Cronidovich Beltyukov
- Department of Faculty Therapy, Endocrinology, Allergology and ImmunologyUral State Medical UniversityYekaterinburgRussia
| | - Veronika Victorovna Naumova
- Department of Faculty Therapy, Endocrinology, Allergology and ImmunologyUral State Medical UniversityYekaterinburgRussia
| | - Michael Kundi
- Institute for Hygiene and Applied Immunology, Center for Public HealthMedical University of ViennaViennaAustria
| | - Musa Khaitov
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
- Pirogov Russian National Research Medical UniversityMoscowRussia
| | - Ursula Wiedermann
- Institute for Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
- National Research Center Institute of Immunology Federal Medical‐Biological Agency of RussiaMoscowRussia
- Laboratory of Immunopathology, Department of Clinical Immunology and AllergologyI.M. Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
- Karl Landsteiner University of Health SciencesKremsAustria
| | - Raffaela Campana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and ImmunologyMedical University of ViennaViennaAustria
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Ragguett RM, Cha DS, Subramaniapillai M, Carmona NE, Lee Y, Yuan D, Rong C, McIntyre RS. Air pollution, aeroallergens and suicidality: a review of the effects of air pollution and aeroallergens on suicidal behavior and an exploration of possible mechanisms. REVIEWS ON ENVIRONMENTAL HEALTH 2017; 32:343-359. [PMID: 28915125 DOI: 10.1515/reveh-2017-0011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Risk factors for suicide can be broadly categorized as sociodemographic, clinical and treatment. There is interest in environmental risk and protection factors for suicide. Emerging evidence suggests a link between environmental factors in the form of air pollution and aeroallergens in relation to suicidality. METHODS Herein, we conducted a systematic review of 15 articles which have met inclusion criteria on the aforementioned effects. RESULTS The majority of the reviewed articles reported an increased suicide risk alongside increased air pollutants or aeroallergens (i.e. pollen) increase; however, not all environmental factors were explored equally. In specific, studies that were delimited to evaluating particulate matter (PM) reported a consistent association with suicidality. We also provide a brief description of putative mechanisms (e.g. inflammation and neurotransmitter dysregulation) that may mediate the association between air pollution, aeroallergens and suicidality. CONCLUSION Available evidence suggests that exposure to harmful air quality may be associated with suicidality. There are significant public health implications which are amplified in regions and countries with greater levels of air pollution and aeroallergens. In addition, those with atopic sensitivity may represent a specific subgroup that is at risk.
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Martucci MA, Dreskin SC. Immunologic similarities between selected autoimmune diseases and peanut allergy: possible new therapeutic approaches. Curr Allergy Asthma Rep 2011; 11:334-9. [PMID: 21556881 DOI: 10.1007/s11882-011-0201-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Food allergies are an important medical problem in Westernized countries. Allergy to peanuts is a dramatic example of a food allergy that tends to be particularly severe and long-lived. This article examines food allergy-specifically peanut allergy-from the perspective that tolerance to foods is a normal state, just as tolerance to self-proteins is a normal state. From this vantage point, loss of tolerance to foods in food-allergic individuals can be viewed as parallel to the loss of tolerance to self-proteins in those with autoimmune diseases. Although our knowledge base is far from satisfactory, there are important similarities in the immunologic abnormalities that are characteristic of both peanut allergy and several autoimmune diseases. Delineation of these similarities may open the door to new therapeutic approaches for the treatment of severe food allergies.
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Affiliation(s)
- Michael A Martucci
- Department of Medicine, University of Colorado Denver School of Medicine, Campus Box B164, 12700 East 19th Avenue, Room 10002, Aurora, CO 80045, USA
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Dreskin SC, Tripputi MT, Aubrey MT, Mustafa SS, Atkins D, Leo HL, Song B, Schlichting D, Talwar H, Wang Q, Freed BM. Peanut-allergic subjects and their peanut-tolerant siblings have large differences in peanut-specific IgG that are independent of HLA class II. Clin Immunol 2010; 137:366-73. [PMID: 20850383 PMCID: PMC2976616 DOI: 10.1016/j.clim.2010.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 08/12/2010] [Accepted: 08/17/2010] [Indexed: 10/19/2022]
Abstract
We enrolled 53 peanut-allergic subjects and 64 peanut-tolerant full siblings, measured peanut-specific IgG and IgE, determined HLA class II at high resolution, and analyzed DRB1 alleles by supertypes. Peanut-specific IgG and IgE were elevated in the peanut-allergic subjects (p<0.0001) but did not stratify with HLA alleles, haplotypes, or supertypes. There were no significant differences in HLA class II between the peanut-allergic and peanut-tolerant siblings but there was an increased frequency of DRB1*0803 in both sets of siblings compared to unrelated controls (p(c)=4.5×10⁻⁹). Furthermore, we identified 14 sibling pairs in which the peanut-allergic and the peanut-tolerant siblings have identical HLA class II and again found an elevation of anti-peanut IgG in the peanut-allergic subjects (p<0.0001). In conclusion, although DRB1*0803 may identify a subset of families with increased risk of peanut allergy, differences in peanut-specific immunoglobulin production between peanut-allergic subjects and their peanut-tolerant siblings are independent of HLA class II.
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Affiliation(s)
- Stephen C Dreskin
- Division of Allergy and Clinical Immunology, Univ. of Colorado Denver, Aurora, CO 80045, USA.
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