Development of immune functions related to allergic mechanisms in young children

Low vitamin D during pregnancy is associated with infantile eczema by up-regulation of PI3K/AKT/mTOR signaling pathway and affecting FOXP3 expression: A bidirectional cohort study

Vitamin D has received increasing attention because of its association with atopic disease development. Limited studies that have been done on the impact of maternal vitamin D levels during pregnancy on infantile eczema are still debatable. We wanted to discover the effect of maternal vitamin D on infantile eczema and explore whether regulatory T cells (Treg) play a role in this process. 219 pairs of mothers and children were enrolled. Maternal fasting venous blood was collected in pregnancy's second and third trimesters to determine vitamin D levels. Cord blood and placenta samples were collected during childbirth for detecting levels of genes, proteins and cytokines. Pediatricians followed up the prevalence of eczema in infants within 1 year. The reported rate of vitamin D deficiency and insufficiency was 35.6% and 28.3%. Lower maternal 25(OH)D3 levels were related to a higher risk of infantile eczema. Foxp3 gene expression is lower in cord blood of infants with eczema compared to infants without eczema. There was a positive correlation between maternal 25(OH)D3 levels and the expression of FOXP3 gene in cord blood. Compared to vitamin D sufficiency women, vitamin D deficiency women's placental FOXP3 protein expression was decreased and PI3K/AKT/mTOR protein was up-regulated. Our study demonstrates that low prenatal maternal vitamin D levels increased the risk of infantile eczema aged 0-1 year, which might be related to the downregulating of the FOXP3 gene expression in cord blood and decreased placental FOXP3 protein expression. Low placental FOXP3 protein was related with activating PI3K/AKT/mTOR signaling pathway.

Proposal for a 6-step-approach for differential diagnosis of neonatal erythroderma

The broad differential diagnosis of neonatal erythroderma often poses a diagnostic challenge. Mortality of neonatal erythroderma is high due to complications of the erythroderma itself and the occasionally severe and life-threatening underlying disease. Early correct recognition of the underlying cause leads to better treatment and prognosis. Currently, neonatal erythroderma is approached by a case by case basis. The purpose of this scoping review was to develop a diagnostic approach in neonatal erythroderma. After a systematic literature search in Embase (January 1990 - May 2020, 74 cases of neonatal erythroderma were identified, and 50+ diagnoses could be extracted. Main causes were the ichthyoses (40%) and primary immunodeficiencies (35%). Congenital erythroderma was present in 64% (47/74) of the cases, predominantly with congenital ichthyosis (11/11; 100%), Netherton syndrome (12/14, 86%), and Omenn syndrome (11/23, 48%). Time until diagnosis ranged from 102 days to 116 days for cases of non-congenital erythroderma and congenital erythroderma respectively. Among the 74 identified cases a total of 17 patients (23%) died within a mean of 158 days and were related to Omenn syndrome (35%), graft versus host disease (67%), and Netherton syndrome (18%). Disease history and physical examination are summarized in this paper. Age of onset and a collodion membrane can help to narrow the differential diagnoses. Investigations of blood, histology, hair analysis, genetic analysis and clinical imaging are summarized and discussed. A standard blood investigation is proposed and the need for skin biopsies with Lympho-Epithelial Kazal-Type related Inhibitor-staining is highlighted. Overall, this review shows that diagnostic procedures narrow the differential diagnosis in neonatal erythroderma. A 6-step flowchart for the diagnostic approach for neonatal erythroderma during the first month of life is proposed. The approach was made with the support of expert leaders from international multidisciplinary collaborations in the European Reference Network Skin-subthematic group Ichthyosis.

[Allergic rhinitis in children: from diagnosis to therapy]

Allergic rhinitis, according to modern data, affects up to a quarter of the population of developed countries. The disease affects not only the nasal mucosa, but also affects the receptors and mediators of inflammation in the bone marrow. A significant decrease in the quality of life of patients against the background of exacerbation of allergic rhinitis makes us look for new approaches to both the treatment of attacks and their prevention. Correction, including surgical, of concomitant pathology of the nasal cavity and paranasal sinuses significantly improves the quality of life of patients with allergic rhinitis. For a long time, surgical treatment of concomitant pathology of the nasal cavity in children was extremely limited due to the risk of damage to the growth zones and, as a consequence, a high probability of recurrence of deformation of the structures of the nose and paranasal sinuses. With the development of endoscopic methods of surgical treatment of the nasal cavity and paranasal sinuses, operations with minimal invasiveness and, as a consequence, safe at any age were introduced into practice. Surgical intervention on the structures of the lymphoid pharyngeal ring in children with allergic rhinitis is causing heated debate in the pediatric community to date. The article considers modern approaches to the diagnosis and treatment of allergic rhinitis in children. Topical problems of conservative and surgical treatment are discussed. Special attention is paid to the safety of various treatment regimens. The discussed practical issues of tactics of treatment of allergic rhinitis are relevant for both pediatric allergists and ENT pediatricians.

Efficacy of screening immune system function in at-risk newborns

This paper explores the introduction of a screening test to highlight impaired immune system status for newborn infants and its efficacy as a preventative clinical measure. Moreover, it is suggested that screening of the infantile immune system has the potential to highlight susceptibility to a range of infant and childhood diseases, bestowing an opportunity to introduce early intervention to reduce the incidence of these diseases. Development of the neonatal immune system is an important health issue, implicated in many childhood problems such as allergies, infection, and autoimmunity. The neonate has a limited immune system and ability to combat bacteria. Depleted levels of the tripeptide reduced glutathione (GSH) have been linked to numerous conditions and its intracellular level is acknowledged as an indicator of immune system function. Introduction of an immune system screening programme for infants is formally reviewed and assessed. Several benefits are reported in the treatment of impaired immune systems, a trial screening programme is proposed for at-risk infants to gather further evidence as to its efficacy. Infants at risk of impaired immune system function include cystic fibrosis, premature infants, and low birth weight infants. The interventions include breastfeeding, milk banks, and appropriate formula to support the immune system.

Natural killer cells in atopic and autoimmune diseases of the skin

Natural killer (NK) cells are best known for their ability to recognize and kill tumor cells and virally infected cells and for their ability to produce large amounts of some cytokines, such as IFN-gamma. Recent research has substantially expanded our view on the function of NK cells in the immune system in health and disease. In addition to the better-studied functions in cancer and autoimmunity, contributions from NK cells to allergies and various skin diseases have emerged. We briefly recount the traditional NK cell functions before focusing on their roles in atopic dermatitis, psoriasis, alopecia areata, and pemphigus vulgaris. Although this field is still developing, strong data are available that indicate NK cell involvement. In patients with allergic diseases, the production of T(H)2 cytokines by NK cells contributes to the known immune deviation. In patients with psoriasis, their pathophysiologic role seems to be especially the production of IFN-gamma. NK cell overactivation can be found in patients with alopecia areata and pemphigus vulgaris. Many details are still unclear; however, we believe that there is solid evidence that NK cells actively participate in a number of diseases that have not been traditionally linked to this type of lymphocyte.

Maternal tobacco smoking and decreased leukocytes, including dendritic cells, in neonates

Maternal smoking in pregnancy is associated with respiratory diseases in the offspring, possibly due to prenatal influences on the developing immune system. We investigated whether maternal smoking in pregnancy was associated with cord blood leukocyte numbers, including precursor dendritic cells, adjusting for concomitant factors. In a prospective healthy birth cohort study, total leukocyte counts were reduced in neonates of smoking mothers [10.7 (8.4-13.0), n=14] compared with nonexposed infants [14.7 (13.7-15.7), n=74, p=0.002] [geometric mean cells x 10(3)/microL (95% confidence interval)]. All leukocyte subsets were decreased, most prominently segmented neutrophils [4.3 (2.8-5.7) versus 6.2 (5.5-6.8), p=0.021], lymphocytes [3.8 (2.9-4.8) versus 5.0 (4.5-5.6), p=0.036], and myeloid precursor dendritic cells [12.7 cells/microL (9.1-17.8) versus 18.3 (15.8-21.2), p=0.055]. These differences persisted after adjustment for possible confounders. Predictors of myeloid precursor dendritic cell numbers in multivariable models were maternal smoking (-5.1 cells/microL, p=0.042), age (-0.5 cells/microL/y, p=0.035), and, marginally, asthma (+8.1 cells/microL, p=0.075). The decrease of all leukocytes in neonates of smoking mothers could be clinically significant and suggests a decreased cell production, increased peripheral recruitment, or retention in bone marrow. Given the importance of dendritic cells in early immune responses, their decrease might reflect an impact of maternal smoking on the developing fetal immune system.

Increased incidence of autoimmune disorders as a late complication in children with early onset dermatitis and/or milk allergy

Subjects with atopic dermatitis and autoimmune disorders share some similar immune response disorders. The aim of this study was to see whether subjects with early onset atopic dermatitis run a risk of eventually developing autoimmune diseases. The results of a questionnaire of 145 adolescents (70 f, 75 m, mean age 18.2 years, range 16-23 years) was compared with those of a group of 262 controls (112 f, 150 m, mean age 17.5 years, range 16-21 years), 164 of whom reported no atopic symptoms and were treated as a separate group for statistical analysis. As compared with the non-atopic controls, the study group subjects showed a significantly increased incidence of autoimmune disorders (9% vs. 1%), the relative risk ratio of a subject with infantile onset atopic eczema getting a gastrointestinal (GI) immune-mediated disease being 2.4 (CI(95)2.1-2.8) and of getting some other autoimmune disorder 3.1 (CI(95)2.8-9.7). The positive skin prick tests showed a negative association with the manifestation of a GI or other autoimmune disorder. The subjects with infantile dermatitis also reported recurrent abdominal pains (23% vs. 15%), and milk-induced gastrointestinal symptoms (19% vs. 10%) significantly more even as young adults than the controls. Our study showed that infantile atopy increases a predisposition to autoimmune disorders, suggesting that these two entities might have a common immunological determinant. While a high incidence of chronic GI complaints among the study subjects suggests the ongoing activity of local immune responses. However, more detailed prospective studies are needed to confirm these observations.

Redecoration of apartments promotes obstructive bronchitis in atopy risk infants--results of the LARS Study

Findings by other authors indicate that exposure to chemical emissions from indoor paint is related to asthma symptoms in adults. In their first years of life children are receptive to obstructive airway diseases. The aim of this study was to investigate the influence of redecoration of the apartment on airway symptoms in infants during the first two years of life. The Leipzig Allergy Risk Children Study (LARS) is a birth cohort study with the following inclusion criteria: double positive family atopy anamnesis, cord blood IgE > 0.9 kU/l, or low birth weight between 1500-2500 g. Within the context of LARS, 186 parents of risk children completed a questionnaire on the respiratory symptoms of their children and the redecoration of their apartment at the end of the first and second year of life. A total 22% of the children suffered from obstructive bronchitis once or more during their first year, and 11% experienced this condition during their second year of life. Redecoration of the apartment had a significant influence on the appearance of obstructive bronchitis in the first (OR 4.1 95% CI 1.4-11.9) and in the second year of life (OR 4.2 95% CI 1.4-12.9). (The OR are adjusted for cord blood-IgE > 0.9 kU/l, birth weight < or = 2500 g, male sex and double positive parental atopy anamnesis, dampness, smoking or pet in the apartment). Simultaneous contamination from redecoration activities and additional exposures such as smoking, a pet or dampness in the apartment increased the risk for obstructive bronchitis in the first year (OR 9.1; 95% CI 2.3-34.8) as well as in the second year (OR 5.1; 95% CI 1.6-15.6). Our data suggest that redecoration of the apartment is associated with the development of acute inflammations, but not with a chronic influence on the airways in atopy risk infants. At an exposure to more than one environmental factor, pronounced effects were seen.

The immunostatus of natural killer cells in people exposed to sulfur mustard

Sulfur mustard (2,2-dichloroethyl sulfide, SM) has been documented as an alkylating agent. It has been widely used as a chemical weapon during the last two decades. Despite extensive worldwide research, no effective therapy has yet been devised for the treatment of patients exposed to SM. A severe suppression of the immune system still remains as the major cause of opportunistic infections, septicemia and death in such patients. The aim of this study was to determine the possible effect of SM on natural killer (NK) cells in patients suffering from SM injuries. Patients were classified into three groups: mild, moderate and severe. Blood sample obtained from each patient was examined using flowcytometric technique. Results showed that the percentage of NK cells (CD45+/CD56+) is significantly lower in severe patients than that of the control group (P<0.05). It was also observed that the activity of NK cells (CD56+/CD25+) in severe alkylating group is noticeably higher compared with the control group (P<0.1).

Serum levels of interleukins (IL)-4, IL-5, IL-13, and interferon-gamma in acute asthma

T-cell activation and alteration of cytokine levels are involved in the pathogenesis of bronchial asthma. However, the profile of circulating T-lymphocyte subsets and related cytokines during acute asthmatic attacks is still unclear. We hypothesized that serum levels of interleukin (IL)-4, IL-5, and IL-13 would be increased, whereas IFN-y would be decreased in acute asthma. The subjects enrolled in this study included 58 acute asthmatics, 22 asymptomatic asthmatics, and 10 healthy controls. Serum levels of IL-4, IL-5, IL-13, and IFN-gamma were measured using a sandwich enzyme-linked immunosorbent assay. We correlated serum levels of IL-4, IL-5, IL-13, and IFN-gamma with initial forced expiratory volume in 1 sec (FEV1). Compared with control subjects, acute asthmatics had significantly increased levels of circulating IL-4 (p < 0.001), IL-5 (p < 0.001), and IL-13 (p < 0.001), although the differences were of borderline significance in serum IFN-gamma (p = 0.069). There were also significant differences in the circulating levels of IL-4, IL-5, and IL-13 between acute asthmatics and asymptomatic asthmatics. There was no significant association between initial FEV1 and serum levels of IL-4 or IL-13, however, among acute asthmatics, a lower initial FEV1 was associated with higher IL-5 and/or lower IFN-gamma levels. Our results suggest that serum levels of IL-4, IL-5, and IL-13 may be elevated in acute asthma, and that higher levels of IL-5 and/or lower levels of IFN-gamma are associated with severe airway obstruction.

TH2 lymphocytes from atopic patients treated with immunotherapy undergo rapid apoptosis after culture with specific allergens

BACKGROUND

In atopic patients treatment with specific immunotherapy (SIT) induced a shift in the balance of T-cell immune response away from a T(H)2-type (producing mostly IL-4) in favor of a T(H)1-type T-lymphocyte response (with the preferential production of IFN-gamma). However, the mechanisms through which SIT acts are less clear. We have recently shown that allergens may induce an activation-induced cell death process in lymphocytes from SIT-treated atopic patients.

OBJECTIVE

This study aimed to determine whether allergen-induced apoptosis can occur in a specific subset of cells.

METHODS

The study was performed in lymphocytes from normal subjects and atopic patients, some of whom were treated with SIT. Cells were cultured in the presence of gramineous pollen (Lolium perenne) allergenic extracts. Cell phenotype and intracellular cytokine expression were measured by means of fluorescent mAbs. Apoptosis was measured by using terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end-labeling. Fluorescence was analyzed in a FACScan flow cytometer, and the data were evaluated with Consort 30 software.

RESULTS

Our results showed that allergens induce apoptosis of lymphocytes in SIT-treated atopic patients. Apoptosis occurs mainly in T(H)2 lymphocytes with the IL-4+/CD4+ phenotype and subsequently increases the percentage of IFN-gamma(+) cells in the culture.

CONCLUSION

These results suggest that the shift from T(H)2 to T(H)1 induced by SIT in atopic patients may be mediated, at least in part, by the induction of an activation-induced cell death process in allergen-responder T(H)2 cells.

[Ontogeny of the immune system]

The newborn immune system differs quantitatively and functionally from adults. At birth, the immune system is partially immature, resulting in deficiency in cell-mediated cytolysis, immunoglobulin synthesis and cytokine production. The most clearly defined deficit in neonatal phagocytosis defenses is diminished neutrophil storage. T cell function is diminished, including T cell-mediated cytotoxicity and T cell help for B cell differentiation. Selective decreases in cytokine production by T cells may contribute to all of these deficits. One of the fundamental differences between adults and newborns for T cell functions resides in whether or not the patient had prior exposure to antigens. Significant immune responses to antigens can be obtained in the neonatal period. These responses are qualitatively different from those induced in adults with a predominance of TH2 pattern.

Can immunization affect the development of allergy?

A changing pattern of infections may be of importance for the increase in prevalence of asthma and other allergic diseases in developed countries during recent decades. The clear inverse relation between number of siblings and atopy observed in several studies may be related to a protective role of infections, although specific information is inconclusive. A recent study showed that positive tuberculin responses in schoolchildren correlated with a lower prevalence of atopic disorders, but other studies did not find a relation between BCG vaccination and allergic disease or sensitization. Transient production of IgE antibodies to pertussis toxin has been demonstrated after pertussis immunization; however, randomized clinical trials involving both whole cell and acellular pertussis vaccines have failed to show any enhancement of atopic manifestations in children. Epidemiologic investigations indicate that viral infections may either promote (RSV) or inhibit (hepatitis A, measles) atopy, although data are scarce. In conclusion, the evidence is limited regarding a direct role of vaccinations for development of atopic manifestations, but speaks against a major effect of some types of vaccinations. On the other hand, since some infections may offer protection in relation to allergy, vaccination could result in an increased risk.

Breast-feeding, maternal IgE, and total serum IgE in childhood

BACKGROUND

There is controversy regarding the relationship of the effect of breast-feeding on markers of allergy such as total serum IgE in childhood.

OBJECTIVE

This study, using longitudinal data, tested the hypothesis that the relation of breast-feeding to IgE in childhood differs depending on maternal total IgE level.

METHODS

Total serum IgE was assessed with the paper radioimmunosorbent test at 4 ages in nonselected children enrolled at birth into the prospective Tucson Children's Respiratory Study. Children were classified as never breast-fed, breast-fed less than 4 months, or breast-fed 4 months or longer, on the basis of physician report or questionnaires completed by parents by the time the child was 18 months old. A longitudinal random effects model was used to test for group differences and temporal trends in IgE for children classified with reference to maternal IgE (high tertile vs all others) and breast-feeding history. A total of 664 children with 1457 observations were included.

RESULTS

Among children whose mothers were in the 2 lower tertiles of IgE, breast-feeding was associated with lower total serum IgE at age 6 years (24.2 vs 44.3 IU/mL for never breast-fed children; P <.02); similar trends existed at age 11 years. In contrast, for children whose mothers were in the highest tertile of IgE, breast-feeding of 4 months or longer was associated with higher IgE levels in the child compared with those never breast-fed or breast-fed less than 4 months (97.0 vs 38.9 IU/mL; P <. 005). These cross-sectional analyses were confirmed with the longitudinal random effects model, which also showed no effect of confounders. Paternal IgE showed no similar relation with child IgE.

CONCLUSION

Breast-feeding appears to have paradoxic relations with IgE in childhood, depending on maternal IgE level. These findings may help explain the contradictory results found in other investigations of the relation of breast-feeding to allergic symptoms and markers.

Inverse social gradient of secondary immune response parameters in children

BACKGROUND

In children, the prevalence of allergy increases with increasing socioeconomic status. If frequent immune response stimulation by infections protects against development of allergic diseases, then a social gradient in infections should exist. The aim of our study was to assess the relation between social class, immune parameters, and the prevalence of respiratory infections in children.

METHODS

A cross-sectional survey examined children aged 5 to 14 years in 3 communities of Sachsen-Anhalt, Germany. Data of 1724 children were gathered by a parent-completed questionnaire and analyses of blood samples. Social class was defined by parental educational level. Immune parameters included serum immunoglobulin (Ig)G, IgA, and IgM; the C3c component of complement; and the total leukocyte count. The period prevalence of febrile colds and lifetime prevalences of physician-diagnosed bronchitis, tonsillitis, otitis media, and pneumonia were assessed from parents' reports. Adjusted odds ratios for the association between social class and belonging to the group of children with immune parameter levels in the upper 50th or 75th percentile or experiencing respiratory infections were calculated by logistic regression.

RESULTS

Social class was inversely associated with secondary immune response parameters (IgG, IgA), whereas indicators of primary immune reactions and inflammation (IgM, C3c, leukocytes) were not related to social status. While an inverse social gradient was found for the period prevalence of febrile colds, the frequency of bronchitis, tonsillitis, and otitis media decreased with decreasing social class.

CONCLUSIONS

Health inequalities exist in immune reactions and respiratory infections in children from different social classes. We hypothesize that in children from lower social classes, increased frequency of infections stimulated the secondary immune response and protected against more severe courses of respiratory infections.

Alterations of T-lymphocyte subsets, soluble IL-2 receptor, and IgE in peripheral blood of children with acute asthma attacks

BACKGROUND

T-cell activation and alteration of cytokines are involved in the pathogenesis of atopic asthma. However, the profile of circulating T-lymphocyte subsets, related cytokines, and plasma IgE during acute asthma attacks is still unclear.

OBJECTIVE

In an attempt to illustrate the dynamics of these parameters in asthma attacks, we investigated the changes of T-cell subsets, lymphocyte activation, soluble IL-2R, and IgE in peripheral blood in children during and after acute asthma attacks.

METHODS

This study was carried out in a cohort of Chinese children (n = 59) with acute asthma attacks. Immunoassays were performed when the patients had acute attacks before treatment, and the patients were reexamined in the 4 weeks after the resolution of acute attacks with therapy. Paired t tests were used for the statistical analysis of these patients to compare the data obtained during and after the acute attacks. Twenty healthy, age-matched subjects were used as normal control subjects. Nine children with long-term stable asthma were used as control subjects with stable asthma.

RESULTS

CD3+, CD4+, CD8+, and IL-2R+ (CD25+) cells; plasma soluble IL-2 receptor; and IgE were significantly higher in patients with acute attacks than in control subjects. (P <.05, P <.05, P <.001, P <.05, P <.0001, and P <.0001, respectively). Immunoelectron microscopy exhibited an increased expression of IL-2R on lymphocytes in acute attacks as compared to control subjects. The abnormalities returned to normal, with the exception of IgE, when clinical remission was achieved after treatment. Correlation analyses revealed a positive relationship between plasma IgE and soluble IL-2R in asthma attacks (r = 0.83, P =.0001). Plasma IgE and soluble IL-2R of those who were in remission positively correlated with their production in acute attacks (r = 0.58, P =.001 and r = 0.71, P =.0001, respectively).

CONCLUSION

This study suggests that (1) the percentage of CD4+, CD8+, or IL-2R+ lymphocytes in peripheral blood was significantly elevated during acute attacks and returned to normal ranges after complete remission was achieved; (2) plasma soluble IL-2R is a sensitive marker for asthma activity; and (3) atopic asthmatic children seem to have a hereditary predisposition of having higher levels of soluble IL-2R in asthma attacks, coinherited with the trait of IgE.