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Golden DBK, Carter MC. Anaphylaxis: Bench to Bedside. J Allergy Clin Immunol Pract 2023; 11:2049-2050. [PMID: 37244441 DOI: 10.1016/j.jaip.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Affiliation(s)
- David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Melody C Carter
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
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2
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Bischoff SC. [Food sensitivities of the digestive tract-Part 1: Food allergies]. Internist (Berl) 2022. [PMID: 35080642 DOI: 10.1007/s00108-021-01256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
Adverse reactions to food affect approximately one third of the population. They are based on very different mechanisms and are divided into food intolerances, which manifest mainly in the gastrointestinal tract, and food allergies, which can also cause extraintestinal symptoms and have an immunological genesis. The most common food allergies in adults are pollen-associated allergies to cereals or pome and stone fruits, while allergies to peanut, milk and egg are particularly common in children. The diagnostics of food allergies are complex and therapy is primarily based on targeted elimination diets. This advanced education article focuses on food allergies with gastrointestinal symptoms.
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3
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Shamji MH, Valenta R, Jardetzky T, Verhasselt V, Durham SR, Würtzen PA, van Neerven RJ. The role of allergen-specific IgE, IgG and IgA in allergic disease. Allergy 2021; 76:3627-3641. [PMID: 33999439 PMCID: PMC8601105 DOI: 10.1111/all.14908] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 12/28/2022]
Abstract
Immunoglobulin E (IgE)‐mediated allergy is the most common hypersensitivity disease affecting more than 30% of the population. Exposure to even minute quantities of allergens can lead to the production of IgE antibodies in atopic individuals. This is termed allergic sensitization, which occurs mainly in early childhood. Allergen‐specific IgE then binds to the high (FcεRI) and low‐affinity receptors (FcεRII, also called CD23) for IgE on effector cells and antigen‐presenting cells. Subsequent and repeated allergen exposure increases allergen‐specific IgE levels and, by receptor cross‐linking, triggers immediate release of inflammatory mediators from mast cells and basophils whereas IgE‐facilitated allergen presentation perpetuates T cell–mediated allergic inflammation. Due to engagement of receptors which are highly selective for IgE, even tiny amounts of allergens can induce massive inflammation. Naturally occurring allergen‐specific IgG and IgA antibodies usually recognize different epitopes on allergens compared with IgE and do not efficiently interfere with allergen‐induced inflammation. However, IgG and IgA antibodies to these important IgE epitopes can be induced by allergen‐specific immunotherapy or by passive immunization. These will lead to competition with IgE for binding with the allergen and prevent allergic responses. Similarly, anti‐IgE treatment does the same by preventing IgE from binding to its receptor on mast cells and basophils. Here, we review the complex interplay of allergen‐specific IgE, IgG and IgA and the corresponding cell receptors in allergic diseases and its relevance for diagnosis, treatment and prevention of allergy.
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Affiliation(s)
| | - Rudolf Valenta
- Department of Pathophysiology and Allergy Research Medical University of Vienna Vienna Austria
- Laboratory of Immunopathology Department of Clinical Immunology and Allergology Sechenov First Moscow State Medical University Moscow Russia
- NRC Institute of Immunology FMBA of Russia Moscow Russia
- Karl Landsteiner University of Health Sciences Krems Austria
| | | | - Valerie Verhasselt
- School of Molecular Sciences University of Western Australia Perth WA Australia
| | | | | | - R.J. Joost van Neerven
- Wageningen University & Research Wageningen The Netherlands
- FrieslandCampina Amersfoort The Netherlands
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4
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Abstract
Mast cells and basophils are key contributors to allergies and other inflammatory diseases since they are the most prominent source of histamine as well as numerous additional inflammatory mediators which drive inflammatory responses. However, a closer understanding of their precise roles in allergies and other pathological conditions has been marred by the considerable heterogeneity that these cells display, not only between mast cells and basophils themselves but also across different tissue locations and species. While both cell types share the ability to rapidly degranulate and release histamine following high-affinity IgE receptor cross-linking, they differ markedly in their ability to either react to other stimuli, generate inflammatory eicosanoids or release immunomodulating cytokines and chemokines. Furthermore, these cells display considerable pharmacological heterogeneity which has stifled attempts to develop more effective anti-allergic therapies. Mast cell- and basophil-specific transcriptional profiling, at rest and after activation by innate and adaptive stimuli, may help to unravel the degree to which these cells differ and facilitate a clearer understanding of their biological functions and how these could be targeted by new therapies.
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Affiliation(s)
- Gilda Varricchi
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy
| | - Ulrike Raap
- Department of Dermatology and Allergology, University of Oldenburg, Oldenburg, Germany
| | - Felice Rivellese
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Gianni Marone
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy.,WAO Center of Excellence, Naples, Italy.,Institute of Experimental Endocrinology and Oncology "Gaetano Salvatore" (IEOS), National Research Council (CNR), Naples, Italy
| | - Bernhard F Gibbs
- Department of Dermatology and Allergology, University of Oldenburg, Oldenburg, Germany
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5
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Carney AS, Tan LW, Adams D, Varelias A, Ooi EH, Wormald PJ. Th2 Immunological Inflammation in Allergic Fungal Sinusitis, Nonallergic Eosinophilic Fungal Sinusitis, and Chronic Rhinosinusitis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240602000204] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Noninvasive fungal sinusitis is a heterogenous group of conditions including allergic fungal sinusitis (AFS) and nonallergic eosinophilic fungal sinusitis (NEFS). Th2-mediated cascades have been postulated to be the major inflammatory response in patients with AFS although other mechanisms also may be involved. The detailed mucosal Th2 cytological status of NEFS still has not been studied in great depth. Methods Using a meticulous patient selection algorithm over a 2-year period, infundibular mucosal tissue from patients with AFS, NEFS, chronic rhinosinusitis (CRS), and normal controls was studied (n = 59). Immunohistochemistry for mast cells, eosinophils, and immunoglobulin E (IgE) cells was performed and cell counts per unit area were measured. Results Mast cell, eosinophil, and IgE+ cell numbers were significantly raised in patients with AFS, NEFS, and CRS when compared with controls. There was no significant difference between cell numbers in patients with AFS and NEFS. Conclusion Patients with AFS exhibit a classic Th2 inflammatory response in nasal mucosal tissue with NEFS and CRS patients showing evidence of a similar Th2 cascade, including the presence of IgE+ cells.
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Affiliation(s)
- A. Simon Carney
- Department of Otolaryngology–Head and Neck Surgery, Flinders Medical Center and Flinders University, Australia
| | - Lor-Wai Tan
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
| | - Damian Adams
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
| | - Antiopi Varelias
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
| | - Eng Hooi Ooi
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
| | - Peter-John Wormald
- Department of Otolaryngology–Head and Neck Surgery, Queen Elizabeth Hospital and Adelaide University, Australia
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6
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Poddighe D, Gelardi M, Licari A, del Giudice MM, Marseglia GL. Non-allergic rhinitis in children: Epidemiological aspects, pathological features, diagnostic methodology and clinical management. World J Methodol 2016; 6:200-213. [PMID: 28074172 PMCID: PMC5183989 DOI: 10.5662/wjm.v6.i4.200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/26/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic rhinitis is a very common disease, as the prevalence in the general population resulted to be 40%. Allergic rhinitis has been considered to be the most frequent form of chronic rhinitis, as non-allergic rhinitis has been estimated to account for 25%. However, several evidences suggested that non-allergic rhinitis have been underrated, especially in children. In pediatrics, the diagnostic definition of non-allergic rhinitis has been often limited to the exclusion of an allergic sensitization. Actually, local allergic rhinitis has been often misdiagnosed as well as mixed rhinitis has not been recognized in most cases. Nasal cytology is a diagnostic procedure being suitable for routine clinical practice with children and could be a very useful tool to characterize and diagnose non-allergic rhinitis, providing important clues for epidemiological analysis and clinical management.
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7
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Caballero N, Welch KC, Carpenter PS, Mehrotra S, O'Connell TF, Foecking EM. Association between chronic acetaminophen exposure and allergic rhinitis in a rat model. Allergy Rhinol (Providence) 2015; 6:162-7. [PMID: 26686207 PMCID: PMC5391484 DOI: 10.2500/ar.2015.6.0131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Several population studies demonstrated an increased risk of allergic rhinitis in patients exposed to acetaminophen. However, no histologic studies have been conducted to assess the relationship between acetaminophen exposure and allergic rhinitis. Objective: In this study, we investigated the association between chronic acetaminophen exposure and the development of allergic rhinitis in a rat model. Methods: Ten female Sprague-Dawley rats were randomly assigned to either a control (n = 5) or an acetaminophen group (n = 5). The acetaminophen group received 200 mg/kg/day of acetaminophen suspended in yogurt via oral gavage for 120 days. The control group received only the yogurt vehicle. Allergic behavioral responses, including nose rub, eye rub, ear scratching, and neck and/or face scratching, were quantified. The rats were killed, and the noses were harvested. The portion of the nose, including the nasal septum and the inferior turbinates, was embedded in paraffin, sectioned, and stained with hematoxylin and eosin to quantify the inflammatory infiltrate. Results: The average number of allergic responses per animal was 13.2 in the acetaminophen group versus 6.2 in the control group (p = 0.032). All the rats in the acetaminophen group (100%) had mast cells infiltrating the lamina propria of the inferior turbinate, whereas mast cells were detected in only 40% of the animals in the control group. The average number of mast cells per animal in the acetaminophen group was 134 versus 21 in the control group (p = 0.048). Conclusions: Our study was the first to demonstrate a histologic association between chronic exposure to acetaminophen and rhinitis. Further research to elucidate the mechanism that underlies these findings is necessary.
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Affiliation(s)
- Nadieska Caballero
- Department of Otolaryngology - Head and Neck Surgery, Stritch School of Medicine, Pathology Department, Loyola University Medical Center, Maywood, Illinois, USA
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8
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Wong KJ, Timbrell V, Xi Y, Upham JW, Collins AM, Davies JM. IgE+ B cells are scarce, but allergen-specific B cells with a memory phenotype circulate in patients with allergic rhinitis. Allergy 2015; 70:420-8. [PMID: 25556717 DOI: 10.1111/all.12563] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND Despite the critical role of immunoglobulin E (IgE) in allergy, circulating IgE+ B cells are scarce. Here, we describe in patients with allergic rhinitis B cells with a memory phenotype responding to a prototypic aeroallergen. METHODS Fifteen allergic rhinitis patients with grass pollen allergy and 13 control subjects were examined. Blood mononuclear cells stained with carboxyfluorescein diacetate succinimidyl ester (CFSE) were cultured with Bahia grass pollen. Proliferation and phenotype were assessed by multicolour flow cytometry. RESULTS In blood of allergic rhinitis patients with high serum IgE to grass pollen, most IgE(hi) cells were CD123+ HLA-DR(-) basophils, with IgE for the major pollen allergen (Pas n 1). Both B and T cells from pollen-allergic donors showed higher proliferation to grass pollen than nonallergic donors (P = 0.002, and 0.010, respectively), whereas responses to vaccine antigens and mitogen did not differ between groups. Allergen-driven B cells that divided rapidly (CD19(mid) CD3(-) CFSE(lo) ) showed higher CD27 (P = 0.008) and lower CD19 (P = 0.004) and CD20 (P = 0.004) expression than B cells that were slow to respond to allergen (CD19(hi) CD3(-) CFSE(mid) ). Moreover, rapidly dividing allergen-driven B cells (CD19(mid) CFSE(lo) CD27(hi) ) showed higher expression of the plasmablast marker CD38 compared with B cells (CD19(hi) CFSE(mid) CD27(lo) ) that were slow to divide. CONCLUSION Patients with pollen allergy but not control donors have a population of circulating allergen-specific B cells with the phenotype and functional properties of adaptive memory B-cell responses. These cells could provide precursors for allergen-specific IgE production upon allergen re-exposure.
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Affiliation(s)
- K. J. Wong
- Lung and Allergy Research Centre; School of Medicine; The University of Queensland; Woolloongabba Qld Australia
| | - V. Timbrell
- Lung and Allergy Research Centre; School of Medicine; The University of Queensland; Woolloongabba Qld Australia
| | - Y. Xi
- Lung and Allergy Research Centre; School of Medicine; The University of Queensland; Woolloongabba Qld Australia
| | - J. W. Upham
- Lung and Allergy Research Centre; School of Medicine; The University of Queensland; Woolloongabba Qld Australia
- Department of Respiratory Medicine; Princess Alexandra Hospital; Woolloongabba Qld Australia
| | - A. M. Collins
- School of Biotechnology and Biomolecular Sciences; University of New South Wales; Kensington NSW Australia
| | - J. M. Davies
- Lung and Allergy Research Centre; School of Medicine; The University of Queensland; Woolloongabba Qld Australia
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9
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Egger C, Lupinek C, Ristl R, Lemell P, Horak F, Zieglmayer P, Spitzauer S, Valenta R, Niederberger V. Effects of nasal corticosteroids on boosts of systemic allergen-specific IgE production induced by nasal allergen exposure. PLoS One 2015; 10:e0114991. [PMID: 25705889 PMCID: PMC4338223 DOI: 10.1371/journal.pone.0114991] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 11/13/2014] [Indexed: 12/30/2022] Open
Abstract
Background Allergen exposure via the respiratory tract and in particular via the nasal mucosa boosts systemic allergen-specific IgE production. Intranasal corticosteroids (INCS) represent a first line treatment of allergic rhinitis but their effects on this boost of allergen-specific IgE production are unclear. Aim Here we aimed to determine in a double-blind, placebo-controlled study whether therapeutic doses of an INCS preparation, i.e., nasal fluticasone propionate, have effects on boosts of allergen-specific IgE following nasal allergen exposure. Methods Subjects (n = 48) suffering from grass and birch pollen allergy were treated with daily fluticasone propionate or placebo nasal spray for four weeks. After two weeks of treatment, subjects underwent nasal provocation with either birch pollen allergen Bet v 1 or grass pollen allergen Phl p 5. Bet v 1 and Phl p 5-specific IgE, IgG1–4, IgM and IgA levels were measured in serum samples obtained at the time of provocation and one, two, four, six and eight weeks thereafter. Results Nasal allergen provocation induced a median increase to 141.1% of serum IgE levels to allergens used for provocation but not to control allergens 4 weeks after provocation. There were no significant differences regarding the boosts of allergen-specific IgE between INCS- and placebo-treated subjects. Conclusion In conclusion, the application of fluticasone propionate had no significant effects on the boosts of systemic allergen-specific IgE production following nasal allergen exposure. Trial Registration http://clinicaltrials.gov/ NCT00755066
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Affiliation(s)
- Cornelia Egger
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Christian Lupinek
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Robin Ristl
- Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Patrick Lemell
- Department Vienna Challenge Chamber, Allergy Centre Vienna West, Vienna, Austria
| | - Friedrich Horak
- Department Vienna Challenge Chamber, Allergy Centre Vienna West, Vienna, Austria
| | - Petra Zieglmayer
- Department Vienna Challenge Chamber, Allergy Centre Vienna West, Vienna, Austria
| | - Susanne Spitzauer
- Department of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Verena Niederberger
- Department of Otolaryngology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
- * E-mail:
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10
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Abstract
Mast cells and basophils are potent effector cells of the innate immune system, and they have both beneficial and detrimental functions for the host. They are mainly implicated in pro-inflammatory responses to allergens but can also contribute to protection against pathogens. Although both cell types were identified more than 130 years ago by Paul Ehrlich, their in vivo functions remain poorly understood. The precursor cell populations that give rise to mast cells and basophils have recently been characterized and isolated. Furthermore, new genetically modified mouse strains have been developed, which enable more specific targeting of mast cells and basophils. Such advances offer new opportunities to uncover the true in vivo activities of these cells and to revisit their previously proposed effector functions.
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11
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Eckl-Dorna J, Pree I, Reisinger J, Marth K, Chen KW, Vrtala S, Spitzauer S, Valenta R, Niederberger V. The majority of allergen-specific IgE in the blood of allergic patients does not originate from blood-derived B cells or plasma cells. Clin Exp Allergy 2012; 42:1347-55. [DOI: 10.1111/j.1365-2222.2012.04030.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- J. Eckl-Dorna
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna; Austria
| | - I. Pree
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna; Austria
| | - J. Reisinger
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna; Austria
| | | | - K.-W. Chen
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna; Austria
| | - S. Vrtala
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna; Austria
| | - S. Spitzauer
- Institute of Medical and Chemical Laboratory Diagnostics; Medical University of Vienna; Vienna; Austria
| | | | - V. Niederberger
- Department of Otorhinolaryngology; Medical University of Vienna; Vienna; Austria
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12
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Lund G, Willumsen N, Holm J, Christensen LH, Würtzen PA, Lund K. Antibody repertoire complexity and effector cell biology determined by assays for IgE-mediated basophil and T-cell activation. J Immunol Methods 2012; 383:4-20. [PMID: 22683539 DOI: 10.1016/j.jim.2012.05.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 05/23/2012] [Accepted: 05/29/2012] [Indexed: 11/23/2022]
Abstract
Effector cell activation and T-cell activation, the latter mediated by facilitated antigen presentation, are immunological mechanisms that play crucial roles in the manifestation and maintenance of allergic disease. In addition to their relevance for the pathogenesis of allergy in-vivo, in-vitro assays based on these immunological mechanisms have been established and used for diagnostics, for monitoring the progression of disease and for the effect of specific immunotherapy as well as for basic research purposes. Here we review different parameters that affect effector cell activation and facilitated antigen uptake and presentation, including assay designs, readout parameters and critical experimental conditions. Central to the two immunological mechanisms is complex formation between allergen-specific IgE, allergen, and cell surface-anchored immunoglobulin receptor; the high affinity IgE-receptor FcεRI on basophils and mast cells, and the low affinity IgE-receptor FcεRII (CD23) on B-cells. Accordingly, the effect of IgE repertoire complexity and allergen diversity on effector cell and facilitated antigen presentation is discussed in detail.
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13
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Abstract
There has been much controversy surrounding the importance of basophils in allergy. These cells are, after all, comparatively rare and yet they display remarkable potential to contribute to the symptoms of allergic inflammation. Furthermore, by virtue of their ability to rapidly elaborate T helper type 2 (Th2)-type cytokines, they are well endowed to support ongoing allergic immunity. Despite this, basophils have often been regarded as redundant in this function as in murine models of allergy, their more numerous tissue-fixed mast cell counterparts also display Th2-type cytokine-releasing potential, which is rather different in most human mast cells. Surprisingly, it is from murine models that the basophil has re-surfaced as a key orchestrator of Th2-type immunity and chronic allergic inflammation, a property that has long been hypothesized by researchers into human basophil function but never demonstrated. Moreover, murine experimental models also highlighted the ability of basophils to take up and present antigens in an MHC-dependent manner. Controversy regarding basophils, however, has remained as recent methods for depleting these cells in murine models of allergy and parasitic infection have yielded conflicting results, where the role for this cell oscillates from essential antigen-presenting cells to mere supporting functions in controlling Th2 responses. This review highlights the recent advances in understanding the role of this rather enigmatic cell in allergy.
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Affiliation(s)
- F H Falcone
- School of Pharmacy, Division of Molecular and Cellular Science, University of Nottingham, Nottingham, UK
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14
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Forester JP, Calabria CW. Local production of IgE in the respiratory mucosa and the concept of entopy: does allergy exist in nonallergic rhinitis? Ann Allergy Asthma Immunol 2010; 105:249-55; quiz 256-8. [PMID: 20934624 DOI: 10.1016/j.anai.2010.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 01/28/2010] [Accepted: 02/01/2010] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To review research regarding locally produced IgE and its impact on patients with chronic rhinitis. DATA SOURCES PubMed search with the following keywords: entopy, local IgE, nonallergic rhinitis, idiopathic rhinitis, vasomotor rhinitis, and allergic rhinitis. STUDY SELECTION Articles were selected based on their relevance to entopy and locally produced IgE and its clinical effect and relationship to idiopathic rhinitis (IR). RESULTS Local IgE has been found in a variety of tissues, including nasal and bronchial mucosa. IgE is produced in these local tissues and not simply the product of migration to the tissue from regional lymphoid tissue or blood. Local IgE has been identified in most of both atopic and nonatopic asthmatic patients and allergic rhinitis patients. Up to 40% of patients with IR and a positive nasal provocation test result have evidence of locally produced IgE, which has been coined entopy. Although patients with allergic rhinitis and IR show similar inflammatory patterns with increased activated mast cells, eosinophils, and T-cell subsets in some studies, other studies on IR patients are conflicting with regard to both inflammation and allergen-specific nasal provocation test results. CONCLUSION The concept of local allergy in IR patients is both intriguing and controversial. Studies have reported conflicting results, and currently there is no single best test to evaluate for entopy. It is known that there are a large number of IR patients for whom current treatment regimens are suboptimal. Therefore, further research elucidating the mechanisms of IR and the concept of localized IgE are needed to optimally diagnose this condition and treat this group of patients.
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Affiliation(s)
- Joseph P Forester
- Department of Allergy and Immunology, Wilford Hall Medical Center, Lackland AFB, Texas 78236, USA.
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15
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Chen JB, Wu PC, Hung AFH, Chu CY, Tsai TF, Yu HM, Chang HY, Chang TW. Unique epitopes on C epsilon mX in IgE-B cell receptors are potentially applicable for targeting IgE-committed B cells. J Immunol 2010; 184:1748-56. [PMID: 20083663 DOI: 10.4049/jimmunol.0902437] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Membrane-bound IgE (mIgE) is part of the IgE-BCR and is essential for generating isotype-specific IgE responses. On mIgE(+) B cells, the membrane-bound epsilon-chain (mepsilon) exists predominantly in the long isoform, mepsilon(L), containing an extra 52 aa CepsilonmX domain between CH4 and the C-terminal membrane-anchoring segment; the short isoform of mepsilon, mepsilon(S), exists in minor proportions. CepsilonmX thus provides an attractive site for immunologic targeting of mIgE(+) B cells. In this study, we show that nine newly prepared CepsilonmX-specific mAbs, as well as the previously reported a20, bound to mIgE.Fc(L)-expressing CHO cells, while only 4B12 and 26H2 bound to mIgE.Fc(L)-expressing B cell line Ramos cells. The mAb 4B12 bound to the N-terminal part, 26H2 the middle part, and all others the C-terminal part of CepsilonmX. Expression of Igalpha and Igbeta on the mIgE.Fc(L)-CHO cells reduces the binding of a20 to CepsilonmX as compared with that of 4B12 and 26H2. The chimeric mAbs c4B12 and c26H2, when cross-linked by secondary antibodies, lysed mIgE.Fc(L)-Ramos cells by apoptosis through a BCR-dependent caspase pathway. Using PBMCs as the source of effector cells, c4B12 and c26H2 demonstrated Ab-dependent cellular cytotoxicity toward mIgE.Fc(L)-Ramos cells in a dose-dependent fashion. In cultures of PBMCs from atopic dermatitis patients, c4B12 and c26H2 inhibited the synthesis of IgE driven by anti-CD40 and IL-4. These results suggest that 4B12 and 26H2 and an immunogen using the peptide segments recognized by these mAbs are potentially useful for targeting mIgE(+) B cells to control IgE production.
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Affiliation(s)
- Jiun-Bo Chen
- Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
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16
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Jeppsson MC, Lindh CH, Kristiansson MH, Nielsen J, Jönsson BAG. Methylhexahydrophthalic anhydride adducted albumin tryptic peptides in nasal lavage fluid. Inhal Toxicol 2009; 21:1013-20. [PMID: 19772480 DOI: 10.1080/08958370802715997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Methylhexahydrophthalic anhydride (MHHPA) is a reactive, low molecular weight chemical used in products such as plastics, paints, and electronic components. Exposure to MHHPA may lead to work-related airway diseases such as rhinitis, conjunctivitis, and asthma. Twelve subjects employed at a plant manufacturing electrical capacitors using MHHPA were included in this study. Nasal lavages were collected from subjects before work Monday morning and after work Tuesday afternoon. The levels of MHHPA adducted to serum albumin were analyzed with a straightforward work-up method. The samples were trypsinated before being analyzed with a liquid chromatography-triple quadrupole mass spectrometer. The mass spectrometer was run using selected reaction monitoring for six adducted peptides. Also, some biomarkers of effect (albumin, total protein, eosinophil cationic protein, and tryptase) were analyzed in nasal lavages. Furthermore, the metabolite MHHP acid in urine after work on Tuesday was analyzed by gas chromatography-mass spectrometry. Symptoms from the airways and the eyes and sensitization were registered. The main result of this study is that protein adducts can be analyzed in vivo after low occupational exposures to MHHPA. The results also show a correlation between adducted peptides and albumin in nasal lavage. Furthermore, there may be a difference in the potential to induce hyperresponsiveness between adducts bound to different amino acids.
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Affiliation(s)
- Marina C Jeppsson
- Department of Occupational and Environmental Medicine, Institute of Laboratory Medicine, University Hospital, Lund, Sweden.
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Gibbs BF, Streatfield C, Falcone FH. Basophils as critical orchestrators of Th2-type immune responses. Expert Rev Clin Immunol 2009; 5:725-734. [DOI: 10.1586/eci.09.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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18
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Lupinek C, Roux KH, Laffer S, Rauter I, Reginald K, Kneidinger M, Blatt K, Ball T, Pree I, Jahn-Schmid B, Allam JP, Novak N, Drescher A, Kricek F, Valent P, Englund H, Valenta R. Trimolecular Complex Formation of IgE, FcεRI, and a Recombinant Nonanaphylactic Single-Chain Antibody Fragment with High Affinity for IgE. J Immunol 2009; 182:4817-29. [DOI: 10.4049/jimmunol.0800726] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Wolfram C, Rasche C, Audring H, Wahls M, Worm M. Isolation and phenotypic characterization of mucosal nasal lymphocytes by direct ex vivo analysis. Eur Arch Otorhinolaryngol 2008; 266:677-83. [PMID: 18766360 DOI: 10.1007/s00405-008-0795-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 08/11/2008] [Indexed: 11/30/2022]
Abstract
Cellular inflammation of the nasal mucosa demonstrates a local immune response which plays an important role in allergic rhinitis. The aim of the present study was to characterize nasal mucosal lymphocytes regarding their activation and differentiation state by direct ex vivo flowcytometric analysis. Lymphocytes from the inferior turbinates were isolated by a mechanical method of preparation and, for comparison, from peripheral blood by Ficoll gradient centrifugation. Patients suffering from rhinitis or difficulty in nasal breathing were divided into an allergic (pollen-allergy, n = 13) and non-allergic group (n = 24). Expression of different T- and B-cell markers was determined by flowcytometric analysis. CD4+ T-cells from the nasal mucosa exhibited a memory phenotype (CD45RO+, 97%), were highly activated (CD69+, 43-73%), and showed low expression of the cutaneous lymphocyte antigen (CLA+, 5%). Nasal CD20+ B-lymphocytes expressed significantly higher levels of mIgE and lower levels of CD23 and CD80 than peripheral B-cells. Subsets of CD80+ (4%) and CD86+ (6%) CD20+ B-lymphocytes were identified in the nasal mucosa. No significant differences between allergic and non-allergic individuals were determined. As expected, the data show profound phenotypical differences between circulating peripheral blood and nasal mucosal lymphocytes. Activated memory lymphocytes are present in the nasal mucosa from allergic, but also non-allergic patients and may indicate to a significant role of a local inflammatory state without systemic criteria for allergy. In our study, we show that direct ex vivo isolation of lymphocytes is practicable method and offers a new technique to examine the local nasal allergic immune response using a multiparametric phenotypical analysis.
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Affiliation(s)
- Christin Wolfram
- Department of Dermatology and Allergy, Allergy-Center-Charité, Medical University Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
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Affiliation(s)
- María Verónica Baroni
- a Departamento de Bioquímica Clínica, Centro de Investigaciones en Bioquímica Clínica (CIBICI)-CONICET, Facultad de Ciencias Químicas , Universidad Nacional de Córdoba , Córdoba, Argentina
| | - Jorge S. Alvarez
- b Servicio de Alergia e Inmunología, Instituto Oulton de Diagnóstico y Tratamiento , Córdoba, Argentina
| | - Daniel Alberto Wunderlin
- a Departamento de Bioquímica Clínica, Centro de Investigaciones en Bioquímica Clínica (CIBICI)-CONICET, Facultad de Ciencias Químicas , Universidad Nacional de Córdoba , Córdoba, Argentina
| | - Gustavo Alberto Chiabrando
- a Departamento de Bioquímica Clínica, Centro de Investigaciones en Bioquímica Clínica (CIBICI)-CONICET, Facultad de Ciencias Químicas , Universidad Nacional de Córdoba , Córdoba, Argentina
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Bousquet J, Fokkens W, Burney P, Durham SR, Bachert C, Akdis CA, Canonica GW, Dahlen SE, Zuberbier T, Bieber T, Bonini S, Bousquet PJ, Brozek JL, Cardell LO, Crameri R, Custovic A, Demoly P, van Wijk RG, Gjomarkaj M, Holland C, Howarth P, Humbert M, Johnston SL, Kauffmann F, Kowalski ML, Lambrecht B, Lehmann S, Leynaert B, Lodrup-Carlsen K, Mullol J, Niggemann B, Nizankowska-Mogilnicka E, Papadopoulos N, Passalacqua G, Schünemann HJ, Simon HU, Todo-Bom A, Toskala E, Valenta R, Wickman M, Zock JP. Important research questions in allergy and related diseases: nonallergic rhinitis: a GA2LEN paper. Allergy 2008; 63:842-53. [PMID: 18588549 DOI: 10.1111/j.1398-9995.2008.01715.x] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Nonallergic rhinitis (NAR) can be defined as a chronic nasal inflammation which is not caused by systemic IgE-dependent mechanisms. It is common and probably affects far more than 200 million people worldwide. Both children and adults are affected. However, its exact prevalence is unknown and its phenotypes need to be evaluated using appropriate methods to better understand its pathophysiology, diagnosis and management. It is important to differentiate between infectious rhinitis, allergic/NAR and chronic rhinosinusitis, as management differs for each of these cases. Characterization of the phenotype, mechanisms and management of NAR represents one of the major unmet needs in allergic and nonallergic diseases. Studies on children and adults are required in order to appreciate the prevalence, phenotype, severity and co-morbidities of NAR. These studies should compare allergic and NAR and consider different age group populations including elderly subjects. Mechanistic studies should be carried out to better understand the disease(s) and risk factors and to guide towards an improved diagnosis and therapy. These studies need to take the heterogeneity of NAR into account. It is likely that neuronal mechanisms, T cells, innate immunity and possibly auto-immune responses all play a role in NAR and may also contribute to the symptoms of allergic rhinitis.
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Affiliation(s)
- J Bousquet
- University Hospital and INSERM, Montpellier, France
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Luengo O, Mollá R, Gámez C, Cardona V, López E, Sastre B, Waisel Y, Belmonte J, Cadahia Á, Lahoz C, del Pozo V. Allergenicity and cross-reactivity of Senecio pollen: identification of novel allergens using the immunoproteomics approach. Clin Exp Allergy 2008; 38:1048-60. [DOI: 10.1111/j.1365-2222.2008.02985.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Emeryk A, Bartkowiak-Emeryk M. [Nasal allergen provocation test, allergic skin tests and serum allergen-specific IgE level in asthmatic children]. Otolaryngol Pol 2007; 61:617-22. [PMID: 18260264 DOI: 10.1016/S0030-6657(07)70497-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The important element in the asthma diagnosis is a confirmation of trigger's asthma symptoms allergens. AIM The aim of this study was to evaluate diagnostic value of an allergic skin prick test and serum allergen-specific IgE level with reference to nasal allergen provocation test (NPT) results in asthmatic children. MATERIAL AND METHODS Study was performed in 80 asthmatic children in 3-14 yrs aged. 118 NPTs accompanied by assessments of nasal airflow by rhinospirography, were done. In all subjects, allergic skin prick tests with mites and grasses or trees pollen allergens and serum allergen specific IgE levels with the allergen used in NPT were done. RESULTS Concordance between SPT and TPN results was shown in 59% cases, most often in group with pollen than mites provocation. SPT's sensitivity and specificity in relation to TPN result was 71% and 53%, respectively. Concordance between asIgE level and TPN results was shown in 76% cases. asIgE results sensitivity and specificity in relation to TPN result was 71% and 82%, respectively. CONCLUSION The usefulness of skin prick test results in allergologic diagnosis of asthma is lesser than serum allergen specific IgE determination, especially in patients with house dust mites allergens hypersensitivity. Nasal provocation test (NPT) with suspected allergen should be performed in asthmatic children with a negative or doubtful skin prick test or serum allergen specific IgE level results.
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Lim A, Luderschmidt S, Weidinger A, Schnopp C, Ring J, Hein R, Ollert M, Mempel M. The IgE repertoire in PBMCs of atopic patients is characterized by individual rearrangements without variable region of the heavy immunoglobulin chain bias. J Allergy Clin Immunol 2007; 120:696-706. [PMID: 17631954 DOI: 10.1016/j.jaci.2007.05.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 05/08/2007] [Accepted: 05/17/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with atopic diseases are characterized by high levels of specific IgE production. However, little is known about the composition of their B-cell repertoires. OBJECTIVES We sought to analyze the complete PBMC-derived IgE repertoire and to compare clonal expansions between different patients. METHODS We have analyzed the IgE-bearing B-cell receptor repertoire in highly atopic patients (>1000 IU/mL) using quantitative RT-PCR, complementarity determining region 3 spectratyping, and sequence analysis. Three representative patients were additionally followed during anti-IgE therapy. RESULTS Atopic patients exhibited 100 to 1000 times more IgE-specific transcripts than control individuals. These patients used a variable region of the heavy immunoglobulin chain (VH) epsilon repertoire highly similar to their IgM and IgG repertoires, with preference of VH3b, VH4, VH3a, and VH1 segments. Each patient harbored individual clonal expansions, most probably as correlation of allergen-specific IgE production. Common expansions within the complementary determining region 3 shared by several individuals with similar sensitization patterns were found in spectratyping analysis. However, these antigen-driven expansions showed differences on the sequence level. In omalizumab-treated patients the clinical improvement was paralleled by a clear increase in the ratio of IgG/IgE transcripts. CONCLUSION The IgE repertoire in atopic patients follows the VH use patterns seen for other immunoglobulins and seems to preferentially recruit individual rearrangements rather than public expansions. CLINICAL IMPLICATIONS The detailed analysis of the IgE B-cell repertoire is highly suitable to follow changes in IgE uses during different therapy modalities.
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MESH Headings
- Adult
- Anti-Allergic Agents/therapeutic use
- Antibodies, Anti-Idiotypic
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Humanized
- Female
- Gene Rearrangement, B-Lymphocyte/drug effects
- Genes, Immunoglobulin
- Humans
- Hypersensitivity, Immediate/drug therapy
- Hypersensitivity, Immediate/genetics
- Hypersensitivity, Immediate/immunology
- Immunoglobulin E/drug effects
- Immunoglobulin E/genetics
- Immunoglobulin E/immunology
- Immunoglobulin G/blood
- Immunoglobulin Heavy Chains/drug effects
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Heavy Chains/immunology
- Immunoglobulin M/blood
- Immunoglobulin Variable Region/drug effects
- Immunoglobulin Variable Region/genetics
- Immunoglobulin Variable Region/immunology
- Leukocytes, Mononuclear/immunology
- Male
- Middle Aged
- Omalizumab
- Receptor-CD3 Complex, Antigen, T-Cell/drug effects
- Receptor-CD3 Complex, Antigen, T-Cell/genetics
- Receptor-CD3 Complex, Antigen, T-Cell/immunology
- Reverse Transcriptase Polymerase Chain Reaction
- Transcription, Genetic
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Affiliation(s)
- Annick Lim
- Unité de Recherche et d'Expertise Immunité anti-virale, Biothérapie et Vaccins, Paris, France; INSERM U668, Institut Pasteur, Paris, France
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Abstract
CONCLUSIONS Single and repeated episodes of acute otitis media (AOM) in 10-year-old children were associated with reported allergic disease. Further, skin prick test (SPT)-negative children with reported asthma and allergic rhinoconjunctivitis had increased risk of AOM. We suggest that optimal treatment of allergic symptoms may have an effect on AOM in school children. OBJECTIVE The objective of the study was to estimate associations between AOM, allergic diseases and SPT positivity in 10-year-old children. MATERIALS AND METHODS Population-based cross-sectional study of 3406 10-year-old children living in Oslo. Main outcome measures were questionnaire-based information on AOM and reported physician-diagnosed allergic diseases with symptoms during the last year. In addition, 2657 children were skin prick tested. Logistic regression analyses were performed to estimate associations and control for potential confounders. RESULTS One or more episodes of AOM were present in 13.8% (n=470) of the children; 9.7% (n=331) had single episodes, while 4.1% (n=139) had two or more infections. We found a statistically significant association between AOM and reported allergic diseases, strongest for AOM and asthma with odds ratio 2.7 (95% confidence interval 1.8-4.0) and 2.3 (95% confidence interval 1.3-4.3) for single and two or more episodes of AOM, respectively. The risk for AOM was increased in asthmatic SPT-negative children compared with asthmatic SPT-positive children, the odds ratios were 3.0 (1.7-5.4) and 1.5 (0.8-2.8), respectively. The same tendency was found for allergic rhinoconjunctivitis.
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Affiliation(s)
- Yngvild E Bentdal
- Department of Otorhinolaryngology, Faculty Division of Akershus University Hospital, University of Oslo, Sykehusvagen 27, 1478 Lørenskog, Norway.
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Niederberger V, Ring J, Rakoski J, Jager S, Spitzauer S, Valent P, Horak F, Kundi M, Valenta R. Antigens drive memory IgE responses in human allergy via the nasal mucosa. Int Arch Allergy Immunol 2006; 142:133-44. [PMID: 17057411 DOI: 10.1159/000096439] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Accepted: 06/20/2006] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Natural allergen contact induces an increase of IgE levels and sensitivity but the mechanisms underlying the allergen-specific memory responses are poorly understood. Furthermore, it has not been studied whether allergen exposure affects the molecular reactivity profiles in patients. The aim of this study was to analyze the influence of nasal allergen encounter on the molecular profile and magnitude of memory IgE responses and on systemic sensitivity. METHODS We investigated allergen-specific IgE, IgG subclass and IgM responses to defined allergen molecules (grass pollen: Phl p 1, Phl p 2 and Phl p 5; birch pollen: Bet v 1 and Bet v 2) in allergic patients in response to natural as well as to controlled nasal and dermal allergen exposure. Changes in systemic sensitivity were monitored by skin prick testing and by basophil histamine release experiments. RESULTS Respiratory antigen exposure boosted IgE levels to a pre-established profile of allergen molecules without inducing significant IgM responses or new IgE specificities in allergic individuals. The importance of the route of allergen contact is demonstrated by an increase of systemic IgE levels and sensitivity after nasal exposure. In vitro sensitisation of basophils with pre- and post-seasonal serum samples suggests an allergen-induced elevation of specific IgE as a cause for the increased allergen-specific sensitivity. CONCLUSION The characteristics of the allergen-driven antibody responses indicate a direct activation of an established pool of IgE memory cells with defined specificities as an underlying mechanism. Our finding that nasal allergen contact is a major factor for the boosting of memory IgE and systemic sensitivity may open new therapeutic possibilities.
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Affiliation(s)
- Verena Niederberger
- Department of Otorhinolaryngology, Center for Public Health, Medical University of Vienna, Vienna, Austria
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28
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Abstract
BACKGROUND Allergic disease has currently reached epidemic proportions, with a high percentage of individuals in the developed world exhibiting an allergic response after exposure to some common environmental factors. Although new strategies for the treatment and management of allergic diseases have decreased the mortality rate, a high percentage of affected persons still require frequent hospitalization and experience decreased quality of life. METHODS An internet-based literature search was performed for recent contributions on the underlying mechanisms provoking an allergic response and their potential for therapeutic approaches. RESULTS Novel concepts on allergic responses have emerged: allergic disease may result from an imbalance between allergen activation of regulatory T cells and effector T helper 2 cells (Th2), a process in which dendritic cells are key players. Cytokines such as interleukin (IL)-6, IL-21, IL-25, and human thymic stromal lymphopoietin (TSLP) seem to be important contributors in allergic processes. New data on IgE effector responses and on the IgE-independent mechanisms involved in allergic reactions have resolved some unanswered questions about these reactions. CONCLUSIONS These new findings on allergic diseases have important implications for diagnosis and management, with potential improvements in prevention and treatment, which could provide a cure in the future.
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Affiliation(s)
- M T Montero Vega
- Servicio de Bioquímica-Investigación, Hospital Ramón y Cajal, Madrid, Spain.
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29
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Abstract
BACKGROUND Rhinitis symptoms and IgE-sensitization often mismatch. Asymptomatic sensitization is an established risk factor for later rhinitis, whereas it is not clear whether rhinitis is a risk factor for later development of IgE-sensitization. OBJECTIVE To investigate whether nonallergic rhinitis is a risk factor for later development of IgE-sensitization in adults during an 8-year follow-up period, and whether asymptomatic sensitization is a risk factor for later development of rhinitis. METHODS In a population-based study of 15-69 years olds in 1990, 734 subjects were re-examined in 1998. On both occasions questionnaires on rhinitis symptoms were completed and serum IgE (against birch, grass, mugwort, cat, dog, and Dermatophagoides pteronyssinus) were determined (positive if >or=0.35 kUA/l). Asymptomatic sensitization: positive IgE levels without any rhinitis symptoms. Nonallergic rhinitis: rhinitis symptoms and no sensitization. RESULTS Asymptomatic sensitization to pollens, pets, or house dust mite was significantly associated with onset of rhinitis symptoms, also when changing baseline cut-off for sensitization to >or=0.1 or >or=0.7 kUA/l. The 8-year incidence of pollen-related rhinitis was 15.1% and 2.6% in subjects sensitized and nonsensitized to pollens, respectively (odds ratio 6.1, 95% CI 2.3-16.0). Persistent or intermittent nonallergic rhinitis was not significantly associated with later sensitization, yet a positive trend for development was observed in nonallergic pollen-related rhinitis. CONCLUSION Asymptomatic sensitization but not nonallergic rhinitis was a significant risk factor for later development of allergic rhinitis.
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Affiliation(s)
- U Bodtger
- Allergy Clinic 7551, Copenhagen University Hospital, Copenhagen, Denmark
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Wilcock LK, Francis JN, Durham SR. IgE-Facilitated Antigen Presentation: Role in Allergy and the Influence of Allergen Immunotherapy. Immunol Allergy Clin North Am 2006; 26:333-47, viii-ix. [PMID: 16701148 DOI: 10.1016/j.iac.2006.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
IgE-facilitated allergen presentation (FAP) is an important pathogenic mechanism in allergic disease and represents a potential therapeutic target. Allergen immunotherapy is a highly effective therapy, particularly in patients with seasonal pollinosis who fail to respond to usual pharmacotherapy. Allergen immunotherapy induces "blocking" IgG antibodies that are detectable in serum and have been shown to inhibit IgE-FAP in vitro. This review summarizes the main components involved in IgE-FAP and the potential value of a validated functional assay of serum inhibitory antibodies for IgE-FAP for monitoring the clinical response to immunotherapy.
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Affiliation(s)
- Louisa K Wilcock
- Upper Respiratory Medicine, Imperial College, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK
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Fish SC, Donaldson DD, Goldman SJ, Williams CMM, Kasaian MT. IgE generation and mast cell effector function in mice deficient in IL-4 and IL-13. J Immunol 2005; 174:7716-24. [PMID: 15944273 DOI: 10.4049/jimmunol.174.12.7716] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IL-4 and IL-13 are potent cytokines that drive production of IgE, which is critical to the development of atopic disease. In this study, we directly compared IgE generation and IgE-dependent mast cell effector function in mouse strains lacking IL-4, IL-13, IL-4 + IL-13, or their common receptor component, IL-4Ralpha. Although serum IgE was undetectable under resting conditions in most animals deficient in one or both cytokines, peritoneal mast cells from mice lacking IL-4 or IL-13 had only partial reductions in surface IgE level. In contrast, peritoneal mast cells from IL-4/13(-/-) and IL-4Ralpha(-/-) animals were severely deficient in surface IgE, and showed no detectable degranulation following treatment with anti-IgE in vitro. Surprisingly, however, intradermal challenge with high concentrations of anti-IgE Ab induced an ear-swelling response in these strains, implying some capacity for IgE-mediated effector function in tissue mast cells. Furthermore, upon specific immunization with OVA, both IL-4/IL-13(-/-) and IL-4Ralpha(-/-) mice produced detectable levels of serum IgE and Ag-specific IgG1, and generated strong ear-swelling responses to intradermal administration of anti-IgE. These findings suggest that a mechanism for IgE production exists in vivo that is independent of IL-4 or IL-13.
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Abstract
Standardized nasal provocation testing (NPT) has been shown to be a safe and very useful tool in the diagnosis of allergic and nonallergic rhinitis. However, in the United States, its use has been mostly limited to scientific investigations, and it has not yet been widely accepted as a standard diagnostic procedure in clinical practice. NPT aims to identify and quantify the clinical relevance of inhalant allergens or occupational irritants. During NPT, nasal respiratory mucosa is exposed to an airborne substance suspected to cause symptoms in the respective individual. Clinical reactions are monitored in a controlled and standardized fashion. Nasal secretions, symptoms such as itching, sneezing and, most importantly, nasal obstruction are assessed as well as ocular, bronchial, cutaneous, and systemic reactions. To achieve objective data on changes in nasal airflow and patency after the challenge, anterior rhinomanometry and acoustic rhinometry have been included in the standard protocol of NPT. By monitoring changes of nasal airflow on one hand and of nasal geometry on the other hand, these methods display nasal function in a graphic way just as speech and pure tone audiometry do for auditory function. Also, by their objective nature, these methods offer a clear and internationally comparable standard. This review outlines a protocol for NPT and discusses practical applications and clinical indications. The use of rhinomanometry and acoustic rhinometry as objective diagnostic tools is emphasized. For the diagnosis of allergic and occupational rhinitis, standardized NPT should be regarded as an international diagnostic standard.
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Affiliation(s)
- Jan Gosepath
- Department of Otolaryngology, Head and Neck Surgery, University of Mainz, School of Medicine, Mainz, Germany.
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Mothes N, Horak F, Valenta R. Transition from a Botanical to a Molecular Classification in Tree Pollen Allergy: Implications for Diagnosis and Therapy. Int Arch Allergy Immunol 2004; 135:357-73. [PMID: 15583457 DOI: 10.1159/000082332] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Tree pollens are among the most important allergen sources. Allergic cross-reactivity to pollens of trees from various plant orders has so far been classified according to botanical relationships. In this context, cross-reactivities to pollens of trees of the Fagales order (birch, alder, hazel, hornbeam, oak, chestnut), fruits and vegetables, between pollens of the Scrophulariales (olive, ash, plantain, privet, lilac) and pollens of the Coniferales (cedar, cypress, pine) are well established. The application of molecular biology methods for allergen characterization has revealed the molecular nature of many important tree pollen allergens. We review the spectrum of tree pollen allergens and propose a classification of tree pollen and related allergies based on major allergen molecules instead of botanical relationships among the allergenic sources. This molecular classification suggests the major birch pollen allergen, Bet v 1 as a marker for Fagales pollen and related plant food allergies, the major olive pollen allergen, Ole e 1, as a possible marker for Scrophulariales pollen allergy and the cedar allergens, Cry j 1 and Cry j 2, as potential markers for allergy to Coniferales pollens. We exemplify for Fagales pollen allergy and Bet v 1 that major marker allergens are diagnostic tools to determine the disease-eliciting allergen source. Information obtained by diagnostic testing with marker allergens will be important for the appropriate selection of patients for allergen-specific forms of therapy.
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Affiliation(s)
- Nadine Mothes
- Center for Physiology and Pathophysiology, Department of Pathophysiology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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Powe DG, Huskisson RS, Carney AS, Jenkins D, McEuen AR, Walls AF, Jones NS. Mucosal T-cell phenotypes in persistent atopic and nonatopic rhinitis show an association with mast cells. Allergy 2004; 59:204-12. [PMID: 14763935 DOI: 10.1046/j.1398-9995.2003.00315.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Allergic rhinitis is characterized by selective expansion of T cell subsets with a CD4+ phenotype. Recently, we identified a subpopulation of nonallergic rhinitis subjects with increased epithelial mast cell and eosinophil populations, suggestive of local mucosal allergy. Previously, T cell subsets have not been characterized in this subselection of nonallergic subjects and furthermore, their relationship to mast cell and basophil effector cells remain unidentified. OBJECTIVE To determine if a subpopulation of nonallergic subjects with idiopathic rhinitis (IR) have localized allergy confined to their nasal mucosa by comparing the T cell subsets and major histocompatibility complex (MHC) II expressing cells to persistent allergic rhinitis (PAR). Furthermore, the relationship between T cell subsets and mast cells/basophils was investigated. METHODS None of the symptomatic patients in this study were clinically allergen-challenged. Nasal turbinate mucosa was removed from patients with PAR, IR and normal controls. Morphometry was performed on immunostained sections for T cell subset populations including CD3+, CD4+, CD8+, CD25+, CD45RA+, CD45RO+, human leucocyte antigen (HLA)-DRalpha (MHC class II), mast cell tryptase and for basophils. RESULTS Subjects with persistent allergic rhinitis differed to normal controls in showing significantly increased numbers of total (CD3+), activated (CD25+) and allergen-naïve (CD45RA+) T lymphocytes in their nasal mucosa (P < 0.025). The naïve CD45RA+ memory T cells correlated to mucosal mast cells in PAR (P = 0.03). IR patients differ to allergic subjects in showing significantly reduced numbers of epithelial HLA-DRalpha+ cells (P = 0.007), but increased numbers of CD8+ lymphocytes (P = 0.02). The CD8+ T cells correlated with mucosal mast cell numbers (P = 0.02). In both rhinitis groups, basophils were present in very low numbers obviating the need for statistical analysis. CONCLUSION PAR is characterized by increased numbers of CD3+, CD25+ and CD45RA+ T lymphocytes compared with normal mucosa. Allergic and nonallergic rhinitis groups can be separated by significant differences in the number of epithelial antigen presenting cells (APCs) (HLA-DRalpha+) and sub-epithelial activated (CD25+) T cells. Moreover, IR patients do not significantly differ to their allergic counterparts with respect to total (CD3+) and naïve (CD45RA+) T cell numbers, or numbers of epithelial activated (CD25+) lymphocytes. IR subjects show significantly increased numbers of CD8+ lymphocytes compared with control mucosa and although our findings suggest that the initiating inflammatory events may differ, both rhinitis groups show a similarity in pathology involving mucosal mast cells with an association to infiltrating T cells.
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Affiliation(s)
- D G Powe
- School of Medical Molecular Science, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Abstract
It has been repeatedly demonstrated that allergic reactions are driven by the continuous flow of antigen uptake and presentation processes, which are perpetuated mainly by dendritic cells (DC). The ability of allergens to cause allergic inflammation is contingent upon the presence of an immunological milieu and microenvironment that either privileges Th2 responses or prohibits these reactions by the induction of contraregulatory anti-inflammatory activities of the immune system. In the light of recent developments it appears that DC have to manage two opposing tasks: on the one hand they can favor pro-inflammatory reactions and actively induce a T-cell response, yet on the other hand they serve an important function as 'silencers' in the immune system by sending out anti-inflammatory, tolerance inducing signals. This unique capacity of DC has opened several exciting possibilities for a role of DC in both - accelerating and slowing down allergic reactions. It is therefore a challenge to understand in which way DC subtypes located at distinct anatomic sites with frequent allergen exposure, such as the skin, the nasal mucosa, the respiratory tree or the mucosa of the intestinal tract can have an impact on mechanisms involved in tolerance induction or effective immunity.
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Affiliation(s)
- N Novak
- Department of Dermatology, University of Bonn, Germany
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Powe DG, Jagger C, Kleinjan A, Carney AS, Jenkins D, Jones NS. 'Entopy': localized mucosal allergic disease in the absence of systemic responses for atopy. Clin Exp Allergy 2003; 33:1374-9. [PMID: 14519143 DOI: 10.1046/j.1365-2222.2003.01737.x] [Citation(s) in RCA: 157] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Th2 immune response in the nasal mucosa of subjects with allergic rhinitis is mediated by allergen-specific IgE. Moreover, these subjects show positive responses for markers of systemic atopy, including allergen-specific skin sensitivity and raised serum IgE titres. In contrast, idiopathic rhinitis (IR) subjects with similar histological nasal mucosal features differ in being defined as non-allergic because they have negative atopic responses. OBJECTIVE We hypothesized that it is possible to have an allergic Th2 disease pathway localized in the nasal mucosa of 'non-allergic' rhinitis subjects despite an absence of atopic responses. METHODS The presence of house dust mite and grass pollen-specific IgE antibodies was investigated in non-atopic (n=10) and atopic (n=11) subjects with persistent rhinitis and compared to normal (n=12) control subjects. Biotin-labelled allergen was used to localize specific allergen-binding antibodies in situ in sections of nasal mucosa. RESULTS Grass pollen allergen binding was detected in the nasal mucosa of 3/10 non-atopic IR subjects but, in contrast, dust mite-specific antibodies were not detected. Specific antibodies were present in a total of 8/11 mucosal samples from the allergic group, but none was detected in normal control tissues. CONCLUSION These findings support the concept of localized nasal allergy in 'non-atopic' rhinitis subjects. We propose the term 'entopy' to define this phenomenon and believe that this concept has a wider implication for localized allergic responses in other mucosal sites.
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Affiliation(s)
- D G Powe
- Department of Clinical Laboratory Sciences, Erasmus University, Dr Molewaterplein 50, Rotterdam, The Netherlands.
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Sacco O, Sale R, Silvestri M, Serpero L, Sabatini F, Raynal ME, Biraghi M, Rossi GA. Total and allergen-specific IgE levels in serum reflect blood eosinophilia and fractional exhaled nitric oxide concentrations but not pulmonary functions in allergic asthmatic children sensitized to house dust mites. Pediatr Allergy Immunol 2003; 14:475-81. [PMID: 14675476 DOI: 10.1046/j.0905-6157.2003.00092.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although elevated levels of serum immunoglobulin E (IgE) are considered the hallmark of atopic diseases, their clinical value in evaluating subjects with allergic disorders is under debate. To evaluate possible relationships between serum IgE levels and a variety of clinical parameters, 83 mild asthmatic children [10.98-year-old (2.95)], sensitized to house dust mites (HDM) Dermatophagoides pteronyssinus (Dp) or D. farinae (Df), were enrolled. As compared with normal control reference values detected in our laboratory, children with allergic asthma had higher blood eosinophil counts (expressed both as percentage and as absolute number) and higher fractional exhaled nitric oxide (FeNO) levels but similar values in pulmonary function parameters. In the allergic asthmatic population, serum levels of total, Dp-specific or Df-specific IgE correlated positively with eosinophil counts (Rho > or = 0.30, p < 0.01, each correlation) and FeNO levels (Rho > or = 0.33, p < 0.01, each correlation) but not with pulmonary function parameters (p > 0.1, each correlation). Finally, significant correlations, although moderate, were found in the allergic asthmatic population between eosinophil counts and FeNO levels (Rho > or = 0.42, p < 0.001, each correlation). Thus, in atopic children sensitized to HDM with mild intermittent asthma, IgE levels in blood appear to reflect systemic (blood eosinophils) and organ-specific (FeNO) markers of allergic inflammation but not pulmonary volumes or the degree of airflow limitation.
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Magnusson J, Lin XP, Dahlman-Höglund A, Hanson L LA, Telemo E, Magnusson O, Bengtsson U, Ahlstedt S. Seasonal intestinal inflammation in patients with birch pollen allergy. J Allergy Clin Immunol 2003; 112:45-50. [PMID: 12847478 DOI: 10.1067/mai.2003.1604] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The pathophysiologic interactions of inflammatory reactions between the mucosa of the respiratory tract and that of the gastrointestinal tract in individuals with allergy are poorly studied, despite the fact that allergic symptoms in the airways and the gastrointestinal tract might arise in the same patient. OBJECTIVE The objective of this study was to examine the inflammatory response histologically by enumerating eosinophils, IgE+ cells, and T cells in duodenal biopsy specimens in adult patients with IgE-mediated birch pollen allergy during the birch pollen season and off-season. METHODS Nine patients with birch pollen allergy verified by skin prick test and serum IgE antibodies were investigated toward the end of the birch pollen season and again 6 months later (off-season). Duodenal biopsy specimens were obtained and studied by immunostaining for the eosinophil major basic protein (MBP), IgE, and CD3+ T cells. RESULTS Oral allergy syndrome to birch-associated foods was present in all patients as indicated by questionnaire. Duodenal increases of MBP+ eosinophils and IgE-bearing cells were found in the patients during the birch pollen season as compared with off-season. No seasonal differences in the T-cell numbers in these patients were seen. Off-season, there was no significant difference between the patients and the control subjects regarding the intestinal frequencies of MBP+ eosinophils, mucosal IgE+ cells, and T cells. CONCLUSION Birch pollen exposure triggered a local inflammation with an increase in duodenal eosinophils and IgE-carrying mast cells in patients with allergy. Our study gives evidence for the interplay between immunologically active cells in the airways and the gut.
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Affiliation(s)
- Jenny Magnusson
- Department of Respiratory Medicine and Allergy, Sahlgrenska University Hospital, Göteborg, Sweden
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Carney AS, Powe DG, Huskisson RS, Jones NS. Atypical nasal challenges in patients with idiopathic rhinitis: more evidence for the existence of allergy in the absence of atopy? Clin Exp Allergy 2002; 32:1436-40. [PMID: 12372122 DOI: 10.1046/j.1365-2745.2002.01465.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pathophysiology of idiopathic rhinitis is unknown although evidence is accumulating to suggest that many patients may have a localized form of allergic rhinitis in the absence of other atopic symptoms and markers. This study compares detailed nasal challenge results obtained from patients with idiopathic rhinitis to those of atopic and normal controls. METHODS Patients with idiopathic rhinitis (n = 23), perennial allergic rhinitis (n = 8) and normal controls (n = 8) underwent a normal saline challenge to exclude hyper-reactivity and then bilateral nasal allergen challenges. Nasal patency was assessed by anterior active rhinomanometry. RESULTS All of the patients with atopic rhinitis demonstrated positive bilateral allergen challenges. All normal control subjects had bilateral negative challenges. Two patients in the idiopathic group tested positively to saline and were excluded from further study with 62% of the remainder testing positive to allergens. Of the idiopathic patients testing positive, 85% were sensitive to house dust mite. CONCLUSION A significant proportion of patients with idiopathic rhinitis have positive nasal challenges, the vast majority to house dust mite allergen. These findings add to the weight of evidence that suggests 'localized allergy' may exist in the absence of systemic atopic markers.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology - Head and Neck Surgery, Flinder's Medical Centre, Bedford Park, Adelaide, SA, Australia.
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Riechelmann H, Mewes T, Weschta M, Gropper G. Nasal allergen provocation with Dermatophagoides pteronyssinus in patients with chronic rhinitis referred to a rhinologic surgical center. Ann Allergy Asthma Immunol 2002; 88:624-31. [PMID: 12086371 DOI: 10.1016/s1081-1206(10)61895-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Skin tests and specific immunoglobulin (Ig)E determinations identify the presence of some immune response to allergens, but frequently do not correlate to allergic disease in vivo. OBJECTIVE To compare clinical history, skin tests and specific IgE determinations with the results of nasal provocation tests (NPT) to confirm clinically relevant allergy to Dermatophagoides pteronyssinus (DP) in patients with chronic rhinitis referred to a rhinologic surgical center. METHODS Clinical data of 2,194 patients with chronic nasal disorders treated at two rhinologic referral centers between 1992 and 1998 were evaluated. Clinical allergy work-up was routinely performed corresponding to German and European guidelines providing consistent data in both centers. RESULTS Of chronic rhinitis patients, 752 of 2,194 (34%) had at least one positive skin reaction to a perennial allergen common in Central Europe. Three hundred seventy-three patients had a positive skin test to DP and were paradigmatically evaluated in detail. In 235 patients, a complete dataset including structured allergic history, skin test, specific IgE determinations, and NPT was available. Quality and severity of symptoms, clinical history, skin tests, and allergen-specific IgE-determinations were unreliable predictors of the outcome of NPT with DP. CONCLUSION In patients referred for surgical treatment of chronic rhinitis, diagnosis of perennial allergy is unreliable unless confirmed with NPT.
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Abstract
Patients in the rhinitis clinic with negative skin prick tests present a challenge. Non-allergic rhinitis consists of a variety of conditions including infection, hormonal changes, drugs and autonomic dysfunction. There is also a range of systemic disorders to be considered. The pathogeneses of many of these are less well understood than that of allergic rhinitis, diagnosis and treatment pathways are also more complex. A detailed accurate history needs to be taken followed by relevant investigations which may include allergen challenge, because skin prick and RAST-negative allergic rhinitis is now recognised. Nitric oxide levels may prove helpful: elevated levels suggest inflammation, very low levels indicate the possibility of primary ciliary dyskinesia or cystic fibrosis. Treatment is of the underlying cause when found: for those without obvious pathology a trial of combined therapy with topical corticosteroids plus antihistamine or plus anti-cholinergic may be worth while. A complex inter-relationship between allergic and infectious rhinitis is becoming apparent.
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Affiliation(s)
- J Bousquet
- Department of Allergy and Respiratory Diseases, University Hospital and INSERM, Montpellier, France
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Carney AS, Hooi D, Powe DG, Huskisson RS, Jones NS. Autoanti-IgE antibodies in patients with allergic and idiopathic rhinitis. Clin Otolaryngol Allied Sci 2001; 26:298-301. [PMID: 11559341 DOI: 10.1046/j.1365-2273.2001.00474.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The pathophysiology of idiopathic rhinitis is unknown although evidence is accumulating to suggest that, in a proportion of patients, it may be a more localized form of allergic rhinitis in the absence of other atopic symptoms and markers. Anti-IgE is thought to be a systemic marker of atopy. This study compared serum IgG autoanti-IgE levels in patients with idiopathic rhinitis, perennial allergic rhinitis and normal controls. Serum samples were obtained from 19 patients with idiopathic rhinitis, 17 patients with perennial allergic rhinitis and 10 normal non-rhinitic controls. The presence or absence of IgG1 and IgG4 anti-IgE antibodies was detected using enzyme-linked immunosorbent assays. Eighty-eight percent of the patients with perennial allergic rhinitis had raised levels of autoanti-IgE antibodies in their serum. None of the controls or patients with idiopathic rhinitis showed raised levels (P < 0.001). Although patients with idiopathic rhinitis may exhibit clinical and pathological features of allergy, they do not show raised levels of anti-IgE in their serum.
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Affiliation(s)
- A S Carney
- Department of Otolaryngology - Head and Neck Surgery, Queen's Medical Centre, Nottingham, UK.
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Abstract
We studied 209 children, referred to a multi-disciplinary 'Glue ear/Allergy' clinic at our hospital with a history of chronic or recurrent otitis media with effusion (OME), in order to determine the prevalence of atopic disease in this population. Referrals were made either from within the hospital by Ear, Nose and Throat (ENT) Surgeons and Audiological Physicians (internal), or by General Practitioners (external). Assessment of atopic status was based on medical history, physical examination, nasal smears and skin-prick testing (SPT) in all children; and on blood eosinophil counts and total immunoglobulin E (IgE) levels in a randomly selected subset. The main outcome measures were number of children with rhinitis, asthma, eczema, positive SPT, raised IgE level (> 100 IU/l), and nasal and blood eosinophilia. We found allergic rhinitis in 89%, asthma in 36%, and eczema in 24%. SPTs were positive to one or more of eight common inhalant aeroallergens in 57% of children. Blood tests in the selected subset revealed eosinophilia in 40% and a raised serum IgE in 28%. The worldwide prevalence of allergic rhinitis in children has been estimated to be 20%. The 89% prevalence found in this study is very high and there are a number of reasons which suggest that there may be a causal relationship. Whole-population studies will be required to confirm these findings, which could have important therapeutic implications for OME.
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MESH Headings
- Allergens/immunology
- Asthma/epidemiology
- Asthma/immunology
- Child
- Child, Preschool
- Chronic Disease
- Eczema/epidemiology
- Eczema/immunology
- Female
- Humans
- Hypersensitivity, Immediate/complications
- Hypersensitivity, Immediate/epidemiology
- Hypersensitivity, Immediate/immunology
- Male
- Otitis Media with Effusion/complications
- Prevalence
- Random Allocation
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/immunology
- Skin Tests
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Affiliation(s)
- R Alles
- Glue Ear Clinic, Royal National Throat, Nose and Ear Hospital, Gray's Inn Road, London, UK
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Abstract
A review of the literature indicates that there is an increase in the prevalence of self-reported symptoms suggestive of seasonal allergic rhinitis over the last 70 years. The reason for this remains unclear. Epidemiological studies which relate to the effect of pollution suggest that while pollution can exacerbate respiratory tract symptoms, there is no consistent evidence that high levels result in an increase in the prevalence of allergic rhinitis. The increased prevalence of house-dust mite, an alteration in immunity--possibly related to the number of childhood respiratory tract infections, and increased disease awareness, are all factors which may influence the reported prevalence of allergic rhinitis. At present the inconsistencies which exist in the literature mean that it is possible to 'pick' publications which support one view and ignore the rest, so that a variety of views may be held, each with apparently well referenced endorsement. The criteria defined by Bradford Hill (1965) to establish causation and not mere association between any of these factors and allergic rhinitis have, as yet, not been met (see Table V).
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Affiliation(s)
- N S Jones
- Department of Otorhinolaryngology, University Hospital, Nottingham
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Toellner KM, Luther SA, Sze DM, Choy RK, Taylor DR, MacLennan IC, Acha-Orbea H. T helper 1 (Th1) and Th2 characteristics start to develop during T cell priming and are associated with an immediate ability to induce immunoglobulin class switching. J Exp Med 1998; 187:1193-204. [PMID: 9547331 PMCID: PMC2212236 DOI: 10.1084/jem.187.8.1193] [Citation(s) in RCA: 176] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The respective production of specific immunoglobulin (Ig)G2a or IgG1 within 5 d of primary immunization with Swiss type mouse mammary tumor virus [MMTV(SW)] or haptenated protein provides a model for the development of T helper 1 (Th1) and Th2 responses. The antibody-producing cells arise from cognate T cell B cell interaction, revealed by the respective induction of Cgamma2a and Cgamma1 switch transcript production, on the third day after immunization. T cell proliferation and upregulation of mRNA for interferon gamma in response to MMTV(SW) and interleukin 4 in response to haptenated protein also starts during this day. It follows that there is minimal delay in these responses between T cell priming and the onset of cognate interaction between T and B cells leading to class switching and exponential growth. The Th1 or Th2 profile is at least partially established at the time of the first cognate T cell interaction with B cells in the T zone. The addition of killed Bordetella pertussis to the hapten-protein induces nonhapten-specific IgG2a and IgG1 plasma cells, whereas the anti-hapten response continues to be IgG1 dominated. This indicates that a Th2 response to hapten-protein can proceed in a node where there is substantial Th1 activity.
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Affiliation(s)
- K M Toellner
- Department of Immunology, University of Birmingham Medical School, Birmingham B15 2TT United Kingdom.
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