Is high prevalence of vitamin D deficiency evidence for asthma and allergy risks?

BACKGROUND

Studies suggest a link between vitamin D deficiency and development of asthma and allergic diseases.

AIM

To determine a) the association between vitamin D and asthma among children, b) difference in level of vitamin D in asthmatic children and control, and c) effect of vitamin D on atopy markers.

SETTING

Case-control study done, between October 2009 to July 2010, on asthmatics and controls (< 15 years) at Pediatric Allergy-Immunology Clinics and Primary Health care Clinics (PHC), Qatar. METHODS & SUBJECTS: A total of 483 cases and 483 controls matched by age, gender and ethnicity. Sociodemographic & clinical data was collected through physician diagnosis and questionnaire. Their health status was assessed by past or present clinical manifestations, family history, physical examination, BMI, and serum 25(OH) vitamin D, calcium, and phosphorus.

RESULTS

44.8% of asthmatic and 50.0% of controls were males, and 55.2% of asthmatic and 50% of controls were females. The mean age (+/- SD, in years)for asthmatic versus controls was 7.0 +/- 3.8 vs. 8.4 +/- 3.6. Vitamin D deficiency was more prevalent in asthmatics than controls. The mean value of Vitamin D in asthmatics was much lower than the normal value, and there was a significant difference found in the mean values of vitamin D between asthmatics (17.5 +/- 11.0) and the controls (20.8 +/- 10.0). Furthermore, there were statistically significant differences between asthmatic subjects and controls with respect to serum level of vitamin D (p < 0.001). Lower Vitamin D levels were associated with more allergic disease and elevated serum IgE.

CONCLUSION

Serum vitamin D levels were lower in asthmatic than control. Vitamin D deficiency was higher among children with asthma, allergic rhinitis, atopic dermatitis, acute urticaria, and food allergy. In addition, vitamin D deficiency was associated with IgE atopy markers in asthmatic children more than controls.

The impact of air pollution on hospital admission for respiratory and cardiovascular diseases in an oil and gas-rich country

OBJECTIVES

Aim of this study was to evaluate the impact of air pollution on hospital admissions for respiratory and cardiovascular diseases in an oil rich developing country, State of Qatar.

METHODS

A prospective cohort population based study was conducted at different stations of Qatar during the period (2002-2005) for recording the concentration of air pollutants daily for sulphur dioxide (SO2), nitric oxide (NO), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3) and particulate matter (PM10). Hospital admission data were collected from the inpatient discharge database of the Medical Records Department, Hamad General Hospital.

RESULTS

An average of 5.36 admissions from ischemic heart diseases was counted daily in all the population which was even higher than the respiratory diseases (3.4/day). Minimum temperature was inversely correlated with all pollutants except for O3 and SO2.

CONCLUSION

There was an association between increasing air pollutant levels and patients admitted for respiratory and cardiovascular diseases.

Anticancer oncolytic activity of respiratory syncytial virus

Oncolytic virotherapy is an emerging bio-therapeutic platform for cancer treatment, which is based on selective infection/killing of cancer cells by viruses. Herein we identify the human respiratory syncytial virus (RSV) as an oncolytic virus. Using prostate cancer models, we show dramatic enhancement of RSV infectivity in vitro in the androgen-independent, highly metastatic PC-3 human prostate cancer cells compared to the non-tumorigenic RWPE-1 human prostate cells. The oncolytic efficiency of RSV was established in vivo using human prostate tumor xenografts in nude mice. Intra-tumoral and intra-peritoneal injections of RSV led to a significant regression of prostate tumors. Furthermore, enhanced viral burden in PC-3 cells led to selective destruction of PC-3 cancer cells in vitro and in xenograft tumors in vivo due to apoptosis triggered by the down-regulation of NF-κB activity (and the resulting loss of anti-apoptotic function of NF-κB) in RSV-infected PC-3 cells. The intrinsic (mitochondrial) pathway constitutes the major apoptotic pathway; however, the death-receptor-dependent extrinsic pathway, mediated by the paracrine/autocrine action of tumor necrosis factor-α produced from infected cells, also partly contributed to apoptosis. Thus, the oncolytic property of RSV can potentially be exploited to develop targeted therapeutics for the clinical management of prostate tumors.

Role of breast feeding in primary prevention of asthma and allergic diseases in a traditional society

BACKGROUND

The fact that breastfeeding may protect against allergic diseases remains controversial, with hardly any reports from developing countries. Prolonged breastfeeding was shown to reduce the risk of allergic and respiratory diseases.

AIM

The aim of this study was to assess the relationship between breastfeeding and the development of childhood asthma and allergic diseases in Qatari children at age 0-5 years. Additionally, this study investigated the effect of prolonged breastfeeding on the allergic diseases in a developing country.

DESIGN

This is a cross sectional survey.

SETTING

Well baby clinics and Pediatric clinics in the 11 Primary Health Care Centers and Hamad General Hospital, Hamad Medical Corporation, State of Qatar.

SUBJECTS

A multistage sampling design was used and a representative sample of 1500 Qatari infants and pre-school children with age range of 0-5 years and mothers aged between 18 to 47 years were surveyed during the period from October 2006 to September 2007 in Qatar. Out of the 1500 mothers of children, 1278 mothers agreed to participate in this study with the response rate of 85.2%.

METHODS

A confidential, anonymous questionnaire was completed by the selected subjects assessing breastfeeding and allergic diseases. Questionnaires were administered to women who were attending Primary Health Centers for child immunization. Questionnaire included allergic rhinitis, wheezing, eczema, and additional questions included mode and duration of breastfeeding, tobacco smoke exposure, number of siblings, family income, level of maternal education, parental history of allergies. Univariate and multivariate statistical methods were performed for statistical analysis.

RESULTS

More than half of the infants (59.3%) were exclusively breastfed, followed by infants with partial breastfeeding (28.3%) and artificial fed (12.4%). There was a significant difference found across these three categories of infants in terms of their age groups, smoking status of father, socio-economic status and parental consanguinity. Asthma (15.6%), wheezing (12.7%), allergic rhinitis (22.6%), and eczema (19.4%) were less frequent in exclusive breast fed children, compared to infants with partial breast feeding and formula milk. Ear infection (P = 0.0001) and eczema (P = 0.007) were found significant in infants with the history of maternal atopy, while asthma (P = 0.0001) and allergic rhinitis (P = 0.015) were found significant in infants with the history of paternal atopy. The main factors associated with mode of feeding were mothers having first baby, asthmatic mother and parental history of allergic rhinitis. The risk of allergic diseases, eczema, wheeze and ear infection in particular, were lower in children with prolonged breast feeding (>6 months) than in those with short-term breast feeding duration (<6 months).

CONCLUSION

The current study indicates that exclusive breast-feeding prevents development of allergic diseases in children. The main factors associated with breastfeeding for allergic diseases were being the first baby, maternal history of asthma, and parental history of allergic rhinitis. The study findings opens a big avenue for interventional role of breastfeeding. Therefore, we recommend breastfeeding is as one possible way to reduce the risk of onset asthma and allergic diseases in developing countries.

Montelukast treatment in children with moderately severe atopic dermatitis

BACKGROUND

Moderately severe atopic dermatitis makes up nearly one-fifth of children with atopic dermatitis.

OBJECTIVE

To determine the clinical and laboratory effects of montelukast in moderately severe atopic dermatitis.

METHODS

Randomized, double-blind, placebo-controlled, crossover trial with washout period, conducted from May 2002 to February 2006. The study involved 25 patients, 2-16 years old with dermatitis. Patients received oral montelukast (9 patients, Group B) or placebo (16 patients, Group A) in phase 1, and were crossed over to placebo or montelukast, respectively, for phase 2. Patients included if > 10% of skin was involved and failed response to 2 week conventional treatment. Itching, sleep disturbance, frequency of use of oral antihistamines & topical steroids, severity scores were serially assessed. In addition, eosinophil and serum IgE were serially collected.

RESULTS

Most of patients were 6-10 years of age. Both groups had comparable gender distribution. The patients in Group B were more likely to have a history of bronchial asthma (55.6%) or allergic rhinitis (33.3%) than patients in Group A, but were less likely to have a positive history of atopy. While on montelukast, there was a reduction of mean score for itching in phase 2, for sleep disturbance in phase 2, for antihistamines in phase 1, for extent-of-disease in phase 1 and 2, and for severity score in phase 2 and blood eosinophil & IgE in phase 2.

CONCLUSION

Montelukast reduces itching, sleep disturbance, disease extent and severity, blood eosinophil count and serum IgE.

Does hospitalization for asthma and allergic diseases occur more frequently in Ramadan fasting: a population based study (2000-2004)

OBJECTIVE

Over one billion Muslims fast worldwide during the month of Ramadan. Fasting during Ramadan is a radical change in life style for the period of a lunar month. Our objective in this study was to investigate whether Ramadan fasting has any effect on the incidence of asthma and to assess whether Ramadan Fasting affected normal lung function values.

DESIGN

This is a hospital-based cohort study.

SETTING

Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.

PATIENTS

We prospectively reviewed 1590 asthmatic Muslim patients who were hospitalized with asthma over a four year period from January 2000 to December 2004. Patients were divided according to the time of presentation in relation to the month of Ramadan, one month before, during and one month after Ramadan.

METHODS

Pulmonary function tests were performed on an electronic spirometer (Compact Vitalograph, Buckingham, U.K.). Performance of the spirometric test and data collection were according to as described by the American Thoracic Society.

RESULTS

There were 1590 patients studied. Among them, 901 were males (56.7%) and 689 were females (43.3%). Their mean age was 30 years (15-60). All patients expressed clinical allergy, 454 patients (28.6%) had asthma and rhinitis, 513 patients (32.3%) had allergic rhinitis, 300 patients (18.9%) had asthma alone and 10.6% had other allergic conditions. The ventilatory capacity of lung function parameters mean did not show any statistically significant differences between a period of pre-Ramadan, during Ramadan and after Ramadan concerning FVC, FEV1, FEF(25-75) FEV1/FVC, and PEF values.

CONCLUSION

This study demonstrated that no significant difference was found in number of hospitalization and the mean spirometric values for asthma while fasting during the month of Ramadan when compared to the non-fasting months.

Pet ownership: its effect on allergy and respiratory symptoms

BACKGROUND

Studies have shown that pets are very important sensitizing agents in patients with asthma. Respiratory disorders such as asthma and allergic rhinitis are common in the State of Qatar.

OBJECTIVE

The aim of the present study was to determine whether exposure to pets and domestic animals plays a significant role in the development of asthma and allergic rhinitis among Qatari population.

DESIGN

A hospital-based prospective descriptive study conducted.

SETTING

Allergy Laboratory at the Hamad General Hospital and Hamad Medical Corporation, State of Qatar.

PATIENTS

Adult patients over 12 years of age diagnosed with bronchial asthma and/or allergic rhintis who were referred for allergy skin prick test. 1106 adult patients recruited with respiratory diseases of suspected allergic origin who attended Allergy Clinic at the Hamad General Hospital, during three years from January 2001 to April 2003. Total of 1106 whom 607 were females (54.9 %) and 499 were males (45.1%) and their mean was age 30 years (12-48).

METHODS

Skin Prick Test (SPT) was performed on 1106 patients for common allergens whom the blood sample was taken for measuring total IgE concentration.

RESULTS

There were 1106 patients studied and 496 patients (44.9%) had positive and 610 (55.1%) had negative skin prick tests. Out of 1106 patients, 311 patients (28.1%) had asthma; 503 patients had allergic rhinitis (45.5%) and 87 patients (7.8%) had skin allerg. Three hundred and forty (340/1106=30.7%) of the 1006 subjects studied had at least one animal at home, and the remaining 69.3% had never had pets in the home. A further 12% reported having had pets in the past, but not anymore. Cats (26.7%), goats (15%) and birds (14.7%), animals were the most common present within the house and was the most frequently seen pet types when compared to other pet types. The risk of having asthma (RR: 1.29; 95% CI: 1.07-1.55; p=0.008), allergic rhinitis (RR: 1.48; 95% CI: 1.24-1.77; p<0.0001) and eczema (RR: 3.56; 95% CI:1.24-1.77; p<0.0001) was significantly higher in subjects with animals than in patients without.

CONCLUSION

In the present study, the prevalence of asthma, rhinitis, and skin allergy was significantly more common in families with animals than in those without.

[Mite allergy in the domestic horse: experience of an equine veterinarian specializing in the field of allergy]

When medical history and clinical examination for a recurrent or chronic cough reveal the presence of perennial allergy, the practitioner would be advised to look for mites present in the horse's environment. He can propose this service to his clients.

[Recurrent or chronic urticaria in thoroughbred race-horses: clinical observations]

Recurrent or chronic urticaria seems to be a food allergy in thoroughbred race-horses during the training season. In resistant cases, allergologic techniques will be required to determine aetiology. Intradermal skin tests with fresh allergenic food may cause syndromic reaction as urticaria and akin to enteritis in some horses. In most cases, an elimination of the allergen responsible brings a rapid and long-lasting result. Study about 22 cases.

[Importance of recombinant k82 in the diagnosis of latex allergy]

Measurement of IgEs keeps a predominant place in the diagnosis of allergy and in particular in certain pathologies such as those induced by dangerous allergens like, for example, latex. The contribution of recombinant allergens is a significant element in the measurement of IgEs and we have observed this for latex. Sensitivity of recombinant k82 is significantly greater than that of k82. It permits better detection of patients who are sensitised to latex and thus a better prevention by absence of frequent contact with latex gloves and detergents.

Early cardiotoxicity of the CHOP regimen in aggressive non-Hodgkin's lymphoma

BACKGROUND

To determine the incidence of early cardiotoxicity induced by the CHOP regimen in patients with aggressive non-Hodgkin's lymphoma (NHL) and to identify associated risk factors.

PATIENTS AND METHODS

A retrospective analysis included 135 consecutive patients who had been treated with the CHOP (cyclophosphamide, doxorubicin, vincristin, prednisone) regimen as first-line therapy between 1994 and 2000. The cardiac evaluation was based on a determination of the resting left ventricular ejection function (LVEF) by gated blood-pool imaging. Cardiotoxicity was defined as a significant decrease in LVEF or clinical evidence of congestive heart failure (CHF).

RESULTS

Twenty-seven (20%) patients developed a cardiac event within 1 year of treatment. Among these, 14 patients had clinical signs of CHF. Three patients died suddenly from presumed cardiac causes. In multivariate analysis, a cumulative dose of doxorubicin >200 mg/m(2) [odds ratio (OR) = 4.2, P = 0.005)] and age over 50 years (OR = 2.9, P = 0.03) appeared to be significant risk factors.

CONCLUSION

Early clinical and subclinical cardiotoxicity was frequent in patients receiving the CHOP regimen. The threshold of the cumulative dose of doxorubicin appeared to be low: at doses >200 mg/m(2), 27% of patients had cardiac events. Elderly patients appeared to be at higher risk. The development of cardioprotective strategies or alternative treatments are mandatory for aggressive NHL patients.

[Value of quantitative IgE measurement]

The results of assay of IgE can only be expressed by a very imprecise system of classes. Quantification of the measurement of IgE by the method of the CAP-system of prognosis of allergic patients. Expression of IgE by a measurement of intensity of fluorescence allows the establishment of a decent curve for each allergen. It makes a method of predictive evaluation of risk of the allergy pathology for each allergen. It significantly improves the sensitivity, since it allows detection of IgE at levels less than 0.35 KUA/l. Thus it gives a considerable improvement for the clinician at the level of diagnosis avoiding the "gold standard" provocation test in allergy diagnosis as well at the level of prognosis.

[The place of new antihistamines in allergy management. Apropos of desloratadine]

Desloratadine, the active metabolite of loratadine, is a new antihistamine. Because of its anti allergy properties, desloratidine has an affinity for histamine receptors 25 to 100 times greater to those of the usual antihistamines, coupled with a capacity to inhibit the production of pro-inflammatory mediators. When evaluated in healthy volunteers, the half life of desloratadine has been estimated at 27 hours, which is comparable with a night time length of action. Many clinical studies made with patients suffering with allergic rhinitis or chronic idiopathic urticaria have shown a rapid symptom reduction, lasting 24 hours after first taking. This action was correlated with an improvement in socio-professional activity, sleep and quality of life in general. In patients suffering from allergic rhinitis, rhinomanometry showed a significant improvement in nasal congestion by desloratadine. The clinical advantages of desloratadine on antihistamines taken previously were measured in a study made on almost 48,000 patients, of whom 91% found its efficacity satisfactory. By its powerful action, coupled with an excellent tolerance profile, desloratadine represents a real therapeutic advance for allergic patients.

[Seafood allergy]

Products of the sea are important source of food. Increase in consumption, due to their nutritive value has also led to a great frequency of reactions, including those that are immunologically mediated. Although hypersensitivity reactions to sea products are often easy to identify and can be confirmed by specific in vitro and in vivo tests, some patients can only be diagnosed by double-blind provocation test against placebo (DBPCFC). An atypical or incomplete clinical history suggests, always, contamination with toxins and/or parasites such as Anisakis. Crossed reactivity between different sea products is frequent. However, there are clinical differences between allergy to molluscs, crustaceans and fishes. From precise evaluation of the reactions to sea produce, will result a reduced and reasoned suppression from this type of allergens at food levels.

Use of dobutamine stress echocardiography in detecting silent myocardial ischaemia in asymptomatic diabetic patients: a comparison with thallium scintigraphy and exercise testing

AIMS

Silent myocardial ischaemia is frequent in diabetic patients. The aim of this study was to compare the efficacy of thallium-201 single-photon emission computed tomography (201Tl SPECT) coupled with exercise stress testing (EST), and dobutamine stress echocardiography (DSE) in the detection of asymptomatic coronary artery disease.

METHODS

Fifty-six asymptomatic diabetic patients, with a known duration of diabetes > 15 years for Type 1 and > 5 years for Type 2, having at least three added risk factors, but without rest ECG abnormalities, were enrolled in this prospective study. All of them were submitted to DSE with a maximum infusion rate of 40 microg/kg per min dobutamine +/- i.v. atropine, and to 201Tl SPECT coupled with EST. Coronary angiography was performed if at least one test was abnormal.

RESULTS

Diabetic patients were 37 males and 19 females, aged mean (sd) 60 +/- 10 years, 10 Type 1 and 46 Type 2, with a known duration of disease of mean (sd) 17 +/- 9 years. Feasibility of DSE was 91%. No serious complication occurred during the test. Coronary angiography was performed in 26 patients (47%); 17 were abnormal (30% of the whole group): six patients had a one-vessel, six a two-vessel and five a three-vessel disease. Predictive positive value was 69% for DSE, 75% for 201Tl SPECT and 60% for EST. DSE was falsely negative in four cases vs. eight for 201Tl SPECT and nine for EST.

CONCLUSIONS

Asymptomatic coronary disease is common in diabetes associated with other risk factors. DSE appears useful in its detection and a good alternative to 201Tl SPECT.

[Biological diagnosis in allergy and immunology]

Diagnosis in allergy-immunology is based on clinical elements (History--Skin tests) and biological elements: search for IgE to allergens or for allergens that are presumed to be responsible and in the case of asthma or rhinitis on tests of respiratory function and/or rhinomanometry and/or nasofibroscopy; finally on provocation tests if necessary.

[Fatal anaphylaxis after eating wild boar meat in a patient with pork-cat syndrome]

Crossed allergy between pork and cat epithelia was described by us in 1994. It is due to serum albumin. Nowadays, other bio-chemical observations allow "completion" of the syndrome by extension of the crossed reactivity between other mammal meats and other epithelia of dog and horse. The authors report an observation of the pork-cat syndrome (developing in the form of anaphylaxis, and then ending in the death of the patient), following consumption of wild boar meat. Co-factors, such as effort, taking alcohol or hormonal condition may complicate the picture to make diagnosis more difficult.

[The developing risks of the allergic child]

6% of infants are allergic to egg. 50% of them are at risk of becoming sensitive to pneumoallergens and of whom 50% develop asthma. These evolutionary risks which are the allergy "course" of the child may be avoided by a precise interrogation which is orientated towards detection by in vitro tests of F x 5 for foods and Phadiatop for pneumoallergens. The responsible allergens may themselves be shown by skin tests, measurement of specific IgE by CAP-RAST made by UNICAP.

Diagnosis of venom allergy by flow cytometry. Correlation with clinical history, skin tests, specific IgE, histamine and leukotriene C4 release

BACKGROUND

Potent allergens such as hymenoptera venoms are capable of inducing severe and life threatening clinical reactions. Percentage of false negative results obtained by the usual diagnostical methods is comprised between 10 and 25%.

OBJECTIVE

Evaluation of the sensitivity and the specificity of cellular tests and particularly evaluation of a new flow cytometric method.

METHODS

Forty-five allergic patients having experienced a local, a systemic reaction or an anaphylactic shock and 10 controls having undergone hymenoptera stings without clinical reactions were selected on the basis of the clinical history, skin tests and specific IgE. Three cellular tests were performed on the same cell suspensions and in the presence of 2 ng/mL of rIL3: histamine release (RIA), leukotriene C4 release (ELISA) and basophil activation test (flow cytometry after double anti-IgE FITC, anti-CD63 PE labelling).

RESULTS

As compared to the clinical history, sensitivities of skin tests, specific IgE, flow cytometry, histamine release and leukotriene release were, respectively; 85%, 88%, 100%, 89% and 100%. Flow cytometric analysis of basophil activation showed a significant decrease of the mean fluorescence density and number of IgE positive cells and a significant increase of the number of CD63 positive cells. The 10 controls tested by flow cytometry were negative.

CONCLUSION

As compared to the clinical history and to the other parameters tested here, flow cytometry showed a high sensitivity and a high specificity. The excellent correlation observed between this method and the other cellular tests such as histamine and leukotriene release are in favour of the specificity of flow cytomery and in favour of the use of this method for venom allergy diagnosis.

[Importance of air purifiers in the prevention of respiratory allergy]

Prevention of respiratory allergy and thus diminution of its prevalence consists of the application not only of preventative measures on the allergens themselves, but also on atmospheric pollutants such as NO, CO and diesel particles. These modify the allergens and increase synthesis of allergen-specific IgE. Use of air purifiers, on condition that they have HEPA or ULPA filters may contribute to reduction of allergenicity linked to pollutants and are one of the not-negligible means of protection from respiratory allergy and asthma in particular.

[The wasp-mosquito syndrome: extension of cross-allergenicity to the horsefly]

The crossed allergenicity between wasp venom and mosquito extract was shown during recent work based on clinical observations and correlation studies between different biological parameters, indicating an IgE-dependent biological mechanism. A common protein was identified by Immunoblot. From observation of one of our patients involved in this work, we examined the possibility of the extension of crossed reactivity between wasp, mosquito and horsefly. In effect, our patient presented an anaphylactic reaction with neurological complications from attack on the central grey nucleus, shown by IRM; the immunological study showed a common protein between wasp venom and the total extracts of mosquito and horsefly.

Comparison of the efficacy, safety, and onset of action of mizolastine, cetirizine, and placebo in the management of seasonal allergic rhinoconjunctivitis. MIZOCET Study Group

BACKGROUND

Mizolastine is a potent and selective H1-receptor antagonist with additional anti-allergic properties.

OBJECTIVE

The aim of this European multicenter, randomized, double-blind study was to compare the efficacy of mizolastine 10 mg (n = 122), cetirizine 10 mg (n = 125), and placebo (n = 128) once daily for 28 days in patients with seasonal allergic rhinoconjunctivitis (SAR), with focus on the onset of action.

METHODS

Symptoms were evaluated by the investigator using a total symptom score (TS) and by the patient (first week). Responders (R) were patients with a TS decrease of at least 50%. Safety was assessed according to the spontaneous reporting of adverse events.

RESULTS

Both mizolastine and cetirizine were effective in relieving the symptoms of SAR. After 7 days of treatment, the improvement in TS and responder's rate were significantly (P < .05) greater in patients treated with mizolastine (TS change versus baseline, mean +/- SD: -6.40 +/- 5.71; R: 55%) and cetirizine (TS change versus baseline: -6.24 +/- 5.24; R: 53%) than with placebo (TS change versus baseline: -4.11 +/- 5.91; R: 40%). Both drugs acted rapidly, within 2 hours of the first intake. During the first 3 days, mizolastine relieved symptoms more effectively than cetirizine, the difference being significant on the second (P = .027) and third (P = .050) day. Both mizolastine and cetirizine were well tolerated.

CONCLUSION

Mizolastine 10 mg once daily is at least as effective as cetirizine in relieving symptoms of SAR, onset of action is rapid with clinical effect evident within 2 hours.

[Anaphylaxis caused by a mosquito: 2 case reports]

Allergy to mosquitoes that produces anaphylaxis is very exceptional. We present two observations of anaphylaxis to mosquitoes with good correlation between the clinical history and the immunological indications of which the basophil activation test proved to be effective. The many allergens of mosquitoes are contained in the juices and salivary glands and their molecular weights are between 22 and 95 kD. Specific immunotherapy, which uses whole body extracts of mosquito, gives good results of protection that induces excellent tolerance and has very good efficacy.

[The wasp/mosquito syndrome]

The authors describe for the first time the Wasp/Mosquito syndrome. The allergenic cross-reactivity between Vespula wasp venom and mosquito extract and the reverse rest objectively on several criteria. The frequency of the association between sensibilization to Vespula wasp venom and mosquito: In 10 subjects who had specific IgE to Vespula wasp venom 3 also had mosquito-specific IgE (30%), but out of 11 subjects with positive mosquito-specific IgE 10 also were positive with Vespula wasp venom specific IgE (about 91%). Three observations were documented showing a clinical and biological relationship between sensitisation to mosquito and wasp venom. A first patient had an anaphylactic reaction after a dozen mosquito bites. The allergy assessment confirmed sensitisation to the mosquitos, but also to Vespides (wasp, hornet) venoms. A second patient had an anaphylactic reaction after a wasp sting in 1997. From that date, he had local reactions, indeed loco-regional, to mosquito bites. The allergy assessment confirmed the double sensibilization to mosquito and wasp venom. Finally, a third patient at first had local reactions, also loco-regional, to mosquito bites, then two systemic reactions after mosquito bites. A first allergy assessment, made exclusively to hymenoptera venoms (not to mosquitos), showed a sensitivity to wasp venom and the patient, by mistake, was desensitised to wasp venom, which did not prevent recurrence after mosquito bites. After a second time, the allergy assessment for hymenoptera and mosquito, confirmed a double sensitisation (mosquito and Vespula wasp). Indirect criteria such as parallel increase in specific IgEs to Vespula wasp venom and mosquito in a patient who was desensitised only to mosquito and who had not been re-stung by wasps. Finally on direct criteria, such as: The inhibition technique by CAP RAST, which was positive in two ways: Vespula wasp--specific IgE was inhibited by mosquito extract, and vice versa. Electrophoresis, which showed a protein common to Vespula wasp venom and mosquito extract of M.W. of the order or 42KD and isoelectric point between 4.5 and 5. An immunoblot study identified this common protein with a M.W. of 44KD which is the same as hyaluronidase.

[Allergy to sunscreens]

Introduced in the 1930s, the sun filters (chemical screens) are very widely used as they are contained in photo-protective creams and in many other cosmetics. Allergy to sun filters seems to be rare in the general population (< 2%), but more frequent in populations which are suspected of photo-dermatosis (2 to 25%). It is composed of contact allergies, but also photo contact allergies in 45 to 85% of cases. Photo-biological exploration is comprised of application of photopatches and thus is necessary together with epidermotests. Crossed allergies, though rare, may be seen between filters, but also with substances that have a close chemical structure. Treatment such as prevention, if photo-protection is necessary, rest in discarding the causal filter and use of non-allergenic mineral screens.

[Chronic urticaria in sports horses]

Chronic urticaria in otherwise healthy sport horses, generally has an origin in a food allergy, accompanied by a facultative latent enteritis. Etiological diagnosis may be made by skin tests that permit a following targeted avoidance.

[Corticosteroids]

The corticosteroids or glucocorticoids have a preponderant place in the treatment of allergic manifestations. They are used to ward of the inflammatory process triggered and auto-maintained by some mediators (histamine, tryptase, leucotrienes, prostaglandin, ECP, MBP ...) that are released by some cells (mastocytes, basophils, eosinophils ...) during the contest of antigen--antigen receptor site. It is essential to understand the mechanism of action of the glucocorticoids as well as their secondary effects to adapt prescriptions better.

[Membrane stabilizers (chromones and ketotifen)]

The drugs called "Membrane stabilisers" are composed of cromones (sodium cromoglycate and nedocromil) and Ketotifen. They inhibit the degranulation of mastocytes by a membrane stabilising effect. Ketotifen is distinguished from the cromones by a conjoint antihistamine effect. Nowadays, the indications are for prophylactic treatment of allergic asthma, rhinitis and allergic conjunctivitis and the manifestations of food allergy. Therapeutic efficacy seems to be good in intermittent or mildly persistent asthma, especially in children or young subjects. Secondary effects are rare and generally benign, with reduced contra-indications.

[Anti-histamines]

The use of anti-histamines remains the therapy of choice for the ensemble of allergic pathologies with a reaginic mechanism. Knowledge of the metabolism of histamine gives an understanding of a number of allergic symptoms and also clarifies the mechanism of action of the anti-histamines. Many molecules are appearing on the market, each with a more precise action on the specific H1 receptors and also carrying other pharmacological specificities of better and better study. Observance of contra-indications, in particular cardio-vascular, allows their use without reserve, whilst knowing that there are always problems of specific tolerance, that are variable from one individual to another, specially on drowsiness. The importance of stopping anti-histamines must be remembered, every time that this is possible, before making an allergic diagnosis by skin tests.

[Apropos of the evaluation and validation of in vitro tests for measurement of specific IgE]

The performances of the reagents for IN VITRO TESTS in Allergy, are very variable, in spite of the existence of registration procedures as well as those of national quality control. Most of the discrepancies have their origin in the choice of technologies used by the manufacturers (reaction support, raw materials, calibration, vigour of the process of execution). It follows from this that the characteristics must be understood and the limitations appreciated of the tests that are used, as well as their interpretation. Of such information that is accessible in the records of the National Control of Quality of the Medicines Agency, as well as in the studies that are done with the aim of evaluating analytical and/or clinical performance of available tests (this work is a review of the performances of most of the tests sold in France today). It stands out that the best borders on very mediocre and that it is indispensable, like the planned nomenclature of the medical biological consultations, to take into consideration the technique used to obtain a result for interpretation of the latter.

[Chronic urticaria caused by cow's milk allergy: immediate or delayed allergy? (apropos of a case)]

Chronic urticaria has multiple etiologies, amongst them food allergy, which is not the most frequent. We report a clinical case of chronic urticaria due to cow milk, where paradoxically the responsibility of the food was shown by an epidermo test when the prick test was negative. Development confirmed the responsibility of cow milk. We discuss the mechanisms that relate chronic urticaria to delayed hypersensitivity.

[Level of histamine in supernatants from the basophil activation test: applications to hymenoptera allergy and drug allergy--preliminary study]

Histamine Release technic consists in calculating histamine liberated by blood cells in touch with an allergen. To this day, this method is only used in Hymenoptera venom allergy diagnosis. The principle of this study is to measure histamine released by activated basophils in surnageons of Basophil Activation Test (BAT) for different allergens: Hymenoptera venoms: Bee, White Faced Hornet, Vespula Wasp. Drugs: Cefaperos, Clamoxyl, Alfatil, Rapifen, Diprivan, Nesdonal, Mivacron. A threshold of positivity (amplification factor in comparison with the control) is determined for these two classes of allergens: 45 for Hymenoptera venoms and 9 for drugs. These results, compared to the other diagnosis technics (Histamine Release, Basophil Activation Test, Prick Tests) discloses very high correlation rates in each case. This method seems to be a reliable method for Hymenoptera venom allergy diagnosis and for drugs allergy diagnosis too. However, this study is based on a few number of patients, so a significant statistic conclusion can't be expressed but it opens an interesting way of research.

[Non-allergic rhinitis or intrinsic rhinitis? Unusual features of nickel allergy]

The clinical expression of nickel is known for its great diversity, from classical contact eczema to rhinitis, including work-related allergy, and by secondary hyperthermia to a metallic heart valve. Very often, hypersensitivity which may be of type I or type IV is secondary to contact of the hapten with sensitive cells, however some authors have reported the possibility of reactivation of lesions, especially dermatological (urticaria-eczema) by tests of oral ingestion. However, review of the literature does not mention the possibility of O.R.L. problems of the rhinitis type, from rhinosinusitis following ingestion of nickel and the two clinical cases that we report that involve one child of 11 years and one patient of 59 years, both of whom presented a serious rhinitis with a tendency to surperinfection, developing to perennial, where a patch-test to nickel was strongly positive, and who have seen an improvement in their clinical problems with a strict diet without this hapten. This confirms that the need is eventually physiopathological and suggests the necessity to search systematically for a possibility of hypersensitivity to haptens by the patch test technique in rhinitis that is labelled "non-allergic", by a negative reaginic history to pneumoallergens and trophallergens.

[Search for a threshold to distinguish between locoregional and systemic reactions using the histamine liberation value and the LTC4 level]

Allergy to Hymenoptera venom (VH) effects more and more patients in France. It is manifest in two main forms, which are Loco-regional (RLR) and Systemic reactions (SR). This allergy is detectable amongst others by the techniques of histamine release (HR) and release of leucotrienes C4 (LTC4). The aim of this work has been to fix a threshold that gives differentiation of RLR ad RS by the two techniques. We found in a positive population a threshold histamine release (HR) value of 25% and a concentration of LTC4 of 600 ng/ml. These are the thresholds above which a patient would be at around 70% risk of RS. This study has a predictive value for patients who are suspected of allergy of VH or who have already had clinical reactions and risk sensitization.

[Basophil activation test using flow cytometry in Hymenoptera venom allergy]

The basophil activation test (TAB) clearly shows evidence to Hymenoptera venoms. Comparison of the TAB value with the clinical history allows fixation of a threshold that will anticipate the type of clinical reaction by the TAB value. For the technique of TAB 3 dilutions are used. The basophil activation values produce a threshold for each dilution. For the first dilution the threshold is 50% activation: below this threshold, 70% of patients would have a local or systemic reaction and above this threshold, 70% of patients would have a systemic allergic reaction.

Analysis of anti-IgE and allergen induced human basophil activation by flow cytometry. Comparison with histamine release

OBJECTIVE AND DESIGN

On the basis of flow cytometric methods previously described for the analysis of human basophil activation, we present here a bi-color anti-IgE FITC, anti CD63 PE method and the correlation with histamine release.

MATERIALS AND SUBJECTS

Subjects allergic to grass pollen were selected by their clinical history, skin tests and specific IgE.

METHODS

Basophils gated in the lymphocyte region of the side scatter (SSC)/forward scatter (FSC) pattern were selected by their high IgE epitope density. Percentage of cells expressing CD63 marker, upregulated on activated basophil membrane, was calculated by the cytometer. Histamine released into the supernatants was measured by RIA.

RESULTS

In these conditions, flow cytometric analysis of blood leukocytes showed that the selected cells had the phenotype CD14-, CD19-, CD45+, IgE++ and CD63- or + which is related to human basophil phenotype, the isotype controls being negative. The use of an anti-CD41 FITC antibody also showed the presence of aggregated platelets on the basophil membrane, CD63 antigen being, however, expressed by basophils themselves and not by platelets. Moreover, no statistical difference was observed between histamine release and flow cytometry after passive sensitization of blood donor leukocytes.

CONCLUSION

Flow cytometry, as a popular method often used in the immunology and haematology departments of clinical laboratories may represent a new alternative for allergy diagnosis and basophil pharmacology.

[Specific immunotherapy using allergens apropos of specific immunotherapy by the sublingual route]

The present number of publications an allergen specific immunotherapy (ITa) by clinically controlled tests, double blind, is objective proof of the value of this treatment in the allergy pathologies mediated by IgE. The mechanisms of action of Ita are better understood, taking account of the intervention of TH2 and TH1 cells with the respective involvement of cytokines IL4-IL5, favouring the synthesis of IgE and interferon gamma (IFN gamma) slowing the synthesis of IgE. Adjuvants of bacterial origin influence the balance TH2/TH1 by blocking the production of TH2 cells. Ita by the sublingual route (SLIT) has been the objective of double blind clinical studies, with favourable results and good tolerance, of a number of allergens, pollens (grass, ragweed, parietaria, olive) and D. pteronyssinus mites. Application of this technique of SLIT to foods and drugs reveals more a mechanism of customisation than induction of cellular acticity, of a mucosal secretory IgA and an oral tolerance with systemic response, mechanisms that are involved in SLIT. Taking into account the restrictions of ITa, SLIT allows inclusion of other allergic patients, such as children receiving injections and subjects who are not inclined to observe and comply with treatment.... The different techniques used for classical ITa by the subcutaneous route are also useable for SLIT with a very good tolerance, apart from some transitory digestive problems. SLIT is no longer a technique of the future, but already one of the present time, currently used and which gives a renewal of value in the form of therapy that is ITa for IgE-mediated allergy pathology.

[Importance of the urinary leukotriene E4 level. Preliminary study]

Post-anesthesia anaphylactic reactions or those seen during drug provocation tests with a systemic clinical reaction may be confirmed by the sequential release into blood of plasma histamine, tryptase and leukotriene C4 and into urine of urinary methylhistamine and leukotriene E4.

[Predictive value of the allergologic profile in anesthesia and resuscitation]

The allergic history to anaesthetics in general and especially to synthetic myorelaxants, poses few etiological diagnostic problems in practice, because of on one hand the excellent collaboration between Anesthetists and Allergologists in the CHU at Angers and on the other because of the great sensitivity of skin testing. Why then have a predictive history for myorelaxants? The results of a study at the CHU at Angers on 15 patients showed sensitivity to anaesthetics in general (myorelaxants 86%, Diprivan) and/or an antibiotic, latex were very encouraging. One 15 new general anaesthetics a single minor incident was seen: the 15 patients had benefited from a predictive history.

[Allergic immunobiology and anesthesiology]

A protocol has been produced for the study of anaphylactic accidents that occur post-operatively that allows definition of the anaphylactic origin, and so reactions that are mediated by IgE in post-operative accidents. This protocol occurs in two stages, the first is done in the minutes and hours that follow the anaphylactic accident, and the second a month or 6 weeks afterwards. At first, we evaluate the sequential study of the liberation of the mediators of anaphylaxis, plasma histamine, serum tryptase, urinary methylhistamine and, more recently, leucotriene E4. The second study is devoted to reactions that are mediated by IgE, essentially, specific serum IgE, tests of activation of basophils by flow cytometry, measurement of leucotriene C4 and skin tests. A study on 16 subjects has evaluated and validated the protocol and shown a significant level of correspondence of results between the sequential measurement of mediators on one hand and on the other the search for IgE-mediated reactions every time that there was an anaphylactic reaction.

[Evaluation of the quality of 2 techniques for measuring IgE: the Pharmacia CAP System (Pharmacia & Upjohn Diagnostics) and Alastat (DPC-France)]

The reliability of results given by specific IgE dosages technology is conditioned by the quality of the technology used. Analytical comparison of two techniques (Pharmacia CAP System and Alastat-DPC) shows important behaviour differences in the evaluation of the precision/reproducibility of results and in dilution tests. The Pharmacia CAP System demonstrates qualities comparable to those awaited from any immunodiagnostic test. The Alastat techniques shows high imprecision and the dilution tests make us wonder about calibration and/or ability of the support used to fix all epitopes.

[Gelatin allergy]

Allergy to the gelatin used as a plasma filler product has not been recognised until now. Methods used have not been validated but are composed of specific serum IgE, skin tests and histamine release by leucotrienes. The clinical observation that we report has the merit of showing the reality of an allergy that is dependent on plasma filler products due to development of a protocol which includes firstly, during anaphylactic shock, measurement of the mediators of immediate hypersensitivity and secondly, after the clinical accident, test of the activation of basophils by flow cytometry (TAB) and measurement of leucotrienes.

[Testing basophil activation by flow cytometry in the diagnosis of allergy to hymenopteran venom]

Diagnosis of allergy to hymenoptera venom must be precise and depends on indisputable bio-clinical criteria, because of specific immunotherapy for indications such as systemic and/or anaphylactic reactions. Until nowadays, diagnosis was by specific IgE, histamine release and skin tests, most often done for the venoms of wasp, honey bee and hornet at the same time since, in 7-8 cases in 10 the patients had not identified the responsible insect. Basophil activation test (TAB) by Flux cytometry and measurement of leukotriene C4 (LTC4) are new techniques of great reliability. The work shows the correlations between the different immunobiological parameters by reference to TAB by CAF and measurement of LTC4. When the overall results for mixed venoms or those for single venoms are considered, the correlations between TAB, LTC4 and the other parameters are highly significant. It can now be considered objectively that TAB by CTF and measurement of LCT4 are the two highest-performing techniques for diagnosis of hymenoptera venom allergy and so validates them.

Azelastine eye drops in the treatment of seasonal allergic conjunctivitis or rhinoconjunctivitis in young children

In a randomised, multicentre study, the effect of azelastine eye drops (n = 51 patients) was compared in a double-blind manner with placebo eye drops (n = 30 patients) and in an open manner with levocabastine eye drops (n = 32 patients) during a 14-day treatment period involving 113 children (aged 4 to 12 years) suffering from seasonal allergic conjunctivitis/rhinoconjunctivitis. The primary variable was the response rate defined as the number of patients showing an improvement after three days of treatment of at least three score points, from a minimum baseline score of six, in the main ocular symptoms of itching, conjunctival redness and lacrimation (each assessed on a four-point scale). Patients discontinuing due to inefficacy were regarded as non-responders. The mean response rate in the azelastine eye drops group (74%) was significantly higher (p < 0.01) than that in the placebo group (39%) and comparable with that in the levocabastine group. The response rates assessed by the patients in their diaries were very similar. Significant differences (p < 0.01) for azelastine compared with placebo were observed on days 3 and 14 in the mean sum scores for the three main symptoms and for a total of eight eye symptoms. The overall assessment of efficacy confirmed the superiority of both active treatments compared with placebo. Adverse drug reactions were reported in 23% of placebo-, 35% of azelastine- and 38% of levocabastine-treated patients. These were mainly local irritant effects. Overall tolerability was assessed as very good or good in 80%, 84% and 91% of placebo-, azelastine- and levocabastine-treated patients, respectively. Azelastine eye drops are effective and well-tolerated in children with seasonal allergic conjunctivitis.

[Comparison of the measurements of total IGE using the CAP-RIA technique and the UNICAP-FEIA technique]

The contribution of a new method of measurement of total IgE by the Fluoro-Enzymo-Immuno-assay (FEIA) with the assistance of Pharmacia UNICAP automation is very reliable since, when compared with the measurement by the CAP SYSTEM RIA on 144 patients who were clinically allergic (84 with a raised and 60 with a normal IgE titre) the result of a comparative study between the two techniques is statistically highly significant. The two methods were also compared by age groups and these results were also statistically highly significant.

[Correlative study of the anti-gluten IgA level in celiac disease. Apropos of some observations]

This work concerns the level of anti-gluten IgA in Coeliac disease, following subjects who have already been diagnosed by clinical signs, biopsy and measurement of anti-gluten IgA. Even if this study had been limited only to a single patient, it would have shown well the clinical sensitivity to these levels, so allowing the following of the development, correlated with improvement of the clinical symptoms with lowering of the level of anti-gluten IgA.