Cambrian radiation speciation events driven by sea level and redoxcline changes on the Siberian Craton

The evolutionary processes of speciation during the Cambrian radiation and their potential extrinsic drivers, such as episodic oceanic oxygenation events, remain unconfirmed. High-resolution temporal and spatial distribution of reef-associated archaeocyath sponge species on the Siberian Craton during the early Cambrian [ca. 528 to 510 million years ago] shows that speciation was driven by increased endemism particularly ca. 521 million years (59.7% endemic species) and 514.5 million years (65.25% endemic species) ago. These mark rapid speciation events after dispersal of ancestors from the Aldan-Lena center of origin to other regions. These speciation events coincided with major sea-level lowstands, which we hypothesize were intervals when relative deepening of the shallow redoxcline permitted extensive oxygenation of shallow waters over the entire craton. This provided oxic corridors for dispersal and allowed the formation of new founder communities. Thus, shallow marine oxygen expansion driven by sea-level oscillations provides an evolutionary driver for sucessive speciation events during the Cambrian radiation.

Ediacaran metazoan reveals lophotrochozoan affinity and deepens root of Cambrian Explosion

Through exceptional preservation, we establish a phylogenetic connection between Ediacaran and Cambrian metazoans. We describe the first three-dimensional, pyritized soft tissue in Namacalathus from the Ediacaran Nama Group, Namibia, which follows the underlying form of a stalked, cup-shaped, calcitic skeleton, with six radially arranged lobes projecting into an apical opening and lateral lumens. A thick body wall and probable J-shaped gut are present within the cup, and the middle layer of the often-spinose skeleton and skeletal pores are selectively pyritized, supporting an organic-rich composition and tripartite construction with possible sensory punctae. These features suggest a total group lophotrochozoan affinity. These morphological data support molecular phylogenies and demonstrates that the origin of modern lophotrochozoan phyla, and their ability to biomineralize, had deep roots in the Ediacaran.

Regional nutrient decrease drove redox stabilisation and metazoan diversification in the late Ediacaran Nama Group, Namibia

The late Ediacaran witnessed an increase in metazoan diversity and ecological complexity, marking the inception of the Cambrian Explosion. To constrain the drivers of this diversification, we combine redox and nutrient data for two shelf transects, with an inventory of biotic diversity and distribution from the Nama Group, Namibia (~550 to ~538 Million years ago; Ma). Unstable marine redox conditions characterised all water depths in inner to outer ramp settings from ~550 to 547 Ma, when the first skeletal metazoans appeared. However, a marked deepening of the redoxcline and a reduced frequency of anoxic incursions onto the inner to mid-ramp is recorded from ~547 Ma onwards, with full ventilation of the outer ramp by ~542 Ma. Phosphorus speciation data show that, whilst anoxic ferruginous conditions were initially conducive to the drawdown of bioavailable phosphorus, they also permitted a limited degree of phosphorus recycling back to the water column. A long-term decrease in nutrient delivery from continental weathering, coupled with a possible decrease in upwelling, led to the gradual ventilation of the Nama Group basins. This, in turn, further decreased anoxic recycling of bioavailable phosphorus to the water column, promoting the development of stable oxic conditions and the radiation of new mobile taxa.

Conflicting evidence for the role of JNK as a target in breast cancer cell proliferation: Comparisons between pharmacological inhibition and selective shRNA knockdown approaches

As a target, the JNK pathway has been implicated in roles including cell death, proliferation, and inflammation in variety of contexts which span cardiovascular disease, neurodegenerative pathologies, and cancer. JNK1 and JNK2 have recently been demonstrated to function independently, highlighting a new parameter in the study of the JNK pathway. In order for JNK1 and JNK2-specific roles to be defined, better tools need to be employed. Previous studies have relied upon the broad spectrum JNK inhibitor, SP600125, to characterize the role of JNK signaling in a number of cell lines, including the breast cancer cell line MCF-7. In line with previous literature, our study has demonstrated that SP600125 treatment inhibited c-Jun and JNK phosphorylation and MCF-7 proliferation. However, in addition to targeting JNK1, JNK2, and JNK3, SP600125 has been previously demonstrated to suppress the activity of a number of other serine/threonine kinases, making SP600125 an inadequate tool for JNK isoform-specific roles to be determined. In this study, lentiviral shRNA was employed to selectively knockdown JNK1, JNK2, and JNK1/2 in MCF-7 cells. Using this approach, JNK phosphorylation was fully inhibited following stable knockdown of respective JNK isoforms. Interestingly, despite suppression of JNK phosphorylation, MCF-7 cell proliferation, cell cycle progression, or cell death remained unaffected. These findings raise the question of whether JNK phosphorylation really is pivotal in MCF-7 cell growth and death or if suppression of these events is a result of one of the many off-targets cited for SP600125.

The use of omalizumab in allergen immunotherapy

Although omalizumab (anti-IgE) is currently only approved for the treatment of asthma and chronic idiopathic urticaria, it has also been studied as an off-label treatment for numerous allergic conditions, including use as an adjunct to allergen immunotherapy in the treatment of allergic rhinitis, asthma, venom hypersensitivity and food allergy. We conducted a review of publications involving the use of omalizumab with allergen immunotherapy, by searching PubMed with key search terms of "omalizumab" and "immunotherapy." Omalizumab has been used in combination with inhalant allergen immunotherapy for the treatment of seasonal allergic rhinitis and comorbid asthma. While there have been no randomized controlled trials evaluating the addition of omalizumab to venom IT, several case reports and small patient series have been published on the use of omalizumab with venom IT. Omalizumab has been used in conjunction with oral immunotherapy for the treatment of milk, peanut and egg, as well as other foods in multi-allergen protocols. In conclusion, omalizumab used in conjunction with immunotherapy has shown promising results, especially in the reduction of adverse reactions. At this stage, larger, randomized, placebo-controlled trials are needed to better identify those patients who would benefit the most from the addition of omalizumab to immunotherapy, as well as optimal dosing strategies and duration of treatment.

Controls on the evolution of Ediacaran metazoan ecosystems: A redox perspective

A growing number of detailed geochemical studies of Ediacaran (635-541 Ma) marine successions have provided snapshots into the redox environments that played host to the earliest known metazoans. Whilst previous compilations have focused on the global evolution of Ediacaran water column redox chemistry, the inherent heterogeneity evident in palaeogeographically distinct environments demands a more dissected approach to better understand the nature, interactions and evolution of extrinsic controls on the development of early macrobenthic ecosystems. Here, we review available data of local-scale redox conditions within a palaeogeographic and sequence stratigraphic framework, to explore the mechanisms controlling water column redox conditions and their potential impact on the record of metazoans. The openly connected Laurentian margin, North America (632-540 Ma) and Nama basin, Namibia (550-538 Ma), and the variably restricted Yangtze Block, South China (635-520 Ma), show continued redox instability after the first fossil evidence for metazoans. This may support opportunistic benthic colonisation during periods of transient oxygenation amidst episodic upwelling of anoxic waters beneath a very shallow, fluctuating chemocline. The first skeletal metazoans appeared under conditions of continued redox stratification, such as those which characterise the Dengying Formation of the Yangtze Block and the Kuibis Subgroup of the Nama basin. Current data, however, suggests that successful metazoan reef-building demanded more persistent oxia. We propose that cratonic positioning and migration throughout the Ediacaran Period, in combination with gradually increasing dissolved oxygen loading, may have provided a first-order control on redox evolution through regulating circulation mechanisms in the Mirovian Ocean. Some unrestricted lower slope environments from mid-high latitudes benefited from sustained oxygenation via downwelling, whilst transit of isolated cratons towards more equatorial positions stifled pervasive ventilation either through ineffective surface ocean mixing, Ekman-induced upwelling, elevated surface ocean productivity or a combination of these processes.

Intraspecific variation in an Ediacaran skeletal metazoan: Namacalathus from the Nama Group, Namibia

Namacalathus hermanastes is one of the oldest known skeletal metazoans, found in carbonate settings of the terminal Ediacaran (~550-541 million years ago [Ma]). The palaeoecology of this widespread, goblet-shaped, benthic organism is poorly constrained yet critical for understanding the dynamics of the earliest metazoan communities. Analysis of in situ assemblages from the Nama Group, Namibia (~548-541 Ma), shows that Namacalathus exhibited size variation in response to differing water depths, hydrodynamic conditions and substrate types. In low-energy, inner ramp environments, Namacalathus attains the largest average sizes but grew in transient, loosely aggregating, monospecific aggregations attached to microbial mats. In high-energy mid-ramp reefs, Namacalathus spatially segregated into different palaeoecological habitats with distinct size distributions. In outer ramp environments, individuals were small and formed patchy, dense, monospecific aggregations attached to thin microbial mats. Asexual budding is common in all settings. We infer that variations in size distribution in Namacalathus reflect differences in habitat heterogeneity and stability, including the longevity of mechanically stable substrates and oxic conditions. In the Nama Group, long-lived skeletal metazoan communities developed within topographically heterogeneous mid-ramp reefs, which provided diverse mechanically stable microbial substrates in persistently oxic waters, while inner and outer ramp communities were often ephemeral, developing during fleeting episodes of either oxia and/or substrate stability. We conclude that Namacalathus, which forms a component of these communities in the Nama Group, was a generalist that adapted to various palaeoecological habitats within a heterogeneous ecosystem landscape where favourable conditions persisted, and was also able to opportunistically colonise transiently hospitable environments. These early skeletal metazoans colonised previously unoccupied substrates in thrombolitic reefs and other microbial carbonate settings, and while they experienced relatively low levels of interspecific competition, they were nonetheless adapted to the diverse environments and highly dynamic redox conditions present in the terminal Ediacaran.

Dynamic anoxic ferruginous conditions during the end-Permian mass extinction and recovery

The end-Permian mass extinction, ∼252 million years ago, is notable for a complex recovery period of ∼5 Myr. Widespread euxinic (anoxic and sulfidic) oceanic conditions have been proposed as both extinction mechanism and explanation for the protracted recovery period, yet the vertical distribution of anoxia in the water column and its temporal dynamics through this time period are poorly constrained. Here we utilize Fe–S–C systematics integrated with palaeontological observations to reconstruct a complete ocean redox history for the Late Permian to Early Triassic, using multiple sections across a shelf-to-basin transect on the Arabian Margin (Neo-Tethyan Ocean). In contrast to elsewhere, we show that anoxic non-sulfidic (ferruginous), rather than euxinic, conditions were prevalent in the Neo-Tethys. The Arabian Margin record demonstrates the repeated expansion of ferruginous conditions with the distal slope being the focus of anoxia at these times, as well as short-lived episodes of oxia that supported diverse biota.

Oceanic anoxia is invoked for driving the Permo-Triassic Mass Extinction, but the timing, distribution and chemical state are poorly understood. Here, the authors show that fluctuations of anoxic, non-sulfidic (ferruginous) conditions were important for the delayed biotic recovery in the Neo-Tethys.

Ediacaran skeletal metazoan interpreted as a lophophorate

While many skeletal biomineralized genera are described from Ediacaran (635-541 million years ago, Ma) strata, none have been suggested to have an affinity above the Porifera-Cnidaria metazoan grade. Here, we reinterpret the widespread terminal Ediacaran (approx. 550-541 Ma) sessile goblet-shaped Namacalathus as a triploblastic eumetazoan. Namacalathus has a stalked cup with radially symmetrical cross section, multiple lateral lumens and a central opening. We show that the skeleton of Namacalathus is composed of a calcareous foliated ultrastructure displaying regular concordant columnar inflections, with a possible inner organic-rich layer. These features point to an accretionary growth style of the skeleton and an affinity with the Lophotrochozoa, more specifically within the Lophophorata (Brachiopoda and Bryozoa). Additionally, we present evidence for asexual reproduction as expressed by regular budding in a bilateral pattern. The interpretation of Namacalathus as an Ediacaran total group lophophorate is consistent with an early radiation of the Lophophorata, as known early Cambrian representatives were sessile, mostly stalked forms, and in addition, the oldest known calcareous Brachiopoda (early Cambrian Obolellida) and Bryozoa (Ordovician Stenolaemata) possessed foliated ultrastructures.

Ocean acidification and the Permo-Triassic mass extinction

Ocean acidification triggered by Siberian Trap volcanism was a possible kill mechanism for the Permo-Triassic Boundary mass extinction, but direct evidence for an acidification event is lacking. We present a high-resolution seawater pH record across this interval, using boron isotope data combined with a quantitative modeling approach. In the latest Permian, increased ocean alkalinity primed the Earth system with a low level of atmospheric CO2 and a high ocean buffering capacity. The first phase of extinction was coincident with a slow injection of carbon into the atmosphere, and ocean pH remained stable. During the second extinction pulse, however, a rapid and large injection of carbon caused an abrupt acidification event that drove the preferential loss of heavily calcified marine biota.

Circulating TSLP associates with decreased wheezing in non-atopic preschool children: data from the URECA birth cohort

BACKGROUND

Mouse models of atopic march suggest that systemic, skin-derived thymic stromal lymphopoietin (TSLP) mediates progression from eczema to asthma.

OBJECTIVE

We investigated whether circulating TSLP is associated with eczema, allergic sensitization, or recurrent wheezing in young children.

METHODS

A prospective analysis of the relationship between plasma levels of TSLP to allergic sensitization and recurrent wheezing was conducted in the birth cohort from the Urban Environment and Childhood Asthma (URECA) study. Plasma TSLP levels were measured at 1, 2, and 3 years of age and analysed for correlation with clinical parameters in each of the three years. Only those children with consecutive samples for all three years were included in this analysis.

RESULTS

We detected TSLP in 33% of 236 children for whom plasma samples were available for all three years. Overall, a consistently significant association was not found between TSLP and eczema or allergic sensitization. With regard to recurrent wheezing, children with detectable TSLP at one year of age were significantly less likely to experience recurrent wheezing by 3 years compared with those children without detectable TSLP, but this was only seen in children without aeroallergen sensitization at 3 years (P < 0.01).

CONCLUSIONS AND CLINICAL RELEVANCE

Contrary to our expectations, circulating TSLP was not significantly associated with eczema, allergen sensitization, or recurrent wheezing during the first three years of life. Early presence of circulating TSLP was significantly associated with reduced incidence of recurrent wheeze in those children not sensitized to aeroallergen. These findings suggest a possible underlying distinction between pathogenesis of developing atopic vs. non-atopic recurrent wheeze.

Umbilical cord plasma 25-hydroxyvitamin D concentration and immune function at birth: the Urban Environment and Childhood Asthma study

BACKGROUND

Recent studies have reported conflicting data on the association between maternal intake of vitamin D during pregnancy and asthma.

OBJECTIVE

To assess the influence of prenatal vitamin D status on immune function at birth.

METHODS

In an inner-city birth cohort of 568 newborns, 520 of whom had at least one atopic parent, we measured the umbilical cord (UC) plasma concentration of 25-hydroxyvitamin D (25(OH)D) and the cytokine responses of UC blood mononuclear cells (UCMCs) to stimuli including phytohaemagglutinin (PHA), lipopolysaccharide (LPS), and peptidoglycan. In a subset, the UCMC expression of regulatory T cell markers and the suppressive activity of CD4(+) CD25(+) UCMCs were measured. Results The 25th, 50th, and 75th percentiles of UC plasma 25(OH)D level were 15.0, 20.2, and 25.6 ng/mL, respectively. Most cytokine responses of UCMC were not correlated with UC 25(OH)D concentration; however, IFN-γ release after LPS stimulation was weakly positively correlated with UC 25(OH)D concentration (r=0.11, P=0.01). PHA responses were not significantly correlated with 25(OH)D concentration. The UC plasma 25(OH)D concentration was inversely related to the number of CD25(+) (r=-0.20, P=0.06), CD25(Bright) (r=-0.21, P=0.05), and CD25(+) FoxP3 (r=-0.29, P=0.06) cells as a proportion of CD4(+) T cells in UC blood (r=-0.26, P=0.04) but not to the suppressive activity of CD4(+) CD25(+) cells (r=0.17, P=0.22).

CONCLUSION AND CLINICAL RELEVANCE

UC 25(OH)D concentration was not correlated with most UCMC cytokine responses to multiple stimuli. There was a suggestion of a weakly positive correlation with IFN-γ release after LPS stimulation. The proportions of CD25(+) , CD25(Bright) , and CD25(+) FoxP3 cells to total CD4(+) T cells were inversely correlated with UC 25(OH)D concentration. Our findings suggest that higher vitamin D levels at birth may be associated with a lower number of T-regulatory cells. Vitamin D status in utero may influence immune regulation in early life.

Dendritic cell and T cell responses in children with food allergy

BACKGROUND

Food allergy (FA) and eosinophilic oesophagitis (EE) are increasingly common clinical problems. Dendritic cells (DCs) are key regulators of the sensitization and effector phases of allergic immune responses, but their role in these diseases is largely unknown.

OBJECTIVE

To evaluate for alterations in the phenotype and function of DCs in children with IgE-mediated milk allergy or EE compared with their non-affected siblings.

METHODS

Plasmacytoid DCs (pDCs) and myeloid DCs (mDCs) were prepared from peripheral blood of children with milk allergy (FA), EE, and non-affected siblings (CON). Purified pDCs and mDCs were cultured alone or with autologous CD4(+) lymphocytes. Cytokine levels in plasma, or culture supernatants following stimulation, were measured using multiplex array immunoassay. Cell-surface molecule expression was determined by flow cytometry.

RESULTS

DCs from FA subjects produced greater levels of pro-inflammatory cytokines (IL-6, TNF-α), granulocyte macrophage-colony forming factor, and mDC-derived IL-10 compared with controls following allergen exposure. T(H) 2 but not T(H) 1 cytokines were spontaneously produced in DC-CD4(+) T cell co-cultures from children with FA and were not significantly increased after stimulation with milk extract, suggesting an ongoing activation in vivo. This hypothesis was further supported by evidence for elevated IL-5 and IL-13 protein in the plasma of children with both FA and EE. The only significant DC phenotypic differences were: (1) reduced levels of CD80 in EE subjects and (2) FcɛRI expression that correlated with serum IgE levels in both groups of subjects.

CONCLUSION

This study suggests that DCs from children with FA and EE produce more pro-inflammatory cytokines, and that their CD4(+) T cells are spontaneously activated to produce T(H) 2 cytokines in the presence of FcɛRI-bearing DCs.

Compilation and network analyses of cambrian food webs

A rich body of empirically grounded theory has developed about food webs--the networks of feeding relationships among species within habitats. However, detailed food-web data and analyses are lacking for ancient ecosystems, largely because of the low resolution of taxa coupled with uncertain and incomplete information about feeding interactions. These impediments appear insurmountable for most fossil assemblages; however, a few assemblages with excellent soft-body preservation across trophic levels are candidates for food-web data compilation and topological analysis. Here we present plausible, detailed food webs for the Chengjiang and Burgess Shale assemblages from the Cambrian Period. Analyses of degree distributions and other structural network properties, including sensitivity analyses of the effects of uncertainty associated with Cambrian diet designations, suggest that these early Paleozoic communities share remarkably similar topology with modern food webs. Observed regularities reflect a systematic dependence of structure on the numbers of taxa and links in a web. Most aspects of Cambrian food-web structure are well-characterized by a simple "niche model," which was developed for modern food webs and takes into account this scale dependence. However, a few aspects of topology differ between the ancient and recent webs: longer path lengths between species and more species in feeding loops in the earlier Chengjiang web, and higher variability in the number of links per species for both Cambrian webs. Our results are relatively insensitive to the exclusion of low-certainty or random links. The many similarities between Cambrian and recent food webs point toward surprisingly strong and enduring constraints on the organization of complex feeding interactions among metazoan species. The few differences could reflect a transition to more strongly integrated and constrained trophic organization within ecosystems following the rapid diversification of species, body plans, and trophic roles during the Cambrian radiation. More research is needed to explore the generality of food-web structure through deep time and across habitats, especially to investigate potential mechanisms that could give rise to similar structure, as well as any differences.

Proterozoic modular biomineralized metazoan from the Nama Group, Namibia

We describe a Proterozoic, fully biomineralized metazoan from the Omkyk Member (approximately 549 million years before the present) of the northern Nama Group, Namibia. Namapoikia rietoogensis gen. et sp. nov. is up to 1 meter in diameter and bears a complex and robust biomineralized skeleton; it probably represents a cnidarian or poriferan. Namapoikia encrusts perpendicular to the walls of vertical synsedimentary fissures in microbial reefs. This finding implies that large, modular metazoans with biologically controlled mineralization appeared some 15 million years earlier than previously documented.

Food-allergic reactions in schools and preschools

BACKGROUND

Food allergies may affect up to 6% of school-aged children.

OBJECTIVES

To conduct a telephone survey to characterize food-allergic reactions in children (defined as those aged 3-19 years in this study) with known food allergies in schools and preschools and to determine mechanisms that are in place to prevent and treat those reactions.

DESIGN

The parents of food-allergic children were contacted by telephone and asked about their child's history of food-allergic reactions in school. The schools the children attended were contacted, and the person responsible for the treatment of allergic reactions completed a telephone survey.

RESULTS

Of 132 children in the study, 58% reported food-allergic reactions in the past 2 years. Eighteen percent experienced 1 or more reactions in school. The offending food was identified in 34 of 41 reactions, milk being the causative food in 11 (32%); peanut in 10 (29%); egg in 6 (18%); tree nuts in 2 (6%); and soy, wheat, celery, mango, or garlic in 1 (3%) each. In 24 reactions (59%), symptoms were limited to the skin; wheezing occurred in 13 (32%), vomiting and/or diarrhea in 4 (10%), and hypotension in 1 (2%). Also, 15 (36%) of the 41 reactions involved 2 or more organ systems, and 6 (15%) were treated with epinephrine. Fourteen percent of the children did not have a physician's orders for treatment, and 16% did not have any medications available. Of the 80 participating schools, 31 (39%) reported at least 1 food-allergic reaction within the past 2 years and 54 (67%) made at least 1 accommodation for children with a food allergy, such as peanut-free tables, a peanut ban from the classroom, or alternative meals.

CONCLUSIONS

It is common for food-allergic children to experience allergic reactions in schools and preschools, with 18% of children having had at least 1 school reaction within the past 2 years. Thirty-six percent of the reactions involved 2 or more organ systems, and 32% involved wheezing. Every effort should be made to prevent, recognize, and appropriately treat food-allergic reactions in schools.

Cockroach allergen abatement with extermination and sodium hypochlorite cleaning in inner-city homes

BACKGROUND

Although the importance of cockroach allergen in chronic asthma has now been well defined, little progress has been made in the control of cockroach allergen in infested homes.

OBJECTIVE

The objective of this study was to examine the ability of a combination of professional pest extermination and household cleaning using a solution of sodium hypochlorite to reduce cockroach infestation and allergen levels in cockroach infested homes.

METHODS

Seventeen cockroach-infested homes were studied with three homes serving as controls. In the intervention homes, a professional exterminator applied 0.05% abamectin twice at 2-week intervals at study entry and a professional cleaner cleaned the homes before and after the extermination. All washable surfaces were cleaned throughout the study with a solution of 0.5% hypochlorite. Monthly home visits were conducted to inspect the home, interview the homeowner, place passive cockroach traps, and to collect settled dust samples from the kitchen, bedroom, and TV/living room.

RESULTS

The number of cockroaches in the passive traps decreased rapidly after the initial intervention in most homes. Median Blatella germanica allergen 1 levels in the settled dust samples fell by 91% in the kitchen, 78% in the bedroom, and 77% in the living room over the course of the study in the intervention homes but gradually rose in the control homes. The overall reductions were very similar to those seen in a previous study with a similar protocol except for the use of the sodium hypochlorite.

CONCLUSIONS

Successful extermination is possible in most inner-city homes and cockroach allergen levels can be reduced by 80% to 90%. However, 0.5% sodium hypochlorite did not seem to improve allergen reduction, and in many homes, allergen levels remained above the proposed threshold of 8 U/g of dust throughout the study.

Laboratory animal allergens

Allergic sensitivity to laboratory animals can pose a significant occupational hazard to anyone with regular animal contact. Reactions to mice and rats are most common although all furred animals produce allergens that can lead to sensitization and disease. Most of the relevant allergens of laboratory animals have been defined and characterized, which has revealed that these allergens are typically small, acidic glycoproteins and that many of them are members of a superfamily of extracellular proteins called lipocalins. In addition to understanding their molecular characteristics, the identification of these allergens has also made it possible to measure their distribution in laboratory environments and to relate exposure levels to sensitization and symptoms. These studies have shown that the major laboratory animal allergens are carried on small particles that are both capable of remaining airborne for extended periods and penetrating into the lower airways of exposed workers. These advances in the understanding of these important occupational allergens will allow for the development of better methods of diagnosis and avoidance for affected workers and others who may be at risk for future difficulties.

The role and remediation of animal allergens in allergic diseases

Animal allergens are common causes of both acute and chronic allergic disease. The most important animal allergens are derived from mammals, principally cats, dogs, rats, mice, horses, and cows, which secrete or excrete allergens into the environment. Allergic sensitization may occur at home or in the workplace. Cat and dog allergens commonly cause allergies in the home and affect the general population. Laboratory animal handlers often have allergic reactions to rats and mice. Cow dander allergy is usually caused by occupational exposure and occurs in farmers and farm workers. Horse allergy occurs among people who regularly handle horses, either professionally or for recreational purposes. Over the past 20 years, the major animal allergens have been defined and characterized with regard to their molecular structure, immunogenicity, and environmental distribution. One remarkable finding has been the fact that most of the mammalian allergens that have thus far been cloned belong to a single family of proteins called the lipocalins. In addition to these molecular similarities, it has also been shown that most of the animal allergens are quite similar with regard to their aerodynamic properties. Although much is yet to be learned, progress is being made in our knowledge regarding the steps that may be necessary to control exposure to these allergens through environmental modifications in both homes and occupational settings. These measures include source control, air filtration devices, barrier devices, removal of carpeting and other reservoirs, and, in some cases, washing of the animal.

The natural history of peanut allergy

BACKGROUND

It has traditionally been assumed that peanut allergy is rarely outgrown.

OBJECTIVE

The goal of this study was to determine the number of children with peanut allergy who become tolerant of peanut.

METHODS

Patients aged 4 to 20 years with a diagnosis of peanut allergy were evaluated by questionnaire, skin testing, and a quantitative antibody fluorescent-enzyme immunoassay. Patients who had been reaction free in the past year and had a peanut IgE (PN-IgE) level less than 20 kilounits of antibody per liter (kU(A)/L) were offered an open or double-blind, placebo-controlled peanut challenge.

RESULTS

A total of 223 patients were evaluated, and of those, 85 (PN-IgE < 0.35-20.4 kU(A)/L [median 1.42 kU(A)/L]) participated in an oral peanut challenge. Forty-eight (21.5%) patients had negative challenge results and were believed to have outgrown their peanut allergy (aged 4-17.5 years [median 6 years]; PN-IgE < 0.35-20.4 kU(A)/L [median 0.69 kU(A)/L]). Thirty-seven failed the challenge (aged 4-13 years [median 6.5 years]; RAST < 0.35-18.2 kU(A)/L [median 2.06 kU(A)/L]). Forty-one patients with PN-IgE levels less than 20 kU(A)/L declined to undergo challenge, and 97 were not eligible for challenge because their PN-IgE levels were greater than 20 kU(A)/L or they had had a recent reaction. Sixty-seven percent of patients with PN-IgE levels less than 2 kU(A)/L and 61% with levels less than 5 kU(A)/L had negative challenge results. Of those who underwent challenge, PN-IgE levels for those who passed versus those who failed were different at the time of challenge (P = .009), but not at the time of diagnosis (P = .25).

CONCLUSION

This study demonstrates that peanut allergy is outgrown in about 21.5% of patients. Patients with low PN-IgE levels should be offered a peanut challenge in a medical setting to demonstrate whether they can now tolerate peanuts.

Mouse allergen. I. The prevalence of mouse allergen in inner-city homes. The National Cooperative Inner-City Asthma Study

BACKGROUND

Although mouse allergen is a well-defined cause of IgE-mediated hypersensitivity in occupational settings, it has not been well studied in the general population.

OBJECTIVE

We sought to determine the prevalence of mouse allergen in inner-city homes.

METHODS

A subset of 608 homes from the National Cooperative Inner-City Asthma Study population had dust samples adequate for analysis of mouse allergen. In addition, data regarding the demographics and housing of the subjects were related to the mouse allergen levels.

RESULTS

Ninety-five percent of all homes had detectable mouse allergen (Mus m 1) in at least one room, with the highest levels found in kitchens (kitchen: range, 0-618 microg/g; median, 1.60 microg/g; bedroom: range, 0-294 microg/g; median, 0.52 microg/g; television-living room: range, 0-203 microg/g; median, 0. 57 microg/g). By city, 100% of the kitchens in Baltimore had detectable mouse allergen, with the lowest percentage (74%) in Cleveland. Mouse allergen levels correlated among rooms (R = 0.65-0. 75). Forty-nine percent of the homes had reported problems with mice within the last year, and 29% of the homes had evidence of mice in one or more rooms on home inspection and had higher levels of mouse allergen (P =.0001). Higher allergen levels were also associated with evidence of cockroach infestation in any room (P =.006). None of the other subject or housing demographics evaluated were associated with a higher prevalence or level of mouse allergen.

CONCLUSIONS

We conclude that mouse allergen is widely distributed in inner-city homes and that cockroach infestation is associated with high mouse allergen levels.

Mouse allergen. II. The relationship of mouse allergen exposure to mouse sensitization and asthma morbidity in inner-city children with asthma

BACKGROUND

Although mouse allergen is known to cause occupational asthma in laboratory workers, its potential significance in home environments has never been studied.

OBJECTIVE

This study was designed to define the prevalence of mouse sensitivity and its relationship to mouse allergen exposure and disease activity in inner-city children with asthma.

METHODS

A subset of 499 subjects from the National Cooperative Inner-City Asthma Study had dust samples adequate for mouse allergen analysis, as well as valid puncture skin test (PST) results. Data were analyzed to relate mouse allergen exposure and other risk factors to mouse sensitization and asthma morbidity.

RESULTS

Eighty-nine (18%) of the 499 children had a positive mouse skin test response. Children whose homes had mouse allergen levels above the median (1.60 microg/g) in the kitchen had a significantly higher rate of mouse sensitization (23% vs 11%, P =. 007). Atopy was also significantly related to mouse sensitization, with 40% of those with more than 4 positive PST responses having mouse sensitivity compared with 4% of those with no other positive PST responses (P <.0001). When atopy and exposure were considered together, 53% of those with more than 4 positive PST responses and allergen levels above the median had a positive PST response to mouse allergen compared with 22% of those with more than 4 positive PST responses and allergen levels below the median (P <.0001). The relationship among mouse allergen exposure, sensitization, and any measures of asthma morbidity was not statistically significant.

CONCLUSIONS

Mouse allergen may be an important indoor allergen in inner-city children with asthma, with exposure and atopy contributing to mouse sensitization.

Quantitative IgE antibody assays in allergic diseases

During the past several years, immunoassays for specific IgE antibodies have been refined to permit reporting results in mass units. Thus quantitative immunoassays for IgE antibodies may be an adjunct to skin tests. In cases of food allergy among children with atopic dermatitis, cutoff values for IgE antibody concentrations to egg, milk, peanut, and fish have been derived to provide 95% positive and 90% negative predictive values. Food-specific IgE antibody determinations can also be used to predict which food allergies are resolving spontaneously. Elevated egg-specific IgE antibody levels in infancy are associated with significantly increased risk for development of inhalant allergies later in childhood. In cases of inhalant allergy, specific IgE antibody levels correlate closely with results of inhalation challenge studies in cat-sensitive persons. Also, mite-specific IgE antibody levels correlate significantly with the mite allergen contents of reservoir dust in the homes of mite-sensitive persons. Immunoassays for quantitation of specific IgE antibodies may be used to document allergen sensitization over time and to evaluate the risk of reaction on allergen exposure. However, immunoassays and skin tests are not entirely interchangeable, and neither will replace the other in appropriate circumstances.

A randomized, double-blind, placebo-controlled trial of the effect of zafirlukast on upper and lower respiratory responses to cat challenge

BACKGROUND

Zafirlukast, a leukotriene antagonist, has been shown to have protective effects against a variety of asthma triggers.

OBJECTIVE

Our purpose was to evaluate zafirlukast's effects on upper and lower airway responses to cat allergen exposure with use of a well-characterized cat exposure model.

METHODS

In a double-blind, placebo-controlled, cross-over trial 18 subjects with cat-induced asthma were randomly assigned to receive 1 week each of zafirlukast or placebo followed by a 1-hour cat challenge. Upper and lower respiratory symptoms were rated and spirometry and acoustic rhinometry were performed. Challenges were stopped early if the subject was too uncomfortable or had a >50% decrease in FEV(1).

RESULTS

Overall changes in FEV(1) were significantly different with zafirlukast treatment (P = .02). Significant differences in FEV(1) change were detected at 15 and 30 minutes (P = .027 and .05, respectively) but not at 45 and 60 minutes. Changes in acoustic rhinometry were also significantly different at 15 and 30 minutes (P =.05 and .0005, respectively) but not at 45 and 60 minutes. Challenge length was significantly longer with zafirlukast versus placebo after adjustment for differences in allergen exposure (P = .022). Respiratory symptom scores were significantly different (lower respiratory, P < .001; upper respiratory, P = .038) through the first 30 minutes of the challenge after adjustment for allergen exposure.

CONCLUSIONS

Zafirlukast was significantly more effective than placebo in preserving pulmonary function and nasal anatomy and extending challenge length when cat-sensitive asthmatic subjects were exposed to high levels of cat allergen.

Detection of growth suppression in children during treatment with intranasal beclomethasone dipropionate

OBJECTIVE

Intranasal beclomethasone dipropionate (BDP) has generally been considered to have no systemic activity at recommended doses, but the potential for long-term effects on growth has not previously been evaluated. This study was undertaken to assess the effects of 1 year of treatment with intranasal BDP on growth in children.

STUDY DESIGN

In this double-blind, randomized, parallel-group study, 100 prepubertal children 6 to 9 years old with perennial allergic rhinitis were treated with aqueous BDP 168 microg twice daily (n = 51) or placebo (n = 49) for 1 year. Subjects' baseline heights were required to be between the 5th and 95th percentile, and skeletal age as determined by left wrist radiograph was required to be within 2 years of chronological age. Washout periods for medications known to affect growth, including other forms of corticosteroids, were established, and these medications were prohibited during the study. However, short courses of oral prednisolone lasting no more than 7 days, and short courses of dermatologic corticosteroids lasting no more than 10 days, were allowed. Height was measured with a stadiometer after 1, 2, 4, 6, 8, 10, and 12 months of treatment. The hypothalamic-pituitary-adrenocortical axis was assessed by measurements of 8 AM basal cortisol concentrations and response to. 25 mg cosyntropin stimulation. The primary safety parameter was the rate of change in standing height. Statistical analyses were based on all randomized subjects who received at least 1 dose of medication (intent-to-treat principle). The rate of change in standing height was analyzed for all subjects who entered the study and for those completing the full 12 months of treatment (n = 80). The rate of change in standing height over the 1-year study was calculated as the slope of a linear regression line fitted to each subject's height measurements over time. Because there was a statistically significant between-group difference in standing height at baseline, an analysis of covariance was performed for all analyses of standing height data.

RESULTS

Of the 100 subjects enrolled, 90 completed the study. The 2 treatment groups were generally comparable at baseline; however, at baseline, mean age and mean height were significantly greater in the BDP treatment group that the in placebo treatment group. In both analyses, overall growth rate was significantly slower in BDP-treated subjects than placebo-treated subjects. The mean change in standing height after 1 year was 5.0 cm in the BDP-treated subjects compared with 5.9 cm in the placebo-treated subjects. The difference in growth rates was evident as early as the 1-month treatment visit, suggesting that the effect on growth occurred initially. The growth-suppressive effect of BDP remained consistent across all age and gender subgroups, and among subjects with and without a previous history of corticosteroid use. Use of additional exogenous corticosteroids during the study was similar in both groups and did not affect the results. Because there was a baseline imbalance in height, a supplemental analysis of the differences in prestudy growth rates was performed. This analysis found no baseline imbalance in prestudy growth rates. To determine whether the difference in growth rates during the study could be attributed to preexisting growth rates, a z score analysis was performed. The heights of both groups were normalized at baseline and at the end of the study using the US National Center for Health Statistics data for mean and standard deviations of height. This analysis confirmed that the difference in growth rates between the 2 groups was primarily attributable to the treatment rather than to any preexisting difference in growth. Additional analyses confirmed that the results were not influenced by outlier values. No significant between-group difference were found in the hypothalamic-pituitary-adrenocortical axis assessments. No unusual adverse events were observed. (ABSTRACT

Removal of cockroach allergen from inner-city homes

BACKGROUND

Allergen avoidance has been shown to improve the morbidity and physiology of asthma. Although cockroach allergen has been implicated in chronic asthma, little work has been reported on the feasibility of allergen removal from infested homes.

OBJECTIVE

The objective of this study was to examine the effect of professional pest control and home cleaning on cockroach infestation and allergen concentrations in settled dust samples from the kitchens, bedrooms, and television-living rooms of inner-city homes.

METHODS

Thirteen homes in inner-city Baltimore, Maryland, received a professional cleaning, with vacuuming and a thorough cleaning in the kitchen. Pest control technicians applied abamectin 0.05% gel to the kitchen and, to a limited extent, to the rest of the home and the cleaning was repeated. Technicians visited monthly from month 2 to month 8 to inspect, collect dust samples, and place passive cockroach traps. Bla g 1 concentrations in dust extract were measured by means of ELISA.

RESULTS

The number of cockroaches captured in passive traps decreased rapidly in 11 homes, but complete extermination was achieved in only 7 homes. Bla g 1 concentrations were reduced by 93% in kitchens, 77% in television-living rooms, and 74% in bedrooms. The relative reduction in cockroach allergen was not related to successful extermination or to signs of poor house-cleaning.

CONCLUSION

We concluded that cockroach extermination is feasible in inner-city homes but that standard house-cleaning procedures are only partially effective in removing residual allergen over 8 months.

Protamine allergy as a complication of insulin hypersensitivity: A case report

BACKGROUND

Although most patients receiving insulin produce insulin-specific IgE, significant allergic symptoms develop in very few of them. Patients receiving neutral protamine Hagedorn (NPH) insulin are at increased risk for the development of protamine hypersensitivity. The case of a 19-year-old woman with insulin-dependent diabetes and regular and NPH insulin hypersensitivity is presented.

OBJECTIVE

The purpose of this study was to determine whether desensitization to NPH insulin, as well as standard insulin desensitization, could control allergic symptoms in a patient allergic to both NPH and regular insulin.

METHODS

The patient required insulin desensitization for severe urticaria, angioedema, and occasional wheezing resulting from her insulin dose. She underwent a standard protocol for insulin desensitization twice in a 2-month period, with persistence in her symptoms. She was found to have high protamine-specific, as well as insulin-specific, IgE levels, and because of her poor response to regular insulin desensitization, she was desensitized to both regular and NPH insulin.

RESULTS

Dual desensitization resulted in marked improvement in her symptoms. The patient had recurrence of urticaria and angioedema a year and a half later, at which point the NPH was stopped and she was desensitized to regular insulin. She continued to receive regular insulin 4 times per day over the following 3 years with only occasional hives.

CONCLUSION

Patients with insulin allergy may not have complete resolution of their symptoms after standard desensitization, particularly those patients with concomitant protamine allergy. These patients may require protamine/NPH desensitization, an alternative insulin preparation, or both.

A comparison of skin prick tests, intradermal skin tests, and RASTs in the diagnosis of cat allergy

BACKGROUND

Skin testing and RASTs are the most commonly used methods for the diagnosis of allergy. Questions remain, however, as to the accuracy of these tests, particularly with regard to the role of intradermal skin tests (IDSTs) in the evaluation of respiratory allergy.

OBJECTIVE

The purpose of this study was to determine the predictive value of skin prick tests (SPTs), IDSTs, and RASTs in the diagnosis of cat allergy.

METHODS

Patients were challenged with a well-characterized cat exposure model after evaluation by history, SPTs, IDSTs (if SPT results were negative), and RASTs. All patients were evaluated with respect to their upper respiratory responses, although only those patients with asthma were included in the analysis of lower airway responses. Challenge results were considered positive if the mean upper respiratory symptom score was 0.5 or more, the mean lower respiratory symptom score was 0.4 or more, or the maximum fall in FEV1 value was 15% or more.

RESULTS

One hundred twenty patients were evaluated. SPT values were positive in 81 patients; of the remaining 39 patients, IDST values were positive in 26 patients. RASTs were performed in 89 patients; the values were positive in 45 of 51 patients with a positive SPT value and were negative in all patients with a negative SPT value. When any positive challenge outcome was considered, positive challenge results were seen in 38 of 41 patients with a positive SPT score, in 10 of 39 patients with a negative SPT score, in 6 of 26 patients with a positive IDST score, in 4 of 13 patients with a negative IDST score, in 27 of 27 patients with a positive RAST score, and in 12 of 44 patients with a negative RAST score.

CONCLUSION

Although both SPT and RAST values exhibited excellent efficiency in the diagnosis of cat allergy, IDST scores added little to the diagnostic evaluation.

The value of acoustic rhinometry in assessing nasal responses to cat exposure

BACKGROUND

Acoustic rhinometry (AR) uses sonar principles to map the anatomy of the nasal cavity and has been used in other studies to assess acute airway responses to allergen exposure.

OBJECTIVE

The purpose of this study was to evaluate the utility of AR in assessing acute airway responses to cat allergen exposure by using a well-characterized cat exposure model.

METHODS

Thirty subjects with a history of cat-induced rhinitis and a positive skin prick test response to cat allergen underwent an environmental cat challenge. Of these 30 subjects, 10 also had repeat challenges at lower levels of antigen to determine whether there was a dose response. Five subjects with negative skin test responses to cat were recruited as control subjects. During the 1-hour cat exposure, upper and lower respiratory symptoms were scored every 5 minutes, and spirometry and AR were obtained every 15 minutes.

RESULTS

Although 29 of 30 subjects had changes in AR measurements, no correlations were detected between upper respiratory symptom scores and any of the changes observed in AR. In comparing the baseline challenges with lower antigen level challenges, upper respiratory symptom scores differed significantly (P = .002), whereas AR responses were nearly identical. Subjects without cat allergy did exhibit less response by AR (P = .05 to .13), but the greatest differences remained in the upper respiratory symptoms scores (P < .0001).

CONCLUSION

We conclude that although AR does provide an objective measure of nasal response to allergen exposure, it has significant limitations. These are evidenced by the lack of correlation with symptoms, the inability to measure a dose response, and the changes noted even among the control subjects.

A placebo-controlled trial of a HEPA air cleaner in the treatment of cat allergy

To evaluate the effect of a room high-efficiency particulate air (HEPA) cleaner on cat-induced asthma and rhinitis, 35 cat-allergic subjects who were living with one or more cats were studied in a double-blind, placebo controlled trial. After a 1 mo baseline period, subjects' bedrooms were equipped with an active or placebo air cleaner for the following 3 mo. Evaluations included monthly measurement of cat-allergen levels, daily morning, afternoon, and nighttime nasal- and chest-symptom scores, twice-daily measurement of peak-flow rates, daily medication scores, monthly spirometry, and methacholine (MCh) challenge testing before and after the study. Airborne allergen levels were reduced in the active-filter group as compared with the placebo group (p = 0.045). However, no differences were detected in settled-dust allergen levels (p = 0.485), morning, afternoon, or nighttime nasal-symptom scores (p = 0.769, 0.534, and 0.138), chest-symptom scores (p = 0.388, 0.179, and 0.215), sleep disturbance (p = 0.101), morning or afternoon peak-flow rates (p = 0. 424 and 0.679), or rescue medication use (nasal, p = 0.164, chest, p = 0.650), respectively. Although the combination of a HEPA room air cleaner, mattress and pillow covers, and cat exclusion from the bedroom did reduce airborne cat-allergen levels, no effect on disease activity was detected for any parameter studied.

Laboratory animal allergy

Approximately one third of laboratory animal workers have occupational allergy to animal danders, and a third of these have symptomatic asthma. Sensitization generally occurs with the first 3 years of employment, and risk factors include atopic background, as well as job description as it relates to the intensity of exposure. A symptomatic worker can reduce allergen exposure with personal protective devices. A laboratory can further reduce exposure with generally available equipment, such as laminar flow caging, and procedures, such as frequent wet washing of vivaria and careful maintenance of ventilation systems. It is advisable to institute periodic medical screening of all laboratory animal workers with questionnaires and allergy skin testing in addition to providing them with training programs to reduce personal exposure.