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Influence of Chronic Sinusitis and Nasal Polyp on the Lower Airway of Subjects Without Lower Airway Diseases.

Suh Young LEE ; Soon Ho YOON ; Woo Jung SONG ; So Hee LEE ; Hye Ryun KANG ; Sun Sin KIM ; Sang Heon CHO

Allergy, Asthma & Immunology Research.2014;6(4):310-315. doi:10.4168/aair.2014.6.4.310

PURPOSE: Upper and lower respiratory tract pathologies are believed to be interrelated; however, the impact of upper airway inflammation on lung function in subjects without lung disease has not been evaluated. This study investigated the association of CT finding suggesting chronic sinusitis and lung function in healthy subjects without lung disease. METHODS: This was a retrospective study of prospectively collected data from 284 subjects who underwent a pulmonary function test, bronchial provocation test, rhinoscopy, and osteomeatal unit computed tomography offered as a private health check-up option. RESULTS: CT findings showed that the sinusitis group had a significantly lower FEV1/FVC ratio than subjects without sinusitis finding (78.62% vs 84.19%, P=0.019). Among the sinusitis group, subjects classified by CT findings as the extensive disease group had a slightly lower FEV1/FVC than those of the limited disease group (76.6% vs 79.5%, P=0.014) and the associations were independent of the presence of airway hyperresponsiveness. The subjects with nasal polyp had also lower FEV1 and FEV1/FVC than subjects without nasal polyp (FEV1: 100.0% vs 103.6%, P=0.045, FEV1/FVC: 77.4% vs 80.0%, P=0.005). CONCLUSIONS: CT findings suggesting chronic sinusitis and nasal polyp were associated with subclinical lower airway flow limitation even in the absence of underlying lung disease.
Bronchial Provocation Tests ; Inflammation ; Lung ; Lung Diseases ; Nasal Polyps* ; Pathology ; Prospective Studies ; Respiratory Function Tests ; Respiratory System ; Retrospective Studies ; Sinusitis*

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The Utility of Serum Tryptase in the Diagnosis of Food-Induced Anaphylaxis.

Patcharaporn WONGKAEWPOTHONG ; Punchama PACHARN ; Chaweewan SRIPRAMONG ; Siribangon BOONCHOO ; Surapon PIBOONPOCANUN ; Nualanong VISITSUNTHORN ; Pakit VICHYANOND ; Orathai JIRAPONGSANANURUK

Allergy, Asthma & Immunology Research.2014;6(4):304-309. doi:10.4168/aair.2014.6.4.304

PURPOSE: This study investigates the utility of serum tryptase for the confirmation of shrimp-induced anaphylaxis. METHODS: Patients with a history of shrimp allergy and positive skin prick tests (SPT) to commercial shrimp extract were recruited for shrimp challenges. Serum total tryptase was obtained at baseline and 60 min (peak) after the onset of symptoms. RESULTS: Thirty-nine patients were challenged. There were 12 patients with anaphylaxis, 20 with mild reactions and 7 without symptoms (control group). Characteristic features and baseline tryptase were not different among the 3 groups. The peak tryptase levels were higher than the baseline in anaphylaxis and mild reaction groups (P<0.05). The delta-tryptase (peak minus baseline) and the tryptase ratio (peak divided by baseline) in the anaphylaxis group were higher than the mild reaction and control groups (P<0.01). The optimum cut-off for peak tryptase to confirm anaphylaxis was 2.99 microg/L with 50% sensitivity, 85% specificity, 3.33 positive likelihood ratio (LR) and 0.59 negative LR. The manufacturer's cut-off for peak tryptase was >11.4 microg/L with 17% sensitivity, 100% specificity, infinity positive LR and 0.83 negative LR. The best cut-off for delta-tryptase was > or =0.8 microg/L with 83% sensitivity, 93% specificity, 11.86 positive LR and 0.18 negative LR. The best cut-off for tryptase ratio was > or =1.5 with 92% sensitivity, 96% specificity, 23 positive LR and 0.08 negative LR. CONCLUSIONS: The peak tryptase level should be compared with the baseline value to confirm anaphylaxis. The tryptase ratio provide the best sensitivity, specificity, positive and negative LR than a single peak serum tryptase for the confirmation of shrimp-induced anaphylaxis.
Anaphylaxis* ; Diagnosis* ; Humans ; Hypersensitivity ; Skin ; Tryptases*

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Trends in Specific Immunotherapy for Allergic Rhinitis: A Survey of Chinese ENT Specialists.

Han ZHOU ; Qi Lei TAO ; Jun Min WEI ; Geng XU ; Lei CHENG

Allergy, Asthma & Immunology Research.2014;6(4):296-303. doi:10.4168/aair.2014.6.4.296

PURPOSE: Specific immunotherapy (SIT) is a suitable but uncommon treatment option for allergic rhinitis (AR) in China. The current understanding and attitude of Chinese ENT (ear, nose, and throat) specialists in regards to SIT is unclear. This study investigates current trends in the awareness and application status of SIT among Chinese ENT specialists. METHODS: We performed a nationwide, cross-sectional survey with a specially designed questionnaire given to 800 ENT specialists in China. A member of the trained research group conducted face-to-face interviews with each respondent. RESULTS: Most of the respondents considered AR (96.0%) and allergic asthma (96.0%) the most suitable indications for SIT. Of all respondents, 77.0% recommended the application of SIT as early as possible; in addition, SIT was considered 'relatively controllable and safe' by most respondents (80.6%). The highest allergen-positive rate in AR was associated with house dust mite (47.7%) and obvious differences existed among geographical regions. Conventional subcutaneous immunotherapy was the most highly recommended treatment option (96.2%). 'The high cost of SIT' (86.6%) and 'lack of patient knowledge of SIT' (85.2%) were probably the main reasons for the lower clinical use of SIT in China. CONCLUSIONS: Most cases showed that the opinions of Chinese ENT specialists appeared to be in agreement with recent SIT progress and international guidelines; however, many areas still need to enhance the standardization and use of SIT in China. Clinical guidelines for SIT require improvement; in addition, Chinese ENT specialists need continuing medical education on SIT.
Asian Continental Ancestry Group* ; Asthma ; China ; Cross-Sectional Studies ; Surveys and Questionnaires ; Education, Medical, Continuing ; Humans ; Immunotherapy* ; Nose ; Pyroglyphidae ; Rhinitis* ; Specialization* ; Surveys and Questionnaires

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Cysteinyl Leukotrienes and Their Receptors; Emerging Concepts.

Yoshihide KANAOKA ; Joshua A BOYCE

Allergy, Asthma & Immunology Research.2014;6(4):288-295. doi:10.4168/aair.2014.6.4.288

Cysteinyl leukotrienes (cys-LTs) are potent mediators of inflammation derived from arachidonic acid through the 5-lipoxygenase/leukotriene C4 synthase pathway. The derivation of their chemical structures and identification of their pharmacologic properties predated the cloning of their classical receptors and the development of drugs that modify their synthesis and actions. Recent studies have revealed unanticipated insights into the regulation of cys-LT synthesis, the function of the cys-LTs in innate and adaptive immunity and human disease, and the identification of a new receptor for the cys-LTs. This review highlights these studies and summarizes their potential pathobiologic and therapeutic implications.
Adaptive Immunity ; Arachidonate 5-Lipoxygenase ; Arachidonic Acid ; Asthma ; Clone Cells ; Cloning, Organism ; Humans ; Inflammation Mediators ; Leukotrienes*

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Epidermal Permeability Barrier Defects and Barrier Repair Therapy in Atopic Dermatitis.

Hae Jin LEE ; Seung Hun LEE

Allergy, Asthma & Immunology Research.2014;6(4):276-287. doi:10.4168/aair.2014.6.4.276

Atopic dermatitis (AD) is a multifactorial inflammatory skin disease perpetuated by gene-environmental interactions and which is characterized by genetic barrier defects and allergic inflammation. Recent studies demonstrate an important role for the epidermal permeability barrier in AD that is closely related to chronic immune activation in the skin during systemic allergic reactions. Moreover, acquired stressors (e.g., Staphylococcus aureus infection) to the skin barrier may also initiate inflammation in AD. Many studies involving patients with AD revealed that defective skin barriers combined with abnormal immune responses might contribute to the pathophysiology of AD, supporting the outside-inside hypothesis. In this review, we discuss the recent advances in human and animal models, focusing on the defects of the epidermal permeability barrier, its immunologic role and barrier repair therapy in AD.
Dermatitis, Atopic* ; Humans ; Hypersensitivity ; Inflammation ; Models, Animal ; Permeability* ; Skin ; Skin Diseases ; Staphylococcus aureus

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Current Specific Immunotherapy for Allergic Rhinitis: Perspectives from Otorhinolaryngologists.

Chae Seo RHEE

Allergy, Asthma & Immunology Research.2014;6(4):273-275. doi:10.4168/aair.2014.6.4.273

No abstract available.
Immunotherapy* ; Rhinitis*

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Using Periostin as a Biomarker in the Treatment of Asthma.

Kenji IZUHARA ; Shoichiro OHTA ; Junya ONO

Allergy, Asthma & Immunology Research.2016;8(6):491-498. doi:10.4168/aair.2016.8.6.491

Periostin acts both as an extracellular matrix protein belonging to the fasciclin family and as a matricellular protein functioning in cell activation by binding to its receptors on the cell surface. It has been established that periostin is a downstream molecule of interleukin (IL)-13, a signature type 2 cytokine, and that periostin plays an important role in the pathogenesis of allergic diseases, including asthma. Based on these findings, much attention has been paid to periostin as a biomarker useful in the treatment of asthma. Periostin is a surrogate biomarker for type 2 immunity; it has been shown that serum periostin can predict the efficacy of anti-IL-13 antibodies (lebrikizumab) and anti-IgE antibodies (omalizumab), and that this usefulness can be potentially expanded to other type 2 antagonists. Moreover, it has been shown that periostin is not a simple surrogate biomarker for type 2 immunity; periostin-high asthma patients have several unique characteristics, including eosinophilia, high fraction of nitric oxide, aspirin intolerance, nasal disorders, and late onset. These characteristics are likely to be correlated with the involvement of periostin in the tissue remodeling of asthma. Periostin is also associated with hyporesponsiveness to inhaled corticosteroids, probably reflecting tissue remodeling. Thus, periostin has 2 characteristics as a biomarker for early diagnosis of asthma: surrogate biomarkers for type 2 immunity and tissue remodeling. Based on these characteristics, we will be able to apply serum periostin to treatment of asthma.
Adrenal Cortex Hormones ; Antibodies ; Aspirin ; Asthma* ; Biomarkers ; Early Diagnosis ; Eosinophilia ; Extracellular Matrix ; Humans ; Interleukins ; Nitric Oxide ; Nose Diseases

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Eicosanoid Mediators in the Airway Inflammation of Asthmatic Patients: What is New?.

Marek SANAK

Allergy, Asthma & Immunology Research.2016;8(6):481-490. doi:10.4168/aair.2016.8.6.481

Lipid mediators contribute to inflammation providing both pro-inflammatory signals and terminating the inflammatory process by activation of macrophages. Among the most significant biologically lipid mediators, these are produced by free-radical or enzymatic oxygenation of arachidonic acid named "eicosanoids". There were some novel eicosanoids identified within the last decade, and many of them are measurable in clinical samples by affordable chromatography-mass spectrometry equipment or sensitive immunoassays. In this review, we present some recent advances in understanding of the signaling by eicosanoid mediators during asthmatic airway inflammation. Eicosanoid profiling in the exhaled breath condensate, induced sputum, or their metabolites measurements in urine is complementary to the cellular phenotyping of asthmatic inflammation. Special attention is paid to aspirin-exacerbated respiratory disease, a phenotype of asthma manifested by the most profound changes in the profile of eicosanoids produced. A hallmark of this type of asthma with hypersensitivity to non-steroid anti-inflammatory drugs (NSAIDs) is to increase biosynthesis of cysteinyl leukotrienes on the systemic level. It depends on transcellular biosynthesis of leukotriene C₄ by platelets that adhere to granulocytes releasing leukotriene A₄. However, other abnormalities are also reported in this type of asthma as a resistance to anti-inflammatory activity of prostaglandin E₂ or a robust eosinophil interferon-γ response resulting in cysteinyl leukotrienes production. A novel mechanism is also discussed in which an isoprostane structurally related to prostaglandin E₂ is released into exhaled breath condensate during a provoked asthmatic attack. However, it is concluded that any single eicosanoid or even their complex profile can hardly provide a thorough explanation for the mechanism of asthmatic inflammation.
Arachidonic Acid ; Asthma ; Eicosanoids ; Eosinophils ; Granulocytes ; Humans ; Hypersensitivity ; Immunoassay ; Inflammation* ; Isoprostanes ; Leukotrienes ; Macrophages ; Oxygen ; Phenotype ; Spectrum Analysis ; Sputum

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Factors Predicting Recovery From Asthma Exacerbations.

Chang Gyu JUNG ; Hae Sim PARK

Allergy, Asthma & Immunology Research.2016;8(6):479-480. doi:10.4168/aair.2016.8.6.479

No abstract available.
Asthma*

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A Case of Serum Sickness-Like Reaction and Anaphylaxis - Induced Simultaneously by Rifampin.

Dong Hyun KIM ; Young Hwan CHOI ; Hyoung Sang KIM ; Ji Eun YU ; Young Il KOH

Allergy, Asthma & Immunology Research.2014;6(2):183-185. doi:10.4168/aair.2014.6.2.183

Rifampin is commonly used as a first-line anti-tuberculosis drug, but it can induce a serum sickness-like reaction or anaphylaxis. However, it is possible for 1 drug antigen to induce 2 or more simultaneous immunologic reactions. Here, we report a case of a serum-sickness-like reaction and anaphylaxis induced concurrently by rifampin. A 25-year-old male presented with high fever and a maculopapular rash with vesicles on the hands, which developed 2 weeks following regular administration of anti-tuberculosis drugs for tuberculous meningitis, including rifampin. Elevated liver enzymes, peripheral neuropathy, and decreased serum C3 and C4 levels were found. Interestingly, these symptoms were accompanied by severe hypotension. A serum-sickness-like reaction was considered after excluding other potential causes for the fever. A drug provocation test showed that the fever developed after oral administration of rifampin, suggesting that rifampin was the cause of the allergic reaction. However, hypotension, epigastric discomfort, and diarrhea also accompanied these symptoms, indicating that IgE-mediated type I hypersensitivity could be part of the serum sickness-like reaction. An intradermal skin test clearly showed an immediate positive reaction to rifampin. This case was diagnosed as concurrent serum-sickness-like reaction and anaphylaxis induced by rifampin. One drug may therefore induce combined allergic reactions via 2 or more simultaneous hypersensitivity responses.
Administration, Oral ; Adult ; Anaphylaxis* ; Diarrhea ; Exanthema ; Fever ; Hand ; Humans ; Hypersensitivity ; Hypersensitivity, Immediate ; Hypotension ; Liver ; Male ; Peripheral Nervous System Diseases ; Rifampin* ; Skin Tests ; Tuberculosis, Meningeal

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