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Background: Early prediction of asthma is crucial for asthma prevention. Objective: We estimated the odds ratio (OR) of recurrent wheezing during the first 3 years of life, atopic rhinitis, and maternal asthma for asthma in school-age children (ages ≥ 6 years). Methods: This case-control study was conducted in Salvador, Brazil. Medical records of children diagnosed with asthma (cases) and of children screened for pulmonary illnesses and without asthma (controls) were reviewed. Information was retrieved and registered in standardized forms. Results: We included 125 subjects (cases) and 375 controls, whose median (percentile 25th‐percentile 75th) age was 8.1 years (6.6‐10.0 years) and 9.2 years (7.0‐11.9 years), respectively. The subjects (cases) and the controls had at least three episodes of wheezing during the first 3 years of life (69.7% and 1.4%, respectively), a maternal history of asthma (36.0% and 4.0%, respectively), and atopic rhinitis (95.9% and 35.1%, respectively). The adjusted OR of three or more episodes of wheezing during the first 3 years of life was OR 132.5 (95% confidence interval [CI], 36.8‐477.1), of a personal history of atopic rhinitis was OR 21.3 (95% CI, 5.3‐85.0), and of maternal asthma was OR 10.2 (95% CI, 3.1‐33.6) for asthma in a logistic regression (which also included age, gender, and maternal history of allergic rhinitis [OR insignificant for these factors]). Conclusion: Children with a history of three or more episodes of wheezing during the first 3 years of life were at least 37 times more likely to develop asthma than children without this history. A maternal history of asthma and a personal history of atopic rhinitis are also predictors of asthma in children.

In this commentary, we focus on allergy as a facilitating factor in the pathogenesis of alopecia areata (AA). From previous studies on AA, it is well known that subsets of patients can have one or more of; seasonal relapse, comorbid atopic rhinitis, asthma and dermatitis, lesion infiltrating eosinophils and plasma cells, high levels of total IgE, specific IgE for house dust mites (HDMs), and/or disrupted skin barrier function by the evaluation of filaggrin. Allergy and AA share a similar genetic background; both contributing to an immune reaction imbalance. Furthermore, adjunctive treatment with antihistamines, or desensitization for HDM, can reduce the severity of alopecia in atopic AA patients. Therefore, allergies may contribute to the onset and relapse of AA. Identification of an allergic or atopic immune component in AA patient subsets may indicate adjunctive treatment intervention measures against allergies should be taken which may improve the success of conventional AA treatment.

Allergic condition such as itching of the skin, or runny nose and sneezing are widely known, but different case of allergic reaction in the mouth. Are still unknown, one of them is Oral Allergy Syndrome (OAS). Almost everyone knows food allergens such as shrimp, or marine fish, but actually fresh fruits and vegetables also can trigger allergic reactions like OAS in the form of itching or swelling of the lips, tongue, palate, and pharynx. Author intends to provide further information about the OAS in this paper. The mechanism of OAS is a type I, immunoglobulin E-mediated hypersensitivity reaction, common in atopic people with history of atopic rhinitis, bronchial asthma, or urticaria. Food allergen that causes OAS have a cross reaction/ homolog with pollen from protein pathogen respons / PR-10 family, such as Bet v 1 (Birch) and Bet v 2 (Birch). Some OAS allergens from vegetables that homolog with Bet v 1 includes celery (Api g 1) and soybean (Gly m 4), and other allergens from fruits homolog with Bet v 2, such as Ana c1 alergen pineapple. The diagnosis of OAS based on medical history, clinical examination and diagnostic tests includes skin prick test, specific IgE serum, or basophil activation test, and cellular antigen stimulation test with an enzyme-linked immunosorbent assay. Management of OAS consists of non-pharmacological includes information and education to avoid the causes, and give suggestion to eat cooked food. Pharmacologically are prescription of antihistamines or epinephrine injection in case of emergencies. Signs and symptoms of OAS in fact have long been found, but its diagnosis and management are still not widely known. Dentist should know about signs and symptoms of food allergy in the oral mucosa include OAS which caused by fruits and vegetables such as celery, soybean, carrot, apple, pineapple, and strawberry, so finally dentist will provide good management for the patient..

Background: Polymorphisms of cytokine genes are an interesting focus for association studies involving atopic diseases due to their role in immune cell communications during inflammation. The aim of this study was to investigate associations of TNFα -308G>A, TNFα -238G>A, IL-1α -889C>T and IL-10 -1082G>A polymorphisms with atopic diseases with adjustment for confounding lifestyle and environmental factors. Methods: This study was performed on 356 Croatian students. The diagnosis of atopic asthma, atopic rhinitis and atopic dermatitis was based on symptoms reported by the modified International Study of Asthma and Allergies in Childhood questionnaire and a positive skin prick test (SPT) to at least one common inhalatory allergen. Genetic polymorphisms were genotyped using the polymerase chain reaction-based technique. The influence of personal (gender, body mass index, parental history of atopic disease), lifestyle (cigarette smoking, pet ownership) and environmental (urban/rural residency, residency in continental/Mediterranean region) factors reported in the questionnaire was investigated by univariate and multivariate analysis. Results: Compared to the control subjects, univariate analysis showed a significant negative association of the TNFα -308G>A polymorphism with atopic asthma, atopic dermatitis, asthma and skin symptoms and positive SPT. These observations were confirmed in a multivariate model only for atopic dermatitis and skin symptoms (atopic dermatitis: OR = 0.27; 95% CI 0.07-1.00; p = 0.050; skin symptoms: OR = 0.29; 95% CI 0.10-0.83; p = 0.021). Conclusions: The results indicate a protective role of TNFα -308G>A genetic polymorphisms regarding atopic dermatitis and skin symptoms even after controlling for personal, lifestyle and environmental factors. Further studies are needed to elucidate the molecular patterns of this association in atopic dermatitis and other chronic inflammatory skin disorders.

Epidemiological studies (International Study of Asthma and Allergies in Childhood [ISAAC], The European Community Respiratory Health Survey [ECRHS]) revealed considerable geographical differences in prevalence of atopic dermatitis (AD). The aim of our study is to present the epidemiology and the risk factors of AD in a Polish population. A total of 18,617 subjects were selected. The sample included respondents in eight cities and one rural area each over 150,000 citizens. The study had two parts: (i) questionnaire survey conducted among all respondents (response rate, 64.4%); and (ii) allergological examination performed among 25.7% with skin prick test (SPT) with 15 aeroallergens. AD was identified in 3.91% of subjects, more often in females, living in the cities, with a mother and/or father with atopy and with a higher education and higher economic status. Comorbidities of AD were atopic rhinitis (AR) in 26.17% and AR and asthma in 14.6%. AD was diagnosed by allergologists in 311 subjects (6.5%). Positive SPT occurred in 66.9% persons with AD (house dust mite, 33.1%; grasses/crop plants, 30.6%). Of the patients, 9.5% with perennial versus 9.3% seasonal and 9.6% with polyvalent versus 9.0% monovalent sensitization had AD. AD prevalence in Poland is below the mean rate for Europe, but risk factor profile is similar to other countries. AD is more frequent in female, well-educated individuals, of high socioeconomic status, with atopic parents and who live in a city. Seasonal and monovalent atopy play a more essential role in subjects with AD compared with AR and asthma.

Asthma and atopy are common diseases. To study associations between personality and asthma, atopy, rhinitis, and personality traits were measured on the Karolinska Scales of Personality for 193 persons working in 19 buildings with suspected indoor air problems. In addition, information on history of atopy, asthma, and rhinitis was collected by postal questionnaire. In analyses, asthma was associated with higher impulsiveness scores, and atopy in non-asthmatics was associated with higher social desirability scores and lower irritability, guilt, and impulsiveness scores. Non-atopic rhinitis was associated with scores on several anxiety-related scales, while atopic rhinitis was not associated with scores on the Karolinska Scales of Personality. This exploration implies that asthma, atopy, and rhinitis may be associated with various but different personality trait scores. The finding of such personality trait associations in persons with non-asthmatic atopy raises the question of a potential role of an emotional conflict in atopy and the role of personality in asthma, atopy, and rhinitis.

Background: longitudinal studies of the natural history of childhood and adolescent rhinitis are lacking. Objectives: to investigate the natural history of rhinitis up to 18 years of age, and how that is influenced by gender and atopy. Methods: the Isle of Wight birth cohort was recruited in 1989 (n=1456). Questionnaire data on nasal symptoms (rhinitis) were collected at 1, 2, 4, 10 and 18 years of age. To define atopy, skin prick tests were conducted at 4, 10 and 18 years. The 12-month period prevalence plus positive and negative transitions (defined as change in disease status in two consecutive study assessments) were stratified by gender and atopic status. Results: overall rhinitis prevalence increased from 5.4% at 4 years to 35.8% at 18 years (P Conclusion: atopic rhinitis becomes increasingly common as children grow into adolescents, with stronger associations to male gender. Non-atopic rhinitis shows a female predominance at 18 years as girls ‘grow into’ it more during adolescence. Our findings suggest differential gender effects on the increasing prevalence of both atopic and non-atopic rhinitis in adolescence. Clinical Relevance: a better understanding of how gender and atopic status influence rhinitis during adolescence emerges from this study. Application of such knowledge could help to improve clinical recognition, judge prognosis and ultimately improve management of this common condition.

Summary Introduction: Assessments of the usefulness of exhaled nitric oxide (NO) in the treatment of asthma have given conflicting results. It is not always obvious if atopic status has been tested in these evaluations. Objectives: The aim of the study is to use extended NO analysis to characterize subjects from a random sample populations with focus on rhinitis and asthma. Methods: Data were extracted from the European Community Respiratory Health Survey II. A subgroup from the Uppsala site that had had their NO measured at multiple flow rates was included (n = 284). The nonlinear model for NO parameters was used. Atopy was defined as having a titre against at least one of the tested allergens ≥0·35 kU l−1. Bronchial responsiveness was assessed by methacholine challenge. Results: Subjects with non-atopic rhinitis or non-atopic asthma could not be separated from healthy subjects regarding NO parameters. There was a gradual increase with atopy in airway diffusion rate (DawNO); healthy subject 8·0 (7·3, 8·8), healthy atopic 8·8 (6·7, 11·5), atopic rhinitis 10·6 (9·0, 12·4) and atopic asthma 11·2 (9·9, 28·3) ml s−1 [geometrical mean (CI95%)]. There was a correlation between bronchial responsiveness and DawNO in atopic rhinitis (r = −0·41, P

There is conflicting evidence for the relationship between parental socioeconomic position and their children's asthma. The aim of this study was to investigate relationships between parental education and respiratory symptoms in their children, distinguishing atopic and non-atopic symptoms. A cross-sectional survey among 3262 elementary school children (age 8-13) was performed; data on parental education were obtained for 3213 children. Parents completed a questionnaire on their child's allergic and respiratory symptoms, and potential explanatory variables including family history, indoor environment, and the child's medical history. Subsets of children were tested for atopy (n = 1983), lung function (n = 2325), and airway hyperresponsiveness (AHR) (n = 880). Logistic regression was used to assess relationships of health outcomes with parental education. A high parental education was associated with an increased risk of atopic sensitization to indoor allergens (OR 1.31, 95% CI 1.02; 1.69). Studied explanatory variables did not influence the relationship. In contrast, a high parental education protected children from wheeze (OR 0.77, 95% CI 0.61; 0.97). This only applied to non-atopic wheeze (OR 0.65, 95% CI 0.43; 0.99) and not to atopic wheeze (OR 0.89, 95% CI 0.60; 1.31). The protection from non-atopic wheeze in children of highly educated parents declined after adjustment for household smoking and breastfeeding (OR 0.96, 95% CI 0.58; 1.57). Similar results were observed for non-atopic and atopic rhinitis. We conclude that children from highly educated parents are protected from non-atopic respiratory symptoms, which is largely explained by a lower rate of household smoking and a higher rate of breastfeeding.

Inflammation through the respiratory tract is a crucial event in immune disorders, including asthma, and atopic rhinitis. To investigate whether an aqueous extract of Angelica archangelica L. (AaL) has a beneficial influence in terms of anti-asthmatic activity, its effects on an ovalbumin-induced asthmatic model were examined. Mice sensitized to ovalbumin were orally administered the AaL extract, and their lungs examined by Haematoxylin-Eosin staining to determine IL-4/13 cytokine expression. The AaL extract exerted strong anti-asthmatic effects by regulating each level in the CD4? cell number, IL-4/13, and other target markers in the lungs. Together, these results collectively indicate that the aqueous AaL extract ameliorates asthmatic symptoms effectively in a mouse ovalbumin-challenge model.

Several studies suggest that the prevalence of allergic diseases have increased worldwide in recent years. However, in Mexico, those diseases have not been assessed throughout time. The aim of this study was to determine whether there has been a change in the prevalence of childhood asthma, eczema, and atopic rhinitis in Mexican schoolchildren. Following the methodology recommended by the International Study of Asthma and Allergy in Childhood, we performed two cross-sectional assessments (1995/2002) using a standardized questionnaire-based survey answered by the parents of schoolchildren aged 6-8 years and 11-14 years randomly selected from schools in Cuernavaca, Mexico. The prevalence of asthma diagnosed by a doctor was 5.8% (95% CI, 5.2, 6.4) for 1995 versus 9.1% (95% CI, 8.3, 10.0) for 2002, with a greater prevalence in children aged 6-8 years in 2002 (5.7% versus 9.0%). No significant differences were found over time for wheezing in the last 12 months: 7.7% (95% CI, 7.1, 8.4) in 1995 and 8.0% (95% CI, 7.3, 8.8) in 2002. The prevalence of nasal and eye symptoms without colds was slightly higher in 1995 than it was in 2002: 9.9% (95% CI, 9.1, 10.7) versus 8.2% (95% CI, 7.4, 9.0), respectively. The results suggest an increase in the prevalence of asthma diagnosed by a doctor. However, no difference was observed in the prevalence of wheezing in the last 12 months, which may indicate a possible absence of "epidemic asthma" in the city of Cuernavaca among schoolchildren.

Background: There is a growing body of evidence that the early childhood environment with respect to day care attendance, older siblings, pet ownership, and early life airway infections may protect from developing atopic disease. Few studies have distinguished between atopic sensitization and symptoms, and none have evaluated independent contributions for all of these different environmental conditions. Objective: Examine independent effects on atopic sensitization and symptoms of day care attendance, older siblings, pet ownership, and early infancy's airway disease. Methods: A cross-sectional survey among 8–13-year-old school children with complete data for 1555 children. Results: After adjustment for confounders, atopic sensitization occurred less frequently in children that had attended a day care centre (OR: 0.73, 95% CI: 0.55–0.98) or had a cat or dog before 2 years of age (OR: 0.78, 95% CI: 0.61–0.99). Having older siblings yielded a nonsignificant trend towards protection (OR: 0.88, 95% CI: 0.70–1.11). For symptoms, there was no relation with having older sibs, day care attendance and pet ownership, although there was a trend towards protection for the combination of atopy and symptoms. In contrast, children with doctors’ treated airway disease before age 2, more frequently reported recent symptoms of wheeze, asthma, rhinitis, or dermatitis (all P

Asthma, atopic dermatitis, and atopic rhinoconjunctivitis are three distinct conditions, which are characterized by the production of specific immunoglobulin E (IgE) against common, ubiquitous allergens such as house dust mites, pollen, or animal dander. Once sensitized, re-exposure to allergen induces an inflammatory reaction of the affected organ: the bronchial system, the nasal and ocular mucosa, or the skin, respectively. At present, atopic diseases are the most common chronic illnesses in children living in the industrialized world. In general, asthma and atopy rates are higher in affluent, Western countries with a high degree of industrialization than in developing countries with a large, rural population. In a worldwide study in approximately 500,000 school-aged children from 56 countries, the highest prevalence of asthma was found in the United Kingdom, New Zealand, and Australia, and most developing countries had comparatively low prevalence rates. Within European countries, a West–East gradient in the prevalence of childhood asthma is present, which became apparent in studies shortly after the fall of the communist East. In the Baltic area of Northern Europe, Swedish children had a higher prevalence of atopic sensitization and asthma than did those from Poland and Estonia [1, 2]. Likewise, the prevalence of asthma, allergic rhinitis, and atopic sensitization was significantly higher in West Germany than in the East [3], a genetically homogeneous study population that had lived under very different economic and environmental circumstances for 40 years. In the years since unification, however, atopic sensitization as well as atopic rhinitis have increased significantly in East German children, almost to levels found in Western Germany, and levels of asthma were still low [4]. As most children in the communist system grew up in day-care centers from an early age, an intriguing explanation for these findings was that the early exposures to infections and microbial matter in day-care centers may have influenced the susceptibility to atopic diseases.

In clinically stable asthma the exhaled NO values (F(E)NO) are generally higher than in control subjects. Therefore, reference values are of limited importance in clinical practice. This is demonstrated in this case report, but it is also shown that NO parameters from non-linear modelling do have a clinical value. A subject with asthma was treated with inhaled corticosteroids for 1 week. The non-linear NO model was used to measure the response to treatment. The NO parameters from subjects with atopic rhinitis and asthma were fed into a computer program to generate theoretical F(E)NO₀.₀₅ values, i.e. target values. There was a dramatic decrease in F(E)NO₀.₀₅ due to treatment, from 82 to 34 ppb, but it remained higher than in healthy controls. This is due to the elevated diffusion rate of NO, unchanged by treatment. When the NO parameters are known, a personal best value of F(E)NO₀.₀₅ (fractional concentration of exhaled NO in the gas phase, 0.05 L/s) can be calculated, which can be the target value when only F(E)NO₀.₀₅ can be monitored. In conclusion, reference values for NO parameters are shown to be clinically useful. It is essential that every patient receives his/her target value of F(E)NO₀.₀₅, when only a single NO measurement is available. In our opinion, this is the reason why there are few successful studies of trying to target the NO value with inhaled corticosteroids.

Background Eosinophilic esophagitis (EoE) has repeatedly been associated with atopic manifestations, which are reported more frequently in these patients than in the general population. Objective To systematically assess the evidence and strength of the associations between EoE and atopy. Methods We performed a systematic search of the MEDLINE, EMBASE, and SCOPUS databases for case-control studies comparing the frequency of atopic diatheses among patients with EoE and control subjects representing the general population without EoE. Using random-effects meta-analyses, we calculated summary estimates, including 95% confidence intervals (CIs), for bronchial asthma, atopic rhinitis, and eczema. Publication bias risks were assessed by means of funnel plot analysis and specific statistical tests. Results Of the 2,954 references identified, data were collected from 21 studies, including a total of 53,542 patients with EoE and 54,759 controls. The criteria for defining a diagnosis of atopy in patients with EoE or controls was not structurally considered in most of the studies. Overall, allergic rhinitis was significantly more common among patients with EoE compared with control subjects (odds ratio [OR], 5.09; 95% CI, 2.91–8.90; I 2 = 86.7%) as were bronchial asthma (OR, 3.01; 95% CI, 1.96–4.62; I 2 = 84.5%) and eczema (OR, 2.85; 95% CI, 1.87–4.34; I 2 = 57.1%). Food allergies and other atopic conditions were also assessed. No significant publication bias was found for studies dealing with allergic rhinitis and eczema in EoE. Conclusion Despite pointing to a significant association between atopy and EoE, most of the studies provided no normalized diagnostic criteria for atopy. Further research should provide clear and standardized definitions of such conditions. Trial Registration www.crd.york.ac.uk/PROSPERO Trial Identifier: CRD42016036161.

Decreased spirometric indices are characteristic of asthma and other respiratory diseases. The aim of this study was to investigate the genetic and environmental components of variance of forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) measured in adulthood in an Australian population-based sample of 468 Caucasian nuclear families. The inter-relationships of the genetic determinants of these traits with asthma and atopic rhinitis were also investigated.Serial cross-sectional studies were conducted in the town of Busselton in Western Australia between 1966 and 1981 and follow-up of previous attendees was undertaken in 1995. Data from each subject included in this study were from a single survey in adulthood (25–60 yrs of age) when the subject was as close to age 45 yrs as possible.Multivariate analysis suggested that FEV1and FVC levels were associated with age, sex, height, tobacco smoke exposure, asthma and atopic rhinitis. After adjustment for relevant covariates, FEV1levels had a narrow-sense heritability (h2N) of 38.9% (SE 9.1 %). FVC levels had anh2Nof 40.6% (SE 8.9%). Extended modelling demonstrated little overlap in the genetic determinants of asthma or atopic rhinitis and either FEV1or FVC levels.The results of this study were consistent with the existence of important genetic determinants of adult lung function that are independent of asthma or other atopic disease, cigarette smoking, height, age or sex.

Upper airway congestive symptoms during pregnancy have been recognized since the turn of the century. 60 Among randomly selected pregnancies, as many as 30% of patients report substantial symptoms of rhinitis and rhinosinusitis, and this figure may be higher among patients with pre-existing atopic disease. 21,58,59 "Rhinitis of pregnancy" can take many forms. The incidence of allergic rhinitis among women of childbearing years is approximately 20%. 82 Of those pregnant women with known allergies, some studies suggest that approximately 10% will experience increasing allergic symptoms during their pregnancy and 90% will remain the same. 35,94 Other rhinitis presentations in pregnancy include rhinosinusitis, rhinitis medicamentosa, and the ill-defined vasomotor rhinitis . Further complicating the picture is the fact that the frequency of sinusitis may be as high as 1.5% in pregnancy, which represents a sixfold increase over the frequency observed in a nonpregnant population. 91 Pregnant women also tend to develop rhinitis medicamentosa, complicating other rhinitis syndromes, probably because of their tendency to use exclusively topical medications to protect their fetuses. 50 A more nonspecific form of rhinitis is described by some pregnant women as nasal stuffiness with some dryness and episodes of epistaxis. This form has been given the confusing term vasomotor rhinitis , which implies an alteration of the natural integrity of the vasomotor or secretomotor function of the nose; however, nasal vascular pooling secondary to the increased circulating blood volume and perhaps other nasal reactive enhancement properties induced by maternal hormones have been forwarded as more likely mechanisms. There is understandable reluctance on the part of physicians caring for pregnant patients to employ the modalities commonly used in the diagnosis and management of rhinitis because of fetal risk factors, the time-limited nature of pregnancy, and the litigious nature of the American public. There are few data regarding the clinical effect of the various forms of rhinitis on pregnancy. On the surface it seems unlikely that gestational forms of rhinitis would have a deleterious effect on the course of pregnancy; however, uncontrolled atopic rhinitis or sinusitis during pregnancy may aggravate coexisting asthma, which can have a distinct adverse effect on pregnancy outcome. Furthermore, the risk of sinusitis and the impact rhinitis may have on the pregnant mother's eating, sleeping, and emotional well-being could be significant, suggesting that rhinitis during pregnancy should be actively evaluated and treated to optimize pregnancy outcome.

Background Exercise-induced bronchospasm (EIB) is frequent among asthmatic children. However, opinions differ on the relation between EIB and rhinitis in the absence of asthma. Objectives We assessed the relationship between EIB and various phenotypes of rhinitis according to asthmatic status at the general population level in the Six Cities Study. Methods Of 7781 schoolchildren with a mean age of 10 years underwent an EIB test and skin prick test to assess allergic sensitization. Their parents completed a standardized questionnaire recording asthma-like symptoms and past-year rhinoconjunctivitis, ever hay fever (EHF), and a score for allergic rhinitis (SFAR) ≥7 as a marker of 'past-year allergic rhinitis'. Exercise-induced bronchospasm was defined as a fall in peak expiratory flow rate ≥15% after exercise. Results Of the 6813 schoolchildren retained for analysis, 227 (3.33%) experienced EIB after exercise. Odds ratios [95% confidence intervals] between EIB and allergic rhinitis phenotypes in the absence of asthma were 1.56 [0.92-2.63] for EHF, 1.97 [1.16-3.35] for past-year rhinoconjunctivitis, and 1.84 [1.16-2.91] for a SFAR ≥7. Results were unchanged after adjustment for confounders. Multiple correspondence analysis showed that EIB, although related to asthma, constitutes a separate entity. Exercise-induced bronchospasm was not significantly related to familial history of asthma. Conclusion In our large population-based sample of children, different phenotypes of atopic rhinitis were associated with EIB, independently of asthma. Exercise-induced bronchospasm, although related to asthma, seems to constitute a separate entity. Clinical relevance In this large (6813) sample of 10-year children drawn from the general population, EIB is associated with rhinitis phenotypes in the absence of asthma. Furthermore, it constitutes an entity independent from asthma and is not related to a familial history of asthma. Thus, investigating these symptoms could be important in this disease, as a specific nasal treatment might improve EIB in these children.

Background Obesity is regarded as a potential risk factor for atopy. The aim of this study was to assess the associations of obesity with atopic dermatitis, rhinitis, asthma and food allergy in Chinese adults. Methods Two hundred and sixty six (266) atopic cases in Harbin, China, were identified according to the current Chinese guidelines for the diagnosis of atopic diseases. All cases had a previous diagnosis of atopic disorders (atopic dermatitis, rhinitis, asthma or food allergy) and were positive in one or more allergen specific IgE tests to 16 common allergens in the region. Each case was individually matched to two healthy controls based on their age, sex, and residential regions. All 532 healthy controls were negative in allergen specific IgE tests. The associations of obesity with four atopic disorders were assessed using a conditional logistic regression method. Results Obesity was significantly associated with the presence of atopic diseases (OR = 3.2, 95% CI: 1.8, 5.7). Males and females had a similar association (OR = 3.1 for males and 3.2 for females). The associations of obesity with atopic dermatitis (OR = 2.7, 95% CI: 1.2, 6.3) and atopic rhinitis (OR = 3.1, 95% CI: 1.1, 8.7) were statistically significant. Although obesity was positively associated with atopic asthma, this association was not statistically significant (OR = 3.4, 95% CI: 0.6, 19.9). The association between obesity and food allergy was weak and not significant (OR = 1.1, 95% CI: 0.4, 3.7). Conclusions Obesity is positively associated with the presence of atopic diseases in Chinese adults. Specifically, obesity is significantly associated with atopic dermatitis and rhinitis. Our findings warrant further investigation on the causal nature between obesity and atopic diseases and the effect of weight reduction on preventing atopic diseases.

The Swiss SAPALDIA study is a large multicenter cross-sectional study initiated in 1991 to evaluate the relationship between environment and respiratory symptoms and diseases in adults, and included subjects from eight areas in Switzerland with distinctive environmental characteristics. We present here prevalence data for atopy, pollinosis and atopic asthma obtained from a random sample of 8,357 adults (18-60 years) assessed by standardized computer-based interview as well as by allergy skin prick tests (SPTs) (performed with Phazet) to grass, birch and Parietaria pollen, house dust mite, cat and dog epithelia and the moulds Alternaria and Cladosporium and by an in vitro allergy screen test (Phadiatop CAP FEIA system). On the basis of a positive Phadiatop (total 28.9%; males 32.9%, females 25.0%; p or = 3 mm), the highest rate was observed for grass (12.7%), followed by house dust mite (8.9%), silver birch (7.9%), cat (3.8%) and dog (2.8%), whereas moulds and Parietaria elicited less than 1% positive SPTs. The prevalence of atopic rhinitis (rhinitis symptoms associated with atopy) was 13.5% (males 14.3%, females 12.6%; p < 0.05) and the prevalence of current hay fever varied between 9.1% (questionnaire answer and a positive SPT to at least one pollen), 11.2% (questionnaire answer and presence of atopy) to 14.2% (questionnaire answer only) with no significant difference by sex.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: We studied subjects with atopic asthma, atopic rhinitis, and nonatopic healthy subjects to evaluate responsiveness to bronchoprovocation with both methacholine and allergen. Methods: Subjects with a demonstrable FEV 1 PD 20 to methacholine or allergen (responders) were further analyzed for putative sensitivity (PD 20 FEV 1 ) and reactivity (dose-response slopes) to determine whether any characteristics could distinguish individuals with asthma from other responders. Subjects were recruited without sex restrictions and were between the ages of 18 and 45 years old. They were nonsmokers, had no other medical problems, and were free of upper respiratory infection for at least 6 weeks before challenge. All had a history taken, physical examination, limited laboratory screening, chest radiography, pulmonary function testing, and intradermal skin testing before admission to the study. Results: Although the groups were significantly different in both sensitivity and reactivity to methacholine, responses to allergen bronchoprovocation were sufficiently similar between responders with asthma and those with rhinitis to prevent separation on the basis of either sensitivity or reactivity. The fall in FEV 1 at the nadir of the late response, which was greater in the asthma group, was significantly correlated with sensitivity and reactivity of the immediate response to allergen but not to methacholine. Regression analysis demonstrated a stronger association between allergen and methacholine responsiveness in subjects with rhinitis than in subjects with asthma. Conclusion: We concluded that (1) nonspecific bronchial hyperresponsiveness fails to explain why patients with allergic asthma have clinical asthma as a result of allergen exposure and patients with allergic rhinitis do not; (2) hyperresponsiveness to allergen does not simply reflect quantitative or qualitative airway nonspecific hyperresponsiveness; and (3) clinical asthma may involve mechanisms difficult to elucidate by laboratory bronchoprovocation techniques.

Inflammation of the respiratory tract is a crucial process in immune diseases, including asthma, and atopic rhinitis. To establish whether an aqueous extract of Spinacia oleracea Linn (SoL) has a beneficial influence in terms of antiasthmatic activity, we examined its effects on an ovalbumin-induced asthmatic model. Mice sensitized to ovalbumin were orally administered the SoL extract, and their lungs examined by hematoxylin and eosin staining to determine IL-4/13 cytokine expression. The SoL extract exerted strong antiasthmatic effects by inducing a decrease in the CD4 + cell number, IL-4/13, and other molecular markers in the lung. Our results collectively indicate that the aqueous SoL extract ameliorates asthmatic symptoms effectively in a mouse ovalbumin-challenge model.

Chemical allergy describes adverse health effects that result from the stimulation of specific immune responses by chemicals. Hypersensitivity reactions are the result of normally beneficial immune responses acting inappropriately against benign antigens, causing inflammatory reactions and tissue damage. The two most frequent manifestations of chemical-induced allergy are contact hypersensitivity and respiratory sensitization, both of which can have serious impact on quality of life, and represent a common occupational health problems. Chemical agents cause approximately 30% of cases of occupational asthma and roughly 90% of these cases involve immunological mechanisms (allergy). Over the past few decades industrialized countries have witnessed a significant increase (although the rate of increase has recently slowed) in the prevalence of atopic diseases including atopic rhinitis, bronchial asthma and urticaria. Many factors, both intrinsic and extrinsic, can contribute to the development of chemical allergy. In particular, the immune response can be affected by the genetic background, pathological conditions, hormonal and central nervous system status, etc. and by chemical related factors, e.g. dose level, frequency, route and duration of exposure, biotransformation, pharmacokinetics, chemical reactivity, etc. Furthermore, chemical pollution, indoor environment, diet, vaccination programs and the "hygiene hypothesis" have also been implicated in the increased prevalence of asthma and atopic diseases. Following the influence of condition of exposure, heritable and acquired factors, such as age, genetic background, gender etc. on chemical allergy is discussed.

Summary Background Epidemiological relation of intestinal helminth infection and atopic disease, both associated with a T-helper (Th) 2 immune response, is controversial, as it has been reported that helminth infection may either suppress or pre-dispose to atopic disease. This relation has not been tested in an area with a high burden of Mycobacterium tuberculosis (MTB) infection, a known Th1-stimulating infection. Objective To study the association of intestinal helminth infection and atopic disease in a community where helminth infection is endemic and MTB infection is high. Methods Three-hundred and fifty-nine randomly selected children aged 6–14 years from a poor urban suburb were tested with allergy questionnaire, skin prick test (SPT) to common aeroallergens, Ascaris-specific IgE (Ascaris-sIgE), fecal examination for pathogenic intestinal helminths and tuberculin skin testing (TST). Histamine bronchoprovocation was tested in the group of children aged 10 years and older. Results were corrected for demographic variables, socioeconomic status, parental allergy, environmental tobacco smoke (ETS) exposure in the household, recent anthelminthic treatment and for clustering in the sampling unit. Results Ascaris-sIgE was elevated in 48% of children, Ascaris eggs were found in 15% and TST was positive in 53%. Children with elevated Ascaris-sIgE had significantly increased risk of positive SPT to aeroallergens, particularly house dust mite, atopic asthma (ever and recent), atopic rhinitis (ever and recent) and increased atopy-related bronchial hyper-responsiveness. In children with negative TST (

A novel IL4RA polymorphism, Ala57Thr, was identified in Greenlander Inuit.We sought to determine whether the novel Thr57 allele is population specific and to assess the associations of Ala57Thr and Ile50Val with atopy in 2 Inuit populations.Ala57Thr and Ile50Val were genotyped in 651 Inuit living in Denmark, 1295 Inuit living in Greenland, and 1329 individuals from 7 populations from widely differing global locations. In Inuit the polymorphisms were evaluated for associations with atopy, rhinitis, asthma, and pulmonary function.Thr57 was in linkage disequilibrium with Ile50 (D' = 1, r(2) = 0.13) and was common (33%) in the Inuit but rare (0.6%) in all other populations. In Inuit living in Denmark, the Thr57 allele (in a dose-dependent manner) and the Ile50/Thr57 haplotype were associated with lower risk of atopy (P(linear) = .003 and P = .034, respectively), with similar trends observed for atopic rhinitis and atopic asthma. In Inuit living in Greenland, Thr57 was not associated with atopy or atopic diseases, but Ile50 was weakly associated with lower risk of atopy.The novel IL4RA Ala57Thr was common in and population specific to Greenlander Inuit, with Thr57 associated with a lower risk of atopy in those living in Denmark. Hence a full investigation of genotype-phenotype relationships in a given population can only be achieved if each gene is screened for novel polymorphisms in that population.Clinical risk attributable to variations in a gene in an ethnic group requires that all variations of the gene are known for that group.

Summary Background Atopy is a common syndrome underlying asthma, rhinitis, and eczema, and is characterised by high immunoglobulin E (IgE) responses to common antigens. IgE and mast-cell chymase (MCC–a serine protease secreted by skin mast cells) have a key role in atopic or allergic inflammation of the skin. The gene for MCC is located within a cluster of genes for cellular proteases on chromosome 14q11·2. We aimed to identify variants of MCC and another gene within this complex, and assess whether there is a genetic association between variants of MCC and atopic disorders–particularly eczema. Methods We randomly selected 100 controls and recruited patients-100 in each group–with atopic asthma, non-atopic asthma, atopic rhinitis, and atopic eczema. PCR amplification was used to test genomic DNA for an association between allelic polymorphisms in MCC and a flanking gene (CGL1, for the cathepsin-G-like protein) on chromosome 14q11 and asthma, rhinitis, and eczema. Findings We found a significant association between a BstXI polymorphism in MCC and eczema (odds ratio 2 17 [95% CM 21-3 88], p=0 009), but no association with atopic asthma, rhinitis, or non-atopic asthma. There was no association between an MboII polymorphism in CGL1 and any of the atopic disorders. Interpretation These findings suggest that variants of MCC may be one source of genetic risk for eczema.

Background: The interleukin (IL) 4/IL13 pathway is involved in the regulation of IgE production associated with atopic diseases. Numerous polymorphisms have been identified in the coding region of the IL4 receptor α chain (IL4Ra) and previous association studies have shown conflicting results. Based on their putative functional role, polymorphisms A148G, T1432C and A1652G, located in the coding region of IL4Ra, were selected for association and haplotype studies in a large German population sample (n = 1,120). Methods: Genotyping was performed using allele-specific PCR and restriction-enzyme-based assays. Haplotypes were estimated, and population-derived IgE percentiles (50% IgE >60 IU/ml, 66% IgE >115 IU/ml and 90% IgE >457 IU/ml) were calculated as outcome variables in a haplotype trend regression analysis. Results: In our population, only polymorphism T1432C showed a trend for a protective effect against atopic rhinitis (odds ratio, OR: 0.52, 95% confidence interval, CI: 0.26–1.02, p = 0.05). When haplotypes were calculated, one haplotype was significantly associated with elevated serum IgE levels at the 50th percentile (OR 1.60, 95% CI 1.08–2.37, p = 0.02). Conclusions: These data indicate that IL4Ra polymorphisms, although suggested to be functionally relevant by in vitro studies, have only a minor influence on IgE regulation in our large population sample.

Background: A high prevalence of bronchial hyperresponsiveness (BHR) was found in atopic subjects with rhinitis. Those subjects may be at higher risk for developing bronchial asthma. We evaluated, in a 7-year follow-up, BHR and atopy in a homogeneous population of nonasthmatic children with allergic rhinitis (AR), and their role in asthma development. Methods: Twenty-eight children (6–15 years) with AR were studied. At enrollment (T0), skin tests, total serum IgE assay, peak expiratory flow (PEF) monitoring and methacholine (Mch) bronchial challenge were performed. BHR was computed as the Mch dose causing a 20% forced expiratory volume (FEV)1 fall (PD20FEV1) and as dose–response slope (DRS). Subjects were reassessed after 7 years (T1) using the same criteria. Results: At T0, 13 children (46%), showing a PD20FEV1

Background: We aimed to investigate the influence of indoor factors on the prevalence of symptoms suggestive of atopic rhinitis in children aged 6–9 years in Upper Austria. Methods: We analyzed the results from an extended ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire, answered by the parents, about indoor environment and symptoms strongly suggesting atopic rhinitis. This was defined as having reported a running, obstructed, or itchy nose apart from having a cold in the last year. The overall response rate was 93.4%. After excluding 6016 children (17.1%) with changed indoor environment (due to allergies in the family), we analyzed the remaining subsample of 18606 questionnaires. Results: The following factors were associated with an increased risk: mother's smoking during pregnancy and/or during time of breast-feeding (OR 1.28; CI 1.07–1.52), synthetic bedding (OR 1.21; CI 1.09–1.36), dampness/mold at home (OR 1.51; CI 1.31–1.74), central heating with gas (OR 1.75; CI 1.06–2.87), and space heating (OR 1.66; CI 1.01–2.98). Cooking with wood (OR 0.62; CI 0.46–0.84) was negatively associated with symptoms. Conclusions: The indoor environment plays a role in the symptoms of atopic rhinitis in children. However, the population-attributable risks were not particularly high; they were between −2.7% and 9% for the various exposures considered in this study.

Chemokines and their receptors play an important role in the late inflammatory stage of asthma. In this study, we aimed to investigate polymorphisms of MCP-1 (CCL2), CCR2 and CCR5 which can affect qualitatively and/or quantitatively their production and thus influence both susceptibility and severity of asthma and its clinical and biological features. MCP-1 (A/G -2518), CCR2 (+/64I), CCR5 (G/A -59029) and CCR5 (032) polymorphisms were evaluated by PCR in 107 Tunisian patients with asthma and 169 healthy controls. No significant association was found between the four investigated polymorphisms and asthma. Nevertheless the haplotype MCP1*AG /CCR2*+/+ was significantly l ess frequent in patients (20.5%) compared to controls (32.5%) (p=0.03; OR=0.54; 95% CI: 0.29-0.98). Whereas no difference was observed in CCR2/CCR5 haplotypes between patients and controls. Analysis of polymorphisms with clinical and biological features showed that the concomitant presence of MCP-1*G/CCR2*64I alleles was less frequent in severe forms (4.34%) compared to moderate disease (12%) but the difference was not significant (p=0.27). No association was observed between the four polymorphisms and the presence of atopic rhinitis or atopic conjunctivitis and an elevated rate of serum IgE over 200 IU/ml. Additional effects of MCP-1 and its receptor CCR2 polymorphisms seem to be involved in disease susceptibility to asthma in Tunisian patients; nevertheless they could be protective against its severe forms.

M O N D A Y 615 Nucleotide Changes in Hypervariable Regions of Genes Coding Heavy Chains of IgE in Patients with Atopic Rhinitis, Bronchial Asthma and Atopic Dermatitis L. P. Titov, E. A. Stolyarova, T. A. Stolyarova, L. M. DuBuske; Republican Scientific and Practical Center for Epidemiology and Microbiology, Minsk, BELARUS, Immunology Research Institute of New England, Gardner, MA. RATIONALE: Prevalence of allergic diseases has increased in Belarus associated with increased production of IgE. METHODS: Sequences of IgE VH genes from databases of Gene-Bank patients with bronchial asthma (506), atopic rhinitis (133), dermatitis (83) and sequences of IgE VH genes from non-atopic donor (127) were studied. For identification of gene families, the software IMGT-QEST was used. Nucleotides replacement was performed by VVK 3.4 programs. RESULTS: VH genes coding IgE antibodies in non-atopic donors are mainly VH3 family (42; 86%), with VH4 and VH5 families also included in the IgE synthesis (17; 29% and 16; 54%, respectively). In patients with asthma versus allergic rhinitis, genes coding IgE mostly were formed by VH3 family (50; 59% versus 42; 86 %, respectively) with less from the VH 5 family (17; 39% versus 16; 54%) and VH4 family (12; 06% versus 17, 29%, respectively). VH genes coding of IgE in atopic dermatitis patients are based on VH4, VH5 and VH3 families (31; 32% versus 20; 48% and versus 24; 1% respectively).The lowest GC content was in the VH3 family (0.54360.002) with VH4 and VH5 families having 0.57260.002 and 0.57560 0019, respectively. VH3 family genes from asthmatics are characterized by predominance of change AT/GC over the substitution GC/AT (p

This study was designed to test the hypothesis that patients with atopic rhinitis and extrinsic asthma have a nasal mucous membrane defect that allows inhaled macromolecules access to immunocompetent cells. Three groups were studied: normal subjects, patients with extrinsic asthma, and patients with atopic rhinitis. Albumin 125I(20 muc) was applied to the nasal mucosa and venous blood samples were drawn at set intervals up to 4 hours. Thirty-two minutes after administration, a significantly greater percentage of the dose was found in the plasma of patients with atopic rhinitis than in that of normal subjects (p smaller than 0.001). Transport of intact albumin across the nasal mucosa was demonstrated by dialysis, gel filtration, and immunopercipitation experiments in 3/9 normal subjects, 1/9 patients with asthma, and 9/10 patients with rhinitis (p smaller than 0.02). These studies suggest that large, potentially antigenic molecules pass more readily across the nasal mucous membrane of patients with allergic rhinitis than that of normal subjects. No increase in nasal transport was seen in patients with extrinsic asthma. It has not been determined whether this defect is a cause or an effect of atopic rhinitis.

1.Three cases of Loeffler's syndrome are discussed. In each instance, atopic rhinitis and asthma were present and sensitivities to multiple inhalant allergens were demonstrated. 2.Presumably, polyvalent bacterial or intrinsic sensitivities were present in all three patients in addition to recognized extrinsic sensitivities. It is difficult and often impossible in the presence of multiple sensitivities to incriminate any single antigen as the cause of an episode of allergic pulmonary infiltration. 3.In two of the patients described, pulmonary infiltrations were characteristically transitory. In the third patient, although early infiltrations were of fleeting character, repeated attacks have left increasing residual fibrosis and evidence of irreversible damage. It is believed that irreversible changes after allergic pulmonary infiltrations are especially apt to occur when so-called intrinsic or bacterial sensitivities are present.

Allergic diseases, such as atopic rhinitis, bronchial asthma and urticaria, are prevalent and increasing in frequency. Mast cells are known to play a central role in the immediate phase reaction of allergic diseases through the IgE-mediated release of a variety of chemical mediators, such as histamine, leukotrienes and prostaglandins. In contrast, T lymphocytes, basophils and eosinophils are thought to be responsible for inducing the late phase response. However, whether the mast cell can be simplistically assigned a role in the immediate phase allergic response and whether mast cells are necessary for the ongoing allergic response, including the development of hyperresponsiveness, remains to be completely studied. In the present article, the author will discuss the integrated roles of mast cells in IgE-mediated allergic inflammation, with specific emphasis on the roles of mast cell-derived cytokines in the late phase allergic response and chronic allergic inflammation.

In atopy, the sex ratio deviates markedly from unity when the specific organ manifestations are considered separately. In atopic asthma, the male to female ratio is about 2:1. In the children of patients affected with atopic asthma, we determined the incidence of atopic dermatitis, atopic asthma and atopic rhinitis. Among children of women affected with atopic asthma, we found more often atopic manifestations than among children of men affected with atopic asthma (44 vs. 25.5%). This phenomenon, called the Carter effect, can be explained by the multifactorial mode of inheritance. A certain number of genes is necessary for clinical signs of atopy to become manifest. Women with atopic asthma have a higher threshold and therefore transmit more predisposing genes to their children. This demonstration of the Carter effect is a further argument in favor of polygenic inheritance of atopy.

Etiologic factors and incidence of bronchial hyperreactivity as a 'stigma' of bronchial asthma were studied in 237 patients suffering from perennial atopic rhinitis. All patients underwent detailed laryngologic and allergologic examination and pulmonary function tests at rest, after exercise, and after histamine inhalation. Most often the patients were sensitized to house dust, animal epidermis and fur, environmental dusts, poultry dander or fungal allergens. Bronchial hyperreactivity, typical of bronchial asthma, was observed in 48.52% of patients. Results were analysed statistically. It was concluded that early institution of causal therapy can cure the symptoms of rhinitis and prevent evolution of the disease into atopic bronchial asthma in patients already suffering from bronchial hyperreactivity.

Sequential annual examinations have been carried out in a group of children who were hospitalized 5 years previously for bronchiolitis. During the subsequent 5 year study period, 40 to 50 per cent of the children were observed to wheeze recurrently. These was a high incidence of positive family histories of allergy, atopic rhinitis and dermatitis, and increased eosinophils in the nasal secretions and peripheral blood. Strong skin test responses to allergens were seen predominantly in the wheezing subjects and increased in frequency during the 5 year period. Wheezing episodes were generally associated with respiratory infections but were also observed during exposure to skin test reactive antigens as the children became older. The relationship of the bronchiolitis episode to childhood asthma is discussed.