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Background: Because of the counter-regulation of Th1 and Th2 cells, Th1-type autoimmune diseases like thyroid autoimmunity and Th2-mediated allergic diseases like atopic dermatitis (AD) should occur in mutually exclusive populations. However, thyroid autoimmunity has been associated with chronic urticaria, and atopy is considered a cause of both AD and urticaria. Objectives: To assess the frequency of thyroid autoimmunity in children with AD and to study the correlation between the clinical severity of AD using the SCORing Atopic Dermatitis (SCORAD) score, and biochemical parameters of serum immunoglobulin E (IgE), absolute eosinophil count, and vitamin D levels. Materials and Methods: A hospital-based cross-sectional study was conducted, recruiting children (0-18 years) with AD. Patients on drugs affecting thyroid dysfunction and those with sick euthyroid syndrome or an immunodeficiency disorder were excluded. Clinical severity was assessed using SCORAD, and the thyroid profile, anti-thyroid peroxidase antibodies, antinuclear antibody (ANA), absolute eosinophil count, serum IgE, and vitamin D levels were measured. Results: Thyroid autoimmunity was diagnosed in 18.9% (10/53) of children. There was a significant correlation between SCORAD and serum IgE (r = 0.432, P = 0.002) and absolute eosinophil count (r = 0.575, P = <0.001). There was a negative correlation between SCORAD and vitamin D levels (r = -0.373, P = 0.006). Conclusions: Thyroid autoimmunity may be associated with AD, and a high index of suspicion is essential. Vitamin D also should be supplemented in children with AD as it is frequently found to be low, especially in severe cases. Multi-center case-control studies are required to determine the prevalence of thyroid autoimmunity in children with AD. [ABSTRACT FROM AUTHOR]

Allergic rhinitis (AR) is a chronic inflammatory disease induced by IgE mediated reaction and identified clinically by presence of nasal discharge, sneezing, itching and nasal congestion. Aim of this study was to determine Serum IgE level which is an important indicator of AR. To analyse the diagnostic significance of serum IgE level and their pharmacoeconomic status in the management of AR with commonly used antihistaminic. Estimation of serum IgE can serve as a simple and reliable investigative tool in the diagnostic and management of AR. Fifty two adult patient with history of allergic rhinitis were randomly divided into four study groups and administered either Cetirizine, Levocetirizine, Loratidine or Fexofenadine respectively for one week. Blood samples were analysed to determine serum IgE level and the results were subjected to statistical analysis. The mean value and standard deviation were obtained and tabulated using paired t test. A total 52 patient were divided into four group, 13 in each group of age between 18 and 65 years (mean age 33.73 ± 10.23 years); 48.08% females and 51.92% male were randomized. Mean compliance with treatment was 100% for all study groups. The mean serum IgE level was significantly reduced in Levocetirizine as compared to Cetirizine, Loratidine and Fexofenadine groups. Levocetirizine controls the symptoms of AR better as compared to Cetirizine, Loratidine and Fexofenadine and is a better choice due to its cost effectiveness, tolerability and safety profile. [ABSTRACT FROM AUTHOR]

Kimura disease is an uncommon disease entity that typically involves the lymph nodes predominantly in the head and neck region together with frequent involvement of salivary glands. Very few cases of it have been reported in literature globally, and in the context of India, it is even rare. Early suspicion of Kimura disease may prevent the patient from unnecessary invasive diagnostic tests. We present a case scenario of a 35 years old female, from a hilly area who presented with painless neck swelling for 3 months that was followed by fever, new onset pain at the site of neck swelling, and skin rashes. Diagnosis of Kimura disease was made based on histopathological findings aided by peripheral eosinophilia and elevated serum Immunoglobulin E (IgE) levels. Following the diagnosis, the patient was treated with a short course of oral steroids which produced an excellent response with a consequent decrease in the size of lymph nodes and resolution of the skin rashes. [ABSTRACT FROM AUTHOR]

Background: India is witnessing an epidemic of dermatophytosis. The role of host immune response against fungi in chronicity and dissemination is topic of ongoing research. We conducted cross‐sectional comparative study to determine the difference in Th1 (IFN‐γ) and Th2 (IL4) response in serum and tissue between acute and localised vs. chronic and disseminated cases. Methods: Patients (18–60 years) were divided in two groups—group A (n = 114, BSA <5%, single anatomic site, duration <6 months, n = 118) and group B (n = 107 BSA >10%, > one anatomic site, duration >12 months, n = 118). Clinical parameters along with serum levels of IgE, IL‐4 and IFN‐γ and expression of IL4 and IFN‐γ in dermal infiltrate were compared between group. Results: Trichophyton mentagrophytes complex was commonest causative fungi. Serum levels of IgE were significantly higher (median A‐539.2, B‐2901.0, p <.001) whereas levels IL‐4(median A‐21.3, B‐20.4, p <.001) and IFN‐γ(median A‐9.6, B‐5.1, p <.001) were significantly lower in chronic cases. Expression of IL‐4 was observed in most biopsy specimens in both groups without any difference in intensity of staining. Expression of IFN‐γ was not detected in all but one specimen across both the groups. Severe itching (OR:0.050, CI:0.018, 0.139, p <.001), sign of topical steroid abuse (OR:0.203,CI:0.077, 0.537; p =.001), ↓IFN‐γ (OR:4.683, CI:1.634, 13.418; p =.004) correlated significantly and independently with chronic dermatophytosis. Conclusion: Our study shows chronic and disseminated cases of dermatophytosis differ immunologically in terms of higher IgE, and lower IL4 and IFN‐γ. Expression of IL4 is present in tissue of both acute, localised and chronic disseminated cases. Expression of IFN‐γ cannot be established in our study. [ABSTRACT FROM AUTHOR]

Background: Latex glove allergy and its impact on healthcare workers (HCWs) have been studied in many countries, but the data is scarce from developing countries. Objectives: We wanted to estimate the prevalence and patterns of latex glove allergy among HCWs and to study the factors associated with it. Materials and Methods: We conducted a cross-sectional study among 1088 HCWs of a tertiary care center in South India with the screening questionnaire adopted from "Allergy and Asthma network." Skin prick test, patch test, and serum total immunoglobulin E (IgE) were performed only in consenting symptomatic HCWs. Results: The prevalence of latex glove allergy in our study subjects was 9.1% (99/1088). This includes latex protein allergy and contact dermatitis to rubber glove allergens. The most common manifestation of latex glove allergy was irritant contact dermatitis observed in 68 HCWs (68.6%). Other presentations were allergic rhinitis (40.4%), allergic contact dermatitis (17.1%), contact urticaria (11.1%), allergic conjunctivitis (6.06%), and asthma (3.03%). The risk factors associated with latex glove allergy in our study were atopy (OR = 20.51), working in both ward and operation theater (OR = 26.6), auxiliary staff (OR = 4.75), and more than ten years of hospital work experience (OR = 3.85). Conclusion: Our study reported a high prevalence of latex glove allergy. With irritant contact dermatitis being the most common manifestation in our study, HCWs at risk shall be educated on the appropriate use of gloves and hand moisturizer to prevent occupational irritant contact dermatitis (ICD). We recommend further research to address the gaps in our knowledge around latex allergy in a healthcare setting. [ABSTRACT FROM AUTHOR]

BACKGROUND: Self-reported food allergy is very common in asthmatics and hence these food items are frequently avoided by the patients. Food allergy is defined as an adverse immunological response to a dietary protein. Skin prick test (SPT) is a sensitive tool for identifying the presence of specific immunoglobulin E antibodies that can be associated with acute allergic reactions. However, sensitization often exists without clinical consequences, and at the same time, self-reported food allergens are frequently negative on SPT. The purpose of our study was to assess the clinical relevance of self-reported food allergy and the role of SPT in identifying food allergies in patients with bronchial asthma. METHODOLOGY: One hundred bronchial asthma patients were screened for this study, and skin prick testing for 22 food allergens frequently consumed in India, particularly Northern India was performed. RESULTS: A total of 36 subjects reported perceiving precipitation or an increase in severity of the asthmatic symptoms by one or more food items, and the most common food items mentioned in history were curd in 24%, rice in 19%, citrus fruits such as lemon in 14%, orange in 14%, banana in 8%, cold drinks in 16%, and ice creams in 16%. There were 68 patients negative for food allergens by SPT (food allergen negative [FAN] group) and 32 patients were positive (Food allergen Positive [FAP] group). Out of 36 asthmatics with self-reported food allergy, none was found to be SPT positive to the reported food allergens. However, 50% of patients with self-reported and only 21.9% with no history of food allergy were positive to one or more food allergens. Further, FAP group patients were tolerating these foods without any trouble or exacerbation of symptoms. Among the FAP group, 96.9% of patients had positive SPT for one or more other allergens also such as insects, pollens, fungi, or other aeroallergens. Only one patient had isolated food allergy by SPT. It implies that isolated food allergy is very rare in asthmatic patients. Common food allergens found positive by SPT were black gram in 12%, followed by red gram 9% and bengal gram, rice, and Baker's yeast 7% each. CONCLUSION: We concluded that the prevalence of food allergy in India among asthmatic adults though high, has a very poor correlation between patient's history of food allergens that is perceived as a precipitating or exaggerating factor for symptoms and actual sensitization as elicited by SPT. At the same time, there is high nonspecific food sensitization in self-reported patients as compared to those with no history of any perceived food allergy. [ABSTRACT FROM AUTHOR]

India has recorded the maximum snakebite deaths in the world. Intravenous administration of polyvalent antivenom (PAV) raised against the 'Big Four' venomous snakes of India (Naja naja, Daboia russelli, Echis carinatus , and Bungarus caeraleus) is the only choice of treatment. The WHO has recommended the evaluation of quality and safety of commercial antivenom by in vitro laboratory tests prior to their pre-clinical evaluation in animal model and therapeutic use. Therefore, in this study an attempt has been made to evaluate the quality of commercial polyvalent antivenom produced in India by simple, and affordable laboratory tests. Proteomic analysis revealed that PAVs contained 78.7–94.8% IgG/F(ab') 2 and small quantities of plasma proteins. The PAVs showed batch-to-batch variations with varying amounts of undigested IgG and its aggregates, and moderate complement activation. However, absence of IgE, negligible endotoxin contamination, and recommended limit of preservative (cresol) in PAVs were observed. The PAVs contain varying proportions and least amount of venom-specific antibodies against venoms of the 'Big Four' snakes from different locales of India, and against eastern India N. kaouthia venom, respectively. The importance of independent in vitro laboratory tests for the quality control and safety assessment for improving the quality of Indian commercial PAV is reinforced. Image 1 • Indian polyvalent antivenoms contain digested and small quantity of undigested immunoglobulin G and other plasma proteins. • Polyvalent antivenoms showed moderate complement activation, devoid of immunoglobulin E and endotoxin contamination. • Polyvalent antivenoms contain varying proportions of 'Big Four' snake venom-specific antibodies. • Study showed varying affinity of polyvalent antivenoms towards 'Big Four' snakes and N. kaouthia venoms. • The Enzyme-linked immunosorbent assay may also be used to determine the venom-specific antibodies in polyvalent antivenoms. [ABSTRACT FROM AUTHOR]

Asthma is a common problem that affects about 20 million peoples in India and can be often under-diagnosed or misdiagnosed. It can be allergic or non-allergic though the former type is more common and prevalent. Allergic asthma can be triggered by many allergens and house dust mites (HDM) are one of the common indoor allergens. The present study emphasizes the significance of house dust mites in allergic asthmatic subjects which is based on 115 asthmatic subjects in Punjab, India. For the quantification and the estimation of total serum Immunoglobulin E and HDM specific IgE, a mixture of 14 allergens and a mixture of two mite allergens viz. Dermatophagoides pteronyssinus and D. farinae were used respectively. Total and specific IgE levels were detected on ImmunoCAP Phadia 100. A statistically significant correlation between total and HDM specific IgE levels of 115 asthmatic subjects was found as compared to control group of 30 non-allergic individuals. The specific IgE levels of 54.78% subjects against the allergen of two mite species were found to be positive. Dust samples were taken from various localities of the houses to identify the diversity of house dust mites which were responsible for allergic asthma. Five common house dust mite species viz. D. pteronyssinus Trouessart, D. farinae Hughes, D. microceras Griffiths and Cunnington, D. aureliani Fain and Euroglyphus maynei Cooreman were identified from the dust. The present study observed that total IgE levels were higher with higher specific IgE levels against the mixture of two mite allergens viz. D. pteronyssinus and D. farinae in the blood serum. D. pteronyssinus was the most abundant and prevalent mite species followed by D. farinae. Therefore, present study concluded that HDM specific IgE levels against the mite allergen of D. pteronyssinus and D. farinae in the serum of allergic asthmatic subjects were found to be higher because of the higher prevalence of these two mites (D. pteronyssinus i.e. 69.80% and D. farinae i.e. 20.72%) in the house of allergic asthmatic subjects as compared to other identified mites. [ABSTRACT FROM AUTHOR]

Little is known about genetic factors and mechanisms underlying shrimp allergy. Genome-wide association studies identified HLA class-II and IL13 genes as highly plausible candidates for shrimp allergy. The present study was designed to investigate potential associations of HLA-DQ rs9275596, IL13 rs20541, and IL13 rs1800925 polymorphisms with challenge-proven shrimp allergy using the data from 532 people of West Bengal, India; selected on basis of positive skin prick test, elevated specific IgE and medical history. Risk genotypes, i.e., HLA-DQ rs9275596 CC, IL13 rs20541 AA, and IL13 rs1800925 TT, were found to be significantly associated with challenge positive shrimp allergy (P = 0.04, 0.01, and 0.03, respectively). Distribution of genotypes for HLA-DQ and IL13 polymorphisms in allergic and control subjects showed significant difference between younger (20–40 years) and older (> 40 years) age group (P = 0.006). Risk genotypes significantly associated with elevated shrimp-specific IgE. IL13 TA haplotype significantly associated with shrimp allergy and elevated specific IgE (P = 0.02). Synergistic effect of IL13 TA haplotype–HLA-DQ rs9275596 CC genotype interaction significantly elevated specific IgE (P = 0.03). The present study suggests that HLA-DQ and IL13 polymorphisms pose major risk for shrimp allergic patients in West Bengal, India and thus could be helpful for early target-specific therapeutic intervention in near future. [ABSTRACT FROM AUTHOR]

Background: Allergic bronchopulmonary aspergillosis (ABPA) may be a risk factor for poorly controlled asthma in children. The studies regarding prevalence and risk factors of ABPA in children with poorly controlled asthma are limited in number.Objectives: To determine prevalence and risk factors of ABPA and aspergillus sensitization (AS) in children with poorly controlled asthma.Methods: In this prospective cross-sectional study from a tertiary care center in India, we enrolled asthmatic children 5-15 years of age with poorly controlled asthma. We did the following investigations: spirometry, skin prick test, serum total immunoglobulin E (IgE), aspergillus-specific IgE and immunoglobulin G, serum precipitin for Aspergillus, absolute eosinophil count, chest X-ray and high-resolution computed tomography of the chest. ABPA and AS were diagnosed as per the recently proposed criteria.Results: We enrolled 106 children [boys 72 (67.9%); mean age of 10.2 ± 2.6 years] with poorly controlled asthma. The prevalence of ABPA and AS were 11.3% (95% CI, 5.2-17.5%) and 61.3% (95% CI, 52.0-70.7%), respectively. The presence of brownish sputum was significantly more in ABPA compared with non-ABPA patients (33.3 vs. 4.2%, p = 0.002). The age, gender, allergic rhinitis and gastroesophageal reflux were not significantly different in ABPA compared with non-ABPA patients.Conclusion: The prevalence of ABPA and AS was 11.3 and 61.3%, respectively in children with poorly controlled asthma. We could not find any risk factors for ABPA except that the presence of brownish sputum was more in children with ABPA. Spirometry parameters were not significantly different in ABPA compared with non-ABPA patients. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by intense pruritus. Hanifin and Rajka's criteria is the most common diagnostic criteria used in the hospital setup, which consists of 4 major and 23 minor criteria. The frequency of minor criteria may vary population wise. Aims: The aim of the study is to estimate the frequency of minor diagnostic criteria of Hanifin and Rajka in children with AD. Methodology: A hospital-based cross-sectional study of 174 children (≤16 years) with AD, was conducted based on history, clinical, and ophthalmological examination. Blood test to assess serum immunoglobulin E (IgE) level was conducted. Results: The most common minor criteria observed were Dennie–Morgan infraorbital fold (71.8%), early age of onset (67.8%), palmar hyperlinearity (67.8%), xerosis (67.2%), pityriasis alba (57.5%), and perifollicular accentuation (47.7%). Out of 143 cases whose serum was tested for IgE level, elevation was seen in 92. History of winter exacerbation was seen in 8% of the cases, while summer exacerbation was seen in none. On the ophthalmological examination of 111 cases, "high reading with no obvious keratoconus" was present in two cases while three cases were labeled as "keratoconus suspect." Conclusion: Clinical features of AD vary with geographical location. The prevalence and severity of AD are influenced by several factors such as ethnic/racial, environmental, and dietary factors. Therefore, it is relevant for dermatologists to have a knowledge regarding common clinical features of AD in a given population for the diagnosis and thereby provide treatment to reduce the morbidity along with appropriate counseling. [ABSTRACT FROM AUTHOR]

Summary: The cut‐offs for total and specific IgE used for diagnosing ABPA in children have been adopted from adult literature and have not been validated in the paediatric population. To establish the ideal cut‐offs of total IgE and Aspergillus‐specific IgE for the diagnosis of ABPA in children. This study was a prospective observational case‐control study, conducted in a tertiary care hospital in North India, enrolling 140 children with partly controlled and uncontrolled asthma. Seventy children had ABPA based on the Rosenberg‐Patterson Criteria (Cases) whereas 70 children were without ABPA (Controls). All children were subjected to clinical examination and investigations such as absolute eosinophil count, total IgE, Aspergillus‐specific IgE, Aspergillus skin prick test and radiological tests. ROC curve analysis was done to determine the ideal cut‐offs of total and specific IgE to diagnose ABPA. The ROC curve analysis determined 1204IU/L as the cut‐off value of total IgE with a sensitivity of 79.7% (95%CI 68.31% to 88.44%) and specificity of 53.1% (95%CI 40.23 to 65.7). The ROC analysis of specific IgE levels of children with ABPA determined the cut‐off value of 0.49 KAU/L with a sensitivity of 94.03% (95%CI 85.41 to 98.35) and specificity of 88.89% (95%CI 75.94% to 96.29%). We propose that the cut‐offs of total and specific IgE need to be relooked in the paediatric population. Cut‐offs of total IgE as 1204 IU/L and for Aspergillus‐specific IgE as 0.49KAU/L seem appropriate. Large multicentric studies should be conducted to determine the ideal values for diagnosing paediatric ABPA. [ABSTRACT FROM AUTHOR]

Food allergy is an important cause of morbidity, significantly affecting the quality of life of the sufferer. Most food allergy research has been undertaken in high-income countries. Here, we summarize literature regarding food allergy in India and other low-middle-income countries (LMIC). We provide summaries of self-reported adverse food reactions and food sensitization in these regions by reviewing published community-based studies of prevalence, burden, and risk factors. We identified 2 community-based studies of food allergy prevalence in Karnataka, India, which estimate that food allergy affects just 0.14% of children and 1.2% of adults. The overall prevalence of allergic sensitization to 'any' food was 26.5% in adults and 19.1% in children by serum-specific IgE; but only 4.48% in children by skin prick test. We identified a further 28 studies in other LMICs, mainly from China but also Turkey, South Africa, Ghana, Mexico, Brazil, Thailand, Philippines, and Korea. The overall prevalence of allergic sensitization to 'any' food ranged from 0.11% to 16.8% in children using serum-specific IgE and 0.14% to 9.6% in children by skin prick test. The questionnaires and skin prick testing materials used and number of allergens tested varied significantly between studies. Other than Karnataka, there is no information on prevalence of food sensitization and probable food allergy in the community in India. Similar lack of information is noted among the majority of the 136 LMICs. Where community-based studies have been undertaken, there is wide variation in the prevalence and patterns of food sensitization across different LMICs, at least partly due to variations in study methodology. International collaboration is required in order to formally assess food allergy prevalence and burden across representative samples from multiple LMICs., (© 2023 John Wiley & Sons Ltd.)

Introduction: Secondary food allergies due to cross-reactivity between pollen and food allergens are a significant health burden in India. Prevalence of cross-reactivity varies by region, and particularly in West Bengal, it remains unexplored. The present study investigated sensitivities of pollen-related food allergy (PFA) patients of West Bengal by empirically determining co-sensitization patterns., Methods: The present study retrospectively analysed 1,310 pollen-allergic (PA) patients from the Allergy and Asthma Research Centre, West Bengal. A questionnaire survey was performed to record patients' demographic and clinical features and categorized into seasonal and perennial ones. All patients were subjected to the skin prick test and specific IgE for evaluation of sensitivity against 16 pollen and 16 food allergens. Co-relation and principal component analysis (PCA) was performed to determine co-sensitivity., Results: Seasonal allergic patients were comparatively higher than perennial ones. PFA patients were mostly sensitive to eggplant (n = 387), while Azadirachta indica (n = 341) was predominant sensitizer among pollen allergen sources. Cynodon dactylon showed maximum significant positive correlation with banana, orange, peanut, pineapple, cucumber, eggplant, potato, tomato, and wheat. In the seasonal group, Cynodon dactylon-specific IgE in PFA patients (median = 4.60 kU/L) was significantly higher from that of PA ones (median = 3.44 kU/L). Among 32 allergens tested, 27 were placed in first two dimensions of the PCA biplot., Conclusion: The present study established that co-sensitivity between pollen and food allergen sources were predominant in allergic patients of West Bengal. The co-sensitization patterns among unrelated allergen sources may be due to possible expression of biologic cross-reactivity to similar allergens., (© 2022 S. Karger AG, Basel.)

Background: The prevalence of IgE mediated food allergies has increased over the last two decades. Food allergy has been reported to be fatal in highly sensitive individuals. Legumes are important food allergens but their prevalence may vary among different populations. The present study identifies sensitization to common legumes among Indian population, characterizes allergens of kidney bean and establishes its cross reactivity with other legumes. Methodology: Patients (n = 355) with history of legume allergy were skin prick tested (SPT) with 10 legumes. Specific IgE (sIgE) and total IgE were estimated in sera by enzyme-linked immunosorbent assay. Characterization of kidney bean allergens and their cross reactivity was investigated by immunobiochemical methods. Identification of major allergens of kidney bean was carried out by mass spectrometry. Principal Findings: Kidney bean exhibited sensitization in 78 (22.0%) patients followed by chickpea 65 (18.0%) and peanut 53 (15%). SPT positive patients depicted significantly elevated sIgE levels against different legumes (r = 0.85, p<0.0001). Sera from 30 kidney bean sensitive individuals exhibited basophil histamine release (16-54%) which significantly correlated with their SPT (r = 0.83, p<0.0001) and sIgE (r = 0.99, p<0.0001). Kidney bean showed eight major allergens of 58, 50, 45, 42, 40, 37, 34 and 18 kDa on immunoblot and required 67.3±2.51 ng of homologous protein for 50% IgE inhibition. Inhibition assays revealed extensive cross reactivity among kidney bean, peanut, black gram and pigeon pea. nLC-MS/MS analysis identified four allergens of kidney bean showing significant matches with known proteins namely lectin (phytohemagglutinin), phaseolin, alpha-amylase inhibitor precursor and group 3 late embryogenesis abundant protein. Conclusion/Significance: Among legumes, kidney bean followed by chick pea and peanut are the major allergic triggers in asthma and rhinitis patients in India. Kidney bean showed eight major allergens and cross reacted with other legumes. A combination of SPT, sIgE and histamine release assay is helpful in allergy diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: The physiological and clinical similarities between asthma and chronic obstructive pulmonary disorder (COPD) make their differentiation difficult. In the present study, we compared reversibility to bronchodilator, immunoglobulin E (IgE), blood eosinophil and neutrophil levels among asthma and COPD patients to differentiate these diseases. Materials and Methods: The study was carried on 20 asthmatics and 29 patients of COPD that reported to the outpatient and inpatient department in University Teaching Hospital, Jamia Hamdard, New Delhi, India. The parameters evaluated included pulmonary function (FEV1, FVC, and FEV1/FVC), IgE levels, and eosinophil and neutrophil count. Results: It was observed that reversibility was significantly higher in asthmatic patients, while irreversibility predominates in COPD patients. There was no significant difference in pre- and post-FEV1 and pre- and post-FVC and in their percentage predicted. However the percentage change in FEV1 significantly varies in asthma and COPD patients. No significant changes in neutrophil and eosinophil levels were observed in these patients. The serum IgE levels were found significantly higher in asthmatic patients. Conclusions: We conclude that reversibility in FEV1 levels or percentage change in FEV1 and serum IgE levels are promising lab parameter to distinguish these two conditions. However, further research is required to fully understand the role of neutrophil and eosinophil in the onset and development of asthma and COPD. [ABSTRACT FROM AUTHOR]

Catharanthus rosetts G. Don. (CR) or periwinkle plants are widely grown/cultivated as garden plants in the tropics and subtropics. In spite of its predominantly entomophilous nature, CR pollen had been reported to be airborne and allergenic. The objective of this study was to discover the seasonal changes of CR pollen concentration in air, to determine its potential to cause respiratory allergy and to analyze its allergenic components. A 2-year aerobiological survey was conducted with a Burkard 7-day sampler in an agricultural farm in the suburban zone of Calcutta city where CR pollen was found to be almost perennial with 3.6-5.4% contribution to the aeropollen load. Skin prick test was conducted on 282 respiratory allergic individuals living within a 15 km radius of the study area. 29.8% of them were positive to CR pollen. Among them, 80.9% were directly involved in gardening. The whole pollen extract was subjected to gel filtration in a Sephacryl S-200 column. Among 5 eluted fractions, fraction 1 showed optimum IgE-reactivity in EL1SA-inhibition. The fraction I shows 4 protein components in SDS-PAGE, within which 3 (40-66 kD molecular mass) were found to be IgE-reactive in immunoblotting using patient sera. It can be concluded that CR pollen can trigger IgE-mediated respiratory allergy in the people living in close proximity. [ABSTRACT FROM AUTHOR]

Background: There is an increase of serum levels of IgE during Plasmodium falciparum infections in individuals living in endemic areas. These IgEs either protect against malaria or increase malaria pathogenesis. To get an insight into the exact role played by IgE in the outcome of P. falciparum infection, total IgE levels and functional anti-parasite IgE response were studied in children and adults, from two different endemic areas Gabon and India, exhibiting either uncomplicated malaria, severe non cerebral malaria or cerebral malaria, in comparison with control individuals. Methodology and results: Blood samples were collected from controls and P. falciparum-infected patients before treatment on the day of hospitalization (day 0) in India and, in addition, on days 7 and 30 after treatment in Gabon. Total IgE levels were determined by ELISA and functional P. falciparum-specific IgE were estimated using a mast cell line RBL-2H3 transfected with a human Fcε RI α-chain that triggers degranulation upon human IgE cross-linking. Mann Whitney and Kruskall Wallis tests were used to compare groups and the Spearman test was used for correlations. Total IgE levels were confirmed to increase upon infection and differ with level of transmission and age but were not directly related to the disease phenotype. All studied groups exhibited functional parasite-specific IgEs able to induce mast cell degranulation in vitro in the presence of P. falciparum antigens. Plasma IgE levels correlated with those of IL-10 in uncomplicated malaria patients from Gabon. In Indian patients, plasma IFN-γ , TNF and IL-10 levels were significantly correlated with IgE concentrations in all groups. Conclusion: Circulating levels of total IgE do not appear to correlate with protection or pathology, or with anti-inflammatory cytokine pattern bias during malaria. On the contrary, the P. falciparum-specific IgE response seems to contribute to the control of parasites, since functional activity was higher in asymptomatic and uncomplicated malaria patients than in severe or cerebral malaria groups. [ABSTRACT FROM AUTHOR]

Background Total immunoglobulin E (IgE) is an important indicator of allergic disorders. However, its role in allergic patients in India has not been evaluated in relation to atopic status for a reference range as compared with healthy subjects. Objective The aim of the study was to establish serum IgE levels in a diseased group, study its relationship with atopy, and to compare the same with healthy volunteers in Indian subjects. Methods Four hundred and eighty asthmatics/allergic patients, 100 first-degree relatives of asthmatics, and 120 unrelated normal healthy volunteers from Delhi region were recruited for the study. Atopy was established by family history and skin test to common indigenous allergens and, total and specific IgE measurements. Statistical analysis was performed with the help of SPSS software program. Results The mean IgE levels were the highest in asthmatic patients and the lowest in the control healthy group. IgE was significantly high in the male than the female healthy volunteers ( P<0.05), but not in the diseased group. Prosopis juliflora among pollen allergens and Alternaria alternata among fungal allergens were important sensitizers in allergic patients with 34.7% and 17.7% skin positivity, respectively. Atopic status and asthma were found to be the best predictor of IgE, which was highly significant ( r2=0.239, P<0.00001). However, at 95% confidence interval as many as 50% of asthmatic patients had their IgE values in the normal range. Conclusion The IgE levels in Indian allergic patients is significantly related to atopy, but due to wide overlap of IgE levels in patients and healthy subjects, its diagnostic significance in Indian population seems to be limited. [ABSTRACT FROM AUTHOR]

IL4 pathway is known to upregulate IgE mediated immune responses and responsible for the manifestation of Atopic disorders. The current study was aimed to elucidate the genetic variations of Interleukin 4 (IL4) and Interleukin 4 receptor alpha (IL4R) genes and their possible association with atopic subjects. The well-designed questionnaire was used to collect the subject demographic and clinical details. Biochemical parameters were analysed using Chemiluminescent Immunoassay (CLIA) technique. The genotyping was performed using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). We observed a statistically significant difference of serum Immunoglobulin-E (IgE) levels among cases and controls (P <0.05). Subjects harbouring the variant genotypes of I50V and Q576R single nucleotide polymorphisms (SNPs) in IL4R gene showed statistically differential risk towards atopic disorders. However, the variants genotype of 70 bp VNTR polymorphism in IL4 gene showed a protective role towards in predisposition to Atopy. On stratification, the above genetic variants had a significant impact on modifiable and non-modifiable factors associated with the disease. Our study demonstrates that increased IgE levels and IL4 gene variants (I50V and Q576R) are significantly associated towards predisposition to allergic disorders in this study population. • Our study results infer that immunoglobulin E and interleukins play an important role in the pathogenesis of allergic disorders as reported throughout the globe. • The studied genotypes do have a significant role as modifiers of environmental exposure and life style factors in determining the risk of atopic disorders in Kashmiri population. • One of the important observations of our study was a protective association of one of the variants of IL4VNTR70bp repeat gene. The subjects harboring variant genotype (homozygous mutant + Heterozygous) of above gene showed an inverse association towards atopic disorders. • Kashmiri population is considered to be a non-migrant pure ethnic Muslim-dominated population with common consanguineous marriages, hence the less chances of frequent admixture of genetic markers. • The differential risk, opposite to what has been observed in other populations has been already reported in some genetic variants for other than allergic diseases in our population. The diversity of pollens, which happens to be substrates for above studied genes, could have different effects in IL4VNTR70bp repeat gene. Additionally, the peak-allergy seasons in Kashmir suit to variety of allergens, which are helped by cotton fluff from Russian poplars to reach to the people. Such carriers are not so common in other parts of India as well as major part of the world. [ABSTRACT FROM AUTHOR]

A standardized in-house reference extract from the pollen of Parthenium hysterophorus, which is responsible for the high incidence of allergic rhinitis in India, was generated and examined by skin test, radio-allergosorbent test inhibition and isoelectric focusing. Parthenium reference allergen discs and positive reference serum were also generated. These reference reagents could not only be used for the quantitation of Parthenium-specific IgE in the sera of rhinitis patients but also for the evaluation of allergenic activity (relative potency and lot-to-lot variation) of different batches of Parthenium pollen. [ABSTRACT FROM AUTHOR]

The increasing burden of respiratory disease is a rising concern in India. Although chronic colonisation is primarily caused by pathogenic fungi, the common environmental fungi also play an important role in developing sensitisation. This study aims to examine the allergenic potency of mycelial proteins of a common indoor fungus Aspergillus ochraceus to a selected atopic patient cohort as well as to identify the novel IgE-binding proteins through an immunoproteomic approach. 1-D and 2-D IgE specific western blot detected the IgE reactive proteins which were identified through MALDI-TOF/TOF and manual de novo peptide sequencing. The results revealed the detection of 10 cross-reactive IgE-binding proteins. Cluster analysis of 1-D immunoblot with individual patient sera identified NADP(+)-dependent glycerol dehydrogenase (GldB) homologous protein as a major allergen, which was further purified and the allergenicity was assessed. Other IgE-binding proteins showed homology with allergens like short-chain dehydrogenase, NAD-dependent mannitol dehydrogenase, and subtilisin-like serine protease. GldB purified under native conditions showed IgE reactivity amongst the selected patient cohort, which is reported for the first time in this study. The identified IgE-binding proteins can act as candidate molecules for developing hypoallergenic vaccines for designing specific immunotherapeutic techniques to fungal allergy. Exposure to environmental fungal allergens is directly associated with promoting allergic response as well as complicating existing respiratory disease, leading to poor respiratory health. Amongst others, Aspergillus spp. contributes to the majority of the fungal derived atopic diseases. Aspergillus ochraceus is a common indoor mould in India, however, its allergenic potency was not explored till date. In this study, we establish A. ochraceus responsible to cause an allergic response to susceptible individuals and identified 10 IgE-binding proteins using an immunoproteomics approach for the first time. A. ochraceus being unsequenced, a homology-driven proteomics approach was used to identify the IgE-binding proteins which can be extended to identify proteins from other unsequenced species. The information on the IgE-binding proteins could be used as a step towards characterising them by molecular and structural methods to investigate the molecular basis of allergenicity. This will also help to enrich the existing database of allergenic proteins and pave a way towards developing therapeutic avenues. [Display omitted] • Aspergillus ochraceus is a common indoor mould found in India. • Ten IgE-binding proteins were identified from A. ochraceus mycelial proteome for the first time. • Manual de novo sequencing followed by homology-driven protein identification was implemented to identify the novel IgE-binding proteins. • A major allergen was purified to its native form and its cross-reactivity with A. fumigatus crude protein extract was validated for the first time. [ABSTRACT FROM AUTHOR]

Abstract: Kimura''s disease (KD) is a rare chronic inflammatory disorder that involves the subcutaneous tissues and occurs predominantly in the head and neck region, frequently associated with regional lymphadenopathy or salivary gland involvement. Although, not an uncommon condition in the Asian countries, it is quite rare among the occidental civilization and in the western countries is more commonly diagnosed among Asian migrants. Kimura''s disease is sometimes confused with angiolymphoid hyperplasia with eosinophilia, which occurs in the superficial skin of the head and neck region. The classical features of angiolymphoid hyperplasia with eosinophilia are characterized by a triad of painless subcutaneous masses in the head and neck region, blood and tissue eosinophilia, and markedly elevated immunoglobulin E (IgE) levels. Here, we report a case of a 33-year-old Indian male with KD who presented with unilateral nodular swelling in the right parotid region. The diagnosis was based on characteristic histopathologic findings in conjunction with peripheral eosinophilia and elevated serum IgE levels [Copyright &y& Elsevier]

The author reflects on the need of researchers to better define the presence of differential prevalence of disease referable to cow's milk protein allergy (CMPA) between developing and developed countries. She discusses the childhood food allergy in cow's milk protein in India. She stresses that protein milk allergies can be classified from Immunoglobulin E (IgE)-mediated allergy and non-IgE mediated syndromes.

Background: Parthenium dermatitis is a major problem in urban and rural India. Patients with severe allergic rhinitis due to exposure to pollens of parthenium are reported to have parthenium specific IgE and IgG antibodies. Parthenium induces contact dermatitis by Type IV hypersensitivity and allergic rhinitis by Type-I hypersensitivity.Aims: The study was undertaken to detect Type-I and Type-IV hypersensitivity amongst patients with parthenium dermatitis.Methods: Fourteen patients with clinical features of parthenium dermatitis who patch tested positive to parthenium were included in the study. Patch testing was done by standard method and results interpreted as recommended by the ICDRG. Serum IgE was determined by chemiluminescence immuno assay system (CLIA). Prick testing was performed and interpreted by standard method.Results: Twelve out of the 14 patients included, showed a positive prick test. Serum IgE was elevated in all patients to varying degrees (mean IgE-1279.9 IU/ml; N--up to 100 IU/ml).Conclusion: The positive patch test, prick test and elevated serum IgE suggest that both Type-I and Type-IV hypersensitivity may play a role in the induction and perpetuation of parthenium dermatitis in most patients. To date, delayed hypersensitivity was thought to be solely responsible for parthenium dermatitis. This study suggests that a combined type-I and type IV hypersensitivity mechanisms may be operational. [ABSTRACT FROM AUTHOR]

Background: Coir industry provides a major share of occupation to the natives of Alappuzha district of Kerala State, South India. A significant proportion of workers in this industry have been found to have nasobronchial symptoms. A pilot study conducted in our institute, among coir workers revealed that more than 35% of coir workers suffered from nasobronchial allergy and it is directly proportional the years spent in the work field. This study was conducted to find out whether coir worker's asthma is immunologically mediated or not and also to find out the difference if any in the Ig E level between males and females with coir workers asthma., Methods: The study was done as a descriptive study. Coir workers with symptoms suggestive of asthma who attended the outpatient clinic of Government TD Medical College Hospital Alappuzha during 2005-2006 were included in the study. Detailed occupational history was taken using a semi structured interview schedule. Symptom profile of the patients were assessed in detail followed by clinical examination and spirometry. The serum Ig E level was estimated by ELISA technique. Data were entered in MS Excel and statistical analysis was performed with Mann-Whitney U test using SPSS version 16. P value < 0.05 was taken as the cut off point for statistical significance., Results: The total number of patients included in the study was 62 out of which 25 were males and 37 were females. (Mean age: 36 years, Males: 33 years and Females: 38 years). All except one patient showed latent period before developing asthmatic symptoms and it varied from 6 months to 44 years, with a mean of 9.9 years. The latency period was considerably more in males.56 patients (91%) had elevated total serum IgE (mean of 1311 IU). Male patients had a considerably higher value of serum Ig E., Conclusions: The serum IgE levels were found to be higher in coir workers with asthmatic symptoms and hence it is reasonable to believe that coir workers asthma is of largely immunological in origin., (© Journal of the Association of Physicians of India 2011.)

Grain storage depot workers suffer from different respiratory problems after getting the exposure to storage grain dust. Which is a mixture of pesticides, fungi, silica, bacteria, spores, storage mites, animal hairs, pollens etc. The present study was undertaken to evaluate the fungal spore concentration in summer and winter season as well as the pulmonary function status of the workers; studies are limited in our country. In summer and winter seasons, air sampling was done to measure the airborne fungal spore concentration inside the godowns by Rotorod sampler, UK. Aspergilla, Alternaria, Drechslera, Epicoccum, Nigrospora, Periconia were very much common and found higher in winter compared to summer. The respiratory functional status was assessed in two groups of workers of the same storage grain depot (total n=316) in summer (n=136) and in winter (n=180). List of the workers was collected from the authority and randomly selected every alternate worker and divide them for the studies in summer and winter seasons. Slow Vital Capacity (SVC), Forced Vital Capacity (FVC), and Peak Expiratory Flow Rate (PEFR) were recorded and Forced Expiratory Volume in one second (FEV1), FEV1% and different flow rates were calculated. The Immunoglobulin- E (IgE) level in the blood serum was assessed on post shift pulmonary function tests (PFT) decreased workers. The age, height and weight of the same categories of workers of both studies are highly comparable. Mean PFT values in summer found higher than winter. A gradual decrement of values were found as age was increased but not with duration of exposure. Post-shift PFT was carried in 21.8% (69) workers of which 46.4% (32) workers showed the decrement of values. The serum IgE level of the post-shift PFT decreased subjects was found more than 250 IU/ml in 53.1% (17) workers. Restrictive, obstructive and combined types of respiratory impairments were noticed among the workers. Presence of different spores in varying concentration in the working atmosphere may be responsible for the post shift decrement of PFT, allergic symptoms, high IgE level and respiratory impairments among the workers.

A comprehensive investigation was done to evaluate the allergenic algae in the Delhi area. Results of 4,000 skin tests performed on 400 patients suffering from naso-bronchial allergy and 300 skin tests on 30 healthy persons with 10 common algae isolated from the Dehli atmosphere are presented and compared. Positive skin reactions (1+ to 3+) to algae extracts ranged from 25.7% with Lyngbya major extract to 1.7% with Oscillatoria simplicissima extract; in healthy non-allergic volunteers there were no positive skin reactions. The Prausnitz-Küstner (PK), bronchial provocation and conjunctival tests were negative in patients with negative skin reactions; in patients with positive skin reactions PK was positive in 70.9%, bronchial provocation in 50% and conjunctival in 48.5%. Levels of total IgE in patients with naso-bronchial allergy were higher, ranging from 1,225 international units per ml to 1,550 international units per ml, while in healthy volunteers the values were less than 885 international units per ml.