Anna Wolańczyk-Mędrala

Exercise-Induced Anaphylaxis: An Update on Diagnosis and Treatment

Exercise-induced anaphylaxis (EIA) and food-dependent, exercise-induced anaphylaxis (FDEIA) are rare but potentially life-threatening clinical syndromes in which association with exercise is crucial. The range of triggering physical activities is broad, including as mild an effort as a stroll. EIA is not fully repeatable (ie, the same exercise may not always result in anaphylaxis in a given patient). In FDEIA, the combined ingestion of sensitizing food and exercise is necessary to precipitate symptoms. Clinical features and management do not differ significantly from other types of anaphylaxis. The pathophysiology of EIA and FDEIA is not fully understood. Different hypotheses concerning the possible influence of exercise on the development of anaphylactic symptoms are taken into consideration. These include increased gastrointestinal permeability, blood flow redistribution, and most likely increased osmolality. This article also describes current diagnostic and therapeutic possibilities, including changes in lifestyle and preventive properties of antiallergic drugs as well as acute treatment of these dangerous syndromes.

Allergens of mites

Mite allergens belong to the group of inhalant allergens and represent antigenic substances which are particutlarly important in the pathogenesis of respiratory system diseases and skin diseases. The most common diseases associated with chronic exposure to these aeroallergens include: allergic rhinitis, bronchial asthma and atopic dermatitis. Mite allergens are simple proteins or glycoproteins with different molecular structures and various biochemical functions. The sensitizing capacity of these proteins is connected from their physicochemical properties. Individual allergens perform, among others, the functions of structural proteins, act as enzymes, transport lipids, bind metal ions, and are capable of glycosylation. In addition, mite allergenic proteases degrade proteins of the skin epithelium-resulting in a weakening of its natural protective barrier-and induce the immune response. The proteases also induce the release of pro-inflammatory cytokines: interleukin-4 (IL-4), interleukin 6 (IL-6), interleukin 8 (IL-8), eotaxin, and granulocyte-macrophage colony-stimulating factor-GM-CSF. The article presents the tertiary structure of major and mid-range mite allergens and their classification. Based on literature reports concerning the chemical structure of allergenic proteins, it was emphasized that the structural differences between homologous proteins with allergenic pozoproperties relate to the distribution of amino acid residues on the surface of the molecule. IgE binding affinity and the similarities and differences in the amino acid sequence of the allergens were also the basis for determining cross-reactivity of allergenic proteins. The paper shows an example of this phenomenon, describing the existence of common allergens for various mite species.

Food-dependent, exercise-induced anaphylaxis triggered by co-incidence of culprit food, physical effort and a very high dose of ibuprofen or menstruation: a case report

Address for correspondence: Krzysztof Gomułka MD, PhD, Department of Internal Diseases and Allergology, Medical University of Wroclaw, 66 Marii Curie-Skłodowskiej St, 50-369 Wroclaw, Poland, phone: +48 71 784 25 28, e-mail: kgomulka@wp.pl Received: 11.12.2015, accepted: 22.04.2016. Food-dependent, exercise-induced anaphylaxis triggered by co-incidence of culprit food, physical effort and a very high dose of ibuprofen or menstruation: a case report

CD164 as a Basophil Activation Marker.

Introduction of flow cytometric technique to the research on basophil activation has led to significant achievements in allergy diagnosis in vitro. Most of the studies employing the flow cytometry used CD63 as a marker of basophil activation and only some of them used CD203c. Recently discovered basophil activation markers, including CD164, opened new possibilities for solving majority of current diagnostic needs. Use of allergen-induced CD164 upregulation in diagnosis of pollen allergy has been validated, and this encourages to further studies on other diagnostic usefulness of this marker. There are some hopeful data indicating that it might be useful in diagnosis of allergy caused by variety of other allergens, including drug allergens. Although CD164 upregulation as a marker of basophil activation is a promising and powerful diagnostic tool, it still requires a lot of both basic research and comparative studies with older and well known markers, in order to select the best of them. A research on basophil CD164 upregulation caused by various stimuli offers a good possibility to increase our knowledge of basophils involvement in allergic inflammation. Moreover, this might trigger a variety of pharmacological studies with known and new anti-inflammatory drugs in the future.

Exercise-induced bronchospasm among athletes in Lower Silesia Province

Abstract A few studies have reported data on the prevalence of exercise-induced bronchospasm in high school and university athletes. Recently published data suggest that exercise-induced bronchospasm may affect up to 39% of American university athletes. To date, no data describing this pathology in athletes from Central Europe have been published. The aim of the present study was to establish the prevalence of exercise-induced bronchospasm in pupils attending sports mastership classes in secondary school as well as students of the University of Physical Education in Wroclaw. The participants were 77 athletes (30 women and 47 men) aged 16–27 years (mean 17.3 years). Only one athlete (1.29%) diagnosed with atopic asthma before testing experienced a fall in forced expiratory volume in one second (12.9% FEV1) compared with baseline, which showed that the exercise test result was positive. From a clinical point of view, the ventilation disturbance was asymptomatic. In the other participants, there were slight but statistically significant rises in FEV1 (P < 0.02). The results of our study indicate a very low prevalence of exercise-induced bronchospasm in the population of athletes examined.

The diagnostic usefulness of the basophil activation test (BAT)with annexin V in an allergy to Alternaria alternata

BACKGROUND The basophil activation test (BAT) is an effective diagnostic tool in mold allergy, which is still not sufficiently known. OBJECTIVES The aim of our study was to assess the degree of annexin V binding to the surface of the basophil cell membrane after stimulation with anti-immunoglobulin E (anti-IgE) and Alternaria alternata allergenic extract. MATERIAL AND METHODS Alternaria alternata allergic patients (n = 32) and healthy volunteers (n = 33) were evaluated using skin prick tests (SPT), quantification of specific IgE (sIgE) and the BAT. Basophil activation was detected as a percentage degree of annexin V binding to the surface of the basophil cell membrane. RESULTS Receiver operating characteristic (ROC) curve analysis yielded a threshold value of 4.95% of activated basophils when the tested group and control group were studied, with a sensitivity and specificity of 100% (area under curve [AUC] = 1; p = 0.00000) for 100 SBU/mL Alternaria alternata allergen extract. The threshold value was 10.28% with a sensitivity of 93.8% and specificity of 100% (AUC = 0.98958; p = 0.00000) for 10 SBU/mL mold extract, and 9.37% with a sensitivity of 90.3% and specificity of 100% (AUC = 0.96307; p = 0.00000) for 1 SBU/mL Alternaria alternata allergen extract. The method was least efficacious in antiIgE stimulation, where the threshold value was 5.48% with a sensitivity of 90.6% and specificity of 30.3% (AUC = 0.46780; p = 0.67039). CONCLUSIONS The BAT with annexin V and sIgE measurement against Alternaria alternata increase the capability of a diagnostic laboratory for detecting mold sensitization. Both methods may certainly replace SPT, which are currently routinely used in allergy diagnosis. Annexin V may be considered a new basophil activation marker with an efficacy comparable to that of CD63 or CD203c.