Barbara Rymarczyk

The association of asthma, nasal allergies, and positive skin prick tests with obesity, leptin, and adiponectin

Cross‐sectional and longitudinal reports show that obese adults have more asthma than non‐obese adults. A proposed mechanism is via effects of adipokines (leptin and adiponectin) on the immune system.

Increased Levels of Interleukin-33 and Thymic Stromal Lymphopoietin in Exhaled Breath Condensate in Chronic Bronchial Asthma

Background: Epithelium-derived cytokines such as thymic stromal lymphopoietin (TSLP), interleukin (IL)-25, and IL-33 are important contributors to inflammation in asthma. Exhaled breath condensate (EBC) is a noninvasive method used to assess the inflammation of airways. Our aim was to assess the levels of TSLP, IL-25, IL-33, and its receptor ST2l/IL-1 R4 in EBC in patients with asthma and to correlate these with serum levels and asthma control. Methods: EBC and serum levels of TSLP, IL-25, IL-33, and ST2l/IL-1 R4 were measured in 44 patients with chronic bronchial asthma (14 in the uncontrolled phase) and 19 healthy control participants. Results: EBC levels of IL-33 and TSLP and serum levels of IL-33 were statistically higher in patients with asthma than in controls. IL-25 and ST2l/IL-1 R4 were present in EBC at barely detectable levels and were not analyzed. The EBC and serum levels of all studied mediators did not differ between controlled and uncontrolled asthma patients, except for the serum level of ST2l/IL-1 R4, which was higher in uncontrolled asthma. There were no correlations between serum and EBC levels of TSLP and IL-33 or between either serum and EBC levels and the forced expiratory volume in 1 s or the total IgE level. Conclusions: Higher levels of IL-33 and TSLP in EBC provide evidence supporting a role for these mediators in asthma. Their levels do not discriminate between controlled and uncontrolled asthma. The local reaction within the epithelium is independent of the systemic reaction.

Chemokine receptors expression on CD3+ blood cells in bronchial asthma

PURPOSE Chemokines and their receptors participate in pathomechanism of bronchial asthma. The aim of the study was to analyze the pattern of chemokine receptor expression on T cells in severe asthmatics and to compare to mild-to-moderate patients and controls. MATERIAL/METHODS Flow cytometric analysis of CXCR1, CXCR2, CXCR3, CCR3, CCR4, CCR5, CCR7, CCR8 expression on CD3(+)CD8(-) and CD3(+)CD8(+) cells was performed in patients with different severity of chronic asthma and in controls. RESULTS Percentages of CD3(+)CD8(+) cells expressing CXCR1 were significantly lower in severe asthmatic than in mild-to-moderate asthmatics and in controls. Percentages of CD3(+)CD8(+) cells expressing CCR7 were significantly lower in the severe asthma group than in control group. Percentages of CD3(+)CD8(-) cells expressing CXCR1, CXCR2 and CCR8 were significantly lower in the severe asthma group than in mild-to-moderate asthmatics and in controls. The number of cells CD3(+)CD8(-) and CD3(+)CD8(+) expressing of CXCR1 was significantly lower in the group of patients using more than 800μg of budesonide daily than in the group of patients using less than 400μg of budesonide. Percentages of CD3(+)CD8(-) cells expressing CXCR3, CCR4 and CCR5 were visibly higher (not significantly) in chronic mild-to-moderate asthma than in healthy controls and severe asthmatics. CONCLUSIONS These results may indicate impairment of some chemokine expression on T cells in severe asthma patients. Moreover participation of both chemokine receptors related to Th1 and Th2 responses in mild-to-moderate asthma and attenuation of these responses in severe asthma has been suggested.

Is fruit and vegetable intake associated with asthma or chronic rhino-sinusitis in European adults? Results from the Global Allergy and Asthma Network of Excellence (GA 2 LEN) Survey

Background Fruits and vegetables are rich in compounds with proposed antioxidant, anti-allergic and anti-inflammatory properties, which could contribute to reduce the prevalence of asthma and allergic diseases.ObjectiveWe investigated the association between asthma, and chronic rhino-sinusitis (CRS) with intake of fruits and vegetables in European adults.MethodsA stratified random sample was drawn from the Global Allergy and Asthma Network of Excellence (GA2LEN) screening survey, in which 55,000 adults aged 15–75 answered a questionnaire on respiratory symptoms. Asthma score (derived from self-reported asthma symptoms) and CRS were the outcomes of interest. Dietary intake of 22 subgroups of fruits and vegetables was ascertained using the internationally validated GA2LEN Food Frequency Questionnaire. Adjusted associations were examined with negative binomial and multiple regressions. Simes procedure was used to control for multiple testing.ResultsA total of 3206 individuals had valid data on asthma and dietary exposures of interest. 22.8% reported having at least 1 asthma symptom (asthma score ≥1), whilst 19.5% had CRS. After adjustment for potential confounders, asthma score was negatively associated with intake of dried fruits (β-coefficient −2.34; 95% confidence interval [CI] −4.09, −0.59), whilst CRS was statistically negatively associated with total intake of fruits (OR 0.73; 95% CI 0.55, 0.97). Conversely, a positive association was observed between asthma score and alliums vegetables (adjusted β-coefficient 0.23; 95% CI 0.06, 0.40). None of these associations remained statistically significant after controlling for multiple testing.Conclusion and clinical relevanceThere was no consistent evidence for an association of asthma or CRS with fruit and vegetable intake in this representative sample of European adults.

Chronic urticaria in myasthenia gravis patients – More than occasional coexistence?

Chronic idiopathic urticaria (CIU) is characterised by transient cutaneous wheals occurring daily or almost daily for more than six weeks. The pathogenic mechanism of more than 65% of patients with CIU remains unknown.1 In these patients mast cell dysfunction or local activating factors should be taken into account.2 The coexistence of CIU with autoimmunity is relatively well proven.3 This phenomenon has mainly been connected with thyroid abnormality although other associations have also been reported. Myasthenia gravis is defined as an organ specific, autoantibody mediated and T-cell dependent human autoimmune disease.4 In myasthenia patients, despite characteristic clinical features, there are numerous immunological abnormalities described, such as activation of T and B lymphocytes and epithelial cells. One of the characteristic features is anti-acetylcholine receptor antibodies production as well as the ability of cultured thymic lymphocytes to proliferate in the presence of acetylcholine receptors (AChRs).5 It is still a matter of debate whether AChR-like molecules can be expressed on the surface of other cells and trigger autosensitisation reactions or autosensitisation of lymphocytes is the primary process which takes place initially in the thymus. Despite the variety of diagnostic procedures, the aetiology of many chronic urticaria cases remains unknown and the reason for further investigation is to find the potential comorbidities which may influence the course of urticaria. In the present study we describe two cases of chronic urticaria and myasthenia coexistence.

Dietary patterns and respiratory health in adults from nine European countries-Evidence from the GA2 LEN study

Dietary patterns defined using principal component analysis (PCA) offer an alternative to the analysis of individual foods and nutrients and have been linked with asthma and allergic disease. However, results have not been reproducible in different settings.

Management of suspected drug hypersensitivity reactions. Guidelines of the Section of Drug Hypersensitivity of the Polish Society of Allergology

1Klinika Immunologii, Reumatologii i Alergii, Uniwersytet Medyczny w Łodzi 2 Klinika Pulmonologii, II Katedra Chorób Wewnętrznych im. Prof. Andrzeja Szczeklika, Uniwersytet Jagielloński Collegium Medicum w Krakowie 3Klinika Alergologii i Chorób Wewnętrznych, Uniwersytet Medyczny w Białymstoku 4 Katedra i Klinika Chorób Wewnętrznych, Alergologii i Immunologii Klinicznej, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach 5Zakład Alergologii Klinicznej, Pomorski Uniwersytet Medyczny w Szczecinie 6Katedra i Klinika Chorób Wewnętrznych i Alergologii, Uniwersytet Medyczny we Wrocławiu 7Zakład Alergologii Klinicznej i Środowiskowej, Uniwersytet Jagielloński Collegium Medicum w Krakowie 8Poradnia Alergologiczna i Poradnia Alergologiczna dla Dzieci w Starachowicach 9 Poradnia Alergologiczna, Samodzielny Publiczny Szpital Kliniczny Nr 2 Pomorskiego Uniwersytetu Medycznego w Szczecinie 10Klinika Reumatologii, Uniwersytet Medyczny w Łodzi

Introduction to management of drug hypersensitivity. Guidelines of the Section of Drug Hypersensitivity of the Polish Society of Allergology

1Klinika Immunologii, Reumatologii i Alergii, Uniwersytet Medyczny w Łodzi 2 Klinika Pulmonologii, II Katedra Chorób Wewnętrznych im. Prof. Andrzeja Szczeklika, Uniwersytet Jagielloński Collegium Medicum w Krakowie 3Klinika Alergologii i Chorób Wewnętrznych, Uniwersytet Medyczny w Białymstoku 4 Katedra i Klinika Chorób Wewnętrznych, Alergologii i Immunologii Klinicznej, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach 5Zakład Alergologii Klinicznej, Pomorski Uniwersytet Medyczny w Szczecinie 6Katedra i Klinika Chorób Wewnętrznych i Alergologii, Uniwersytet Medyczny we Wrocławiu 7Zakład Alergologii Klinicznej i Środowiskowej, Uniwersytet Jagielloński Collegium Medicum w Krakowie 8Poradnia Alergologiczna i Poradnia Alergologiczna dla Dzieci w Starachowicach 9 Poradnia Alergologiczna, Samodzielny Publiczny Szpital Kliniczny Nr 2 Pomorskiego Uniwersytetu Medycznego w Szczecinie 10Klinika Reumatologii, Uniwersytet Medyczny w Łodzi

Hypersensitivity to nonsteroidal anti-inflammatory drugs. Guidelines of the Section of Drug Hypersensitivity of the Polish Society of Allergology

1Katedra i Klinika Chorób Wewnętrznych i Alergologii, Uniwersytet Medyczny we Wrocławiu 2 Klinika Pulmonologii, II Katedra Chorób Wewnętrznych im. Prof. Andrzeja Szczeklika, Uniwersytet Jagielloński Collegium Medicum w Krakowie 3Klinika Alergologii i Chorób Wewnętrznych, Uniwersytet Medyczny w Białymstoku 4 Katedra i Klinika Chorób Wewnętrznych, Alergologii i Immunologii Klinicznej, Wydział Lekarski z Oddziałem Lekarsko-Dentystycznym w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach 5Klinika Immunologii, Reumatologii i Alergii, Uniwersytet Medyczny w Łodzi 6Zakład Alergologii Klinicznej i Środowiskowej, Uniwersytet Jagielloński Collegium Medicum w Krakowie 7Poradnia Alergologiczna i Poradnia Alergologiczna dla Dzieci w Starachowicach 8Klinika Reumatologii, Uniwersytet Medyczny w Łodzi

A case of Good's syndrome diagnosed after more than 20 years since onset of myasthenia in a patient with psoriasis.

Good’s syndrome is an acquired secondary immunodeficiency associated with thymoma. According to WHO it is classified as a distinct entity; however, pathogenesis of the discussed disorder is unknown. In typical cases hypogammaglobulinemia as well as T cell and B cell depletion is observed. It is characterized by susceptibility to infection induced by encapsulated bacteria, viruses and fungi. Good’s syndrome may be associated with recurrent infections and autoimmune conditions such as myasthenia gravis and it is usually present in patients about fourth or fifth decade of life [1]. We describe a case of Good’s syndrome in a 55-year-old female with two features distinct from those which have been reported so far: co-existence with psoriasis and a long distance between thymoma and the onset of recurrent infections. The patient suffered from psoriasis and in 1985 was diagnosed as having the pseudo-paralytic myasthenia gravis and treatment with pirydostigminum bromide and neostigminum was introduced. In 1986 a mass in an anterior mediastinal space was found and was considered as a thymoma but the patient did not agree for surgical treatment. Between August 2009 and November 2010 the patient had experienced three episodes of pneumonia with radiological findings. In 2009 presence of the anterior mediastinal tumor was confirmed by computed tomography suggesting thymoma. In October 2010 computed tomography demonstrated bronchiectasis. Afterwards the patient was directed to our department with suspicion of immune deficiency. The patient reported productive cough lasting for 2 years and frequent respiratory infections. In addition, symptoms of psoriasis were found on the skin of left elbow. In laboratory tests, reduced gamma-globulin [1, 9; normal range (N) 5–15 g/l] and immunoglobulin levels (IgA 29 mg/dl, IgG 26 mg/dl, IgM 2 mg/dl) were found. Lymphocyte subset analysis revealed lack of CD19? cells, reduced number of CD4? cells (22 %) and inverted CD4?/CD8? ratio and elevated inflammatory markers such as total leukocyte number: 16.3 9 10/ll, c-reactive protein 32.6 mg/l [N\ 5.0], ESR: 30 mm/h and complement C4 serum level: 72 mg/dl (N 10–40). Subsequently, the immunoglobulin replacement therapy was introduced. She received 25 g of Kiovig (Baxter AG) every 4 weeks and trough level of 550 mg/dl was obtained. Since the introduction of immunoglobulin supplementation there was only one episode of respiratory tract infection and the patient was in a good medical condition (Fig. 1), though we must be aware that prognosis in Good’s syndrome is worse than in common variable immunodeficiency or X linked agammaglobulinaemia [1]. Good’s syndrome belongs to a group of secondary causes of hypogammaglobulinemia in adults. Strict diagnostic criteria of this condition are missing and the diagnosis is based on clinical picture. In our case, the diagnosis of myasthenia gravis and mediastinal tumor was made over 20 years before the first symptoms of immune deficiency [2]. The diagnosis of thymoma may be established after onset of immune deficiency, but in some cases thymoma precedes the diagnosis of hypogammaglobulinemia. According to a systematic review of 132 patients, thymoma was diagnosed between 3 months and 18 years before symptoms of immune deficiency. Thus in our patient the & Z. Brzoza zbrzoza@mp.pl