Emad Koshak

Sensitization to Indigenous Pollen and Molds and Other Outdoor and Indoor Allergens in Allergic Patients From Saudi Arabia, United Arab Emirates, and Sudan

BackgroundAirborne allergens vary from one climatic region to another. Therefore, it is important to analyze the environment of the region to select the most prevalent allergens for the diagnosis and treatment of allergic patients.ObjectiveTo evaluate the prevalence of positive skin tests to pollen and fungal allergens collected from local indigenous plants or isolated molds, as well as other outdoor and indoor allergens in allergic patients in 6 different geographical areas in the Kingdom of Saudi Arabia (KSA), the United Arab Emirates, and Sudan.Materials and methodsFour hundred ninety-two consecutive patients evaluated at different Allergy Clinics (276 women and 256 men; mean age, 30 years) participated in this study. The selection of indigenous allergens was based on research findings in different areas from Riyadh and adjoining areas. Indigenous raw material for pollen grains was collected from the desert near the capital city of Riyadh, KSA. The following plants were included: Chenopodium murale, Salsola imbricata, Rumex vesicarius, Ricinus communis, Artiplex nummularia, Amaranthus viridis, Artemisia monosperma, Plantago boissieri, and Prosopis juliflora. Indigenous molds were isolated from air sampling in Riyadh and grown to obtain the raw material. These included the following: Ulocladium spp., Penicillium spp., Aspergillus fumigatus, Cladosporium spp., and Alternaria spp. The raw material was processed under Good Manufacturing Practices for skin testing. Other commercially available outdoor (grass and tree pollens) and indoor (mites, cockroach, and cat dander) allergens were also tested.ResultsThe highest sensitization to indigenous pollens was detected to C. murale (32%) in Khartoum (Sudan) and S. imbricata (30%) and P. juliflora (24%) in the Riyadh region. The highest sensitization to molds was detected in Khartoum, especially to Cladosporium spp. (42%), Aspergillus (40%), and Alternaria spp. (38%). Sensitization to mites was also very prevalent in Khartoum (72%), as well as in Abu Dhabi (United Arab Emirates) (46%) and Jeddah (KSA) (30%).ConclusionsThe allergenicity of several indigenous pollens and molds derived from autochthonous sources was demonstrated. Prevalence studies in different regions of KSA and neighbor countries indicate different sensitization rates to these and other outdoor and indoor allergens.

Is There a Role for Automated Eosinophil Count in Asthma Severity Assessment

Advances in asthma clinical assessment help in categorizing patients based on their clinical severity. Eosinophilia is a common laboratory finding in asthmatics. This paper explores the correlation between the clinical severity of asthmatic children and the degree of total peripheral eosinophil count (TPEC). Eighty asthmatic children referred to pediatric and allergy clinics were selected. Their clinical severity levels were assessed using the recent Global Strategy for Asthma Management and Prevention guidelines. Absolute TPEC was performed for all cases by the Cell-Dyne 3500 automated hematology counter. Correlation between clinical severity and TPEC was measured and their means in each severity group were compared for any significant association. Asthmatic children aged between 6 months and 15 years (mean = 5.9 years; 67.5% male) were studied. The clinical severity of their bronchial asthma was divided into four groups: intermittent (6, or 7.5%), mild-persistent (48, or 60%), moderate persistent (20, or 25%), and severe-persistent (6, or 7.5%). TPEC for the groups ranged between 10 and 2100 cells/mm3 (mean = 581.7 cells) and showed a very significant positive correlation with increased asthma severity (R = 0.61, p<0.001). A high linear trend of TPEC within each clinical group was found (F = 51.3, p<0.0001), and the means among each group also showed a significant increase as asthma severity level increased (F = 19.98, p<0.001). The study documents a significant positive correlation between the clinical severity of bronchial asthma and eosinophil counts. The authors advocate the use of this simple and sensitive laboratory test as a significant adjunct objective technique in the assessment of asthma severity and management.

Nigella sativa Supplementation Improves Asthma Control and Biomarkers: A Randomized, Double-Blind, Placebo-Controlled Trial

Poor compliance with conventional asthma medications remains a major problem in achieving asthma control. Nigella sativa oil (NSO) is used traditionally for many inflammatory conditions such as asthma. We aimed to investigate the benefits of NSO supplementation on clinical and inflammatory parameters of asthma. NSO capsules 500 mg twice daily for 4 weeks were used as a supplementary treatment in a randomized, double‐blind, placebo‐controlled trial in asthmatics (clinicaltrials.gov: NCT02407262). The primary outcome was Asthma Control Test score. The secondary outcomes were pulmonary function test, blood eosinophils and total serum Immunoglobulin E. Between 1 June and 30 December 2015, 80 asthmatics were enrolled, with 40 patients in each treatment and placebo groups. After 4 weeks, ten patients had withdrawn from each group. Compared with placebo, NSO group showed a significant improvement in mean Asthma Control Test score 21.1 (standard deviation = 2.6) versus 19.6 (standard deviation = 3.7) (p = 0.044) and a significant reduction in blood eosinophils by −50 (−155 to −1) versus 15 (−60 to 87) cells/μL (p = 0.013). NSO improved forced expiratory volume in 1 second as percentage of predicted value by 4 (−1.25 to 8.75) versus 1 (−2 to 5) but non‐significant (p = 0.170). This randomized, double‐blind, placebo‐controlled trial demonstrated that NSO supplementation improves asthma control with a trend in pulmonary function improvement. This was associated with a remarkable normalization of blood eosinophlia. Future studies should follow asthmatics for longer periods in a multicentre trial. Copyright

Medicinal benefits of Nigella sativa in bronchial asthma: A literature review

Nigella sativa L. (NS) seeds, known as black seed, is a spice and a traditional herbal medicine used in various diseases including bronchial asthma. This review aimed to assess the studies supporting the medicinal use of NS in asthma and to highlight future research priorities. Various medical databases were searched for the effects of NS and its active secondary metabolites in asthma inflammation and outcomes. There were fourteen preclinical studies describing multiple effects of NS in animal or cellular models of asthma including bronchodilation, anti-histaminic, anti-inflammatory, anti-leukotrienes and immunomodulatory effects. Furthermore, seven clinical studies showed improvements in different asthma outcomes including symptoms, pulmonary function and laboratory parameters. However, often these studies are small and used ill-defined preparations. In conclusion, NS could be therapeutically beneficial in alleviating airway inflammation and the control of asthma symptoms, but the evidence remains scanty and is often based on poorly characterised preparations. Accordingly, well-designed large clinical studies using chemically well characterised NS preparation are required.

Common Environmental Allergens in the Kingdom of Saudi Arabia and Their Use in the Diagnosis of Allergic Diseases by Skin test

Much human allergy is caused by a limited number of inhaled small proteins called allergens. Allergens are relatively large and complex molecules, such as pollens, molds, mites and house dust, which are capable of eliciting allergic reactions in susceptible persons. This study was conducted to identify the most common allergens in the kingdom of Saudi Arabia (KSA). Allergens were collected from different areas in the kingdom and used to prepare allergenic extracts to be used as diagnostic kits for diagnosis of allergy by skin prick test. The study included 494 patients diagnosed as truly allergic from five different areas in KSA; Jeddah, Riyadh, Al- Ehsaa, Al-Khobar, and Khamis Mushait. The study revealed that the mean prevalence of allergy in KSA is 24.7%. Using the locally prepared Saudi allergens, the most common allergens in KSA differed from one area to the other. They were Mites DF (49.1%), House dust mite (42.9%), and Mites DP (39.3%) in Al-Khobar, Mites DF (51.5%), Mite DP (48.5%), and house dust mite (39.8%) in Jeddah, Salsola kali (60.7%), Mites DP (52.3%), and Mites DF (48.6%) in Al-Ehsaa, Mites DP (56.7%), Mites DF (53.6%), Cat epithelium (46.4%) in Riyadh, and Salsola kali (54.7%), Mites DP (48%), and Prosopis (42.7%) in Khamis Mushait. These differences were attributed to many variable factors as environmental factors, geographical variation, and general change in indoor and outdoor environments. To assess the validity of Saudi allergenic extracts, they were compared to an imported kit; Canadian Omega kit. Although excellent validity was recorded for some allergens, validity of Saudi allergens was generally ranged from good to poor. This may be attributed to incomplete purity of collected allergens, different method for preparation and manufacturing, or may be due to different Saudi strain of the same allergen from the imported allergen. Adjustment of the methods of extraction, clarification, purification, and concentration of allergenic extracts was recommended. Reevaluation of methods and tools of allergy diagnosis in KSA keeping in consideration the common local allergens in the kingdom together with training of its physicians and doctors were also recommended.

Comparative Immunomodulatory Activity of Nigella sativa L. Preparations on Proinflammatory Mediators: a Focus on Asthma

Introduction: A range of traditional and commercial preparations of NS is frequently used in the treatment of several inflammatory diseases. Often, these preparations have poor preclinical characterization that may lead to variable pharmacological effects. Objective: To assess the in vitro effects of different chemically defined preparations of NS on some asthma-related mediators of inflammation. Methods: Different NS preparations were obtained by either seed extraction with a spectrum of solvents ranging from lipophilic to hydrophilic, or commercial products were collected. The TQ concentration of NS was analyzed by HPLC. Immunomodulatory activity was assessed by the release of mediators (IL-2, IL-6, PGE2) in primary human T-lymphocytes, monocytes, and A549 human lung epithelial cells. Results: Ten distinct NS preparations showed variability in TQ concentration, being highest in the oily preparations extract-7 (2.4% w/w), followed by extract-10 (0.7%w/w). Similarly, the release of mediators was varied, being greatest in extract-7 and 10 via significantly (<0.05) suppressing IL-2, IL-6, and PGE2 in T-lymphocytes as well as IL-6 and PGE2 in monocytes. Also, PGE2 release in A549 cells was significantly enhanced by both extracts. Conclusion: The TQ concentration and in vitro activity were variable among the different NS preparations. TQ-rich oily NS preparations produced potent favorable immunomodulation in asthma inflammation and can be used in future studies.