Joanna Glück

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.

Platelet aggregation in atopic dermatitis

Many observations suggest the active role of platelets in allergic inflammation. However, this problem is poorly researched in atopic dermatitis. The aim of study was to examine the intensity and velocity of platelet aggregation and a potential relationship with some immunological parameters (total IgE and specific-IgE serum levels) in atopic dermatitis patients. Platelet aggregation was evaluated in 12 subjects with atopic dermatitis and 12 healthy, nonatopic persons, according to the Born method, in a dual-channel aggregometer, in response to three exogenous stimulators (ADP, thrombin and collagen). The intensity and velocity of platelet aggregation and total platelet counts did not differ between the two groups irrespective of the type of extrinsic stimulator used. In contrast to other atopic diseases, in atopic dermatitis platelet aggregation is not impaired.

Prevalence of IgE-mediated allergy and evaluation of Th1/Th2 cytokine profiles in patients with severe bronchial asthma.

Introduction The pathogenesis of asthma remains unclear, especially in cases of the severe disease. Aim To explore IgE-mediated inhalant sensitization in severe asthma compared with a group of patients with chronic mild disease and evaluate the Th1/Th2 cytokine profiles in asthma by different disease severities. Material and methods One hundred and fifty-four patients (age range: 28–69) with severe chronic asthma (study group) and 141 patients with chronic mild disease (control group) diagnosed according to GINA criteria were included in the study. Seventy-eight severe asthmatics and 43 subjects with mild disease were randomly selected for serum Th1/Th2 cytokine level estimation. The groups were matched in terms of age and atopy features (skin prick tests, specific and total serum IgE). Results Positive skin tests to at least one allergen were observed with comparable frequencies. Sensitization to Dermatophagoides pteronyssinus was the most prevalent positive result in both groups. An earlier onset of asthma together with a greater number of exacerbations was noted in severe asthmatics compared to patients with mild disease. Serum levels of interleukin 4 and 2 (IL-4 and IL-2) were detectable only in severe asthmatics irrespective of atopy features. The levels of interferon γ and tumour necrosis factor α were undetectable in both groups. IL-10 and IL-5 were detected in the serum of only 7 and 12 severe asthmatics, respectively. Conclusions The serum level of IL-2 and IL-4 could be perceived as a marker of severe asthma. Neither IL-2 nor IL-4 levels in the serum could differentiate allergic and non-allergic asthma.

Risks and benefits of allergen immunotherapy.

Specific allergen immunotherapy is an effective method of causative treatment of IgE-dependent allergic disorders. Its safety is still a matter of concern especially because of the risk of life-threatening reactions. The side effects of immunotherapy may be divided into IgEand non-IgE-dependent, early and late, mild or severe, local or systemic. In this article some aspects of side effects of immunotherapy, risk factors of their occurrence and the way of their management are discussed. Long-term consequences of immunotherapy, such as immune complexes disease and future trends in immunotherapy, are also covered. Specific allergen immunotherapy is the only, beside avoidance of the offending allergens, causative treatment of IgE-mediated allergic disorders. The efficacy and safety of this mode of treatment has been well established in many well-controlled, well-designed studies. Allergen immunotherapy has been successfully used worldwide since near the beginning of the previous century; nevertheless, its safety is still a matter of concern. Every medical procedure involves risk and burden. It is also the case with regard to allergen immunotherapy. One should remember this kind of treatment consists of the administration of gradually increasing doses of allergens to human beings hypersensitive to them aimed at inducing immune tolerance to the offending agents and consequently suppress the symptoms of the diseases. It constitutes the risk of anaphylaxis induction. Apart from the undoubted advantages of allergen immunotherapy as the ability of significant suppression or even total remission of allergic symptoms and alteration of the natural evolution of allergic rhinitis with regard to diseases progression and onset of new sensitisations, this mode of treatment can produce life-threatening reactions [1-4]. Additionally, in spite of the great progress in the field, it remains to be further explained which of the changes in immune function occurring following immunotherapy are directly responsible for clinical improvement and may be used to monitor continuing the treatment. The awareness of this risk among the physicians dealing with allergen immunotherapy is essential for assuring the optimal safety of the patients undergoing this mode of treatment. From the pathophysiological point of view, adverse reactions to the treatment are classified as IgEand non-IgE-dependent, and with regard to the time of onset as early and late. Considering the extensiveness and intensity of the reactions, the division as mild and severe ones has been proposed [5]. The injection of allergen vaccine can induce:

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

Coexistence of Angioedema Alone with Impaired Glucose Tolerance

Background: Most patients with chronic spontaneous urticaria (CSU) exhibit recurrent angioedema. As of yet, the pathogenesis of angioedema in CSU is largely unclear, especially when angioedema occurs in patients who do not develop wheals. Over the past years, we and others have repeatedly observed that patients with recurrent angioedema alone exhibit impaired glucose tolerance. Aim: To assess blood glucose levels and glucose tolerance in these patients and to compare the results to those of CSU patients who do not develop angioedema. Methods: A total of 29 patients with angioedema alone (15 women, mean age 43.2 ± 12.8 years) and 33 CSU patients (17 women, mean age 41.9 ± 17 years) were investigated and compared for clinical features and laboratory values, including fasting and random blood glucose levels, and glycated hemoglobin (HbA1c%). All patients were subjected to oral glucose tolerance testing (OGTT). Results: Fasting plasma glucose levels, random blood glucose levels and OGTT glucose levels were significantly higher in patients with angioedema alone as compared to CSU patients. Glucose tolerance was impaired in 17 of 29 patients with angioedema alone (58.6%) and only in 2 of 33 CSU patients (6.1%). Patients were found to have an increased risk of high glucose (OR 1.74) and HbA1c (OR 1.83) blood levels and of developing a high BMI (OR 1.97). Conclusion: Recurrent angioedema in patients who do not develop wheals appears to be associated with impaired glucose tolerance and elevated blood glucose levels. We recommend blood glucose measurements in patients with recurrent angioedema alone.

Coexistence of two types of allergic hypersensitivity to drugs: case report

Hypersensitivity to drugs is a complex diagnostic challenge. Detailed medical history remains the mainstay of drug hypersensitivity evaluation, which further determines diagnostic procedures, especially the types of skin tests to be performed. The current paper presents the case of a female patient with coexisting features of supposed immunoglobulin E (IgE) dependent allergic hypersensitivity to fluoroquinolones and those of non-IgE dependent allergic hypersensitivity to povidone-iodine. Hypersensitivity was diagnosed based on the appropriately selected skin tests.

Zaburzenia odporności humoralnej i alergia wśród dzieci chorujących na nawracające zakażenia układu oddechowego

Streszczenie Dzieci chorujące na nawracające zakazenia ukladu oddechowego powinny miec wykonane badania przesiewowe w kierunku zaburzen odporności. Niektore zaburzenia odporności wiązą sie z czestszym wystepowaniem alergii. Cel Celem badania byla retrospektywna analiza wystepowania zaburzen odporności typu humoralnego i atopowych chorob alergicznych wśrod dzieci z nawracającymi zakazeniami ukladu oddechowego. Material i metody Badaniem objeto 226 dzieci (140 dziewczynek, 62%) chorujących na nawracające zakazenia ukladu oddechowego. U dzieci oznaczono stezenia immunoglobulin IgA, IgG, IgM oraz określono cechy atopii na podstawie punktowych testow skornych i/lub oznaczenia stezenia swoistych IgE przeciw alergenom wziewnym. Wyniki Zmniejszone stezenia immunoglobulin klas IgG, IgM i IgA stwierdzono u 94 dzieci (41%). U 64 (28%) wystepowal niedobor jednej immunoglobuliny, w tym u 21 (9,3%) byl to niedobor IgA, u 25 (11%) niedobor IgG, u 18 (7,9%) niedobor IgM. U 30 dzieci (13,2%) stwierdzono niedobor dwoch lub trzech immunoglobulin. Niedobor immunoglobulin stwierdzano statystycznie cześciej w grupie dzieci w wieku ponizej 3 roku zycia. Choroby alergiczne rozpoznano u 60 dzieci (26,5%). U 19 (8,4%) rozpoznano zespol wyprysku/atopowego zapalenia skory, u 25 (11,1%) astme oskrzelową, u 21 (9,3%) alergiczny niezyt nosa, u 2 (0,88%) wspolistniejące z alergicznym zapaleniem spojowek i u 3 (1,3%) alergie pokarmową. Czestośc wystepowania zaburzen immunologicznych byla niezalezna od wystepowania chorob alergicznych. Wniosek U dzieci z nawracającymi zakazeniami ukladu oddechowego czesto stwierdza sie obnizone stezenia immunoglobulin, co wskazuje na koniecznośc szerszej diagnostyki ukladu odpornościowego u tych chorych.