Orathai Jirapongsananuruk

Upregulation of B7.2, but not B7.1, on B cells from patients with allergic asthma

BACKGROUND Allergic asthma is associated with TH2-like cell responses and increased IgE production. Recent studies in mice have suggested that the costimulatory molecule B7.2 (CD86) may influence the development of TH2 cells. OBJECTIVE We sought to determine the potential role of B7.2 in patients with asthma. METHODS We performed an analysis of B cells from patients with allergic asthma and healthy control subjects for expression of B7.1 and B7.2 on B cells using five-parameter flow cytometry. RESULTS We report that atopic patients with asthma who are exposed to allergens have significantly (p < 0.005) higher levels of B7.2 expression on B cells than atopic asthmatic subjects not exposed to allergen in vivo or nonatopic control subjects. In contrast, there were no differences in B7.1 (CD80) expression among the three study subject groups. When peripheral blood mononuclear cells from asthmatic patients or normal control subjects were stimulated with IL-4 or IL-13, the expression of B7.2, but not B7.1, was significantly increased (p < 0.005) on B cells. Interferon-gamma or IL-12 did not affect the expression of either molecule. The functional significance of B7.2 induction by IL-4 in allergic disease was suggested by the increased expression of this molecule on CD23+, but not CD23-, B cells. CONCLUSION These results indicate that the same B cell involved in allergen presentation also expresses the costimulatory molecule B7.2 and support the hypothesis that this molecule is an important costimulatory molecule in allergic responses, the expression of which can be modulated by TH2-like cytokines.

Genetic polymorphisms of major house dust mite allergens

Background Polymorphic sequence substitutions in the major mite allergens can markedly affect immunoglobulin E binding and T cell responses, but there are few studies on environmental isolates from Dermatophagoides pteronyssinus and none for D. farinae.

Features of patients with anaphylaxis admitted to a university hospital

BACKGROUND Anaphylaxis in hospitalized patients has been infrequently reviewed. There are few studies of anaphylaxis from Asian countries. OBJECTIVE To describe the clinical characteristics of patients with anaphylaxis admitted to Siriraj Hospital. METHODS The medical records of 101 patients admitted with clinical anaphylaxis between January 1, 1999, and December 31, 2004, were reviewed. Data were analyzed using the chi2 test. RESULTS The annual occurrence of anaphylaxis increased from 9.16 per 100,000 admitted persons in 1999 to 55.45 per 100,000 admitted persons in 2004. The case fatality rate was 0.19 per 100,000 admitted persons. The mean +/- SD age was 23.73 +/- 21.84 years. Males experienced more anaphylaxis than females in pediatric patients and vice versa in adult patients. Biphasic anaphylaxis was found in 7% of pediatric and 2% of adult patients. Anaphylaxis occurred in the hospital in 37% of patients. Involved systems were cutaneous (86%), respiratory (80%), cardiovascular (52%), and oral and gastrointestinal (36%). Identifiable causes were drugs (50%), foods (24%), idiopathic (15%), and insect stings/bites (11%). Epinephrine was given to 77% of the patients. CONCLUSIONS We report the clinical characteristics of patients with anaphylaxis admitted to a university hospital. Knowing the clinical features will raise physician awareness of this condition.

ICON: chronic rhinosinusitis

Chronic rhinosinusitis (CRS) is a public health problem that has a significant socio-economic impact. Moreover, the complexity of this disease due to its heterogeneous nature based on the underlying pathophysiology - leading to different disease variants - further complicates our understanding and directions for the most appropriate targeted treatment strategies. Several International/national guidelines/position papers and/or consensus documents are available that present the current knowledge and treatment strategies for CRS. Yet there are many challenges to the management of CRS especially in the case of the more severe and refractory forms of disease. Therefore, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), a collaboration between EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus (ICON) on Chronic Rhinosinusitis. The purpose of this ICON on CRS is to highlight the key common messages from the existing guidelines, the differences in recommendations as well as the gaps in our current knowledge of CRS, thus providing a concise reference. In this document we discuss the definition of the disease, its relevance, pharmacoeconomics, pathophysiology, phenotypes and endotypes, genetics and risk factors, natural history and co-morbidities as well as clinical manifestations and treatment options in both adults and children comprising pharmacotherapy, surgical interventions and more recent biological approaches. Finally, we have also highlighted the unmet needs that wait to be addressed through future research.

IgE antibodies to omega-5 gliadin in children with wheat-induced anaphylaxis.

Background:  Wheat can cause severe immunoglobulin E (IgE)‐mediated systemic reactions including anaphylaxis but knowledge on relevant wheat allergens at the molecular level is scanty.

Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients

Jirapongsananuruk O, Pongpreuksa S, Sangacharoenkit P, Visitsunthorn N, Vichyanond P. Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients.
Pediatr Allergy Immunol 2010: 21: 508–514.
© 2009 John Wiley & Sons A/S

Specific allergy to Penaeus monodon (seawater shrimp) or Macrobrachium rosenbergii (freshwater shrimp) in shrimp-allergic children

Background Allergy to specific shrimp species has not been studied systematically by oral challenges. A comparison of allergy to different shrimp species, especially seawater or freshwater varieties treatment, would be useful in testing shrimp‐allergic subjects.

Clinical Applications of Cytokines: New Directions in the Therapy of Atopic Diseases

OBJECTIVES This review will enable the readers to understand the pathogenesis of allergic inflammation, and the role of various cells and cytokines in allergic diseases. Pathogenic cytokines may become key therapeutic targets in the future treatment of allergic diseases. DATA SOURCES MEDLINE literature search limited to the English language was performed using the relation between specific cytokines and allergic inflammation as well as therapy of allergic diseases. Relevant articles referenced in retrieved sources and current texts on ctyokines and allergic responses were also utilized. RESULTS The mechanism underlying allergic inflammation involves complex interactions between various cells and cytokines. The immediate reaction is caused mainly by mast cells and followed by a cell mediated response that involves eosinophils, mononuclear cells, neutrophils, T lymphocytes and macrophages. The majority of T cells in early allergic reactions are T helper type 2 (TH2)-like producing IL-4, IL-5, IL-13 but not IFN-gamma. These cytokines regulate IgE synthesis, promote eosinophil differentiation and survival, and induce vascular endothelial adhesion molecules, thus contributing to allergic inflammation. CONCLUSIONS Although studies of cytokine modulation have utilized animal models of allergic diseases, the increasing availability of recombinant cytokines and cytokine antagonists is likely to lead to more wide scale applications in allergic diseases.

Identification of hemocyanin as a novel non‐cross‐reactive allergen from the giant freshwater shrimp Macrobrachium rosenbergii

SCOPE Sensitization to giant freshwater shrimp Macrobrachium rosenbergii (Mr) was recently reported. However, the allergens have yet to be identified. This study aimed to identify and characterize a novel allergen of Mr shrimp. METHODS AND RESULTS Extracted proteins were separated and purified by anion and in some experiments, size-exclusion chromatography. Serum IgE from shrimp allergic donors identified a candidate protein, which was characterized by LC-MS/MS. The specificity of IgE binding was tested using immunoblotting and inhibition ELISA. The IgE-binding profiles from 12 of 13 Mr allergic subjects that were pre-incubated with an extract of Penaeus monodon showed residual binding to ~60-80 kDa proteins. The 60-80 kDa IgE-bound proteins were fractionated in the flow-through of anion chromatography showing a high IgE reactivity. Peptides identified by LC-MS/MS showed the proteins closely match subunits of hemocyanin (Hcs). Purified Hcs from hemolymph markedly inhibited binding of IgE from sera of Mr allergic subjects to solid-phased Mr proteins in inhibition ELISA. CONCLUSION Hcs were identified as heat-stable, non-cross-reactive, high-molecular-weight (MW) allergens from Mr shrimp. Since circulatory organs are not always removed during food preparation, high concentrations of Hcs may be present along with shrimp meat, which contains the known cross-reactive tropomyosin protein.

Nasal cytology in the diagnosis of allergic rhinitis in children

BACKGROUND Inflammatory cellular infiltrates of eosinophils and basophilic metachromatic cells are the hallmark of the atopic nasal responses in allergic rhinitis. Nasal cytologic examination for these cells not only establishes the diagnosis of allergic rhinitis but is also useful in the followup of patients with this condition. OBJECTIVES To determine the usefulness of quantitative nasal cytology as an adjunctive diagnostic tool for children with allergic rhinitis in addition to history, physical examination and allergy skin testing. MATERIALS AND METHODS Forty-eight children with allergic rhinitis less than 15 years of age were recruited and evaluated for the following variables: symptoms and signs of allergic rhinitis, skin prick tests to common aeroallergens, paranasal sinus radiographs, and nasal cytology. Forty-one normal and healthy children less than 15 years of age served as controls. Nasal mucosal specimens were obtained by scraping the middle one-third of inferior turbinates with Rhinoprobes and were stained with Wright-Giemsa stain. Nasal cytology was examined under a light microscope and graded according to a previously suggested scoring system. RESULTS There were distinctive differences in the scores for nasal eosinophils and basophilic metachromatic cells between the allergic rhinitis and the control groups (P < .001). The sensitivity for nasal eosinophil scores or nasal basophilic metachromatic cell scores more than 0.5 in the diagnosis of allergic rhinitis was 91.7% with a specificity of 100%, positive predictive value of 100% and a negative predictive value of 91.1%. Presence of polymorphonuclear cells did not correlate with the presence of sinusitis as diagnosed by paranasal sinus radiographs. Nasal eosinophil scores correlated significantly with sign scores (P = .009). House dust mites were the most common allergens sensitized by this group of children (67.4% to 88.4%). CONCLUSION Nasal cytology is a quick, simple, and inexpensive tool not only for the diagnosis of allergic rhinitis but also for serial evaluations of children with this condition as well.