Serum IgE profiles in Chinese pollinosis patients with grass pollen sensitisation.

PURPOSE: Pollen from trees, grasses, and weeds is a common allergen source. The characteristics of pollen allergy in China are obviously different from Europe. Most studies have focused on tree and weed pollen, but there is a paucity of data on grass pollen sensitisation in China. Therefore, we used component-resolved diagnostics to investigate the serum-specific immunoglobulin E (sIgE) to grass pollen in Chinese patients with pollinosis. METHODS: We retrospectively analysed 547 patients with pollen allegy from an outpatient Allergy Department in Beijing, China. All the patients answered questionnaires about their clinical allergy histories. Total immunoglobulin E (IgE) and sIgE levels to grass pollen (Bermuda, Timothy grass) were quantified by ImmunoCAP using 0.35 kUA/L as a threshold for positivity. RESULTS: Of the 547 pollinosis patients, 389 (71.1%) showed a positive sIgE reaction to either grass pollen, or both. The prevalence of food allergy was significantly lower in patients with grass pollen sensitisation. Among the 389 patients with grass pollen sensitisation, the prevalence of sIgE to allergen extracts of bermuda, mugwort, ragweed, plane, hop, ash, birch, and timothy grass was 97%, 96%, 94%, 88%, 88%, 84%, 78%, and 78%, respectively. However, only 134/389 (34%) were positive for Cyn d 1, 29/389 (7%) for Phl p 1, and 8/389 (2%) for Phl p 5b. For pollinosis patients, 62/547 (11%) were sIgE-positive for cross-reactive carbohydrate determinants (CCDs), and their grass pollen-sIgE was also positive. CONCLUSIONS: The prevalence of in vitro IgE sensitisation to grass pollen extract is high in Chinese patients with pollinosis. But mostly spurious and characterized by IgE sensitisation to profilins and CCD, induced by other pollen. Component-resolved diagnostics is an extremely useful tool precise diagnostics of pollen allergy in China.

The Association Between Intestinal Bacteria and Allergic Diseases-Cause or Consequence?

The incidence of allergic disorders has been increasing over the past few decades, especially in industrialized countries. Allergies can affect people of any age. The pathogenesis of allergic diseases is complex and involves genetic, epigenetic, and environmental factors, and the response to medication is very variable. For some patients, avoidance is the sole effective therapy, and only when the triggers are identifiable. In recent years, the intestinal microbiota has emerged as a significant contributor to the development of allergic diseases. However, the precise mechanisms related to the effects of the microbiome on the pathogenesis of allergic diseases are unknown. This review summarizes the recent association between allergic disorders and intestinal bacterial dysbiosis, describes the function of gut microbes in allergic disease development from both preclinical and clinical studies, discusses the factors that influence gut microbial diversity and advanced techniques used in microbial analysis. Ultimately, more studies are required to define the host-microbial relationship relevant to allergic disorders and amenable to new therapeutic interventions.

Hereditary angioedema caused by a premature stop codon mutation in the SERPING1 gene.

BACKGROUND: Hereditary angioedema with deficient and dysfunctional C1 inhibitor (C1-INH-HAE) is a rare genetic disorder. The majority of the cases with this disease are caused by mutations in the C1-inbitor gene SERPING1 and are classified as type 1 and type 2. We aimed to detect mutations in the SERPING1 gene and evaluate its expression in nine probands with hereditary angioedema from nine different families. METHODS: Nine probands with hereditary angioedema from nine different families and 53 healthy controls were recruited in this study. All eight exons and intron-exon boundaries in the SERPING1 gene were amplified by PCR and then sequenced. Mutations were identified by alignment with reference sequences. mRNA expression was measured by real-time PCR. RESULTS: All probands were diagnosed with HAE type 1. Nine mutations were found in nine patients: c.44delT, c.289C

Comparison and evaluation of several Dermatophagoides pteronyssinus allergen extracts for skin prick test.

OBJECTIVE: To evaluate the significance of several Dermatophagoides pteronyssinus allergen extracts for skin prick test (SPT) in patients allergic to Dermatophagoides pteronyssinus. METHODS: Two hundred and nineteen patients enrolled in Peking Union Medical College Hospital underwent SPT and serum specific IgE assay to detect the Dermatophagoides pteronyssinus allergen. Three kinds of house dust mite allergen extracts were used for SPT, including the Dermatophagoides pteronyssinus extract prepared by our laboratory (group A), standardized Dermatophagoides pteronyssinus extract (group B), and mixed extracts of Dermatophagoides pteronyssinus and Dermatophagoides farinae (group C). Human serum specific IgE result was regarded as the reference standard for diagnosis of Dermatophagoides pteronyssinus allergy. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of SPT with the extracts of three groups. RESULTS: SPT results showed that the median wheal diameter of group A, group B, and group C was 0.43, 0.35, and 0.28 cm, respectively, with significant difference among three groups (P<0.05). The difference was significant between group A and B (P<0.01) as well as group A and C (P<0.01), but not between group B and C (P>0.05). There was no local urticaria or systemic allergic reactions following the procedure of SPT. Local reaction was observed in 5 patients and delayed reaction was in 2 patients of group A. As for group B and C, local reaction occurred in 3 cases and delayed reaction in 2 cases in each group. The area under ROC curve of SPT with extract in group A, group B, and group C was 0.765, 0.801, and 0.782, respectively. Based on the detection results of serum specific IgE, the sensitivity of SPT in diagnosis of Dermatophagoides pteronyssinus allergy with extract of group A, group B, and group C was 92.4%, 87.0%, and 81.5%, and the specificity was 60.6%, 73.2%, and 74.8%, respectively. CONCLUSION: The Dermatophagoides pteronyssinus extract for SPT prepared by our laboratory offers good sensitivity and specificity comparable to commercially available allergen extracts, and it may be an appropriate candidate for clinical screening and diagnosis of Dermatophagoides pteronyssinus allergy.

[Natural course from rhinitis to asthma in the patients with autumnal pollinosis: a clinical study of 1096 patients].

OBJECTIVE: To investigate the natural course from rhinitis to asthma in the patients with autumnal pollinosis. METHODS: 1096 patients with autumnal pollinosis, 488 males and 632 females, aged 38 +/- 14 (5 - 77), 511 with pure allergic rhinitis and 585 with allergic rhinitis complicated with asthma, underwent skin test of inhalant allergens, serum IgE specific to autumnal pollens, and questionnaire survey. RESULTS: The age range of rhinitis induced by autumnal pollens was 2 - 75. The peak onset age of rhinitis was 15 - 44, and the peak onset age of asthma was 25 - 54. 33% of the rhinitis patients complicated with asthma (194/585) had their first attack of rhinitis and the first attack of asthma in the same year, 66% of them (386/585) had the first attack of asthma later than the first attack of rhinitis, and only 0.8% of them (5/585) had their first attack of asthma earlier than that of rhinitis. 37% of the patients with autumnal pollen allergic rhinitis (410/1096) developed asthma within 5 years, 47% (511/1096), within 9 years, 5% (58/1096) within 10 approximately 19 years, and 1.5% (16/1096) within 20 - 40 years. CONCLUSION: Almost half of the patients with autumnal pollen allergic rhinitis develop to seasonal allergic asthma within 9 years.

[The clinical study of the relationship between allergic rhinitis and allergic asthma in the patients with autumnal pollinosis].

OBJECTIVE: To investigate the relationship between allergic rhinitis and allergic asthma in the patients with autumnal pollinosis. METHODS: 1120 patients with autumnal pollinosis, aged 5 - 75, excluding those with typical symptoms of seasonal rhinitis or asthma but with positive skin test and serum IgE specific to dustmite and fungi, underwent standardized clinical questionnaire survey, including the onset age, onset time, and symptoms as well as the severity of asthma, skin tests, and examination of serum IgE specific to autumnal pollens. RESULTS: The average onset age of the allergic rhinitis patients induced by autumnal pollens was 27.9 years, significantly younger than that of the allergic asthma patients (32.6 years, P < 0.001). Out of the 1120 patients 1096 (97.9%) had allergic rhinitis, 602 (53.8%) had asthma, 507 (45.3%) had allergic rhinitis only, and 10 (0.9%) had allergic asthma only. Among the 1096 patients with allergic rhinitis 585 (53.4%) suffered from seasonal asthma. Among the 602 patients with asthma 585 (97.2%) suffered from seasonal rhinitis, and 183 of the 602 patients (30.8%) needed emergency treatment. CONCLUSION: Autumnal pollens are very important causes which induce asthma during autumnal season in northern China.

Clinical features of hereditary angioedema in Chinese patients: new findings and differences from other populations.

BACKGROUND: Hereditary angioedema (HAE), caused by C1 inhibitor deficiency, is characterized by recurrent subcutaneous or submucosal swelling. Because it is rare, data on clinical features, especially in Chinese patients, are not comprehensive. OBJECTIVE: Our aim was to identify the characteristics of HAE in a Chinese population and enhance clinical knowledge of this disease. METHODS: One hundred and fifty-eight symptomatic patients were studied retrospectively. Data were obtained from medical records. Statistical analyses were performed using statistical software package: R version 2.14.0. RESULTS: The majority of patients first experienced attacks during the second (42%) and third (32%) decades: the mean onset of symptoms was at the age of 21.25 years. The percentage of patients having experienced a swelling at least once for the following sites were: extremities (83.54%); pharyngolarynx (58.86%); face (55.06%); gastrointestinal tract (34.17%); trunk (18.35%) and genitalia (15.33%). Rare manifestations included melaena, swollen gastric mucosa inverting into the oesophagus, pleural effusion, dysuria and syncope. For patients who first experienced swelling in pre-adolescence, 41.67% noted intensified attack rates when they entered puberty. In pregnancy, 61.70% did not note a change in HAE attack frequency. CONCLUSION: Compared with previous studies, the mean age of symptom onset is older. The frequencies of abdominal attacks occurring in patients on the Chinese Mainland, as well as in Taiwan and Japan, appears much lower than in western countries. Ethnic or environmental differences may contribute to this finding. Melaena and gastric mucosa inverting into the oesophagus secondary to edema are first reported here.