Montelukast treatment response according to eosinophil-derived neurotoxin level in children with allergic rhinitis.

BACKGROUND: Eosinophil-derived neurotoxin (EDN) is an important biomarker of eosinophilic inflammation. METHODS: This study evaluated Montelukast treatment response according to EDN concentration in children with perennial allergic rhinitis (PAR). Fifty-two children with PAR were recruited and took a combination of Montelukast (5mg) and Levocetirizine (5mg) "Mont/Levo Group" or only Montelukast (5mg) "Mont Group" for 4 weeks. All caregivers were instructed to record rhinitis symptoms for 4 weeks. EDN was measured before and after treatment. RESULTS: Daytime nasal symptom scores (DNSS) significantly decreased in both the Mont/Levo (p = 0.0001; n = 20) and Mont Group (p < 0.0001; n = 20), but there were no significant differences between the two groups. EDN concentration also significantly decreased after treatment in both groups (p < 0.0001 and p < 0.001, respectively). For secondary analysis, children with a high initial EDN concentration (EDN ≥ 53 ng/mL) were placed in the "High EDN Group", while those with a lower initial EDN concentration (EDN < 53 ng/mL) were put in the "Low EDN Group". Both groups experienced significant reductions in DNSS after either treatment regimen (p < 0.0001 and p = 0.0027, respectively) but the High EDN Group had greater reductions. EDN concentrations in the High EDN Group decreased significantly from either treatment (p < 0.0001). CONCLUSION: We found that children with AR and a high serum EDN concentration may respond well to Montelukast treatment. A therapeutic strategy using EDN concentrations in patients with AR to evaluate therapeutic response may help improve quality of care.

Annual and seasonal patterns in etiologies of pediatric community-acquired pneumonia due to respiratory viruses and Mycoplasma pneumoniae requiring hospitalization in South Korea.

BACKGROUND: Community-acquired pneumonia (CAP) is one of the leading worldwide causes of childhood morbidity and mortality. Its disease burden varies by age and etiology and is time dependent. We aimed to investigate the annual and seasonal patterns in etiologies of pediatric CAP requiring hospitalization. METHODS: We conducted a retrospective study in 30,994 children (aged 0-18 years) with CAP between 2010 and 2015 at 23 nationwide hospitals in South Korea. Mycoplasma pneumoniae (MP) pneumonia was clinically classified as macrolide-sensitive MP, macrolide-less effective MP (MLEP), and macrolide-refractory MP (MRMP) based on fever duration after initiation of macrolide treatment, regardless of the results of in vitro macrolide sensitivity tests. RESULTS: MP and respiratory syncytial virus (RSV) were the two most commonly identified pathogens of CAP. With the two epidemics of MP pneumonia (2011 and 2015), the rates of clinical MLEP and MRMP pneumonia showed increasing trends of 36.4% of the total MP pneumonia. In children < 2 years of age, RSV (34.0%) was the most common cause of CAP, followed by MP (9.4%); however, MP was the most common cause of CAP in children aged 2-18 years of age (45.3%). Systemic corticosteroid was most commonly administered for MP pneumonia. The rate of hospitalization in intensive care units was the highest for RSV pneumonia, and ventilator care was most commonly needed in cases of adenovirus pneumonia. CONCLUSIONS: The present study provides fundamental data to establish public health policies to decrease the disease burden due to CAP and improve pediatric health.

Comparison of serum eosinophil-derived neurotoxin levels between wheezing and non-wheezing groups in children with respiratory tract infection.

Objective: Eosinophil-derived neurotoxin (EDN) is associated with recurrent wheezing episodes after bronchiolitis, childhood asthma, and allergic rhinitis. We investigated if there is a measurable difference between serum EDN levels in children with wheezing and non-wheezing respiratory infections.Methods: 171 children who visited a university hospital with respiratory infections were enrolled in the study. Subjects were divided into two groups: wheezing (n = 46) and non-wheezing (n = 125). Serum EDN levels were compared.Results: Serum EDN levels in the wheezing group were significantly higher than in the non-wheezing group (P < 0.001). The non-wheezing group was divided into three sub-groups: pneumonia, common cold, and tonsillitis. Serum EDN levels in the wheezing group were significantly higher than in the pneumonia, common cold, or tonsillitis subgroups (P < 0.001). There was no significant difference in serum EDN levels among the pneumonia, common cold, and tonsillitis subgroups.Conclusions: These findings suggest that elevated serum EDN levels could be a distinctive feature of respiratory infections with wheezing. EDN's utility as a biomarker for wheezing-associated disease should be explored through further study.

Utility of serum eosinophil-derived neurotoxin (EDN) measurement by ELISA in young children with asthma.

BACKGROUND: This study was done to compare the efficacy of a recently developed eosinophil-derived neurotoxin (EDN) ELISA kit ("BioTracer™ K® EDN ELISA Kit") to a commercially available EDN ELISA kit ("MBL EDN ELISA Kit") and demonstrate the usefulness of serum EDN measurement in young asthmatic children. METHODS: Forty-eight children with physician-diagnosed asthma (Asthma group) and 31 age-matched normal controls (Control group) were recruited from the Asthma and Allergy Center at Inje University Sanggye Paik Hospital, Seoul, Korea from January 2010 to September of 2012. EDN levels in each serum specimen were measured 2 times using the: 1) BioTracer™ K® EDN ELISA Kit and 2) MBL EDN ELISA Kit at the Inje University Sanggye Paik Hospital laboratory. EDN level measurements in each serum specimen were compared. RESULTS: EDN measurements from the BioTracer™ K® EDN ELISA Kit correlated well with those from the MBL EDN ELISA Kit: r = 0.9472 at the Inje University Sanggye Paik Hospital laboratory. These r values were considered both clinically relevant (i.e., r > 0.85) and statistically significant (p < 0.0001). EDN measurements from both kits positively correlated with asthma symptom severity (p < 0.0001). No serious adverse events occurred during the study. CONCLUSIONS: The BioTracer™ K® EDN ELISA Kit was accurate and useful in measuring EDN levels in young asthma patient serum. Because of our kit's distinct advantages and utility, we suggest this kit can be used for the timely diagnosis, treatment, and monitoring of asthma in asthma patients of all ages, especially those too young to perform pulmonary function tests.

Promotion of adhesive penetration and resin bond strength to dentin using non-thermal atmospheric pressure plasma.

Non-thermal atmospheric pressure plasmas (NT-APPs) have been shown to improve the bond strength of resin composites to demineralized dentin surfaces. Based on a wet-bonding philosophy, it is believed that a rewetting procedure is necessary after treatment with NT-APP because of its air-drying effect. This study investigated the effect of 'plasma-drying' on the bond strength of an etch-and-rinse adhesive to dentin by comparison with the wet-bonding technique. Dentin surfaces of human third molars were acid-etched and divided into four groups according to the adhesion procedure: wet bonding, plasma-drying, plasma-drying/rewetting, and dry bonding. In plasma treatment groups, the demineralized dentin surfaces were treated with a plasma plume generated using a pencil-type low-power plasma torch. After the adhesion procedures, resin composite/dentin-bonded specimens were subjected to a microtensile bond-strength test. The hybrid layer formation was characterized by micro-Raman spectroscopy and scanning electron microscopy. The plasma-drying group presented significantly higher bond strength than the wet-bonding and dry-bonding groups. Micro-Raman spectral analysis indicated that plasma-drying improved the penetration and polymerization efficacy of the adhesive. Plasma-drying could be a promising method to control the moisture of demineralized dentin surfaces and improve the penetration of adhesive and the mechanical property of the adhesive/dentin interface.

Effects of non-thermal atmospheric pressure pulsed plasma on the adhesion and durability of resin composite to dentin.

This study investigated the effect of low-power, non-thermal atmospheric pressure plasma (NT-APP) treatments, in pulsed and conventional modes, on the adhesion of resin composite to dentin and on the durability of the bond between resin composite and dentin. A pencil-type NT-APP jet was applied in pulsed and conventional modes to acid-etched dentin. The microtensile bond strength (MTBS) of resin composite to dentin was evaluated at 24 h and after thermocycling in one control group (no plasma) and in two experimental groups (pulsed plasma and conventional plasma groups) using the Scotchbond Multi-Purpose Plus Adhesive System. Data were analyzed using two-factor repeated-measures anova and Weibull statistics. Fractured surfaces and the bonded interfaces were evaluated using a field-emission scanning electron microscope. Although there were no significant differences between the plasma treatment groups, the plasma treatment improved the MTBS compared with the control group. After thermocycling, the MTBS did not decrease in the control or conventional plasma group but increased in the pulsed plasma group. Thermocycling increased the Weibull moduli of plasma-treated groups. In conclusion, plasma treatment using NT-APP improved the adhesion of resin composite to dentin. Using a pulsed energy source, the energy delivered to the dentin was effectively reduced without any reduction in bond strength or durability.

Biomarkers in allergen immunotherapy: Focus on eosinophilic inflammation.

Asthma and allergic rhinitis (AR) are 2 of the most common chronic inflammatory disorders and they appear to be on the rise. Current pharmacotherapy effectively controls symptoms but does not alter the underlying pathophysiology. Allergen immunotherapy (AIT) is an evidence-based therapy for asthma and AR and has been recognized as the only therapeutic method that actually modifies the allergic disease process. There is a lack of objective markers that accurately and reliably reflect the therapeutic benefits of AIT. A biomarker indicating patients that would benefit most from AIT would be invaluable. Eosinophilic inflammation is a cardinal feature of many allergic diseases. Biomarkers that accurately reflect this inflammation are needed to better diagnose, treat, and monitor patients with allergic disorders. This review examines the current literature regarding AIT's effects on eosinophilic inflammation and biomarkers that may be used to determine the extent of these effects.

Eosinophil-derived neurotoxin levels at 3 months post-respiratory syncytial virus bronchiolitis are a predictive biomarker of recurrent wheezing.

OBJECTIVE: To determine whether eosinophil-derived neurotoxin (EDN) is a predictive marker of recurrent wheezing episodes in post-respiratory syncytial virus (RSV) bronchiolitis. METHODS: EDN levels and recurrent wheezing episodes were serially measured in 200 infants hospitalized with RSV bronchiolitis. RESULTS: Serum EDN levels at 3 months correlated significantly with total wheezing episodes at 12 months in the RSV-PLC (n = 71; r = 0.720, p < 0.0001) and RSV-MONT groups (n = 79; r = 0.531, p < 0.001). Positive predictive value of 3-mo EDN level for total wheezing episodes was 57%; negative predictive value, 76%; sensitivity, 72%; specificity, 62%. CONCLUSION: EDN levels have predictive value for the development of recurrent wheezing post-RSV bronchiolitis.

Dexibuprofen for fever in children with upper respiratory tract infection.

BACKGROUND: The aim of this study was to investigate the safety and efficacy of dexibuprofen compared to ibuprofen. METHODS: This double-blind, double-dummy study enrolled patients from January 2008 to May 2009 presenting at one of five tertiary care centers in Seoul, Korea with febrile illness who were then given one of three active treatments: one dose of dexibuprofen 2.5 or 5 mg/kg (DEX 1); dexibuprofen 3.5 or 7 mg/kg (DEX 2); or ibuprofen 5 or 10 mg/kg (control) syrup. Those with a temperature <38.5°C were given the lower dose. Temperature was measured every hour for 4 h. Primary study outcome was mean change in temperature 4 h after one dose. RESULTS: A total of 264 children (aged 6 months-14 years) with febrile illness due to upper respiratory tract infection were consecutively sampled and screened, with 260 randomized. No patients withdrew due to adverse effects. Mean temperature change after 4 h (mean ± SD: DEX 1, 0.99 ± 0.84°C; DEX 2, 1.12 ± 0.92°C; control, 1.38 ± 0.84°C) differed only between DEX 1 and controls (P = 0.007, 95% confidence interval [CI]: -0.61 to -0.15). When groups were subdivided according to initial temperature, there were no significant differences in mean temperature change after 4 h between DEX 2 subgroups (<38.5°C, 0.88 ± 0.86°C; ≥38.5°C, 1.46 ± 0.90°C) and controls (1.07 ± 0.84°C and 1.72 ± 0.91°C, respectively), but there was a significant difference between DEX 1 (≥38.5°C, 1.25 ± 0.76°C) and controls (P = 0.0222, 95%CI: -0.80 to -0.13). There were no significant differences in adverse events among groups. CONCLUSION: Dexibuprofen (3.5 or 7 mg/kg) is as effective and tolerable as ibuprofen for fever caused by upper respiratory tract infection in children.

Eosinophil granule proteins as a biomarker in managing asthma and allergies.

In the past few decades, biomarkers have been successfully used for the diagnosis, treatment, and monitoring of disease. Taking together clinical, genetic, lifestyle, and information on relevant biomarkers, the therapy of diseases can be personalized to an individual. Several novel biomarkers have been recently reported for allergic diseases. However, to interpret the validity of biomarker data, the validation of their reliability, precision, and reproducibility is imperative. Once validated, they can be used in therapeutic product development and in clinical practice. Eosinophils are multifunctional leukocytes and major effector cells that play a crucial role in the immunological mechanisms of allergic disease. Measuring eosinophils has been the gold standard for treating and monitoring eosinophil-related diseases such as asthma, atopic dermatitis, and allergic rhinitis. However, eosinophil numbers/percentages yield little information about eosinophil activity. Eosinophil activation leads to the extracellular release of 4 granule proteins, with the most promising biomarker of the 4 being eosinophil-derived neurotoxin (EDN). EDN is more easily recovered from measuring instruments and cell surfaces than other eosinophil biomarkers because of its weaker electrical charge. EDN is known to be released from eosinophils at a greater efficiency, adding to its recoverability. It also has antiviral activity in respiratory infections associated with allergic disease development in early life (eg, respiratory syncytial virus and human rhinovirus infections in early childhood). EDN can be measured in several body fluids, including blood, urine, sputum, nasal secretions, and bronchoalveolar lavage. EDN is a stable biomarker utilized to precisely diagnose, treat, and monitor many eosinophil-related allergic diseases. This eosinophil granule protein may prove useful in precision medicine approaches and should always be considered as a useful tool for the clinician to give the best patient care possible.

Clinical Potential of Eosinophil-Derived Neurotoxin in Asthma Management.

The assessment and management of patients with asthma is challenging because of the complexity of the underlying inflammatory mechanisms and heterogeneity of their clinical presentation. Optimizing disease management requires therapy individualization that should rely on reliable biomarkers to unravel the phenotypes and endotypes of asthma. The secretory activity and turnover of eosinophils, as assessed by measuring eosinophil-derived proteins, may provide an accurate and complementary tool that mirrors the eosinophil activation status. Emerging evidence suggests that eosinophil-derived neurotoxin has considerable potential as a precision medicine biomarker. In this review, we explore the suitability of eosinophil-derived neurotoxin as a biomarker in asthma management, with particular emphasis on its clinical significance in the management of both pediatric and adult populations.

Natural history of eosinophil­derived neurotoxin levels and the onset of allergic airway disease in preschool children.

'Atopic march' is the progression of allergic conditions through infancy and childhood. The present study investigated the association between blood eosinophil-derived neurotoxin (EDN) levels in preschool children with food allergy (FA) or atopic dermatitis (AD) and the onset of allergic airway disease [bronchial asthma (BA), allergic rhinitis (AR)]. A total of 123 children below the age of 1 year were enrolled in the present study, along with controls (n=37). Blood specimens were taken, serum EDN levels were measured and immunoglobulin E was quantified. Finally, a total of 86 subjects were analyzed. EDN values were measured at 3 time-points: before 1 year of age, before 2 years of age and before 3 years of age. The EDN levels were initially similar between those patients who did and those who did not develop allergic airway disease but then markedly diverged at the 2-year time-point (226.6 vs. 65.0 ng/ml; P<0.01) and remained divergent at the 3-year time-point (173.9 vs. 62.7 ng/ml; P<0.01). EDN levels prior to diagnosis were compared between the two groups and they were much higher in the Onset group (n=10) compared to the Non-onset group (n=67) (171.2±34.28 vs. 81.3±10.02 ng/ml; P=0.003), with 4 cases of BA and 6 cases of AR in the Onset group. After diagnosis, EDN levels were compared twice: i) At 1 and 2 years of age; and ii) 1 and 3 years of age. A significant difference was found only in the comparison at 2 years (P=0.001). In conclusion, young children with elevated EDN levels during the FA/AD disease period were more likely to develop allergic airway disease (BA, AR) in their first three years of life. A factor leading to this progression may be increased eosinophil activity.

Effect of the applied power of atmospheric pressure plasma on the adhesion of composite resin to dental ceramic.

PURPOSE: To evaluate the effect of applied power on dental ceramic bonding of composite resin using nonthermal atmospheric pressure plasma (APP). MATERIALS AND METHODS: A pencil-type APP torch was used to modify the surface chemical composition and hydrophilicity of dental ceramic and to improve the adhesion of composite resin to the surface. The effect of the applied power on chemical changes of the plasma polymer on a ceramic surface and the adhesive strength between the composite resin and feldspathic porcelain were examined. Adhesion was evaluated by comparing shear bond strengths (SBS) using the iris method. The chemical composition of the plasma polymer deposited on the ceramic surface was evaluated using x-ray photoelectron spectroscopy (XPS). Hydrophilicity was evaluated by contact angle measurements. The fracture mode at the interface was also evaluated. RESULTS: The APP treatment was effective and the SBS of the experimental groups were significantly higher than those of the negative control group (p < 0.05). Moreover, the SBS obtained with the APP treatment at the highest input voltage was statistically similar to the gold standard of HF etching and silane coupling-agent coating. Two-thirds of the fractures observed in the specimens bonded with application of APP were mixed and cohesive fractures. CONCLUSION: Application of APP enhanced adhesion by producing carboxyl groups on the ceramic surface and as a result by improving surface hydrophilicity. The carboxyl group contents in the plasma polymer on the ceramic surface increased as the applied power increased.

Lung- and liver-dominant phenotypes of Korean eight constitution medicine have different profiles of genotype associated with each organ function.

Eight Constitution Medicine (ECM), a ramification of traditional Korean medicine, has categorized people into eight constitutions. The main criteria of classification are inherited differences or predominance in the functions of organs, such as the liver or lung, diagnosed through ECM-specific pulse patterns. This study investigated the association between single nucleotide polymorphism (SNP) genotypes and ECM phenotypes and explored candidate genetic makeups responsible for each constitution using a genome-wide association study (GWAS). Sixty-three healthy volunteers, who were either categorized as the Hepatonia (HEP, n = 32) or Pulmotonia (PUL, n = 31) constitution, were enrolled. HEP and PUL are two contrasting ECM types representing the dominant liver and lung phenotypes, respectively. SNPs were analyzed from the oral mucosa DNA using a commercially available microarray chip that can identify 820,000 SNPs. We conducted GWAS using logistic regression analysis and additive mode genotypes and constructed phylogenetic trees using the SNPhylo program with 8 SNPs specific for the liver phenotype and 15 SNPs for the lung phenotype. Although genome-wide significant SNPs were not found, the phylogenetic tree showed a clear difference between the two constitutions. This is the first observation suggesting genetic involvement in the ECM and can be extended to all ECM constitutions.

Increase in eosinophil-derived neurotoxin level in school children with allergic disease.

Background: Eosinophils are major effector cells of allergic disease and excellent markers of eosinophilic inflammation. Accurate and reliable biomarkers are helpful in the diagnosis, treatment, and control of allergic disease. Objective: This study aimed to investigate an alternate marker of eosinophilic inflammation, eosinophil-derived neurotoxin (EDN), in a number of allergic diseases. Methods: Three hundred ninety-six elementary school-age children with various allergic conditions were recruited for this study. Subgroups included food allergies (FAs), atopic dermatitis (AD), bronchial asthma (BA), and allergic rhinitis (AR). EDN levels in these groups were compared to those in 93 healthy controls (HC). Results: All subjects with allergic disease had elevated levels of serum EDN (median [interquartile range]: FA, 124.2 ng/mL [59.13-160.5 ng/mL]; AD, 110.8 ng/mL [57.52-167.9 ng/mL]; BA, 131.5 ng/mL [60.60-171.0 ng/mL]; AR, 91.32 ng/mL [46.16-145.0 ng/mL]) compared to HC (38.38 ng/mL [32.40-55.62 ng/mL]) (p < 0.0001). These elevated levels were consistent throughout the age range (6-12 years) of the healthy study subjects (p = 0.0679). EDN levels also correlated well with total immunoglobulin E (Rs = 0.5599, p < 0.0001). Looking at all individuals with an allergic disease, the area under the curve was 0.790. Conclusions: Direct measures of eosinophilic inflammation are needed for accurate diagnosis, treatment, and monitoring of allergic diseases. EDN may be a worthy biomarker of eosinophil activity and a useful screening tool for allergic diseases including FA, AD, BA, and AR.

Clinical Characteristics of Macrolide-Refractory Mycoplasma pneumoniae Pneumonia in Korean Children: A Multicenter Retrospective Study.

Mycoplasma pneumoniae is a major causative pathogen of community-acquired pneumonia in children, and the treatment of choice is macrolides. There is an increasing trend in reports of refractory clinical responses despite macrolide treatment due to the emergence of macrolide-resistant M. pneumoniae. Early discrimination of macrolide-refractory M. pneumoniae pneumonia (MrMP) from macrolide-sensitive M. pneumoniae pneumonia (MSMP) is vital; however, testing for macrolide susceptibility at the time of admission is not feasible. This study aimed to identify the characteristics of MrMP in Korean children, in comparison with those of MSMP. In this multicenter study, board-certified pediatric pulmonologists at 22 tertiary hospitals reviewed the medical records from 2010 to 2015 of 5294 children who were hospitalized with M. pneumoniae pneumonia and administered macrolides as the initial treatment. One-way analysis of variance and the Kruskal-Wallis test were used to compare differences between groups. Of 5294 patients (mean age, 5.6 years) included in this analysis, 240 (4.5%), 925 (17.5%), and 4129 (78.0%) had MrMP, macrolide-less effective M. pneumoniae pneumonia, and MSMP, respectively. Compared with the MSMP group, the MrMP group had a longer fever duration, overall (13.0 days) and after macrolide use (8.0 days). A higher proportion of MrMP patients had respiratory distress, pleural effusion, and lobar pneumonia. The mean aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, and C-reactive protein levels were the highest in the MrMP group, along with higher incidences of extrapulmonary manifestations and atelectasis (during and post infection). Pre-existing conditions were present in 17.4% (n = 725/4159) of patients, with asthma being the most common (n = 334/4811, 6.9%). This study verified that MrMP patients show more severe initial radiographic findings and clinical courses than MSMP patients. MrMP should be promptly managed by agents other than macrolides.

Respiratory viruses, eosinophilia and their roles in childhood asthma.

With the advent of highly sensitive and specific screening of respiratory specimens for viruses, new viruses are discovered, adding to the growing list of those associated with wheezing illness and asthma exacerbations. It is not known whether early childhood infections with these viruses cause asthma, and, if so, what exactly are the pathophysiologic mechanisms behind its development. The current consensus is that respiratory viral infection works together with allergy to produce the immune and physiologic conditions necessary for asthma diasthesis. One link between viruses and asthma may be the eosinophil, a cell that plays a prominent role in asthma and allergy, but can also be found in the body in response to viral infection. In turn, the eosinophil and its associated products may be novel therapeutic targets, or at the very least, used to elucidate the complex pathophysiologic pathways of asthma and other respiratory illnesses. Together or separately, they can be used for diagnosis, treatment and monitoring. Not only symptoms, but also the underlying disease mechanisms must be taken into consideration for the optimal care of a patient.

Eosinophil degranulation is more important than eosinophilia in identifying asthma in chronic cough.

OBJECTIVE: We investigated whether eosinophil degranulation is a distinctive feature of asthma and can distinguish between chronic cough patients with asthma and those without. METHODS: Thirty-seven patients, with a chronic cough for more than 1 month, and nine normal individuals (controls) were enrolled. Subjects were divided into two groups: one group with asthma and positive bronchial hyperresponsiveness (BHR) (Asthma group, n = 18) and the other group without asthma and negative BHR (Non-Asthma group, n = 19). From induced sputum, total cell counts and differentials were determined. Myeloperoxidase levels were measured by Enzyme-Linked Immunosorbent Assay (ELISA), and eosinophil-derived neurotoxin (EDN) and major basic protein (MBP) levels were measured by radioimmunoassay. RESULTS: The percentage of sputum eosinophils was increased in the Asthma (p < .001) and Non-Asthma (p < .05) groups compared with the Control group and when comparing the Asthma and Non-Asthma (p < .001) groups. Sputum EDN and MBP levels were increased in the Asthma group compared with the Non-Asthma (p < .05 and p < .05, respectively) and Control groups (p < .05 and p = .055, respectively). However, EDN and MBP levels were not increased in the Non-Asthma group compared with the Control group. The percentage of sputum eosinophils in the Asthma group correlated positively with sputum EDN (Rs = 0.921, p < .001) and MBP (Rs = 0.882, p < .0001) levels and negatively with maxΔFEV(1) (Rs = -0.501, p < .05) (FEV(1), forced expiratory volume in 1 second). Unexpectedly, the percentage of eosinophils in the Non-Asthma group did not correlate significantly with any of these markers. Increased EDN and MBP levels and significant correlations between the percentage of eosinophils and EDN and MBP were only observed in asthma patients. CONCLUSIONS: These findings suggest that eosinophil degranulation is more important than eosinophilia in identifying asthma.

Allergen Immunotherapy management during vaccinations: An international survey.

Vaccination against viral and bacterial pathogens represents a challenging issue in allergic subjects, mainly concerning patients undergoing allergen immunotherapy (AIT). For this reason, an international survey has been performed involving a panel of experts who responded to a series of questions, also concerning the COVID-19 impact on allergen immunotherapy and vaccinations. The results showed that co-administration of vaccines and AIT requires caution, mainly during the pandemic era. Moreover, the choice of AIT product should be oriented considering also the safety profile.