Effect of continuing the use of renin-angiotensin system inhibitors on mortality in patients hospitalized for coronavirus disease 2019: a systematic review, meta-analysis, and meta-regression analysis.

BACKGROUND: The effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on mortality was preliminarily explored through the comparison of ACEIs/ARBs with non-ACEIs/ARBs in patients with coronavirus disease 2019 (COVID-19). Reaching a conclusion on whether previous ACEI/ARB treatment should be continued in view of the different ACE2 levels in the comparison groups was not unimpeachable. Therefore, this study aimed to further elucidate the effect of ACEI/ARB continuation on hospital mortality, intensive care unit (ICU) admission, and invasive mechanical ventilation (IMV) in the same patient population. METHODS: We searched PubMed, the Cochrane Library, Ovid, and Embase for relevant articles published between December 1, 2019 and April 30, 2022. Continuation of ACEI/ARB use after hospitalization due to COVID-19 was considered as an exposure and discontinuation of ACEI/ARB considered as a control. The primary outcome was hospital mortality, and the secondary outcomes included 30-day mortality, rate of ICU admission, IMV, and other clinical outcomes. RESULTS: Seven observational studies and four randomized controlled trials involving 2823 patients were included. The pooled hospital mortality in the continuation group (13.04%, 158/1212) was significantly lower than that (22.15%, 278/1255) in the discontinuation group (risk ratio [RR] = 0.45; 95% confidence interval [CI], 0.28-0.72; P = 0.001). Continuation of ACEI/ARB use was associated with lower rates of ICU admission (10.5% versus 16.2%, RR = 0.63; 95% CI 0.5-0.79; P < 0.0001) and IMV (8.2% versus 12.5%, RR = 0.62; 95% CI 0.46-0.83, P = 0.001). Nevertheless, the effect was mainly demonstrated in the observational study subgroup (P < 0.05). Continuing ACEI/ARB had no significant effect on 30-day mortality (P = 0.34), acute myocardial infarction (P = 0.08), heart failure (P = 0.82), and acute kidney injury after hospitalization (P = 0.98). CONCLUSION: Previous ACEI/ARB treatment could be continued since it was associated with lower hospital deaths, ICU admission, and IMV in patients with COVID-19, although the benefits of continuing use were mainly shown in observational studies. More evidence from multicenter RCTs are still needed to increase the robustness of the data. Trial registration PROSPERO (CRD42022341169). Registered 27 June 2022.

Multiplexed analysis of circulating IgA antibodies for SARS-CoV-2 and common respiratory pathogens in COVID-19 patients.

Previous studies have revealed a diagnostic role of pathogen-specific IgA in respiratory infections. However, co-detection of serum specific IgA for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and common respiratory pathogens remains largely unexplored. This study utilizes a protein microarray technology for simultaneous and quantitative measurements of specific IgAs for eight different respiratory pathogens including adenovirus, respiratory syncytial virus, influenza virus type A, influenza virus type B, parainfluenza virus, mycoplasma pneumoniae, chlamydia pneumoniae, and SARS-CoV-2 in serum sample of patients with coronavirus disease 2019 (COVID-19). A total of 42 patients with COVID-19 were included and categorized into severe cases (20 cases) and nonsevere cases (22 cases). The results showed that co-detection rate of specific-IgA for SARS-CoV-2 with at least one pathogen were significantly higher in severe cases than that of nonsevere cases (72.2% vs. 46.2%, p = .014). Our study indicates that co-detection of IgA antibodies for respiratory pathogens might provide diagnostic value for the clinics and also be informative for risk stratification and disease management in patients with COVID-19.

Acid/Salt/pH Gradient Improved Resolution and Sensitivity in Proteomics Study Using 2D SCX-RP LC-MS.

The usage of strong cation exchange (SCX) chromatography in proteomics is limited by its poor resolution and nonspecific hydrophobic interactions with peptides, which lead to peptide overlap across fractions and change of peptide retention, respectively. The application of high concentration of salt (up to 1000 mM) in SCX also restricted its use in online 2D SCX-RP LC. In the present research, we first exploited the chromatographic ability of online 2D SCX-RP LC by combination of acid, salt, and pH gradient, three relatively independent modes of eluting peptides from SCX column. 50% ACN was added to elution buffer for eliminating hydrophobic interactions between SCX matrix and peptides, and the concentration of volatile salt was reduced to 50 mM. Acid/salt/pH gradient showed superior resolution and sensitivity as well as uniform distribution across fractions, consequently leading to significant improvements in peptide and protein identification. 112 191 unique peptides and 7373 proteins were identified by acid/salt/pH fractionation, while 69 870 unique peptides and 4536 proteins were identified by salt elution, that is, 62.5 and 60.6% more proteins and unique peptides, respectively, identified by the former. Fraction overlap was also significantly minimized by acid/salt/pH approach. Furthermore, acid/salt/pH elution showed more identification for acidic peptides and hydrophilic peptides.

Allergy-related evidences in relation to serum IgE: data from the China state key laboratory of respiratory disease, 2008-2013.

OBJECTIVE: To investigate the serum total IgE (tIgE) and specific IgE (sIgE) to common allergens among allergic patients in Guangzhou, China. METHODS: 7 085 patients were examined for tIgE and sIgE to 15 allergens, based on the protocols of reversed enzyme allergosorbent test and the sandwich enzyme-linked immunosorbent assay. RESULTS: 3 758 (53.04%) patients tested positive for tIgE, and 4 640 (65.49%) for sIgE. Der pteronyssinus, Der farinae, eggs, and cow's milk were the most common allergens leading to higher positive rates of sIgE responses. Several peaks of sensitization were: Der pteronyssinus, Der farinae, and Blomia tropicalis at age 10-12; cow's milk at age below 3; eggs at age 4-6. The mean level and positive rate of tIgE tended to increase in subjects sensitized to more allergens. Sensitization to Der pteronyssinus (OR, 1.6; P<0.05), Der farinae (OR, 1.5; P<0.05), Blomia tropicalis (OR, 1.4; P<0.05), Blattella germanica (OR, 1.5; P<0.05), cow's milk (OR, 1.3; P<0.05), and soy beans (OR, 2.0; P<0.05) were independently correlated with allergy-related conditions in preliminary diagnosis. CONCLUSION: The major allergens in Guangzhou include Der pteronyssinus, Der farinae, cow's milk, and eggs. Sensitization to these allergens appears to be predictors of allergy-related disorder.

Blood Eosinophil Endotypes across Asthma and Chronic Obstructive Pulmonary Disease (COPD).

Background: Eosinophils were common inflammatory cells involved in the occurrence and development of various inflammatory diseases. Multiple recent studies have pointed to the increasingly important role of eosinophils in respiratory diseases. This article aims to compare the expression differences of blood eosinophil counts between asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO). Methods: Patients with asthma, COPD, and ACO who were seen in the First Affiliated Hospital of Guangzhou Medical University from January 2012 to June 2019 were included. We collected information such as age, gender, diagnosis, the eosinophil counts from the medical records. Moreover, the levels of 10 cytokines in the plasma of each group were detected by using the Meso Scale Discovery method. Results: We included 9787 patients with asthma, 15806 patients with COPD, and 831 ACO patients. From our results, it can be first found that eosinophil levels were age-related in the three diseases (asthma and ACO: p < 0.001; COPD: P = 0.001); in asthma and COPD, the number of eosinophils in males was more significant than that in females (asthma: p < 0.001; COPD: p = 0.012). Second, asthma patients had higher blood eosinophil counts than those with COPD and ACO (p < 0.001). Moreover, we found out that eosinophil levels were highly expressed in the stable group of all three diseases. Finally, we found that most cytokines in ACO patients showed a downward trend when the level of eosinophils was low, whereas the results were reversed in asthma patients; 7 cytokines had similar trends in COPD and ACO patients. Conclusions: In conclusion, eosinophils have their own unique endotypes in asthma, COPD, and ACO patients, which were reflected in the fluctuation of their levels and changes in cytokine secretion.

Clinical application of fractional exhaled nitric oxide and nasal nitric oxide levels for the assess eosinophilic inflammation of allergic rhinitis among children.

BACKGROUND: Allergic rhinitis is one of the most common nasal inflammatory diseases among children. Assessment of clinical symptoms, skin prick test and serum immunoglobulin E (IgE) are common methods used to diagnose allergic rhinitis and assess inflammation degree in clinical settings. However, via blood tests assess eosinophils inflammation is invasive, and may cause fear in children. It makes have burden of the diagnosis of allergic rhinitis. Nasal nitric oxide (nNO) and fractional exhaled nitric oxide (FeNO) are noninvasive, inexpensive, and can provide immediate results. These methods may therefore be preferable to assess the inflammation of allergic rhinitis. METHODS: This study was a retrospective analysis. We recruited 61 children with allergic rhinitis from November 2019 to March 2020. The participants were assessed using the FeNO and nNO tests. We also administered questionnaires and carried out traditional allergen and blood tests. We analyzed the relationship between diagnosis results and FeNO and nNO levels before and after the treatment of allergic rhinitis, to investigate the clinical application of FeNO and nNO levels for assess eosinophilic inflammation of allergic rhinitis in children. RESULTS: We observed a significant association both FeNO, nNO level with eosinophils, total IgE. In different levels of eosinophils (EOS), the correlation of detection parameters had obvious change. FeNO and nNO levels were obvious higher compared to pre-treatment. CONCLUSIONS: Using NO concentration can indicates the extent of allergic inflammation and can measure allergy treatment effects combine other influence indexes. The combined use of FeNO and nNO levels may be a useful method for assess the degree of eosinophilic inflammation of allergic rhinitis in children.

Serum levels of the IgA isotype switch factor TGF-ß1 are elevated in patients with COVID-19.

We previously observed enhanced immunoglobulin A (IgA) responses in severe COVID-19, which might confer damaging effects. Given the important role of IgA in immune and inflammatory responses, the aim of this study was to investigate the dynamic response of the IgA isotype switch factor TGF-ß1 in COVID-19 patients. We observed, in a total of 153 COVID-19 patients, that the serum levels of TGF-ß1 were increased significantly at the early and middle stages of COVID-19, and correlated with the levels of SARS-CoV-2-specific IgA, as well as with the APACHE II score in patients with severe disease. In view of the genetic association of the TGF-ß1 activator THBS3 with severe COVID-19 identified by the COVID-19 Host Genetics Initiative, this study suggests TGF-ß1 may play a key role in COVID-19.

Factors associated with exhaled nitric oxide in children with asthma and allergic rhinitis.

BACKGROUND: Factors attributable to the level of fraction of exhaled nitric oxide (FeNO) in different age groups of asthmatic children are still lack of report. OBJECTIVE: To evaluate factors associated with FeNO and the response of FeNO to inhaled steroid in different age groups of asthmatic children with allergic rhinitis. METHODS: Asthmatic children aged 5 to 12 years were recruited. FeNO, lung function and bronchial hyperresponsiveness (BHR) to methacholine, skin prick testing to a panel of aeroallergens, total immunoglobulin E (T-IgE) in serum and eosinophils in blood were tested. Correlations between FeNO and the measured parameters were assessed. FeNO was measured again after the treatment of combined inhaled corticosteroid and long-acting beta-agonist (ICS/LABA) for 4 weeks. Changes in FeNO between different age groups were compared. RESULTS: A total of 121 eligible subjects were enrolled in and completed this study. Asthmatic children aged 10 to 12 years old had significantly higher FeNO than those between 8 and 9 years and 5 to 7 years of children (both P < 0.01). Greater height/age (P < 0.01) and higher level of total allergen IgE (P < 0.01) are associated with a higher value of FeNO. After 4 weeks of treatment with ICS/LABA, asthma control test scores were significantly increased in all age groups (P < 0.01), while the level of FeNO significantly decreased in the elder age group only (P < 0.01). CONCLUSIONS: Height and T-IgE are well correlated with FeNO in asthmatic children aged 5 to 12 years. Measurement of FeNO is more suitable for evaluating the efficacy of ICS/LABA in elder asthmatic children.

Effects of Intranasal Cellulose Powder on Asthma Control in Children With Mild-to-Moderate Perennial Allergic Rhinitis: A Randomized, Placebo-Controlled Trial.

BACKGROUND: Perennial allergic rhinitis (PAR) often coexists in asthmatic patients. Intranasal cellulose powder (ICP) was reportedly effective in ameliorating PAR. OBJECTIVE: We investigated whether ICP is equally effective compared with intranasal corticosteroids in improving asthma control as well as nasal symptoms among children with PAR and allergic asthma (AA). METHODS: Between July 2015 and September 2016, we did a single-center, randomized, placebo-controlled trial. Asthmatic children aged 6 to 11 years with mild-to-moderate PAR were randomly assigned to formoterol/budesonide inhalation (4·5 µg/80 µg, twice daily) plus intranasal budesonide 64 µg twice daily (group A), ICP 250 µg thrice daily (group B), or intranasal placebo 250 µg thrice daily (group C) for 8 weeks. The primary outcome was change in asthma control test for children (C-ACT) score from baseline to week 8 posttreatment. Changes in spirometry, peak expiratory flow (PEF), fractional exhaled nitric oxide (FeNO), and visual analog scale (VAS) for nasal and ocular symptoms were detected as secondary outcomes. RESULTS: We included 121 patients (38 in group A, 41 in group B, and 42 in group C) in full-analysis set. C-ACT score was markedly higher at week 8 compared with baseline (mean difference: 5.11, 6.05, and 4.85 points in groups A, B, and C, respectively; P < .05). There were interactions between baseline and treatment in C-ACT scores ( P < .05). Group B demonstrated greater improvement in C-ACT score than group C among children with baseline C-ACT score of 6 to 18. 95% confidence intervals of group A at baseline overlapped with those of groups B and C. The treatment achieved reduced VAS symptoms in groups A and B but not in group C. Incidence of adverse events was comparable. No serious adverse event was reported. CONCLUSIONS: ICP could be recommended for children with PAR and AA who have poorer asthma control.

Profiling of polyunsaturated fatty acids in human serum using off-line and on-line solid phase extraction-nano-liquid chromatography-quadrupole-time-of-flight mass spectrometry.

Polyunsaturated fatty acids (PUFAs) play a pivotal role in the biological effects, and are the potential biomarkers for some diseases. However, the structural diversity and similarity, the low concentration, and the interference of high abundant endogenous components challenge the PUFAs profiling. Herein, a novel analytical approach, off-line and on-line solid phase extraction-nano-liquid chromatography-quadrupole-time-of-flight mass spectrometry (off-line and on-line SPE-nano-LC-Q-TOF-MS), was established to monitor the PUFAs. The combination of off-line and on-line SPE removed most of impurities, and the recoveries ranged from 80.1% to 93.0% and the matrix effects were from 85.1% to 92.8%. Using this method, 51 PUFAs could be separated well and quantified with the limits of quantification between 0.006 and 2.2 pg. Finally, this developed method was applied successfully to simultaneously qualify and quantify the potential biomarkers in the allergic patients. 21 PUFAs including LTB4, 5S-, 11S-, 15S-HETE and 15S-HEPE showed significant differences. Our study indicated that the established method has the potential to sensitively and accurately determine the PUFAs in biological samples.

[A survey on the relationship between atopy and bronchial asthma among adolescents in the city of Guangzhou, China].

OBJECTIVE: To access the relationship between atopy and bronchial asthma in adolescents. METHODS: A cross-sectional study was conducted. Cluster randomized subgroups of schoolchildren who had participated in ISAAC phase III survey in Guangzhou were enrolled from april to May, 2002. Skin prick test with 5 groups totally for 9 common aeroallergens (dermatophagoides pteronyssinus, Dermatophagoides farinae, cat, Alternaria tenuis, mixed tree pollen, mixed grass pollen, American cockroach, German cockroach and mixed moulds) was performed. Asthma was defined as wheezing or whistling in the chest in the lifetime or in the last 12 months, or diagnosed asthma. Allergy disease was defined as any of asthma, rhinitis and eczema. A wheal size with the diameter of 3 mm or more after subtraction of the negative control was considered as positive and subjects with one or more positive reactions were considered as atopy. The degree of atopy and the sensitivity of the allergen were graded by atopic index (AI) and skin index (SI), respectively. RESULTS: 1543 subjects were selected randomly for the skin prick test, and the response rate was 77.0% (1187/1543). 51.6% (613/1187) were males and 48.4% (574/1187) were females. The median age was 14 years old (range from 12 - 17 years old). The prevalence of asthma was 9.4% (111/1187), among whom 81.1% (90/111) also had rhinitis and 24.3% (27/111) had eczema. Asthma was more prevalent in 686 patients with rhinitis [13.1% (90/686)] or 200 patients with eczema [13.5% (27/200)] than those without rhinitis [4.2% (21/501), OR: 3.444, 95% CI: 2.110 - 5.622, P < 0.01] or eczema [8.5% (84/987), OR: 1.676, 95% CI: 1.055 - 2.663, P < 0.05]. The prevalence of atopy was 46.3% (549/1187) and the positive rates of house dust mite (Der p and Der f) were the highest [41.8% (496/1187) and 42.7% (507/1187), respectively]. Atopy was more common in asthmatic patients [71.2% (79/111)] than in those without any allergic diseases [26.4% (112/425), OR: 6.812, 95% CI: 4.276 - 10.853, P < 0.01]. Asthma was more prevalent in patients with atopy (14.4%) than those without atopy (5.5%, OR: 3.183, 95% CI: 2.075 - 4.883, P < 0.01). The relative risk of having asthma was increased with the higher AI degree. Univariate Logistic regression analysis showed that the risk factors for asthma were Der p (SI >/= 2), Der f (SI = 3 - 4), American cockroach, German cockroach, cat, Alternaria tenuis, mixed grass pollen. Multivariate Logistic regression analysis showed that Der p (SI = 3 - 4), and Alternaria tenuis were independent risk factors for asthma. CONCLUSION: Most asthmatic adolescents were allergic to house dust mite in the city of Guangzhou. The risk of asthma was positively correlated with the degree of atopy, as well as the sensitivity to Der p.

[Effect of 1-year specific immunotherapy with standardized house dust mite vaccine on mild to moderate allergic asthmatic patients].

OBJECTIVE: To evaluate the clinical efficacy and safety of specific immunotherapy (SIT) with standardized house dust mite (HDM) vaccine on allergic asthmatic patients. METHODS: The investigation was a multicentre, randomized, double-blind, placebo-controlled clinical study. 132 patients with mild to moderate asthma who were allergic to HDM, recruited from three hospitals of China (The First Affiliated Hospital of Guangzhou Medical College, Shenyang General Military Hospital, Suzhou Children's Hospital), were randomly allocated to the active group (n = 66) or the control group (n = 66) respectively. The active group received SIT with a standardized depot Dermatophagoides pteronyssinus (Der p) extract absorbed to aluminium hydroxide (Alutard SQ, ALK-Abelló, Denmark), while the control group received a placebo containing histamine dihydrochloride by subcutaneous injections for 1 year. Treatment of each group was started from the initial concentration. Updosing was performed with weekly injections from four 10-fold dose-increase vials (active group: 100, 1,000, 10,000, 100,000 SQ-U/ml, control group: 0.01, 0.1, 1.0, 10 microg/ml. 100,000 SQ-U/ml of Der p extract contains 9.8 microg/ml of the majoy allergen Der p1). The single-dose was injected weekly with 0.2, 0.4, 0.8 ml of each concentration in turn from the preceding 3 vials, totally for 9 weeks. Subsequently, the dose with 0.1, 0.2, 0.4, 0.6, 0.8 ml of the highest concentration was injected weekly from the 10th-14th week and a maintenance dose with 1 ml was reached at the 15th week. The dosing interval was then gradually increased to 2, 4, 6 weeks until the end of the first 26-weeks updosing phase (phase I, H(1)). Thereafter, the dosing continued at 6-week intervals for maintenance phase (phase II, H(2)) till the end of the complete treatment. The patient was observed for at least 30 minutes in the clinic after each injection. RESULTS: A total of 132 subjects were randomized and 129 subjects (64 in the active group, 65 in the control group) completed the whole study. Dropouts included three females because of poor compliance, being afraid of the epidemic of Severe Acute Respiratory Syndrome (SARS) and emigration respectively. Both groups were comparable at baseline in all clinical and laboratory parameters. The mean daily symptom scores in 4-weekly began to diverge at the 29th-32nd week with the active group showing a significant lower scores (0.17 +/- 0.33) than the control group (0.39 +/- 0.74, Z = 2.031, P < 0.05) till the end of the study. Significant difference was found in average daily symptom scores between H(1) (0.29 +/- 0.39) and H(2) (0.19 +/- 0.27) in the active group (Z = 2.923, P < 0.01), while no significant difference was found between H(1) (0.45 +/- 0.62) and H(2) (0.40 +/- 0.68) in the placebo group (Z = 1.885, P > 0.05). There were significant differences in subjective judgement of the improvement about overall asthmatic symptoms, exacerbation severity and exacerbation frequency between the active group (96.9%, 95.3%, 95.4%) and the control group (80.0%, 75.4%, 83.1%) with the self-evaluation questionnaire (chi(2) = 13.246, 11.576, 16.204, all P < 0.01). The trend line of daily medication scores in weekly intervals showed a significant decline. The mean daily medication score of phase II (0.20 +/- 0.36) was significant lower than that of phase I (0.33 +/- 0.67, Z = 3.344, P < 0.01), whereas the control group did not show a significant difference between phase II (0.35 +/- 0.96) and phase I (0.32 +/- 0.95, Z = 0.744, P > 0.05). After 1-year treatment, no significant differences were found in morning and evening peak expiratory flow of predicted value (PEF%), forced expiratory volume in one second of predicted value (FEV(1)/FVC), forced vital capacity of predicted value (FVC%), forced expiratory volume in one second to forced vital capacity ratio (FEV(1)/FVC), provoking dose decreasing FEV(1) by 20% (PD(20)-FEV(1)) between the active group [(97 +/- 17)%, (98 +/- 18)%, (91 +/- 11)%, (98 +/- 9)%, (82 +/- 10)%, 2.35 (7.9) micromol] and the control group [(99 +/- 19)%, (100 +/- 19)%, (90 +/- 14)%, (99 +/- 13)%, (82 +/- 9)%, 1.80 (7.8) micromol] (t = 0.170 - 0.630, Z = 0.264, all P > 0.05). Skin index (SI) to Der p in the active group (1.2 +/- 0.5) was significantly lower than that of the control group (1.5 +/- 0.6) after treatment (t = 2.395, P < 0.05). There was no significant difference in the level of serum sIgE against Der p between groups, which was 76.80 (97.0) kU/L in active group and 66.50 (99.3) kU/L in the control group (Z = 0.232, P > 0.05). The frequency of systemic adverse reactions graded by guidelines based on the position paper of European Academy of Allergology and Clinical Immunology (EAACI), was 5.7% and 1.8% of the total injections in the active group and the control group, respectively. Although significant difference was found in adverse reactions between groups (chi(2) = 4.705, P < 0.05), all were mild or moderate. The majority occurred within 30 minute after injection and were controlled well with symptomatic therapy. No any severe systemic adverse reaction was shown in the study. CONCLUSION: One year specific immunotherapy with standardized house dust mite (HDM) vaccine significantly improved symptoms and reduced medication use in mild to moderate allergic asthmatic patients. SIT also reduced skin prick test reactivity to Der p. Complying with the EAACI immunotherapy guidelines, SIT with standardized HDM vaccine was a safe treatment.

[Effect of anti-midgut-protein-ingredient antibodies of Anopheles stephensi on the oocysts of Plasmodium yoelii].

OBJECTIVE: To observe the inhibitory effect of the antibodies against midgut-protein-ingredient of Anopheles stephensi on the oocysts of Plasmodium yoelii. METHODS: Female An. stephensi mosquitoes raised in laboratory were dissected and the midguts were collected. Eight BALB/c mice were immunized using midgut-protein (100 microg/mouse, 4 times with an interval of 7-10 day). Ten days after the last immunization, blood was taken from mice armpit artery and serum separated. The immune active antigen of the midgut protein was analyzed by Western blotting. Protein with Mr 38 000-50 000 was separated by sephadex filtering and used to immunize 12 BALB/c mice (100 microg/ mouse, 4 times with interval of 7-10 days). PBS control group was established. Seven days after the last immunization, serum antibody was detected by ELISA. When the antibody titer in immunized mice reached > or = 1:2 560, mice in both groups were infected by P. yoelii (about 2 x 10(7) plasmodium-infected RBC) by abdominal injection. The mosquitoes were fed on the infected mice when the number of female gametes was higher than 2 per 10 microscopical fields 3 days later. After 9 days, the mosquitoes were dissected and the amount of oocysts in midgut was counted. RESULTS: Eight protein bands were shown in midgut-protein of An. stephensi by Western blotting and the band of Mr 38 000-50 000-midgut-protein appeared clearer. The infection rate of oocysts in the experiment and control groups were 28.70% (62/216) and 51.09% (47/92) respectively (P<0.05), with an oocyst index of 14.14 (1 541/109) and 26.02 (1 223/47) respectively (P<0.01). CONCLUSIONS: The midgut protein of Anopheles stephensi with Mr 38 000-50 000 has immune activity, and the antibodies against this protein shows an inhibitory effect on the development of oocysts of Plasmodium yoelii.

Efficacy of intramuscular BCG polysaccharide nucleotide on mild to moderate bronchial asthma accompanied with allergic rhinitis: a randomized, double blind, placebo-controlled study.

BACKGROUND: Atopy is a state of allergy to common antigens and is founded on an immune disturbance of exuberant Th2 activity and IgE production. There is also epidemiological and experimental evidence that exposure to mycobacteria has the potential to suppress the development of asthma or atopy. Since Th1 and Th2 immune mechanisms are significantly antagonistic, it is hypothesized that mycobacterial exposure may moderate atopic disease by modification of immune responses. METHODS: One hundred and twenty mild to moderate persistent asthmatics accompanied with allergic rhinitis were randomly divided into four groups with one injection every other day for 18 times for group A with 1 ml of normal saline, B with 0.5 mg of Bacillus Calmette-Guérin polysaccharide nucleotide (BCG-PSN) and C with 1 mg of BCG-PSN, 36 times for group D with 0.5 mg of BCG-PSN. Markers for the severity of asthma and rhinitis including the amount of inhaled corticosteriod, bronchodilator and oral H1 blocker-loratidine being used to obtain optimal symptomatic control, symptom scores of asthma and allergic rhinitis, peak expiratory flow (PEF), histamine provocative dose that produces at least a 20% change in forced expiratory volume with in 1 second (PD20-FEV1), blood IgE levels as well as dermatophagoides pteronysinus (DP) and dermatophagoides farinae (DF) skin prick test were measured every visit for 6 months. RESULTS: There were no differences for symptom scores of asthma, daily use of bronchodilator, PEF, PD20-FEV1, blood IgE as well as DF and DP skin prick test among the four groups. Score for allergic rhinitis decreased significantly in groups B, C and D on day 36 and 72 as compared with group A (P < 0.05). Score for allergic rhinitis increased after day 72 in group B and C while it was significantly lower in group D (P < 0.05). The patients in group D used less amount of inhaled beclomethosone than other groups (P < 0.05) from day 72 after the treatment to day 180. Oral loratadine consumption in groups B, C and D was significantly less on day 36 and 72 as compared with their baseline and group A after the treatment (P < 0.05). Group D maintained significantly lower dosage of oral loratadine until day 150 comparing with its baseline and group A. CONCLUSIONS: BCG-PSN has a symptomatic effect on allergic rhinitis. BCG-PSN may reduce the dosage of non-sedative H1 blocker loratadine as well as the dosage of inhaled beclomethosone in the treatment of mild to moderate asthma and allergic rhinitis.

Food allergy and related risk factors in 2540 preschool children: an epidemiological survey in Guangdong Province, southern China.

BACKGROUND: Although the number of studies on allergic diseases in the general population of southern China is increasing, only a few have addressed food allergy (FA) in children in this region. The present study aimed to investigate the prevalence, clinical manifestations, spectrum of allergens, and related risk factors of FA in preschool children in Guangdong Province, southern China. METHODS: A random cluster-sampling method was used to select 24 kindergartens from 12 cities in Guangdong Province. The parents or guardians of the children were requested to complete a questionnaire on general information and data regarding FA diagnosis and symptoms in the children and their first-degree relatives. Thereafter, the Chi-square test, multivariate regression analysis, and Spearman's rank-order correlation coefficient analysis were performed to identify statistically significant differences. RESULTS: Analysis of 2540 valid questionnaires revealed an FA prevalence rate of 4%. Adverse food reactions were due to the consumption of shrimp (4.4%), crab (3.2%), mango (2.3%), cow's milk and dairy products (1.9%), and eggs (1.4%). Logistic regression analysis indicated that a history of FA and a history of allergic rhinitis in the first-degree relatives were the major factors leading to FA in children. CONCLUSIONS: The incidence of FA in children in Guangdong Province is higher than that commonly believed. An individual's genetic background is an important risk factor for FA. Hence, mitigation of the impact of lifestyle and environmental factors should be carefully considered to reduce the incidence of childhood FA.

Characterization of a new subtype of allergen in dermatophagoides farinae-Der f 28.

BACKGROUND: House dust mites (HDMs) are the major sources of indoor allergens which induce asthma, dermatitis, rhinitis, and some other allergic diseases. Close to 30 sub-allergens have been identified. METHODS: Through analyzing the full genome sequence of dust mite, a new allergen whose primary structure belongs to the heat shock protein family was identified. The sequence of this allergen was determined by cDNA cloning. The allergenicity was assayed by skin prick test, Western-blot and enzyme-linked immunosorbent assay (ELISA). RESULTS: r-Der f 28 bound to serum IgE from mite allergic patients. Positive responses to r-Der f 28 were shown in 11.5% by skin prick testing from 26 DM-allergic patients. Airway hyperresponsiveness, serum specific IgE and IL-4 were significantly increased in allergic asthma mouse model sensitized to r-Der f 28. CONCLUSIONS: Der f 28 is a new subtype of allergen in dermatophagoides farinae.

House dust mite allergen (Derp1 and Blot5) levels in asthmatics' home in Hongkong.

OBJECTIVE: To measure Derp1 and Blot5 allergen levels in asthmatics' homes in Hongkong. METHODS: Seventy houses were enrolled for a mite indoor environment study. Dust samples were obtained from two sites of each patients' house: bed and floor. Derp1 and Blot5 levels were quantified by a two-site monoclonal antibody-based ELISA technique. RESULTS: The levels of Derp1 allergens found in bed (geometric mean (GM) 3.43 microg/g of dust; 95%CI, 1.89-4.96 microg/g) and on the floor (GM 1.12 microg/g of dust; 95%CI, 0.71-1.53 microg/g) indicated significant differences (P=0.005). However, the levels of Blot5 allergens found in bed (GM 19.00 microg/g of dust; 95%CI, 0.89-38.90 microg/g) and on the floor (GM 6.14 microg/g of dust; 95%CI, 0.40-11.90 microg/g) showed no statistically significant difference. In addition, in regards to the exposure index for Derp1 and Blot5 allergens found in bed and on the floor, 17.6% in bed and 8.6% on the floor had levels of Blot5 > or = 10 microg/g of dust, higher than those obtained for Derp1 (7.2% and 0% in bed and on the floor respectively, P<0.05); higher percentages in bed and on the floor (25.0% and 35.7%) were observed for levels of Blot5 = 0 microg/g of dust as compared with Derp1 in bed and on the floor (4.3% and 14.5% respectively, P<0.05). CONCLUSIONS: Derp1 and Blot5 are the major allergens found in this regional study, Blot5 is a more potent allergen in Hongkong, probably reflecting the high level of exposure to Blomia tropicalis (Bt). Bt and Dermatophagoides pteronyssinus (Dp) allergens should be included for precise diagnosis and effective immuno-therapeutic treatment of mite allergy in Hongkong.

[Clinical feature and airway inflammation in eosinophilic bronchitis].

OBJECTIVE: To study the clinical features and airway inflammation in eosinophilic bronchitis (EB) and the treatment outcomes. METHODS: Irwin's anatomic protocol for diagnosing chronic cough was used in 86 patients with chronic cough, and induced sputum by hypertonic saline aerosol inhalation was performed. Differential cell counts were performed in induced sputum, and eosinophilic cationic protein (ECP) was measured with fluoroimmunoassay, while interleukin-8 (IL-8) was measured with enzyme-linked absorbed immunoassay. EB was diagnosed according to Gibson's criteria and treated with inhaled budesonide 200 - 400 micro g twice daily for four weeks, and in some patients oral prednisone 10 - 15 mg/d or methyl-prednisone 8 - 12 mg/d was given for one week. RESULTS: 13 (15%) out of 86 patients with chronic cough were diagnosed as having EB. Dry cough was the major compliant and all had normal lung function with negative histamine provocation test. The Eos count was 0.1862 +/- 0.1632 and the concentration of ECP (2.53 +/- 2.07) mg/L in induced sputum were significant higher in patients with EB as compared with those normal subjects (P < 0.01). The cough disappeared in all patients at the end of one week of inhaled or orally administered corticosteroids. CONCLUSION: EB, an eosinophilic airway inflammation, is one of important causes of chronic cough and responds well to corticosteroid therapy.

[Etiological diagnosis of chronic cough with unknown causes].

OBJECTIVE: To explore the spectrum and frequency of causes for chronic cough in Chinese patients. METHODS: 86 patients with chronic cough were enrolled in the study. The diagnostic procedure was based on the anatomical protocol for diagnosing chronic cough designed by Irwin, and additional cytological assay was performed for sputum induced by hypertonic saline aerosol inhalation. The efficacy of therapy specific to the diagnosis was evaluated. RESULTS: Definite diagnosis was made in 77 (89.5%) out of the 86 patients with chronic cough. The most common causes included cough variant asthma (CVA) (24/86, 27.9%), postnasal drip syndrome (PNDs) (22/86, 25.6%), eosinophilic bronchitis (EB) (13/86, 15.1%), and gastroesophageal reflux (GER) (12/86, 14.0%). After active management based on the diagnosis, cough improved in 72 patients (93.5%). CONCLUSIONS: In addition to CVA, PNDs and GER, eosinophilic bronchitis is also an important cause of chronic cough. A positive response to the specific therapy is essential to a definite diagnosis.