Prevalence of asthma and severity of allergic rhinitis comparing 2 perennial allergens: house dust mites and Parietaria judaica pollen.

BACKGROUND: Allergic rhinitis (AR) is an increasingly prevalent worldwide disease that has a considerable impact on quality of life and health care costs. Asthma and AR may be part of the same disease, with AR leading to an increased risk of asthma. OBJECTIVES: To assess the prevalence of asthma in patients with AR due to house dust mites (HDMs) or Parietaria judaica and analyze the characteristics of asthma and AR in each group. METHODS: Cross-sectional, multicenter study with recording of demographic and clinical characteristics. All patients had AR confirmed by symptoms and a positive skin prick test to HDMs or P judaica. They were classified according to the severity and frequency ofAR following the Allergic Rhinitis and its Impact on Asthma (ARIA) and modified ARIA criteria and according to the severity of asthma following the Global Initiative for Asthma criteria. RESULTS: We studied 395 patients (226 in the HDM group and 169 in the Pjudaica group) with a mean (SD) age of 43 (15.3) years. Using the modified ARIA criteria, we detected more severe and persistent AR in the P judaica group than in the HDM group (44.5% vs 24.8%, P < .001). Nevertheless, there were no statistically significant differences between the groups in terms of the severity or prevalence (50% in HDM vs 47.9% in P judaica, P = .685) of asthma. CONCLUSION: AR due to P judaica pollen, which behaves like a perennial allergen, is associated with the same prevalence of asthma and with more severe rhinitis than AR due to HDMs.

Prevalence of Asthma and Severity of Allergic Rhinitis Comparing 2 Perennial Allergens: House Dust Mites and Parietaria judaica Pollen

Antecedentes: La rinitis alérgica (RA) es una enfermedad de prevalencia creciente en todo el mundo, con un importante impacto en la calidad de vida, generando un elevado coste sanitario. La rinitis y el asma pueden ser consideradas como parte de una misma enfermedad y por tanto, la RA puede conducir a un incremento del riesgo de desarrollar asma. Objetivos: Evaluar la prevalencia de asma en pacientes con RA por ácaros del polvo doméstico (APD) y en pacientes con RA por Parietaria judaica y evaluar las características de la rinitis y del asma en cada grupo. Métodos: Estudio multicéntrico, transversal. Se registraron las características demográficas y clínicas de todos los pacientes. Todos los pacientes tenían RA confirmada por síntomas y pruebas positivas a APD o a Parietaria judaica. Los pacientes se clasificaron según la gravedad y la frecuencia de la rinitis siguiendo los criterios del ARIA y ARIA modificada y la gravedad del asma según los criterios de la GINA. Resultados: Se incluyeron un total de 395 pacientes, 226 en el grupo de APD y 169 en el grupo de la Parietaria judaica, con una media de edad de 43±15,3 años. La clasificación ARIA modificada nos permitió detectar que el grupo de Parietaria presentaba una rinitis más persistente y grave comparado con el grupo de APD (44,5% versus 24,8%, p<0,001). Sin embargo, no se obtuvieron diferencias estadísticamente significativas entre la gravedad y la prevalencia (50% en APD vs 47,9% en Parietaria, p=0,685) del asma en los dos grupos. Conclusiones: La RA por polen de Parietaria judaica, que se comporta como un alérgeno perenne, puede causar la misma prevalencia de asma y una rinitis más grave que APD (AU)

Background: Allergic rhinitis (AR) is an increasingly prevalent worldwide disease that has a considerable impact on quality of life and health care costs. Asthma and AR may be part of the same disease, with AR leading to an increased risk of asthma. Objectives: To assess the prevalence of asthma in patients with AR due to house dust mites (HDMs) or Parietaria judaica and analyze the characteristics of asthma and AR in each group. Methods: Cross-sectional, multicenter study with recording of demographic and clinical characteristics. All patients had AR confirmed by symptoms and a positive skin prick test to HDMs or P judaica. They were classified according to the severity and frequency of AR following the Allergic Rhinitis and its Impact on Asthma (ARIA) and modified ARIA criteria and according to the severity of asthma following the Global Initiative for Asthma criteria. Results: We studied 395 patients (226 in the HDM group and 169 in the P judaica group) with a mean (SD) age of 43 (15.3) years. Using the modified ARIA criteria, we detected more severe and persistent AR in the P judaica group than in the HDM group (44.5% vs 24.8%, P<.001). Nevertheless, there were no statistically significant differences between the groups in terms of the severity or prevalence (50% in HDM vs 47.9% in P judaica, P=.685) of asthma. Conclusion: AR due to P judaica pollen, which behaves like a perennial allergen, is associated with the same prevalence of asthma and with more severe rhinitis than AR due to HDMs (AU)

Sensitization to tomato peel and pulp extracts in the Mediterranean Coast of Spain: prevalence and co-sensitization with aeroallergens.

BACKGROUND: Tomatoes (Lycopersicon esculentum) are consumed world-wide. The prevalence of sensitization to tomatoes remains unknown. OBJECTIVE: To determine the prevalence of skin test reactivity to tomato and to describe the characteristics of tomato-sensitized subjects. METHODS: Individuals attending for the first time during the period of the study to six Allergy centres, located along the Mediterranean coast of Spain, reporting respiratory and/or cutaneous symptoms, were included. All patients were skin prick tested with a battery of inhalant allergens and with peel and pulp of Canary tomato extracts. RESULTS: The study included 1734 individuals (757 males, 977 females; 31.9+/-17.8 years old). The prevalence of sensitization to tomato was 6.52% (113 patients; 65 males, 48 females; 29.5+/-13 years old). The peel extract was positive in 110 patients and the pulp extract in 47 patients; three patients were positive exclusively to pulp. Only 1.8% of individuals reported symptoms with tomato; 44% of them had skin test negative to both extracts. Among tomato-sensitized subjects, 16% reported symptoms with tomato, 97% were sensitized to inhalant aeroallergens, including 84% to pollens (mainly Artemisia vulgaris and Platanus hybrida), with differences between Northern and Southern centres. CONCLUSIONS: The prevalence found of skin test sensitivity to tomato is high. Peel extracts detected most of the sensitized subjects. Most of the sensitized subjects were asymptomatic and some patients reported symptoms without skin test sensitivity. Positive subjects were very frequently sensitized to pollens, suggesting allergen cross-reactivity. Regional differences may exist, possibly related to the pattern of sensitization to cross-reacting pollens.

Purified allergens vs. complete extract in the diagnosis of plane tree pollen allergy.

BACKGROUND: Plane tree pollen allergy is a clinical disorder affecting human population in cities of Europe, North America, South Africa, and Australia. OBJECTIVE: To compare IgE-reactivity of the natural and recombinant forms of two major plane allergens, Pla a 1 and Pla a 2, with the reactivity of Platanus acerifolia pollen extract. METHODS: Forty-seven patients with P. acerifolia allergy, 15 of them monosensitized, and 24 control subjects were included in the study. Natural Pla a 1 and Pla a 2 were purified by standard chromatographic methods and recombinant proteins were expressed in Escherichia coli. Skin prick test and determination of specific IgE were performed with commercial P. acerifolia extract and natural and recombinant purified allergens. RESULTS: Pla a 1 and Pla a 2 were responsible for 79% of the IgE-binding capacity against P. acerifolia pollen extract. A high correlation has been found between the IgE response to nPla a 1 (R = 0.80; P < 0.001) or nPla a 2 (R = 0.79; P < 0.001) vs. P. acerifolia extract as well as between natural and recombinant Pla a 1 (R = 0.89; P < 0.001). Skin testing showed no significant differences between extract and nPla a 2, whereas a higher reactivity was found with nPla a 1. In contrast, rPla a 1 revealed markedly reduced sensitivity in comparison with extract by skin prick test and specific IgE. The sensitivity of the mix Pla a 1+Pla a 2 was 100% and 87.5% for monosensitized and polysensitized patients, respectively, with no false-positive reactions detected. Conclusion Pla a 1 and Pla 2 are sufficient for a reliable diagnosis of P. acerifolia in most patients and induce comparable skin test reactivity as a whole extract.

IgE reactivity to profilin in Platanus acerifolia pollen-sensitized subjects with plant-derived food allergy.

BACKGROUND: The presence of profilin-specific IgE antibodies is a cause of cross-reactivity between botanically-unrelated allergen sources. Recently, the association between Platanus acerifolia pollinosis and plant-derived food allergy has been described. The aim of this study was to ascertain whether the P. acerifolia profilin is involved in such cross-reactivity. METHODS: Twenty-three patients suffering from Platanus acerifolia pollinosis and plant-derived food allergy were evaluated in an allergy department. Specific IgE levels to P. acerifolia pollen, P. acerifolia profilin and food extracts were measured. Molecular masses of IgE-binding proteins were calculated by Western blotting and cross-reactivity studies among P. acerifolia profilin and different food extracts were evaluated by Enzyme AllergoSorbent Test (EAST)-inhibition assays. Also, EAST-inhibition assays with the two known P. acerifolia allergens, Pla a 1 and Pla a 2, were performed. RESULTS: Surprisingly, a high IgE-binding prevalence (90%) of P. acerifolia profilin was found. EAST-inhibition showed high inhibition values when Platanus acerifolia pollen extract was used as free phase and plant-derived food extracts as solid phase, whereas the other way round showed low inhibition values. IgE reactivity to profilin was studied using a pool of patient sera, by EAST-inhibition assays with hazelnut, apple peel, peanut, chickpea and peanut extracts as solid phase and no inhibition was obtained when P. acerifolia profilin was used as inhibitor phase. The same results were obtained when purified Pla a 1 and Pla a 2 were also used as inhibitor phase. CONCLUSIONS: The clinical association observed between Platanus acerifolia pollen and plant-derived food could be explained by the in vitro IgE cross-reactivity detected by EAST-inhibition. However, it appears that neither P. acerifolia profilin nor the two major allergens described (Pla a 1 and Pla a 2) can explain such a strong cross-reactivity.

Effects of specific immunotherapy on the development of new sensitisations in monosensitised patients.

BACKGROUND: Specific immunotherapy (SIT) is the only treatment that interferes with the basic pathophysiological mechanisms of allergic disease and is widely used in the management of clinically significant respiratory IgE-mediated diseases. Nevertheless, until recently, information on the influence of SIT on the development of new allergic sensitisations has been scant. METHODS: One hundred consecutive patients (45 males and 55 females, aged 6 to 69 years) with respiratory allergic diseases and attending the allergy unit of a general hospital were selected. All had been diagnosed by clinical history and skin prick tests of allergic rhinitis and/or asthma, were monosensitised (71 to Dermatophagoides spp, 22 to Parietaria judaica pollen and 7 to grass pollen) and had been followed up as outpatients between 1990-98. Sixty-six patients had been treated with conventional SIT for at least 3 years, while thirty-four followed only environmental measures and drug treatment. Family atopy status (first-degree relatives), smoking, family pets (cat and/or dog), rhinitis and/or asthma symptom score and inhalant skin prick tests to the same aeroallergens were compared between baseline and after 3 to 5 years of treatment. RESULTS: No statistically-significant differences in the development of new sensitisations were observed between the two groups (36.4 % of SIT-treated patients versus 38.2 % in control group, RR = 0.97, CI 95 %: 0.72-1.3). Smoking, family atopy history and pets did not appear to be risk factors for the development of neosensitisations (p < 0.05). Nevertheless, SIT-treated patients presented a better clinical score than the control group, with improvements of 89.4 % and 61.8 %, respectively (p = 0.007). CONCLUSIONS: Three-year SIT did not protect against development of new sensitisations in monosensitised allergic rhinitis or asthma. Smoking, family atopy history and pets were not associated with development of new sensitisations. Clinical score improved significantly in the SIT-treated group compared with drug-treated patients.

Effects of specific immunotherapy on the development of new sensitisations in monosensitised patients

Background: Specific immunotherapy (SIT) is the only treatment that interferes with the basic pathophysiological mechanisms of allergic disease and is widely used in the management of clinically significant respiratory IgE-mediated diseases. Nevertheless, until recently, information on the influence of SIT on the development of new allergic sensitisations has been scant. Methods: One hundred consecutive patients (45 males and 55 females, aged 6 to 69 years) with respiratory allergic diseases and attending the allergy unit of a general hospital were selected. All had been diagnosed by clinical history and skin prick tests of allergic rhinitis and/or asthma, were monosensitised (71 to Dermatophagoides spp, 22 to Parietaria judaica pollen and 7 to grass pollen) and had been followed up as outpatients between 1990-98. Sixty-six patients had been treated with conventional SIT for at least 3 years, while thirty-four followed only environmental measures and drug treatment. Family atopy status (first-degree relatives), smoking, family pets (cat and/or dog), rhinitis and/or asthma symptom score and inhalant skin prick tests to the same aeroallergens were compared between baseline and after 3 to 5 years of treatment. Results: No statistically-significant differences in the development of new sensitisations were observed between the two groups (36.4 % of SIT-treated patients versus 38.2 % in control group, RR = 0.97, CI 95 %: 0.72-1.3). Smoking, family atopy history and pets did not appear to be risk factors for the development of neosensitisations (p < 0.05). Nevertheless, SIT-treated patients presented a better clinical score than the control group, with improvements of 89.4 % and 61.8 %, respectively (p = 0.007). Conclusions: Three-year SIT did not protect against development of new sensitisations in monosensitised allergic rhinitis or asthma. Smoking, family atopy history and pets were not associated with development of new sensitisations. Clinical score improved significantly in the SIT-treated group compared with drug-treated patients (AU)

Introducción: La inmunoterapia específica es el único tratamiento que actúa sobre los mecanismos fisiopatológicos de las enfermedades alérgicas y se utiliza frecuentemente en el manejo clínico de los pacientes con enfermedades respiratorias mediadas por IgE. Recientemente se ha sugerido que la inmunoterapia podría tener un efecto protector sobre el desarrollo de nuevas sensibilizaciones, siendo el objetivo de este estudio analizar este posible efecto. Pacientes y métodos: Se seleccionaron 100 pacientes consecutivos (45 hombres y 55 mujeres, con edades comprendidas entre los 6 y 69 años) con alergia respiratoria que consultaron en una unidad de alergia de un hospital general durante el período comprendido entre 1990 y 1998. Estos pacientes se diagnosticaron de rinitis y/o asma por historia clínica y prick test, siendo todos ellos monosensibles (71 a Dermatophagoides spp, 22 al polen de Parietaria judaica y 7 al polen de gramíneas). Sesenta y seis pacientes se trataron con inmunoterapia convencional durante un mínimo de 3 años (grupo inmunoterapia) y treinta y cuatro realizaron únicamente medidas ambientales y tratamiento farmacológico (grupo control).Al inicio del estudio y después de 3 a 5 años de tratamiento se realizó todos ellos un estudio que incluía la realización de pruebas cutáneas con la misma batería de aeroalergenos, valoración de la gravedad de la rinitis y/o asma mediante un baremo de síntomas e interrogatorio sobre la presencia de ciertos factores que pudieran influir en su evolución o en la aparición de nuevas sensibilizaciones (antecedentes familiares de atopia de primer grado, tabaquismo y exposición a los animales domésticos perro y/o gato). Resultados: No se observaron diferencias estadísticamente significativas en el desarrollo de nuevas sensibilizaciones entre los dos grupos (el 36,4 por ciento en el grupo tratado con inmunoterapia frente el 38,2 por ciento en el grupo control, RR = 0,97; IC 95 por ciento:0,72-1,3). La presencia de antecedentes familiares de atopia, el tabaquismo o la exposición a animales no fueron factores de riesgo para el desarrollo de nuevas sensibilizaciones (p< 0,05). Sin embargo, los pacientes tratados con inmunoterapia presentaron una mejor evolución clínica que el grupo control, con mejorías del 89,4 por ciento y del 61,8 por ciento respectivamente (p = 0,007).Conclusiones: La inmunoterapia específica durante un período mínimo de 3 años no protegió de la aparición de nuevas sensibilizaciones en pacientes monosensibles con rinitis y/o asma. Tampoco influyeron en la aparición de nuevas sensibilizaciones los antecedentes familiares de atopia, el tabaquismo o a la exposición a animales domésticos. El baremo clínico mejoró significativamente en el grupo tratado con inmunoterapia en relación al grupo control (AU)