Citrus juice fermented with Lactobacillus plantarum YIT 0132 alleviates symptoms of perennial allergic rhinitis in a double-blind, placebo-controlled trial.

This study aimed to examine whether citrus juice fermented with Lactobacillus plantarum YIT 0132 (LP0132), which was pasteurised after fermentation, could alleviate the symptoms of perennial allergic rhinitis in a double-blind, placebo-controlled, parallel-group trial. Subjects with perennial allergic rhinitis consumed LP0132-fermented juice (n=17) or unfermented citrus juice (placebo; n=16) once a day for 8 weeks. During the pre-intervention and intervention periods, the subjects recorded nasal symptoms (number of sneezing attacks, number of nose-blowing incidents, and stuffy nose score). The primary endpoint, nasal symptoms score (NSS), was scored from 0 to 4 according to the 'Practical Guideline for the Management of Allergic Rhinitis in Japan 2009' using a combination of the three nasal symptom items. Blood samples were collected at pre-intervention and at 8 weeks after commencing the intervention. There were several significant improvements not only in the LP0132 group but also in the placebo group because of potential anti-allergic effects of citrus. Compared with the placebo group, the LP0132 group showed a significant reduction in the NSS and stuffy nose score during the intervention period. Also, the LP0132 group, but not the placebo group, showed significant attenuation of type 2 helper T cells (Th2 cells)/helper T cells, serum total immunoglobulin E (IgE), and eosinophil cationic protein (ECP), and showed significant augmentation of type 1 helper T cells (Th1 cells)/Th2 cells at 8 weeks of intervention compared with baseline. It is suggested that daily intake of fermented citrus juice containing heat-killed LP0132 has beneficial effects on symptoms of perennial allergic rhinitis, and these benefits may be associated with the attenuation of Th2 cells, total IgE, and ECP via the immunomodulating activities of LP0132.

Characteristics of laryngeal symptoms induced in patients with allergic rhinitis in an environmental challenge chamber.

BACKGROUND: People with allergic rhinitis often have laryngeal symptoms (LSs) in addition to nasal symptoms during the pollen-scattering season. OBJECTIVE: To clarify the characteristics of the LSs induced by pollen exposure using an environmental challenge chamber. METHODS: Cypress pollen exposure using an environmental challenge chamber for 25 participants with cypress pollen-induced allergic rhinitis was performed for 3 hours for 2 consecutive days in 3 study courses: namely, pollen exposure under normal nasal breathing and pollen or sham pollen exposure with nasal blockage, which eliminated any allergic reactions in the nasal mucosa. The nasal and LSs scores and the levels of serum inflammatory mediators, including eosinophil cationic protein (ECP), were monitored. Laryngeal examinations and physiologic lung tests were also conducted. RESULTS: Various LSs were reported, and these LSs were significantly elevated during pollen exposure and even under sham exposure with artificial nasal blockage. The pollen exposure with artificial nasal blockage exaggerated the LSs in 32% of the participants and also increased the serum ECP levels. The serum ECP levels did not change after sham exposure. The findings of both laryngeal examinations and lung tests failed to reveal any significant changes. CONCLUSION: Nasal obstruction could induce significant LSs even without pollen exposure. LSs were enhanced by pollen exposure and allergic reactions in the larynx could thus be involved in this enhancement. TRIAL REGISTRATION: clinicaltrials.gov Identifier: UMIN000015667.

[The influence of Xuanfeijiedu granules on trace elements, IgE, ECP of allergic rhinitis].

OBJECTIVE: To study the influence of Xuanfeijiedu granules on trace elements, immunoglobulin E (IgE), eosinophil cationic protein (ECP) of allergic rhinitis. METHOD: One hundred and ten cases of allergic rhinitis ere randomly divided into two groups, 55 cases of the observation group were treated with budesonide, 55 cases of the control group were treated with Xuanfeijiedu granules, the treatment efficacy and serum trace elements, IgE, ECP level were observed. RESULT: The total effective rate of observation group and control group were 92. 7% and 96. 4%, there was no significant difference between two groups (P>0. 05). Before treatment, the serum zinc (Zn), copper (Cu), manganese (Mn) and IgE, ECP levels of two groups were compared, there was no significant difference (P>0. 05); after treatment, the serum Zn level was significantly increased, the serum Cu, Mn, IgE, ECP levels were significantly reduced, and the observation group changed more significantly, there were significant differences between two groups (P<. 05). CONCLUSION: Xuanfeijiedu granules in the treatment of allergic rhinitis can significantly improve the patient's serum trace elements and IgE, ECP levels, improve the state of patient's disease, and promote the rehabilitation of patients.

The effects of phototherapy on eosinophil and eosinophilic cationic protein in newborns with hyperbilirubinemia.

Newborns with jaundice requiring or not requiring phototherapy (PT) are at greater risk of developing asthma later in life. In this study, we investigated the effect of PT treatment on eosinophil and eosinophilic cationic protein (ECP) levels in newborns with severe hyperbilirubinemia. Thirty newborns diagnosed with severe hyperbilirubinemia and exposed to light-emitting diode (LED) PT were enrolled into the study. Total serum bilirubin (TSB) levels, complete blood count and serum ECP concentrations were measured before and after PT. TSB and hemoglobin (Hb) counts were lower after PT (p = 0.001). There was no difference between leukocyte, lymphocyte, neutrophil and platelet count before and after PT. Eosinophil levels were increased after PT, although not significantly. ECP levels were higher after PT (p = 0.006). It may be speculated that newborns treated with LED PT, increased ECP might play a role in developing allergic diseases later in life.

The effects of PG102, a water-soluble extract from Actinidia arguta, on serum total IgE levels: a double-blind, randomized, placebo-controlled exploratory clinical study.

BACKGROUND: Recent studies have reported that blocking IgE has a potentially beneficial role in the treatment of various allergic diseases. Previously, we found that PG102, a water-soluble extract prepared from the edible fruits of Actinidia arguta, can effectively reduce IgE levels using murine models. AIMS: To evaluate the efficacy of PG102 at lowering levels of total IgE in asymptomatic subjects with atopy. METHODS: A total of 90 asymptomatic subjects with atopy were randomized equally to a PG102 group or a placebo control group and treated for 8 weeks in a double-blind manner. Total serum IgE, eosinophilic cation protein (ECP), eotaxin, thymus, and activation-regulated chemokine (TARC), IL-4, IL-5, and IL-13 levels were measured. Eosinophil counts were determined before and after treatment, and results were compared. In addition, possible adverse reactions were thoroughly checked in this first human trial. RESULTS: Levels of total IgE significantly increased in the control group but showed no change in the PG102 group, and change differences between the control and PG102 groups were significant (+12.9%, vs.-5.7%, p = 0.015). Levels of ECP and eotaxin and eosinophil counts produced similar results. However, the other variables showed no significant changes after treatment. CONCLUSION: In this exploratory clinical trial, it was found that 8 weeks of treatment with PG102 effectively reduced the levels of total IgE in apparently asymptomatic subjects with atopy.

Full-spectrum light phototherapy for atopic dermatitis.

BACKGROUND: Atopic dermatitis (AD) is a chronic skin disease resulting in a profound deterioration in quality of life. The FSL® is a newly developed phototherapy device generating full-spectrum light (FSL) with a continuous wavelength (320-5000 nm). This study aimed to evaluate the efficacy and safety of FSL® phototherapy in AD. METHODS: We enrolled 38 patients with moderate to severe AD in this open, randomized, controlled, prospective study. In the FSL-irradiated group (20 patients), irradiation was conducted twice per week for 4 consecutive weeks. In the control group (18 patients), only emollient application was allowed. SCORing Atopic Dermatis (SCORAD) values were obtained at baseline, week 4 and 8. Patients were asked to give subjective assessments of improvement and laboratory tests including serum eosinophil counts, ECP levels, IgE levels and 22 cytokine levels were performed. RESULTS: In the FSL-irradiated group, the mean SCORAD value decreased significantly after 4 weeks of phototherapy and remained reduced for a further 4 weeks after the cessation of treatment. In the control group, the mean SCORAD value did not change significantly over the study period. Patients' subjective assessments indicated good to excellent responses in 75% of the FSL-irradiated group, by contrast with 50% of the control group. The mean values for serum eosinophil counts, IL-4 and IL-5 levels decreased significantly after FLS phototherapy. No serious adverse effects were reported. CONCLUSIONS: In this study, we showed that FSL® phototherapy can be an effective and safe treatment option in AD.

Chinese medicine acupoint herbal patching for allergic rhinitis: a randomized controlled clinical trial.

The aim of this study is pursue the effect of herbal point-patch treatment on allergic rhinitis patients by investigation of the changes of serum total IgE (T-IgE) and eosinophile cationic protein (ECP) levels and through assessment of the results of SF-36 and rhinitis severity questionnaires. A prospective, randomized, single-blind, parallel, controlled study was used. Forty- three eligible participants were selected from outpatients of the Dept. of Ear, Nose, and Throat and Chinese medicine clinic, and 33 eligible participants completed the treatment satisfactorily. Participants used a Chinese herbal point-patch or a placebo patch once a week, for three hours at a time, after being randomly assigned to a control or an experimental group. Each treatment course was three weeks in duration, and each participant underwent two courses of treatment. Before and after each course, participants evaluated the effectiveness of the treatment by completing a questionnaire, and blood samples were collected for T-IgE and ECP analysis. The data revealed that the acupoint herbal patch is a valuable treatment for allergic rhinitis, especially in the symptoms of sneezing, running and itchy nose. The results of the SF-36 indicate a distinct improvement in GH (general health) and VT (vitality) in patients treated with acupoint herbal patches. This study supports the belief that the acupoint herbal patch is an effective treatment for allergic rhinitis and can significantly improve general health, social life and vitality in quality of life.

Relationship between squamous cell carcinoma antigen and the clinical severity of allergic rhinitis caused by Dermatophagoides farinae and Japanese cedar pollen.

OBJECTIVES: Allergic rhinitis is known to be related to the Th2-type immune response, but no sensitive biomarker of severity yet exists. Serum squamous cell carcinoma antigen (SCCA) is clinically used as a popular tumor biomarker. We have demonstrated that SCCA is related to allergic diseases such as asthma. The purpose of the present study was to clarify the relationship between allergic rhinitis and SCCA, which had not yet been investigated. METHODS: We compared the serum SCCA levels in patients with allergic rhinitis due to Japanese cedar pollen and Dermatophagoides farinae with those in normal subjects. Thereafter, the correlations between the clinical severity of allergic rhinitis and the serum levels of SCCA were investigated. Furthermore, the influence of 8 variables (serum levels of SCCA, immunoglobulin E, eosinophil cationic protein, and eosinophils; age; gender; oral administration of antiallergic or antihistaminic agents; and use of nasal drops) in regard to the severity of allergic rhinitis was studied by a multiple regression analysis. RESULTS: The SCCA levels of the D farinae group were statistically higher than those of the control group, and they correlated with the severity of rhinitis. Among the 8 variables, only the SCCA level was found to be a predictive factor of severity on a multiple regression analysis. No relationship between SCCA level and Japanese cedar pollen allergy was demonstrated. CONCLUSIONS: These results suggest that the serum SCCA level may be a useful biomarker to evaluate the severity of allergic rhinitis caused by D farinae.

Efficacy of Lactobacillus plantarum strain HSK201 in relief from Japanese cedar pollinosis.

To determine the effects of Lactobacillus plantarum strain HSK201 on Japanese cedar pollinosis, a single-blind, placebo-controlled study was conducted in 2008. The HSK201 group was administered fermented milk prepared with HSK201 for 8 weeks, and the placebo group was administered non-fermented milk adjusted to the same acidity and taste. We found HSK201 strain intake to suppress both helper T cell type 1/2 ratio reduction and serum Japanese cedar pollen-specific IgE elevation at the peak of pollen dispersion. In addition, the nasal and ocular symptom scores in the HSK201 group were also lower than those in the placebo group during the early phase of the pollen season. Although this was a preliminary study with 19 employees of our own company serving as subjects, the results suggest that ingestion of the HSK201 strain alleviates pollinosis symptoms during the period when pollen exposure is low and the symptoms are mild.

Clinical data and inflammation parameters in patients with cypress allergy treated with sublingual swallow therapy and subcutaneous immunotherapy.

The clinical efficacy of immunotherapy, either by high dose sublingual-swallow therapy (SLIT) or subcutaneous immunotherapy (SCIT), has been demonstrated in patients with pollinosis but few studies have been carried out analysing differences in these treatments in terms of an improvement of clinical and allergic phlogosis parameters. The aim of this double-blind placebo-controlled study is to investigate the efficacy of high dose SLIT and SCIT using a purified standardized Juniperus ashei extract in a population of allergic patients monosensitized to cypress. Forty patients with cypress-allergic rhino conjunctivitis were administered therapeutic or placebo SLIT or SCIT for 12 months. Laboratory parameters were studied, namely the eosinophil cationic protein (ECP) level in nasal lavage and in serum, as well as the number of eosinophils (EOS) in peripheral blood and in nasal lavage and the level of eosinophil chemotactic activity (ECA). These parameters were correlated with clinical symptoms, evaluated by means of the clinical symptoms score (CSS). After SCIT and SLIT the levels of ECP and ECA were reduced in nasal lavage. We also observed a significant reduction in the values of ECP in serum in the patients treated with SLIT. EOS were unchanged in peripheral blood, but significantly reduced in nasal lavage. These data were in accordance with the improvement of clinical symptoms, supported by the close correlation between CSS and laboratory parameters. Our data confirm a clinical improvement correlated with a decline in inflammation parameters after one year of immunotherapy, supporting the hypothesis that treatment with a major allergen of cypress is able to change the course of allergic rhinitis.

Medium-dose ultraviolet (UV) A1 vs. narrowband UVB phototherapy in atopic eczema: a randomized crossover study.

BACKGROUND: Ultraviolet (UV) A1 and narrowband (NB)-UVB have been reported to be effective treatments for atopic eczema (AE). OBJECTIVES: We aimed to compare the efficacy of medium-dose UVA1 and NB-UVB mono-phototherapy in patients with AE. METHODS: A randomized double-blind controlled crossover trial (ClinicalTrials.gov Identifier: NCT00419406) was conducted in which patients with AE received a 6-week course of both medium-dose UVA1 and NB-UVB. Clinical efficacy was assessed using the Six Area, Six Sign, Atopic Dermatitis (SASSAD) score and a visual analogue scale for pruritus. Assessment of health-related quality of life was performed using the Skindex-29. Total immunoglobulin E (IgE) and eosinophilic cationic protein (ECP) were evaluated at baseline and after each phototherapy course. RESULTS: Twenty-eight patients who completed both UVA1 and NB-UVB phototherapy courses on an intention-to-treat basis were analysed according to the crossover design. Both interventions were associated with significant clinical improvement but there was no significant difference between treatments with respect to the mean +/- SD relative reduction (RR) of the clinical scores (SASSAD, 43.7 +/- 31.4% vs. 39.4 +/- 24.1%, P = 0.5; pruritus score, 16 +/- 61.8% vs. 25.2 +/- 30.5%, P = 0.5, respectively). There was no significant difference in the mean +/- SD RR of the Skindex-29 after UVA1 and NB-UVB phototherapy (12.7 +/- 18.8% vs. 16.5 +/- 17.6%, P = 0.1). Changes in the total IgE and ECP levels following UVA1 and NB-UVB did not differ significantly (P = 0.3 and P = 0.9, respectively). CONCLUSIONS: A 6-week course of NB-UVB and UVA1 phototherapy of AE resulted in significant clinical improvement. With regard to efficacy and tolerability, both phototherapeutic modalities may be considered comparably good.

Treatment of perennial allergic rhinitis using Shi-Bi-Lin, a Chinese herbal formula.

AIM OF THE STUDY: Shi-Bi-Lin (SBL) is modified from the classic formula Cang-Er-Zi-San which has been used to treat chronic rhinitis, paranasal sinusitis and allergic rhinitis by herbal practitioners. The present study aimed at patients with moderate to severe perennial allergic rhinitis. SBL which has been shown effective in treating a guinea-pig model of allergic rhinitis, was evaluated for its efficacy and safety. MATERIALS AND METHODS: 126 allergic rhinitis patients were recruited in a double-blind randomized control trial. Half of the patients received SBL capsules and the others half received placebo for 4 weeks. Symptoms scores, physician's evaluation, nose examination, quality of life, adverse effects, serum cytokines were evaluated before and after treatment. RESULTS: SBL was found to be safe and effective in relieving some symptoms of perennial allergic rhinitis, improving the nose condition, and enhancing some domains of quality of life when compare to placebo, (p<0.05). In the 2 weeks follow up after treatment completion, the SBL enjoyed a prolongation of symptom control (p=0.05). CONCLUSION: SBL relieved symptoms of nose blockage among patients with perennial allergic rhinitis, and some aspects of the quality of life were also improved. The improvement was sustained for at least 2 weeks after treatment. No serious adverse events were encountered.

Correlation of quality of life with clinical parameters and eosinophilic cation protein levels in children with allergic rhinoconjunctivitis.

BACKGROUND: Systemic and mucosal roles of eosinophils in the pathogenesis of allergic rhinoconjunctivitis (AR) are known. The aim of this study was to investigate the relationship of clinical parameters and quality of life with eosinophilic cationic protein (ECP) in grass pollen-sensitive children with seasonal AR. METHODS: This study included 31 children with AR and 18 healthy controls aged between 5 and 15 years. ECP levels in nasal lavage fluid and serum were measured. AR symptom scores were calculated and the pediatric rhinoconjunctivitis quality of life questionnaire (PRQLQ) was filled in for all patients. RESULTS: Mean serum and nasal ECP levels (ng/ml) were significantly higher in the patient group (p < 0.05 for both). In the AR group, the mean clinical symptom score was 7.3 +/- 2.2, while the total PRQLQ score, activity limitation, symptoms and emotional function domains were 2.5 +/- 0.9, 3.0 +/- 1.1, 2.5 +/- 1.2 and 2.6 +/- 1.1, respectively. The total clinical symptom score and disease duration showed a significant correlation with the total PRQLQ score (p = 0.00 and 0.003, respectively). However, neither nasal lavage nor serum ECP levels were significantly correlated with symptom score, duration of disease, PRQLQ total score or domains (p > 0.05 for all). CONCLUSION: These results may indicate the absence of a correlation between clinical status and quality of life and levels of ECP in tissues with allergic inflammation.

Allergy in marathon runners and effect of Lactobacillus GG supplementation on allergic inflammatory markers.

OBJECTIVE: We studied the prevalence of asthma and allergy in non-elite marathon runners and investigated the effects of probiotic supplementation on allergic inflammatory markers. METHODS: Asthma and allergies were surveyed by questionnaire, and blood eosinophils, serum eosinophil cationic protein (ECP), total IgE, and Phadiatop were measured in 141 Finnish marathon runners who took part in the Helsinki City Marathon. They were also randomized to receive either Lactobacillus GG (LGG) or placebo during the 3 months of the pollen season prior to the marathon. RESULTS: Lifetime prevalence of physician-diagnosed asthma was 4.3% (six out of 139 athletes), of allergic rhinitis 17.3% (24/139), of food allergy 5.0% (7/139), and of atopic eczema 4.3% (6/139). Prevalence of atopy was 31% (35/112), and 21% (24/112) of the athletes were sensitized to birch pollen. Asthma or allergy medication was used by 20% (28/139) of the athletes. During pollen season, serum ECP increased significantly in all athletes, and total IgE and Phadiatop in atopics. The marathon induced a significant eosinopenia but had no effect on serum ECP or total IgE. No differences in changes were seen between groups receiving LGG or placebo. CONCLUSION: Non-elite marathon runners have asthma and allergies similar to Finnish general population. LGG supplementation did not prevent the increase of allergic markers during the pollen season, or the eosinopenia induced by the marathon.

Chlorine in breath condensate--a measure of airway affection in pollinosis?

BACKGROUND: Infiltration of inflammatory cells in bronchial mucosa and glandular hypersecretion are hallmarks of asthma. It has been postulated that exhaled breath condensate (EBC) mirrors events in epithelial lining fluid of airways, such as presence of local inflammation as well as glandular hypersecretion. It is also well known that eosinophil cationic protein (ECP) and cysteinyl-leukotrienes (cys-LT) are released by circulating inflammatory cells when triggered by antigen stimulation in asthma patients. OBJECTIVES: The aim of this study was to evaluate whether chlorine and/or cys-LT in EBC would reflect changes of exposure of airborne pollen in patients with asthma. METHODS: EBC and serum were collected from 23 patients with allergic asthma during a pollen season and repeated 5 months later during a period with no aeroallergens. Chlorine was measured by means of a sensitive coulometric technique and cys-LT by an EIA technique. Serum ECP was measured and lung function tests were performed and symptoms noted during both occasions. RESULTS: Significantly higher concentrations of chlorine in EBC (p = 0.007) and ECP in serum (p = 0.003) were found during the pollen season compared to post-season. Chlorine levels tended to be higher in patients who reported of chest symptoms compared to those who denied symptoms during the pollen season (p = 0.06). Areas under the receiver-operated characteristic curves (AUC(ROC)) were compared and similar discriminative power to identify exacerbations of asthma was recorded by chlorine in EBC (range 0.67-0.78) and ECP in serum (range 0.64-0.78). CONCLUSION: It is concluded that chlorine in EBC and ECP in serum decreased significantly post-season, and this is suggested to mirror the decrement in airborne antigen. It is furthermore proposed that chlorine in EBC and ECP in serum tend to have a similar capacity to identify seasonal variations in airborne pollen in patients with asthma.

Evaluation of serum IgG4 antibodies specific to grass pollen allergen components in the follow up of allergic patients undergoing subcutaneous and sublingual immunotherapy.

BACKGROUND: A number of reports suggest that induction of IgG 'blocking antibodies' may be important for successful allergen immunotherapy. Nevertheless, a significant increase in specific IgG and IgG4 antibodies has not been consistently demonstrated for sublingual immunotherapy (SLIT). METHODS: The present observation included three groups of grass pollen allergic patients all submitted to three different allergen immunotherapeutic regimens in an open, non-placebo controlled clinical study: (i) 16 patients underwent a modified 'cluster' regimen of weekly injections of a standardized aluminium-absorbed Phleum pratense extract for 5 weeks, followed by 3 weeks of maintenance injections. (ii) Fifteen patients were treated with standardized timothy grass pollen-allergen oral vaccine. In the first session of a SLIT protocol without up-dosing, each patient received 2.4 ml of sublingual vaccine containing about 57 microg of Phl p 5 and received a maintenance dose of 24 microg of Phl p 5 once a day for 120 days. (iii) Fourteen subjects were treated with a standardized allergen extract containing 5-grass pollen mixture; a SLIT protocol was performed without up-dosing, administering a dose corresponding to about 10.0 microg/ml grass-pollen Group 5 and a maintenance dose of 4 microg of grass-pollen Group 5 once a day for 135 days. Patients' sera were characterized in detail by determining IgG4 antibodies to rPhl p 1, 2, 5, 6, 7, 11, 12 and nPhl p 4 and eosinophil cationic protein before the start of immunotherapy and during the peak of pollen season. RESULTS: No relevant systemic side effects were registered in patients treated with the modified cluster subcutaneous immunotherapy (SCIT) protocol and the two SLIT protocols without build-up phase. After SCIT all patients had high titres of serum allergen-specific IgG4 antibodies. High-dose SLIT led to an IgG4 increase comprising 25% of the SCIT level, while low-dose SLIT increased to 4% of the SCIT. Furthermore, the increase of specific IgG antibodies corresponds to a decrease of serum ECP during allergen exposure. CONCLUSIONS: These preliminary data seem to indicate that: (i) pre-seasonal high-dose SLIT protocol without build-up phase is safe and well-tolerated by allergic patients; (ii) compared to IgG4 levels induced by SCIT, only a high-dose SLIT regimen results in an appreciable serum specific IgG4 increase.

[Efficacy and safety of specific immunotherapy of upper airways allergic diseases caused by allergy to mites]. / Skutecznosc i bezpieczenstwo doustnej immunoterapii swoistej alergicznych schorzen górnych dróg oddechowych w zwiazku z uczuleniem na roztocza.

AIM OF THE STUDY: The aim of this study was to evaluate the efficacy and safety of 3 years oral specific immunotherapy in patients with perannial allergic rhinitis and bronchial asthma caused by allergy to mites. MATERIAL AND METHODS: Fifteen patients with allergic perannial rhinitis entered the study. Ten of them suffered also from bronchial asthma. During 3 years of therapy we have monitored the appearance of side effects, clinical parameters (symptoms degree and medication usage score) and immunological parameters (serum eosinophil cationic protein concentration and leukotriene C4 liberation by peripheral blood leukocytes upon in vitro specific allergens stimulation). RESULTS: We have not observed the appearance of any adverse event, so medication has been recognized as a safe. Moreover, we have observed a lot of positive therapeutical effects--the lowering of symptoms scores, accompanied by advantageous changes in immunological parameters. However, in spite of 3 years of therapy, many patients still reported the substantial clinical symptoms, accompanied by still elevated serum ECP concentration and relatively high leukotriene C4 liberation by peripheral blood leukocytes upon in vitro stimulation by specific allergens. CONCLUSION: Oral specific immunotherapy in the patients with allergic diseases of upper airways is a safe medication but leads only to moderate clinical efficacy accompanied by lowering serum ECP concentration and reducing of leukotrienes C4 liberation by peripheral blood leukocytes stimulated by specific allergens.

Circulating eosinophils in asthma, allergic rhinitis, and atopic dermatitis lack morphological signs of degranulation.

BACKGROUND: In allergic diseases, eosinophils in affected tissues release granule proteins with cytotoxic, immunoregulatory, and remodelling-promoting properties. From recent observations, it may be assumed that eosinophils degranulate already in circulating blood. If degranulation occurs in the circulation, this could contribute to widespread systemic effects and provide an important marker of disease. OBJECTIVE: To determine the degranulation status of circulating eosinophils in common allergic diseases. METHODS: Using a novel approach of whole blood fixation and leucocyte preparation, the granule morphology of blood eosinophils from healthy subjects, non-symptomatic patients, symptomatic patients with asthma, asthma and Churg-Strauss syndrome, allergic rhinitis, and atopic dermatitis was evaluated by transmission electron microscopy (TEM) and eosinophil peroxidase (TEM) histochemistry. Plasma and serum levels of eosinophil cationic protein were measured by fluoroenzymeimmunoassay. Selected tissue biopsies were examined by TEM. RESULTS: Regardless of symptoms, circulating eosinophils from allergic patients showed the same granule morphology as cells from healthy subjects. The majority of eosinophil-specific granules had preserved intact electron-density (96%; range: 89-98%), while the remaining granules typically exhibited marginal coarsening or mild lucency of the matrix structure. Abnormalities of the crystalline granule core were rarely detected. Furthermore, granule matrix alterations were not associated with any re-localization of intracellular EPO or increase in plasma eosinophil cationic protein. By contrast, eosinophils in diseased tissues exhibited cytolysis (granule release through membrane rupture) and piecemeal degranulation (loss of granule matrix and core structures). CONCLUSION: In symptomatic eosinophilic diseases, circulating blood eosinophils retain their granule contents until they have reached their target organ.

Evaluation of food-pollen cross-reactivity by nose-mouth cross-challenge in pollinosis with oral allergy syndrome.

BACKGROUND: Oral allergy syndrome (OAS) is often associated with pollen-induced rhinitis, and there are preferential associations between causative substances. If OAS and rhinitis are both immunoglobulin (Ig)E-mediated and there are cross-reacting proteins, it is expected that similar reactions can be elicited in the nose and mouth. In order to test this hypothesis we performed a series of 'cross-challenges' with foods and pollens in both the nose and the mouth. METHODS: Nine patients with ascertained OAS due to vegetables and rhinitis due to pollens were studied. On the first day a nasal challenge with pollen extracts and an oral challenge with fresh food was carried out. After a week, washout nasal challenge with food and an oral challenge with pollens were performed. Immediate symptoms, mucosal tryptase and soluble eosinophil cationic protein (ECP) were assessed after each challenge. RESULTS: The administration of pollen into the nose and food into the mouth elicited symptoms as expected, but the cross-challenge had no clinical effect. In parallel, tryptase and ECP increased after nasal challenge with pollens, whereas foods did not elicit a measurable response. CONCLUSION: The cross-reactivity between foods and pollens, when evaluated at the shock organ, was not clinically evident. This data can be explained with a low concentration of cross-reagent epitopes in pollen extracts and food homogenized because of degradation. The different behaviour upon challenge suggests that different immunological mechanisms may act in the nose and mouth.