The Role of Exhaled Breath Condensate in Chronic Inflammatory and Neoplastic Diseases of the Respiratory Tract.

Asthma and chronic obstructive pulmonary disease (COPD) are among the most common chronic respiratory diseases. Chronic inflammation of the airways leads to an increased production of inflammatory markers by the effector cells of the respiratory tract and lung tissue. These biomarkers allow the assessment of physiological and pathological processes and responses to therapeutic interventions. Lung cancer, which is characterized by high mortality, is one of the most frequently diagnosed cancers worldwide. Current screening methods and tissue biopsies have limitations that highlight the need for rapid diagnosis, patient differentiation, and effective management and monitoring. One promising non-invasive diagnostic method for respiratory diseases is the assessment of exhaled breath condensate (EBC). EBC contains a mixture of volatile and non-volatile biomarkers such as cytokines, leukotrienes, oxidative stress markers, and molecular biomarkers, providing significant information about inflammatory and neoplastic states in the lungs. This article summarizes the research on the application and development of EBC assessment in diagnosing and monitoring respiratory diseases, focusing on asthma, COPD, and lung cancer. The process of collecting condensate, potential issues, and selected groups of markers for detailed disease assessment in the future are discussed. Further research may contribute to the development of more precise and personalized diagnostic and treatment methods.

Basophil Activation Test Is Inferior to Provocation Test in Diagnosing Aspirin Hypersensitivity.

INTRODUCTION: Diagnostic of aspirin (ASA) hypersensitivity is largely based on provocation tests. However, they have significant limitations including influence of medications, necessity of hospitalization, and safety issues. Basophil activation test (BAT) seems to be a promising in vitro alternative. It has already proven to be a useful tool for diagnosing IgE-mediated allergy to certain food and airborne allergens as well as insects venoms. The aim of the study was to assess performance of BAT in diagnosing aspirin hypersensitivity in comparison with current golden standard (oral provocation test, OPT). METHODS: The study group comprised 148 adult patients with suspicion of aspirin hypersensitivity, including 51 (36%) with chronic urticaria, 73 (51%) with asthma, and 55 (39%) with chronic sinusitis. The control group was 10 healthy adult patients who used NSAIDs during preceding year with good tolerance. BAT with ASA was conducted in all the participants. Additionally, in the study group, OPT was performed with cumulative dose of 1,000 mg of ASA. RESULTS: Out of 148 study group participants, 114 underwent BAT and ASA provocation with conclusive results acquired in both tests. In this group, the threshold for positive BAT was 4.9%. Sensitivity and specificity of BAT were found to be 55.9% and 75%, respectively, with a positive predictive value of 77% and a negative predictive value of 54%. The highest sensitivity (78%) was found in subgroup patients with chronic urticaria, while specificity was highest in the subgroup with chronic respiratory diseases (87%). CONCLUSION: Despite significant advantages of BAT such as safety, no influence of drugs, and objectivity, its performance makes it inferior to current standard in ASA hypersensitivity.

Hypersensitivity of azo dyes in urticaria patients based on a single-blind, placebo-controlled oral challenge.

Introduction: The role of azo dyes in urticaria is not fully understood. Aim: To assess the incidence rate of hypersensitivity reactions to food azo dyes based on a placebo-controlled oral challenge in a group of patients with suspected urticaria exacerbation after consuming food additives. Material and methods: The study included patients over 18 years of age with chronic urticaria, in whom hypersensitivity to food additives was suspected based on a questionnaire and medical history. Patients suspected of urticaria exacerbations after ingestion of azo dyes were enrolled in a placebo-controlled single-blind oral challenge (OC) with a mixture of azo food dyes: tartrazine, Quinoline Yellow, Sunset Yellow, Cochineal Red, Allura Red, and azorubine. Results: Out of 110 patients (76 women and 34 men, mean age 46.1 (20-76 years), 39 patients were qualified for the oral challenge. We observed two subjects (5.1%) with a positive result. Conclusions: Azo dyes ingested in food or medications incidentally cause urticaria but may exacerbate its course. Oral challenge-confirmed hypersensitivity to azo dyes is much less common than reported by patients.

Protocol of safe vaccination against COVID-19 in patients with high risk of allergic reactions.

Background: Sars-CoV-2 infections are hazardous, especially to the elderly and patients with comorbidities. With no efficient treatment available, newly developed vaccines are the only way to change the course of the pandemic. However, reports of allergic reactions resulted in some patients and practicing physicians being concerned about the safety of vaccine administration, particularly in people with severe anaphylactic reactions to multiple or unknown factors in their medical history.This study aimed to develop an allergic work-up protocol based on skin prick tests (SPT), intradermal testing (IDT) and intramuscular provocations, and desensitisation which may contribute to diagnosis and management of anti-COVID-19 vaccine allergy. Methods: Two hundred and eighty-five patients were enrolled. Two hundred and five of them entered the study based on severe anaphylactic reaction to unknown or multiple factors in their medical history which disqualified them for standard treatment. Another 80 patients were enrolled after developing an allergic reaction to the first dose of one such vaccine. In all subjects, SPT and IDT were performed. Serum tryptase was assessed in 79 patients randomly chosen from the study group. Results: Two hundred and seventy-seven patients with negative tests were given a vaccine without complications. Seven patients had positive skin tests. In two cases, tests confirmed Comirnaty allergy, while the other five confirmed solely skin sensitisation with no exposure prior to the study. Six patients with positive tests received titrated challenge using desensitisation protocol with a reasonable tolerance. One patient did not consent to desensitisation and one patient resigned despite negative tests. Overall, 283 (99%) patients were vaccinated using this newly developed protocol. Patients with adverse reactions to the first dose of the vaccine before the study had a significantly lower basal serum tryptase concentration (p = 0.001). Conclusion: Skin tests with anti-COVID-19 vaccines are a useful tool in the vaccination protocol. This protocol enables safe immunisation of high-allergy-risk patients even in cases of positive skin tests.

Carmine allergy in urticaria patients.

Introduction: Carmine, a commonly used natural red dye, can cause immediate and delayed allergic reactions, which are frequently overlooked. Aim: To assess the incidence of carmine allergy and its clinical significance based on the placebo-controlled oral challenge in urticaria patients and suspected hypersensitivity to food additives. Material and methods: Patients' histories were recorded by means of a standardized questionnaire. The subjects underwent skin prick tests and patch tests for carmine, while the level of specific IgE was measured in 52 patients. The patients with at least one positive carmine test or with suspected hypersensitivity to carmine were suggested to undergo a placebo-controlled oral challenge test. Results: One hundred and ten patients were enrolled in the study. Carmine skin testing was positive in 22 patients: skin prick tests were positive in 17% (n = 19), while patch tests were doubtful in 6% (n = 6). In 25/52 patients, the level of specific IgE was min. 0.01 kU/l. Oral challenge was performed in 33 subjects. Allergy to carmine was diagnosed in 9 (8%) patients; all of them suffered from chronic inducible urticaria. Conclusions: Carmine is a potential allergen in patients with chronic inducible urticaria especially with concomitant systemic symptoms. Skin tests and specific IgE level measurement may be helpful tools to diagnose E120 hypersensitivity.

Asthma prevalence and risk factors analysis in Tricity university students' group.

INTRODUCTION: Asthma is the most prevalent chronic disease in a young and middle age population worldwide. It is also one of the main reasons for the lost working days and lost days at school. Several epidemiological surveys have evidenced an increase in the prevalence of asthma in Poland. This trend is further evident in urban areas such as Tricity (Gdansk, Sopot, Gdynia). The aim of the study was to assess the prevalence of the disease as well as the risk factors affecting the university student population. MATERIAL AND METHODS: Two surveys were distributed electronically to students of the four major universities in Tricity. The first survey contained nine questions concerning asthma diagnoses and symptoms. The second survey, which evaluated the occurrence of identified risk factors, was sent to students who answered the first survey. Asthmatics also received an Asthma Control Test (ACT). The results were analyzed using the Statistica 10 software. Study group consisted of 1380 students: 1031 (75%) women and 349 (25%) men; the average age was 22.2. RESULTS: Asthma was diagnosed in 138 students (9.6%), additionally 76 students (5.5%) reported asthmatic symptoms; however, these students had no previous diagnoses. Asthma tended to occur more frequently in students living in poorly maintained houses (19%) (p = 0.06), in contrast to those living in a normal environment (10%). According to their ACTs, 81% of diagnosed patients reported that their asthma was well-controlled. CONCLUSIONS: Asthma is becoming an important issue for Tricity students. Educational activities aimed at raising university students' awareness regarding asthma treatment and control should be implemented.

[Application of basophil activation test in diagnosing aspirin hypersensitivity]. / Zastosowanie testu aktywacji bazofilów w diagnostyce nadwrazliwosci na kwas acetylosalicylowy.

In the face of increasing prevalence of hypersensitivity reactions, introduction of effective, reliable and safe methods plays a crucial role in their diagnosing. Among the currently available laboratory (in vitro) methods is basophil activation test (BAT). It is a flow- cytometry based assay that allows to identificate in the blood sample basophils and additionally to asses the degree of cell activation after exposure to an antigen. The most common superficial identification markers are CD63 and CD203c, which increase in number after activation. Basophil actvation test can be applied to confirm diagnosis of allergy to Hymenoptera venoms, food, pollens and hypersensitivity to drugs. The aim of present paper is to present theoretical methods of this test as well as its pros and cons. We focus also on presentation of clinical case where BAT seemed to be a necessary addition to a routine diagnostic pathway. We present a case of identification of the culprit drug which caused an anaphylactic reaction.