Compositional differences between gut microbiota of adult patients with asthma and healthy controls.

Introduction: Asthma is a complex and multifactorial disorder, with severe public health implications. Over the last several years, our knowledge in the field of human gut microbiota has expanded and allowed us to understand its crucial role in the development of many diseases. Aim: To analyse the nature of human gut microbiota patterns among patients with asthma compared to healthy controls. Material and methods: Composition of the complex gut microbiota was analysed in faecal samples from 13 asthma patients and 7 healthy volunteers using Next-Generation Sequencing technology (NGS). The Kruskal-Wallis Analysis of Variance (ANOVA) and Mann-Whitney tests were used to compare the above two groups of subjects. Results: The composition of the gut microbiota of asthma patients differed from that of healthy volunteers at each of the analysed levels (p < 0.05). Compared to healthy individuals, bacterial diversity was significantly lowered among the asthma group, which is the evidence of gut microbiota depletion in asthma patients. The analysis of beta diversity showed that the gut community compositions of asthma are widely dispersed in contrast to the tight clustering observed in the control group. Finally, the similarity index was found to be lower in the inter-group comparison than in the intra-group comparison, which confirmed changes in the gut microbial composition in the asthmatic group. Conclusions: The study revealed significant differences in the human gut microbiome composition between asthma patients and the healthy control group.

Higher Risk for Sensitization to Commonly Consumed Herbs among Adults and Youngsters Suffering from Birch, Mugwort or Grass Pollinosis.

Background: According to recent findings, mugwort and birch pollen-allergic patients represent a high-risk group for developing adverse allergic reactions to herbal spices due to cross-reacting allergens found in both pollen and raw herbs. Such associations are known as a pollen-plant food allergy syndrome. Objective: The aim of the study was to evaluate the extent of sensitization to commonly consumed herb species representing Lamiaceae, Apiaceae and Brassicaceae families in Polish patients with suspected birch, mugwort or grass pollen allergy. Materials and Methods: Data were obtained from 180 patients, adults and children with suspected allergy to aeroallergens. Skin prick tests (SPT) were performed with standard birch, mugwort, grass mixture or dust mite extracts. Prick by prick tests were performed with fresh extracts of popular herbs: basil, oregano, lemon balm, mint, salvia, rosemary, thyme, anise, caraway and mustard. Results: Twenty-nine percent of patients were characterized by concomitant positive skin prick reactions to both herbs and pollens extracts. The concomitant pollinosis significantly increased the risk of SPT reaction to all tested herbs in adults (odds ratio, OR = 2.15−7.35) and children (OR = 5.3−28). The extent of SPT responses to herbs from Lamiaceae + Apiaceae were strongly correlated with SPT responses to pollens in the pediatric group (r = 0.685/p < 0.001). Conclusion: The study demonstrates that youngsters suffering from pollinosis are at high risk of developing allergic reactions to herbs and highlights the importance of including native skin prick tests with herbs in the diagnostic work-up for suspected food allergy.

Home self-monitoring in patients with asthma using a mobile spirometry system.

BACKGROUND: Self-management is an appealing strategy for prevention of asthma exacerbations. This study aimed to evaluate the feasibility and safety of a portable spirometer for unsupervised home spirometry measurements among patients with asthma. METHODS: A multi-center, prospective, single-arm, open study recruited 86 patients with controlled or partly controlled asthma (41 women, 38.6 ± 10.4 y/o and 45 men, 36.2 ± 12.1 y/o). After a training session, patients performed daily spirometry at home with the AioCare® mobile spirometry system. Each spirometry examination was recorded and evaluated according to the ATS/ERS acceptability and repeatability criteria. The primary endpoint was defined as three or more acceptable examinations in any given seven-day period (+/- 1 day) during any of the three weeks of the study. The system allowed for online review of measurements by physicians/nurses to provide feedback to patients. RESULTS: Of 78 patients with complete data, 67 (86%) achieved the primary endpoint. Seventy-five (96%) participants used the device correctly once or more, and 10 (13%) patients succeeded every single day over the three-week follow-up. The rate of acceptable spirometry examinations differed between the sites (p = 0.013). Retraining was required in 20 of 62 (32%) eligible patients, and successful in 8 individuals (40%). Satisfaction with the AioCare® system was high, 90% of respondents perceived it as useful and user-friendly. CONCLUSIONS: Self-monitoring of asthma with a connected mobile spirometer is feasible, safe and satisfactory for patients with asthma. It remains to be established whether unsupervised home spirometry measurements may improve early diagnosis and outcomes of self-management in cases of exacerbation or loss of asthma control.

Highlights BoxThis study aimed to evaluate the ability of patients with asthma to perform high-quality daily spirometry examinations at home with using the AioCare^® mobile spirometry system. The study showed that unsupervised home spirometry is safe and feasible in patients with asthma. Most patients used the device on most days of the study, and nearly 90% of all patients achieved the primary endpoint. There were no device-related adverse events.

New allergens from spices in the Apiaceae family: anise Pimpinella anisum L. and caraway Carum carvi L.

Spices are gaining popularity in individual consumption, food industry, and medicine. While the incidence of allergies is constantly rising, those caused by consumption of herbs and spices are relatively rare. The allergic potential of spices added to many dishes and products is dangerous, as consumers may ingest them unknowingly. At particular risk are persons allergic to both birch and mugwort pollen because of cross-reactivity to proteins similar to birch allergen, Bet v 1 and profilins, who often exhibit a clinical condition termed "mugwort-celery-spice syndrome". The aim of our research was to analyze the extracts of anise and caraway for the presence of major pan-allergens, such as Bet v 1 analogues and profilins. Secondly, we analyzed the prevalence of reactions towards these pan-allergens among patients sensitive to spices. Finally, we tried to identify some of the previously unidentified allergenic proteins in these spices. In order to identify Bet v 1 analogues and profilins in anise and caraway, we conducted immunoblotting of the proteins extracted from the spices with anti-Bet v 1 and anti-profilin antibodies. The identification of new allergens was performed by initial selection of proteins through immunoblotting with sera of patients sensitive to spices. The proteins were subsequently characterized with LC-MS/MS. The presence of Bet v 1 analogues and profilins in anise was confirmed and a new allergen, glyceraldehyde 3-phosphate dehydrogenase, was identified. Moreover, new caraway allergens were found, including Bet v 1 analogue, profilin, and elongation factor α.

Impaired resolution of wheals in the skin prick test and low diamine oxidase blood level in allergic patients.

INTRODUCTION: Histamine is the major mediator of IgE- and non-IgE-mediated allergic reactions upon allergen or hapten contact. Reduced histamine degradation capacity was associated with atopic eczema as well as with non-immunological histamine intolerance. Higher blood serum histamine level concomitant with decreased intestinal diamine oxidase activity were observed in patients with food allergy. AIM: To evaluate the relationship between patients' blood diamine oxidase (DAO) activity/histamine status and their reactivity to time-resolved histamine skin prick test in respect to vulnerability to allergic diseases. MATERIAL AND METHODS: Fifty-three patients were examined with skin prick tests (SPT) and patch tests for suspected presence of either IgE- or non-IgE-mediated allergy. All individuals were skin prick tested with histamine and the resolution of the wheal was monitored for 50 min. Blood DAO activity and histamine concentration were measured with a radio-extraction radioimmunoassay. RESULTS: Time-resolved histamine skin prick testing revealed presence of wheals which were 35% larger in diameter in 47% of examined subjects at 20 min of the test. These patients exhibited significantly compromised time-course wheal resolution (wheal ≥ 3 mm at 50 min) compared to a group of patients with the normal-rate of wheal resolution (wheal = 0 mm at 50 min). Within a group of subjects exhibiting impaired wheal resolution, 61% of patients were diagnosed allergic compared to 50% in a group of patients with a normal rate of wheal resolution. Finally, allergic patients were characterized by a significantly lower DAO activity and higher histamine content compared to healthy subjects. CONCLUSIONS: The results of this study indicate that patients with IgE- or non-IgE-mediated allergy are likely to have low DAO blood activity and may concomitantly suffer from histamine intolerance. Furthermore, our results suggest that allergic patients are more likely to develop an excessive SPT reaction. Our results emphasize caution in interpretation of the SPT results in allergic patients with diagnosed histamine intolerance or histamine/DAO activity imbalance.

Accelerated Up-Dosing of Subcutaneous Immunotherapy with a Registered Allergoid Birch Pollen Preparation.

BACKGROUND: Early pollen flight and new allergens prolonging the pollen season means that the time for up-dosing of allergen-specific subcutaneous immunotherapy (SCIT) outside the pollen season becomes shorter. Hence, for patients who wish or need to be up-dosed faster, an accelerated induction regimen would provide a useful treatment option. METHODS: An accelerated up-dosing regimen (0.1-0.3-0.5 mL at weekly intervals) was compared to conventional up-dosing (0.05-0.1-0.2-0.3-0.4-0.5 mL at weekly intervals) using an allergoid birch pollen SCIT preparation. After up-dosing, the maintenance dose (0.5 mL) was given 3 times at biweekly intervals. The multicenter study was performed according to an open randomized, parallel-group design. RESULTS: A total of 123 birch pollen-allergic patients (81 adults and 42 adolescents) presenting with rhinitis or rhinoconjunctivitis with or without mild asthma (FEV1 >70%) were randomized to either the conventional registered up-dosing or an accelerated regimen. In total, 96.7 and 98.4% successfully reached the maintenance dose for the conventional and accelerated regimen, respectively, without relevant differences between adults and adolescents. Both regimens were safe and well tolerated. Furthermore, significant increases (similar in size) in specific IgG and IgG4 after 3 months of treatment were observed in both groups, independent of age. CONCLUSION: The accelerated SCIT regimen was revealed to be as safe as the conventional regimen, and the immunological effects of both regimens are similar. Accordingly, the accelerated regimen may be used to up-dose patients of adult as well adolescent age within 2 weeks.

Allergy to apple cultivars among patients with birch pollinosis and oral allergy syndrome.

BACKGROUND: Oral allergy syndrome (OAS) is caused by cross-reacting allergens found in pollen, raw fruits, vegetables, and some tree nuts. The major apple allergen, Mal d 1, is a cause of food allergic reactions in birch pollen sensitized patients. OBJECTIVE: To explore the allergenicity of the most popular and commonly consumed apple cultivars in Poland in patients with birch pollen allergy with or without OAS. METHODS: Data were obtained from 46 adults with clinical symptoms of birch allergy and allergic rhinitis or rhinoconjunctivitis. Patients were divided into 2 groups according to the occurrence of OAS to apple. Skin prick tests (SPTs) were performed with pulp from the 11 most popular apple cultivars in Poland. Specific IgE (sIgE) to Bet v 1 was measured by radioallergosorbent test. RESULTS: Patients with OAS had more positive responses to apple SPT vs patients without OAS (odds ratios, 4.8-11.96). Patients with OAS had distinctive responses to apple cultivars. Szara Reneta and Cortland induced positive responses in 50% and 83% of patients, respectively. Patients with OAS vs patients without OAS who were allergic to apples vs nonallergic had 2-fold (P = .008) and 7-fold (P = .03) higher blood concentrations of sIgE Bet v 1, respectively. There were different profiles of correlations of sIgE Bet v 1 with wheal diameter for low and high allergenic cultivars in patients without and with OAS. CONCLUSION: We noted a substantial role for Bet v 1 sensitization in the allergic response based on evaluation of the allergenicity of 11 apple cultivars. The sIgE Bet v 1 and SPT results of patients with and without OAS allowed differentiation between low and high allergenic cultivars.

L-ficolin (ficolin-2) insufficiency is associated with combined allergic and infectious respiratory disease in children.

We previously reported an association between relative L-ficolin deficiency and recurrent respiratory infections co-existing with allergic disorders in children. To confirm and extend this preliminary finding, we performed a prospective study on children of a similar age (mean 8.9 years) designed to establish whether the principal relationship was with infection or allergy. Serum L-ficolin values in healthy children were normally distributed with a mean value of 3838 ng/ml. L-ficolin concentrations were generally lower in patients with asthma and/or allergic rhinitis with (mean 3413 ng/ml; p=0.02) or without (3512 ng/ml; p<0.07) respiratory infections, but not in patients with respiratory infections without allergic disease (3623 ng/ml; p=0.2). The lower average values in the group comprised of children with respiratory allergy and infections were largely due to a high proportion of very low values: 18.3% had values below 2150 ng/ml compared to only 5.5% of healthy controls (OR=3.9; p=0.01). This relationship was not apparent in the groups characterized by allergy without infection or infections without allergy. An association between mannan-binding lectin (MBL) insufficiency and recurrent respiratory infections was also confirmed. One of the patients was MASP-2 deficient, evidenced both by MASP2 genotyping and by lectin pathway activity measurement. In conclusion, L-ficolin may confer some protection from microorganisms that exacerbate allergic inflammation in the lung and its relative deficiency may contribute to enhanced susceptibility to respiratory infections. MBL insufficiency and MASP-2 deficiency are risk factors for recurrence of infections independently of allergic disease.

[Anaphylactic reaction caused by conjunctival provocation with birch recombinant allergen rBet v 1a Mut1-6--case report]. / Reakcja anafilaktyczna wywolana prowokacja spojówkowa z rekombinowanym alergenem brzozy rBet v 1a mut1-6--opis przypadku.

UNLABELLED: Conjunctival provocations with recombinant allergens are new kind of examinations in allergology but they are estimated as safe. The aim of the work was to present a case of anaphylactic reaction caused by birch recombinant allergen with theoretically decreased allergenity. RESULTS: A patient allergic to birch pollen revealed strong local and anaphylactic reaction (I/II stage) after conjunctival provocation with recombinant allergen rBet v 1a Mut1-6. CONCLUSIONS: Provocation tests with allergens are at risk of anaphylaxis and that is why they should be conducted with caution and with resuscitation procedures for a patient safety.

[Bronchial asthma prevalence in children and youth with overweight]. / Czestosc wystepowania astmy oskrzelowej u dzieci i mlodziezy z nadmierna masa ciala.

THE AIM OF THE STUDY: Relationships between bronchial asthma prevalence in children and youth and selected nutritional indices together with fatty tissue distribution were analyzed. MATERIAL AND METHODS: The study comprised randomly chosen group of 126 children and youth living in the city of Lodz, between the ages from 9 to 17 years (74 boys, 52 girls) including 25 subjects with mild and 34 with moderate asthma. In all participants basic anthropometric and percentage evaluation of the fat content (FAT%) by means of a bioimpedance method were performed. A level of 85 centiles of the body mass index (BMI) determined on the basis of centile charts was regarded as a criterion for overweight. Fatty tissue distribution was assessed basing on the waist-to-hip ratio (WHR). RESULTS: In girls with overweight or obesity (BMI > 85%) a statistically significant prevalence of asthma (71.4%; p < 0.01) with different intensity was observed, as compared to girls with a normal BMI (23.7%). Similar tendencies related to the WHR index and the total fat content (FAT%) were also notified. Asthma was found to occur more frequently in the group of girls with overweight or obesity as well as with abnormal (abdominal) distribution of fatty tissue. CONCLUSIONS: Results reveal significant relations between overweight and abnormal distribution of fatty tissue and asthma prevalence in girls. Such relationships did not appear in the group of boys. Obese children with bronchial asthma--mainly girls--more frequently require a careful approach towards the pharmacological control of asthma due to obesity-related complications e.g. hypertension.

[The heart rate variability analysis in youth and children with bronchial asthma]. / Analiza wybranych parametrów zmiennosci rytmu serca u mlodziezy i dzieci chorych na astme oskrzelowa.

UNLABELLED: The aim of the study was analysis of the spectral parameters of heart rate variability (HRV) in children and youth with different intensity of bronchial asthma. MATERIAL AND METHODS: The study was conducted in the group of 107 children and adolescents, aged 10-17 years, comprising 58 healthy subjects and 49 with bronchial asthma (22 with mild and 27 with moderate asthma). Spectral HRV parameters at rest and under active orthostatic test conditions (5 min--supine position, 5 min--standing position) were analysed in two age subgroups: group A--children aged 10-13 years and group B--youth aged 14-17 years. RESULTS: In both subgroups at rest a growing tendency for high frequency components (HF) of HRV spectra was observed together with greater intensity of asthma. In the youth group with moderate asthma, the HF component (40.8 +/- 14.0 n.u.) at rest was significantly higher (p < 0.05) than in the age-matched control (30.8 +/- 10.7 n.u.). In all the groups examined assuming erect position resulted in a significant rise in LF/HF index, which was most pronounced in the groups with mild (p < 0.01) and moderate asthma (p < 0.05). CONCLUSIONS: The study confirmed a significant association between the vagal activity in children and youth and frequency and intensity of bronchial asthma. A short-term HRV analysis can be utilised in the assessment of autonomic mechanism role in the development of bronchial asthma in children and youth.

[The influence of desloratadine on course of intermittens allergic rhinitis]. / Wplyw desloratadyny na przebieg przerywanego alergicznego niezytu nosa.

Influence of desloratadine (DL) therapy on intermittens allergic rhinitis was presented. Investigated group consisted of 60 patients, aged average 29, among them 23 women and 37 men. Score of nasal symptoms as discharge congestion, itching, sneezing and eye symptoms was evaluated. All measurements of nose airways resistance were performed by means of rhinomanometer Rhinotest 1000 (MES). The result was a significant statistic improvement both of separate nasal or eye symptoms, total nasal symptom score and global therapeutic assessments of response to DL therapy. At the beginning the investigation a statistically significant improvement after DL therapy was shown by rhinomanometry among patients with severe or moderate nasal resistance in contrast to low nasal resistance group.

[Allergy of the oral cavity, throat and larynx]. / Alergia jamy ustnej, gardla i krtani.

Current views, mainly clinical, concerning allergic inflammation in the upper respiratory tract are presented.

[Safety and efficacy of inhaled ciclesonide in asthma]. / Bezpieczenstwo i skutecznosc wziewnego cyklezonidu w astmie.

Poor adherence to medications and other aspects of the treatment plan are described in patients with asthma, especially with adverse events concerning the upper respiratory and digestive tracts. Against this background a review is presented of current knowledge about the new class of glucocorticoids (ciclesonide).

[Analysis of depression among persons with middle and moderate asthma]. / Analiza depresji wsród osób z astma lekka i umiarkowana.

The aim of the study was to establish a difference/lack of difference in depression level between 83 patients with moderate or middle asthma and 78 healthy persons. Investigated group consisted of 37 men (aged 35.2 years) and 46 woman (38.5 years), and control group accordingly of 37 men (35.6 years) and 41 women (35.2 years). Results of Beck Depression Inventory appeared in asthmatic group 41% persons without depression symptoms and 18%--with severe depression level (in comparison to healthy persons 78.2% and 3.8%). Difference was statistically significant (p < 0.000).

[Oral allergy syndrome (OAS)--diagnostic values of skin prick test]. / Ustny zespól uczuleniowy (UZU)--wartosc diagnostyczna skórnych testów punktowych.

The authors presented results of allergological investigation concerning 58 patients with OAS and tree pollenosis versus 27 persons with isolated tree pollenosis. Commercial skin prick tests presented lower diagnostic usefulness, in comparison to test with fresh or boiled crude foods.