A seven-year-old girl developed angioedema and a generalized, erythematous rash several hours after receiving lignocaine with adrenaline reproducible on provocative challenge, confirming the first known case of generalized delayed-type hypersensitivity to local anaesthetics with cross-reactivity to bupivacaine but not chloroprocaine.
Background: The worldwide prevalence of allergic diseases has increased during the last few decades, but it is not well known about the sensitization profiles of adult patients in Shanghai. Objective: This study aimed to identify the prevalence and sex difference of allergen sensitization among adult with allergic diseases in Shanghai. Methods: The sensitization profiles of 7,996 patients (18-60 yrs old) with allergic diseases at our center were retrospectively analyzed, based on the results of skin prick tests. The prevalence of various allergen, age and sex difference of allergen sensitization were investigated. Results: The most common allergens were Dermatophagoidesfarinae(73.10%), Dermatophagoidespteronyssinus (72.21%) and Blomia tropicalis (53.10%), followed by Blattella germanica (31.18%), Periplaneta americana (27.75%), dog dander (24.96%), mixed molds (17.56%), and shrimp (17.02%). For the patients aged 18-30 yrs, mites and animal dander were most common allergen, whereas cockroaches and mixed molds for those aged over 40 yrs old. As for sex difference, males were more sensitive to Blomia tropicalis,cockroaches and mixed molds. Females were more sensitive to Dermatophagoides farinae and animal dander. Conclusions: The most common allergen in Shanghai are mites, cockroaches, and dog dander. There are sex and age difference on profiles of allergen sensitization.
Background: Allergic rhinitis (AR) and asthma are the most common inflammatory diseases of the airways. The relationship between asthma and AR is widely and clinically recognised. The concept "one airway, one disease" has been gradually accepted. However, in China, we could not find any systematic review and meta-analysis on the prevalence of AR with asthma and asthma with AR. Objective: The aim of this research was to carry out a meta-analysis on the results of all conducted studies to present valid information about the co-occurrence rate of AR with asthma and asthma with AR in China. Methods: Pubmed/Medline, Science, Springer, Elsevier, Embase, Wanfang data, VIP, CBM, and CNKI were searched systemically and data were extracted from eligible studies by two independent reviewers. Meta-analysis, study quality assessment, and publication bias assessments were all done using Stata 12.1 software. Results: The results of this meta-analysis showed that pooled prevalence estimates of AR with asthma ranged from 6.69% to 14.35%, asthma with AR from 26.67% to 54%. Furthermore, an overall prevalence of 10.17% (95% CI 9.08-11.27%) was ascertained for AR with asthma, and 38.97% (95% CI 34.42-43.53%) for asthma with AR. Conclusions: The present meta-analysis comprehensively provided the first quantitative summary of the prevalence of AR with asthma and asthma with AR in China. Our study demonstrated that, in China, asthma and AR are often comorbid diseases and co-exist in the same patients. There is a close correlation between AR and asthma from an epidemiological standpoint.
Introduction:There is a high and rising prevalence of many allergic diseases in the Asia Pacific, including Hong Kong (HK), which is unmatched by a commensurate provision of clinical allergy services. Method:This review highlights progress and deficiencies in allergy service and training in HK. The allergy work force was estimated from the numbers of doctors practicing allergy registered with the HK Medical Council Specialist Register in Immunology and Allergy; Paediatric Immunology and Infectious Diseases (includes allergy); Paediatrics; and Immunology (as a discipline of Pathology). The numbers of trainees were estimated from the trainee lists of the Hong Kong Colleges of Physicians, Paediatrics and Pathology. The numbers of allergy clinics were estimated from existing services in Hospital Authority public hospitals in HK. Results:In the last 3 years, two new drug allergy clinics have been established in public hospitals, and for the first time in 20 years, Hong Kong has a trainee in adult allergy. The current ratio of allergists per head of population has improved slightly from 1:1.46 million in 2014 to 1:1.17 million, but it is still low compared to many countries. There are 5-fold more paediatric allergists than adult allergists per head of population in HK. Discussion:Hong Kong is not equipped to take advantage of major public health advances in allergy prevention. If the unbalance of adult to paediatric allergists remains uncorrected, continuing care for allergic children as they grow into adulthood will be an increasing problem. Conclusion:Hong Kong still has an unmet need for allergy specialists and is ill equipped to exploit recently discovered public health opportunities to prevent allergy. This review provides recommendations to improve allergy service provision and training, including the creation of Centres of Excellence in allergy to drive the growth of the specialty.
Objective: To investigate whether there were differences in Th17 cells mediated immunological responses among asthmatics with or without allergic rhinitis. Methods: A case-control comparison was conducted in a cohort of 67 children with asthma (AS), 50 children with allergic rhinitis (AR), 52 children with both AS and AR (ASR), 25 infectious rhinitis (IR), and 55 healthy controls (H). The percentages of circulating Th17 cells were determined by flow cytometry. The Th2- and Th17-related cytokines in plasma and culture supernatants were measured by enzyme-linked immunosorbent assay. The effect of proinflammation cytokine IL-17E on Th2 cytokines production from human T helper (Th) lymphocytes was analyzed. Results: (1) A inter-group comparison revealed that Th17 cells levels were highest in ASR group [(0.89% +/- 0.27) %], followingby AS group [(0.82 +/- 0.29) %] and AR group[(0.78 +/- 0.17) %] (P < 0.05). (2) After in-vitro stimulation with house dust mite (HDM) antigen, the levels of IL-4 and IL-17E in culture supernatants of PBMCs from allergic children (AS group, AR group and ASR group) were significantly enhanced. (3) The release of Th2 cytokines from IL-17E treated Th cells of allergic children (AS group, AR group and ASR group) were significantly induced, no similar result was observed in IR group and HC group. Conclusion: Our findings preliminarily revealed that Th17 cell and its related cytokines might be involved in pathogenesis of airway inflammation diseases, and also presenting varying immunological characteristics among asthmatic children with or without allergic rhinitis.
Background: The prevalence of allergen sensitization varies in different geographic areas and population subsets. This study investigated the prevalence and distribution of inhaled and food allergens among allergic patients in Henan Province, China. Method: The prevalence and distribution of 19 inhaled and food allergens among 15,534 patients with suspected allergic diseases were retrospectively analyzed in Henan Province, China between December 2012 and August 2016. Reactivity of their serum-specific immunoglobulin E (sIgE) to allergens was tested using the AllergyScreen test, sIgE >= 0.35 IU/mL was considered positive. Results: Of the 15,534 patients tested, the sIgE of 6520 (41.97%) was tested positive for at least one of the 19 tested allergens. Dermatophagoides pteronyssinus (3540, 22.79%), cockroach (1398, 9.00%), and mold mix (1301, 8.38%) were the most frequently tested positive inhaled allergens, while cashew nut (1320, 8.50%), mango (768, 4.94%) and cow's milk (748, 4.82%) were the most frequently tested positive food allergens. The overall sIgE positive rate was higher in males than that in females (p < 0.05). Moreover, the sIgE positive rates to the most of the inhaled and food allergens were statistically different between age groups (p < 0.05). The sIgE positive rates of the main inhaled allergens increased with age. However, the sIgE positive rates for the primary food allergens were higher in the younger groups and lower in the older groups. Conclusions: The characteristics of allergen sensitization revealed in this study in Henan Province would facilitate the prevention, diagnosis, and management of allergic diseases in this region.
Background: A proportion of cases of Rosai-Dorfman disease exhibit some histological features consistent with IgG4-related disease (IgG4RD). Several investigators have discussed whether Rosai-Dorfman disease belongs to the spectrum of IgG4RD or is concurrent with it by coincidence. Objective: To elucidate the relationship between the two diseases, we report key features, including IgG4 and antyloid levels, of four cases of Rosai-Dorfman disease in the breast. Methods: The histological features of the four cases were analyzed and the numbers of IgG4+ plasma cells and IgG4/IgG ratios were evaluated. Serum IgG4 concentrations were also measured in two recent. cases. A literature review was also performed. Results: Two cases (case 1 and 2) showed features of IgG4RD, including lymphoid follicle formation with regressive changes, obliterative phlebitis, increased number of IgG4+ plasma cells, and increased IgG4/IgG ratio; one of the two had an elevated serum IgG4 level. Amyloidosis was detected in these cases, with amyloid in the stroma and the vessel walls of the lesion. The other two cases (case 3 and 4) only had mild increases in the numbers of IgG4+ plasma cells, while amyloid was deposited in the stroma only. Conclusions: A subset of Rosai-Dorfman disease may overlap with IgG4RD in the breast. When Rosai-Dorfman disease has features of IgG4RD, amyloidosis could be induced in the lesion.
Background: Maternal allergic diseases have an important influence on the origin of allergic rhinitis (AR) in offspring, but the mechanism and the duration of the maternal effect are unknown. Previous researches prompted the important roles of Tregs and Foxp3 DNA methylation in the development of allergic diseases.& para;& para;Objective: To investigate the immune state and Tregs in the offspring of Der p 1-exposed female mice.& para;& para;Method: BALB/c female mice were exposed to Der pl to construct the mouse AR model, then mated with normal male mice. Offspring were kept in an allergen-free environment after birth. At postnatal weeks 3, 5 and 8, mice were culled for testing.& para;& para;Result: Compared with the offspring of PBS-exposed female mice (N-N), the offspring of Der p 1-exposed female mice (A-N) showed increased IL-4 and decreased IL-10 levels in serum at postnatal weeks 3 and 5. Correspondingly, the percentage of Tregs in spleen CD4(+) cells declined significantly at postnatal week 5 in A-N. Further analysis of the methylation status of spleen lymphocytes revealed hypermethylation of the Foxp3 promoter in A-N mice at postnatal weeks 3 and 5. However, by 8 weeks of age, all abnormalities in cytokines, Treg counts and Foxp3 DNA methylation in A-N mice had returned to normal levels.& para;& para;Conclusion: Under the influence of maternal AR, offspring have an abnormal immune state at birth. However, without exposure to allergens, the immune state in AR offspring recovered by maturity. Changes in Tregs and Foxp3 DNA methylation may be the mechanism for this reversible immune abnormality in AR offspring.
Background: The cysteinyl leukotrienes (cysLTs) are prointlammatory lipid mediators that act on the type 1 cysLT receptor (CysLT1R) in the pathogenesis of chronic rhinosinusitis with nasal polyps (CRSwNP). GPR17, a G protein-coupled orphan receptor with homology to the cysLT receptors, has been proposed as a damage sensor during inflammation. However, the expression and correlation of GPR17 and CysLT1R in eosinophilic CRSwNP (ECRS) and non-eosinophilic CRSwNP (non-ECRS) have not been well investigated. Objective: To evaluate the expression of GPR17 and its correlation with CysLT1R in the 2 CRSwNP subsets. Methods: Polyp tissues were collected from CRSwNP subjects (15 ECRS and 14 non-ECRS), and uncinate processes were collected from 12 CRSsNP subjects and 13 control subjects. The mRNA and protein levels of GPR17 and CysLT1R were examined using gRT-PCR, immunohistochemistry, and western blotting. Additionally, the correlation between GPR17 and CysLT1R at the mRNA and protein levels was evaluated. All assays were performed in a blinded manner. Results: Polyp tissues exhibited significantly increased GPR17 expression relative to uncinate process tissues from CRSsNP patients, or healthy controls (P=0.0012 and P<0.0001, respectively). Compared with the non-ECRS subset, the ECRS subset showed significantly increased GPR17 expression. Moreover, the GPR17 expression was positively correlated with CysLT1R in nasal polyps. Conclusions: The increased expression of GPR17 in nasal polyps and the differential expression between eosinophilic and non-eosinophilic CRSwNP subsets suggest that these subsets may have distinct pathogenic mechanisms. The positive correlation between GPR17 and CysLT1R in polyp tissues might imply substantial regulatory mechanisms that must be elucidated.
Background: With the rising prevalence of allergic rhinitis, the utility of indoor environmental management deserves increasing scrutiny. This research aims at evaluating the ability of air purifiers to be a therapy of allergic rhinitis. Methods: 32 subjects (25 +/- 13.5 years old) diagnosed with allergic rhinitis were selected and HEPA air purifiers placed in their bedrooms for 4 months. Before the intervention and each month, dust samples were collected with a vacuum cleaner and the dust collector assessed for allergen content. Additionally, static dust collectors were left in place all month to collect dust by sedimentation. Particulate matter (PM) was assessed in terms of PMindoor/outdoor ratios. The Rhinitis Quality of Life Questionnaire (RQLQ) was used to assess symptoms. Results: Der p 1(78 (30, 82) ng/g) was the dominant dust mite allergen in air samples of patients' bedroom as well as static collections. Der f1 (444 (345, 667) ng/g) was the dominant allergen in bedding. Der f1 levels in both air and bed sampling significantly decreased after initiation of HEPA air purifiers (P < 0.05). PM1.0(indoor/)(outdoor) PM2.5(indoor/)(outdoor) PM10(indoor/)(outdoor) all decreased (P < 0.001) with the HEPA filtration intervention. According to RQLQ data, HEPA filtration was associated with improvements in activity limitation, non-nasal-eye symptoms, practical problems, and nasal symptoms (P < 0.001). Conclusion: HEPA air purifiers can effectively reduce PM and HDM allergen concentration in the indoor air, and thereby improve clinical manifestations of patients with AR.