Asian Pacific journal of allergy and immunology最新文献

Background: Renal tubulointerstitial fibrosis is known to occur as a result of epithelial cell transformation into myofibroblasts via the epithelial-to-mesenchymal transition (EMT) process. It has been reported that macrophages, regulatory T (Treg) cells, and gamma delta T (γδ T) cells can promote fibrosis via EMT in vivo.

Objective: Our study intended to detect whether thymocytes can induce renal tubular cells to undergo the EMT.

Methods: Rat thymocytes were activated by phytohemagglutinin and concanavalin A. The rat renal tubular epithelial cells (NRK-52E) were incubated in a conditioned medium harvested from activated thymocytes or co-cultured with freshly isolated thymocytes for 48 hours. Real-time reverse transcription-polymerase chain reaction, immunofluorescence, and western blotting analysis were used to test the expression of the epithelial and mesenchymal markers in NRK-52E cells. Scratch assay was designed to test the cell migration abilities of NRK-52E cells. Student's t test and oneway analysis of variance test were used for statistical analysis.

Results: The combined stimulation with phytohemagglutinin and concanavalin A activated the primary isolated rat thymocytes. After treatment with conditioned medium or freshly isolated thymocytes, the expression levels of cytokeratin 19 and E-cadherin were downregulated in NRK-52E cells, while the mRNA and protein expression levels of alpha-smooth muscle actin, desmin, and vimentin were upregulated (P < 0.05). We found that the cell migration abilities of the induced NRK-52E cells were significantly improved.

Conclusions: Both activated rat thymocytes (more percentage of CD8+ T cells) and freshly isolated thymocytes have promoting effects on the EMT of NRK-52E cells.

Background: It is often difficult to differentiate between asthma and chronic obstructive pulmonary disease (COPD), and useful biomarkers are needed for accurate diagnosis.

Objective: We evaluated anti-elastin antibody to identify useful biomarkers for differentiating between a diagnosis of asthma and COPD.

Methods: Patients with asthma (male to female ratio = 10/13; mean age, 67.3 years), COPD (16/0; 74.8 years) and controls (8/4; 72.3 years) were enrolled. Samples from sputum and serum were collected and levels of anti-elastin Ab were measured.

Results: The levels of anti-elastin Ab in sputum were significantly higher in asthma (11.4 ± 7.16 μg/mL) than in COPD (5.82 ± 5.16 μg/mL; P < 0.01), and serum levels in asthma (67.4 ± 29.7 μg/mL) were also significantly higher than in COPD or controls (45.0 ± 12.8 μg/mL; P < 0.05, 38.6 ± 10.4 μg/mL; P < 0.01, respectively). Anti-elastin Ab in sputum showed a positive correlation with smoking in asthma (r2 = 0.218, P < 0.05). However, no significant differences were observed in the levels of anti-elastin Ab and eosinophils, asthma phenotypes, inhaled corticosteroids, or severity in patients with asthma. Elastin was strongly expressed under the airway basement membrane in asthma compared with COPD or the healthy control.

Conclusions: Anti-elastin Ab in sputum could be a useful biomarker for COPD and asthma in ever-smokers. In asthma, anti-elastin Ab was recruited to the airways by both airway allergic inflammation and smoking, and it may contribute to the progression of airway remodeling via autoimmune inflammation, but not emphysema, in COPD.

Background: Laboratory animal allergy (LAA) has not been sufficiently investigated, although LAA is a relatively common work-related condition and important occupational hazard.

Objective: This study aimed to evaluate the prevalence of LAA and analyze the diagnostic value of serum specific IgE (sIgE) using the skin prick test (SPT) as a comparative standard.

Methods: Korean laboratory animal researchers who attended an annual symposium were requested to answer questionnaires regarding demographic characteristics, laboratory animal exposure, and symptoms related to laboratory animal exposure. A total of 213 participants underwent a SPT with mouse and rat epithelial allergen extract. We measured sIgE against rodent urine, epithelium, and serum allergens from 63 participants. SPT outcome served as the comparison method.

Results: Among 223 participants, 213 had direct/indirect exposure to mice or rats, and 30% and 14% of them complained of allergic symptoms after exposure to mouse and rat, respectively. Sensitization rates were 28% for mouse epithelium and 23% for rat epithelium. Compared to a positive SPT with wheal ≥ 3 mm, presence of sIgE against rodent allergens showed a higher positive predictive value of 87-91% at a cut-off level of 0.35 KUA/L. Agreement between SPT and sIgE test was determined to be fair to moderate.

Conclusions: Sensitization and allergy to mouse and rat were prevalent among laboratory personnel in Korea. When evaluating cases of potential LAA, the sIgE test can provide added diagnostic value if the skin test is positive. Careful interpretation of two tests is required to accurately diagnose LAA.

Background: Pollen of grasses in Chloridoideae and Panicoideae subfamilies is a major source of grass group-1 allergens in tropical/subtropical areas. Previously, most studies of subtropical grass pollen allergens have focused on Cynodon dactylon (Bermuda grass-Chloridoideae) and Sorghum halepense (Johnson grass-Panicoideae). However, little information is available about allergenicity of pollen from Zoysia matrella (Manila grass or Zoysia grass-Chloridoideae), which is among the most popular turfgrasses in tropical/subtropical areas.

Objective: This study aimed to investigate the IgE reactivity and cross-reactivity of grass group-1 allergen from Z. matrella. In addition, the clinical relevance of Z. matrella in comparison with other species was assessed.

Methods: IgE reactivity and cross-reactivity between recombinant proteins of group-1 allergen from Z. matrella (Zoy m 1) and C. dactylon (Cyn d 1) were determined by ELISA and immunoblot assays. Clinical relevance of Z. matrella pollen in Thai atopic patients was assessed using its pollen crude extract for skin-prick test, in comparison with extracts from four other pollen species.

Results: The Zoy m 1 had high IgE binding and could interfere with binding to C. dactylon crude extract. In addition, Z. matrella pollen extract elicited positive skin-prick test results comparable to previously reported allergenic species. Group-1 grass pollen allergen was confirmed to be a major allergen from Z. matrella among Thai atopic patients and was officially designated Zoy m 1.0101.

Conclusions: Zoy m 1 allergen is a major allergen from Z. matrella that cross-reacts with other group-1 grass pollen allergens in the tropical/subtropical region.

Background: Systemic sclerosis (SSc), characterized by fibrosis of the skin and other organs, is a devastating systemic autoimmune disease. Lung involvement is frequent in SSc and contributes to the high rate of mortality.

Objective: To describe the first case report of SSc and interstitial lung disease (ILD) receiving autologous hematopoietic stem cell transplantation (ASCT) in Taiwan.

Methods: Case report.

Results: A 51-year-old man presented with rapid skin thickening and shortness of breath. Early progressive SSc-associated ILD was diagnosed. Because his lung function rapidly declined and his skin disease progressed, he received ASCT with satisfactory treatment responses in both skin thickness and lung function. In addition, lung imaging analysis showed remarkable improvements in ILD after treatment.

Conclusions: We suggest that ASCT can be considered in selected patients with early, rapidly progressive SSc associated with ILD.

Background: Assessment of quality of life is needed to assess therapeutic response. There is currently no instrument available for assessing the quality of life of chronic urticaria patients in Indonesia. CU-Q2oL is a specific questionnaire for chronic urticaria that was first developed in Italian. Validity and reliability tests are important to ensure that the language or term used are appropriate to the local culture and there is no change in the validity and reliability of the questionnaire.

Objective: The aim of this study is to develop an Indonesian version of CU-Q2oL.

Methods: The Italian version CU-Q2oL was translated into Indonesian and underwent cross-cultural adaptation. The translated questionnaire was completed online by 40 chronic urticaria patients of the Dermatovenereology Outpatient Clinic of the Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.

Results: Validity test resulted in correlation coefficient values for all questions of 0.467 to 0.856. Reliability test showed a Cronbach's α coefficient of all questions of 0.923 and the intraclass correlation coefficient (ICC) for all questions was 0.913.

Conclusions: This study demonstrates that the Indonesian CU-Q2oL questionnaire is valid, reliable, and suitable to assess the quality of life of chronic urticaria patients in Indonesia.

Background: Incorrect penicillin 'allergy' labels predispose patients to adverse outcomes but are under-recognised in many Asian countries. Studies on performance and post-delabelling outcomes of penicillin allergy evaluation among Chinese remain scarce.

Objective: To evaluate the diagnostic performance of allergy testing and post-delabelling outcomes among Chinese patients in a prospective penicillin allergy cohort - Prospective Assessment of Penicillin Allergy (PAPA).

Methods: All adult patients (age ≥ 18 years) who underwent penicillin allergy evaluation between January 2020 to December 2021 were recruited and prospectively reviewed by both medical records and individual interviews at least 6 months after delabelling or allergy confirmation.

Results: Out of 372 patients who completed penicillin allergy evaluation, 335 (90%) patients were delabelled. The overall negative predictive value of penicillin skin testing was 95%, but lower for patients with non-immediate type reactions (88%). History of non-immediate symptom onset (OR = 4.501 [95%CI = 2.085-9.716], p < 0.001) and duration since index reaction (OR = 0.942 [95%CI = 0.899-0.987], p = 0.012) were associated with positive skin testing. After at least 6 months, 60 (18%) of de-labelled patients had received penicillins again without any adverse reactions. Fluoroquinolone-use was significantly lower among delabelled patients compared to those with penicillin allergy (38[11%] vs 11[30%], p = 0.004).

Conclusions: After at least 6 months, one in six delabelled patients already received penicillins again safely, with significantly lower fluoroquinolone usage. None experienced adverse reactions. History of non-immediate onset and shorter duration since index reaction were associated with genuine allergy. In patients with severe non-immediate reactions, skin tests should be supplemented with thorough clinical history and adjunct diagnostic evaluations.

Background: Inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) for moderate/severe asthma i.e. regular Fluticasone propionate/Salmeterol (FP/Salm) with as-needed short acting beta-2 agonist (SABA) or ICS/Formoterol Maintenance And Reliever Therapy (MART) are the recommended options.

Objective: To compare healthcare cost between regular FP/Salm with as-needed SABA vs MART in Thailand.

Methods: Direct healthcare cost data from 3 published randomized trials in asthma patients aged ≥12 years comparing regular twice-daily FP/Salm with as-needed SABA vs Budesonide/Formoterol (BUD/Form) MART in moderate/severe asthma were considered: AHEAD (NCT00242775/17 countries/2309 patients), COMPASS (AstraZeneca study SD-0390735/16 countries/3335 patients), and COSMOS (AstraZeneca study SD-039-0691/16 countries/2143 patients). Total direct treatment cost comparison/patient/year was calculated as a combination from 1) medication costs plus 2) healthcare utilization costs i.e. cost for health care visit, emergency room visit, and hospitalization. Unit costs referred from National drug information and Health Intervention and Technology Assessment (HITAP), Ministry of Public Health.

Results: Annual medication costs of FP/Salm + SABA were lower than MART in all studies with average cost as 182.01 vs 347.21 USD. Average annual healthcare utilization costs were 17.51 vs 13.01 USD in FP/Salm + SABA and MART, respectively. In overall, total direct treatment costs/patient/year with FP/Salm was 199.53 vs 360.22 USD of MART. Percent saving of total direct treatment costs by FP/Salm + SABA was 45% lower than with MART.

Conclusions: In moderate/severe asthma patients, total direct treatment costs with regular twice-daily FP/Salm with as-needed SABA were lower than with BUD/Form MART primarily due to lower medication costs. Healthcare cost should be considered for asthma care in Thailand.

Background: Allergic bronchopulmonary aspergillosis (ABPA) is an airway disease caused by Aspergillus (mainly Aspergillus fumigatus).

Objective: To evaluate the diagnostic performance of four fungal-related allergen-specific immunoglobulin E (sIgE) detection systems.

Methods: A total of 99 patients with ABPA and 30 control patients admitted to the First Affiliated Hospital of Guangzhou Medical University from 2017 to 2019 were included in the study. Four allergen detection systems were used to detect Aspergillus-related sIgE.

Results: The 99 patients were divided into two groups based on the total IgE. Fluorescence immunoassay for fungal mixtures detected positive rates of 100% and 81% in the Confirmed and Probable groups, respectively. For Aspergillus fumigatus, the positive rates were 90.2% and 87.9%, respectively. In the detection of sIgE of fungal mixtures in all ABPA patients, the sensitivity of System 1 was 90.9%, which was higher than for the other three systems (System 2, 38.4%; System 3, 44.4%; System 4, 52.5%), All four systems have excellent specificity ( > 90.0%) and had higher consistency in the Confirmed group than in the Probable group (P < 0.05). Consistency for the Aspergillus mixture and Aspergillus fumigatus detected by fluorescence immunoassay was 90.2% and 86.2% in the Confirmed and Probable groups, respectively.

Conclusions: Despite the many methods used to detect fungal-related sIgE, the ImmunoCAP system has the best clinical diagnostic performance. It is recommended that this method be used to detect fungal (mixtures or Aspergillus fumigatus) sIgE in order to reduce the missed diagnosis rate of ABPA.

Background: Nivolumab, an immune checkpoint inhibitor is used to treat advanced metastatic malignancies. Data showed that nivolumab can cause exacerbated response of T-Helper 2 cells and lead to airway inflammation.

Objective: To present the upper airway findings of a 69-year-old woman after treatment with nivolumab.

Methods: Case report.

Results: A 69-year old woman with no history of chronic rhinosinusitis developed complaints of nasal congestion, rhinorrhea, sneezing, and anosmia. These symptoms started after one year of treatment with nivolumab. Pale polyps were observed on fiberoptic endoscopy examination. A gradual increase in eosinophil blood counts was noted. On histopathology, heavy infiltrates of eosinophils were seen in the tissue.

Conclusions: Nivolumab is used to treat various advanced metastatic malignancies, with a good safety profile. Nevertheless, physicians must be alert to the possibility of evolving type II inflammation in patients, as appropriate therapy can be provided to improve their quality of life.