Allergologia et Immunopathologia

Estrogen and estrogen receptor signaling promotes allergic immune responses: Effects on immune cells, cytokines, and inflammatory factors involved in allergy Publication date: Available online 24 June 2019 Source: Allergologia et Immunopathologia Author(s): Z. Fan, H. Che, S. Yang, C. Chen Abstract Hypersensitivity occurs when the body is stimulated by an antigen, resulting in an immune response, and leads to a physiological disorder or abnormal tissue trauma. Various immune cells, cytokines, and inflammatory mediators are involved in the immune responses related to allergic diseases, which are the core of anaphylaxis. Estrogen receptors are widely distributed in immune cells, which combine with estrogen and participate in allergic responses by affecting immune cells, cytokines, and inflammatory factors. We aimed to summarize the association between estrogen and allergic reactions to provide a scientific basis for understanding and studying the mechanisms of allergic diseases.

Direct medical costs of RSV-related bronchiolitis hospitalizations in a middle-income tropical country Publication date: Available online 22 June 2019 Source: Allergologia et Immunopathologia Author(s): C.E. Rodriguez-Martinez, M.P. Sossa-Briceño, J.A. Castro-Rodriguez Abstract Introduction and objectives With the objective of making informed decisions on resource allocation, there is a critical need for studies that provide accurate information on hospital costs for treating respiratory syncytial virus (RSV)-related bronchiolitis, mainly in middle-income countries (MICs). The aim of the present study was to evaluate the direct medical costs associated with bronchiolitis hospitalizations caused by infection with RSV in Bogota, Colombia. Material and methods We reviewed the available electronic medical records (EMRs) for all infants younger than two years of age who were admitted to the Fundacion Hospital de La Misericordia with a discharge principal diagnosis of RSV-related bronchiolitis over a 24-month period from January 2016 to December 2017. Direct medical costs of RSV-related bronchiolitis were retrospectively collected by dividing the infants into three groups: those requiring admission to the pediatric ward (PW) only, those requiring admission to the pediatric intermediate care unit (PIMC), and those requiring to the pediatric intensive care unit (PICU). Results A total of 89 patients with a median (IQR) age of 7.1 (3.1–12.2) months were analyzed of whom 20 (56.2%) were males. Overall, the median (IQR) cost of infants treated in the PW, in the PIMC, and in the PICU was US$518.0 (217.0–768.9) vs. 1305.2 (1051.4–1492.2) vs. 2749.7 (1372.7–4159.9), respectively, with this difference being statistically significant (p < 0.001). Conclusions The present study helps to further our understanding of the economic burden of RSV-related bronchiolitis hospitalizations among infants of under two years of age in a middle-income tropical country.

Socio-environmental profile of child and adolescents sensitized by house dust mite in northeast of Brazil Publication date: Available online 21 June 2019 Source: Allergologia et Immunopathologia Author(s): I.M.S. Araújo, M.G.P. Bena, P.O.L. de Brito, J.L. do Carmo Lima, M. da Silva Aguiar, L.G.L. Neto, S.G. Monteiro, P.V.S. Pereira, A. Falcai Abstract Introduction The association regarding the atopic sensitization to mite aeroallergens and the socio-environmental features is still inconsistent. Objectives We analyzed the role played by socioeconomic and environmental factors in the prevalence of sensitization to house dust mite (HDM) allergens, and associated with the risk of developing asthma symptoms. Patients and methods This is a case–control study conducted with 108 patients, aged 1–17. We inquired about family habits, socioeconomic and environmental features. We applied the International Study of Asthma and Allergies in Childhood questionnaire. Results We observed patients sensitized to all HDM tested, Derp (42%), Derf (37%) and Blot (33%). Middle family income (OR: 2.74; CI95%: 1.127–6.684), exposure to dog (OR: 3.758, CI95%: 1.127–6.684) and artificial climatization (OR: 4.319, CI95%: 1.398–13.348) were associated with sensitization to Derp. We also observed protective factors, such as sharing of dormitories, washing cycle for bedspreads and the presence of basic sanitation. An increased risk of sensitization to Derf was associated with Blot sensitization (OR: 3.172, CI95%: 1.083–9.292) and presence of mold on the walls (OR: 3.095, CI95%: 1.063–9.008). A protective factor was dormitory sharing. For sensitization to Blot, we observed an increase in the risk associated with Derp sensitization (OR: 3.462, CI95%: 1.191–10.061) and exposure to dog (OR: 3.255, CI95%: 0.987–10.736). In addition, sensitization to Blot increases the risk of developing asthma symptoms (OR: 2.732, CI95%: 0.981–7.606). Conclusion Our data show distinct sociodemographic and environmental relations that lead to HDM sensitization and increased probability of development of allergic diseases.

Budesonide up-regulates vitamin D receptor expression in human bronchial fibroblasts and enhances the inhibitory effect of calcitriol on airway remodeling Publication date: Available online 14 June 2019 Source: Allergologia et Immunopathologia Author(s): Yaqin Xu, Jun Qian, Zhiwei Yu Abstract Introduction and objectives Transforming growth factor β1 (TGFβ1) and dysregulated microRNA-21 (miR-21) expression is associated with TGFβ/Smad signaling pathway activation and fibrosis. While calcitriol has been shown to improve airway remodeling in asthmatic mice, its mechanism remains unknown. In this study, the effect of calcitriol on the TGFβ/Smad signaling pathway and miR-21 expression in human bronchial fibroblasts was investigated to explore the mechanism of action of calcitriol and the inhaled glucocorticoid, budesonide, in airway remodeling. Materials and methods Human bronchial fibroblasts were pretreated with budesonide, calcitriol, or budesonide plus calcitriol, and stimulated with TGFβ1 for 48 h. Quantitative real-time PCR was used to determine the expression of miR-21. Western blot was used to determine airway remodeling-related proteins, TGFβ/Smad signaling pathway-related proteins, glucocorticoid receptor, and vitamin D receptor (VDR) expression. Results Both budesonide and calcitriol down-regulated miR-21 expression in human bronchial fibroblasts, up-regulated Smad7 expression, and inhibited the expression of airway remodeling-related proteins. Both budesonide and calcitriol up-regulated the low expression of VDR induced by TGFβ1 in human bronchial fibroblasts. The expression of VDR in the combined treatment group (budesonide plus calcitriol) was significantly higher than that in the calcitriol treatment group. The expression of collagen type I in the combined treatment group was significantly lower than that in the calcitriol treatment group. Conclusions Calcitriol can up-regulate the expression of VDR in human bronchial fibroblasts and exert an anti-airway remodeling effect. Budesonide can up-regulate the expression of VDR in human bronchial fibroblasts and enhance the inhibitory effect of calcitriol on airway remodeling.

The signal transducer and activator of transcription 6 (STAT-6) mediates Th2 inflammation and tissue damage in a murine model of peanut-induced food allergy Publication date: Available online 10 June 2019 Source: Allergologia et Immunopathologia Author(s): C.R. Cardoso, P.R. Provinciatto, D.F. Godoi, M.T. Fonseca, B.R. Ferreira, G. Teixeira, F.Q. Cunha, C.F. Pinzan, J.S. da Silva Abstract Introduction Food allergies are inflammatory conditions mediated by Th2 and probably STAT-6 dependent immune responses. Objective and design Here we investigated the role of Signal Transducer and Activator of Transcription 6 (STAT-6) in development of inflammation in peanut allergy. Methods To induce food allergy, wild-type (WT) and mice deficient for STAT-6 (Stat6−/−) were sensitized with peanut proteins and challenged with peanut seeds. Results WT animals lost weight and refused the peanut diet, in contrast to Stat6−/− mice, which had a better maintenance of body weight and more regular seeds’ consumption. The augmented peanut-specific IgG, IgG1 and IgE in the allergic WT was abolished in Stat6−/− animals that also presented increased IgG2a. There was an overall reduction in the gut mediators in the absence of STAT-6, including those related to inflammatory and Th2 responses, in contrast to a rising counter regulatory and Th1 reaction in Stat-6−/− mice. These animals had IFN-γ and IL-10 similar to WT after the four-week challenge. Most interestingly, Stat-6−/− mice had no intestinal damage, in contrast to WT animals, which had inflammatory infiltrate, tissue destruction, epithelial exulceration, edema, congestion and loss of villous architecture in the small gut segments. Conclusions STAT-6 plays an important role in the establishment of the Th2 inflammatory responses and intestinal damage in peanut allergy.

Increased number of regulatory T cells in esophageal tissue of patients with eosinophilic esophagitis in comparison to gastro esophageal reflux disease and control groups Publication date: Available online 6 June 2019 Source: Allergologia et Immunopathologia Author(s): F. Mousavinasab, D. Babaie, Y. Nilipour, M. Mansouri, F. Imanzadeh, N. Dara, P. Rohani, K. Khatami, A. Sayyari, M. Khoddami, M. Kazemiaghdam, M. Mesdaghi Abstract Background Eosinophilic esophagitis (EoE) is a primarily polygenic allergic disorder. Although most patients have IgE sensitization, it seems that non-IgE mediated responses mainly contribute to the pathogenesis of EoE. Regulatory T cells (Tregs) may have an important role in allergies. There are limited data on the association of Tregs and EoE. In this study, we enumerated and compared T lymphocytes and Tregs in esophageal tissue of patients with EoE, gastroesophageal reflux disease (GERD) and normal controls. Methods Ten patients with EoE, ten patients with GERD and eight normal controls were included. Immunohistochemistry staining was used to enumerate T lymphocytes and Tregs. CD3+ cells were considered as T cells and FOXP3+, CD3+ cells were considered as Tregs. T cells and Tregs were counted in 10 high power fields (HPF) (×400) for each patient and the average of 10 HPFs was recorded. Results The mean ± SEM of Tregs in esophageal tissue of patients with EoE (10.90 ± 2.14 cells/HPF) was significantly higher than the GERD (2.77 ± 0.66 cells/HPF) and control groups (0.37 ± 0.08 cells/HPF) (P < 0.001). Additionally, the mean ± SEM of T lymphocytes in esophageal tissue of patients with EoE (24.39 ± 3.86 cells/HPF) were increased in comparison to the GERD (10.07 ± 2.65 cells/HPF) and control groups (3.17 ± 0.93 cells/HPF) (P < 0.001). Conclusion There is an increase in the number of esophageal T lymphocytes and regulatory T cells in patients with EoE compared to the GERD and control groups.

B subset cells in patients with chronic granulomatous disease in a Mexican population Publication date: Available online 5 June 2019 Source: Allergologia et Immunopathologia Author(s): C.F. Beltrán-Pozo, M.A. Suárez-Gutiérrez, M.A. Yamazaki-Nakashimada, I. Medina-Vera, F. Saracho-Weber, A.P. Macías-Robles, M.N. Guzmán-Martínez, E.M. Navarrete-Rodríguez, B.E. del Río-Navarro, S.E. Espinosa-Padilla, L. Blancas-Galicia Abstract Introduction Chronic granulomatous disease (CGD) is a disorder of phagocyte function, characterized by pyogenic infections and granuloma formation caused by defects in NADPH oxidase complex activity. Although the effect of CGD mainly reflects the phagocytic compartment, B cell responses are also impaired in patients with CGD. Materials and methods Flow cytometric analysis was performed on peripheral blood samples from 35 CGD patients age-matched with healthy controls (HC). The target cells of our study were the naive (IgD+/CD27−), memory (IgD−/CD27+), and B1a (CD5+) cells. Immunoglobulins (Igs) were also measured. This study was performed in a Latin American cohort. Results We found significantly higher levels of naive B cells and B1a cells, but lower levels of memory B cells were found in CGD patients compared to HC. There was no significant difference of cell percentages per inheritance type. Discussion Our findings suggest that the deficiency of NADPH oxidase components can affect the differentiation of naive B cells to memory B cells. Consequently, memory cells will be low, which also influenced the expression of CD27 in memory B cells and as a result, the percentage of naive cells increases. An altered phenotype of B lymphocytes in CGD patients may contribute to the opportunistic infections and autoimmune disorders that are seen in this disease.

Turkish teachers’ self-efficacy to manage food allergy and anaphylaxis: A psychometric testing study Publication date: Available online 4 June 2019 Source: Allergologia et Immunopathologia Author(s): M. Ozturk Haney, S. Ozbıcakcı, G. Karadağ Abstract Introduction and objectives Food allergy in school children ranges between 5.7 and 6.4% in Turkey. Studies emphasize the importance of improving school personnel's self-efficacy in managing food allergy and anaphylaxis. However, a brief and valid measurement tool for school personnel is not available in Turkey. The aim of this study was to determine the validity and reliability of the Turkish version of the School Personnel's Self-efficacy in Managing Food Allergy and Anaphylaxis (SPSMFAA-T) scale with teachers. Patients or materials and methods This methodological study was conducted by 282 primary school teachers. Data were collected with a demographic characteristics form and SPSMFAA-T. The psychometric properties of the SPSMFAA-T were evaluated by content, discriminant, construct validity and internal consistency. Results Cronbach's alpha for the scale was 0.91 and item-total correlations were between 0.50 and 0.82 (p < 0.001). The discriminant validity suggested that the scale successfully discriminated the teachers who had training on food allergy and anaphylaxis from the teachers who did not. The model fit indices of scale were determined to be the root mean square error of approximation (RMSEA) at 0.08, goodness of fit index (GFI) at 0.96, comparative fit index (CFI) at 0.99. Conclusions The results supported that the SPSMFAA-T was a valid and reliable measurement tool to assess Turkish teachers’ self-efficacy levels to manage food allergy and anaphylaxis in school setting. The scale can be used in education programs to improve school personnel's skills to manage food allergy and anaphylaxis.

Nutritional status and food intake of children with cow's milk allergy Publication date: Available online 2 June 2019 Source: Allergologia et Immunopathologia Author(s): R.M. Boaventura, R.B. Mendonça, F.A. Fonseca, M. Mallozi, F.S. Souza, R.O.S. Sarni Abstract Introduction and objectives Cow's milk allergy (CMA) is common, especially in children. The treatment is based on the exclusion of milk and dairy products and guidance regarding the exclusion diet. This study aimed to compare the anthropometric measurements and food intake of children with CMA with those of healthy controls, and to evaluate the serum concentrations of Vitamin A and 25(OH)D in children with CMA. Methods This is a cross-sectional study with 27 children in the CMA group and 30 in the control group. z-Scores of body mass index and height, skinfolds, food intake and serum concentrations of retinol, beta-carotene, lycopene, 25(OH)D, parathyroid hormone and high sensitivity C-reactive protein were evaluated. Results Mean age was four years (±1.9). The CMA group evidenced a lower height compared to those from the control group (p = 0.0043). The CMA group showed a lower intake of calcium (p = 0.0033) and lipids (p = 0.0123). Low serum concentrations of retinol, beta-carotene, lycopene, 25(OH)D were found in 25.9%, 59.3%, 48.1% and 70.3% of the CMA group, respectively. Conclusions Children with CMA consume smaller amounts of calcium and lipids and have shorter height compared to healthy controls. Insufficient levels of vitamins A and D were frequent in the CMA group, emphasizing the need for nutritional guidance and monitoring.

Why despite the lower prevalence, is asthma more severe in the semiarid region? Publication date: Available online 2 June 2019 Source: Allergologia et Immunopathologia Author(s): M.A.V. Correia Junior, E.C. Costa, S.W. Sarinho, J.Â. Rizzo, D. Solé, E.S.C. Sarinho Abstract Introduction and objectives Asthma is a chronic inflammatory disease which is very prevalent throughout the world, and climatic factors, especially air humidity, have been considered fundamental to its development. This study aims to evaluate the relationship between the climate factor and the severity of asthma episodes in the semiarid region, comparing it to the coast and an intermediate climate region, considering the use of medication as an intervening factor. Materials and methods Ecological study in cities with different climatic conditions (semiarid, intermediate region and Coast). Prevailing data was obtained from the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. We evaluated the temperature, humidity and use of drugs for asthma/100,000 inhabitants. Results The prevalence of asthma was lower in the semiarid (14%; 95%CI = 12.1–15.7) than the intermediate region (19.1%; 95%CI = 17.7–20.6) and coast (17.9%; 95%CI = 16.6–19.2). Episodes of severe asthma attacks were surprisingly higher in semiarid (10.4%; 95%CI = 8.9–11.9) when compared to coast (4.1%; 95%CI = 3.4–4.9) and intermediate region (5.0%; 95%CI = 4.3–5.8). In the semiarid region, the humidity was lower and the temperature higher than the other cities evaluated. The dispensing of medications was lower in the semiarid region. Conclusions Temperature and humidity may have contributed to a lower prevalence and greater severity of asthma in the semiarid region. The dispensing of medications was lower in the semiarid region, indicating that access to both relief and control drugs was lower in this city. The possibility of lack of health care in the semiarid region can also be another explanatory factor associated.