Assessment of vitamin D status in common variable immunodeficiency or ataxia–telangiectasia patients Publication date: Available online 31 July 2019 Source: Allergologia et Immunopathologia Author(s): J.R.S. Cruz, R. da Silva, I.G.A. Andrade, F.L.A. Fonseca, B.T. Costa-Carvalho, R.O.S. Sarni Abstract Introduction and objectives Vitamin D plays a role in the immune system, however studies regarding this are scarce. This study aimed to evaluate the nutritional status of vitamin D in patients with Common Variable Immunodeficiency (CVID) or Ataxia–Telangiectasia (A–T) and to relate it to body composition, inflammatory and bone metabolism markers. Patients and methods This is a cross-sectional and controlled study involving 24 patients of both sexes (59.3% male), aged 8–56 years, with CVID (n = 15) or A–T (n = 9). The following variables were evaluated: body mass index (BMI), 25-hydroxyvitamin D (25 (OH) D), hepatic profile, parathormone, calcium, phosphorus, alkaline phosphatase, interleukin 6 and high-sensitivity C-reactive protein. Results The median age was 26.0 years. A deficiency of 25 (OH) D was found in four A–T patients (44%) and two CVID patients (13%). Nine patients with CVI (60%) and six with A–T (66.7%) were overweight and underweight, respectively. There was a negative correlation between vitamin D and fat mass in the CVID group, and vitamin D and BMI in the A–T group. Vitamin D was negatively associated with the percentage of total fat among the patients (β – 0.842, 95% CI: −1.5–0.17, p = 0.015), R2 = 0.21, after adjusting for sex and age. Conclusion Vitamin D deficiency occurred in a quarter of the patients although there was no difference between the patient and the control group; without association with bone and inflammation biomarkers. The percentage of fat and BMI were negatively associated with the concentrations of 25 (OH) D.

Serum soluble Fas ligand levels and peripheral blood lymphocyte subsets in patients with drug-induced maculopapular rashes, dress, and viral exanthemas Publication date: Available online 30 July 2019 Source: Allergologia et Immunopathologia Author(s): M. Yazicioglu, P. Gokmirza Ozdemir, B. Turgut, N. Sut Abstract Background Fatty acid synthetase (Fas)/Fas ligand (FasL)-dependent apoptotic pathways have been reported as being involved in the pathogenesis of drug-induced maculopapular rashes. Objective We investigated serum soluble FasL (sFasL) levels and peripheral blood lymphocyte subtypes to discriminate maculopapular drug eruptions (MPDE) from viral exanthema (VE). Patients/methods Children with confirmed MPDE (group I), VE (group II), and drug rashes with eosinophilia and systemic symptoms (DRESS) or drug-induced hypersensitivity syndrome (DIHS) (group III) were included. Serum sFasL levels and peripheral blood lymphocyte subtypes were analyzed in groups I–III on admission, and repeated twice (only once for group IV – controls). Results There were no significant serum soluble FasL level differences among the groups for all the samples. In the initial samples, CD19+ cell numbers in group II were significantly higher than in group IV, and the CD4+/CD8+ ratio was higher than groups I and IV. In the second samples, CD4+ and CD19+ cell numbers were significantly higher in group II than group I. In the final samples, CD4+ cell numbers in group II were significantly higher than group I and group III. CD19+ cells numbers in group III were significantly lower than the other groups for all samples. Conclusion Serum sFasL levels were not found to be useful in discriminating viral exanthemas from other drug rashes. The significant differences between MPDE, VE, and DRESS were high CD4+ and CD19+ cell-count numbers in VE but low B-cell numbers in DRESS. This might be important for discriminating VE from DRESS, and the low B-cell count in early symptoms might be a useful predictor of DRESS development.

Immunological features in pediatric patients with recurrent and severe infection: Identification of Primary Immunodeficiency Diseases in Merida, Venezuela Publication date: Available online 29 July 2019 Source: Allergologia et Immunopathologia Author(s): N.A. Linares, M. Bouchard, N.S. Gutiérrez, M. Colmenares, A. Cantor-Garcia, J.C. Gabaldon-Figueira, A.V. Bellorin, B. Rujano, D.L. Peterson, S. Salmen Abstract Introduction and objectives Primary immunodeficiency diseases (PIDs) are disorders associated mainly with recurrent and severe infection and an increase in susceptibility to autoimmune conditions and cancer. In Venezuela, PIDs are underdiagnosed and there is usually a delay in their diagnosis. Hence there are no data concerning the frequency and type of PIDs that occur. The aim of this study was to identify and quantify the types of PIDs that occur in Merida, a population within Venezuela. Patients or materials and methods Following an informative program designed to alert local health professionals to the warning signs for PIDs, patients with a history of recurrent infections were referred to the Instituto de Inmunologia Clinica, Universidad de Los Andes. Results and conclusions During the three-year period January 2014 to January 2017, thirty-two cases of PIDs were identified in pediatric patients, and 17 different types of PIDs, were identified. Predominantly antibody deficiencies were most frequent (40.6%), followed by immunodeficiencies affecting cellular and humoral immunity (21.8%), congenital defects of phagocyte (18.7%), CID with associated or syndromic features (9.3%), defects in intrinsic and innate immunity (6.4%) and diseases of immune dysregulation (3.2%). These results have important implications not only to the future approach for management of patients in our regions, but add important knowledge concerning PIDs in Latin America and worldwide.

Are the most common food allergens in an Iranian atopic population compatible with worldwide reports? A systemic review and meta-analysis with molecular classification of frequent allergens Publication date: Available online 26 July 2019 Source: Allergologia et Immunopathologia Author(s): R.Shokouhi Shoormasti, N. Sabetkish, A. Kazemnejad, N. Vahabi, M.R. Fazlollahi, Z. Pourpak Abstract Background Undesirable immunological responses to alimentary allergens are one of the hallmarks of atopic diseases. The prevalence of common food allergens is dissimilar among different communities with distinct nutritional habits and genetic characteristics. Aim To assess the prevalence of the most common food allergens in Iran, using different reliable studies. Methods All studies determining sensitization to common food allergens that were indexed in PubMed, Web of Science, Google Scholar, ProQuest, Scopus, Iran Medex, and Magiran were included in this review. To perform a meta-analysis, STATA 14 and metaprop command was applied. A logistic-normal random-effects model with Freeman–Tukey double arcsin transformation was applied to combine the findings of different studies and evaluate their heterogeneity. Random pooled estimate (ES) (pooled prevalence), 95% confidence interval (95% CI) and p-value were determined. Results A total of 23 studies with data from a total of 6126 children and adults met the inclusion criteria for entering this meta-analysis. The respective pooled prevalence of a positive family history of allergy and positive specific IgE to at least one food allergen was 72% (95% CI: 66–77%) and 41% (95% CI: 33–49%), respectively. Our results in the total population revealed that allergic sensitization to egg yolk, cow’s milk (CM), egg white, and wheat were 25% (95% CI: 16%–35%), 24% (95% CI: 19–29%), 23% (95% CI: 18%–28%), and 9% (95% CI: 6%–14%), respectively. Walnut, peanut, and soybean sensitization was detected in 23% (95% CI: 17%–31%), 23% (95% CI: 13%–33%), and 20% (95% CI: 12%–28%) of patients, respectively. Random pooled ES for sensitization to shrimp and fish was 32% (95% CI: 21–45%) and 12% (95% CI: 6–20%), respectively. The result of analysis in different age groups revealed that allergic sensitization to milk, egg white, and egg yolk declines in higher age groups; while shrimp sensitization increases in older patients. In patients with atopic dermatitis, egg white was the most frequent food allergen 29% (95% CI = 18–42%); while wheat was the least frequent 8% (95% CI = 4–14%). Conclusions Considering the prevalence of different food allergens, the results of the current meta-analysis revealed that egg yolk and cow’s milk had the second and third rate after shrimp, respectively. The high prevalence of sensitization to shrimp may be attributed to its high consumption in coastal areas and/or cross-reactivity of shrimp with some aeroallergens such as mites.

Mendelian susceptibility to mycobacterial disease: Clinical and immunological findings of patients suspected for IL12Rβ1 deficiency Publication date: Available online 23 July 2019 Source: Allergologia et Immunopathologia Author(s): L. Moradi, T. Cheraghi, R. Yazdani, G. Azizi, S. Rasouli, F.T. Zavareh, L. Parvaneh, N. Parvaneh, M. Sohani, S. Delavari, H. Abolhassani, Nima Rezaei, A. Aghamohammadi Abstract Background Mendelian susceptibility to mycobacterial disease (MSMD) is characterized by increased susceptibility to weakly virulent mycobacteria (Bacillus Calmette-Guérin [BCG] vaccines and environmental mycobacteria), Mycobacterium tuberculosis, Candida spp. and Salmonella spp. The aim of this study is to evaluate clinical features and immunological findings of MSMD patients with interleukin 12 receptor beta 1 (IL12Rβ1) deficiency. Methods Among 117 screened patients with BCG infection following vaccination, 23 suspected MSMD subjects were recruited to this study by the exclusion of severe combined immunodeficiencies and chronic granulomatous diseases. Flow cytometric assessment for surface expression of IL12Rβ1 was performed. Moreover, the clinical and immunological data from the patients was evaluated. Results A significant decrease (less than 1%) in the surface expression of IL12Rβ1 was reported in six cases which showed a significant increase in the count of lymphocytes (p = 0.009) and CD8+ T cells (p = 0.008) as compared to MSMD subjects with normal expression of surface IL12Rβ1. The frequency of disseminated BCGosis (50% vs. 20%, p = 0.29), recurrent infection (83.3% vs. 40%, p = 0.14) and salmonellosis (33.3% vs. 0.0%, p = 0.07) was higher in IL12Rβ1 deficient subjects than IL12Rβ1 sufficient individuals. Conclusion MSMD patients with childhood onset of mycobacteriosis (mostly after BCG vaccination) and recurrent salmonellosis could be evaluated for IL12Rβ1 expression with flow cytometry for punctual diagnosis.

Molecular study of hypersensitivity to spores in adults and children from Castile & Leon Publication date: July–August 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 4 Author(s): A. Armentia, S. Martín-Armentia, A. Moral, D. Montejo, B. Martin-Armentia, R. Sastre, S. Fernández, A. Corell, D. Fernandez Abstract Introduction and objectives Biological aerosols play a vital role in the interactions between the atmosphere, biosphere, climate and public health and fungal spores are a component with allergic importance. We constructed a database in Castile & Leon (Spain) and carry out molecular-level component-resolved diagnosis to complete the air quality study carried out since 2006 by our aerobiological network (RACYL) to aid clinical diagnosis and treatment. Methods We reviewed a database of 19,774 patients (adults and children) with allergic respiratory disease treated in our unit during the last 12 years. We also made a component-resolved diagnosis of the molecules involved in the pathology in a randomly selected population of 150 patients. Results The dimeric glycoprotein Alt a1 from Alternaria is the most prevalent and most useful allergen in the diagnosis of patients with allergy to fungi in our area (94.4%), followed by enolase Alt a 6 (Alternaria), ribonuclease Asp f 1 of Aspergillus and mannitol dehydrogenase from Cla h 8 (Cladosporium). Conclusions Our results have helped determine which spore molecules are most-closely associated with allergies. Molecular analysis will be useful to determine more accurate and useful immunotherapy in these patients.

Development of a tool for screening adverse food reactions and food allergy in Portuguese children Publication date: July–August 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 4 Author(s): A. Jorge, M. Santos Silva, C. Lozoya-Ibánez, F. Lorente, E. Sarinho, R.M. Afonso, H. Pereira, L. Taborda-Barata Abstract Introduction and objectives A standardised questionnaire may be an excellent tool for epidemiological studies aiming at screening children with suspected food allergies. Thus, the aim of the present study was to develop a screening questionnaire for assessing children with suspected food allergy and to analyse its reproducibility. Materials and methods A questionnaire of adverse food reactions was developed by literary review of similar questionnaires validated in other countries as well as less well defined, non-validated Portuguese questionnaires. Peer review of the questionnaire by a panel of specialists and subsequent exploratory analysis was carried out by applying the questionnaire in children with confirmed food allergy. Test–retest analysis was performed by giving a face-to-face questionnaire to 159 children with suspected adverse food reactions, aged between three and 11 years. Temporal stability using Spearman Rho correlation test and reproducibility was studied using Cohen's Kappa index. Results 115 children confirmed adverse food reactions that occurred with one or more foods. Retest was given about three weeks after the test, to 50 of these children who were randomly selected. The questionnaire showed good temporal stability (Spearman correlation coefficient of 0.834), and good reproducibility (only two of the 27 items had a Kappa index <0.60). Conclusions This questionnaire showed good temporal stability and reproducibility. Its validation for screening children with suspected food allergy will allow a standardised approach to diagnosis and comparison of results obtained in different centres.

‘Real-life’ experience in asthmatic children treated with omalizumab up to six-years follow-up Publication date: July–August 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 4 Author(s): M.M. Folqué, J. Lozano, C. Riggioni, M. Piquer, M. Álvaro, A. Machinena, M.T. Giner, O. Domínguez, R.M. Jiménez-Feijoo, M. Dias da Costa, A.M. Plaza Abstract Introduction and objectives Omalizumab is present in international guidelines for the control of severe asthma, but data on the long-term effects in children are limited. Our objective was to perform a ‘real-life’ long-term trial of omalizumab in children with allergic asthma. Materials and methods An observational single center ‘real-life’ study was performed. Data for treatment, lung function, side effect, asthma exacerbations and hospitalizations were recorded at six months and annually. Results Forty-eight patients <18 years of age were enrolled. Median treatment period was 2.9 (0.5–6). Fluticasone dose for the maintenance treatment decreases significantly at six months (452 mcg/day to 329.89 mcg/day, respectively). This difference was maintained throughout the follow-up. Nobody used oral corticosteroid after six months. The rate of hospital admissions and visits to the emergency department for asthma exacerbations decreased significantly in the third years and fourth years follow-up, respectively. There was an improvement in lung function. Mean values of FEV1 and FEF25–75% before treatment were 79.88 and 62.94, respectively; after six months of treatment a statistically significant change was seen with a mean FEV1 of 92.29 and FEF25–75% of 76.31 (p = 0.0001). Lung function values were above normal throughout the six years of treatment. No side effects were reported. Conclusions Overall in ‘real life’ omalizumab in children reduces asthma exacerbations and hospitalizations, improves lung function, and decreases the maintenance therapy. It is shown to be safe for up to six years of treatment in children.

Youth tobacco use in Latin America: What is the real extent of the problem? Publication date: July–August 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 4 Author(s): M. Urrutia-Pereira, D. Solé, H.J. Chong Neto, H. Badellino, V. Acosta, R.L. Castro-Almarales, M.G. León, M.M. Avalos, C.C. Fernández, J.C. Sisul-Alvariza, V.J. Oliano, P.N. Rinelli Abstract Introduction Cigarette consumption among teenagers is one of the most critical health-related risk behaviors. Method Prospective study carried out in seven sites of five Latin American countries (Argentina [Cordoba, N = 958, Corrientes, N = 1013], Brazil [Curitiba, N = 650; Uruguaiana, N = 997], Cuba [Havana, N = 1004], Mexico [Veracruz, N = 991] and Paraguay [Ciudad del Este, N = 868]) with public-school adolescents (aged 12–19 years). Respondents were asked to answer the California Student Tobacco Survey. Results 6550 adolescents took part in the survey (average age: 14 years). 38.5% (N = 2517) “tried smoking” and 37.5% started smoking before the age of 12. Sixty-one percent of adolescents think that cigarettes are easily accessible; 41.7% considered that smokers have more friends; 88% indicated knowledge of the harms of smoking one to five cigarettes per day; 58.9% would smoke new cigarette types with less harmful substances; 27.8% have already used e-cigarettes; 28% have smoked hookah. Fifty-seven point five percent have been, in the past seven days, in the same room with someone who was smoking a cigarette; and 30.5% indicated that there were not any no-smoking rules inside their homes. Identifiable risk factors were (logistic regression analysis): smoking cigarettes offered by friends, smoking cigarettes with less harmful substances, knowing what a hookah is, being in the same room with a smoker in the past week. Identifiable protective factors against tobacco use were: knowing the health risks caused by smoking hookah and to have their own room. Conclusion Youth tobacco use in Latin America is a major public health concern, and tobacco control measures are highly needed.

Yogurt is tolerated by the majority of children with IgE-mediated cow's milk allergy Publication date: July–August 2019 Source: Allergologia et Immunopathologia, Volume 47, Issue 4 Author(s): S. Monaco, G. Russo, A. Romano, L. Liotti, M.C. Verga, S. Miceli Sopo Abstract Background Children with IgE-mediated cow's milk allergy (IgE-CMA) with gastrointestinal symptoms tolerate yogurt at 100%. Yogurt tolerance in children with IgE-CMA with urticaria and anaphylaxis was 7%. Methods We enrolled children with IgE-CMA with cutaneous, respiratory, gastrointestinal and anaphylactic symptoms. All performed prick by prick (PbP) and oral food challenge (OFC) with yogurt. Some children performed also an OFC with CM mixed with wheat flour and baked, baked liquid CM, parmesan. Results 34 children were enrolled, 31/34 (91%) with systemic adverse reaction after ingestion of CM (systemic CMA), 3/34 (9%) with isolated contact urticaria (ICU CMA). PbP with yogurt was negative only in one patient. OFC with yogurt was passed (that is, the OFC was negative) by 20/31 (64%) of the children with systemic CMA. 10/11 (91%) of the patients who failed OFC (that is, the OFC was positive) with yogurt were positive to SPT with casein vs. 8/20 (40%) of the patients who passed it (p = 0.018). None of the 19 children who passed OFC with yogurt failed all OFC with processed CM forms other than yogurt that tested vs. 4/8 among those who failed OFC with yogurt (p = 0.006). The rub test with yogurt was negative in 1/3 (33%) of the patients with ICU CMA. Conclusions The results of our study are placed alongside others already present in the literature and concerning other methods of processing CM proteins and help to reduce the dietary restrictions of the majority of children with systemic IgE-CMA.