Atopy sensitization

There are few definitive data to substantiate the efficacy of LTRA therapy in refractory asthma, except for patients with aspirin-sensitive asthma. This is a fairly uncommon form of asthma that occurs generally in adults who often have no prior (i.e., childhood) history of asthma or atopy, may have nasal polyposis, and who often are dependent upon oral corticosteroids for control of their asthma. This syndrome is not specific to aspirin but is provoked by any inhibitors of the cycloxygenase-1 (COX-1) pathway. These patients have been shown to have a genetic defect that causes... 

Genetic factors cannot explain the recent rapid rise in asthma prevalence. Asthma appears to require both genetic predisposition and environmental exposure. Many patients with occupational asthma develop the disease late in life upon exposure to specific allergens in the workplace. Environmental influences in utero or in infancy may contribute to the development of asthma. Maternal smoking during pregnancy or exposure to secondhand smoke after birth increases the risk of childhood asthma.3 Adult-onset asthma is not uncommon and may be related to atopy, nasal polyps, aspirin sensitivity, occupational exposure, or a recurrence of childhood asthma. 

The influence of environmental factors has been established, but remains controversial. The strategy of strict avoidance of exposure to bacteria, viruses, and allergens until sensitization diminishes belongs to the canons of prophylaxis and treatment of choice of atopic diseases. For years, elimination of allergens from the environment of potentially-affected patients was not undermined as the method for preventing allergy. According to medical instructions, children with an atopy in their case history should have stayed in virtually sterile conditions. 

Certain Investigators, however, have expressed interest in the matter recently. The possibility that a history of asthma may increase the probability of an acute byssinotic reaction to cotton dust is suggested by a paper by Hamilton et al. ( ). The senior author of this paper had had asthma as a child. Promptly after exposure to the air in a dusty part of a cotton mill he exhibited pronounced shortness of breath with tightness in the chest and accompanying major temporary decreases in FEVi and arterial oxygen tension. The episode is described as "byssinosis". The authors remark It is unlikely that many textile workers with an initial response to cotton dust such as the one described here would remain working in dusty areas." Although the authors state that "It is not possible from the present study to conclude that a prior history of atopy confers sensitivity to cotton dust", the present writers were left with the impression that the authors suspect that such may be the case. 

There is therefore a need to investigate atopy, particularly as that variable may interact with dust exposure, in cotton textile mills." The reader is left with the thought that perhaps "reactors" who exhibit symptoms of acute byssinosis in a cotton mill might be in some sense people who are not obvious asthmatics but who, however, have some minimal or borderline type of asthma or other mildly increased bronchial sensitivity. Merchant et al. (51) tested workshift declines in FEVi workers exposed to cotton dust. In their summary they state "The patterns of FEVi response over a week suggest that there are distinct individual patterns of response not dependent upon previous cotton dust exposure."... 

In addition to diseases of important organs such as the lungs, the liver, and the kidneys, hereditary or acquired characteristics such as immunodeficiency and hypersensitivity may also influence sensitivity to xenobiotics. For example, atopies (individuals with immunologically mediated allergy) may develop life-threatening reactions to a chemical at an exposure level that is insignificant for the population in general (KEMI 2003). 

A history of atopy (asthma, hay fever or eczema) or of allergy to any injected substance is frequently seen in patients reacting to anaesthetic drugs and this association can be confirmed statistically. In most of these cases there is probably a raised IgE level, but this is not an essential feature in patients having true hyper-sensitivity reactions. Repeated exposure to... 

Herz U, Joachim R, Ahrens B, Scheffold A, Radbruch A, Renz H Allergic sensitization and allergen exposure during pregnancy favor the development of atopy in the neonate. Int Arch Allergy Immunol 2001 124 193-196. 

Atopy refers to the allergic sensitivity that certain individuals develop towards common and mostly innocuous environmental antigens such as dust mites, plant pollens and animal proteins. The condition of atopy generally manifests itself clinically in the form of asthma, hay fever, eczema or allergic rhinitis. The development of an atopic condition has been associated with the generation of predominately Th2 biased immune response to the particular allergen, and is thus often referred to as a Th2 based disease (Romagnani, 1994). 

The CBA (BD Pharmingen) is a series of spectrally discrete, uniform-size microparticles that can be used simultaneously to detect different soluble analytes including cytokines in a single sample on the basis of different color using flow cytometry. This series of particles with discrete fluorescence intensities can simultaneously detect a panel of six human cytokines (IFN-y, TNF-o , IL-2, IL-4, IL-5, and IL-10) (C9, C16) (Fig. 3 see color insert). This newly developed method can save more time, consume less sample, and achieve similar sensitivity (pg/ml) and reproducibility compared with ELISA. Moreover, the ability of the CBA to measure the concentrations of six cytokines from the same sample permits the calculation of cytokine ratios. Cytokine ratios are considered markers of various disease states such as asthma, atopy, and SLE (K3, A4). The relative balances... 

Fusidic acid and mupirocin has been proven to be equal in clinical efficacy 85-87 The risk of allergic contact dermatitis to fusidic acid in patients with AD can be considered very low. In an analysis of multicenter surveillance data in Germany, fusidic acid did not cause any case of sensitization in the subgroup of atopies.29 Topical neomycin, however, is rarely indicated not only because of inefficacy and high resistance rates, but also because of frequent development of allergic contact dermatitis.88,89... 

Seidenari, S., Skin sensitivity, interindividual factors atopy, in The Irritant Contact Dermatitis Syndrome, Van der Valk, P.G.M. and Maibach, H.I., Eds., CRC Press, Boca Raton, FL, 1996. 

We performed a clinical study [33] at a local hospital during 1997 in order to assess the diagnostic value of the above-described pure recombinant allergens of A. altemata in comparison with two commercial A. altemata extracts. Seven patients with a positive clinical history for A. altemata sensitization, 5 normal healthy subjects and 5 atopies not sensitized to any mold allergen according to clinical history and previous SPT, were tested. The study was approved by the local ethics committee. 

---