آلرژی

 Inborn error of immunity (IEI) includes variety of genetic disorders that affect both the innate and acquired immune system. The number of primary immune deficiency disorders is increasing due to advanced laboratory testing methods. The patients with IEI are susceptible to multiple infectious and non-infectious diseases، including autoimmune disorders، allergies، and malignancies. Several studies have shown an increasing prevalence of non-infectious disorders in patients in IEI. Among the non-infectious manifestations of primary immunodeficiency، allergic symptoms can play an effective and important role in diagnosis and treatment of these patients.Articles were searched in Google Scholar، PubMed، Web of Science، and Scopus databases. In this review، we have tried to use the latest and most reliable articles related to the subject that have been published in Persian and English language.

 Allergic diseases can be a common part of some primary immunodeficiency diseases. Even in some types of primary immunodeficiency، they are considered the main symptom and important indicator of the disease، which are very decisive factors for the diagnosis of immunodeficiency.

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder characterized by intensely itchy eczema. Sensitivity to Malassezia species may be associated with the severity of AD symptoms. The growth conditions for Malassezia spp. on children's skin are lower than on adult skin, making adults more susceptible to Malassezia. There is a minor suspicion that Malassezia spp. plays a role in AD as it may interact with skin immune reactions and barrier function, and sensitization against this skin-colonizing yeast can be correlated with illness activity. Additionally, antifungal treatment shows beneficial effects in some patients. However, the pathogenetic process and mutual interaction between Malassezia spp. and AD remain relatively unclear, necessitating further research.

Allergen exposure and sensitivity, asthma progression, and increased airway hyperresponsiveness (AHR) are interconnected. The relationship between mite sensitivity and lung function is still unclear. Therefore, this study aimed to investigate the relationship between mite allergy and   pulmonary function decline in patients with asthma referred to Deziani Allergy Clinic in 2017.

This descriptive cross-sectional study was performed on patients referred to Deziani Allergy Clinic in Gorgan in 2017. The patients were included in the study based on the clinical criteria for asthma. Mite antigen skin test was performed for all patients, and they were divided into two groups: sensitive and non-sensitive. A pulmonologist, allergist, and clinical immunologist performed a pulmonary function test (PFT) and bronchial stimulation test to confirm and evaluate the severity of asthma. Pulmonary function data were statistically compared between the two groups.

In total, 382 patients with a mean age of 42.75±16.50, including 146 (38.2%) males and 236 (61.8%) females, were included in the study. Moreover, 144 (37.7%), 101 (26.4%), and 137 (35.9%) patients had mild, moderate, and severe asthma, respectively. In addition, 173 (45.3%) cases were sensitive to mites. The FVC, FEV1, and FEF 25-75 values were significantly lower in patients with sensitivity, compared to the group without mite sensitivity (P<0.05). PFT results in females sensitive to mites were significantly lower in all cases, except for FEV1/FVC (P<0.050). The use of bronchodilators was significantly associated with improved pulmonary function in those who were over the age of 45 years (P=0.05).

Patients with mite allergy have poorer pulmonary function, and it plays an obvious role in the severity of asthma symptoms. Pulmonary specialists can help better control and reduce these patients' symptoms by adopting appropriate treatment programs, including improving the living environment and presenting the necessary guidelines to reduce contact with this allergen.

Allergy to cow's protein without treatment can cause problems such as insufficient growth in height and weight of children. The present study was conducted with the aim of comparing 4 types of treatment regimens in cow's milk protein sensitivity.In this cross-sectional study, a total number of 50 infants with cow's milk feeding syndrome who referred to the pediatric clinic were selected. The rate of response to therapeutic regimens, including the elimination of dairy from the mother's diet, semi-hydrolyzed formula, fully hydrolyzed formula, and the amino acid-based formula was evaluated in children. The tool for compiling a checklist was prepared based on the literature review and under the supervision of a specialist in pediatrics. The analysis was done in spss19 software.In this study, the most common findings of visiting a doctor were 31 (68 %) gastrointestinal bleeding, and 14 (28 %) dermatitis. The rate of response to different treatments was 6 (12%), semi-hydrolyzed formula 2 (4%), fully hydrolyzed formula 8 (14%), and formula based on amino acids 34 (68%), respectively, to remove dairy products from the mother's diet.The most common finding in infants with cow's milk protein allergy referred to a pediatric gastroenterology clinic was gastrointestinal bleeding, and the best treatment responses were to the formula based on amino acids.

The prevalence of asthma and allergic diseases in the world has increased in recent decades, and it is necessary to identify allergens in different regions. The aim of this study was to evaluate the frequency of allergens in patients with atopic and non-atopic asthma in Dazyani Asthma and Allergy Clinic, Gorgan City, Iran in 2020.

This cross-sectional descriptive study was performed on 96 children with asthma aged 1 to 16 years. Diagnosis of asthma was based on the patient's clinical signs, life-saving medications used, activity limitation established, and pulmonary function tests. Accordingly, the definitive diagnosis of asthma was a 15% increase in forced expiratory volume-1 (FEV1) after inhalation of 2 puffs of salbutamol. Children were divided into two groups of atopic and non-atopic based on experiments. In this study, if immunoglobulin E (IgE) levels were high and Prick test was positive, they were in the atopic group, otherwise they were in the non-atopic group. Serum levels of eosinophils and immunoglobulin E were analyzed by type of asthma and severity of asthma.

Among the studied children, 54.17% had atopic and 45.83% non-atopic phenotype. A total of 71.78% of children with asthma were at least allergic to one of the allergens tested. There were also significant relationships between the severity of asthma and being atopic, immunoglobulin E, and eosinophil count.

Asthma is more severe in children with atopic asthma than non-atopic asthma. The mean of immunoglobulin E and eosinophils in atopic asthma is higher than non-atopic. Immunoglobulin E and eosinophil levels are also directly related to the severity of asthma.

Genetic and environmental factors are known to be related to the development of childhood Eczema. We aimed to assess the ecological factors associated with the prevalence of Eczema among children using the ISAAC questionnaire.

A total of 1600 primary school girls and boys were selected and examined by multistage random sampling in this cross-sectional study. Data were collected and completed using the International ISAAC Questionnaire, including demographic questions and risk factors through interviews with parents, especially the student’s mother. The data were analyzed in SPSS v. 19 software using the Chi-square test and multiple logistic regression.

This study was approved by the Ethics Committee of Zahedan University of Medical Sciences (Code: REC.1397.481).

 The prevalence of current Eczema was 10.4% (95%CI: 8.9-11.9). Co-morbidity with Asthma and Rhinitis was 82.8% and 74.5%, respectively. In multiple logistic regression models, history of allergies in family members (OR: 2.35, 95%CI: 1.53-3.59), father snoring (OR: 3.00, CI95%: 1.98-4.55), Keeping any animal in (OR: 1.6, 95%CI: 1.002-2.58), family size (OR: 0.85, 95%CI: 0.68-0.95), exposure to tobacco smoke at home (OR: 2.84, 95%CI: 1.18-6.81), showed a significant relationship with the occurrence of students’ Eczema.

 Exposure to tobacco smoke at home, keeping any animal at home are effective factors in the prevalence of Eczema in children. By eliminating these factors, the prevalence of this disease can be reduced. However, the mothers have the most crucial role in screening and early diagnosis of Eczema in school children regarding determinants in this study. According to the results of this study, it is suggested that parents’ education, especially mothers, be emphasized by paying attention to these favorable factors.

The prevalence of Allergy Rhinitis (AR) has increased dramatically among children. The aim of this study was to determine the prevalence of AR symptoms among school‐age children in Zahedan, southeast of Iran.

In this cross-sectional study, 1600 primary school girls and boys were selected and examined by multistage random sampling. Data were collected and completed using the International ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire including demographic questions and risk factors through interviews with parents, especially the studentchr('39')s mother. The data were analyzed in SPSS19 software using chi-square test and multiple logistic regression.

The prevalence of current AR and Rhinoconjunctivitis among elementary school Children was 15.3% and 10.2% respectively. The prevalence of current AR was not statistically significant in girls with 14.2% and boys with 16.4% (p>0.05). Co-morbidity with asthma and eczema was 27.3% and 28%, respectively. The occurrence of AR was related to BMI, family size, snoring father, type of heating and cooking (p<0.05).

The prevalence of AR in Zahedan is relatively high due to the special climatic conditions and geographical climate of the region. Overweight in students and the use of fire for cooking and heating the house is an effective factor in the prevalence of AR in children, which can be eliminated by reducing the prevalence of this disease. However, the mothers have most important role in screening and early diagnosis of AR in school children regarding determinants in this study.

The outbreak of the new coronavirus (COVID-19) has posed a global health challenge since late 2019. In the meantime and due to Covid-19 pandemic, many parameters and possible diseases were considered as the creating and or exacerbating factors of the emerged disease. In regard to the nature and pathogenesis of therespiratory disorders; and especially asthma; they are deemed as the notable special conditions. The immunologic manifestations of COVID-19 and its clinical presentations have conducted an especial attention on patients with allergic disorders, while exposing to new emerged infection. Therefore, the present study tries to investigate the interactive effects of the new coronavirus infection and conditions of the patients with allergic disorders.

Modern lifestyle of societies, and living in small houses or apartments, make the allergen-sensitive individuals to be predisposed to allergic asthma following challenge with environmental allergens such as fungal spores. The air-borne fungal conidia can be a major contributor to allergic asthma in children. Therefore, in this study, we aimed to study the effect of exposure to fungal conidia on asthma in an animal model. Twenty-four Balb/C mice were divided into four groups (n=6) as followings: the asthmatic mice, the asthmatic and fungal spore (Penicillium chrysogenum)-exposed mice, the asthmatic and spore-exposed mice that is also treated with an antifungal drug (nystatin) and the healthy mice (PBS-treated mice). After the last administration on the day 31, bronchoalveolar lavage (BAL) fluid and tissue samples of lung were obtained. The gene expression of interleukin 4, 5 and 13 and pathologic changes in lung tissue of mice were investigated. The mRNA expression of the interleukin genes, perivascular and peribronchial inflammation, mucus secretion and goblet cells hyperplasia were increased in asthmatic mice that is also exposed to fungal spores in comparison to the asthmatic but not spore-exposed mice. Nystatin treatment in asthmatic and spore-exposed mice caused notable decrease in pathologic changes in lung tissue and mRNA expression of IL-4, 5 and 13. Antifungal treatment is recommended in asthmatic patients that also have high chance to be exposed to fungal spores. The results indicated that fungal spores are potential stimulators of allergic asthma so it is suggested that allergen-sensitive patients particularly children and those with the allergy history avoid any exposure with air-borne fungal spores.

The chitinase-like protein, YKL-40, plays an important role in allergic diseases pathogenesis. Allergens induce its production from macrophages and epithelial cells. Some investigations indicated that loratadine has anti-inflammatory effects apart from its H1 receptors antagonist activity. We sought to know whether human epithelial cells and macrophages stimulated for YKL-40 synthesis by house dust mite (HDM) extract, might be influenced by loratadine. We used the human pulmonary type II epithelial cell line A549 and the human monocytic cell line (THP-1) for our in vitro study. This research is an experimental study. After dose-finding studies using neutral red cytotoxicity assay, the cells were pre-incubated with loratadine (0.5 μg/ml) and then stimulated by HDM extract (GREER Lab). Also, in post-treatment condition; A549 and THP-1 cells were stimulated with HDM extract followed by incubation with loratadine. Finally, the amount of YKL-40 released into the cell supernatants was determined by a specific ELISA. Data were analyzed using SPSS software v.16.

A549 cells cannot produce and secret YKL-40 at baseline level or in HDM stimulated condition. In spite of A549, THP-1 cells stimulated with HDM extract showed a significantly increased release of YKL-40. In comparison with control cells, Pre-incubation with loratadine diminished the YKL-40 release from the HDM stimulated THP-1 cells in a significant manner. The YKL-40 level in loratadine group was 4470 pg/ml while it was 8700 pg/ml in the control group (P≤0.05). Although in HDM pretreated cells followed by incubation with loratadine YKL-40 decrease was not found. The Neutral Red Assay results represented nontoxicity of treatments. A549 cells that are used widely in in-vitro models of allergic reactions cannot produce YKL-40 as a mediator of allergic reactions. Therefore, this cell line should not use alone in these studies. Loratadine may have anti-inflammatory effects by suppressing YKL-40 secretion from myeloid cells. As regard to the ability of loratadine to attenuate YKL-40, therefore, we suggest that further studies are warranted to examine its therapeutic potential in diseases that YKL-40 plays a critical role in the pathogenesis.

Allergy is one of the most common diseases that is rapidly increasing. Since this disease is a psychosomatic disease, to evaluate the factors affecting it, a combination of biological and psychological factors should be considered. The aim of this study was to compare the personality traits and emotion regulation styles in patients with and without allergy with healthy people. This descriptive-analytical cross-sectional study was conducted in the Allergy Clinic in Urmia city in 2017. In this study, 100 patients (50 patients with allergy, and 50 patients without allergy) and 50 healthy people were selected through matching with the patient group using convenience sampling method. Data were collected using Personality Trait Questionnaire (PTQ) and Cognitive Emotion Regulation Questionnaire (CERQ). Data were analyzed using multivariate analysis of variance, Levin and Scheffe test. Neuroticism was more common in patients with and without allergy than those healthy people (P=0.001). Patients with allergy obtained lower scores of the extraversion trait and adaptive emotion regulation compared to the other two groups (P=0.001). There was no significant difference between the three groups in terms of agreeableness and openness to experience.  It seems necessary to use psychological interventions in the training of emotion regulation skills and pay attention to the personality traits in these patients.

Benign migratory glossitis, or geographic tongue is an asymptomatic inflammatory disorder of unknown etiology that affects the epithelium of the tongue. Genetical disposition, allergic reactions, psoriasis, stress, consumption of particular foods, pernicious anemia, acquired immunodeficiency, psychological disorders, lithium consumption are some of the conditions that are associated with geographic tongue. The purpose of this study was to investigate the correlation between the periodic prevalence of geographic tongue and allergic phenomena among patients admitting to the Alborz dental clinic, Urmia, Iran.
In this study, 1811 patients admitted to Alborz Dental Clinic during 2016-2017 in Urmia were studied. After completion of the form and oral examination, the data were analyzed by descriptive and analytic statistics, chi-square and Spearman test using statistical software SPSS 22.
From the total number of 1811 examined patients (1002 women and 809 men), 248 (13.7%) had geographic tongue. This study showed that there was a positive and statistically significant relationship between geographic tongue and allergic phenomena. (r=0/138, p According to the results of this study individuals with a history of allergy are twice more likely to have geographic tongues. The more severe the allergic signs the higher the probability of having geographic tongue.

Geographic tongue and fissured tongue are the most common developmental tongue disorders. One of their causes is allergy. Allergy usually is accompanied by different abnormalities such as lymphoid hyperplasia and post nasal discharge (PND). The purpose of this study was assessing coincidence of oral lymphatic condition and PND in patients with geographic or fissured tongue.
This case control study was done on 190 patients referring to oral medicine department of Yazd dental school with convenience sampling method. All patients were divided into two groups, the first group with geographic or fissured tongue and the other one without it. After taking informed consent, all of them were examined for PND and involvement of Waldeyer's lymphatic ring. Finally the results of both groups were compared with Chi-Square test and SPSS 17 software.
Findings: 19 persons of examined patients (10%) in this study had tongue tonsils. Involvement of pharyngeal tonsils were seen in 30 and 21 persons in case and control group respectively.According to the results, it was found that, there was a significant relationship between the involvement of Waldeyer's lymphatic ring and the presence of geographic or fissured tongue (Pvalue=.015). 20 persons in case group (21.1%) had PND, and there was no significant relationship between PND and geographic or fissured tongue (Pvalue=.562).
Discussion & According to significant difference in Waldeyer's lymphatic ring involvement in groups, the probable signs and symptoms of allergy should be considered in these patients. Also, with regular follow up in these susceptible persons well-timed diagnosis and treatment could be achieved.

Toxocariasis is a common parasitic zoonosis of humans, dogs and cats. Migration of Toxocara larva in the internal organs is accompanied by a variety of complications such as hepatomegaly, marked eosinophilia, pulmonary and ocular symptoms. In some cases, symptoms are nonspecific and the patients may only show allergy-like cutaneous and pulmonary manifestations. Considering the significant increase in the prevalence of allergic disorders, study of the possible etiologies of these disorders can lead to the early diagnosis and effective treatment of the disease. In this study prevalence of anti-toxocara antibody and some hematological parameters were compared between allergic and non-allergic children.
Our experimental group included 200 children under 15 years of age with skin and/or respiratory allergies referring to allergy clinics, and our control group consisted of 238 non-allergic children, matched to the experimental group in regard to age and sex. Specific anti-toxocara IgG titers were measured by TES/Ag-ELISA technique. Eosinophilia and leukocytosis were extracted from the CBC results. We used T-test and chi-square to compare the results between the two groups.
The prevalence of anti-toxocara IgG in the children with allergic manifestations was significantly higher (4.5%) than that in the healthy children (0.8%). Children with allergic manifestations had a higher rate of eosinophilia (16.5%) compared to healthy children (0.4%), but there was no significant correlation between eosinophilia and toxocariasis serology.
Regarding the higher prevalence of anti-toxocara antibodies in the children with skin and respiratory allergies, investigation of toxocariasis in the patients with allergic symptoms is recommended.

In recent years, the role of vitamin D deficiency in the incidence and aggravation of types of allergy have been considered and much study has been done in this regard. Because vitamin D deficiency and as well as the prevalence of allergy is the important issues in the health field, this study was aimed to investigate the relationship between vitamin D level and and IgE in children in Tehran.
In a cross sectional study, 112 allergic children aged less than 12 years (64 boys and 48 girls) were evaluated. Vitamin D was classified in three levels as deficient ( The mean of vitamin D level was 64.17±27.14ng/ml that fall into insufficient range. The abnormal level of vitamin D was present in 61.9% (20.5% insufficient and 41.4% deficient). Vitamin D deficiency was significantly higher in girls(P=0.03). Although vitamin D deficiency was increased with age, the mean of vitamin D deficiency was not different between age groups. However, 43.8% of total IgE levels were higher than normal range, there was no association between serum vitamin D and IgE level.
Given the prevalence of vitamin D deficiency in the children and its impact on the incidence of allergic diseases, design a national project to determinate the vitamin D deficiency levels and its associated risk factors, and screening of vitamin D deficiency seems necessary.

Allergy to food substances is considered as one of global health problems particularly in developing countries and its rate, as with other allergic disorders, is growing. The aim of this study was to study frequency of common food allergens in the region.
In this descriptive-analytical study conducted on 230 children 1 to 6 years referring Imam Ali Clinic, Shahrekord in 2014 enrolled by convenience sampling. The children were assigned to two groups of 115 each, those with suspected food allergy and those without food allergy symptoms, and the common food allergens consisting of cow milk, egg, and groundnut were investigated for skin test. T-test and chi-square statistics were used for data analysis.
There was a statistically significant difference between allergic to peanuts, eggs and other allergens (Pepper, banana, fish, kiwi, melons, wheat, peaches, eggplant, squash, tomato and watermelon) in studied groups (P Other allergens were identified with the highest and cow’s milk with the lowest frequency of food allergy in the children. This allergy was higher in food allergy-suspected children compared to the control group.