Iranian Journal of Allergy, Asthma and Immunology
Volume:15 Issue: 2, Apr 2016

In this study, we aimed to conduct a meta-analysis on the results of eligible studies to estimate the prevalence of asthma, COPD, and Chronic bronchitis in Iran. International and Iranian databases including PubMed, Scopus, Web of Science, Iranmedex, and scientific information database (SID) were searched for population–based studies that had reported the prevalence of asthma and COPD from 1990 to 2015. We conducted the meta-analysis using metaprop application of Stata statistical software. I-Squared was used for calculating heterogeneity among the studies. To determine causes of heterogeneity, subgroup analysis and meta-regression method were used. Based on the results of random effect method, the overall prevalence of asthma ever was 4.56% (3.76%-5.36%) among men while it was 4.17% (3.42%-4.91%) among women. Pooled prevalence of current asthma was 7.95% while confidence interval changed from 5.85% to 10.06% (men 5.83% (2.75%-8.92%), women 9.13% (3.35%-14.94%)). Also based on the results of random effect model pooled prevalence of chronic bronchitis of five studies was 5.57%. It seems that the total crude prevalence of current asthma in Iran is less than many other countries such as Kuwait, Lebanon, Thailand, Japan, Australia and Germany and is higher than some other countries such as Oman, Pakistan, South Korea, India, China, Taiwan, Indonesia, Spain, Russia, and Greece. On the other hand, Iran is in middle situation in terms of the prevalence current asthma. Our results can fill the information and knowledge gaps about the status of the prevalence of respiratory diseases in Iran.

Few biomarkers that can predict the clinical response to allergen immunotherapy (AIT) have been identified. The aim of the present study was to investigate parameters that could be used “in predicting the clinical response to AIT” in children with asthma caused by house dust mites. We evaluated 107 children with mild persistent asthma who were sensitised only to mite aeroallergens. The study group included 47 patients who underwent a 4-to-5-year course of subcutaneous immunotherapy with standardised mite allergenic extract. Sixty patients who had not undergone AIT but were allergic to house mites were included in the control group. The clinical features and laboratory parameters of patients who did and did not sustain remission were compared. Remission was achieved in 74.5% of the 47 patients in the study group and in 20% of those in the control group. In the study group, one parameter predictive of a clinical response to AIT was identified by multivariate logistic analysis. This parameter was the serum total IgE level (tIgE) at the time of diagnosis (OR 131.64 and CI 0.858–20193; p = 0.032). Serum tIgE levels ≤ 339 kU/L at diagnosis were associated with an effective clinical response to AIT, with a sensitivity of 64.5% and specificity of 88.9%. We conclude that measurement of the serum tIgE level can be used as a predictive test prior to AIT in patients sensitized to mite aeroallergens.

Sublingual allergen immunotherapy (SLIT) is considered to be safer and more convenient than subcutaneus immunotherapy. SLIT trials with house dust mites involving patients with allergic rhinitis (AR) and asthma reported discordant results. The aim of the study was to investigate the clinical efficacy and safety of SLIT with Dermatophagoides pteronyssinus (D.pt) extract produced in Serbia and patient’s satisfaction through open-label trial. Adult patients with allergic rhinitis were randomized into two groups: one received drugs and SLIT, while other received only drugs. Symptom score (SS), medication score (MS) and cumulative score (CS), skin prick tests (SPT) and serum level of D. pt specific IgE were assessed. One year after, the patients were re-evaluated. In total, 61 patients were enrolled in the study, but 52 of them were analyzed at the end of the year. CS (29.3%, p

Pollen from mesquite (Prosopis juliflora) is one of the important causes of immediate hypersensitivity reactions in the arid and semi-arid regions of the world. The aim of present study is to produce and purify the recombinant form of allergenic Ole e 1-like protein from the pollen of this allergenic tree. Immunological and cross-inhibition assays were performed for the evaluation of IgE-binding capacity of purified recombinant protein. For molecular cloning, the coding sequence of the mesquite Ole e 1-like protein was inserted into pTZ57R/T vector and expressed in Escherichia coli using the vector pET-21b(). After purification of the recombinant protein, its immunoreactivity was analysed by in vitro assays using sera from twenty one patients with an allergy to mesquite pollen. The purified recombinant allergen was a member of Ole e 1-like protein family and consisted of 150 amino acid residues, with a predicted molecular mass of 16.5 kDa and a calculated isoelectric point (pI) of 4.75. Twelve patients (57.14%) had significant specific IgE levels for this recombinant allergen. Immunodetection and inhibition assays indicated that the purified recombinant allergen might be the same as that in the crude extract. Herein, we introduce an important new allergen from P. juliflora pollen (Pro j 1), which is a member of the Ole e 1-like protein family and exhibits significant identity and similarity to other allergenic members of this family.

Exposure to indoor allergens plays an important role in the etiology of asthma. This study was designed to quantify indoor allergens from homes of families that had at least one case of childhood asthma at home in a southwestern city of Iran. The relationship between the indoor allergen levels and home characteristics was also investigated. Dust samples were collected from the bedrooms and the kitchens of 35 homes where children with persistent asthma were living. The levels of indoor allergens were measured by enzyme linked immunosorbent assay (ELISA). Detectable amounts of mite, mouse and cockroach allergens were found in all evaluated places. None of our patients were exposed to a threshold concentration of indoor allergen for sensitizing at home. Regarding of mite allergens, the levels of Der f1 were significantly higher than Der p1 and a direct correlation was observed between living in an apartment and Der f1 levels. Moreover, Fel d1 (cat) and Bla g1 (cockroach) allergens were found in the children’s bedrooms more frequently than those in the kitchens. In this study, direct associations were obtained between Bla g1 allergen and the duration of occupancy and between Fel d1 and average home size. A total of 34.2% of the patients showed positive skin reactions to at least one of the tested allergens as 17.1% of them showed reactivity to D. pteronyssinus. Proper controlling of cockroaches and mice by public health officials would be a practical approach to avoid inducing asthma or worsening the symptoms.

The prevalence of atopic dermatitis (AD) and obesity have been increasing considerably in Korean school-children. AD is a chronic pruritic recurrent inflammatory skin disorder. Leptin is secreted by adipocytes which has been suggested to be immunologically active; however, their role in AD has not yet been well understood. A total of 227 subjects out of 2,109 elementary school children were defined as having AD based on the ISAAC questionnaire survey. Ninety subjects with AD, aged between 6 and 12 years, completed scoring of severity of AD (SCORAD), skin prick testing, blood tests for total IgE, eosinophil counts, eosinophil cationic protein (ECP) and lipid profiles. Serum leptin levels were also measured. A subject with atopic AD was defined as an AD patient showing at least 1 positive reaction to allergens in skin prick testing. There were no significant differences in age, body mass index, percentage of breast milk feeding, mode of delivery, prevalence of atopy, and lipid profiles between atopic AD and non-atopic AD subjects. The serum leptin levels (log mean±SD) were significantly higher in non-atopic AD group than in the atopic AD group (0.86±0.57 ng/mL vs 0.53±0.72 ng/mL, p=0.045). Subjects with mild-to-moderate AD showed significantly higher serum leptin levels than those with severe AD (0.77±0.67 ng/mL vs 0.33±0.69 ng/mL, p=0.028). There was a marginal inverse correlation between the SCORAD index and the serum leptin concentration in total AD subjects (r=-0.216, p=0.053). The serum leptin levels were significantly higher in non-atopic AD subjects or mild-to-moderate AD subjects. Leptin did not seem to be associated with IgE-mediated inflammation in AD. Obesity-associated high leptin differed between non-atopic AD and atopic AD subjects.

Multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE), are inflammatory autoimmune diseases of the central nervous system. Chymotrypsin is a serine protease with immunomodulatory effect in the peripheral organs. We previously demonstrated the immunomodulatory effect of chymotrypsin in ameliorating the EAE in female Lewis rats. However, there are sex-based differences in the immune system, drug activity, and CNS structure and composition. In addition, female gender is a better prognostic indicator of MS and males are more severely affected by EAE than females. Consequently, gender may have an important impact on therapeutic effect. Therefore, in this study we investigated the anti-inflammatory effect of chymotrypsin in male Lewis rat model of EAE. The disease was induced in male Lewis rats and the animals were evaluated for weight loss and clinical signs for 14 days. Intra-CSF injection of chymotrypsin was done on day 7 and expression of mRNA for IFN-γ, IL-4, IL-17, and FoxP3 in brain, spinal cord and deep cervical lymph node were determined using a two-step real-time PCR. Administration of 0.2mg/ml chymotrypsin ameliorated the disease by decreasing IFN-γ and increasing expression of IL-4 and IL-17 at the inflammatory foci. This is consistent with anti-inflammatory effect of IL-4 and IL-17 at high concentrations. We conclude that Immunomodulatory affect of chymotrypsin in CNS is sex-independent. Our result also provides more evidence on the anti-inflammatory role of IL-17. However more research is needed to elucidate the underlying immunomodulatory role of chymotrypsin and how to increase its beneficial effect by modification of dosage and/or regimen of administration.

Allergy diagnosis needs to be improved in polysensitized patients due to the existence of possible confounding factors in this type of patients. Component resolved diagnosis (CRD) is a new concept in the investigation of polysensitized patients. The aim of this study was to evaluate if the utilization of ImmunoCAP ISAC improve the diagnosis of the polysensitized allergic rhinitis patients. Skin prick test (SPT) to 58 crude allergen extracts and CRD (ImmunoCAP ISAC) were carried out for 5 polysensitized allergic rhinitis patients. Two patients had a shellfish allergy and avoidance of shellfish was the only way to prevent an allergic reaction. In contrast, although the remaining three patients had low risk for shellfish allergy, but they were the best candidates for immunotherapy using mite extracts. CRD and particularly ImmunoCAP ISAC have proven to be a valuable diagnostic tool in polysensitized patients. ImmunoCAP ISAC helps refine the individual patient’s sensitization profile and predict the potential risk of allergic reactions and improve the selection of patients for immunotherapy.

Cow's milk allergy (CMA) is an immunological response to cow's milk proteins such as casein, α-lactalbumin and β lactoglobulin. The aim of this study was to determine the most common cow's milk allergenic proteins in patients with CMA and identify the most effective proteins in different allergic symptoms. Eighty seven patients (≤18 years) with allergy to cow’s milk from 2006 to 2013 entered this study. They had a positive history of allergic reactions to cow’s milk and a positive specific IgE test to whole cow's milk. The patients’ symptoms were divided into four groups. Serum specific IgEs against four different main proteins of cow's milk were measured using RIDA Allergy Screen. Among 87 patients, 53 (60.5%) were male and the median age was 2.5 years. The frequency of respiratory, skin, gastrointestinal symptoms, and anaphylaxis were 63.3%, 55.7%, 20.3%, and 13.4%, respectively. Specific IgEs to total cow's milk protein (n=75, 89.3%), and the main Cow’s Milk Proteins including α-lactalbumin (n=65, 77.4%), casein (n=64, 75.3%), β-lactoglobulin (n=52, 62.7%), and bovine serum albumin (n=35, 44.9%) were detected. Specific IgE tests to β-lactoglobulin were positive in 90% of the patients with anaphylaxis. Moreover, significant relationship was found between specific IgE to β-lactoglobulin and anaphylaxis (p=0.04). Although it is presumed that α-lactalbumin and casein are the most common allergenic proteins of cow's milk, in this study there is a significant relationship between the anaphylaxis and the presence of β-lactoglobulin-specific IgE. Therefore, more precautions are recommended due to possible anaphylactic reactions in patients with a positive test history for β-lactoglobulin specific IgE.