bluuebunny/crossref_metadata_2025 huggingface dataset:
Crosstalk between biotic and abiotic stress responses in tomato is mediated by the AIM1 transcription factor
Authors: AbuQamar Synan , Luo Hongli , Laluk Kristin , Mickelbart Michael V. , Mengiste Tesfaye
Published: December 2008

Plants deploy diverse molecular and cellular mechanisms to survive in stressful environments. The tomato (Solanum lycopersicum) abscisic acid‐induced myb1 (SlAIM1) gene encoding an R2R3MYB transcription factor is induced by pathogens, plant hormones, salinity and oxidative stress, suggesting a function in pathogen and abiotic stress responses. Tomato SlAIM1 RNA interference (RNAi) plants with reduced SlAIM1 gene expression show an increased susceptibility to the necrotrophic fungus Botrytis cinerea, and increased sensitivity to salt and oxidative stress. Ectopic expression of SlAIM1 is sufficient for tolerance to high salinity and oxidative stress. These responses correlate with reduced sensitivity to abscisic acid (ABA) in the SlAIM1 RNAi, but increased sensitivity in the overexpression plants, suggesting SlAIM1‐mediated ABA responses are required to integrate tomato responses to biotic and abiotic stresses. Interestingly, when exposed to high root‐zone salinity levels, SlAIM1 RNAi plants accumulate more Na+, whereas the overexpression lines accumulate less Na+ relative to wild‐type plants, suggesting that SlAIM1 regulates ion fluxes. Transmembrane ion flux is a hallmark of early responses to abiotic stress and pathogen infection preceding hypersensitive cell death and necrosis. Misregulation of ion fluxes can result in impaired plant tolerance to necrotrophic infection or abiotic stress. Our data reveal a previously uncharacterized connection between ABA, Na+ homeostasis, oxidative stress and pathogen response, and shed light on the genetic control of crosstalk between plant responses to pathogens and abiotic stress. Together, our data suggest SlAIM1 integrates plant responses to pathogens and abiotic stresses by modulating responses to ABA.
Late‐onset Papillon–Lefevre syndrome with pyogenic liver abscesses: report of one case
Authors: Yazdanfar Ameneh , Farahnaki Sasan
Published: December 2008

A 25‐year‐old woman living in Hamedan, Iran, presented originally at 7 years of age with erythematous, hyperkeratotic lesions on the palms and soles with extension to the dorsal side of the hands and feet. Involvement of the elbows and knees was also seen. From 12 years of age, she started to lose her teeth. At the same age, she experienced fever, chills, malaise, myalgia, and right upper quadrant abdominal pain. With a diagnosis of pyogenic liver abscesses, the patient underwent successful surgical treatment.

 Examination revealed erythematous, hyperkeratotic, scaling plaques on the palms and soles, dorsal side of the hands and feet (Fig. 1), elbows and knees. All the teeth were missing from the mouth (Fig. 2), and she used a dental prosthesis. A surgical scar was observed on the right upper quadrant of the abdomen (Fig. 3). Skull X‐ray and computed tomography scan were normal. Skin biopsy of the dorsal right hand demonstrated hyperkeratosis, focal parakeratosis, hypergranulosis, and acanthosis with a mild inflammatory infiltrate around the vessels (Fig. 4).

Hyperkeratotic plaques on the hands and feet

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Loss of permanent teeth

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Surgical scar on the right upper quadrant of the abdomen and hyperkeratotic plaques on the hand

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Hyperkeratosis, focal parakeratosis, hypergranulosis, and acanthosis (hematoxylin and eosin, ×40)

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Nasal sensitization
Authors: Van Cauwenberge Paul B.
Published: December 2008

Because humans breathe through the nose, the nasal mucosa becomes sensitized to inhalant allergens. Allergic rhinitis is, together with allergic conjunctivitis, the best example of a type I hypersensitivity reaction. It is an inflammation of the nasal mucosa induced by specific immune recognition of exogenous allergens. The production of IgE plays a major role in the pathophysiology. During the sensitization phase, an antigen is presented to an antigen‐presenting cell at the epithelial level. Cells that express class TI major histocompatibility complex Ia on their surface can act as an antigen‐presenting cell for immunocompetent cells (dentritic cells, monocytes, macrophages, B lymphocytes and epithelial cells). Macrophages and Langerhans cells are increased in number in the nasal mucosa of patients with seasonal allergic rhinitis during the season and also after allergen challenge. Topical corticosteroid treatment reduces the number of Langerhans cells in the epithelium. The epithelium also participates in antigen presentation through its possession of antigen‐binding surface proteins. The antigen is finally presented to CD4 T‐helpe cells and B cells; this is monitored by cytokines and leads to the development of memory cells and IgE‐producing plasmocytes. In humans, IL‐4 has been shown to be capable of differentiating B cells into IgE‐producing plasma cells. The IL‐4 production is inhibited by interferon γ and by prostaglandin E2. The CD4+ cells also produce IL‐2, which causes differentiation and proliferation of T lymphocytes, and IL‐3, IL‐5, IL‐6 and IL‐7, which stimulate the B lymphocytes. Topical administration of anti‐allergic drugs or immunotherapy seems to be a logical approach in the treatment of patients with allergic rhinitis, because it has very direct activity on the main components of nasal sensitization.
Rhinopharyngoscopy, computed tomography and magnetic resonance imaging
Authors: Bonifazi F. , Bilò M. B. , Antonicelli L , Bonetti M. G.
Published: December 2008

Rhinitis is defined as nasal congestion, sneezing, itching and rhinorrhoea, recently classified as allergic, infective, structural or “other”. The increasing employment of flexible rhynolaringoscopy may represent one of the most useful diagnostic tools in the complex differential diagnosis between allergic and nonallergic rhinitis. Furthermore, chronic allergic rhinitis, with secondary impairment of mucociliary clearance and the plethora of frequent anatomical variations, especially in the ostiomeatal complex, appear to predispose the patient to recurrent rhinosinusitis. In the last two decades, a better understanding of mucociliary clearance of nasal cavity and paranasal sinuses has shifted the attention from the maxillary sinuses to the area of the antherior ethmoid sinuses. Plain fiim radiographic examination, the historical standard, due to its inability to individualize ethmoid and sphenoid disease, is being rapidly supplanted by computed tomography and magnetic resonance imaging in the diagnosis of rhinosinusitis In allergic and non‐allergic rhinitis the diagnostic role of magnetic resonance imaging and computed tomography is still under debate. Computed tomography and magnetic resonance imaging are more efficient in demonstrating the bone wall, mucosal layer and sinus content than classical and computerized radiology; they have a higher diagnostic performance index in spite of a higher cost and, for computed tomography, a higher radiation dose.
Clinical efficacy and safety of local nasal immunotherapy
Authors: Andri L. , Senna G. E. , Dama A. R.
Published: December 2008

Local nasal immunotherapy represents an alternative route of allergen administration. It was proposed to overcome the risk of systemic reactions rarely reported during the traditional subcutaneous immunotherapy. Some studies carried out in the past generally showed good efficacy but poor tolerability. The aqueous extracts mostly used in these studies carry some drawbacks such as the volume effect, self‐digestion and the difficulty of administering reproducible dosages. The recent availability of allergen extracts in powder form has led to better stability and standardization. The studies carried out with these freeze‐dried allergens showed clinical efficacy and good tolerability in perennial (mite, cat) and seasonal (grass, birch,Purieturia) allergic rhinitis. According to these findings this new local nasal immunotherapy with extract in powder form represents a suitable alternative to the traditional immunotherapy in the treatment of allergic rhinitis.
The eosinophil and the eye
Authors: Bonini Se. , Magrini L. , Rotiroti G. , Lambiase A. , Tomassini M. , Rumi C. , Bonini St.
Published: December 2008

Personal studies in allergic eye diseases reviewed in this paper indicate that: 1. An increased number and an abnormal distribution of eosinophils is present in conjunctival biopsies of patients with vernal keratoconjunctivitis (VKC). 2. Eosinophil and eosinophil products, such as ECP, are also increased in tears of VKC patients and, in hay fever conjunctivitis, accumulate during the late‐phase of allergic reaction following specific allergen challenge. 3. Circulating eosinophils of VKC patients show a typical activation phenotypic profile which is associated with increased serum level of eosinophil cationic protein and eosinophil‐derived neurotoxin/protein X. A clinical study of the modulatory effect of cetirizine on the early and late phase of the allergic reaction as well as on the eosinophil activation and tissue recruitment following conjunctival allergen challenge is reported as an example of the need to evaluate eosinophil functions when investigating anti‐allergic drugs. Drugs modulating various aspects of eosinophil function could play a primary role in the treatment of allergic eye disease.
Purine derivatives in the study of allergic inflammation in respiratory diseases
Authors: Crimi Nunzio , Polosa Riccardo , Mistretta Antonino
Published: December 2008

Adenosine, a naturally occurring purine nucleoside, elicits dose‐related bronchoconstriction in asthmatic subjects when administered by inhalation and it is recovered in increased amounts from the bronchial lavage fluid of subjects with active asthma when compared to normal controls. Although the mechanism by which adenosine mediates bronchoconstriction in asthmatic subjects is not clear, recent data indicate an important role for mast cell mediator release. We have recently shown that local airway challenge with adenosine in subjects with asthma and rhinitis provokes an increase in the levels of PGD2, histamine and tryptase. However, airway responsiveness and atopic status are the most important determinants of adenosine‐induced responses, regardless of any increases in mast cell mediators in airway fluids. New discoveries suggest that the airway response to adenosine may be an index of mast cell priming and therefore may provide a useful tool to further explore the inflammatory processes in allergic asthma and rhinitis. Therefore adenosine provocation may gain increasing acceptance as an additional measure of disease activity in asthma and rhinitis.
The pharmacological basis for the treatment of perennial allergic rhinitis and non‐allergic rhinitis with topical corticosteroids
Authors: Meltzer E. O.
Published: December 2008

The currently available respiratory topical corticosteroids are all effective at reducing the nasal symptoms of itch, sneezing, rhinorrhoea and obstruction associated with allergic rhinitis. The mechanism of action of corticosteroids is related to their anti‐innammatory activities. They have been documented to prevent fluid exudation and reduce the number of circulating inflammatory cells, including lymphocytes, mast cells, basophils, eosinophils, macrophages, and neutrophils. This occurs through multiple mechanisms, e.g. eosinophil infiltration is suppressed by preventing cytokine production, reducing local mechanisms of tissue infiltration, and decreasing eosinophil survival. Furthermore, corticosteroids also reduce preformed and newly‐generated mediators (e.g. histamine, tryptase, prostanoids, leukotrienes), and inhibit production of cytokines and chemokines by inflammatory cells (e.g. IL‐1 through IL‐6, IL‐8, RANTES, TNF‐α, IFN‐γ and GM‐CSF). The currently available corticosteroids differ pharmacologically. Fluticasone propionate appears to have the greatest affinity for the glucocorticoid receptor, and binds more quickly and dissociates more slowly from the receptor compared with other corticosteroids, suggesting a more prolonged duration of action. Its increased specificity for respiratory tissue may lead to greater potency with less potential for systemic adverse effects. Fluticasone propionate has been compared with other corticosteroids in animal models for relative topical and systemic potency, and according to these data. it has the most favourable risk‐benefit ratio.
Trends in air quality in the UK
Authors: AYRES J. G.
Published: December 2008

Ayres JG. Trends in air quality in the UK.

Many problems are encountered when assessing trends in air quality, including changes in methods of measuring pollutants over time, different sampling timeframes, and the number and distribution of monitoring sites. Nevertheless, reasonable projections have been established for trends in sulphur dioxide (SO2), particulate matter, nitrogen dioxide (NO2), and ozone levels in the UK, which allow some estimate of future levels. The major source of SO1 is coal‐fired power stations. Since the Clean Air Act of 1956, SO2 levels have decreased substantially. Nevertheless, a small but progressive increase in SO2 emissions is predicted over the next 15 years, but this is unlikely to exceed current UK air quality standards on a frequent basis. Particulate pollution (as black smoke) has also decreased dramatically since the 1960s, when the main source was fossil fuel burning. In the 1990s, the main source of particle emissions is from heavy goods vehicles. If measures currently under consideration in the UK are implemented, annual emissions may decrease to below 60 kT over the next decade, but a progressive increase is predicted thereafter. No significant changes have occurred with respect to oxides of nitrogen (NOx) and ozone levels over the last 20 years. It is predicted that NOx emissions will decline in the future due in part to the introduction of catalytic converters, while trends in ozone levels will depend on substrate supply (NOx and hydrocarbons) and weather conditions. Despite short‐term trends downwards in air pollutant levels, trends may reverse in the next millennium, and continued efforts must be made to develop new ways of reducing ambient air pollutant levels.
Epidemiology of pollution‐induced airwav disease in Japan
Authors: MIYAMOTO T.
Published: December 2008

Miyamoto T. Epidemiology of pollution‐induced airway disease in Japan.

Air pollution has been implicated as one of the factors responsible for the increased incidence of allergic diseases seen over recent years. Epidemiological studies in Japan demonstrate that atopic subjects living in urban areas are more likely to suffer from the effects of air pollution, with increased coughing, sputum production, wheezing and throat irritation. Furthermore, animal studies show that high concentrations of pollutant gases can promote airway sensitization. The incidence of allergic rhinitis and asthma have been shown to be greater in areas where there is heavy traffic and hence high levels of automobile exhaust emissions. Intranasal administration of diesel exhaust particles in mice produces a stimulatory effect on immunoglobulin E production, and a similar finding has also been shown with suspended particulate matter in air. Air pollutants, such as ozone and nitrogen dioxide (NO2), have been shown to stimulate the production of granulocyte‐macrophage colony stimulating factor, which may play a vital role in airway hyperreactivity and asthma. In comparative studies of asthma in urban and rural areas, history of airway infection and a younger age of onset were found to be sifificantly greater in urban areas. When the asthmatic patients were divided into two groups according to environmental NO2 levels (group I: NO2 >30 ppb; group II: NO2 <30 ppb), no signficant difference regarding the various parameters was noted between the two groups, except for a greater severity of asthma in adults in group I, and a greater severity in children in group 11. These studies imply that air pollution may be one reason for the increase in allergic diseases in Japan, but a definitive conclusion cannot be drawn, and further investigation is warranted.
Microvascular anatomy of the nose
Authors: Widdicombe John
Published: December 2008

The microvasculature of the nose consists of: 1) A dense subepithelial network of capillaries, with fenestrations between the endothelial cells. This network provides nutrients to the epithelium and glands, and allows passage of water into the lumen for evaporation and air‐conditioning. 2) A system of capacitance vessels or sinuses, which when they distend, block the nasal lumen, and when they empty, open the nasal passages. Changes in their volume will affect the filtering and air‐conditioning functions of the nose. 3) Arteriovenous anastomoses which allow rapid passage of blood through the mucosa. They are probably important in air‐conditioning, and in the countercurrent mechanisms that tend to keep the brain cool in a hot dry climate. The anatomical interrelationships between these different systems is not well understood, nor is their differential control in terms of actions of mediators and nerves. In neurogenic inflammation sensory nerves are excited and release local mediators such as substance P via axon reflexes. These sensory neuropeptides will cause vasodilatation, vascular congestion and extravasation of liquid from the postcapillary venules, with resultant oedema and exudate. They may also cause secretion from the submucosal glands.
Rbtis medicamentosa: aspects of pathophysiology and treatment
Authors: Graf Peter
Published: December 2008

With modern vasoconstrictors, such as oxy‐ and xylometazoline, the risk of developing rhinitis medicamentosa (RM) has been considered to be small or even nonexistent. However, recent studies have shown that overuse of these drugs may result in rebound congestion, nasal hyperreactivity, tolerance, and histologic changes of the nasal mucosa. Using rhinostereometry, it has also been shown that the long‐term use of the preservative benzalkonium chloride (BKC) in oxymetazoline nasal spray accentuates the severity of rhinitis medicamentosa in healthy volunteers. A nasal decongestant spray composed of a combination of vasoactive substances and BKC has a long‐term adverse effect on the nasal mucosa. BKC alone induces mucosal swelling after 30 days use of the nasal spray in healthy subjects, unlike placebo. According to the author, rhinitis medicamentosa can be defined as a condition of nasal hyperreactivity, mucosal swelling, and tolerance that is induced, or aggravated, by the overuse of topical vasoconstrictors with or without a preservative. An adequate treatment of these patients consists of a combination of vasoconstrictor withdrawal and a topical corticosteroid to alleviate the withdrawal process. The underlying nasal disorder must then be treated. Patients with rhinitis medicamentosa who overuse topical decongestants and are able to stop using such drugs should be careful about taking these drugs again, even for a few days. They must be informed about the rapid onset of rebound congestion upon repeated use in order to avoid the return of the vicious circle of nose‐drop abuse.
Effect of corticosteroids on nasal blockage in rhmitis measured by objective methods
Authors: Mygind Niels , Dahl Ronald , Nielsen Lars Peter , Hilberg Ole , Bjerkex Torbjørn
Published: December 2008

This paper gives an overview of placebo‐controlled studies of the effect of corticosteroid treatment on nasal blockage, based on objective measurements of nasal airway patency. A few studies of perennial rhinitis have indicated that pretreatment with an intranasal corticosteroid has a moderate effect on nasal hyperresponsiveness, measured as the histamine‐induced increase of nasal blockage. Whereas the effect on allergen‐induced early‐phase symptoms is variable, the effect on the late‐phase blockage is almost complete. In seasonal allergic rhinitis, a few studies have shown an effect of intranasal steroids on nasal airway resistance, nasal peak flow and on acoustic rhinometry, but there are no reports on the effect in adults with perennial rhinitis. In children with perennial disease, intranasal treatment results in increased nasal patency and, in one study, also in reduced mouth breathing and in an increased threshold for exercise‐induced bronchoconstriction. In patients with nasal polyposis, intranasal steroids have an effect on nasal airway resistance and on nasal peak flow both before and after polypectomy. There is convincing evidence that intranasal corticosteroids provide a better effect than antihistamine on nasal blockage. Amazingly, there does not appear to be any report on the effect of systemic corticosteroid treatment on nasal airway patency, and it is therefore difficult to recommend this treatment in a rational dosage. In conclusion, there is a fairly good documentation in support of the efficacy of intranasal steroid treatment on nasal airway patency in rhinitis. An objective measurement of nasal airway patency ought to be the routine in controlled rhinitis trials.
Characterization of allergens in plant‐derived spices: Apiaceae spices, pepper (Piperaceae), and paprika (bell peppers, Solanaceae)
Authors: Ebner C. , Jensen‐Jarolim E. , Leitner A. , Breiteneder H.
Published: December 2008

Allergens in spices from the botanic families Apiaceae, Piperaceae, and Solanaceae were characterized. IgE‐immunoblotting and IgE‐inhibition experiments revealed broad cross‐reactivity among spices and to pollen‐derived proteins. Moreover, monoclonal antibodies raised against cross‐reactive pollen allergens (profilin, Bet v 1) detected homologous proteins in almost every spice source analyzed. It can be concluded that allergy to spices rarely represents an autonomous sensitization, but is rather a consequence of pollen allergy on the basis of immunologic cross‐reactivity.
Management of food allergy
Authors: Nekarn K.
Published: December 2008

Our present options for the management of food allergy are avoidance and pharmacotherapy. There are, however, many promising perspectives for better future management such as the more extensive use of hydrolyzed and elemental formulas for therapy and prevention, or greater emphasis on diagnosis and treatment of accompanying diseases linked with increased gut permeability. In selected situations, specific immunotherapy might be helpful. Rapid progress is expected in the search for the conditions of induction of oral tolerance. The latest results in genetic engineering can give us very effective tools for mass production of less allergenic foods with high nutritional value ‐ if all safety, stability, productivity, and antigenicity problems can be solved.
Taxonomy and identification of dust mites
Authors: Colloff M. J.
Published: December 2008

Taxonomy provides the basis for the identity of species, allowing the construction of keys and the reliable, reproducible identification of dust mites for ecologic purposes and other studies. Details are given of nomenclatorial conventions in taxonomy as applied to dust mites, and taxonomically problematic entities are highlighted, such as Blomia kulagini and the sibling species Dermatophagoides farinae and D. microceras. Current keys to dust mites and advances in interactive computer keys are reviewed. An hypothesis of the phylogeny of the family Pyroglyphidae is presented, based on habitat specificity, geographic distribution, and association with birds. The value of predictive classifications based on phylogenies is stressed. Finally, a pictorial key is presented to the mites found in house dust in Scandinavia.
Quantification of house‐dust‐mite populations
Authors: Hill M. R.
Published: December 2008

Since the proposal that allergen from the mite Dermatophagoides pteronyssinusis identical to the house‐dust allergen supposed to cause asthma and allergy, interest

in the abundance, species diversity, and frequency of mites in the home has expanded.

Surveys and ecologic studies have confirmed the ubiquity of mites in house dust, especially mites of the family Pyroglyphidae, but most do not give an accurate estimate of population size or mite exposure. These are still important issues today in attempts to quantify theexposure to house‐dust mite that constitutes a risk, to assess mite‐eradication trials, and to determine fluctuations in mite population. The problems encountered with common methods of house‐dust sampling, mite extraction, and measuring house‐dust allergen are

discussed.
Epidemiology of house‐dust mites
Authors: Korsgaard J.
Published: December 2008

Available epidemiologic data on the occurrence of house‐dust mites in dwellings demonstrates a clear association between increased indoor air humidity and the increased occurrence of house‐dust mites in house dust. Furthermore, in temperate climates, there is a threshold level of indoor air humidity of 7 g/kg (45% relative humidity at usual indoor air temperatures). Indoor air humidities below this level for extended periods will eradicate house‐dust mites from dwellings. A reduction in inhabitant exposure to house‐dust mites is implemented by reduction of indoor air humidity by controlled mechanical ventilation. Individual ventilation levels are estimated from the actual size of house, number of inhabitants, and average outdoor air humidity in winter. In contrast, more humid areas of the world with average outdoor humidities above 6–7 g/kg in winter will support uniformly large populations of house‐dust mites, and reductions in indoor air humidity will have a comparatively minor effect on the occurrence of house‐dust mites. Present‐day building of energy‐efficient houses with increased sealing of the building envelope, paralleled by a similar renovation of older houses, has increased indoor air humidity and is probably the cause of the almost fourfold increase in the occurrence of house‐dust mites in Danish dwellings.
Identification and quantification of mite allergens
Authors: Luczynska C. M.
Published: December 2008

Allergens from the house dust mite are ubiquitous in house dust. Exposure to these allergens can cause acute symptoms in patients who are sensitized to house‐dust mite and have asthma or other allergic diseases, such as rhinitis or atopic dermatitis. It is not clear how much mite‐allergen exposure is a risk factor for the development of sensitization or for triggering acute symptoms. Therefore, it is important to be able to quantify accurately the amount of mite allergen present in the indoor environment in order to carry out studies to identify risk factors for exposure, to investigate exposure‐response effects, and to monitor the progress of allergen‐reducing regimens.
Mite sensitization in the Scandinavian countries and factors influencing exposure
Authors: Munir A. K. M.
Published: December 2008

Mites are the common sources of indoor allergen and play a major role in sensitization and elicitation of allergic disease. In the Scandinavian countries, mite infestations in the home were not common in the past decades. Recent studies show that sensitization to mites among children, particularly in Sweden, is increasing. Similar trends have also been reported in Norway. Poor indoor climate, e.g., high humidity and poor ventilation as a consequence of energy‐saving measures, are cited as a possible explanation of this increase. Modern furnishings, e.g., carpets and various kinds of upholstery, may also serve as reservoirs of indoor allergens. At least 2 μg of mite allergen per g of dust is considered to be a risk level for sensitization and symptoms of asthma. As compared to experience from other parts of the world, mite‐allergen levels are generally low in the northern Scandinavian regions. Recent studies from Sweden and other European countries show that mite sensitization may occur below 2 μg/g dust. Various environmental adjuvant factors may affect the threshold levels of allergen. In this review, the importance of the indoor environment for the accumulation of mite allergens, sensitization to mites in the Scandinavian countries, and various environmental factors that could influence exposure levels will be discussed.
House‐dust mites and asthma. A review on house‐dust mites as a domestic risk factor for mite asthma
Authors: Korsgaard J.
Published: December 2008

Increased exposure to house‐dust mites entails a greatly increased frequency of sensitization and increased frequency of mite asthma in the population. The available case‐control studies demonstrate large variations worldwide in sensitization and disease risk dependent on the actual level of population exposure. In areas with comparatively low population exposure to house‐dust mites, there is a strong association between exposure and effect, while other areas with a more or less uniformly high population exposure do not demonstrate significant differences between patients and controls because the unexposed groups are too small. As to the existence of a hygienic maximum threshold exposure level, current data all point to a single value of 100 mites/g of dust, corresponding to 2 μg allergen/g of dust. This applies to the risk of sensitization and risk of disease, and when programs of prevention imply exposure below this value, convincing clinical improvement is always observed. Today, the magnitude of the health problem related to population exposure to house‐dust mites in many areas is comparable to the effects of active tobacco smoking and traffic accidents.
Risk levels for mite allergen: are they meaningful, where should samples be collected, and how should they be analyzed?
Authors: Munir A. K. M.
Published: December 2008

Indoor allergen exposure plays a major role in the development of sensitization and triggering of asthma in children. All over the world, mites are common sources of indoor allergens. Risk levels for mite‐allergen exposure have been recommended. A mite‐allergen level of ≥2 μg/g dust is considered a risk level for sensitization and symptoms of asthma. Data from several ongoing prospective studies of children show that mite sensitization may occur below the suggested threshold level. However, from these studies, it seems that high mite‐allergen exposure increases the risk of early sensitization, whereas low exposure levels probably take a longer time to induce sensitization. Assessment of allergen exposure and consideration of allergen‐elimination strategies should not be limited only to the home environment. High levels of mite allergens are also found in day‐care centers, schools, and various other public places, such as bars. Thus, in addition to homes, these environments should also be considered when allergen‐avoidance measures are taken. Allergen content in dust can be expressed in several units, e.g., ng/g, ng/m2, and ng/sampling, and as the total amount of allergen. At present, there is no consensus on the best way to measure and express mite‐allergen levels. In this paper, aspects of threshold levels for mite sensitization, various exposure environments, and sampling, determination, and expression units of mite exposure will be discussed in brief.
Mite elimination ‐ clinical effect on eczema
Authors: Friedmann P. S. , Tan B. B.
Published: December 2008

Allergic reactivity to house‐dust mites (HDM) can be detected in patients with atopic eczema by prick and patch test challenge. To determine the clinical relevance of this reactivity, we performed a placebo‐controlled, double‐blind trial of anti‐HDM measures. Active treatment comprised Gortex bags for all the bedding elements, a high‐powered vacuum cleaner, and a spray containing benzyl alcohol and tannic acid to kill mites and denature allergens. Placebo treatment was light cotton bags, a cheap vacuum cleaner, and water spray. Forty‐eight patients (28 active group) completed the trial, which lasted 6 months. Dust was sampled from the mattress surface and bedroom and living‐room carpets before and at monthly intervals after institution of the measures. Dust was weighed and Der p 1 determined by ELISA (ALK). Patients were assessed for area and severity of eczema by a blinded observer. There was a highly significant reduction in bed surface dust ‐ most beds yielded insufficient dust to extract and assay. Carpet Der p 1 levels were reduced to similar minimal levels by both active and placebo treatments (about 250 ng/m2). There were highly significant benefits on the eczema scores, the active treatment being greatly superior to placebo (P < 0.0006; analysis of covariance). In conclusion, Gortex bed bags were highly effective at containing dust within the bed. This was associated with clinical improvement in most patients with atopic eczema ‐ the biggest improvements were seen in the most severely affected subjects. (The results of this study have been published [Lancet 1996;347:15–18].)
Peak expiration flow variations may reflect house‐dust‐mite exposure and patient
Authors: Hallas T. E. , Korsgaard J.
Published: December 2008

Peak expiration flow records from patients allergic to house‐dust mites (Dermatophagoides spp.) may show a characteristic variation from week to week due to the general life cycle of these mites in dwellings. This was demonstrated from the combined records of 10 patients recorded in their own homes, covering a period of 30 consecutive weeks and comprising 973 peak flows. The levels of house‐dust mites were predicted from published data for floor‐dust samples from Danish dwellings. Peak flow increased or decreased in accordance with weekly changes in the concentration of mites, rather than as an immediate reaction to the current concentration of live, active mites. A dose‐response relation was demonstrated. This suggests that the patients' peak flow variations might be linked to molting in mites. As such, peak flow measurements have a potential as a tool for the specific diagnosis of, monitoring of, and research in asthma caused by domestic mites.
Allergy to mites: relation to lung function and airway hyperresponsiveness
Authors: van der Heide S. , Dubois A. E. J. , Kauffman H. F. , de Monchy J. G. R.
Published: December 2008

Exposure to house‐dust‐mite allergens is an important cause of allergic reactions in sensitized patients. In community‐based studies, sensitization to house‐dust mites, as ascertained by a positive skin test or by an increased allergen‐specific IgE level in serum, is associated with both diminished lung function and enhanced airway hyperresponsiveness. Sensitization to house‐dust mites is an independent risk factor for the development of asthma, especially in areas which favor the growth of house‐dust mites. In studies with asthmatic patients, however, the relationship between sensitization to mites and lung function or airway hyperresponsiveness is less clear. The selection of asthmatic individuals (with sensitization to other inhalant allergens) and the use of medication such as inhaled steroids may interfere with the demonstration of a possible association between mite allergy and lung function or airway hyperresponsiveness in asthmatic patients.
Mechanisms of mucosal inflammation in the nose and lungs
Authors: Kips J.
Published: December 2008

To cite this article:

Kips J. Mechanisms of mucosal inflammation in the nose and lungs.

Allergy 1999, 54, 37–38.

Copyright © Munksgaard 1999 ISSN 0108–1675
What is the optimal way of treating these patients today and in the future?
Authors: Steinsvåg S.
Published: December 2008

To cite this article:

Steinsvåg S. What is the optimal way of treating these patients today and in the future! Allergy 1999, 54, 48–50.

Copyright © Munksgaard 1999 ISSN 0108–1675
3. Advances in the medical treatment of nasal polyps
Authors: Mygind Niels
Published: December 2008

The objectives of the medical management of nasal polyposis are to eliminate or reduce the size of polyps, re‐establish nasal breathing, reduce symptoms of rhinitis, restore the sense of smell and prevent the recurrence of nasal polyps. Corticosteroids have a proven therapeutic effect on the symptoms of nasal polyposis and may reduce one of the underlying causes of polyps, inflammation. The efficacy of topical corticosteroids such as beclomethasone dipropionate nasal spray and betamethasone nasal drops in reducing polyp size and rhinitis symptoms has been demonstrated in several randomized, placebo‐controlled trials. Flunisolide and budesonide have also been shown to delay the recurrence of polyps after surgery. Topical corticosteroids can be used as long‐term therapy either alone in mild cases, or combined with systemic corticosteroids and/or surgery in severe cases. Most patients will respond well to topical corticosteroid treatment of their nasal polyposis; consequently, the requirement for repetitive nasal surgery will be reduced.
4. Pharmaceutical properties of fluticasone propionate nasal drops: a new formulation
Authors: Denyer S.
Published: December 2008

A variety of corticosteroid delivery systems have been considered for the treatment of nasal polyposis. Safety considerations favour local delivery of the drug to the nasal cavity. No topical delivery system is entirely without problems, however, and formulations must address issues of microbiological quality, drug stability, reproducible drug delivery and adequate drug distribution at site, while also offering environmental and patient acceptability. Fluticasone propionate has been formulated in a new nasal drop preparation. As a highly water‐insoluble compound, the active fluticasone propionate requires microniza‐tion to an optimal particle size and subsequent dispersion with a surface‐active wetting agent. The product is presented in a unit dose low‐density polyethylene container, manufactured by a blow‐fill‐seal process and stored in an aluminium foil overwrap. Micronized active has been used to promote optimal local drug delivery, and excipients have been selected for low irritancy potential and high formulation stability. There is no microbiological risk with fluticasone propionate unit dose nasal drops 400 μg and therefore no need to include a preservative in the preparation. They provide a convenient and effective treatment option for patients with nasal polyposis.
Cornulin, a marker of late epidermal differentiation, is down‐regulated in eczema
Authors: Liedén A. , Ekelund E. , Kuo I ‐C. , Kockum I. , Huang C ‐H. , Mallbris L. , Lee S. P. , Seng L. K. , Chin G. Y. , Wahlgren C ‐F. , Palmer C. N. A. , Björkstén B. , Ståhle M. , Nordensköld M. , Bradley M. , Chua K. Y. , D’Amato M.
Published: December 2008

Background:  Eczema is a common chronic inflammatory skin disorder which shows strong genetic predisposition. To identify new potential molecular determinants of the disease pathogenesis, we performed a gene expression study in an eczema mouse model. This analysis identified a marked down regulation of the cornulin gene (CRNN), a member of the epidermal differentiation complex, in the eczema‐like skin. We then investigated CRNN as an eczema candidate gene and studied its polymorphism and the expression in the skin of eczema patients.

Methods:  An eczema‐like phenotype was induced in mice by allergen (Der p2) patching. Gene expression analysis was performed with the subtractive suppression hybridization method and validated by real time PCR and the transmission disequilibrium test was used to test for genetic associations in 406 multiplex eczema families.

Results:  Der p 2 patched mice developed a localized eczema and a Th 2 skewed systemic response. Real time PCR analysis confirmed a down regulation of CRNN mRNA in eczema‐like skin in the mouse model and in human eczema. The CRNN polymorphism rs941934 was significantly associated with atopic eczema in the genetic analysis (P = 0.006), though only as part of an extended haplotype including a known associated variant (2282del4) in the filaggrin gene.

Conclusions:  CRNN mRNA expression is decreased in eczematous skin. Further studies are needed to verify whether the associated cornulin polymorphism contribute to the genetic susceptibility in eczema.
Preoxygenation in children: for how long?
Authors: Videira R. L. R. , Neto P. P. R. , do Amaral R. V. Gomide , Freeman J. A.
Published: December 2008

Although preoxygenation has been extensively studied, to our knowledge this is the first study addressing its optimal length in children, who form a high risk group for developing hypoxaemia during induction of anaesthesia. Recommended preoxygenation times in children range between 1 and 4 min, but whether one of these times maintains arterial oxygen saturation (Sao2) at an adequate level for a longer time period is unknown. This study was performed on 11 healthy children, randomly distributed into either Group 1 (1 min of preoxygenation, n = 6) or Group 2 (3 min of preoxygenation, n = 5). Sao2 was measured by pulse oximetry. While the patients were breathing room air, Sao2 was similar in both groups (97%) and rose to 100% after preoxygenation in all patients. After intravenous induction of anaesthesia and muscle relaxation, all patients became apnoeic. The time taken for the Sao2 to decrease to 90% was measured. In Group 1 this occurred in 91 s, whereas Group 2 required 144 s. Thus, a 3‐min rather than a 1‐min period of preoxygenation would appear to maintain Sao2 at a safe level for a longer time in children.
Serum steroids and prolactin during and after major surgical trauma
Authors: Lindh A. , Carlström K. , Eklund J. , Wilking N.
Published: December 2008

Serum levels of cortisol, dehydroepiandrosterone (DHA) and its sulfate (DHAS), 4‐androstene‐3,17‐dione (A‐4), 17‐alfa‐hydroxy‐progesterone (17 OHP), testosterone (T, only in males), unconjugated (E1) and total estrone (tE1 >85% estrone sulfate) were studied in six male and two female patients before, during and up to 30 days after aortic graft surgery. All steroids except 17 OHP decreased following induction of anesthesia but, except for testosterone, rose again during surgery to preoperative levels or slightly above. Extremely high peak values for El and tE1 and a less pronounced peak for cortisol were noted on postoperative day 2; after that, the levels of these steroids returned to normal. The levels of 17‐OHP, DHA and DHAS decreased after surgery and were below preoperative values from postoperative day 4 to day 16 or (DHAS) day 30. In males, 17 OHP showed a pronounced peak 30 min after initiation of surgery, but decreased after that to below preoperative values. Testosterone levels decreased further during surgery and remained very low until postoperative day 16. Major surgical trauma has a rapid, profound and long‐lasting effect on gonadal activity, as judged from decreased testosterone levels, while the effect on adrenal steroids is less pronounced. Adrenal Δ4 and Δ5‐steroids showed different patterns in the postoperative period, indicating differences in their regulation. The highly elevated estrogen levels on postoperative day 2 probably reflect either transiently elevated peripheral aromatization or decreased estrogen metabolism rather than increased levels of substrate steroids (A‐4).The biological significance of this remains to be elucidated.
The influence of halothane on spermatogenesis in surgical patients
Authors: Andersen B. N. , Mortensen J. T. , Hansen P. , Jakobsen J. , Johansen J. P.
Published: December 2008

Seventeen male patients delivered a sperm sample before and 80–90 days after halothane anaesthesia, acting as their own control. The sample was tested according to WHO criteria. There was no difference before and after anaesthesia. We conclude that halothane used in normal anaesthetic concentration in combination with nitrous oxide during arthroscopic knee surgery had no certain effect on the quality of sperm.
Cerebral arteriovenous difference of oxygen during gradual and sudden increase of the concentration of isoflurane for induction of deliberate hypotension
Authors: Haraldsted V. Y. , Asmussen J. , Herlevsen P. , Cold G. E.
Published: December 2008

In 20 patients undergoing surgery for cerebral aneurysms, hypotension was induced with either gradual (over 5 min) or sudden increase of inspiratory concentration of isoflurane from 0.5% to 3%. Both modes elicited the same speed of induction of deliberate hypotension and similar decreases of cerebral arteriovenous difference of oxygen (AVDo2). The overall median values of mean arterial blood pressure decreased from 75.5 (range 64–90) mmHg (10 (8.5–12.0) kPa) to 55 (40–66) mmHg (7.3 (5.3–8.8) kPa) and the overall AVDo2 decreased from 6.75 ml/100 ml (3.8–9.4 ml/100 ml) to 5.85 ml/100 ml (2.6–8.1 ml/100 ml) within 10 min. It is concluded that irrespective of gradual or sudden increase of isoflurane concentration, cerebral blood flow is in surplus of metabolism and a favourable oxygen demand/supply ratio is maintained during induction of deliberate hypotension by isoflurane below 2.5 MAC.
Oral clonidine premedication for elderly patients undergoing intraocular surgery*
Authors: Kumar A. , Bose S. , Bhattacharya A. , Tandon O. P. , Kundra P.
Published: December 2008

In a randomized double‐blind study, the effects of clonidine premedication as a sedative, anxiolytic, analgesic and oculohypotensive agent were studied in 100 elderly patients (62 to 65 ± 10 years, ASA grade I–II) undergoing elective intraocular surgery under local anaesthesia. The control group (Group A, n = 50) received oral diazepam 0.15 mg/kg 120 min before surgery and Group B (n = 50) received oral clonidine 300 μg 120 min before surgery. Two hours after the premedication, there was significantly more sedation (P<0.05) and less subjective anxiety (P<0.05) in the clonidine group than in the control group. There was a significant fall in intraocular pressure (IOP) from 20 ± 0.5 to 13 ± 0.5 mmHg (P<0.05) and significant reduction in systolic and diastolic blood pressure (BP) and heart rate (HR) (P<0.05) in the clonidine group as compared to the control group. Perioperatively, significantly more supplementation with i.v. diazepam was given in the control group than in the clonidine group (P<0.01). The incidence of intra‐operative hypertension (P<0.01) and tachycardia (P<0.05) was significantly greater in the control group than in the clonidine group. A significantly larger number of patients in the clonidine group scored a Post‐Anaesthesia Recovery (PAR) score of 10 as compared to the control group (P<0.01). There was no statistical difference in the postoperative Visual Analogue Scale (VAS) scores for pain, number of analgesic requests and emesis. Hence premedication with oral clonidine in these elderly patients undergoing elective intraocular surgery produced intraoperative sedation, reduction in anxiety and decrease in intraocular pressure. Postoperative recovery was improved in the clonidine group.
Effects of nitrous oxide/oxygen inhalation on the maternal circulation during vaginal delivery
Authors: Westling F. , Milsom I. , Zetterström H. , Ekström‐Jodal B.
Published: December 2008

The hemodynamic changes occurring during the first stage of labor were studied in 24 healthy pregnant women during inhalation of different nitrous oxide/oxygen (N2O/O2) gas mixtures (intermittent 70/30, 40/60, 0/100 and continuous 40/60). Cardiac output increased (P<0.01) from 6.6 ± 0.2 1/min between uterine contractions to 8.5 ± 0.3 1/min during contractions. Heart rate, stroke volume, systolic, diastolic and mean arterial pressures were increased (P<0.01) and total peripheral vascular resistance was reduced (P<0.01) during contractions compared to measurements performed between contractions. The maternal circulation was influenced by the use of N2O/O2. During intermittent inhalation, higher concentrations of N2O were associated with a decrease (P<0.01) in heart rate, cardiac output and arterial pressure as well as an increase (P<0.01) in stroke volume. The degree of pain relief also increased (P<0.01) with increasing concentrations of inhaled nitrous oxide. The circulatory influence of intermittent inhalation given during uterine contractions was also apparent during the interval between contractions when N2O/O2 was not administered. The most obvious effects on both circulation and pain were demonstrated during continuous inhalation of N2O/O2. There was a close association between analgetic and cardiovascular effects indicating that the latter, at least partly, were due to pain relief. However, it was not possible to exclude or confirm possible direct pharmacological effects of N2O/O2 on maternal circulation.