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Sample records for allergic fungal rhinosinusitis

  1. Allergic Fungal Rhinosinusitis.

    PubMed

    Hoyt, Alice E W; Borish, Larry; Gurrola, José; Payne, Spencer

    2016-01-01

    This article reviews the history of allergic fungal rhinosinusitis and the clinical, pathologic, and radiographic criteria necessary to establish its diagnosis and differentiate this disease from other types of chronic rhinosinusitis. Allergic fungal rhinosinusitis is a noninvasive fungal form of sinus inflammation characterized by an often times unilateral, expansile process in which the typical allergic "peanut-butter-like" mucin contributes to the formation of nasal polyps, hyposmia/anosmia, and structural changes of the face. IgE sensitization to fungi is a necessary, but not sufficient, pathophysiologic component of the disease process that is also defined by microscopic visualization of mucin-containing fungus and characteristic radiological imaging. This article expounds on these details and others including the key clinical and scientific distinctions of this diagnosis, the pathophysiologic mechanisms beyond IgE-mediated hypersensitivity that must be at play, and areas of current and future research. PMID:27393774

  2. Allergen Immunotherapy in an HIV+ Patient with Allergic Fungal Rhinosinusitis

    PubMed Central

    Myles, Ian A.; Gada, Satyen

    2015-01-01

    Patients with HIV/AIDS can present with multiple types of fungal rhinosinusitis, fungal balls, granulomatous invasive fungal rhinosinusitis, acute or chronic invasive fungal rhinosinusitis, or allergic fungal rhinosinusitis (AFRS). Given the variable spectrum of immune status and susceptibility to severe infection from opportunistic pathogens it is extremely important that clinicians distinguish aggressive fungal invasive fungal disease from the much milder forms such as AFRS. Here we describe a patient with HIV and AFRS to both remind providers of the importance of ruling out invasive fungal disease and outline the other unique features of fungal sinusitis treatment in the HIV-positive population. Additionally we discuss the evidence for and against use of allergen immunotherapy (AIT) for fungal disease in general, as well as the evidence for AIT in the HIV population. PMID:25954557

  3. Allergic fungal rhinosinusitis due to Curvularia lunata.

    PubMed

    Cavanna, Caterina; Seminari, Elena; Pusateri, Alessandro; Mangione, Francesca; Lallitto, Fabiola; Esposto, Maria Carmela; Pagella, Fabio

    2014-04-01

    We report a case of Curvularia lunata infection in an immunocompetent male with an initial diagnosis of suspected left side allergic fungal rhinosinusitis (AFRS), treated surgically. He had a relapse of nasal polyposis and underwent a surgical revision under local anaesthesia with endoscopic nasal polypectomy. The histological examination of the surgical specimen showed an inflammatory polyp of the paranasal sinuses, with eosinophil and lymphocyte infiltration, but without evidence of fungi. However, Curvularia spp fungus grew in cultures of nasal sinus drainage and bioptical specimens. The fungus was identified by DNA sequencing as C. lunata. The patient was then treated with itraconazole (200 mg BID for 4 weeks), mometasone furoate nasal spray (100 mcg BID for 6 months) and normal saline nasal irrigations. At the last follow-up endoscopic evaluation after 19 month from treatment, the patient was symptomless and free from disease. No polyp recurrence nor seromucous discharges were noticed. This first case of C. lunata-associated AFRS reported in Italy, highlights the difficulty of this diagnosis and the usefulness of molecular identification of the fungal species involved.

  4. CD8+ T cells implicated in the pathogenesis of allergic fungal rhinosinusitis

    PubMed Central

    Macardle, Peta

    2014-01-01

    Fungi in paranasal sinuses are characteristic and considered a major pathogenic factor in a subset of chronic rhinosinusitis (CRS) patients, known as allergic fungal rhinosinusitis (AFRS). CD8+ T cells are enriched in AFRS sinuses but their role in fungal-specific responses is unknown. Alternaria alternata– and Aspergillus fumigatus–specific T lymphocyte responses were investigated in 6 AFRS patients, 10 eosinophilic mucus CRS (EMCRS) patients, 10 CRS with nasal polyps (CRSwNPs) patients, 6 allergic rhinitis with fungal allergy (ARFA) patients, and five controls. Fungal-specific proliferation of human peripheral blood mononuclear cells (PBMCs) was studied prospectively. Proliferating cells were examined for CD3, CD4, CD8, and CD25 expression. Relevant clinical characteristics, fungal allergy, detection of fungi in sinuses, and CD4+ and CD8+ composition of sinus T cells were also examined. CD4+ T-cell division to fungi occurred in all samples, regardless of fungal allergy or CRS. Fungal-specific CD8+ T-cell division occurred in all ARFA and control samples and the majority of CRSwNP patients; however, CD8+ T cells failed to proliferate in AFRS and EMCRS patients. The CD8+ T cells from AFRS patients also did not up-regulate the activation marker, CD25, with fungal antigen exposure. Presence of A. alternata– and A. fumigatus–specific CD4+ and CD8+ T-cell proliferation in healthy individuals, ARFA, and CRSwNP patients suggests that both T-cell subsets may be important in immune responses to these fungi. In AFRS and EMCRS patients, only fungal-specific CD4+ T-cell proliferation occurred; hence, a lack of CD8+ T-cell proliferation and activation in the presence of sinus eosinophilic mucus in these patients, regardless of fungal allergy, is a novel finding. This raises the question whether a dysfunctional CD8+ T-cell response predisposes to ineffective clearance and accumulation of fungi in the sinuses of susceptible patients. PMID:25565051

  5. Overview of fungal rhinosinusitis.

    PubMed

    Chakrabarti, Arunaloke; Das, Ashim; Panda, Naresh K

    2004-10-01

    The incidence of fungal rhinosinusitis has increased to such extent in recent years that fungal infection should be considered in all patients with chronic rhino sinusitis. In India though the disease was reported earlier only from northern regions of this country, nowadays the disease is increasingly diagnosed from other parts as well. The disease has been categorized with possible five types: acute necrothing (fulminant), chronic invasive, chronic granulomatous invasive, fungal hall (sinus mycetoma), allergic. The first three types are tissue-invasive and the last two are non-invasive fungal rhinosinusitis. However, the categorization is still controversial and open to discussion. Chronic fungal rhinosinusitis can occur in otherwise healthy host and Aspergillus flavus is the common etiological agent in Indian scenario. The pathophys iologic mechanism of the disease remains unclear. It may represent an allergic IgE response, a cell-mediated reaction, or a combination of two. Early diagnosis may prevent multiple surgical procedures and lead to effective treatment. Histopathology and radio-imaging techniques help to distinguish different types and delineate extension of disease process. Culture helps to identify the responsible etiological agent. The presence or absence oj precipitating antibody correlates well with disease progression or recovery. The most immediate need regarding management is to establish the respective roles of surgery and antifungal therapy. Non-invasive disease requires surgical debridement and sinus ventilation only, though, additional oral or local corticosterold therapy may be beneficial in allergie type. For invasive disease, the adjuvant medical therapy is recommended to prevent recurrence and further extension. Itraconazole has been found as an effective drug in such situation. Patients with acute neerotizing type require radical surgery and amphotericin B therapy.

  6. Prevalence and clinical profile of fungal rhinosinusitis

    PubMed Central

    Arumugam, Dayanand; Zacharias, George; Palaninathan, Sengottaiah; Vishwanathan, Ravisankar; Venkatraman, Vaidyanathan

    2016-01-01

    Background: There are only a few landmark studies from the Indian subcontinent on fungal rhinosinusitis. The lack of awareness among clinicians regarding the varying clinical presentations of fungal rhinosinusitis prompted us to undertake this study. Objective: To determine the prevalence, etiologic basis, clinical features, radiologic features, and microscopic features of fungal rhinosinusitis, and to evaluate the various treatment modalities available. Methods: This was a prospective study in which evaluation of 100 patients with chronic rhinosinusitis was done. Specimens collected were subjected to both microbiology and pathologic examination; data collected, including clinical and radiologic features, were analyzed by the Pearson χ2 test and Fisher's exact test. Results: The prevalence of fungal rhinosinusitis in our study was 30% (n = 30). Mucor was the most commonly isolated species (n = 15 [50%]) of fungus. Pathologic examination had a higher sensitivity (76.67%) compared with microbiology tests (50%) in the diagnosis of fungal rhinosinusitis. Fungus ball (n = 14 [46.6%]) was the most prevalent entity in the spectrum of fungal rhinosinusitis. Forty percent of cases (n = 12) were of invasive fungal rhinosinusitis. The prevalence of fungal rhinosinusitis was higher among individuals who were immunocompetent (n = 17 [56.6%]). Of patients who were immunocompromised, 84.6% (n = 11) had mucormycosis. Conclusions: Unilateral involvement of paranasal sinuses was more in favor of fungal etiology. Complications were more common in fungal rhinosinusitis caused by Mucor species. Mucormycosis, a rare clinical entity, in subjects who were immunocompetent, had a high prevalence in our study. PMID:27349695

  7. Chapter 8: Invasive fungal rhinosinusitis.

    PubMed

    Duggal, Praveen; Wise, Sarah K

    2013-01-01

    Invasive fungal rhinosinusitis (IFRS) is a disease of the paranasal sinuses and nasal cavity that typically affects immunocompromised patients in the acute fulminant form. Early symptoms can often mimic rhinosinusitis, while late symptoms can cause significant morbidity and mortality. Swelling and mucosal thickening can quickly progress to pale or necrotic tissue in the nasal cavity and sinuses, and the disease can rapidly spread and invade the palate, orbit, cavernous sinus, cranial nerves, skull base, carotid artery, and brain. IFRS can be life threatening if left undiagnosed or untreated. While the acute fulminant form of IFRS is the most rapidly progressive and destructive, granulomatous and chronic forms also exist. Diagnosis of IFRS often mandates imaging studies in conjunction with clinical, endoscopic, and histopathological examination. Treatment of IFRS consists of reversing the underlying immunosuppression, antifungal therapy, and aggressive surgical debridement. With early diagnosis and treatment, IFRS can be treated and increase patient survival.

  8. Allergic fungal otomastoiditis: a case report.

    PubMed

    Chen, Chiung-Ming; Chiang, Ching-Wen

    2013-04-01

    Allergic mucin is described as thick, peanut butter-like mucus impacted in the paranasal sinuses of patients with allergic fungal rhinosinusitis. The presence of allergic mucin in the middle ear has never been reported. We encountered a 65-year-old female with allergic mucin found impacted in her left middle ear and mastoid cavity during revised tympanoplasty surgery at our institute. Bilateral endoscopic sinus surgery performed 3 months later showed no evidence of fungal infection or allergic mucin in her paranasal sinuses. We report the case herein and propose the term allergic fungal otomastoiditis for this disease entity. PMID:22825725

  9. Pediatric rhinosinusitis.

    PubMed

    Magit, Anthony

    2014-10-01

    This review addresses the diagnosis and treatment of acute and chronic rhinosinusitis. Antimicrobial and adjuvant therapies, including topical treatments, are discussed. Surgical intervention is included in the treatment options. Clinical characteristics of rhinosinusitis are presented with an emphasis on history and physical examination. The use of imaging is described with regard to the indications for imaging and selection of imaging modalities. Complications of rhinosinusitis, with management recommendations based on recent data, are described. The evaluation and management of patients with cystic fibrosis and allergic fungal sinusitis is part of the discussion of less common scenarios of patients with sinus disease. PMID:25213280

  10. The spectrum of allergic fungal diseases of the upper and lower airways.

    PubMed

    Rodrigues, Jonathan; Caruthers, Carrie; Azmeh, Roua; Dykewicz, Mark S; Slavin, Raymond G; Knutsen, Alan P

    2016-01-01

    Fungi cause a wide spectrum of fungal diseases of the upper and lower airways. There are three main phyla involved in allergic fungal disease: (1) Ascomycota (2) Basidiomycota (3) Zygomycota. Allergic fungal rhinosinusitis (AFRS) causes chronic rhinosinusitis symptoms and is caused predominantly by Aspergillus fumigatus in India and Bipolaris in the United States. The recommended treatment approach for AFRS is surgical intervention and systemic steroids. Allergic bronchopulmonary aspergillosis (APBA) is most commonly diagnosed in patients with asthma or cystic fibrosis. Long term systemic steroids are the mainstay treatment option for ABPA with the addition of an antifungal medication. Fungal sensitization or exposure increases a patient's risk of developing severe asthma and has been termed severe asthma associated with fungal sensitivity (SAFS). Investigating for triggers and causes of a patient's asthma should be sought to decrease worsening progression of the disease. PMID:26776889

  11. Novel treatment of allergic fungal sinusitis using omalizumab.

    PubMed

    Evans, Martin Oman; Coop, Christopher Albert

    2014-01-01

    A case report of recalcitrant allergic fungal sinusitis (AFS) refractory to systemic corticosteroids and multiple functional endoscopic sinus surgeries (FESSs) treated with anti-IgE antibody omalizumab is reported. AFS is often classified with chronic rhinosinusitis (CRS). Although similar symptoms are among the two diseases, AFS has a unique pathophysiology. Patients with AFS demonstrate type 1 hypersensitivity to fungal allergens, increased total serum IgE, increased CD8(+) T-cell prevalence, and IL-4 and IL-5 response. Omalizumab should be considered in the treatment of AFS. PMID:25565055

  12. Orbital Metastasis of Breast Cancer Mimicking Invasive Fungal Rhinosinusitis.

    PubMed

    Tabai, Mayara; Hazboun, Igor Moreira; Sakuma, Emerson Taro Inoue; Sampaio, Marcelo Hamilton; Sakano, Eulalia

    2016-01-01

    Introduction. A range of traumatic, vascular, inflammatory, infectious, and neoplastic processes can affect the orbit and its structures. In the area of otolaryngology, the rhino-orbital-cerebral involvement of invasive fungal rhinosinusitis can affect the orbit, which may look like initially a rhinosinusitis or even mimic malignancy. Case Presentation. Female patient, 32 years old, with headache and ocular proptosis. She was using prednisone in immunosuppressive doses for a year and had breast cancer treated three years earlier. The initial CT scan showed opacification of the sphenoid and ethmoid sinuses, left intraorbital involvement and contrast impregnation in the cavernous sinus. The biopsy resulted positive for invasive ductal carcinoma of the breast. Discussion. The initial CT scan of our patient showed both signs of early changes of invasive fungal rhinosinusitis (IFR) and possible metastatic involvement. The intracranial extension and ocular involvement are usually the most common signs of IFR (first hypothesis). Among metastases at the orbit and the eye, breast and lung carcinomas are the most frequent. Conclusion. Although several studies on the differential diagnosis of orbital lesions exist, especially when it concerns the involvement of the nasal cavity, the diagnosis by imaging is still a challenge. PMID:27563478

  13. Orbital Metastasis of Breast Cancer Mimicking Invasive Fungal Rhinosinusitis

    PubMed Central

    Hazboun, Igor Moreira; Sakuma, Emerson Taro Inoue; Sampaio, Marcelo Hamilton

    2016-01-01

    Introduction. A range of traumatic, vascular, inflammatory, infectious, and neoplastic processes can affect the orbit and its structures. In the area of otolaryngology, the rhino-orbital-cerebral involvement of invasive fungal rhinosinusitis can affect the orbit, which may look like initially a rhinosinusitis or even mimic malignancy. Case Presentation. Female patient, 32 years old, with headache and ocular proptosis. She was using prednisone in immunosuppressive doses for a year and had breast cancer treated three years earlier. The initial CT scan showed opacification of the sphenoid and ethmoid sinuses, left intraorbital involvement and contrast impregnation in the cavernous sinus. The biopsy resulted positive for invasive ductal carcinoma of the breast. Discussion. The initial CT scan of our patient showed both signs of early changes of invasive fungal rhinosinusitis (IFR) and possible metastatic involvement. The intracranial extension and ocular involvement are usually the most common signs of IFR (first hypothesis). Among metastases at the orbit and the eye, breast and lung carcinomas are the most frequent. Conclusion. Although several studies on the differential diagnosis of orbital lesions exist, especially when it concerns the involvement of the nasal cavity, the diagnosis by imaging is still a challenge. PMID:27563478

  14. Chronic Invasive Nongranulomatous Fungal Rhinosinusitis in Immunocompetent Individuals

    PubMed Central

    Turhan, Ozge; Ozbudak, Irem Hicran; Turhan, Murat

    2016-01-01

    Chronic invasive nongranulomatous fungal rhinosinusitis is a well-described but uncommon type of fungal rhinosinusitis (FRS). While the prevalence of chronic FRS is 0.11% in healthy individuals, only 1.3% of them are in nongranulomatous invasive nature. The majority of the cases in the literature have been reported from developing countries mostly located in the tropical regions, as typically occurring in the background of diabetes mellitus or corticosteroid treatment. The current paper reports four consecutive cases, who were diagnosed within a short period of six months at a single center of a country located outside the tropical climate zone. None of the patients had a comorbid disease that may cause immune suppression or a history of drug use. The only risk factor that may have a role in development of chronic invasive nongranulomatous FRS was that all of our patients were people working in greenhouse farming. Three cases underwent endoscopic sinus surgery, and one case underwent surgery with both endoscopic and external approaches. Systemic antifungal therapy was initiated in all cases in the postoperative period with voriconazole 200 mg orally twice a day. All patients achieved a complete clinical remission. Chronic invasive nongranulomatous FRS should be kept in mind in the presence of long-standing nonspecific sinonasal symptoms in immunocompetent individuals, particularly with a history of working in greenhouse farming. PMID:27703827

  15. Acupuncture Treatment of a Patient with Persistent Allergic Rhinitis Complicated by Rhinosinusitis and Asthma

    PubMed Central

    Kim, Ae-Ran; Choi, Jun-Yong; Kim, Jong-In; Jung, So-Young; Choi, Sun-Mi

    2011-01-01

    A pathophysiologic relationship between allergic rhinitis and rhinosinusitis and asthma has long been suggested. However, few clinical studies of acupuncture have been conducted on these comorbid conditions. A 48-year-old male suffering from persistent allergic rhinitis with comorbid chronic rhinosinusitis and asthma since the age of 18 years was studied. He complained of nasal obstruction, sneezing, cough, rhinorrhea and moderate dyspnea. He occasionally visited local ear-nose-throat clinics for his nasal symptoms, but gained only periodic symptom relief. The patient was treated with acupuncture, infrared radiation to the face and electro-acupuncture. Needles were inserted at bilateral LI20, GV23, LI4 and EX-1 sites with De-qi. Electro-acupuncture was performed simultaneously at both LI20 sites and additional traditional Korean acupuncture treatments were performed. Each session lasted for 10 min and the sessions were carried out twice a week for 5 weeks. The patient's Mini-Rhinoconjunctivitis Quality-of-Life Questionnaire score decreased from 38, at the beginning of treatment, to 23, 3 weeks after the last treatment. The Total Nasal Symptom Score was reduced from six (baseline) to five, 3 weeks after the last treatment. There was significant clinical improvement in the forced expiratory volume in 1 s—from 3.01 to 3.50 l—with discontinuation of the inhaled corticosteroid, and no asthma-related complaints were reported. Further clinical studies investigating the effectiveness of acupuncture for the patients suffering from allergic rhinitis and/or rhinosinusitis with comorbid asthma are needed. PMID:21785632

  16. Ministry of Health clinical practice guidelines: Management of Rhinosinusitis and Allergic Rhinitis.

    PubMed

    Siow, J K; Alshaikh, N A; Balakrishnan, A; Chan, K O; Chao, S S; Goh, L G; Hwang, S Y; Lee, C Y; Leong, J L; Lim, L; Menon, A; Sethi, D S; Tan, H; Wang, D Y

    2010-03-01

    The Ministry of Health publishes national clinical practice guidelines to provide doctors and patients in Singapore with evidence-based guidance on managing important medical conditions. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the Ministry of Health clinical practice guidelines on Management of Rhinosinusitis and Allergic Rhinitis, for the information of readers of the Singapore Medical Journal. Chapters, page and figure numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website (http://www.moh.gov.sg/mohcorp/publications.aspx?id=24046). The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

  17. Exophiala oligosperma involved in a refractory chronic rhinosinusitis.

    PubMed

    Badali, H; Hedayati, M T; Bahoosh, M; Kasir, A; Ghasemi, M; Motahari, J; Meis, J F; De Hoog, G S

    2011-03-01

    Fungal rhinosinusitis refers to a wide variety of conditions caused by fungal infections of the paranasal sinuses. Allergic fungal rhinosinusitis and sinus fungus balls are mostly noted in healthy individuals. Aspergillus species are supposed to be the most common etiologic agents of the disorder, but melanized fungi also occur, and these potentially are able to lead to fatal dissemination into brain parenchyma. We report on a case of fungus ball in a 20-year-old female with refractory chronic rhinosinusitis (RCRS) and bronchial asthma due to the black yeast Exophiala oligosperma which was confirmed by mycological and molecular (sequences of ITS rDNA) investigations. Exophiala oligosperma has previously not been reported to cause fungus balls or invasive fungal rhinosinusitis. Patient underwent functional endoscopic sinusitis surgery and the hypertrophic mucosa was removed completely. Without antifungal therapy, successful cure was achieved after spray therapy with corticosteroids for 1 month, without any relapse after a 6 month-follow up. PMID:21528779

  18. Perceived stress and severity of chronic rhinosinusitis in allergic and nonallergic patients.

    PubMed

    Tomljenovic, Dejan; Pinter, Darko; Kalogjera, Livije

    2014-01-01

    Chronic stress exposure carries greater risk of onset of atopic respiratory disorders such as rhinitis and asthma. The interaction between depression, anxiety, and severity of chronic rhinosinusitis (CRS) has been suggested. We aimed to access the relationship between psychological stress, severity of CRS, and atopy. Sixty-three consecutive patients referred with CRS were asked to score the severity of rhinosinusitis symptoms on a visual analog scale and to fill in questionnaires on the disease-specific quality of life and perceived stress-22-item Sino-Nasal Outcome Test (SNOT-22) and measure of perceived stress (MPS) scale, respectively. Inclusion criteria for the study were a reliable allergy evaluation and a recent computerized tomography (CT) scan of the sinuses. Patients with nasal polyps (NPs), asthma, and previous surgery were excluded. The study group consisted of 14 allergic and 18 nonallergic patients with CRS without NPs (CRSsNPs). Correlation between MPS and SNOT-22 scores in the study group was highly significant (Pearson r = 0.61; p = 0.001). Patients with higher stress scores had significantly stronger postnasal discharge, thick discharge, cough, disturbed sleep, fatigue, and sadness. Postnasal drip was significantly stronger in patients with allergy. The correlation between SNOT-22 and CT scores was insignificant. The correlation between MPS and SNOT-22 scores suggests an interaction between severity of CRS and chronic stress, but not with the extent of the disease on CT in CRSsNPs. Chronic psychological stress might be one of the factors that modifies the disease severity and may lead to uncontrolled disease in CRS patients. PMID:25295807

  19. The status quo and unmet needs in the management of allergic rhinitis and chronic rhinosinusitis: a Malaysian perspective

    PubMed Central

    Wang, De Yun; Nair, Gopalan; Maurer, Marcus

    2014-01-01

    Background Allergic rhinitis and rhinosinusitis, common and debilitating conditions, should be managed in accordance with guideline recommendations. Guideline adherence shows regional differences. As of now, there is little data from Asia and none from Malaysia on the current treatment practices and unmet needs in the management of these conditions. Objective The objective of this study was to assess the current practice in the management of allergic rhinitis and rhinosinusitis by conducting a survey among ear, nose and throat (ENT) specialists, pharmacists, and general practitioners (GPs) in Malaysia. Methods We conducted a survey study among ENT specialists, pharmacists, and GPs in Malaysia, who answered a multiple choice questionnaire focused on the current practice in the management of allergic rhinitis and rhinosinusitis in their respective field. More than 200 ENT specialists, 100 pharmacists, and 200 GPs participated in the survey. Results Antihistamines were the most preferred choice for the treatment of mild allergic rhinitis by ENT specialists (45%), pharmacists (78%), and GPs (51%), with the most preferable duration of <2 weeks. In moderate-to-severe allergic rhinitis, a combination of antihistamines and intranasal steroids was the most preferred treatment of choice in 90% of ENT specialists, 72% of pharmacists, and 69% of GPs. Efficacy of antihistamines was the main criteria of choice in 58%, 53%, and 38% of ENT specialists, pharmacists, and GPs, respectively. Notably, complaints of drowsiness associated with nonsedative antihistamines were the major unmet need identified in the survey. For chronic rhinosinusitis, a combination of antihistamines and intranasal steroids was the most preferred treatment. The majority of the respondents preferred a treatment duration of >3 months with antihistamines. Satisfaction with the recommendations in the current Allergic Rhinitis and its Impact on Asthma (ARIA) guideline was high; 66%, 58%, and 89% of the ENT

  20. A novel insight into the immunologic basis of chronic granulomatous invasive fungal rhinosinusitis

    PubMed Central

    Rae, William; Doffinger, Rainer; Shelton, Fenella; Sproson, Eleanor; Ismail-Koch, Hasnaa; Lund, Valerie J.; Harries, Philip G.; Eren, Efrem

    2016-01-01

    Background: Chronic granulomatous invasive fungal rhinosinusitis (CGIFRS) is a rare disease. The underlying immune responses that drive the development of CGIFRS, as opposed to successful pathogen clearance and controlled inflammation, are not currently known. Objective: To characterize the immune responses associated with CGIFRS. Methods: In addition to a battery of basic investigations, more in-depth immunologic testing involves ex vivo whole-blood stimulation with the polyclonal T-cell mitogen phytohemagglutinin and fungal antigens with interleukin (IL) 12, was undertaken to investigate cell-mediated immune responses associated with CGIFRS. Results: Ex vivo whole-blood stimulation with the polyclonal T-cell mitogen phytohemagglutinin and fungal antigens with IL-12 identified reduced interferon gamma and increased IL-17A levels within the supernatant, which indicated increased in vivo T-helper (Th)17 responses and impaired Th1 responses compared with healthy controls. Conclusion: These findings suggest that the development of CGIFRS may be associated with an abnormally exaggerated host Th17 response, which caused failure to clear the fungal pathogen with refractory fungal infection of mucosal membranes, resulting in chronic tissue inflammation. PMID:27658186

  1. Imaging of acute invasive fungal rhinosinusitis in a patient with gorlin syndrome and acute lymphocytic leukemia.

    PubMed

    Donovan, S T; Thompson, J W; Sandlund, J T; Adderson, E E; Pivnick, E K; Harreld, J H

    2013-01-01

    Gorlin Syndrome (GS), also known as nevoid basal cell carcinoma syndrome, is a rare autosomal dominant condition characterized by developmental abnormalities and predisposition to certain neoplasms. Acute invasive fungal rhinosinusitis (AIFRS) is an uncommon clinical entity characterized by high morbidity and mortality. In immunocompromised patients, computed tomography plays a critical role in screening for suspected AIFRS. However, due to the association between exposure to ionizing radiation and subsequent development of malignancies in patients with GS, patients with GS and suspected AIFRS present a unique and challenging clinical scenario. We present a case of a pediatric patient with GS and acute lymphocytic leukemia (ALL) diagnosed with AIFRS; to the best of our knowledge, it is the only case described in the literature.

  2. ASSESSING THE ALLERGIC POTENTIAL OF INDOOR AIR FUNGAL CONTAMINANTS

    EPA Science Inventory

    Assessing the Allergic Potential of Indoor Air Fungal Contaminants
    Marsha D W Ward1, Michael E Viana2, Yonjoo Chung3, Najwa Haykal-Coates1, Lisa B Copeland1, Steven H Gavett1, and MaryJane K Selgrade1. 1US EPA, ORD, NHEERL, RTP, NC, USA. 2NCSU, CVM, Raleigh, NC, USA, 3 UNC, S...

  3. Hyperprolactinemia Secondary to Allergic Fungal Sinusitis Compressing the Pituitary Gland

    PubMed Central

    Chapurin, Nikita; Wang, Cynthia; Steinberg, David M.; Jang, David W.

    2016-01-01

    Objective. We aim to describe the first case in the literature of allergic fungal sinusitis (AFS) presenting with hyperprolactinemia due to compression of the pituitary gland. Case Presentation. A 37-year-old female presented with bilateral galactorrhea and occipital headaches of several weeks. Workup revealed elevated prolactin of 94.4, negative pregnancy test, and normal thyroid function. MRI and CT demonstrated a 5.0 × 2.7 × 2.5 cm heterogeneous expansile mass in the right sphenoid sinus with no pituitary adenoma as originally suspected. Patient was placed on cabergoline for symptomatic control until definitive treatment. Results. The patient underwent right endoscopic sphenoidotomy, which revealed nasal polyps and fungal debris in the sphenoid sinus, consistent with AFS. There was bony erosion of the sella and clivus. Pathology and microbiology were consistent with allergic fungal sinusitis caused by Curvularia species. Prolactin levels normalized four weeks after surgery with resolution of symptoms. Conclusion. Functional endoscopic sinus surgery alone was able to reverse the patient's pituitary dysfunction. To our knowledge, this is the first case of AFS presenting as hyperprolactinemia due to pituitary compression. PMID:26998375

  4. Air pollution and its effect on the upper respiratory tract and on allergic rhinosinusitis.

    PubMed

    Trevino, R J

    1996-02-01

    The nose is the first organ system encountered by inhaled air and its associated pollutants. Pollutants are deposited during inspiration through the nose. They accumulate on mucus and are absorbed in the nasal mucosa, resulting in a number of deleterious effects on the body. Irritation of the nose and sinus from these pollutants, resulting from direct contact with the nasal mucosa, leads to inflammation, edema, swelling, and blocked sinuses. The result is acute and chronic sinusitis. Absorption of these chemicals into the body produces systemic effects. Their effect on the immune system, although subtle, leads to dramatic changes in the allergic diathesis. The T suppressor cell is the most sensitive cell of the immune system and the first to be affected by exposure to chemical pollutants. Diminution of the suppressor activity and the relative increase in helper activity in turn lead to increased immunoglobulin production and the manifestation of allergy symptoms. The underlying biochemical reaction is caused by the effects of pollutants on the T suppressor cell. Patients with existing allergies become brittle and difficult to treat with the exacerbation of the allergic diathesis. Removal of these chemical pollutants from the body as quickly as possible is essential for effective treatment of this problem. Dietary antioxidants help reduce the oxidizing effect of the pollutants and act as conjugators to remove the pollutants from the body.

  5. Necessary and sufficient role for T helper cells to prevent fungal dissemination in allergic lung disease.

    PubMed

    Porter, Paul C; Roberts, Luz; Fields, Anna; Knight, Morgan; Qian, Yuping; Delclos, George L; Han, Shuhua; Kheradmand, Farrah; Corry, David B

    2011-11-01

    Mucosal immune responses to fungal infection range from T helper type 2 (Th2) cell-directed allergic inflammation to Th1-predominant neutrophilic inflammation, but the mechanisms directing these divergent mucosal immune outcomes and the role of T cells in host defense against mucosal fungal infections are not known. Here we examined the mouse mucosal immune responses to 12 filamentous environmental fungal species over a broad range of exposure doses and determined the requirement of T cells for host defense. For all tested fungi, low-grade conidium exposures induced Th2- and eosinophil-predominant allergic lung disease, whereas higher exposures led to rapid conversion to neutrophil- and Th1 cell-predominant inflammation, a phenomenon we term immune phenotype switching. All fungal exposure doses were further linked to the secretion of interleukin-17A (IL-17A). Fungal infections with Curvularia lunata and Aspergillus fumigatus were typically confined to the airway during allergic inflammation but became locally invasive and disseminated to the brain at higher conidium challenge doses, in association with predominant Th1 responses. Fungal dissemination occurred at relatively low challenge doses with the conidia of Aspergillus fumigatus administered to recombinase activating gene 1 (Rag-1)-deficient mice, which lack B and T cells, but B cell-deficient μMT mice and T helper cell-reconstituted Rag-1-deficient mice were comparable to wild-type mice in preventing fungal dissemination. Our findings demonstrate that Th2 cell-predominant allergic responses followed by immune phenotype switching and fungal dissemination are highly predictable outcomes with progressive fungal infectious burdens and that T helper cell responses are protective against lethal fungal dissemination.

  6. The role of powered instrumentation in the surgical treatment of allergic fungal sinusitis.

    PubMed

    Mirante, J P; Krouse, J H; Munier, M A; Christmas, D A

    1998-08-01

    Allergic fungal sinusitis is a chronic disorder that is being more frequently recognized by otolaryngologists. It is a recurrent illness characterized by frequent exacerbations, and requires aggressive medical and surgical treatment. When surgical therapy is employed, it is necessary to ensure adequate debridement and removal of edematous tissue. We have been using powered dissection as our primary method in sinus surgery over the past three year. We have treated 11 patients with allergic fungal sinusitis, and find powered instrumentation to be very effective in removing the polypoid tissue from the nose and sinuses, and in providing a clear surgical field. The procedure can be performed safely with minimal trauma to normal tissue. We believe that the use of powered dissection greatly enhances the comprehensive treatment of allergic fungal sinusitis.

  7. Prevalence of IgE reactivities in mold-allergic subjects to commercially available fungal enzymes.

    PubMed

    Horner, W Elliott; Armstrong, Maricelis; El-Dahr, Jane; McCants, Marjorie; Reese, Gerald; Kobernick, Aaron K; Lehrer, Samuel B

    2008-01-01

    Fungi are important aeroallergens. However, fungal allergen sources of consistent quality for clinical testing are not readily available. Because some allergens have been identified as enzymes, we assessed the prevalence of IgE reactivity to commercially available fungal enzymes. The purpose of this study was to determine IgE antibody reactivity by radioallergosorbent assay (RAST) to commercially available fungal enzymes in mold-allergic individuals. Sera from 20 subjects with symptoms of respiratory allergies and skin test reactivity to 2 or more fungal allergens (4 conidial [imperfecti] fungi and/or 8 basidiomycetes) were selected. Controls were six atopic individuals with neither history of fungal allergy nor skin test reactivity to fungi. Seventeen commercial fungal enzymes were used as antigens to evaluate the subjects' IgE antibody reactivity by RAST. Sera from most fungus-allergic individuals showed substantial IgE antibody reactivity to enzymes; control sera showed little or no reactivity. The mean reactivity to all commercial enzymes of all subjects tested was RAST > or = 3% with only one exception. The most reactive fungal enzymes were invertase (bakers' yeast, Saccharomyces cerevisiae), cellulase (Trichoderma viride), and glucosidase (brewers yeast, S. cerevisiae) with mean binding of 14.6, 9.5, and 8.8%, respectively. Using RAST results with a combination of four enzymes from S. cerevisiae (brewers yeast glucosidase, bakers' yeast maltase, invertase, and invertase V), a sensitivity of 100% was shown for detecting mold-allergic patients. The studies suggest that fungal enzymes may be useful source materials for the identification of fungal allergens and may also provide readily available source materials to produce improved diagnostic and therapeutic reagents.

  8. Effect of thermoneutral housing on fungal-induced respiratory allergic disease in mice

    EPA Science Inventory

    Climate change is projected to increase the number of fungal, bacterial, and pollen agents both indoors and outdoors and may become a significant health impact. Combined with the thermal stress from a rise in global temperatures, it is important to consider how respiratory allerg...

  9. Update on the management of chronic rhinosinusitis

    PubMed Central

    Cain, Rachel B; Lal, Devyani

    2013-01-01

    Chronic rhinosinusitis (CRS) is a common disorder characterized by mucosal inflammation of the nose and paranasal sinuses with sinonasal symptoms persisting for greater than 12 weeks. The etiology of CRS is incompletely understood. Current understanding supports inflammation, rather than infection, as the dominant etiologic factor. CRS significantly impacts patients’ quality of life and health care expenditure. There is no standard management of CRS. Treatment strategies differ based on divergent etiologies of the various CRS subclasses. Both systemic and topical agents are used. These interventions differ in CRS with nasal polyposis (CRSwNP), CRS without nasal polyposis (CRSsNP) and specific situations such as allergic fungal rhinosinusitis or aspirin-exacerbated respiratory disease. Antibiotics are the most commonly prescribed medication for CRS, but their role in management is not strongly supported by high-level studies. This paper provides a succinct review of the evidence supporting or refuting common therapeutic agents in the management of CRS. Novel and emerging strategies will also be discussed. PMID:23378777

  10. Oral Therapeutics for Rhinosinusitis with Nasal Polyposis.

    PubMed

    Thomas, Andrew J; Alt, Jeremiah A

    2016-01-01

    Oral therapeutics for chronic rhinosinusitis with nasal polyps (CRSwNP) include oral corticosteroids (OCS), antibiotics, antifungals and anti-leukotrienes. Of these treatments, the strongest evidence exists to support the use of a short course of OCS for treatment of CRSwNP, and OCS are the most consistently recommended oral therapy in practice guidelines. Antibiotics have demonstrated some utility, which appears more likely related to an anti-inflammatory rather than antimicrobial effect. The non-macrolide antibiotics lack sufficient evidence to support their use, though among this class doxycycline has some limited evidence of benefit in CRSwNP. Greater evidence exists for the use of macrolide antibiotics which have shown reduction of subjective and objective measures of CRSwNP severity. A short course of a macrolide should be considered as an option. Oral antifungals are not recommended in the treatment of CRSwNP given disappointing results and known potential adverse effects, except in allergic fungal rhinosinusitis where they may play a role. Leukotriene antagonists have demonstrated some promise in the treatment of CRSwNP, though studies are limited, but should be considered a potentially useful oral therapeutic. The current level of evidence for these oral therapeutic options for CRSwNP is reviewed in this chapter. PMID:27466856

  11. RELATIVE POTENCY OF FUNGAL EXTRACTS IN INDUCING ALLERGIC ASTHMA-LIKE RESPONSES IN BALB/C MICE

    EPA Science Inventory

    Indoor mold has been associated with the development of allergic asthma. However, relative potency of molds in the induction of allergic asthma is not clear. In this study, we tested the relative potency of fungal extracts (Metarizium anisophilae [MACA], Stachybotrys ...

  12. Sinonasal Fungal Infections and Complications: A Pictorial Review

    PubMed Central

    Gavito-Higuera, Jose; Mullins, Carola Birgit; Ramos-Duran, Luis; Sandoval, Hugo; Akle, Nassim; Figueroa, Ramon

    2016-01-01

    Fungal infections of the nose and paranasal sinuses can be categorized into invasive and non-invasive forms. The clinical presentation and course of the disease is primarily determined by the immune status of the host and can range from harmless or subtle presentations to life threatening complications. Invasive fungal infections are categorized into acute, chronic or chronic granulomatous entities. Immunocompromised patients with poorly controlled diabetes mellitus, HIV and patients receiving chemotherapy or chronic oral corticosteroids are mostly affected. Mycetoma and Allergic Fungal Rhinosinusitis are considered non-invasive forms. Computer tomography is the gold-standard in sinonasal imaging and is complimented by Magnetic resonance imaging (MRI) as it is superior in the evaluation of intraorbital and intracranial extensions. The knowledge and identification of the characteristic imaging patterns in invasive – and non- invasive fungal rhinosinusitis is crucial and the radiologist plays an important role in refining the diagnosis to prevent a possible fatal outcome. PMID:27403401

  13. Sinonasal Fungal Infections and Complications: A Pictorial Review.

    PubMed

    Gavito-Higuera, Jose; Mullins, Carola Birgit; Ramos-Duran, Luis; Sandoval, Hugo; Akle, Nassim; Figueroa, Ramon

    2016-01-01

    Fungal infections of the nose and paranasal sinuses can be categorized into invasive and non-invasive forms. The clinical presentation and course of the disease is primarily determined by the immune status of the host and can range from harmless or subtle presentations to life threatening complications. Invasive fungal infections are categorized into acute, chronic or chronic granulomatous entities. Immunocompromised patients with poorly controlled diabetes mellitus, HIV and patients receiving chemotherapy or chronic oral corticosteroids are mostly affected. Mycetoma and Allergic Fungal Rhinosinusitis are considered non-invasive forms. Computer tomography is the gold-standard in sinonasal imaging and is complimented by Magnetic resonance imaging (MRI) as it is superior in the evaluation of intraorbital and intracranial extensions. The knowledge and identification of the characteristic imaging patterns in invasive - and non- invasive fungal rhinosinusitis is crucial and the radiologist plays an important role in refining the diagnosis to prevent a possible fatal outcome. PMID:27403401

  14. Nanoparticle uptake by airway phagocytes after fungal spore challenge in murine allergic asthma and chronic bronchitis

    PubMed Central

    2014-01-01

    Background In healthy lungs, deposited micrometer-sized particles are efficiently phagocytosed by macrophages present on airway surfaces; however, uptake of nanoparticles (NP) by macrophages appears less effective and is largely unstudied in lung disease. Using mouse models of allergic asthma and chronic obstructive pulmonary disease (COPD), we investigated NP uptake after challenge with common biogenic ambient air microparticles. Methods Bronchoalveolar lavage (BAL) cells from diseased mice (allergic asthma: ovalbumin [OVA] sensitized and COPD: Scnn1b-transgenic [Tg]) and their respective healthy controls were exposed ex vivo first to 3-μm fungal spores of Calvatia excipuliformis and then to 20-nm gold (Au) NP. Electron microscopic imaging was performed and NP uptake was assessed by quantitative morphometry. Results Macrophages from diseased mice were significantly larger compared to controls in OVA-allergic versus sham controls and in Scnn1b-Tg versus wild type (WT) mice. The percentage of macrophages containing AuNP tended to be lower in Scnn1b-Tg than in WT mice. In all animal groups, fungal spores were localized in macrophage phagosomes, the membrane tightly surrounding the spore, whilst AuNP were found in vesicles largely exceeding NP size, co-localized in spore phagosomes and occasionally, in the cytoplasm. AuNP in vesicles were located close to the membrane. In BAL from OVA-allergic mice, 13.9 ± 8.3% of all eosinophils contained AuNP in vesicles exceeding NP size and close to the membrane. Conclusions Overall, AuNP uptake by BAL macrophages occurred mainly by co-uptake together with other material, including micrometer-sized ambient air particles like fungal spores. The lower percentage of NP containing macrophages in BAL from Scnn1b-Tg mice points to a change in the macrophage population from a highly to a less phagocytic phenotype. This likely contributes to inefficient macrophage clearance of NP in lung disease. Finally, the AuNP containing

  15. Infectious Chronic Rhinosinusitis.

    PubMed

    Bose, Sumit; Grammer, Leslie C; Peters, Anju T

    2016-01-01

    Chronic rhinosinusitis (CRS) is a persistent inflammatory disease that affects a multitude of people worldwide. The pathogenesis of CRS involves many factors including genetics, status of the sinonasal microbiome, infections, and environmental influences. Comorbidities associated with CRS include asthma, allergic rhinitis, bronchiectasis, and certain kinds of immunodeficiency. CRS can be divided into different subtypes based on endotypes and phenotypes. Infectious CRS is one such category. The etiology of infectious CRS is usually secondary to chronic bacterial infection that commonly begins with a viral upper respiratory tract infection. Humoral antibody deficiencies can underlie difficult-to-treat or recurrent CRS. Infectious CRS can be treated with antimicrobials, topical or oral corticosteroids, and nasal saline irrigations. Patients with CRS and humoral immunodeficiency may require an aggressive treatment approach including immunoglobulin replacement therapy. Despite advancements in the field of CRS, targeted therapies and reliable biomarkers are still lacking. PMID:27393772

  16. [Polypous rhinosinusitis in the children].

    PubMed

    Karpova, E P; Emel'yanova, M P; Tulupov, D A

    2016-01-01

    We present an overview of the modern literature concerningpolypous rhinosinusitis (PRS) in the children. The information thus derived is compared with the available results of the clinical investigations involving the adults patients with this pathology. Allergic diseases and mucoviscidosis appear to be the pathological conditions most likely leading to the development of polyps in the nasal cavity. The patients suffering from rhinosinusitis associated with the disorders of arachidonic acid metabolismare very rarely encountered in the pediatric practice unlike those among the adult population. Intranasal glucocorticosteroids (INGCS), especially in the form of the mometasonefuroate nasal spray, are considered to be the most promising medications for the treatment of the children presenting with PRS. However, further clinical studies are needed to confirm the effectiveness and safety of this therapeutic modality. PMID:27213662

  17. Differential Diagnosis of Chronic Rhinosinusitis with Nasal Polyps.

    PubMed

    London, Nyall R; Reh, Douglas D

    2016-01-01

    Nasal polyps are semi-translucent mucosal outgrowths of the paranasal sinuses which typically arise in the setting of chronic rhinosinusitis (CRS). Nasal polyps are also associated with asthma, aspirin sensitivity, cystic fibrosis and allergic fungal rhinosinusitis (AFS). The majority of nasal polyps are bilateral and characterized by tissue edema and eosinophil infiltration. Patients with nasal polyps often present with complaints including nasal obstruction, congestion, rhinorrhea or altered sense of smell. The differential diagnosis ranges from benign masses such as schneiderian papilloma, antrochoanal polyp, angiofibroma and encephalocele to malignant neoplasms such as squamous cell carcinoma (SCC), esthesioneuroblastoma, nasal lymphoma and rhabdomyosarcoma. These lesions may have a similar appearance as nasal polyps and particular attention to an alternative diagnosis for nasal polyps should be entertained if the mass is unilateral or congenital in nature. Workup for patients with a unilateral mass should include radiographic imaging, possible biopsy and careful follow-up when appropriate. Here, we review the disease etiology of nasal polyps and describe the approach to the patient with nasal polyps with emphasis on differential diagnosis and workup. PMID:27466841

  18. EFFECTS OF ULTRAVIOLET RADIATION (UVR) ON THE RESPIRATORY ALLERGIC RESPONSES OF BALB/C MICE TO A FUNGAL ALLERGEN

    EPA Science Inventory

    EFFECTS OF ULTRAVIOLET RADIATION (UVR) ON THE RESPIRATORY ALLERGIC RESPONSES OF BALB/C MICE TO A FUNGAL ALLERGEN. M D W Ward, D M Sailstad, D L Andrews, E H Boykin, and MJ K Selgrade. National Health and Environmental Effects Research Laboratory, Office of Research and Developmen...

  19. Rhinosinusitis diagnosis and management for the clinician: a synopsis of recent consensus guidelines.

    PubMed

    Meltzer, Eli O; Hamilos, Daniel L

    2011-05-01

    Rhinosinusitis (RS) affects approximately 1 in 7 adults in the United States, and its effect on quality of life, productivity, and finances is substantial. During the past 10 years, several expert panels from authoritative bodies have published evidence-based guidelines for the diagnosis and management of RS and its subtypes, including acute viral RS, acute bacterial RS, chronic RS (CRS) without nasal polyposis, CRS with nasal polyposis, and allergic fungal RS. This review examines and compares the recommendations of the Rhinosinusitis Initiative, the Joint Task Force on Practice Parameters, the Clinical Practice Guideline: Adult Sinusitis, the European Position Paper on Rhinosinusitis and Nasal Polyps 2007, and the British Society for Allergy and Clinical Immunology. Points of consensus and divergent opinions expressed in these guidelines regarding classification, diagnosis, and management of adults with acute RS (ARS) and CRS and their various subtypes are highlighted for the practicing clinician. Key points of agreement regarding therapy in the guidelines for ARS include the efficacy of symptomatic treatment, such as intranasal corticosteroids, and the importance of reducing the unnecessary use of antibiotics in ARS; however, guidelines do not agree precisely regarding when antibiotics should be considered as a reasonable treatment strategy. Although the guidelines diverge markedly on the management of CRS, the diagnostic utility of nasal airway examination is acknowledged by all. Important and relevant data from MEDLINE-indexed articles published since the most recent guidelines were issued are also considered, and needs for future research are discussed.

  20. Rhinosinusitis Diagnosis and Management for the Clinician: A Synopsis of Recent Consensus Guidelines

    PubMed Central

    Meltzer, Eli O.; Hamilos, Daniel L.

    2011-01-01

    Rhinosinusitis (RS) affects approximately 1 in 7 adults in the United States, and its effect on quality of life, productivity, and finances is substantial. During the past 10 years, several expert panels from authoritative bodies have published evidence-based guidelines for the diagnosis and management of RS and its subtypes, including acute viral RS, acute bacterial RS, chronic RS (CRS) without nasal polyposis, CRS with nasal polyposis, and allergic fungal RS. This review examines and compares the recommendations of the Rhinosinusitis Initiative, the Joint Task Force on Practice Parameters, the Clinical Practice Guideline: Adult Sinusitis, the European Position Paper on Rhinosinusitis and Nasal Polyps 2007, and the British Society for Allergy and Clinical Immunology. Points of consensus and divergent opinions expressed in these guidelines regarding classification, diagnosis, and management of adults with acute RS (ARS) and CRS and their various subtypes are highlighted for the practicing clinician. Key points of agreement regarding therapy in the guidelines for ARS include the efficacy of symptomatic treatment, such as intranasal corticosteroids, and the importance of reducing the unnecessary use of antibiotics in ARS; however, guidelines do not agree precisely regarding when antibiotics should be considered as a reasonable treatment strategy. Although the guidelines diverge markedly on the management of CRS, the diagnostic utility of nasal airway examination is acknowledged by all. Important and relevant data from MEDLINE-indexed articles published since the most recent guidelines were issued are also considered, and needs for future research are discussed. PMID:21490181

  1. Th2 Allergic Immune Response to Inhaled Fungal Antigens is Modulated By TLR-4-Independent Bacterial Products

    PubMed Central

    Allard, Jenna B.; Rinaldi, Lisa; Wargo, Matt; Allen, Gilman; Akira, Shizuo; Uematsu, Satoshi; Poynter, Matthew E.; Hogan, Deborah A.; Rincon, Mercedes; Whittaker, Laurie A.

    2009-01-01

    SUMMARY Allergic airway disease is characterized by eosinophilic inflammation, mucus hypersecretion and increased airway resistance. Fungal antigens are ubiquitous within the environment and are well know triggers of allergic disease. Bacterial products are also frequently encountered within the environment and may alter the immune response to certain antigens. The consequence of simultaneous exposure to bacterial and fungal products on the lung adaptive immune response has not been explored. Here we show that oropharyngeal aspiration of fungal lysates (Candida albicans, Aspergillus fumigatus) promotes airway eosinophilia, secretion of Th2 cytokines and mucus cell metaplasia. In contrast, oropharyngeal exposure to bacterial lysates (Pseudomonas aeruginosa) promotes airway inflammation characterized by neutrophils, Th1 cytokine secretion and no mucus production. More importantly, administration of bacterial lysates together with fungal lysates deviates the adaptive immune response to a Th1 type associated with neutrophilia and diminished mucus production. The immunomodulatory effect that bacterial lysates have on the response to fungi is TLR4-independent but MyD88 dependent. Thus, different types of microbial products within the airway can alter the host's adaptive immune response, and potentially impact the development of allergic airway disease to environmental fungal antigens. PMID:19224641

  2. What is living on your dog's skin? Characterization of the canine cutaneous mycobiota and fungal dysbiosis in canine allergic dermatitis

    PubMed Central

    Meason-Smith, Courtney; Diesel, Alison; Patterson, Adam P.; Older, Caitlin E.; Mansell, Joanne M.; Suchodolski, Jan S.; Rodrigues Hoffmann, Aline

    2015-01-01

    To characterize the skin-associated fungal microbiota (mycobiota) in dogs, and to evaluate the influence of body site, individual dog or health status on the distribution of fungi, next-generation sequencing was performed targeting the internal transcribed spacer region. A total of 10 dogs with no history of skin disease were sampled at 10 distinct body sites consisting of haired and mucosal skin, and 8 dogs with diagnosed skin allergies were sampled at six body sites commonly affected by allergic disease. Analysis of similarities revealed that body site was not an influencing factor on membership or structure of fungal communities in healthy skin; however, the mucosal sites were significantly reduced in fungal richness. The mycobiota from body sites in healthy dogs tended to be similar within a dog, which was visualized in principle coordinates analysis (PCoA) by clustering of all sites from one dog separate from other dogs. The mycobiota of allergic skin was significantly less rich than that of healthy skin, and all sites sampled clustered by health status in PCoA. Interestingly, the most abundant fungi present on canine skin, across all body sites and health statuses, were Alternaria and Cladosporium—two of the most common fungal allergens in human environmental allergies. PMID:26542075

  3. What is living on your dog's skin? Characterization of the canine cutaneous mycobiota and fungal dysbiosis in canine allergic dermatitis.

    PubMed

    Meason-Smith, Courtney; Diesel, Alison; Patterson, Adam P; Older, Caitlin E; Mansell, Joanne M; Suchodolski, Jan S; Rodrigues Hoffmann, Aline

    2015-12-01

    To characterize the skin-associated fungal microbiota (mycobiota) in dogs, and to evaluate the influence of body site, individual dog or health status on the distribution of fungi, next-generation sequencing was performed targeting the internal transcribed spacer region. A total of 10 dogs with no history of skin disease were sampled at 10 distinct body sites consisting of haired and mucosal skin, and 8 dogs with diagnosed skin allergies were sampled at six body sites commonly affected by allergic disease. Analysis of similarities revealed that body site was not an influencing factor on membership or structure of fungal communities in healthy skin; however, the mucosal sites were significantly reduced in fungal richness. The mycobiota from body sites in healthy dogs tended to be similar within a dog, which was visualized in principle coordinates analysis (PCoA) by clustering of all sites from one dog separate from other dogs. The mycobiota of allergic skin was significantly less rich than that of healthy skin, and all sites sampled clustered by health status in PCoA. Interestingly, the most abundant fungi present on canine skin, across all body sites and health statuses, were Alternaria and Cladosporium--two of the most common fungal allergens in human environmental allergies.

  4. Chronic Rhinosinusitis without Nasal Polyps.

    PubMed

    Cho, Seong Ho; Kim, Dae Woo; Gevaert, Philippe

    2016-01-01

    Chronic rhinosinusitis without nasal polyps (CRSsNP) is more prevalent than chronic rhinosinusitis with nasal polyps (CRSwNP). Certain diseases predispose to whereas others are associated with CRSsNP. Predisposing diseases include allergic and nonallergic upper and lower airway diseases, epithelial cell disorders, immunodeficiencies, autoimmune diseases, and some infectious diseases. In addition, environmental and host factors, examples of which include smoking, a higher incidence of abnormal biofilms, and innate immune defects, play a role in the pathogenesis of this disease. CRSsNP is characterized by histologic abnormalities, including basement membrane thickening (fibrosis) and goblet cell hyperplasia. Neutrophils and several chemokines, TGF-β and C-X-C motif chemokine ligand (CXCL)-8, play a role in CRSsNP remodeling. However, there are conflicting data about CRSsNP endotypes, for example, whether it is characterized by neutrophilia or eosinophilia or both. In spite of advancements and the understanding of the pathogenesis of this disease, additional study is necessary to better comprehend its underlying mechanisms, endotypes, and evidence-based treatment strategies. PMID:27393771

  5. Chronic rhinosinusitis in adults.

    PubMed

    Cherry, W Brett; Li, James T

    2008-03-01

    There is no consensus on diagnostic criteria for chronic rhinosinusitis. By convention, the symptoms of chronic rhinosinusitis are similar to those of acute rhinosinusitis but last more than 8 weeks. Diagnosis is based on history, physical examination, and computed tomography scan of the sinuses or rhinoscopy. Treatment options are numerous and, for the most part, not evidence based. They include antibiotics, nasal or oral corticosteroids, antihistamines, naval lavage, decongestants, immunotherapy, and surgery. Which diagnostic and therapeutic options to exercise when, is the focus of this article.

  6. AB042. Allergy Working Group Update: the burden and management of rhinitis and rhinosinusitis in UK primary care

    PubMed Central

    Fokkens, Wytske; Nibber, Anjan; Chisholm, Alison; Hellings, Peter; Skinner, Derek; Price, David

    2016-01-01

    Background Rhinitis and rhinosinusitis are diseases of the upper airways with a high prevalence and when they are chronic with a high quality of life burden on patients and costs for society. To date, data on the primary care burden of rhinitis and rhinosinusitis are limited as is knowledge of how primary care physicians currently manage these patients. This study aims to quantify the burden of CRS and characterize related management approaches in UK primary care. Methods Patients with diagnostic codes for rhinitis and rhinosinusitis were identified within the UK’s Optimum Patient Care Research Database (OPCRD), a respiratory enriched primary care database. Consultations over a 5-year period (latest for each patient) code for rhinitis and rhinosinusitis symptoms resulting in prescriptions for antibiotics, oral steroids and/or antihistamines were identified. Diagnostic codes were used to further categorize patients into acute/chronic rhinitis/rhinosinusitis and allergic/non allergic chronic rhinitis subgroups. Prescribed therapies were categorized as: antibiotics (all); steroids (oral, injectable, nasal) and antihistamines, nasal spray and eye drops and mapped across rhinitis/rhinosinusitis and allergic/non-allergic patient subgroups. Results A total of 685,429 patients were identified with rhinitis and rhinosinusitis diagnostic codes. Of these patients: 80,900 (5%) had a diagnostic code for acute rhinitis (common cold); 176,353 (26%) for acute rhinosinusitis; 65,610 (10%) for chronic rhinosinusitis; 306,030 (45%) for chronic allergic rhinitis; 4,747 (1%) for chronic non-allergic rhinitis and 51,790 (8%) undefined chronic rhinitis. A total of 1,664,068 consultations for rhinitis and rhinosinusitis symptoms were identified, of which 185,730 (27%) resulted in an antibiotic prescription, 5,597 (0.8%) in an oral steroid prescription and 1,898 (0.3%) in an antibiotic and oral steroid prescription. Drug prescribing varied markedly across diagnostic subgroups with

  7. Allergic and non-allergic rhinitis: relationship with nasal polyposis, asthma and family history.

    PubMed

    Gelardi, M; Iannuzzi, L; Tafuri, S; Passalacqua, G; Quaranta, N

    2014-02-01

    Rhinitis and rhinosinusitis (with/without polyposis), either allergic or non-allergic, represent a major medical problem. Their associated comorbidities and relationship with family history have so far been poorly investigated. We assessed these aspects in a large population of patients suffering from rhinosinusal diseases. Clinical history, nasal cytology, allergy testing and direct nasal examination were performed in all patients referred for rhinitis/rhinosinusitis. Fibre optic nasal endoscopy, CT scan and nasal challenge were used for diagnosis, when indicated. A total of 455 patients (60.7% male, age range 4-84 years) were studied; 108 (23.7%) had allergic rhinitis, 128 (28.1%) rhinosinusitis with polyposis, 107 (23.5%) non-allergic rhinitis (negative skin test); 112 patients had associated allergic and non-allergic rhinitis, the majority with eosinophilia. There was a significant association between non-allergic rhinitis and family history of nasal polyposis (OR = 4.45; 95%CI = 1.70-11.61; p = 0.0019), whereas this association was no longer present when allergic rhinitis was also included. Asthma was equally frequent in non-allergic and allergic rhinitis, but more frequent in patients with polyposis. Aspirin sensitivity was more frequent in nasal polyposis, independent of the allergic (p = 0.03) or non-allergic (p = 0.01) nature of rhinitis. Nasal polyposis is significantly associated with asthma and positive family history of asthma, partially independent of the allergic aetiology of rhinitis.

  8. Diagnosis of acute rhinosinusitis.

    PubMed

    Esposito, Susanna; Marchisio, Paola; Tenconi, Rossana; Tagliaferri, Laura; Albertario, Giada; Patria, Maria Francesca; Principi, Nicola

    2012-08-01

    Rhinosinusitis is almost always a complication of a viral infection involving the upper respiratory tract. A common cold is the first symptom of rhinosinusitis, but infectious processes involving the nose inevitably affect the paranasal sinuses because of their anatomical contiguity. The symptoms remain those of a common cold as long as nasal phlogosis is moderate and the ostia between the nose and sinuses are patent. If the inflammation is intense, edema may obliterate the ostia and isolate the sinuses, thus stopping the removal of the exudates. The duration of symptoms makes it possible to distinguish acute (10-30 days) from subacute (30-90 days) and chronic rhinosinusitis (>90 days). The diagnosis of rhinosinusitis should only be based on anamnestic and clinical criteria in children with serious or persistent symptoms of upper respiratory tract infection, or which appear within a short time of an apparent recovery. Computed tomography and magnetic resonance images of the paranasal sinuses should be reserved for children reasonably considered to be candidates for surgery. Antibiotics are recommended in cases of mild acute bacterial rhinosinusitis as a means of accelerating the resolution of symptoms. The use of antibiotics is mandatory in severe acute bacterial rhinosinusitis to cure the disease and avoid the possible onset of severe complications.

  9. 240 Mold Sensitization in Chronic Rhinosinusitis Patients

    PubMed Central

    Gawlik, Radoslaw; Czecior, Eugeniusz

    2012-01-01

    Background It is estimated that about 10% of the population have IgE antibodies to common inhalant molds. Exposure to fungal allergens could be linked to the presence and persistence of asthma, rhinitis and atopic dermatitis. Mold sensitization is a risk factor for development and deterioration of upper airway allergy, especially chronic rhinosinusitis. We addressed the incidence of mold allergy measured as specific IgE to molds and skin prick tests in chronic sinusitis patients. We assessed prevalence of allergic reactions to mould among surgery treated chronic sinusitis patients. Methods A group of 28 chronic sinusitis patients after surgery were included into the study. Routine medical examination, skin prick tests with common inhaled allergens and extended mold panel (Alternaria alternate, Cladosporium herbarium, Aspergilus fumigatus, Candida albicans, Mucor mucedo, Botrytis cinerea, Rhisopus nigricans, Penicilliumi notatum, Fusarum moniliforme Pullularia pullulans (Allergopharma, Germany), tIgE, asIgE measurement were performed (Phadia, Sweden). All investigated patients were consulted by laryngologist and mycological examination was performed. Results We found that sensitization to at least one allergen was present in 43.8(14/32) of sinusitis patients. The most prevalent was sensitization to house dust mite Dermatophagoides pt., found in 21.8 % (7/32) patients. Positive results of skin prick tests with Candida albicans we observed in 18.8% (6/32), with Alternaria alternate in 15,6% (5/32), Cladosporium herbarium in 6,3% (2/32), Aspergilus fumigatus in 3,13 % (1/32). None of investigated patients presented sensitization to other mold allergens. Microbiological methods demonstrated fungal infection only in 2 patients. Conclusions Almost half of chronic sinusitis patients presented sensitization to at least one allergen. Fungal allergy is relatively rare in chronic sinusitis patients.

  10. Rhinosinusitis in Children

    PubMed Central

    Shahid, Sukhbir K.

    2012-01-01

    Rhinosinusitis is the inflammation of the mucous membranes of nose and paranasal sinus(es). 5–13% of upper respiratory tract infections in children complicate into acute rhinosinusitis. Though not life threatening, it profoundly affects child's school performance and sleep pattern. If untreated, it could progress to chronic rhinosinusitis (CRS). The pathogens involved in perpetuation of CRS consist of multidrug-resistant mixed microflora. CRS is challenging to manage and could further extend to cause eye or intracranial complications. In children, CRS diagnosis is often either missed or incomprehensive. Due to this, morbidity and strain on healthcare budget are tremendous. Flexible fiberoptic endoscopy has revolutionized management of CRS. Its utility in children is being increasingly recognized. Optimal management entails specific appropriate antimicrobials as well as treatment of underlying causes. The aim is to normalize sinus anatomy and physiology and regain normal mucociliary function and clearance. PMID:23762621

  11. Diagnosis and management of chronic rhinosinusitis in adults.

    PubMed

    Marple, Bradley F; Stankiewicz, James A; Baroody, Fuad M; Chow, James M; Conley, David B; Corey, Jacqueline P; Ferguson, Berrylin J; Kern, Robert C; Lusk, Rodney P; Naclerio, Robert M; Orlandi, Richard R; Parker, Michael J

    2009-11-01

    Chronic rhinosinusitis (CRS) is characterized by mucosal inflammation affecting both the nasal cavity and paranasal sinuses; its causes are potentially numerous, disparate, and frequently overlapping. The more common conditions that are associated with CRS are perennial allergic and nonallergic rhinitis, nasal polyps, and anatomical mechanical obstruction (septum/turbinate issues). Other less common etiologies include inflammation (eg, from superantigens), fungal sinusitis or bacterial sinusitis with or without associated biofilm formation, gastroesophageal reflux, smoke and other environmental exposures, immune deficiencies, genetics, and aspirin-exacerbated respiratory disease. A diagnosis of CRS is strongly suggested by a history of symptoms (eg, congestion and/or fullness; nasal obstruction, blockage, discharge, and/or purulence; discolored postnasal discharge; hyposmia/anosmia; facial pain and/or pressure) and their duration for > 3 months. A definitive diagnosis requires physical evidence of mucosal swelling or discharge appreciated during physical examination coupled with CT imaging if inflammation does not involve the middle meatus or ethmoid bulla. Multivariant causation makes the diagnosis of CRS and selection of treatment complex. Furthermore, various types of health care providers including ear, nose, and throat (ENT) specialists, allergists, primary care physicians, and pulmonologists treat CRS, and each is likely to have a different approach. A structured approach to the diagnosis and management of CRS can help streamline and standardize care no matter where patients present for evaluation and treatment. A 2008 Working Group on CRS in Adults, supported by the American Academy of Otolaryngic Allergy (AAOA), developed a series of algorithms for the differential diagnosis and treatment of CRS in adults, based on the evolving understanding of CRS as an inflammatory disease. The algorithms presented in this paper address an approach for all CRS patients as

  12. Other Phenotypes and Treatment of Chronic Rhinosinusitis.

    PubMed

    Naclerio, Robert M; Baroody, Fuad M

    2016-01-01

    Chronic rhinosinusitis (CRS) is difficult to define, partly because the disease recognized by clinicians is both heterogeneous and the endpoint of different pathophysiologic, genetic, and environmental interactions. For this article, we define CRS as symptoms lasting more than 3 months combined with an imaging study showing inflammation in the sinuses. This article comments on some factors that are believed to influence the expression of CRS. These factors include anatomic abnormalities, immotile cilia, age, allergic sensitization, immune deficiency, dental infections, gastrointestinal reflux, smoking, biofilm, and the microbiome. Other factors are discussed in other sections. The article concludes with an overview of treatment. In brief, nasal steroids and large volume nasal irrigations are the first line of treatment for this inflammatory disease. Antibiotics are used when infections are thought to contribute. Oral steroids are frequently used in severe disease. Endoscopy and sinus computed tomography scans are used when surgery is contemplated. PMID:27393776

  13. ICON: chronic rhinosinusitis.

    PubMed

    Bachert, Claus; Pawankar, Ruby; Zhang, Luo; Bunnag, Chaweewan; Fokkens, Wytske J; Hamilos, Daniel L; Jirapongsananuruk, Orathai; Kern, Robert; Meltzer, Eli O; Mullol, Joaquim; Naclerio, Robert; Pilan, Renata; Rhee, Chae-Seo; Suzaki, Harumi; Voegels, Richard; Blaiss, Michael

    2014-01-01

    Chronic rhinosinusitis (CRS) is a public health problem that has a significant socio-economic impact. Moreover, the complexity of this disease due to its heterogeneous nature based on the underlying pathophysiology - leading to different disease variants - further complicates our understanding and directions for the most appropriate targeted treatment strategies. Several International/national guidelines/position papers and/or consensus documents are available that present the current knowledge and treatment strategies for CRS. Yet there are many challenges to the management of CRS especially in the case of the more severe and refractory forms of disease. Therefore, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), a collaboration between EAACI, AAAAI, ACAAI, and WAO, has decided to propose an International Consensus (ICON) on Chronic Rhinosinusitis. The purpose of this ICON on CRS is to highlight the key common messages from the existing guidelines, the differences in recommendations as well as the gaps in our current knowledge of CRS, thus providing a concise reference. In this document we discuss the definition of the disease, its relevance, pharmacoeconomics, pathophysiology, phenotypes and endotypes, genetics and risk factors, natural history and co-morbidities as well as clinical manifestations and treatment options in both adults and children comprising pharmacotherapy, surgical interventions and more recent biological approaches. Finally, we have also highlighted the unmet needs that wait to be addressed through future research. PMID:25379119

  14. 181 Olfactory Disfunctions in Patients with Chronic Rhinosinusitis

    PubMed Central

    Sánchez Vallecillo, María Victoria; Fraire, María Emilia; Baena-Cagnani, Carlos E.; Zernotti, Mario

    2012-01-01

    Background There are several factors that could produce olfactory dysfunction. The chronic inflammation of the upper air tract, especially allergic rhinitis is mentioned as a trigger factor. The aim of this study is assess the prevalence and identify clinical features associated with olfactory dysfunction in patients with chronic rhinosinusitis. Methods A prospective, analytical and observational study in adult patients (> 18 years) with chronic rhinosinusitis during the period May-October of 2010. We used the CCCRC (Connecticut Chemosensory Clinical Research Center smell test) Results A total of 33 patients were investigated. In the group of patients between 18 and 39 years, 73% of patients suffer from hyposmia and 18% anosmia; for the group of 40 to 64 years, 63% with hyposmia and 37% anosmia; patients older than 65 years, 67% hyposmia and 33% with anosmia. In the smokers group the 11% of patient presented hyposmia and 13% anosmia (P < 0.05); 5% in both cases had a history of nasal endoscopic surgery. In patients with chronic rhinosinusitis with nasal polyps have 18% with hyposmia and 19% with anosmia (P < 0.05). A 20% with allergic rhinitis had hyposmia while anosmia in 22% (P < 0.05). Septal deviation patients had 20% of hyposmia (P < 0.001) and 12% anosmia. Patients with turbinate hypertrophy had 22% hyposmia (P < 0.001) and 13% anosmia while in the group of patients with Asthma, the 4% had hyposmia and 16% anosmia (P < 0.001). Conclusions Nasal polyposis, septal deviation, turbinate hypertrophy, smoke, allergic rhinitis and asthma are negative predictors factors of olfactory dysfunction in patients with CRS. A previous endoscopic surgery, age and sex would not intervene in the olfactory loss.

  15. Microbiology of chronic rhinosinusitis.

    PubMed

    Brook, I

    2016-07-01

    Most sinus infections are viral and only a small percentage develop bacterial infection. Rhino-, influenza, and para-influenza viruses are the most frequent viral causes of sinusitis. The most common bacterial isolates from children and adult patients with community-acquired acute bacterial sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes. Staphylococcus aureus and anaerobic organisms (Prevotella and Porphyromonas, Fusobacterium, and Peptostreptococcus spp.) are the commonest isolates in chronic rhinosinusitis (CRS). Aerobic and anaerobic beta lactamase-producing bacteria (BLPB) were recovered from over a third of these patients. Methicillin-resistant S. aureus (MRSA) accounted for over 60 % of S. aureus isolates. Pseudomonas aeruginosa and other aerobic and facultative Gram-negative rods are frequently recovered in nosocomial sinusitis, the immunocompromised host, individuals with human immunodeficiency virus infection, and in cystic fibrosis. The CRS infection evolves the formation of a biofilm that might play a significant role in the pathogenesis and persistence of CRS. The microbiology of sinusitis is influenced by previous antimicrobial therapy, vaccinations, and the presence of normal flora capable of interfering with the growth of pathogens. Recognition of the unique microbiology of CRS and their antimicrobial susceptibility is of great importance when selecting antimicrobial therapy. PMID:27086363

  16. Fungal Sinusitis.

    PubMed

    Raz, Eytan; Win, William; Hagiwara, Mari; Lui, Yvonne W; Cohen, Benjamin; Fatterpekar, Girish M

    2015-11-01

    Fungal sinusitis is characterized into invasive and noninvasive forms. The invasive variety is further classified into acute, chronic and granulomatous forms; and the noninvasive variety into fungus ball and allergic fungal sinusitis. Each of these different forms has a unique radiologic appearance. The clinicopathologic and corresponding radiologic spectrum and differences in treatment strategies of fungal sinusitis make it an important diagnosis for clinicians and radiologists to always consider. This is particularly true of invasive fungal sinusitis, which typically affects immuno compromised patients and is associated with significant morbidity and mortality. Early diagnosis allows initiation of appropriate treatment strategies resulting in favorable outcome.

  17. Canadian guidelines for chronic rhinosinusitis

    PubMed Central

    Kaplan, Alan

    2013-01-01

    Abstract Objective To provide a clinical summary of the Canadian clinical practice guidelines for chronic rhinosinusitis (CRS) that includes recommendations relevant for family physicians. Quality of evidence Guideline authors performed a systematic literature search and drafted recommendations. Recommendations received both strength of evidence and strength of recommendation ratings. Input from external content experts was sought, as was endorsement from Canadian medical societies (Association of Medical Microbiology and Infectious Disease Canada, Canadian Society of Allergy and Clinical Immunology, Canadian Society of Otolaryngology—Head and Neck Surgery, Canadian Association of Emergency Physicians, and Family Physicians Airways Group of Canada). Main message Diagnosis of CRS is based on type and duration of symptoms and an objective finding of inflammation of the nasal mucosa or paranasal sinuses. Chronic rhinosinusitis is categorized based on presence or absence of nasal polyps, and this distinction leads to differences in treatment. Chronic rhinosinusitis with nasal polyps is treated with intranasal corticosteroids. Antibiotics are recommended when symptoms indicate infection (pain or purulence). For CRS without nasal polyps, intranasal corticosteroids and second-line antibiotics (ie, amoxicillin– clavulanic acid combinations or fluoroquinolones with enhanced Gram-positive activity) are recommended. Saline irrigation, oral steroids, and allergy testing might be appropriate. Failure of response should prompt consideration of alternative diagnoses and referral to an otolaryngologist. Patients undergoing endoscopic sinus surgery require postoperative treatment and follow-up. Conclusion The Canadian guidelines provide diagnosis and treatment approaches based on the current understanding of the disease and available evidence. Additionally, the guidelines provide the expert opinion of a diverse group of practice and academic experts to help guide clinicians

  18. Drivers of chronic rhinosinusitis: Inflammation versus infection.

    PubMed

    Hamilos, Daniel L

    2015-12-01

    Studies of the underlying cause or causes of chronic rhinosinusitis (CRS) over the past 20 or more years have expanded from a focus on systemic immune and allergic mechanisms to an intense search for the underlying drivers of mucosal inflammation. These drivers involve mucosal inflammatory pathways that become activated by allergens, microbial stimuli, or poorly understood exogenous or endogenous stimuli. The holy grail in the study of CRS is to identify specific drivers of mucosal inflammation and translate these into more effective treatment for CRS. Certain deficiencies in local innate immunity have been described in patients with CRS that predispose to increased sinus mucosal bacterial colonization/infection, including deficient local production of antimicrobial lactoferrin and deficient functioning of the bitter taste receptor TAS2R38. Conversely, certain innate factors, namely IL-25, IL-33, and thymic stromal lymphopoietin (TSLP), are elaborated by sinus epithelial cells in response to microbial stimulation or airway injury and promote local TH2 inflammation. The precise physiologic role of these factors in innate or adaptive immunity is unclear, although IL-33 might function as an alarmin triggered by damage-associated molecular patterns. The cytokines IL-25 and TSLP, similarly promote proinflammatory tissue responses. Another feature of epithelial dysregulation in patients with CRS is overproduction of eosinophil-promoting C-C chemokines by sinus epithelium, perhaps driven in part through innate stimuli, as well as TH2 cytokines, such as IL-13. Strategies to reduce the microbial stimulation of maladaptive TH2 inflammation or to suppress the local elaboration of TH2-promoting epithelial factors, such as IL-33, have potential therapeutic benefit in patients with CRS, although the extent to which this is realized in patient care remains limited at present. This rostrum will summarize my views on the major microbial drivers of mucosal inflammation and

  19. Novel microbiome-based therapeutics for chronic rhinosinusitis.

    PubMed

    Cope, E K; Lynch, S V

    2015-03-01

    The human microbiome, i.e. the collection of microbes that live on, in and interact with the human body, is extraordinarily diverse; microbiota have been detected in every tissue of the human body interrogated to date. Resident microbiota interact extensively with immune cells and epithelia at mucosal surfaces including the airways, and chronic inflammatory and allergic respiratory disorders are associated with dysbiosis of the airway microbiome. Chronic rhinosinusitis (CRS) is a heterogeneous disease with a large socioeconomic impact, and recent studies have shown that sinus inflammation is associated with decreased sinus bacterial diversity and the concomitant enrichment of specific sinus pathogens. Here, we discuss the potential role for probiotic supplementation for CRS in light of this increasing understanding of the airway microbiome and microbial interactions with the host. We focus on the ecological significance of microbiome-based probiotic supplementation and potential interactions with the gastrointestinal tract and consider microbial administration methods for treatment of CRS.

  20. Allergic rhinitis

    MedlinePlus

    ... allergic to, such as dust, animal dander, or pollen. Symptoms can also occur when you eat a ... article focuses on allergic rhinitis due to plant pollens. This type of allergic rhinitis is commonly called ...

  1. Acute rhinosinusitis in adults: an update on current management

    PubMed Central

    Masood, Ajmal; Moumoulidis, Ioannis; Panesar, Jaan

    2007-01-01

    Acute rhinosinusitis is a common disease with worldwide prevalence. It is a significant burden on the health services. It is most commonly caused by viruses and is self‐limiting in nature. The diagnosis of acute rhinosinusitis is clinical and sinus radiography is not indicated routinely. Most cases of acute rhinosinusitis are treated symptomatically. However, symptoms may persist beyond 10 days when secondary bacterial infection prevails. Antibiotics are reserved for moderate or severe cases or when there is development of complications of acute rhinosinusitis. This paper provides an update on the current management of acute rhinosinusitis. PMID:17551072

  2. [Cerebral arachnoiditis in patients with chronic rhinosinusitis].

    PubMed

    Gushchin, A N

    1994-01-01

    The examination and treatment of 66 patients with rhinosinusogenic cerebral arachnoiditis (RCA) were performed using otorhinolaryngological and neurological tests with special emphasis on pneumoencephalography to provide objective assessment of the brain layers and ventricles. It is shown that RCA occurs most frequently in subjects suffering from chronic purulent axillary sinusitis or recurrent polysinusitis. RCA manifestations depend on the duration of rhinosinusitis and its recurrence rate. RCA onset is usually not acute and takes place at the time of rhinosinusitis exacerbation. There are also mild frontal headaches, pathological changes in the coats of the anterior cranial fossa. The above abnormalities were most pronounced at the side of rhinosinusitis or most affected sinus. The treatment should be first of all oriented on elimination of maxillary infection in line with pathogenetic treatment of RCA. An individual approach to treatment policy is advocated.

  3. Pathogenesis of eosinophilic chronic rhinosinusitis.

    PubMed

    Shah, Said Ahmad; Ishinaga, Hajime; Takeuchi, Kazuhiko

    2016-01-01

    Eosinophilic chronic rhinosinusitis (ECRS) is considered a refractory and intractable disease. Patients with ECRS present with thick mucus production, long-term nasal congestion, loss of sense of smell, and intermittent acute exacerbations secondary to bacterial infections. Despite medical and surgical interventions, there is a high rate of recurrence with significant impairment to quality of life. The recent increasing prevalence of ECRS in south Asian countries and the strong tendency of ECRS to reoccur after surgery should be considered. The majority of cases need repeat surgery, and histological examinations of these cases show eosinophilic-dominant inflammation. The degradation and accumulation of eosinophils, release of cytokines, and mucus secretion have important roles in the pathogenesis of ECRS. ECRS differs from non-ECRS, in which eosinophils are not involved in the pathogenesis of the disease, and also in terms of many clinical characteristics, blood examination and nasal polyp histological findings, clinical features of the disease after surgery, efficacy of medications, and computed tomography findings. This review describes the clinical course, diagnosis, and treatment of ECRS as well as its pathophysiology and the role of eosinophils, mucus, cytokines, and other mediators in the pathogenesis of ECRS. PMID:27053925

  4. Mometasone implant for chronic rhinosinusitis.

    PubMed

    Wei, Calvin C; Kennedy, David W

    2012-01-01

    The Propel mometasone-eluting stent (Intersect ENT, Palo Alto, CA) is the first Food and Drug Administration-approved device for delivering steroid medication into the ethmoid cavity following surgery. The implant is composed of a biodegradable polymer in a lattice pattern that expands in a spring-like fashion to conform to the walls of a dissected ethmoid cavity and contains a total of 370 μg of mometasone furoate designed for gradual release over 30 days. The purpose of this article is to review the mode of action and the evidence supporting the efficacy of this novel technology. Three recently published clinical trials have demonstrated that the mometasone-eluting stent produced statistically significant reductions in inflammation, polyp formation, and postoperative adhesions. In addition, the implant has been found to significantly reduce the need for postoperative administration of oral steroids and to decrease the frequency of postoperative lysis of adhesions. Minimal adverse effects were reported in these trials and included infection, crusting, and granulation tissue formation. Although the placement of steroid-impregnated packing, stents, sponges, and gels has previously been used in the postoperative sinus cavities, the Propel mometasone-eluting stent introduces a new mechanism for localized and controlled delivery of topical therapy directly to the nasal mucosa for chronic rhinosinusitis.

  5. Risk Factors For Chronic Rhinosinusitis

    PubMed Central

    Min, Jin-Young; Tan, Bruce K.

    2015-01-01

    Purpose of review To review the recent literature on risk factors for chronic rhinosinusitis (CRS) with an emphasis on genetic, comorbid diseases and environmental factors associated with CRS. Through identifying potential risk factors for CRS, we glean insights into the underlying pathogenic mechanisms and essential for developing effective therapeutic strategies. Recent findings Recent findings demonstrate that genetics, comorbid medical conditions including airway diseases, gastroesophageal reflux disease, inflammatory and autoimmune diseases and various demographic and environmental factors are associated with having a CRS diagnosis. Limitations of current studies include, variable application of disease definitions, lack of prospective longitudinal studies and a disproportionate focus on tertiary care populations. Summary CRS has a broad spectrum of associations ranging from genetics to comorbid diseases and environmental factors. These predisposing factors provide valuable information for possible designing therapeutic and preventive interventions. However, to better understand whether these associations cause CRS, further studies are needed to independently replicate findings, establish temporal relationships between exposure and disease onset, evaluate the influence of exposure dose on disease severity, and to understand the biological effects of these risk factors in the context of CRS. PMID:25479315

  6. Fungal allergens.

    PubMed Central

    Horner, W E; Helbling, A; Salvaggio, J E; Lehrer, S B

    1995-01-01

    Airborne fungal spores occur widely and often in far greater concentrations than pollen grains. Immunoglobulin E-specific antigens (allergens) on airborne fungal spores induce type I hypersensitivity (allergic) respiratory reactions in sensitized atopic subjects, causing rhinitis and/or asthma. The prevalence of respiratory allergy to fungi is imprecisely known but is estimated at 20 to 30% of atopic (allergy-predisposed) individuals or up to 6% of the general population. Diagnosis and immunotherapy of allergy to fungi require well-characterized or standardized extracts that contain the relevant allergen(s) of the appropriate fungus. Production of standardized extracts is difficult since fungal extracts are complex mixtures and a variety of fungi are allergenic. Thus, the currently available extracts are largely nonstandardized, even uncharacterized, crude extracts. Recent significant progress in isolating and characterizing relevant fungal allergens is summarized in the present review. Particularly, some allergens from the genera Alternaria, Aspergillus, and Cladosporium are now thoroughly characterized, and allergens from several other genera, including some basidiomycetes, have also been purified. The availability of these extracts will facilitate definitive studies of fungal allergy prevalence and immunotherapy efficacy as well as enhance both the diagnosis and therapy of fungal allergy. PMID:7621398

  7. Allergic Conjunctivitis

    MedlinePlus

    ... water. This is called conjunctivitis, also known as “pink eye.” Causes & Risk Factors What causes allergic conjunctivitis? ... example, if you are allergic to pollen or mold, stay indoors when pollen and mold levels are ...

  8. Allergic Aspergillus sinusitis and its association with allergic bronchopulmonary aspergillosis

    PubMed Central

    Panjabi, Chandramani

    2011-01-01

    Allergic Aspergillus sinusitis (AAS) is a three decade old clinicopathologic entity in which mucoid impaction akin to that of allergic bronchopulmonary aspergillosis (ABPA) occurs in the paranasal sinuses. Features such as radiographic evidence of pansinusitis, passage of nasal plugs and recurrent nasal polyposis in patients with an atopic background is suggestive of AAS. Histopathlogic confirmation from the inspissated mucus is a sine qua non for the diagnosis. Heterogeneous densities on computed tomography of the paranasal sinuses are caused by the 'allergic mucin' in the sinuses. Many patients give a history of having undergone multiple surgical procedures for symptomatic relief. The current approach to treatment appears to include an initial surgical debridement followed by postoperative oral corticosteroids for long durations. Although both ABPA and AAS are classified as Aspergillus-related hypersensitivity respiratory disorders, their co-occurrence appears to be an infrequently recognised phenomenon. This could perhaps be attributed to the fact that these two diseases are often treated by two different specialties. A high index of suspicion is required to establish the diagnoses of ABPA and AAS. All patients with asthma and/or rhinosinusitis along with sensitisation to Aspergillus antigens are at an increased risk of developing ABPA and/or AAS. ABPA must be excluded in all patients with AAS and vice versa. Early diagnosis and initiation of appropriate therapy could plausibly alter the course of the disease processes and prevent the possible development of long term sequelae. PMID:22053309

  9. Asthma in Rhinosinusitis: A Survey from Iran

    PubMed Central

    Bakhshaee, Mehdi; Majidi, Mohamad-Reza; Gharavi, Vahideh; Alavizadeh, Fatemeh-Sadat; Movahed, Rahman; Asnaashari, Parasto; Asnaashari, Amir-Mohammad-Hashem

    2016-01-01

    Introduction: The coexistence of asthma and chronic rhinosinusitis (CRS) is more common than expected given their individual prevalence in the general population and may affect patient’s quality of life. The aim of this study was to evaluate the prevalence of asthma in chronic rhinosinusitis in Mashhad, Northeast Iran. Materials and Methods: This study was performed in two university hospital from November 2012 for 12 months. In total, 153 patients with chronic rhinosinusitis were enrolled and referred to a particular pulmonologist for asthma evaluation. Results: The mean age of participants was 40.54±13.11 years, and 41.8% were male. In total, 63.4% of patients had the polypoid form of CRS. The proportion of patients in this study with asthma was 41.8%, compared with a general asthma prevalence in this region of 13.5%. Conclusion: There is a high prevalence of asthma among patients with CRS, but it often remains undiagnosed. Asthma in CRS patients should be diagnosed and treated in order to improve patient’s quality of life. We recommend an evaluation of the lower airways in all of these patients as well as further studies in this field. PMID:27602339

  10. Topical Drug Delivery for Chronic Rhinosinusitis

    PubMed Central

    Liang, Jonathan; Lane, Andrew P.

    2013-01-01

    Chronic rhinosinusitis is a multifactorial disorder that may be heterogeneous in presentation and clinical course. While the introduction of endoscopic sinus surgery revolutionized surgical management and has led to significantly improved patient outcomes, medical therapy remains the foundation of long-term care of chronic rhinosinusitis, particularly in surgically recalcitrant cases. A variety of devices and pharmaceutical agents have been developed to apply topical medical therapy to the sinuses, taking advantage of the access provided by endoscopic surgery. The goal of topical therapy is to address the inflammation, infection, and mucociliary dysfunction that underlies the disease. Major factors that impact success include the patient’s sinus anatomy and the dynamics of the delivery device. Despite a growing number of topical treatment options, the evidence-based literature to support their use is limited. In this article, we comprehensively review current delivery methods and the available topical agents. We also discuss biotechnological advances that promise enhanced delivery in the future, and evolving pharmacotherapeutical compounds that may be added to rhinologist’s armamentarium. A complete understand of topical drug delivery is increasingly essential to the management of chronic rhinosinusitis when traditional forms of medical therapy and surgery have failed. PMID:23525506

  11. Phenotypes and Emerging Endotypes of Chronic Rhinosinusitis.

    PubMed

    Bachert, Claus; Akdis, Cezmi A

    2016-01-01

    Chronic rhinosinusitis can be differentiated into several phenotypes based on clinical criteria; however, these phenotypes do not teach us much about the underlying inflammatory mechanisms. Thus, the use of nasal endoscopy and CT scanning, and eventually taking a swab or a biopsy, may not be sufficient to fully appreciate the individual patient's pathology. Endotyping of chronic rhinosinusitis on the basis of pathomechanisms, functionally and pathologically different from others by the involvement of specific molecules or cells, may in contrast provide us with information on the risk of disease progression or recurrence and on the best available treatment, and also helps us identifying innovative therapeutic targets for treatment. Endotyping may best be structured around T helper cells and their downstream events, such as tissue eosinophilia or neutrophilia; this approach involves the cytokines and chemokines related to specific T helper cell populations, and related markers such as IgE. Endotyping is of specific interest at the time of the arrival of new biologicals, confronting us with the challenge of the selection of eligible patients for treatment and predicting their therapeutic response; defining suitable biomarkers is therefore an urgent task. Failure to appreciate the underlying mechanisms and endotypes of chronic rhinosinusitis may limit progress in the management of the disease at present.

  12. Phenotypes and Emerging Endotypes of Chronic Rhinosinusitis.

    PubMed

    Bachert, Claus; Akdis, Cezmi A

    2016-01-01

    Chronic rhinosinusitis can be differentiated into several phenotypes based on clinical criteria; however, these phenotypes do not teach us much about the underlying inflammatory mechanisms. Thus, the use of nasal endoscopy and CT scanning, and eventually taking a swab or a biopsy, may not be sufficient to fully appreciate the individual patient's pathology. Endotyping of chronic rhinosinusitis on the basis of pathomechanisms, functionally and pathologically different from others by the involvement of specific molecules or cells, may in contrast provide us with information on the risk of disease progression or recurrence and on the best available treatment, and also helps us identifying innovative therapeutic targets for treatment. Endotyping may best be structured around T helper cells and their downstream events, such as tissue eosinophilia or neutrophilia; this approach involves the cytokines and chemokines related to specific T helper cell populations, and related markers such as IgE. Endotyping is of specific interest at the time of the arrival of new biologicals, confronting us with the challenge of the selection of eligible patients for treatment and predicting their therapeutic response; defining suitable biomarkers is therefore an urgent task. Failure to appreciate the underlying mechanisms and endotypes of chronic rhinosinusitis may limit progress in the management of the disease at present. PMID:27393777

  13. ALLERGIC POTENTIAL OF INDOOR MOLDS

    EPA Science Inventory

    Many fungi have been associated with allergic lung disease, but few are well studied and even fewer allergens of fungal origin are well characterized. Exposure to damp moldy environments has been associated with the exacerbation of asthma, but the role of molds in the induction o...

  14. [Clinical diagnosis and treatment of allergic pharyngitis].

    PubMed

    Liu, Jinfeng; Yan, Zhanfeng; Zhang, Mingxia

    2015-08-01

    Although the concept of united airway disease has been widely accepted, most scholars emphasize only the effect of rhino-sinusitis while ignoring the pharyngeal factors to the lower airway, especially to the allergic pharyngitis (AP), which still lacks enough awareness. First of all, absence of unified diagnostic standard leads to the lack of epidemiological data, which, results in doctors' personal experience but no guideline in treatments. In addition, it is still not clear that the role of AP in the allergic airway diseases and its relationship with asthma. However, the number of patients with AP has been increasing obviously in daily clinic practice. Combined with the previous observation, this paper does a systematic review about the clinical problems of AP, expecting to give a hand to the clinical diagnosis and treatment of AP. PMID:26685417

  15. Predictors of Olfactory Dysfunction in Patients with Chronic Rhinosinusitis

    PubMed Central

    Litvack, Jamie R.; Fong, Karen; Mace, Jess; James, Kenneth E.; Smith, Timothy L.

    2009-01-01

    Objectives To measure the prevalence of and identify clinical characteristics associated with poor olfactory function in a large cohort of patients with chronic rhinosinusitis (CRS). Study Design Multi-institutional, cross sectional analysis. Methods An objective measure of olfactory dysfunction, the Smell Identification Test (SIT), demographic data, clinical factors and co-morbidity data were collected from a cohort of 367 patients who presented with CRS at three tertiary care centers. Data was analyzed using univariate and multivariate analyses. Results Sixty-four percent of men and women aged 18 to 64 had olfactory dysfunction whereas 95% of patients ≥ 65 years had olfactory dysfunction (p<0.001); no significant difference was noted by gender. By multivariate logistic regression analysis, patients with nasal polyposis (OR 2.4, 95% confidence interval (CI) 1.3, 4.2; p=0.003) and patients ≥ 65 years (OR 10.0, 95% CI 2.3, 43.7; p=0.002) were at increased risk of hyposmia. Patients with nasal polyposis (OR 13.2, 95% CI 5.7, 30.7; p<0.001), asthma (OR 4.2, 95% CI 1.8, 9.8; p=0.001), ≥ 65 years (OR 15.6, 95% CI 2.3, 104.9; p=0.005), and smokers (OR 7.6, 95% CI 1.8, 31.6; p=0.005) were at increased risk of anosmia. Conclusions Poor olfactory function is common in patients with CRS. Age, nasal polyposis, smoking, and asthma were significantly associated with olfactory dysfunction in patients with CRS. Neither prior endoscopic sinus surgery nor a history of allergic rhinitis was associated with olfactory dysfunction. Septal deviation and inferior turbinate hypertrophy were associated with normal olfactory function. PMID:19029858

  16. Pediatric atrophic rhinosinusitis: what can we do?

    PubMed

    Magalhães, Clara; Viana, Miguel; Alves, Valquíria; Nakamura, Roberto; Duarte, Delfim

    2015-05-01

    A 5-year-old female had history of chronic foul smelling nasal discharge. Rhinoscopy showed greenish crusts lining the nasal cavities and inferior turbinates were shriveled significantly. Nasal cavity cultures of crusts by swab revealed Klebsiella ozaenae making the diagnosis of primary atrophic rhinosinusitis. After several unsuccessful treatment, we have decided to try sulfamethoxazole-trimethoprim prophylaxis and 1 year later there was a complete clinical improvement. There are many medical therapies and surgical options described, but none of them showed effective at long term. We present antibiotic prophylaxis as a viable alternative for long term control of the disease. PMID:25799383

  17. Chronic rhinosinusitis and emerging treatment options

    PubMed Central

    Piromchai, Patorn; Kasemsiri, Pornthep; Laohasiriwong, Supawan; Thanaviratananich, Sanguansak

    2013-01-01

    This review describes the epidemiology and various treatments in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). Evidence for short-term use of systemic corticosteroids has been shown to be favorable in CRSwNP, but still limited in CRSsNP. Topical corticosteroids improve symptom scores in both CRS subgroups. The role of microbes in CRS is still controversial. Culture-directed antibiotics are recommended for CRSsNP with exacerbation. Long-term use of low dosage antibiotics is recommended for CRSsNP for their anti-inflammatory effects. Other emerging treatment options are also discussed. PMID:23785241

  18. Revision endoscopic ethmoidectomy for chronic rhinosinusitis.

    PubMed

    Corey, J P; Bumsted, R M

    1989-08-01

    In summary, revision endoscopic surgery for chronic rhinosinusitis can be performed safely by using the middle turbinate (or portion thereof) or the anterior wall of the sphenoid as a landmark. These cases are more difficult and may be more prone to bleeding and scarring. The surgeon should be thoroughly familiar with and not hesitate to switch to conventional techniques in the event of excessive bleeding, proptosis, or a loss of landmarks. Aggressive postoperative care and follow-up, including office endoscopic "touch-up" procedures, may be necessary to maintain control of aggressive disease, along with continued medical management and any indicated immunotherapy.

  19. Pathophysiology of chronic rhinosinusitis, pharmaceutical therapy options

    PubMed Central

    Bachert, Claus; Holtappels, Gabriële

    2015-01-01

    Research in immunology has brought great progress in knowledge of inflammatory processes in the last 2 decades, which also has an impact on the upper airways. Our understanding of the pathophysiology of chronic rhinosinusitis developed from a rather mechanistic point of view with a focus on narrow clefts and mucociliary clearance to the appreciation of a complex network of immunological pathways forming the basis of disease. We today differentiate various forms of inflammation, we start to understand complex immune-regulatory networks and the reasons for their failure, and have already developed innovative approaches for therapy for the most severely ill subjects. Due to this new knowledge in inflammation and remodeling processes within mucosal tissue, specifically on the key driving factors, new diagnostic tools and therapeutic approaches for chronic rhinosinusitis have developed; the differentiation of endotypes based on pathophysiological principles will be crucial for the use of innovative therapies, mostly humanized monoclonal antibodies. Several hundred of those antibodies are currently developed for various indications and will impact our specialty as well as pneumology to a great extent. PMID:26770283

  20. Allergic Reactions

    MedlinePlus

    ... immune system identifies pollen as an invader or allergen. Your immune system overreacts by producing antibodies called ... IgE has specific "radar" for each type of allergen. That's why some people are only allergic to ...

  1. Cytokine Patterns and Endotypes in Acute and Chronic Rhinosinusitis.

    PubMed

    Scheckenbach, Kathrin; Wagenmann, Martin

    2016-01-01

    Since rhinosinusitis is an inflammatory disease, cytokines as key regulators of inflammation play a central role in its pathophysiology. In acute rhinosinusitis, several proinflammatory cytokines of different types have been identified. Initial information about the involvement of the inflammasome in rhinosinusitis has been gained, but this area remains open for more detailed research. Although it has been accepted now that chronic rhinosinusitis (CRS) needs to be differentiated into CRS with and without nasal polyps, it has become clear that this distinction is insufficient to clearly define subgroups with uniform pathophysiology and cytokine patterns. While Th1-cytokines are mostly found in CRSsNP and Th2 cytokines in CRSwNP, there is a substantial overlap, and several other cytokines have also been detected. Attempts to identify CRS endotypes based on cytokines are ongoing but not yet generally accepted. Despite the central role of cytokines in rhinosinusitis, no specific cytokine-targeted therapies are currently available, and only very few studies have specifically addressed the effects of such biologicals in rhinosinusitis.

  2. [Chronic Rhinosinusitis - EPOS 2012 Part I].

    PubMed

    Riechelmann, H

    2013-03-01

    An expert group of the European Academy of Allergy and Clinical Immunology (EAACI) and the European Rhinologic Society (ERS) has recently published the revised position paper for acute and chronic rhinosinusitis (EPOS 2012). In the following article, the most important aspects of the EPOS 2012 paper concerning chronic rhinosinusitis (CRS) are referenced. Every 10th European is suffering from a chronic inflammation of the nose and paranasal sinuses.2 EPOS key messages according CRS are: 1. CRS is an inflammatory disease, not an infection. 2. CRS comes in 2 different subtypes, namely CRS without polyps (CRSsNP) and CRS with polyps (CRSwNP). CRSwNP is diagnosed, when nasal polyps are visible at an appropriate nasal endoscopic examination. Otherwise CRSsNP is classified. In the EPOS 2012 paper the current pathogenetic knowledge of these 2 different CRS subtypes are discussed. Current research focuses on epithelial/immune cell interactions, the biofilm hypothesis and the superantigen hypothesis. Both CRS subtypes may be associated with different frequencies with other diseases, especially allergies, asthma and aspirin exacerbated respiratory disease (AERD). These comorbidities should be recorded and treated. The standard diagnostic procedures include medical history, nasal endoscopy, CT-scans of the paranasal sinus, and allergy test of common inhalant allergens. The classification of disease severity in mild, moderate and severe was complemented with a concept of symptom control in controlled, partly controlled and uncontrolled. Also, a 'difficult-to-treat-CRS' was defined. The choice of therapy depends upon symptom intensity. In patients with moderate and severe symptoms, usually several weeks of conservative treatment including topical steroids are administered. In non-responders, surgical treatment (functional endonasal sinus surgery) is indicated. The EPOS Group offers evidence-based treatment algorithms for general practitioners and ENT-specialists.

  3. Allergic Rhinitis.

    PubMed

    Kakli, Hasan A; Riley, Timothy D

    2016-09-01

    Among the atopic disorders, allergic rhinitis is the most prevalent. Patients who suffer from allergic rhinitis sustain significant morbidity and loss of productivity. Cardinal symptoms include nasal congestion, rhinorrhea, sneezing, and nasal itching, although multiple related symptoms may occur. Causes should be ruled out with a thorough history and physical examination, with particular attention to red flag or atypical symptoms. Skin testing or serum sampling can confirm diagnosis and also guide therapy. Therapy is multimodal, tailored to a particular patient's symptom burden and quality of life. PMID:27545735

  4. Phytoneering: a new way of therapy for rhinosinusitis.

    PubMed

    Passali, D; Cambi, J; Passali, F M; Bellussi, L M

    2015-02-01

    A growing amount of scientific evidence suggests that herbal medicine may be helpful as an adjuvant treatment in rhinosinusitis. Herein, we systematically review and determine the role, efficacy and safety of phytotherapy in the treatment of acute and chronic rhinosinusitis and establish the qualities of herbal drugs as demonstrated by in vitro and in vivo experiments. Eligible studies published in English or German from January 1990 until June 2014 were identified via electronic database searches. Keywords were: sinusitis, phytotherapy, phytomedicine and herbal drugs. Additional studies were obtained through the references of selected articles. Twenty-two articles met inclusion criteria. Overall, the publications indicated that herbal medicines can have mucolytic, antiviral, antimicrobial, anti-inflammatory and secretolytic effects in experimental animals. Phytotherapy has also been found to be efficacious in reducing the symptoms of acute and chronic rhinosinusitis in children and the adult population in vivo, demonstrating a high level of tolerability and safety. Herbal products developed using phytoneering techniques have shown improvements in performance compared with previous formulations. The current literature suggests that phytotherapy is an effective and safe form of ancillary treatment for rhinosinusitis. In particular, herbal drugs made with the technique of phytoneering have proven effective in acute rhinosinusitis.

  5. Faropenem medoxomil: a treatment option in acute bacterial rhinosinusitis.

    PubMed

    Hadley, James A; Tillotson, Glenn S; Tosiello, Robert; Echols, Roger M

    2006-12-01

    Faropenem medoxomil is the first oral penem in a new class of beta-lactam antibiotics. Faropenem medoxomil has excellent in vitro activity against Streptococcus pneumoniae, Haemophilus influenzae and other key pathogens implicated in acute bacterial rhinosinusitis. Clinical studies have demonstrated that, in the treatment of acute bacterial rhinosinusitis in adults, 7 days of treatment with faropenem medoxomil is as clinically and bacteriologically effective as 10 days of treatment with cefuroxime axetil. One study showed faropenem medoxomil to be superior to cefuroxime axetil. Overall, the safety profile of faropenem medoxomil is similar to that of most comparators. Specifically, the minimal impact of faropenem medoxomil on the gastrointestinal flora leads to less diarrhea and other adverse events than coamoxicillin-clavulanate. Faropenem medoxomil has almost no drug-drug interactions and little requirement for dosage adjustments in the typical acute rhinosinusitis population. PMID:17181408

  6. Recent advances in the surgical management of rhinosinusitis

    PubMed Central

    Jaksha, Alexandria F.; Weitzel, Erik K.; Laury, Adrienne M.

    2016-01-01

    Rhinosinusitis affects a significant portion of the US population, and its management imposes a substantial burden on the healthcare system. The treatment of chronic rhinosinusitis includes initial medical management prior to consideration of surgical intervention. However, if surgery does become necessary, several factors must be considered in order to optimize outcomes. This review evaluates surgical patient selection, perioperative medical management, and the extent of operative intervention, with the goal of improving surgical results, decreasing the need for revision surgery, and enhancing the patient’s quality of life. Specific variations in patient genotypes and phenotypes will be further explored with regard to their implications on surgical outcomes. Additionally, the evidence behind pre- and post-operative antibiotic and steroid use will be evaluated. Finally, we will review evolving surgical tools and techniques that are currently being utilized for the treatment of specific subsets of rhinosinusitis. PMID:27746900

  7. European position paper on rhinosinusitis and nasal polyps 2007.

    PubMed

    Fokkens, Wytske; Lund, Valerie; Mullol, Joaquim

    2007-01-01

    Rhinosinusitis is a significant and increasing health problem which results in a large financial burden on society. This evidence based position paper describes what is known about rhinosinusitis and nasal polyps, offers evidence based recommendations on diagnosis and treatment, and considers how we can make progress with research in this area. Rhinitis and sinusitis usually coexist and are concurrent in most individuals; thus, the correct terminology is now rhinosinusitis. Rhinosinusitis (including nasal polyps) is defined as inflammation of the nose and the paranasal sinuses characterised by two or more symptoms, one of which should be either nasal blockage/obstruction/congestion or nasal discharge (anterior/posterior nasal drip), +/- facial pain/pressure, +/- reduction or loss of smell; and either endoscopic signs of polyps and/or mucopurulent discharge primarily from middle meatus and/or; oedema/mucosal obstruction primarily in middle meatus, and/or CT changes showing mucosal changes within the ostiomeatal complex and/or sinuses. The paper gives different definitions for epidemiology, first line and second line treatment and for research. Furthermore the paper describes the anatomy and (patho)physiology, epidemiology and predisposing factors, inflammatory mechanisms, evidence based diagnosis, medical and surgical treatment in acute and chronic rhinosinusitis and nasal polyposis in adults and children. Evidence based schemes for diagnosis and treatment are given for the first and second line clinicians. Moreover attention is given to complications and socio-economic cost of chronic rhinosinusitis and nasal polyps. Last but not least the relation to the lower airways is discussed. PMID:17844873

  8. Cystic fibrosis chronic rhinosinusitis: A comprehensive review

    PubMed Central

    Chaaban, Mohamad R.; Kejner, Alexandra; Rowe, Steven M.

    2013-01-01

    Background: Advances in the care of patients with cystic fibrosis (CF) have improved pulmonary outcomes and survival. In addition, rapid developments regarding the underlying genetic and molecular basis of the disease have led to numerous novel targets for treatment. However, clinical and basic scientific research focusing on therapeutic strategies for CF-associated chronic rhinosinusitis (CRS) lags behind the evidence-based approaches currently used for pulmonary disease. Methods: This review evaluates the available literature and provides an update concerning the pathophysiology, current treatment approaches, and future pharmaceutical tactics in the management of CRS in patients with CF. Results: Optimal medical and surgical strategies for CF CRS are lacking because of a dearth of well-performed clinical trials. Medical and surgical interventions are supported primarily by level 2 or 3 evidence and are aimed at improving clearance of mucus, infection, and inflammation. A number of novel therapeutics that target the basic defect in the cystic fibrosis transmembrane conductance regulator channel are currently under investigation. Ivacaftor, a corrector of the G551D mutation, was recently approved by the Food and Drug Administration. However, sinonasal outcomes using this and other novel drugs are pending. Conclusion: CRS is a lifelong disease in CF patients that can lead to substantial morbidity and decreased quality of life. A multidisciplinary approach will be necessary to develop consistent and evidence-based treatment paradigms. PMID:24119602

  9. The link between chronic rhinosinusitis and asthma

    PubMed Central

    Huang, Chien-Chia; Wang, Chun-Hua; Fu, Chia-Hsiang; Huang, Chi-Che; Chang, Po-Hung; Chen, I-Wei; Lee, Ta-Jen

    2016-01-01

    Abstract Treatments for chronic rhinosinusitis (CRS) and asthma can affect both conditions, based on the united airway concept. This study aimed to evaluate the link between CRS and asthma, based on disease-specific quality of life measures. We performed a prospective cohort study to investigate the correlations between results from CRS- and asthma-specific questionnaires. Thirty-two patients with asthma and CRS were evaluated before and after undergoing nasal surgery at a tertiary medical center. There were significant correlations between the results from the Asthma Control Test (ACT) and the Sino-Nasal Outcome Test-22, as well as between the results of the ACT and Rhinoconjunctivitis Quality of Life Questionnaire, at both the preoperative and 3-month postoperative evaluations (P < 0.01). Moreover, nasal surgery improved the sinonasal symptoms, asthma control, and pulmonary function (P < 0.01). Increasingly severe sinonasal symptoms of CRS were associated with poor asthma control. Therefore, CRS and asthma should be considered and treated as common airway diseases. PMID:27495032

  10. Therapeutic Targets in Rhinosinusitis: Infection or Inflammation?

    PubMed Central

    Lund, Valerie J.

    2008-01-01

    Context Rhinosinusitis (RS) is an inflammatory condition of the contiguous nasal and paranasal sinuses that is accompanied by a viral or bacterial infection. Controlling the inflammation will attenuate many of the symptoms of RS, including nasal blockage discharge, facial discomfort, headache, and hyposmia, and promote the clearance of the infectious agent. Objective The objective is to review the efficacy of symptomatic treatment with intranasal corticosteroids (INS) for the inflammatory component of acute, recurrent, or chronic RS in adults and children. Data sources Published English-language articles identified in the PubMed and MEDLINE databases. Study selection Only studies about clinical trials that were randomized, double-blind, and controlled for either placebo or active comparator were selected as valid evidence of the efficacy and tolerability of symptomatic treatment. Studies of INS use as monotherapy or adjunctive therapy with an antibiotic were consulted. Data extraction Data from clinical studies included size of patient population, efficacy endpoints, systemic and topical adverse events, and criteria for confirming a diagnosis of RS Data synthesis Data showed that INS improved many of the symptoms of RS, including nasal blockage and purulence, facial discomfort, and headache. Significant improvement compared with placebo was demonstrated in most studies in adults and children with acute RS and in adults with recurrent or chronic RS, whether INS were used as monotherapy or adjunctive treatment. INS were shown to be well tolerated in all of these studies. Conclusion INS reduce local inflammation and improve drainage, effects that are critical to the resolution of acute RS. PMID:18504478

  11. Chronic Rhinosinusitis in Patients with Cystic Fibrosis.

    PubMed

    Hamilos, Daniel L

    2016-01-01

    Chronic rhinosinusitis (CRS) is highly prevalent in patients with cystic fibrosis (CF) and accounts for significant morbidity and contribution to CF lung disease. Mutations of the cystic fibrosis transmembrane regulator gene occur with increased prevalence in patients with CRS without CF, suggesting some contribution to CRS pathophysiology. Nasal polyps (NPs) occur with increased prevalence in patients with CF of all ages and have a more neutrophilic appearance with fewer eosinophils and increased submucosal glandular elements in comparison to NPs from patients without CF. Mainstays of medical treatment include isotonic saline irrigations and topical intranasal glucocorticoids, with some evidence that topical intranasal glucocorticoids reduce NP size. Although inhaled hypertonic saline (7%) has been widely studied as a mucolytic agent for CF lung disease, there are no reports of its use in CF CRS. Mucolytics have also not been studied as a treatment for CRS in CF, and most evidence does not support their use for CF lung disease. Nasally nebulized dornase alfa (recombinant human deoxyribonuclease) following sinus surgery shows promise for treatment. Other unproven therapies include addition of baby shampoo to isotonic saline to potentially thin mucus and help prevent biofilm formation. There are no data to support the use of low-dose oral macrolide antibiotics or the use of prophylactic oral antibiotics for CRS in patients with CF. However, there is some support for the use of topical antibiotics, including colistimethate sodium or tobramycin, administered as a sinus irrigation or antral lavage in patients following sinus surgery when susceptible bacteria are cultured. Key components of CF sinus surgical management include extensive surgery to ensure that the maxillary, frontal, sphenoid, and ethmoid sinuses are all widely opened with smoothing of bony overhangs to prevent mucus retention and bacterial recolonization, postoperative meticulous daily nasal irrigations

  12. Biofilm detection in chronic rhinosinusitis by combined application of hematoxylin-eosin and gram staining.

    PubMed

    Tóth, László; Csomor, Péter; Sziklai, István; Karosi, Tamás

    2011-10-01

    The pathomechanism of chronic rhinosinusitis with nasal polyposis (CRS/NP) seems to be unclear. Bacterial-, fungal- and combined biofilms might play a potential role in the pathogenesis of various inflammatory diseases and recently in CRS/NP. A prospective, blinded observational study was performed to confirm that the combination of conventional hematoxylin-eosin (HE) and Gram staining protocols could be used to detect bacterial and fungal biofilms in patients with CRS/NP. A total of 50 patients with CRS/NP undergoing endoscopic sinus surgery (ESS) were analyzed. The negative control group consisted of 12 patients undergoing septoplasty for nasal obstruction without CRS/NP. The nasal polyps and inferior turbinate mucosa specimens applied as negative controls were processed to HE and Gram staining. Biofilm was detected in 44 of 50 patients with CRS/NP and in none of 12 negative controls. In our series, HE method showed an obvious correlation with the results of Gram staining and was allocated to be a good predictor of biofilm existence. It was found that the microscopic structure and thickness of biofilms were strongly associated with the integrity of nasal mucosa and with the characteristics of subepithelial cellular infiltration. This study confirmed the presence of bacterial and fungal biofilms on the surface of NPs obtained from patients with CRS. Since biofilms may affect the severity and recurrence rate of CRS treated by ESS they should be detected histologically. In conclusion, HE staining combined with Gram protocol is a robust and reliable method for the detection of bacterial and fungal biofilms in CRS/NP.

  13. INDOOR FUNGAL CONTAMINANTS: ASSESSING THE ALLERGIC POTENTIAL

    EPA Science Inventory

    The indoor environment has increased in importance to children's health with children now spending more than 90% of their time indoors. Molds are an important component of this environment and have been associated with exacerbation of asthma as well as a number of other health e...

  14. Chronic Rhinosinusitis Associated with Erectile Dysfunction: A Population-Based Study.

    PubMed

    Tai, Shu-Yu; Wang, Ling-Feng; Tai, Chih-Feng; Huang, Yu-Ting; Chien, Chen-Yu

    2016-01-01

    Few studies have investigated the relationship between chronic rhinosinusitis (CRS) and erectile dysfunction (ED). This case-control study aimed to investigate the association between CRS and the risk of ED in a large national sample. Tapping Taiwan's National Health Insurance Research Database, we identified people 30 years or older with a new primary diagnosis of CRS between 1996 and 2007. The cases were compared with sex- and age-matched controls. We identified 14 039 cases and recruited 140 387 matched controls. Both groups were followed up in the same database until the end of 2007 for instances of ED. Of those with CRS, 294 (2.1%) developed ED during a mean (SD) follow-up of 3.20 (2.33) years, while 1 661 (1.2%) of the matched controls developed ED, mean follow up 2.97 (2.39) years. Cox regression analyses were performed adjusting for sex, age, insurance premium, residence, hypertension, hyperlipidemia, diabetes, obesity, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, asthma, allergic rhinitis, arrhythmia, ischemic stroke, intracerebral hemorrhage, and medications. CRS was revealed to be an independent predictor of ED in the fully adjusted model (HR = 1.51; 95% CI = 1.33-1.73; P < 0.0001). PMID:27578370

  15. Chronic Rhinosinusitis Associated with Erectile Dysfunction: A Population-Based Study

    PubMed Central

    Tai, Shu-Yu; Wang, Ling-Feng; Tai, Chih-Feng; Huang, Yu-Ting; Chien, Chen-Yu

    2016-01-01

    Few studies have investigated the relationship between chronic rhinosinusitis (CRS) and erectile dysfunction (ED). This case-control study aimed to investigate the association between CRS and the risk of ED in a large national sample. Tapping Taiwan’s National Health Insurance Research Database, we identified people 30 years or older with a new primary diagnosis of CRS between 1996 and 2007. The cases were compared with sex- and age-matched controls. We identified 14 039 cases and recruited 140 387 matched controls. Both groups were followed up in the same database until the end of 2007 for instances of ED. Of those with CRS, 294 (2.1%) developed ED during a mean (SD) follow-up of 3.20 (2.33) years, while 1 661 (1.2%) of the matched controls developed ED, mean follow up 2.97 (2.39) years. Cox regression analyses were performed adjusting for sex, age, insurance premium, residence, hypertension, hyperlipidemia, diabetes, obesity, coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, asthma, allergic rhinitis, arrhythmia, ischemic stroke, intracerebral hemorrhage, and medications. CRS was revealed to be an independent predictor of ED in the fully adjusted model (HR = 1.51; 95% CI = 1.33–1.73; P < 0.0001). PMID:27578370

  16. RELATIVE POTENCY OF MOLD AND HOUSE DUST MITE EXTRACTS IN INDUCING ALLERGIC RESPONSES IN BALB/C MICE

    EPA Science Inventory

    Rationale: Mold has been associated with the exacerbation of allergic asthma. However, its role in induction of allergic asthma is not clear. Using a previously developed mouse model for allergic asthma, we compared potencies of two fungal extracts (Metarhizium anisop...

  17. Does Spore Count Matter in Fungal Allergy?: The Role of Allergenic Fungal Species

    PubMed Central

    Lin, Wan-Rou; Lee, Mey-Fann; Hsu, Ling-Yi; Tien, Chih-Jen; Shih, Feng-Ming; Hsiao, Shih-Ching

    2016-01-01

    Purpose Fungi have been known to be important aeroallergens for hundreds of years. Most studies have focused on total fungal concentration; however, the concentration of specific allergenic fungi may be more important on an individual basis. Methods Ten fungal allergic patients and 2 non-fungal allergic patients were enrolled. The patients with a decrease in physician or patient global assessment by more than 50% of their personal best were considered to have an exacerbation of allergic symptoms and to be in the active stage. Those who maintained their physician and patient global assessment scores at their personal best for more than 3 months were considered to be in the inactive stage. The concentrations of dominant fungi in the patients' houses and outdoors were measured by direct and viable counts at active and inactive stages. Results The exacerbation of allergic symptoms was not correlated with total fungal spore concentration or the indoor/outdoor ratio (I/O). Specific fungi, such as Cladosporium oxysporum (C. oxyspurum), C. cladosporioides, and Aspergillus niger (A. niger), were found to be significantly higher concentrations in the active stage than in the inactive stage. Presumed allergenic spore concentration threshold levels were 100 CFU/m3 for C. oxysporum, and 10 CFU/m3 for A. niger, Penicillium brevicompactum and Penicillium oxalicum. Conclusions The major factor causing exacerbation of allergic symptoms in established fungal allergic patients may be the spore concentration of specific allergenic fungi rather than the total fungal concentration. These results may be useful in making recommendations as regards environmental control for fungal allergic patients. PMID:27334778

  18. Treatment of Orbital Complications Following Acute Rhinosinusitis in Children

    PubMed Central

    Wan, Yuzhu; Shi, Guanggang; Wang, Haibo

    2016-01-01

    Background: The orbital complications account for about 80% of all complications secondary to acute rhinosinusitis. If the treatment is not correct and in time, orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications. Aims: To evaluate the therapeutic efficacy of conservative therapy for the patients with orbital cellulitis and endoscopic sinus surgery (ESS) performed on patients with subperiosteal abscess (SPA) secondary to acute rhinosinusitis in children. Study Design: Retrospective cross-sectional study. Methods: The retrospective study included 31 pediatric patients with orbital complications secondary to acute rhinosinusitis. In all cases, intensive treatment was initiated with a combination of oral or intravenous antibiotics, glucocorticoid and gelomyrtol forte after admission. ESS was performed if an improvement in the condition of patients did not occur after 48 hours. However, the patients with orbital SPA, motility disorders of eyeball or decreased vision received ESS immediately within 24 hours. Results: Sixteen patients were cured by conservative therapy and 15 patients by ESS. All of the signs and symptoms disappeared after conservative therapy or ESS. There were no recurrences within the follow-up period of 1 to 8 years. Conclusion: Conservative therapy is an effective method for patients with inflammatory edema and most cases of orbital cellulitis in children. SPA can be cured by ESS.

  19. Treatment of Orbital Complications Following Acute Rhinosinusitis in Children

    PubMed Central

    Wan, Yuzhu; Shi, Guanggang; Wang, Haibo

    2016-01-01

    Background: The orbital complications account for about 80% of all complications secondary to acute rhinosinusitis. If the treatment is not correct and in time, orbital complications could progress rapidly, leading to optic neuritis, cavernous sinus thrombophlebitis or life-threatening intracranial complications. Aims: To evaluate the therapeutic efficacy of conservative therapy for the patients with orbital cellulitis and endoscopic sinus surgery (ESS) performed on patients with subperiosteal abscess (SPA) secondary to acute rhinosinusitis in children. Study Design: Retrospective cross-sectional study. Methods: The retrospective study included 31 pediatric patients with orbital complications secondary to acute rhinosinusitis. In all cases, intensive treatment was initiated with a combination of oral or intravenous antibiotics, glucocorticoid and gelomyrtol forte after admission. ESS was performed if an improvement in the condition of patients did not occur after 48 hours. However, the patients with orbital SPA, motility disorders of eyeball or decreased vision received ESS immediately within 24 hours. Results: Sixteen patients were cured by conservative therapy and 15 patients by ESS. All of the signs and symptoms disappeared after conservative therapy or ESS. There were no recurrences within the follow-up period of 1 to 8 years. Conclusion: Conservative therapy is an effective method for patients with inflammatory edema and most cases of orbital cellulitis in children. SPA can be cured by ESS. PMID:27606135

  20. Invasive fungal sinusitis in a healthy athlete due to long-term anabolic steroid use.

    PubMed

    Kim, Irene A; Thompson, Christopher F; Kedeshian, Paul A; Palma-Diaz, Fernando; Suh, Jeffrey D

    2014-08-01

    Invasive fungal rhinosinusitis is a potentially fatal infection that affects immunocompromised patients. Prognosis is generally poor despite aggressive medical and surgical treatments. We present the first reported case of invasive fungal sinusitis in a healthy 18-year-old male athlete who was taking anabolic androgenic steroids (AAS). The effects of excessive AAS use on the immune system are not fully understood, but there may be consequences at supraphysiological concentrations. This case demonstrates potential immunomodulatory effects of anabolic steroids and highlights a previously unknown cause of invasive fungal sinusitis.

  1. The Etiology and Pathogenesis of Chronic Rhinosinusitis: a Review of Current Hypotheses

    PubMed Central

    Lam, Kent; Schleimer, Robert; Kern, Robert C.

    2016-01-01

    Chronic rhinosinusitis (CRS) is a broad clinical syndrome that is characterized by prolonged mucosal inflammation of the nose and paranasal sinuses, and is typically divided into two subtypes based on the presence or absence of nasal polyps. The etiology and pathogenesis of both forms remain areas of active research. Over the last 15 years, a number of hypotheses have been proposed to explain all or part of the clinical CRS spectrum. These hypotheses reflect the concept that CRS results from a dysfunctional interplay between individual host characteristics and factors exogenous to the host. Six broad theories on CRS etiology and pathogenesis are discussed as follows: (1) the “fungal hypothesis,” (2) the “superantigen hypothesis,” (3) the “biofilm hypothesis,” and (4) the “microbiome hypothesis,” all of which emphasize key environmental factors, and (5) the “eicosanoid hypothesis” and (6) the “immune barrier hypothesis,” which describe specific host factors. These theories are reviewed, and the evidence supporting them is critically appraised. PMID:26143392

  2. Allergic reactions (image)

    MedlinePlus

    Allergic reaction can be provoked by skin contact with poison plants, chemicals and animal scratches, as well as by ... dust, nuts and shellfish, may also cause allergic reaction. Medications such as penicillin and other antibiotics are ...

  3. Fungal Tests

    MedlinePlus

    ... effectiveness of treatment. For many superficial skin and yeast infections, a clinical examination of the affected person ... the chemical solution dissolves non-fungal elements; reveals yeast cells and fungal hyphae (branching filaments) on a ...

  4. Fungal arthritis

    MedlinePlus

    Mycotic arthritis; Infectious arthritis - fungal ... Marquez J, Espinoza LR. Infectious arthritis II: mycobacterial, brucellar, fungal, and parasitic arthritis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology . ...

  5. Outdoor air pollution in urban areas and allergic respiratory diseases.

    PubMed

    D'Amato, G

    1999-12-01

    Respiratory allergic diseases (rhinitis, rhinosinusitis, bronchial asthma and its equivalents) appear to be increasing in most countries, and subjects living in urban and industrialized areas are more likely to experience respiratory allergic symptoms than those living in rural areas. This increase has been linked, among various factors, to air pollution, which is now an important public health hazard. Laboratory studies confirm the epidemiological evidence that inhalation of some pollutants, either individually or in combination, adversely affect lung function in asthmatics. The most abundant air pollutants in urban areas with high levels of vehicle traffic are respirable particulate matter, nitrogen dioxide and ozone. While nitrogen dioxide does not exert consistent effects on lung function, ozone, respirable particulate matter and allergens impair lung function and lead to increased airway responsiveness and bronchial obstruction in predisposed subjects. However, besides acting as irritants, airborne pollutants can modulate the allergenicity of antigens carried by airborne particles. By attaching to the surface of pollen grains and of plant-derived paucimicronic particles, pollutants can modify the morphology of these antigen-carrying agents and after their allergenic potential. In addition, by inducing airway inflammation, which increases airway epithelial permeability, pollutants overcome the mucosal barrier and so facilitate the allergen-induced inflammatory responses. Moreover, air pollutants such as diesel exhaust emissions are thought to modulate the immune response by increasing immunoglobulin E synthesis, thus facilitating allergic sensitization in atopic subjects and the subsequent development of clinical respiratory symptoms. PMID:10695313

  6. [Acute rhinosinusitis in adults--EPOS 2012 Part II].

    PubMed

    Riechelmann, H; Giotakis, A; Kral, F

    2013-11-01

    Rhinosinusitis (RS) is an inflammatory disorder of the mucous membranes of the nose and paranasal sinuses, which are almost always affected concurrently. The EPOS2012 position paper initiated by the European Rhinologic Society and the European Academy of Allergy and Clinical Immunology is a recent comprehensive source on this common disease affecting approximately 20% of the population worldwide. Inflammation, not infection, is considered the cornerstone of RS, which is considered a temporal and pathophysiologic disease continuum with various subtypes. Acute rhinosinusitis is diagnosed, if typical symptoms last less than 12 weeks. It affects approximately 10% of the European population. Acute RS is further subdivided into acute viral, acute postviral and acute bacterial RS. Acute viral RS lasts less than 10 days with decreasing symptom intensity, while acute postviral RS is characterized by longer duration or a sudden increase of symptom severity around the 5th day ('double sickening'). Acute bacterial RS is assumed if 3 of the following 5 criteria are additionally met: Discoloured discharge (with unilateral predominance), severe local pain (with unilateral predominance), fever (>38ºC), elevated ESR/CRP, and 'double-sickening'. For the treatment of acute viral RS, nasal saline irrigations and OTC cold remedies are advised. In acute postviral RS, additional topical steroids are suggested. Advantages and disadvantages of antibiotic treatment in acute bacterial RS are detailed. Overall, the new EPOS position paper infers a reorientation in this area of high medical, pharmaceutical and economic relevance.

  7. Fungal Endocarditis

    PubMed Central

    Yuan, Shi-Min

    2016-01-01

    Fungal endocarditis is a rare and fatal condition. The Candida and Aspergillus species are the two most common etiologic fungi found responsible for fungal endocarditis. Fever and changing heart murmur are the most common clinical manifestations. Some patients may have a fever of unknown origin as the onset symptom. The diagnosis of fungal endocarditis is challenging, and diagnosis of prosthetic valve fungal endocarditis is extremely difficult. The optimum antifungal therapy still remains debatable. Treating Candida endocarditis can be difficult because the Candida species can form biofilms on native and prosthetic heart valves. Combined treatment appears superior to monotherapy. Combination of antifungal therapy and surgical debridement might bring about better prognosis. PMID:27737409

  8. Canadian clinical practice guidelines for acute and chronic rhinosinusitis

    PubMed Central

    2011-01-01

    This document provides healthcare practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in guidelines development, and do not address the particulars of the Canadian healthcare environment. Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections, and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused. Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability rather than

  9. A 51-year-old woman with acute onset of facial pressure, rhinorrhea, and tooth pain: review of acute rhinosinusitis.

    PubMed

    Hwang, Peter H

    2009-05-01

    Acute rhinosinusitis is a common ailment accounting for millions of office visits annually, including that of Mrs D, a 51-year-old woman presenting with 5 days of upper respiratory illness and facial pain. Her case is used to review the diagnosis and treatment of acute rhinosinusitis. Acute viral rhinosinusitis can be difficult to distinguish from acute bacterial rhinosinusitis, especially during the first 10 days of symptoms. Evidence-based clinical practice guidelines developed to guide diagnosis and treatment of acute viral and bacterial rhinosinusitis recommend that the diagnosis of acute rhinosinusitis be based on the presence of "cardinal symptoms" of purulent rhinorrhea and either facial pressure or nasal obstruction of less than 4 weeks' duration. Antibiotic treatment generally can be withheld during the first 10 days of symptoms for mild to moderate cases, given the likelihood of acute viral rhinosinusitis or of spontaneously resolving acute bacterial rhinosinusitis. After 10 days, the likelihood of acute bacterial rhinosinusitis increases, and initiation of antibiotic therapy is supported by practice guidelines. Complications of sinusitis, though rare, can be serious and require early recognition and treatment.

  10. Epigenomics and allergic disease.

    PubMed

    Lockett, Gabrielle A; Patil, Veeresh K; Soto-Ramírez, Nelís; Ziyab, Ali H; Holloway, John W; Karmaus, Wilfried

    2013-12-01

    Allergic disease development is affected by both genes and the environment, and epigenetic mechanisms are hypothesized to mediate these environmental effects. In this article, we discuss the link between the environment, DNA methylation and allergic disease, as well as questions of causality inherent to analyses of DNA methylation. From the practical side, we describe characteristics of allergic phenotypes and contrast different epidemiologic study designs used in epigenetic research. We examine methodological considerations, how best to conduct preprocessing and analysis of DNA methylation data sets, and the latest methods, technologies and discoveries in this rapidly advancing field. DNA methylation and other epigenetic marks are firmly entwined with allergic disease, a link that may hold the basis for future allergic disease diagnosis and treatment.

  11. Epigenomics and allergic disease

    PubMed Central

    Lockett, Gabrielle A; Patil, Veeresh K; Soto-Ramírez, Nelís; Ziyab, Ali H; Holloway, John W; Karmaus, Wilfried

    2014-01-01

    Allergic disease development is affected by both genes and the environment, and epigenetic mechanisms are hypothesized to mediate these environmental effects. In this article, we discuss the link between the environment, DNA methylation and allergic disease, as well as questions of causality inherent to analyses of DNA methylation. From the practical side, we describe characteristics of allergic phenotypes and contrast different epidemiologic study designs used in epigenetic research. We examine methodological considerations, how best to conduct preprocessing and analysis of DNA methylation data sets, and the latest methods, technologies and discoveries in this rapidly advancing field. DNA methylation and other epigenetic marks are firmly entwined with allergic disease, a link that may hold the basis for future allergic disease diagnosis and treatment. PMID:24283882

  12. Chronic Rhinosinusitis and Irritable Bowel Syndrome: A Case Report

    PubMed Central

    Kogan, Mikhail; Castillo, Carlos Cuellar; Barber, Melissa S.

    2016-01-01

    Introduction Chronic rhinosinusitis (CRS) and irritable bowel syndrome (IBS) can be comorbidities that are difficult to treat. In this patient, an evidence-informed treatment pathway guided by laboratory biomarkers was used to address both conditions. Case Presentation A 69-y-old female patient presented with a 50-y history of sinusitis that was worse in the winter, postnasal drip, frequent sore throats, gastrointestinal complaints, headaches, and yeast infections. Two sinus surgeries (in years 2000 and 2002) and multiple courses of antibiotics had not resolved her sinus symptoms. In addition to CRS and IBS, this patient was noted to have intestinal overgrowth of Candida albicans, multiple food sensitivities, and leaky gut syndrome. Conclusion Antifungal medication and dietary changes in the course of 8 mo resulted in the resolution of her CRS and IBS. PMID:27547167

  13. Acute post-operative rhinosinusitis following endonasal dacryocystorhinostomy

    PubMed Central

    Shams, P N; Selva, D

    2013-01-01

    Purpose To investigate the incidence and risk factors for acute rhinosinusitis (ARS) following endoscopic dacryocystorhinostomy (EnDCR). Methods Retrospective single-surgeon interventional case series, including 196 consecutive patients undergoing 203 endonasal DCR, with clinical and radiological evidence of nasolacrimal duct or common canalicular obstruction. Pre-operative lacrimal and sinonasal clinical assessment and imaging, intraoperative endoscopic video recording, and post-operative clinical and endoscopic findings were analysed for cases of ARS occurring within the first 4 weeks following DCR among patients with and without a past history of chronic rhinosinusitis (CRS). Surgical complications and outcomes at 12 months and management of ARS are reported. Results Three patients (1.5%) developed ARS within the first 5 post-operative days, none of which had experienced peri-operative complications and all had a past history of CRS. The rate of CRS in this cohort of 196 patients was 10.2% (n=20), of which 15% (n=3) developed ARS, although none had symptoms of CRS at the time of surgery; one had undergone previous sinus surgery. Presenting symptoms of ARS included facial pain, tenderness over the affected sinus, and nasal discharge; all patients responded to oral antibiotic therapy. Discussion The rate of ARS following EnDCR was 1.5%. In those with a prior history of CRS, it was 15% (P=0.009). ARS developed within the first post-operative week among patients with a past history of CRS, who were asymptomatic at the time of surgery, and responded to oral antibiotics. CRS may be a risk factor for the development of post-operative ARS. PMID:23846379

  14. Identification of chronic rhinosinusitis phenotypes using cluster analysis

    PubMed Central

    Soler, Zachary M.; Hyer, J. Madison; Ramakrishnan, Viswanathan; Smith, Timothy L.; Mace, Jess; Rudmik, Luke; Schlosser, Rodney J.

    2015-01-01

    Introduction Current clinical classifications of chronic rhinosinusitis (CRS) have been largely defined based upon preconceived notions of factors thought to be important, such as polyp or eosinophil status. Unfortunately, these classification systems have little correlation with symptom severity or treatment outcomes. Unsupervised clustering can be used to identify phenotypic subgroups of CRS patients, describe clinical differences in these clusters and define simple algorithms for classification. Methods A multi-institutional, prospective study of 382 patients with CRS who had failed initial medical therapy completed the SinoNasal Outcome Test (SNOT-22), Rhinosinusitis Disability Index (RSDI), Short Form-12 (SF-12), Pittsburgh Sleep Quality Index (PSQI), and Patient Health Questionnaire (PHQ-2). Objective measures of CRS severity included Brief Smell Identification Test (B-SIT), CT and endoscopy scoring. All variables were reduced and unsupervised hierarchical clustering was performed. After clusters were defined, variations in medication usage were analyzed. Discriminant analysis was performed to develop a simplified, clinically useful algorithm for clustering. Results Clustering was largely determined by age, severity of patient reported outcome measures, depression and fibromyalgia. CT and endoscopy varied somewhat among clusters. Traditional clinical measures including polyp/atopic status, prior surgery, B-SIT and asthma did not vary among clusters. A simplified algorithm based upon productivity loss, SNOT-22 score and age predicted clustering with 89% accuracy. Medication usage among clusters did vary significantly. Discussion A simplified algorithm based upon hierarchical clustering is able to classify CRS patients and predict medication usage. Further studies are warranted to determine if such clustering predicts treatment outcomes. PMID:25694390

  15. The Role of Innate Immunity and Aeroallergens in Chronic Rhinosinusitis.

    PubMed

    London, Nyall R; Tharakan, Anuj; Ramanathan, Murugappan

    2016-01-01

    Allergy has been inferred to contribute to the pathophysiology of chronic rhinosinusitis (CRS) although this role is controversial and the mechanism is debated. Furthermore, the role of aeroallergens in CRS is poorly defined and has been postulated to contribute to CRS through direct penetration in the sinuses or downstream systemic consequences. Common aeroallergens implicated in chronic rhinosinusitis include air pollution/second hand smoke, dust mite and pollen [1,2,3]. One emerging potential mechanism whereby aeroallergens contribute to CRS is through sinonasal epithelial barrier disruption (fig. 1). Characterization of cytokine disruption of sinonasal epithelial cell barrier has been described including interleukin (IL)-4 and IL-13, as well as aeroallergens such as house dust mite and cigarette smoke. Recent results have demonstrated severe barrier disruption in response to direct application of either particulate matter (PM) or house dust mite (HDM) to sinonasal epithelial cells. Sinonasal epithelial barrier disruption may contribute to CRS by enabling the perpetual and chronic exposure of inflammatory allergens and stimuli. The sinonasal epithelial barrier plays a significant role in innate immune host defense. Mechanisms of innate immune defense include pattern recognition receptors (PRRs), secreted endogenous antimicrobials and inflammatory cytokines that aid in repair mechanisms including IL-33. Here we discuss recent evidence implicating aeroallergens and dysregulated host innate immune responses in the development of CRS.

    1Fig. 1. Aeroallergens and inflammatory stimuli disrupt sinonasal epithelial barrier function. These agents act to destabilize the barrier through stimulating endocytosis and destruction of cell junction proteins via oxidative stress and MyD88-dependent mechanisms. Furthermore

  16. The Role of Innate Immunity and Aeroallergens in Chronic Rhinosinusitis.

    PubMed

    London, Nyall R; Tharakan, Anuj; Ramanathan, Murugappan

    2016-01-01

    Allergy has been inferred to contribute to the pathophysiology of chronic rhinosinusitis (CRS) although this role is controversial and the mechanism is debated. Furthermore, the role of aeroallergens in CRS is poorly defined and has been postulated to contribute to CRS through direct penetration in the sinuses or downstream systemic consequences. Common aeroallergens implicated in chronic rhinosinusitis include air pollution/second hand smoke, dust mite and pollen [1,2,3]. One emerging potential mechanism whereby aeroallergens contribute to CRS is through sinonasal epithelial barrier disruption (fig. 1). Characterization of cytokine disruption of sinonasal epithelial cell barrier has been described including interleukin (IL)-4 and IL-13, as well as aeroallergens such as house dust mite and cigarette smoke. Recent results have demonstrated severe barrier disruption in response to direct application of either particulate matter (PM) or house dust mite (HDM) to sinonasal epithelial cells. Sinonasal epithelial barrier disruption may contribute to CRS by enabling the perpetual and chronic exposure of inflammatory allergens and stimuli. The sinonasal epithelial barrier plays a significant role in innate immune host defense. Mechanisms of innate immune defense include pattern recognition receptors (PRRs), secreted endogenous antimicrobials and inflammatory cytokines that aid in repair mechanisms including IL-33. Here we discuss recent evidence implicating aeroallergens and dysregulated host innate immune responses in the development of CRS.

    1Fig. 1. Aeroallergens and inflammatory stimuli disrupt sinonasal epithelial barrier function. These agents act to destabilize the barrier through stimulating endocytosis and destruction of cell junction proteins via oxidative stress and MyD88-dependent mechanisms. Furthermore

  17. Chronic invasive fungal sinusitis causing a pathologic Le Fort I fracture in an immunocompetent patient.

    PubMed

    Richter, Amy L; Gallagher, K Kelly

    2016-09-01

    We describe the case of a 77-year-old immunocompetent woman with a history of chronic rhinosinusitis who presented with a pathologic Le Fort I fracture after a forceful sneeze. Imaging revealed diffuse sinus opacification and a Le Fort type I complex fracture involving the maxilla, pterygoid plates, clivus, and right nasal bridge. The patient underwent endoscopic debridement of her sinuses, which revealed mucosal dehiscence and otherwise normal healthy bleeding tissue. Anatomic pathology identified necrotic bone with invasive fungal hyphae. Cultures demonstrated Burkholderia cepacia, diphtheroid organisms, and Enterococcus and Serratia spp. The patient was administered an intravenous antibiotic and antifungal for several months, but interval imaging found no significant improvement in bone healing although the stability of her palate had improved on clinical examination. Chronic rhinosinusitis has been found to be a complication of soft-tissue, orbital, and intracranial infections but, to the best of our knowledge, a pathologic facial fracture secondary to chronic invasive fungal and bacterial rhinosinusitis has not been previously reported in the literature. PMID:27657320

  18. FUNGAL SPECIATION USING QUANTITATIVE POLYMERASE CHAIN REACTION (QPCR) IN PATIENTS WITH AND WITHOUT CHRONIC RHINOSINUSITIS

    EPA Science Inventory

    Objectives/Hypothesis: 1. to determine the mycology of the middle meatus using an endoscopically guided brush sampling technique and polymerase chain reaction laboratory processing of nasal mucous. 2. To compare the mycology of the middle meatus in patients with sinus disease to...

  19. Allergic Host Defenses

    PubMed Central

    Palm, Noah W.; Rosenstein, Rachel K.

    2012-01-01

    Allergies are generally thought to be a detrimental outcome of a mistargeted immune response that evolved to provide immunity to macro-parasites. Here we present arguments to suggest that allergic immunity plays an important role in host defense against noxious environmental substances, including venoms, hematophagous fluids, environmental xenobiotics and irritants. We argue that appropriately targeted allergic reactions are beneficial, although they can become detrimental when excessive. Furthermore, we suggest that allergic hypersensitivity evolved to elicit anticipatory responses and to promote avoidance of suboptimal environments. PMID:22538607

  20. Respiratory Allergic Disorders.

    PubMed

    Woloski, Jason Raymond; Heston, Skye; Escobedo Calderon, Sheyla Pamela

    2016-09-01

    Allergic asthma refers to a chronic reversible bronchoconstriction influenced by an allergic trigger, leading to symptoms of cough, wheezing, shortness of breath, and chest tightness. Allergic bronchopulmonary aspergillosis is a complex hypersensitivity reaction, often in patients with asthma or cystic fibrosis, occurring when bronchi become colonized by Aspergillus species. The clinical picture is dominated by asthma complicated by recurrent episodes of bronchial obstruction, fever, malaise, mucus production, and peripheral blood eosinophilia. Hypersensitivity pneumonitis is a syndrome associated with lung inflammation from the inhalation of airborne antigens, such as molds and dust. PMID:27545731

  1. [Fungal contamination of dwelling and public buildings: hygienic aspects].

    PubMed

    Gubernskiĭ, Iu D; Nel'nikova, A I; Kalinina, N V; Chuprina, O V

    2010-01-01

    Dwelling and public buildings underwent comprehensive hygienic studies for fungal contamination. Human allergization associated with fungal contamination within the building envelopes and with the viable fungal spores in the air of enclosed spaces was found to be prevalent. The leading factors determining the extent to which the internal environment of premises was exposed to fungal contamination: their increased air humidity due to leakages and inlets, the affected area of building envelopes, and a temperature factor were revealed. The criteria showing it necessary to undertake specific measures to optimize the living conditions of the population were defined.

  2. Allergic rhinitis during pregnancy.

    PubMed

    2016-04-01

    During pregnancy, the first-choice drugs for allergic rhinitis are nasal or oral "non-sedating" antihistamines without antimuscarinic activity, in particular cetirizine, or loratadine after the first trimester. PMID:27186624

  3. Allergic reactions (image)

    MedlinePlus

    Allergic reaction is a sensitivity to a specific substance, called an allergen, that is contacted through the skin, inhaled into the lungs, swallowed or injected. The body's reaction to an allergen can be mild, such as ...

  4. Allergic Contact Dermatitis

    MedlinePlus

    ... causes of allergic contact dermatitis include nickel, chromates, rubber chemicals, and topical antibiotic ointments and creams. Frequent ... construction workers who are in contact with cement. Rubber chemicals are found in gloves, balloons, elastic in ...

  5. Management of Allergic Rhinitis

    PubMed Central

    Sausen, Verra O.; Marks, Katherine E.; Sausen, Kenneth P.; Self, Timothy H.

    2005-01-01

    Allergic rhinitis is the most common chronic childhood disease. Reduced quality of life is frequently caused by this IgE-mediated disease, including sleep disturbance with subsequent decreased school performance. Asthma and exercise-induced bronchospasm are commonly seen concurrently with allergic rhinitis, and poorly controlled allergic rhinitis negatively affects asthma outcomes. Nonsedating antihistamines or intranasal azelastine are effective agents to manage allergic rhinitis, often in combination with oral decongestants. For moderate to severe persistent disease, intranasal corticosteroids are the most effiective agents. Some patients require concomitant intranasal corticosteroids and nonsedating antihistamines for optimal management. Other available agents include leukotriene receptor antagonists, intranasal cromolyn, intranasal ipratropium, specific immunotherapy, and anti-IgE therapy. PMID:23118635

  6. Allergic Rhinitis Quiz

    MedlinePlus

    ... allergic conjunctivitis (eye allergy). Is it true that mold spores can trigger eye allergy symptoms? True False ... allergy) are seasonal allergens such as pollen and mold spores. Indoor allergens such as dust mites and ...

  7. Allergic Rhinitis: Antihistamines

    MedlinePlus

    MENU Return to Web version Allergic Rhinitis | Antihistamines What are antihistamines? Antihistamines are medicines that help stop allergy symptoms, such as itchy eyes, sneezing and a runny nose. Sometimes, an antihistamine ...

  8. [Therapy of allergic rhinitis].

    PubMed

    Klimek, Ludger; Sperl, Annette

    2016-03-01

    If the avoidance of the provoking allergen is insufficient or not possible, medical treatment can be tried. Therapeutics of the first choice for the treatment of the seasonal and persistent allergic rhinitis are antihistamines and topical glucocorticoids. Chromones are less effective so they should only be used for adults with a special indication, for example during pregnancy. Beside the avoidance of the allergen the immunotherapy is the only causal treatment of allergic diseases. PMID:27120870

  9. Genetics of Allergic Diseases

    PubMed Central

    Ortiz, Romina A.; Barnes, Kathleen C.

    2015-01-01

    The allergic diseases are complex phenotypes for which a strong genetic basis has been firmly established. Genome-wide association studies (GWAS) has been widely employed in the field of allergic disease, and to date significant associations have been published for nearly 100 asthma genes/loci, in addition to multiple genes/loci for AD, AR and IgE levels, for which the overwhelming number of candidates are novel and have given a new appreciation for the role of innate as well as adaptive immune-response genes in allergic disease. A major outcome of GWAS in allergic disease has been the formation of national and international collaborations leading to consortia meta-analyses, and an appreciation for the specificity of genetic associations to sub-phenotypes of allergic disease. Molecular genetics has undergone a technological revolution, leading to next generation sequencing (NGS) strategies that are increasingly employed to hone in on the causal variants associated with allergic diseases. Unmet needs in the field include the inclusion of ethnically and racially diverse cohorts, and strategies for managing ‘big data’ that is an outcome of technological advances such as sequencing. PMID:25459575

  10. Long-Acting Beta Agonists Enhance Allergic Airway Disease

    PubMed Central

    Knight, John M.; Mak, Garbo; Shaw, Joanne; Porter, Paul; McDermott, Catherine; Roberts, Luz; You, Ran; Yuan, Xiaoyi; Millien, Valentine O.; Qian, Yuping; Song, Li-Zhen; Frazier, Vincent; Kim, Choel; Kim, Jeong Joo; Bond, Richard A.; Milner, Joshua D.; Zhang, Yuan; Mandal, Pijus K.; Luong, Amber; Kheradmand, Farrah

    2015-01-01

    Asthma is one of the most common of medical illnesses and is treated in part by drugs that activate the beta-2-adrenoceptor (β2-AR) to dilate obstructed airways. Such drugs include long acting beta agonists (LABAs) that are paradoxically linked to excess asthma-related mortality. Here we show that LABAs such as salmeterol and structurally related β2-AR drugs such as formoterol and carvedilol, but not short-acting agonists (SABAs) such as albuterol, promote exaggerated asthma-like allergic airway disease and enhanced airway constriction in mice. We demonstrate that salmeterol aberrantly promotes activation of the allergic disease-related transcription factor signal transducer and activator of transcription 6 (STAT6) in multiple mouse and human cells. A novel inhibitor of STAT6, PM-242H, inhibited initiation of allergic disease induced by airway fungal challenge, reversed established allergic airway disease in mice, and blocked salmeterol-dependent enhanced allergic airway disease. Thus, structurally related β2-AR ligands aberrantly activate STAT6 and promote allergic airway disease. This untoward pharmacological property likely explains adverse outcomes observed with LABAs, which may be overcome by agents that antagonize STAT6. PMID:26605551

  11. Fungal nail infection

    MedlinePlus

    Nails - fungal infection; Onychomycosis; Infection - fungal - nails; Tinea unguium ... hair, nails, and outer skin layers. Common fungal infections include: Athlete's foot Jock itch Ringworm on the ...

  12. MBP-Positive and CD11c-Positive Cells Are Associated with Different Phenotypes of Korean Patients with Non-Asthmatic Chronic Rhinosinusitis

    PubMed Central

    Chang, Dong-Yeop; Eun, Kyung Mi; Shin, Hyun-Woo; Mo, Ji-Hun; Shin, Eui-Cheol; Jin, Hong Ryul; Shin, Sue; Roh, Eun Youn; Han, Doo Hee; Kim, Dae Woo

    2014-01-01

    Background Asthmatic nasal polyps primarily exhibit eosinophilic infiltration. However, the identities of the immune cells that infiltrate non-asthmatic nasal polyps remain unclear. Thus, we thought to investigate the distribution of innate immune cells and its clinical relevance in non-asthmatic chronic rhinosinusitis (CRS) in Korea. Methods Tissues from uncinate process (UP) were obtained from controls (n = 18) and CRS without nasal polyps (CRSsNP, n = 45). Nasal polyps (NP) and UP were obtained from CRS with nasal polyps (CRSwNP, n = 56). The innate immune cells was evaluated by immunohistochemistry such as, eosinophil major basic protein (MBP), tryptase, CD68, CD163, CD11c, 2D7, human neutrophil elastase (HNE) and its distribution was analyzed according to clinical parameters. Results In comparisons between UP from each group, CRSwNP had a higher number of MPB+, CD68+, and CD11c+ cells relative to CRSsNP. Comparisons between UP and NP from CRSwNP indicated that NP have a higher infiltrate of MBP+, CD163+, CD11c+, 2D7+ and HNE+ cells, whereas fewer CD68+ cells were found in NP. In addition, MBP+ and CD11c+ cells were increased from UP of CRSsNP, to UP of CRSwNP, and to NP of CRSwNP. Moreover, in UP from CRSwNP, the number of MBP+ and CD11c+ cells positively correlated with CT scores. In the analysis of CRSwNP phenotype, allergic eosinophilic polyps had a higher number of MBP+, tryptase+, CD11c+, 2D7+ cells than others, whereas allergic non-eosinophilic polyps showed mainly infiltration of HNE+ and 2D7+ cells. Conclusions The infiltration of MBP+ and CD11c+ innate immune cells show a significant association with phenotype and disease extent of CRS and allergic status also may influences cellular phenotype in non-asthmatic CRSwNP in Korea. PMID:25361058

  13. Malassezia spp. overgrowth in allergic cats.

    PubMed

    Ordeix, Laura; Galeotti, Franca; Scarampella, Fabia; Dedola, Carla; Bardagí, Mar; Romano, Erica; Fondati, Alessandra

    2007-10-01

    A series of 18 allergic cats with multifocal Malassezia spp. overgrowth is reported: atopic dermatitis was diagnosed in 16, an adverse food reaction in another and one was euthanized 2 months after diagnosis of Malassezia overgrowth. All the cats were otherwise healthy and those tested (16 out of 18) for feline leukaemia or feline immunodeficiency virus infections were all negative. At dermatological examination, multifocal alopecia, erythema, crusting and greasy adherent brownish scales were variably distributed on all cats. Cytological examination revealed Malassezia spp. overgrowth with/without bacterial infection in facial skin (n = 11), ventral neck (n = 6), abdomen (n = 6), ear canal (n = 4), chin (n = 2), ear pinnae (n = 2), interdigital (n = 1) and claw folds skin (n = 1). Moreover, in two cats Malassezia pachydermatis was isolated in fungal cultures from lesional skin. Azoles therapy alone was prescribed in seven, azoles and antibacterial therapy in eight and azoles with both antibacterial and anti-inflammatory therapy in three of the cats. After 3-4 weeks of treatment, substantial reduction of pruritus and skin lesions was observed in all 11 cats treated with a combined therapy and in five of seven treated solely with azoles. Malassezia spp. overgrowth may represent a secondary cutaneous problem in allergic cats particularly in those presented for dermatological examination displaying greasy adherent brownish scales. The favourable response to treatment with antifungal treatments alone suggests that, as in dogs, Malassezia spp. may be partly responsible for both pruritus and cutaneous lesions in allergic cats. PMID:17845619

  14. Sinobronchial allergic aspergillosis with allergic bronchopulmonary aspergillosis: a less common co-existence

    PubMed Central

    Upadhyay, Rashmi; Kant, Surya; Prakash, Ved; Saheer, S

    2014-01-01

    Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder that is characterised by a hyper-responsiveness of the airways to Aspergillus fumigatus. Although several other fungi may also present with similar clinical conditions, Aspergillus remains the most common fungal pathogen causing airway infections. Co-existence of ABPA with allergic Aspergillus sinusitis (AAS) is an uncommon presentation. The concept of one airway/one disease justifies the co-existence of ABPA with AAS, but it does not always hold true. We report a case of a 35-year-old woman who presented with symptoms suggestive of bronchial asthma. On further investigation, the radiological pattern showed fleeting shadows and CT scan showed central cystic bronchiectatic changes characteristic of ABPA. The nasal secretions were investigated for the presence of Aspergillus and were found to be positive. Hence a diagnosis of ABPA with AAS was established. The patient was treated with oral steroids and antifungal drugs. PMID:25371437

  15. A genomewide screen for chronic rhinosinusitis genes identifies a locus on chromosome 7q

    PubMed Central

    Pinto, Jayant M.; Hayes, M. Geoffrey; Schneider, Daniel; Naclerio, Robert M.; Ober, Carole

    2014-01-01

    Background Chronic rhinosinusitis is an important public health problem with substantial impact on patient quality of life and health care costs. We hypothesized that genetic variation may be one factor that affects this disease. Objective To identify genetic variation underlying susceptibility to chronic rhinosinusitis using a genome-wide approach. Methods We studied a religious isolate that practices a communal lifestyle and shares common environmental exposures. Using physical examination, medical interviews, and a review of medical records, we identified 8 individuals with chronic rhinosinusitis out of 291 screened. These 8 individuals were related to each other in a single 60 member, 9 generation pedigree. A genome-wide screen for loci influencing susceptibility to chronic rhinosinusitis using 1123 genome-wide markers was conducted. Results The largest linkage peak (P = 0.0023; 127.15 cM, equivalent to LOD=2.01) was on chromosome 7q31.1-7q32.1, 7q31 (127.15 cM; 1-LOD support region: 115cM to 135cM) and included the CFTR locus. Genotyping of 38 mutations in the CFTR gene did not reveal variation accounting for this linkage signal. Conclusion Understanding the genes involved in chronic rhinosinusitis may lead to improvements in its diagnosis and treatment. Our results represent the first genome-wide screen for chronic rhinosinusitis and suggest that a locus on 7q31.1-7q32.1 influences disease susceptibility. This may be the CFTR gene or another nearby locus. PMID:18622306

  16. [Background factors in the detection of drug-resistant bacteria in adult patients with acute rhinosinusitis].

    PubMed

    Tomiyama, Michio

    2014-02-01

    In the treatment of adult patients with acute rhinosinusitis, it has been assumed that subjects over 65 years of age or living with children attending a day nursery, are at higher risk for infection with drug-resistant bacteria. However there are few reports which have discussed the relationship between those risk factors and adult patients with acute rhinosinusitis. I investigated the association between adult patients with acute rhinosinusitis living with children attending a day nursery and gender, ages, and frequency of detection of drug-resistant bacteria. From 2010 to 2012, a total of 598 adult patients with acute rhinosinusitis were enrolled. The majority of the study subjects were women, and the largest 10-year age group was 30-39 years. By sex, a greater proportion of the female subjects than the male subjects lived with children attending a day nursery. By age, the proportion of subjects who lived with children attending a day nursery was significantly higher in the 30-39-year age group than other age groups. Drug-resistant Streptococcus pneumoniae and ampicillin (ABPC)-resistant Haemophilus influenzae were detected at significantly higher rates in subjects with children attending a day nursery than in those without. There were no significant difference in drug-resistant bacteria detection between subjects over 65 years of age, and under 65 years. These findings suggested that living with children attending a day nursery is a risk factor and source of infection by drug-resistant organisms that may cause intra-familial infections of adult patients with acute rhinosinusitis. These results suggested we must ask adult patients with acute rhinosinusitis whether they are living with children attending a day nursery or not, when we plan their treatment strategy.

  17. Molecular characteristics of Staphylococcus aureus associated with chronic rhinosinusitis.

    PubMed

    Thunberg, Ulrica; Hugosson, Svante; Monecke, Stefan; Ehricht, Ralf; Söderquist, Bo

    2015-01-01

    The anterior nares have been regarded as the major carriage site of Staphylococcus aureus. From here, the organism can spread to other parts of the body where it might act as harmless commensal or cause mild to severe infections. Nasal sinuses are normally sterile, but in patients with chronic rhinosinusitis (CRS), the finding of S. aureus in maxillary sinus cultures is common. Isolates were obtained from the nares and maxillary sinus of patients with CRS and the nares of healthy controls. A significantly higher frequency of S. aureus was found in nares samples from patients (24/42) compared to controls (16/57) (p = 0.004). There is no consensus regarding whether S. aureus is a relevant pathogen in CRS. A DNA microarray was used to investigate the prevalence of S. aureus virulence genes with focus on staphylococcal enterotoxins, toxic shock syndrome toxin-1, agr types, and cell wall-associated proteins. The genotyping of S. aureus isolates revealed only small and non-significant differences in gene prevalence between isolates collected from patients with CRS and those collected from healthy nasal carriers. This study provides an increased knowledge of the genetic pattern of virulence genes among S. aureus collected in CRS. PMID:25131615

  18. Lipidomic profiling of sinus mucosa from patients with chronic rhinosinusitis

    PubMed Central

    Fazlollahi, Farbod; Kongmanas, Kessiri; Tanphaichitr, Nongnuj; Gopen, Quinton; Faull, Kym F.; Suh, Jeffrey D.

    2014-01-01

    Sinusitis is a cause of significant morbidity, substantial healthcare costs, and negative effects on quality of life. The primary objective of this study is to characterize the previously unknown lipid profile of sinonasal mucosa from patients with chronic rhinosinusitis (CRS) and from controls. Sinus mucosa samples were analyzed from 9 CRS patients with concomitant nasal polyps, 11 CRS patients without polyps, and 12 controls. Ten lone polyp samples were also analyzed. Samples were subjected to a modified Bligh/Dyer lipid extraction, then high performance thin layer chromatography (HPTLC), combined gas chromatography/electron impact-mass spectrometry (GC/EI-MS), and flow-injection/electrospray ionization-tandem mass spectrometry (FI/ESI-MS/MS). Data was analyzed for identification and profiling of major components. HPTLC revealed an array of species reflecting the lipid complexity of the samples. GC/EI-MS revealed cholesterol and several fatty acids. FI/ESI-MSMS revealed numerous lipid species, namely a host of phosphatidylcholines, phosphatidylethanolamines, ceramides and cholesteryl esters, but no detectable amounts of phosphatidyinositols or sulfated lipids. These results are a first step to uncover unique molecular biomarkers in CRS. PMID:25588779

  19. Natural killer cells regulate eosinophilic inflammation in chronic rhinosinusitis

    PubMed Central

    Kim, Ji Heui; Choi, Go Eun; Lee, Bong-Jae; Kwon, Seog Woon; Lee, Seung-Hyo; Kim, Hun Sik; Jang, Yong Ju

    2016-01-01

    Eosinophils play a major pathologic role in the pathogenesis of diverse inflammatory diseases including chronic rhinosinusitis (CRS). Dysregulated production of prostaglandin (PG), particularly PGD2, is considered to be an important contributing factor to eosinophilic inflammation in CRS primarily through proinflammatory and chemotactic effects on eosinophils. Here, we provide evidence that PGD2 can promote eosinophilic inflammation through a suppression of Natural killer (NK) cell effector function and NK cell-mediated eosinophil regulation. Eosinophil apoptosis mediated by NK cells was significantly decreased in CRS patients compared with healthy controls. This decrease was associated with NK cell dysfunction and eosinophilic inflammation. Tissue eosinophils were positively correlated with blood eosinophils in CRS patients. In a murine model of CRS, NK cell depletion caused an exacerbation of blood eosinophilia and eosinophilic inflammation in the sinonasal tissue. PGD2 and its metabolite, but not PGE2 and a panel of cytokines including TGF-β, were increased in CRS patients compared with controls. Effector functions of NK cells were potently suppressed by PGD2-dependent, rather than PGE2-dependent, pathway in controls and CRS patients. Thus, our results suggest decreased NK cell-mediated eosinophil regulation, possibly through an increased level of PGD2, as a previously unrecognized link between PG dysregulation and eosinophilic inflammation in CRS. PMID:27271931

  20. Sinus Microbiome Diversity Depletion and Corynebacterium tuberculostearicum Enrichment Mediates Rhinosinusitis

    PubMed Central

    Song, Yuanlin; Roediger, Frederick C.; Pletcher, Steven D.; Goldberg, Andrew N.; Lynch, Susan V.

    2016-01-01

    Persistent mucosal inflammation and microbial infection are characteristics of chronic rhinosinusitis (CRS). Mucosal microbiota dysbiosis is found in other chronic inflammatory diseases; however, the relationship between sinus microbiota composition and CRS is unknown. Using comparative microbiome profiling of a cohort of CRS patients and healthy subjects, we demonstrate that the sinus microbiota of CRS patients exhibits significantly reduced bacterial diversity compared with that of healthy controls. In our cohort of CRS patients, multiple, phylogenetically distinct lactic acid bacteria were depleted concomitant with an increase in the relative abundance of a single species, Corynebacterium tuberculostearicum. We recapitulated the conditions observed in our human cohort in a murine model and confirmed the pathogenic potential of C. tuberculostearicum and the critical necessity for a replete mucosal microbiota to protect against this species. Moreover, Lactobacillus sakei, which was identified from our comparative microbiome analyses as a potentially protective species, defended against C. tuberculostearicum sinus infection, even in the context of a depleted sinus bacterial community. These studies demonstrate that sinus mucosal health is highly dependent on the composition of the resident microbiota as well as identify both a new sino-pathogen and a strong bacterial candidate for therapeutic intervention. PMID:22972842

  1. Sinus microbiome diversity depletion and Corynebacterium tuberculostearicum enrichment mediates rhinosinusitis.

    PubMed

    Abreu, Nicole A; Nagalingam, Nabeetha A; Song, Yuanlin; Roediger, Frederick C; Pletcher, Steven D; Goldberg, Andrew N; Lynch, Susan V

    2012-09-12

    Persistent mucosal inflammation and microbial infection are characteristics of chronic rhinosinusitis (CRS). Mucosal microbiota dysbiosis is found in other chronic inflammatory diseases; however, the relationship between sinus microbiota composition and CRS is unknown. Using comparative microbiome profiling of a cohort of CRS patients and healthy subjects, we demonstrate that the sinus microbiota of CRS patients exhibits significantly reduced bacterial diversity compared with that of healthy controls. In our cohort of CRS patients, multiple, phylogenetically distinct lactic acid bacteria were depleted concomitant with an increase in the relative abundance of a single species, Corynebacterium tuberculostearicum. We recapitulated the conditions observed in our human cohort in a murine model and confirmed the pathogenic potential of C. tuberculostearicum and the critical necessity for a replete mucosal microbiota to protect against this species. Moreover, Lactobacillus sakei, which was identified from our comparative microbiome analyses as a potentially protective species, defended against C. tuberculostearicum sinus infection, even in the context of a depleted sinus bacterial community. These studies demonstrate that sinus mucosal health is highly dependent on the composition of the resident microbiota as well as identify both a new sino-pathogen and a strong bacterial candidate for therapeutic intervention.

  2. [A Systematic Review of Phytotherapy for Acute Rhinosinusitis].

    PubMed

    Koch, Anna K; Klose, Petra; Lauche, Romy; Cramer, Holger; Baasch, Jennifer; Dobos, Gustav J; Langhorst, Jost

    2016-01-01

    Herbal medicine is a promising alternative in the treatment of acute rhinosinusitis (ARS). We performed a systematic review for phytopharmaceutical treatments of ARS. A computerized search of databases (Cochrane Library, PubMed, and Scopus) up to 16 September 2015 was performed. Randomized controlled trials (RCTs) and controlled trials (CTs) were included and assessed using the Cochrane risk of bias tool. Seven trials on Pelargonium sidoides (EPs 7630, Umckaloabo®), Myrtol (GeloMyrtol® forte), BNO 1016 (Sinupret® extract), BNO 101 (Sinupret®), Cyclamen europaeum (Nasodren®), and Esberitox® were included. Risk of bias was heterogeneous. EPs 7630 appeared to be useful in the treatment of ARS. Myrtol showed benefits against a placebo compound, and BNO 1016 and BNO 101 might be helpful; however, there was little evidence for the effectiveness of Cyclamen europaeum and Esberitox®. Herbal medicine might be effective for the treatment of ARS, but given the low number of clinical trials and the heterogeneous methodological quality, further research is necessary. PMID:27404100

  3. Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity.

    PubMed

    Shah, Ashok; Panjabi, Chandramani

    2016-07-01

    In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in the diagnosis and monitoring of the disease. Demonstration of central bronchiectasis with normal tapering bronchi is still considered pathognomonic in patients without CF. Elevated serum IgE levels and Aspergillus-specific IgE and/or IgG are also vital for the diagnosis. Mucoid impaction occurring in the paranasal sinuses results in AAS, which also requires a set of diagnostic criteria. Demonstration of fungal elements in sinus material is the hallmark of AAS. In spite of similar histopathologic features, co-existence of ABPA and AAS is still uncommon. Oral corticosteroids continue to be the mainstay of management of allergic aspergillosis. Antifungal agents play an adjunctive role in ABPA as they help reduce the fungal load. Saprophytic colonization in cavitary ABPA may lead to aspergilloma formation, which could increase the severity of the disease. The presence of ABPA, AAS, and aspergilloma in the same patient has also been documented. All patients with Aspergillus-sensitized asthma must be screened for ABPA, and AAS should always be looked for. PMID:27126721

  4. Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity

    PubMed Central

    Panjabi, Chandramani

    2016-01-01

    In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in the diagnosis and monitoring of the disease. Demonstration of central bronchiectasis with normal tapering bronchi is still considered pathognomonic in patients without CF. Elevated serum IgE levels and Aspergillus-specific IgE and/or IgG are also vital for the diagnosis. Mucoid impaction occurring in the paranasal sinuses results in AAS, which also requires a set of diagnostic criteria. Demonstration of fungal elements in sinus material is the hallmark of AAS. In spite of similar histopathologic features, co-existence of ABPA and AAS is still uncommon. Oral corticosteroids continue to be the mainstay of management of allergic aspergillosis. Antifungal agents play an adjunctive role in ABPA as they help reduce the fungal load. Saprophytic colonization in cavitary ABPA may lead to aspergilloma formation, which could increase the severity of the disease. The presence of ABPA, AAS, and aspergilloma in the same patient has also been documented. All patients with Aspergillus-sensitized asthma must be screened for ABPA, and AAS should always be looked for. PMID:27126721

  5. [Cytokines and allergic response].

    PubMed

    Guenounou, M

    1998-01-01

    Allergic reactions are under the control of several events that occur sequentially following allergen exposure, recognition by the immune system, IgE production and their interaction with effector cells bearing Fc epsilon receptors. The lymphocyte activation in response to allergens determines the intensity and the nature of the immune response. Cytokines produced by T (and non-T) cells are involved in the polarized development of the specific immune response. In particular, type 1 and type 2 cytokines are responsible for the control of the different steps during allergic reactions. Th2 cytokines and particularly IL4 are responsible for switching the immunoglobulin synthesis by B cells to IgE production. They also play a key role in the activation of effector cells that occurs following allergen interaction with fixed specific IgE and participate to the local inflammatory reaction. Cytokine profile determination appears to represent a helpful laboratory parameter in the understanding of the mechanisms underlying allergic diseases. The development of new technological tools may allow the use of cell activation parameters, and cytokine profiles determination in clinical biology. This review aims to analyze the involvement of the cytokine network in the mechanisms leading to IgE production and the involvement of cytokines in effector mechanisms of allergic reactions. It also analyses the potential use of cytokine profile determination for diagnosis purpose and survey of immune desensitization of allergic diseases.

  6. Sensitization to fungal allergens: Resolved and unresolved issues.

    PubMed

    Fukutomi, Yuma; Taniguchi, Masami

    2015-10-01

    Exposure and sensitization to fungal allergens can promote the development and worsening of allergic diseases. Although numerous species of fungi have been associated with allergic diseases in the literature, the significance of fungi from the genera Alternaria, Cladosporium, Penicillium, Aspergillus, and Malassezia has been well documented. However, it should be emphasized that the contribution of different fungal allergens to allergic diseases is not identical, but species-specific. Alternaria and Cladosporium species are considered to be important outdoor allergens, and sensitization and exposure to species of these genera is related to the development of asthma and rhinitis, as well as epidemics of asthma exacerbation, including life-threatening asthma exacerbation. In contrast, xerophilic species of Penicillium and Aspergillus, excluding Aspergillus fumigatus, are implicated in allergic diseases as indoor allergens. A. fumigatus has a high capacity to colonize the bronchial tract of asthmatic patients, causing severe persistent asthma and low lung function, and sometimes leading to allergic bronchopulmonary aspergillosis. Malassezia are common commensals of healthy skin, although they are also associated with atopic dermatitis, especially on the head and neck, but not with respiratory allergies. Despite its importance in the management of allergic diseases, precise recognition of species-specific IgE sensitization to fungal allergens is often challenging because the majority of fungal extracts exhibit broad cross-reactivity with taxonomically unrelated fungi. Recent progress in gene technology has contributed to the identification of specific and cross-reactive allergen components from different fungal sources. However, data demonstrating the clinical relevance of IgE reactivity to these allergen components are still insufficient. PMID:26433528

  7. Genetics Home Reference: allergic asthma

    MedlinePlus

    ... Understand Genetics Home Health Conditions allergic asthma allergic asthma Enable Javascript to view the expand/collapse boxes. Download PDF Open All Close All Description Asthma is a breathing disorder characterized by inflammation of ...

  8. Fungal Aflatoxins Reduce Respiratory Mucosal Ciliary Function.

    PubMed

    Lee, Robert J; Workman, Alan D; Carey, Ryan M; Chen, Bei; Rosen, Phillip L; Doghramji, Laurel; Adappa, Nithin D; Palmer, James N; Kennedy, David W; Cohen, Noam A

    2016-01-01

    Aflatoxins are mycotoxins secreted by Aspergillus flavus, which can colonize the respiratory tract and cause fungal rhinosinusitis or bronchopulmonary aspergillosis. A. flavus is the second leading cause of invasive aspergillosis worldwide. Because many respiratory pathogens secrete toxins to impair mucociliary immunity, we examined the effects of acute exposure to aflatoxins on airway cell physiology. Using air-liquid interface cultures of primary human sinonasal and bronchial cells, we imaged ciliary beat frequency (CBF), intracellular calcium, and nitric oxide (NO). Exposure to aflatoxins (0.1 to 10 μM; 5 to 10 minutes) reduced baseline (~6-12%) and agonist-stimulated CBF. Conditioned media (CM) from A. fumigatus, A. niger, and A. flavus cultures also reduced CBF by ~10% after 60 min exposure, but effects were blocked by an anti-aflatoxin antibody only with A. flavus CM. CBF reduction required protein kinase C but was not associated with changes in calcium or NO. However, AFB2 reduced NO production by ~50% during stimulation of the ciliary-localized T2R38 receptor. Using a fluorescent reporter construct expressed in A549 cells, we directly observed activation of PKC activity by AFB2. Aflatoxins secreted by respiratory A. flavus may impair motile and chemosensory functions of airway cilia, contributing to pathogenesis of fungal airway diseases. PMID:27623953

  9. Fungal Aflatoxins Reduce Respiratory Mucosal Ciliary Function

    PubMed Central

    Lee, Robert J.; Workman, Alan D.; Carey, Ryan M.; Chen, Bei; Rosen, Phillip L.; Doghramji, Laurel; Adappa, Nithin D.; Palmer, James N.; Kennedy, David W.; Cohen, Noam A.

    2016-01-01

    Aflatoxins are mycotoxins secreted by Aspergillus flavus, which can colonize the respiratory tract and cause fungal rhinosinusitis or bronchopulmonary aspergillosis. A. flavus is the second leading cause of invasive aspergillosis worldwide. Because many respiratory pathogens secrete toxins to impair mucociliary immunity, we examined the effects of acute exposure to aflatoxins on airway cell physiology. Using air-liquid interface cultures of primary human sinonasal and bronchial cells, we imaged ciliary beat frequency (CBF), intracellular calcium, and nitric oxide (NO). Exposure to aflatoxins (0.1 to 10 μM; 5 to 10 minutes) reduced baseline (~6–12%) and agonist-stimulated CBF. Conditioned media (CM) from A. fumigatus, A. niger, and A. flavus cultures also reduced CBF by ~10% after 60 min exposure, but effects were blocked by an anti-aflatoxin antibody only with A. flavus CM. CBF reduction required protein kinase C but was not associated with changes in calcium or NO. However, AFB2 reduced NO production by ~50% during stimulation of the ciliary-localized T2R38 receptor. Using a fluorescent reporter construct expressed in A549 cells, we directly observed activation of PKC activity by AFB2. Aflatoxins secreted by respiratory A. flavus may impair motile and chemosensory functions of airway cilia, contributing to pathogenesis of fungal airway diseases. PMID:27623953

  10. Fungal Aflatoxins Reduce Respiratory Mucosal Ciliary Function.

    PubMed

    Lee, Robert J; Workman, Alan D; Carey, Ryan M; Chen, Bei; Rosen, Phillip L; Doghramji, Laurel; Adappa, Nithin D; Palmer, James N; Kennedy, David W; Cohen, Noam A

    2016-01-01

    Aflatoxins are mycotoxins secreted by Aspergillus flavus, which can colonize the respiratory tract and cause fungal rhinosinusitis or bronchopulmonary aspergillosis. A. flavus is the second leading cause of invasive aspergillosis worldwide. Because many respiratory pathogens secrete toxins to impair mucociliary immunity, we examined the effects of acute exposure to aflatoxins on airway cell physiology. Using air-liquid interface cultures of primary human sinonasal and bronchial cells, we imaged ciliary beat frequency (CBF), intracellular calcium, and nitric oxide (NO). Exposure to aflatoxins (0.1 to 10 μM; 5 to 10 minutes) reduced baseline (~6-12%) and agonist-stimulated CBF. Conditioned media (CM) from A. fumigatus, A. niger, and A. flavus cultures also reduced CBF by ~10% after 60 min exposure, but effects were blocked by an anti-aflatoxin antibody only with A. flavus CM. CBF reduction required protein kinase C but was not associated with changes in calcium or NO. However, AFB2 reduced NO production by ~50% during stimulation of the ciliary-localized T2R38 receptor. Using a fluorescent reporter construct expressed in A549 cells, we directly observed activation of PKC activity by AFB2. Aflatoxins secreted by respiratory A. flavus may impair motile and chemosensory functions of airway cilia, contributing to pathogenesis of fungal airway diseases.

  11. Fungal Infections

    MedlinePlus

    ... it, you'll be saying bye-bye to fungi (say: FUN-guy). What Is a Fungal Infection? Fungi , the word for more than one fungus, can ... but of course, they're not!). Because the fungi that cause tinea (ringworm) live on different parts ...

  12. Local Allergic Rhinitis.

    PubMed

    Campo, Paloma; Salas, María; Blanca-López, Natalia; Rondón, Carmen

    2016-05-01

    This review focuses on local allergic rhinitis, a new phenotype of allergic rhinitis, commonly misdiagnosed as nonallergic rhinitis. It has gained attention over last decade and can affect patients from all countries, ethnic groups and ages, impairing their quality of life, and is frequently associated with conjunctivitis and asthma. Diagnosis is based on clinical history, the demonstration of a positive response to nasal allergen provocation test and/or the detection of nasal sIgE. A positive basophil activation test may support the diagnosis. Recent studies have demonstrated that allergen immunotherapy is an effective immune-modifying treatment, highlighting the importance of early diagnosis. PMID:27083105

  13. Bacterial Communities Vary between Sinuses in Chronic Rhinosinusitis Patients.

    PubMed

    Joss, Tom V; Burke, Catherine M; Hudson, Bernard J; Darling, Aaron E; Forer, Martin; Alber, Dagmar G; Charles, Ian G; Stow, Nicholas W

    2015-01-01

    Chronic rhinosinusitis (CRS) is a common and potentially debilitating disease characterized by inflammation of the sinus mucosa for longer than 12 weeks. Bacterial colonization of the sinuses and its role in the pathogenesis of this disease is an ongoing area of research. Recent advances in culture-independent molecular techniques for bacterial identification have the potential to provide a more accurate and complete assessment of the sinus microbiome, however there is little concordance in results between studies, possibly due to differences in the sampling location and techniques. This study aimed to determine whether the microbial communities from one sinus could be considered representative of all sinuses, and examine differences between two commonly used methods for sample collection, swabs, and tissue biopsies. High-throughput DNA sequencing of the bacterial 16S rRNA gene was applied to both swab and tissue samples from multiple sinuses of 19 patients undergoing surgery for treatment of CRS. Results from swabs and tissue biopsies showed a high degree of similarity, indicating that swabbing is sufficient to recover the microbial community from the sinuses. Microbial communities from different sinuses within individual patients differed to varying degrees, demonstrating that it is possible for distinct microbiomes to exist simultaneously in different sinuses of the same patient. The sequencing results correlated well with culture-based pathogen identification conducted in parallel, although the culturing missed many species detected by sequencing. This finding has implications for future research into the sinus microbiome, which should take this heterogeneity into account by sampling patients from more than one sinus. PMID:26834708

  14. Bacterial Communities Vary between Sinuses in Chronic Rhinosinusitis Patients

    PubMed Central

    Joss, Tom V.; Burke, Catherine M.; Hudson, Bernard J.; Darling, Aaron E.; Forer, Martin; Alber, Dagmar G.; Charles, Ian G.; Stow, Nicholas W.

    2016-01-01

    Chronic rhinosinusitis (CRS) is a common and potentially debilitating disease characterized by inflammation of the sinus mucosa for longer than 12 weeks. Bacterial colonization of the sinuses and its role in the pathogenesis of this disease is an ongoing area of research. Recent advances in culture-independent molecular techniques for bacterial identification have the potential to provide a more accurate and complete assessment of the sinus microbiome, however there is little concordance in results between studies, possibly due to differences in the sampling location and techniques. This study aimed to determine whether the microbial communities from one sinus could be considered representative of all sinuses, and examine differences between two commonly used methods for sample collection, swabs, and tissue biopsies. High-throughput DNA sequencing of the bacterial 16S rRNA gene was applied to both swab and tissue samples from multiple sinuses of 19 patients undergoing surgery for treatment of CRS. Results from swabs and tissue biopsies showed a high degree of similarity, indicating that swabbing is sufficient to recover the microbial community from the sinuses. Microbial communities from different sinuses within individual patients differed to varying degrees, demonstrating that it is possible for distinct microbiomes to exist simultaneously in different sinuses of the same patient. The sequencing results correlated well with culture-based pathogen identification conducted in parallel, although the culturing missed many species detected by sequencing. This finding has implications for future research into the sinus microbiome, which should take this heterogeneity into account by sampling patients from more than one sinus. PMID:26834708

  15. Coagulase-negative staphylococcus culture in chronic rhinosinusitis

    PubMed Central

    Zhang, Zi; Adappa, Nithin D.; Lautenbach, Ebbing; Chiu, Alexander G.; Doghramji, Laurel J.; Cohen, Noam A.; Palmer, James N.

    2014-01-01

    Objective Coagulase-negative staphylococcus (CoNS) is commonly isolated from patients with chronic rhinosinusitis (CRS). However, the role of CoNS in CRS remains controversial. We aimed to determine the associations between positive CoNS culture at functional endoscopic sinus surgery (FESS) and CRS severity. Methods Adult CRS patients who underwent FESS between 10/1/2007 to 12/31/2011 were recruited. Patient demographics, disease characteristics, medication use, Lund-Mackay CT scores, and SNOT-22 scores were collected at baseline before FESS. Intraoperative cultures were obtained in a standard manner. Patients were placed into two groups based on culture findings: patients with CoNS as the sole positive culture result and patients with all other positive culture results, including CoNS, as part of a polymicrobial culture. Results 376 CRS patients met the criteria. 106 patients (28%) had CoNS as their only isolate, 260 (69%) had other positive cultures, and 10 (3%) had no bacterial growth. Compared to patients with other positive cultures, patients with the sole result of CoNS were significantly less likely to have a history of FESS (52% versus 65%, p=0.019), nasal polyps (50% versus 65%, p=0.006), and had a better Lund-Mackay CT score (11.95 versus 14.18, p=0.020). After adjusting for all factors in the multiple logistic regression model, CoNS as the sole positive culture result was independently associated with having no history of FESS (OR=0.45, 95%CI, 0.22-0.94, p=0.034). Conclusion Positive intraoperative CoNS cultures alone do not result in increased CRS disease burden by objective or subjective measures as compared to patients with other bacterial or polymicrobial culture isolates. PMID:25367456

  16. DOSE-DEPENDENT INCREASE IN THE PRODUCTION OF NERVE GROWTH FACTOR, NEUROTROPHIN-3, AND NEUROTROPHIN-4 IN A PENICILLIUM CHRYSOGENUM-INDUCED ALLERGIC ASTHMA MODEL

    EPA Science Inventory


    Increased levels of neurotrophins (nerve growth factor [NGF], brain-derived neurotrophic factor [BDNF], neurotrophin [NT]-3, and/or NT-4) have been associated with asthma as well as in animal models of allergic asthma. In our mouse model for fungal allergic asthma, repeated ...

  17. INCREASED PRODUCTION OF NERVE GROWTH FACTOR, NEUROTROPHIN-3, AND NEUROTROPHIN-4 IN A PENICILLIUM CHRYSOGENUM -INDUCED ALLERGIC ASTHMA MODEL IN MICE

    EPA Science Inventory

    Increased levels of neurotrophins (nerve growth factor [NGF], brain-derived neurotrophic factor [BDNF], neurotrophin [NT]-3, and/or NT-4) have been associated with asthmatics and in animal models of allergic asthma. In our mouse model for fungal allergic asthma, repeated pulmona...

  18. Some Chronic Rhinosinusitis Patients Have Significantly Elevated Populations of Seven Fungi in their Sinuses

    EPA Science Inventory

    Abstract: Objectives/Hypothesis: To measure the populations of 36 fungi in the homes and sinuses of chronic rhinosinusitis (CRS) and non-CRS patients. Study Design: Single-blind cross-sectional study. Methods: Populations of 36 fungi were measured in sinus samples and in the home...

  19. Expression of Vascular Endothelial Growth Factor in Nasal Polyp and Chronic Rhinosinusitis

    PubMed Central

    Azizzadeh Delshad, Alireza; Jalali Nadoushan, Mohammadreza; Davati, Ali; Rostami, Aida

    2016-01-01

    Background: Nasal inflammatory disorders such as chronic rhinosinusitis and nasal polyp are among the most prevalent complications with high socioeconomic costs. Vascular Endothelial Growth Factor (VEGF) plays a key role in angiogenesis and cell proliferation. In the present study the effect of VEGF on the development and prognosis of chronic rhinosinusitis and nasal polyp was investigated. Methods: This cross sectional study was performed on the nasal histological specimens of two groups of patients suffering from nasal polyp or chronic rhinosinusitis, and the expression of VEGF in the two groups was compared immunohistochemically. Based on the percentage of VEGF-positive cells the specimens were classified into four scores. Furthermore, the relations between the VEGF expression and some demographic characteristics were evaluated. Results: The VEGF immunohistochemistry findings indicated a significantly higher expression of VEGF in nasal polyp group compared to chronic rhinosinusitis without nasal polyp group. In terms of VEGF-expression scoring, in both groups most of the specimens were classified as score-2, namely indicating 10-50% of VEGF-positive epithelial cells. In both groups no significant relation between VEGF expression and age or sex of the patients could be seen. Conclusion: Local modulation of VEGF expression might be taken as a putative therapeutic strategy in management of sinunasal inflammatory disorders, especially nasal polyps. PMID:27781069

  20. Allergic contact dermatitis.

    PubMed

    Becker, Detlef

    2013-07-01

    Allergic contact dermatitis is a frequent inflammatory skin disease. The suspected diagnosis is based on clinical symptoms, a plausible contact to allergens and a suitable history of dermatitis. Differential diagnoses should be considered only after careful exclusion of any causal contact sensitization. Hence, careful diagnosis by patch testing is of great importance. Modifications of the standardized test procedure are the strip patch test and the repeated open application test. The interpretation of the SLS (sodium lauryl sulfate) patch test as well as testing with the patients' own products and working materials are potential sources of error. Accurate patch test reading is affected in particular by the experience and individual factors of the examiner. Therefore, a high degree of standardization and continuous quality control is necessary and may be supported by use of an online patch test reading course made available by the German Contact Dermatitis Research Group. A critical relevance assessment of allergic patch test reactions helps to avoid relapses and the consideration of differential diagnoses. Any allergic test reaction should be documented in an allergy ID card including the INCI name, if appropriate. The diagnostics of allergic contact dermatitis is endangered by a seriously reduced financing of patch testing by the German statutory health insurances. Restrictive regulations by the German Drug Law block the approval of new contact allergens for routine patch testing. Beside the consistent avoidance of allergen contact, temporary use of systemic and topical corticosteroids is the therapy of first choice.

  1. Periostin in allergic inflammation.

    PubMed

    Izuhara, Kenji; Arima, Kazuhiko; Ohta, Shoichiro; Suzuki, Shoichi; Inamitsu, Masako; Yamamoto, Ken-ichi

    2014-06-01

    Periostin, an extracellular matrix protein belonging to the fasciclin family, has been shown to play a critical role in the process of remodeling during tissue/organ development or repair. Periostin functions as a matricellular protein in cell activation by binding to their receptors on cell surface, thereby exerting its biological activities. After we found that periostin is a downstream molecule of interleukin (IL)-4 and IL-13, signature cytokines of type 2 immune responses, we showed that periostin is a component of subepithelial fibrosis in bronchial asthma, the first formal proof that periostin is involved in allergic inflammation. Subsequently, a great deal of evidence has accumulated demonstrating the significance of periostin in allergic inflammation. It is of note that in skin tissues, periostin is critical for amplification and persistence of allergic inflammation by communicating between fibroblasts and keratinocytes. Furthermore, periostin has been applied to development of novel diagnostics or therapeutic agents for allergic diseases. Serum periostin can reflect local production of periostin in inflamed lesions induced by Th2-type immune responses and also can predict the efficacy of Th2 antagonists against bronchial asthma. Blocking the interaction between periostin and its receptor, αv integrin, or down-regulating the periostin expression shows improvement of periostin-induced inflammation in mouse models or in in vitro systems. It is hoped that diagnostics or therapeutic agents targeting periostin will be of practical use in the near future.

  2. Fungal keratitis

    PubMed Central

    Tuli, Sonal S

    2011-01-01

    Clinical question: What is the most appropriate management of fungal keratitis? Results: Traditionally, topical Natamycin is the most commonly used medication for filamentous fungi while Amphotericin B is most commonly used for yeast. Voriconazole is rapidly becoming the drug of choice for all fungal keratitis because of its wide spectrum of coverage and increased penetration into the cornea. Implementation: Repeated debridement of the ulcer is recommended for the penetration of topical medications. While small, peripheral ulcers may be treated in the community, larger or central ulcers, especially if associated with signs suggestive of anterior chamber penetration should be referred to a tertiary center. Prolonged therapy for approximately four weeks is usually necessary. PMID:21468333

  3. Fungal Diagnostics

    PubMed Central

    Kozel, Thomas R.; Wickes, Brian

    2014-01-01

    Early diagnosis of fungal infection is critical to effective treatment. There are many impediments to diagnosis such as a diminishing number of clinical mycologists, cost, time to result, and requirements for sensitivity and specificity. In addition, fungal diagnostics must meet the contrasting needs presented by the increasing diversity of fungi found in association with the use of immunosuppressive agents in countries with high levels of medical care and the need for diagnostics in resource-limited countries where large numbers of opportunistic infections occur in patients with AIDS. Traditional approaches to diagnosis include direct microscopic examination of clinical samples, histopathology, culture, and serology. Emerging technologies include molecular diagnostics and antigen detection in clinical samples. Innovative new technologies that use molecular and immunoassay platforms have the potential to meet the needs of both resource-rich and resource-limited clinical environments. PMID:24692193

  4. Burden of fungal infections in Senegal.

    PubMed

    Badiane, Aida S; Ndiaye, Daouda; Denning, David W

    2015-10-01

    Senegal has a high rate of tuberculosis and a low HIV seropositivity rate and aspergilloma, life-threatening fungal infections, dermatophytosis and mycetoma have been reported in this study. All published epidemiology papers reporting fungal infection rates from Senegal were identified. Where no data existed, we used specific populations at risk and fungal infection frequencies in each to estimate national incidence or prevalence. The results show that tinea capitis is common being found in 25% of children, ~1.5 million. About 191,000 Senegalese women get recurrent vaginal thrush, ≥4 times annually. We estimate 685 incident cases of chronic pulmonary aspergillosis (CPA) following TB and prevalence of 2160 cases. Asthma prevalence in adults varies from 3.2% to 8.2% (mean 5%); 9976 adults have allergic bronchopulmonary aspergillosis (ABPA) and 13,168 have severe asthma with fungal sensitisation (SAFS). Of the 59,000 estimated HIV-positive patients, 366 develop cryptococcal meningitis; 1149 develop Pneumocystis pneumonia and 1946 develop oesophageal candidiasis, in which oral candidiasis (53%) and dermatophytosis (16%) are common. Since 2008-2010, 113 cases of mycetoma were diagnosed. In conclusion, we estimate that 1,743,507 (12.5%) people in Senegal suffer from a fungal infection, excluding oral candidiasis, fungal keratitis, invasive candidiasis or aspergillosis. Diagnostic and treatment deficiencies should be rectified to allow epidemiological studies. PMID:26449509

  5. Efficacy of medical therapy in treatment of chronic rhinosinusitis.

    PubMed

    Young, Lee C; Stow, Nicholas W; Zhou, Lifeng; Douglas, Richard G

    2012-01-01

    Uncomplicated chronic rhinosinusitis (CRS) is generally treated with medical therapy initially and surgery is contemplated only after medical therapy has failed. However, there is considerable variation in the medical treatment regimens used and studies defining their efficacy are few. The aim of this study was to determine the proportion of patients treated medically who responded sufficiently well so that surgery was not required. Subgroup analysis to identify clinical features that predicted a favorable response to medical therapy was also performed. Eighty patients referred to the Otorhinolaryngology Clinic at North Shore Hospital were treated with a standardized medical therapy protocol (oral prednisone for 3 weeks, oral antibiotics and ongoing saline lavage and intranasal budesonide spray). Symptom scores were collected before and after medical therapy. Clinical features such as presence of polyps, asthma, and aspirin hypersensitivity were recorded. Failure of medical therapy was defined as the persistence of significant CRS symptoms, and those patients who failed medical therapy were offered surgery. Follow-up data were available for 72 (90%) patients. Of this group, 52.5%, (95% CI, 42.7%, 62.2%) failed to respond adequately to medical therapy and were offered surgery. The remaining patients (37.5%) were successfully treated with medical therapy and did not require surgery at the time of follow-up. The premedical therapy symptom scores were significantly higher than the postmedical therapy symptom scores (p < 0.01). The symptom scores of those patients postmedical therapy who proceeded to have surgery were significantly higher than the group who responded well to maximum medical therapy (MMT) and did not require surgery (p < 0.0001). There were no significant differences in the proportion of patients with asthma, aspirin sensitivity, or polyps between the groups failing or not failing MMT. In approximately one-third of patients with CRS, medical therapy

  6. Shoe allergic contact dermatitis.

    PubMed

    Matthys, Erin; Zahir, Amir; Ehrlich, Alison

    2014-01-01

    Foot dermatitis is a widespread condition, affecting men and women of all ages. Because of the location, this condition may present as a debilitating problem to those who have it. Allergic contact dermatitis involving the feet is frequently due to shoes or socks. The allergens that cause shoe dermatitis can be found in any constituent of footwear, including rubber, adhesives, leather, dyes, metals, and medicaments. The goal of treatment is to identify and minimize contact with the offending allergen(s). The lack of product information released from shoe manufacturers and the continually changing trends in footwear present a challenge in treating this condition. The aim of this study is to review the current literature on allergic contact shoe dermatitis; clinical presentation, allergens, patch testing, and management will be discussed. PubMed and MEDLINE databases were used for the search, with a focus on literature updates from the last 15 years.

  7. [Allergic risk in anaesthesia].

    PubMed

    Mertes, Paul Michel; De Blay, Frédéric; Dong, Siwei

    2013-03-01

    Anaphylactic reactions may be either of immune(allergy, usually IgE-mediated, sometimes IgG-mediated) or non-immune origin. The incidence of anaphylactic reactions during anaesthesia varies between countries ranging from 1/1250 to 1/13,000 per procedure. In France, the estimated incidence of allergic reactions is 100.6 [76.2-125.3]/million procedures with a high female predominance (male: 55.4 [42.0-69.0], female: 154.9 [117.2-193.1]). This predominance is not observed in children. In adults, the most frequently incriminated substances are neuromuscular blocking agents, followed by latex and antibiotics. The estimated incidence of allergic reactions to neuromuscular blocking agents is 184.0 [139.3-229.7]/million procedure. In most cases there is a close reaction between clinical symptoms and drug administration. When the reaction is delayed, occurring during the surgical procedure, a reaction involving latex, a vital dye, an antiseptic or a volume expanding fluid should be suspected. Reaction severity may vary. The most frequently reported initial symptoms are pulselessness, erythema, increased airway pressure, desaturation or decreased end-tidal CO2. Clinical symptoms may occur as an isolated condition, making proper diagnosis difficult. In some cases a cardiovascular arrest can be observed. Reaction mechanism identification relies on mediators (tryptase, histamine) measurement at the time of the reaction. In case of allergic reaction, the responsible drug can be identified by the detection of specific IgE using immunoassays or by skin tests performed 6 weeks after the reaction. Predictive allergy investigation to latex or anaesthetics in the absence of history of reaction should be restricted to at-risk patients. Premedication cannot prevent the onset of an allergic reaction. Providing a latex-free environment can be used for primary or secondary prevention. Treatment is based on allergen administration interruption, epinephrine administration in a titrated

  8. [Pseudotumoral allergic bronchopulmonary aspergillosis].

    PubMed

    Otero González, I; Montero Martínez, C; Blanco Aparicio, M; Valiño López, P; Verea Hernando, H

    2000-06-01

    Allergic bronchopulmonary aspergillosis (ABPA) develops as the result of a hypersensitivity reaction to fungi of the genus Aspergillus. Clinical and radiological presentation can be atypical, requiring a high degree of suspicion on the part of the physician who treats such patients. We report the cases of two patients with APBA in whom the form of presentation--with few asthma symptoms, images showing lobar atelectasia and hilar adenopathy--led to an initial suspicion of lung cancer. PMID:10932345

  9. The burden of serious fungal diseases in Russia.

    PubMed

    Klimko, N; Kozlova, Y; Khostelidi, S; Shadrivova, O; Borzova, Y; Burygina, E; Vasilieva, N; Denning, D W

    2015-10-01

    The incidence and prevalence of fungal infections in Russia is unknown. We estimated the burden of fungal infections in Russia according to the methodology of the LIFE program (www.LIFE-worldwide.org). The total number of patients with serious and chronic mycoses in Russia in 2011 was three million. Most of these patients (2,607,494) had superficial fungal infections (recurrent vulvovaginal candidiasis, oral and oesophageal candidiasis with HIV infection and tinea capitis). Invasive and chronic fungal infections (invasive candidiasis, invasive and chronic aspergillosis, cryptococcal meningitis, mucormycosis and Pneumocystis pneumonia) affected 69,331 patients. The total number of adults with allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitisation was 406,082.

  10. Management of allergic rhinitis

    PubMed Central

    Solelhac, Geoffroy

    2014-01-01

    In this paper, we review the current management of allergic rhinitis and new directions for future treatment. Currently, management includes pharmacotherapy, allergen avoidance and possibly immunotherapy. The simple washing of nasal cavities using isotonic saline provides a significant improvement and is useful, particularly in children. The most effective medication in persistent rhinitis used singly is topical corticosteroid, which decreases all symptoms, including ocular ones. Antihistamines reduce nasal itch, sneeze and rhinorrhea and can be used orally or topically. When intranasal antihistamine is used together with topical corticosteroid, the combination is more effective and acts more rapidly than either drug used alone. Alternative therapies, such as homeopathy, acupuncture and intranasal carbon dioxide, or devices such nasal air filters or intranasal cellulose, have produced some positive results in small trials but are not recommended by Allergic Rhinitis and its Impact on Asthma (ARIA). In the field of allergic immunotherapy, subcutaneous and sublingual routes are currently used, the former being perhaps more efficient and the latter safer. Sublingual tablets are now available. Their efficacy compared to standard routes needs to be evaluated. Efforts have been made to develop more effective and simpler immunotherapy by modifying allergens and developing alternative routes. Standard allergen avoidance procedures used alone do not provide positive results. A comprehensive, multi-trigger, multi-component approach is needed, including avoidance of pollutants such as cigarette smoke. PMID:25374672

  11. Comparative study of aural microflora in healthy cats, allergic cats and cats with systemic disease.

    PubMed

    Pressanti, Charline; Drouet, Clémence; Cadiergues, Marie-Christine

    2014-12-01

    Twenty healthy cats (group 1) with clinically normal ears, 15 cats with systemic disease (group 2) and 15 allergic cats (group 3) were included in a prospective study. The experimental unit was the ear. A clinical score was established for each ear canal after otoscopic examination. Microbial population was assessed on cytological examination of smears performed with the cotton-tipped applicator smear technique. Fungal population was significantly more prominent in allergic cats (P <0.001) and in diseased cats compared with healthy cats (P <0.02). Bacterial population was significantly higher in allergic cats than in healthy cats (P <0.001) and cats suffering from systemic disease (P <0.001). Bacterial overgrowth was also higher in cats with systemic disease than healthy cats. In cats from group 2, only fungal overgrowth was associated with otitis severity. In group 3, only bacterial overgrowth was associated with otitis severity.

  12. Comparative study of aural microflora in healthy cats, allergic cats and cats with systemic disease.

    PubMed

    Pressanti, Charline; Drouet, Clémence; Cadiergues, Marie-Christine

    2014-12-01

    Twenty healthy cats (group 1) with clinically normal ears, 15 cats with systemic disease (group 2) and 15 allergic cats (group 3) were included in a prospective study. The experimental unit was the ear. A clinical score was established for each ear canal after otoscopic examination. Microbial population was assessed on cytological examination of smears performed with the cotton-tipped applicator smear technique. Fungal population was significantly more prominent in allergic cats (P <0.001) and in diseased cats compared with healthy cats (P <0.02). Bacterial population was significantly higher in allergic cats than in healthy cats (P <0.001) and cats suffering from systemic disease (P <0.001). Bacterial overgrowth was also higher in cats with systemic disease than healthy cats. In cats from group 2, only fungal overgrowth was associated with otitis severity. In group 3, only bacterial overgrowth was associated with otitis severity. PMID:24509255

  13. [Cross-reactivity in allergic fungal sinusitis. Case report].

    PubMed

    González-Díaz, Sandra Nora; Arias-Cruz, Alfredo; Rivero-Arias, Dulce María; Partida-Ortega, Alma Belén; Elizondo-Villarreal, Bárbara; Ibarra-Chávez, Jesús Arturo; Ramos-Valencia, Lissette; Monge-Ortega, Olga Patricia; Macouzet-Sánchez, Carlos; Salinas-Díaz, María Rocío

    2016-01-01

    Antecedentes: La presencia de mucina alérgica en la rinosinusitis alérgica fúngica (RAF) es una manifestación que la identifica como un proceso de hipersensibilidad. En la RAF existe un fenómeno de reactividad cruzada entre proteínas unidas a IgE que tienen al menos dos epítopes compartidos. Caso clínico: Varón de 13 años de edad con síntomas obstructivos nasales de tres años de evolución. Por exploración física y tomografía se identificó masa obstructiva en los senos paranasales. En la cirugía endoscópica, en la fosa nasal izquierda se identificó pólipo con aspecto macroscópico de mucina alérgica; el pólipo fue resecado. El examen histopatológico final mediante tinciones con ácido peryódico de Schiff y metenamina plata de Grocott indicó Aspergillus. Dos semanas después de la cirugía, las pruebas percutáneas mostraron sensibilización a Alternaria alternata, Helminthosporium sativum y Deramatophagoides farianae, con negatividad a Aspergillus fumigatus. Conclusiones: La ausencia de títulos significativos de anticuerpos IgE específicos para Aspergillus fumigatus constituyó la evidencia de que la respuesta de hipersensibilidad fue desencadenada por un patógeno distinto del aislado en el estudio histopatológico, que aunada a las pruebas positivas para otros hongos puede explicarse por el fenómeno de reactividad cruzada en un probable fenómeno de hipersensibilidad.

  14. Systemic corticosteroid monotherapy for clinically diagnosed acute rhinosinusitis: a randomized controlled trial

    PubMed Central

    Venekamp, Roderick P.; Bonten, Marc J.M.; Rovers, Maroeska M.; Verheij, Theo J.M.; Sachs, Alfred P.E.

    2012-01-01

    Background: Patients with acute rhinosinusitis are frequently encountered in primary care. Although corticosteroids are being increasingly used for symptom control, evidence supporting their use is inconclusive. We conducted a randomized controlled trial to examine the effectiveness of systemic corticosteroid monotherapy for clinically diagnosed, uncomplicated acute rhinosinusitis. Methods: We conducted a block-randomized, double-blind, placebo-controlled clinical trial at 54 primary care practices (68 family physicians) in the Netherlands between Dec. 30, 2008, and Apr. 28, 2011. Adult patients with clinically diagnosed acute rhinosinusitis were randomly assigned to receive either prednisolone 30 mg/d or placebo for 7 days and asked to complete a symptom diary for 14 days. The primary outcome measure was the proportion of patients with resolution of facial pain or pressure on day 7. Results: Of the 185 patients included in the trial (93 in the treatment group, 92 in the placebo group), 2 withdrew from the study and 9 were excluded from the primary analysis because of incomplete symptom reporting. The remaining 174 patients (88 in the treatment group, 86 in the placebo group) were included in the intention-to-treat analysis. The proportions of patients with resolution of facial pain or pressure on day 7 were 62.5% (55/88) in the prednisolone group and 55.8% (48/86) in the placebo group (absolute risk difference 6.7%, 95% confidence interval −7.9% to 21.2%). The groups were similar with regard to the decrease over time in the proportion of patients with total symptoms (combined symptoms of runny nose, postnasal discharge, nasal congestion, cough and facial pain) and health-related quality of life. Adverse events were mild and did not differ significantly between the groups. Interpretation: Systemic corticosteroid monotherapy had no clinically relevant beneficial effects among patients with clinically diagnosed acute rhinosinusitis. Netherlands Trial Register

  15. Chronic rhinosinusitis in patients requiring surgical repair of a midface fracture.

    PubMed

    Yelverton, Joshua C; Jackson, Peter; Schmidt, Robert S

    2014-09-01

    Midface fractures commonly occur following trauma to the face and may cause changes in the normal sinus outflow system. To the best of our knowledge, no study has examined the incidence of rhinosinusitis following midface fractures. We report the incidence of chronic rhinosinusitis in patients who underwent surgical repair of a midface fracture. Our evaluation tool was the 20-item Sino-Nasal Outcome Test quality-of-life survey (SNOT-20). We mailed a demographic survey and the SNOT-20 questionnaire to 486 eligible patients who had undergone surgical repair of either a midface (n = 234) or mandible (n = 252) fracture; we had intended to use the latter cohort as a control group. Of the 234 midface patients, 34 (14.5%) returned a usable survey, but only 7 of the 252 mandibular patients (2.8%) did so, which was not a sufficient number for analysis; therefore we used normative data obtained from another study for comparison purposes. The mean SNOT-20 score in our cohort was 24.15, which was similar to the 28.7 mean score in the control cohort of patients with rhinosinusitis. The highest mean scores for the individual components of the SNOT-20 were for "Wake up at night," "Lack of a good night's sleep," "Wake up tired," and "Frustrated/restless/irritable." The components that the most patients found bothersome were "Facial pain/pressure," "Need to blow nose," "Runny nose," and "Lack of a good night's sleep." We conclude that patients who experience a midface fracture have a much higher risk of developing chronic rhinosinusitis that negatively affects their long-term quality of life. These patients should be monitored with long-term follow-up and treated appropriately. PMID:25255355

  16. A patient with allergic bronchopulmonary mycosis caused by Aspergillus fumigatus and Candida albicans.

    PubMed

    Wardhana; Datau, E A

    2012-10-01

    Allergic Bronchopulmonary Mycosis (ABPM) is an exagregated immunologic response to fungal colonization in the lower airways. It may cause by many kinds of fungal, but Aspergillus fumigatus is the most common cause of ABPM, although other Aspergillus and other fungal organisms, like Candida albicans, have been implicated. Aspergllus fumigatus and Candida albicans may be found as outdoor and indoor fungi, and cause the sensitization, elicitation of the disease pathology, and its clinical manifestations. Several diagnostic procedurs may be impicated to support the diagnosis of ABPM caused by Aspergillus fumigatus and Candida albicans. A case of allergic bronchopulmonary mycosis caused by Aspergillus fumigatus and Candida albicans in a 48 year old man was discussed. The patient was treated with antifungal, corticosteroids, and antibiotic for the secondary bacterial infection. The patient's condition is improved without any significant side effects. PMID:23314973

  17. The evaluation of allergens and allergic diseases in children.

    PubMed

    Lee, C S; Tang, R B; Chung, R L

    2000-12-01

    Knowing the incidence of allergic diseases and their relationship with allergens is a crucial requirement for therapeutic judgment. We present our experience on the incidence, clinical features and allergens of the allergic diseases detected by multiple allergosorbent chemiluminescent assay (MAST-CLA) in children from 1997 to 1999 at the Taipei Veterans General Hospital. The incidence of bronchial asthma, allergic rhinitis and atopic dermatitis are significantly different when stratified by age groups. Among the enrolled 2008 patients, 980 (48.8%) patients have positive MAST-CLA results. Of these, 562 (57.3%) are male and 418 (42.7%) are female. A significant increase among patients with positive allergens is also found when stratified by age group. Inhalant allergen is the major allergen detected in our patients. House dust mites Dermatophagoides pteronyssinus (Dp) and Dermatophagoides farinae (Df), cockroaches, feathers, and dog dander show the highest incidence in the 7- to 12-year-old group. In the fungal group, Aspergillus and Penicillium also show a significant difference in the incidence among different age groups. Pollen allergens, on a whole, show significant difference in incidence among different age groups. The food allergen group shows variable significant difference in incidence. Crab, milk, and egg white show the highest significant incidence in the 2- to 6-year-old group. These results suggest that the incidence of allergens detected in allergic diseases varies among different age groups. PMID:11269366

  18. Allergic reactions to insect secretions.

    PubMed

    Pecquet, Catherine

    2013-01-01

    Some products derived from insects can induce allergic reactions. The main characteristics of some products from honeybees, cochineal and silkworms are summarised here. We review allergic reactions from honey-derived products (propolis, wax, royal jelly), from cochineal products (shellac and carmine) and from silk : clinical features, allergological investigations and allergens if they are known.

  19. Allergies to molds caused by fungal spores in air conditioning equipment

    SciTech Connect

    Schata, M.; Jorde, W. ); Elixmann, J.H.; Linskens, H.F. )

    1989-01-01

    People suffering from various symptoms while in air-conditioned rooms often show sensitizations to fungi that can be isolated when the fungi are removed from air conditioners. By using specific challenge tests it was shown that fungal spores in air conditioners can evoke allergic symptoms. Hyposensitization was the specific therapy prescribed for such allergic reactions. After hyposensitization therapy, more than 70% of the patients so treated could live and work again in air-conditioned rooms without developing specific symptoms.

  20. The Impact of Aspergillus fumigatus Viability and Sensitization to Its Allergens on the Murine Allergic Asthma Phenotype

    PubMed Central

    Pandey, Sumali; Hoselton, Scott A.; Schuh, Jane M.

    2013-01-01

    Aspergillus fumigatus is a ubiquitously present respiratory pathogen. The outcome of a pulmonary disease may vary significantly with fungal viability and host immune status. Our objective in this study was (1) to assess the ability of inhaled irradiation-killed or live A. fumigatus spores to induce allergic pulmonary disease and (2) to assess the extent to which inhaled dead or live A. fumigatus spores influence pulmonary symptoms in a previously established allergic state. Our newly developed fungal delivery apparatus allowed us to recapitulate human exposure through repeated inhalation of dry fungal spores in an animal model. We found that live A. fumigatus spore inhalation led to a significantly increased humoral response, pulmonary inflammation, and airway remodeling in naïve mice and is more likely to induce allergic asthma symptoms than the dead spores. In contrast, in allergic mice, inhalation of dead and live conidia recruited neutrophils and induced goblet cell metaplasia. This data suggests that asthma symptoms might be exacerbated by the inhalation of live or dead spores in individuals with established allergy to fungal antigens, although the extent of symptoms was less with dead spores. These results are likely to be important while considering fungal exposure assessment methods and for making informed therapeutic decisions for mold-associated diseases. PMID:24063011

  1. Restoring airway epithelial barrier dysfunction: a new therapeutic challenge in allergic airway disease.

    PubMed

    Steelant, B; Seys, S F; Boeckxstaens, G; Akdis, C A; Ceuppens, J L; Hellings, P W

    2016-09-01

    An intact functional mucosal barrier is considered to be crucial for the maintenance of airway homeostasis as it protects the host immune system from exposure to allergens and noxious environmental triggers. Recent data provided evidence for the contribution of barrier dysfunction to the development of inflammatory diseases in the airways, skin and gut. A defective barrier has been documented in chronic rhinosinusitis, allergic rhinitis, asthma, atopic dermatitis and inflammatory bowel diseases. However, it remains to be elucidated to what extent primary (genetic) versus secondary (inflammatory) mechanisms drive barrier dysfunction. The precise pathogenesis of barrier dysfunction in patients with chronic mucosal inflammation and its implications on tissue inflammation and systemic absorption of exogenous particles are only partly understood. Since epithelial barrier defects are linked with chronicity and severity of airway inflammation, restoring the barrier integrity may become a useful approach in the treatment of allergic diseases. We here provide a state-of-the-art review on epithelial barrier dysfunction in upper and lower airways as well as in the intestine and the skin and on how barrier dysfunction can be restored from a therapeutic perspective.

  2. Endotypes of allergic diseases and asthma: An important step in building blocks for the future of precision medicine.

    PubMed

    Agache, Ioana; Akdis, Cezmi A

    2016-07-01

    Discoveries from basic science research in the last decade have brought significant progress in knowledge of pathophysiologic processes of allergic diseases, with a compelling impact on understanding of the natural history, risk prediction, treatment selection or mechanism-specific prevention strategies. The view of the pathophysiology of allergic diseases developed from a mechanistic approach, with a focus on symptoms and organ function, to the recognition of a complex network of immunological pathways. Several subtypes of inflammation and complex immune-regulatory networks and the reasons for their failure are now described, that open the way for the development of new diagnostic tools and innovative targeted-treatments. An endotype is a subtype of a disease condition, which is defined by a distinct pathophysiological mechanism, whereas a disease phenotype defines any observable characteristic of a disease without any implication of a mechanism. Another key word linked to disease endotyping is biomarker that is measured and evaluated to examine any biological or pathogenic processes, including response to a therapeutic intervention. These three keywords will be discussed more and more in the future with the upcoming efforts to revolutionize patient care in the direction of precision medicine and precision health. The understanding of disease endotypes based on pathophysiological principles and their validation across clinically meaningful outcomes in asthma, allergic rhinitis, chronic rhinosinusitis, atopic dermatitis and food allergy will be crucial for the success of precision medicine as a new approach to patient management.

  3. Oral immunotherapy for allergic conjunctivitis.

    PubMed

    Ishida, Waka; Fukuda, Ken; Harada, Yosuke; Yagita, Hideo; Fukushima, Atsuki

    2014-11-01

    Antigen-specific immunotherapy is expected to be a desirable treatment for allergic diseases. Currently, antigen-specific immunotherapy is performed by administering disease-causing antigens subcutaneously or sublingually. These approaches induce long-term remission in patients with allergic rhinitis or asthma. The oral route is an alternative to subcutaneous and sublingual routes, and can also induce long-term remission, a phenomenon known as "oral tolerance." The effectiveness of oral tolerance has been reported in the context of autoimmune diseases, food allergies, asthma, atopic dermatitis, and allergic rhinitis in both human patients and animal models. However, few studies have examined its efficacy in animal models of allergic conjunctivitis. Previously, we showed that ovalbumin feeding suppressed ovalbumin-induced experimental allergic conjunctivitis, indicating the induction of oral tolerance is effective in treating experimental allergic conjunctivitis. In recent years, transgenic rice has been developed that can induce oral tolerance and reduce the severity of anaphylaxis. The major Japanese cedar pollen antigens in transgenic rice, Cryptomeria japonica 1 and C. japonica 2, were deconstructed by molecular shuffling, fragmentation, and changes in the oligomeric structure. Thus, transgenic rice may be an effective treatment for allergic conjunctivitis.

  4. Fragrance allergic contact dermatitis.

    PubMed

    Cheng, Judy; Zug, Kathryn A

    2014-01-01

    Fragrances are a common cause of allergic contact dermatitis in Europe and in North America. They can affect individuals at any age and elicit a spectrum of reactions from contact urticaria to systemic contact dermatitis. Growing recognition of the widespread use of fragrances in modern society has fueled attempts to prevent sensitization through improved allergen identification, labeling, and consumer education. This review provides an overview and update on fragrance allergy. Part 1 discusses the epidemiology and evaluation of suspected fragrance allergy. Part 2 reviews screening methods, emerging fragrance allergens, and management of patients with fragrance contact allergy. This review concludes by examining recent legislation on fragrances and suggesting potential additions to screening series to help prevent and detect fragrance allergy.

  5. Exophiala pisciphila: a novel cause of allergic bronchopulmonary mycosis.

    PubMed

    Kebbe, Jad; Mador, M Jeffery

    2016-07-01

    Allergic bronchopulmonary mycosis (ABPM) is a hypersensitivity reaction to fungal antigens, which may particularly plague uncontrolled asthmatics. Non-aspergillus fungal organisms may be implicated and may elicit a more severe immunologic response. Exophiala pisciphila, a marine organism, has not been reported as a culprit yet. However, this report indicates it may be implicated in unrelenting symptoms in a severe asthmatic patient who had become dependent on corticosteroids. Proper identification and adequate therapy of this organism led to complete resolution of respiratory symptoms, with adequate subsequent control of the asthma. ABPM may complicate asthma and lead to a lack of its control. Proper awareness, testing and treatment of non-aspergillus pulmonary mycosis is essential to proper asthma care and beneficial for its control. PMID:27499992

  6. Exophiala pisciphila: a novel cause of allergic bronchopulmonary mycosis

    PubMed Central

    Mador, M. Jeffery

    2016-01-01

    Allergic bronchopulmonary mycosis (ABPM) is a hypersensitivity reaction to fungal antigens, which may particularly plague uncontrolled asthmatics. Non-aspergillus fungal organisms may be implicated and may elicit a more severe immunologic response. Exophiala pisciphila, a marine organism, has not been reported as a culprit yet. However, this report indicates it may be implicated in unrelenting symptoms in a severe asthmatic patient who had become dependent on corticosteroids. Proper identification and adequate therapy of this organism led to complete resolution of respiratory symptoms, with adequate subsequent control of the asthma. ABPM may complicate asthma and lead to a lack of its control. Proper awareness, testing and treatment of non-aspergillus pulmonary mycosis is essential to proper asthma care and beneficial for its control. PMID:27499992

  7. Allergic rhinitis - self-care

    MedlinePlus

    Hay fever - self-care; Seasonal rhinitis - self-care; Allergies - allergic rhinitis - self-care ... in a row. Talk to your child's health care provider before giving your child decongestants. Nasal corticosteroid ...

  8. Allergic Mechanisms in Eosinophilic Esophagitis

    PubMed Central

    Wechsler, Joshua B; Bryce, Paul J

    2014-01-01

    Paralleling the overall trend in allergic diseases, Eosinophilic Esophagitis is rapidly increasing in incidence. It is associated with food antigen-triggered, eosinophil-predominant inflammation and the pathogenic mechanisms have many similarities to other chronic atopic diseases, such as eczema and allergic asthma. Studies in animal models and from patients over the last 15 years have suggested that allergic sensitization leads to food-specific IgE and T-helper lymphocyte type 2 cells, both of which appear to contribute to the pathogenesis along with basophils, mast cells, and antigen-presenting cells. This review will outline our current understandings of the allergic mechanisms that drive eosinophilic esophagitis, drawing from clinical and translational studies in humans as well as experimental animal models. PMID:24813516

  9. Opportunistic invasive fungal infections: diagnosis & clinical management

    PubMed Central

    Badiee, Parisa; Hashemizadeh, Zahra

    2014-01-01

    Invasive fungal infections are a significant health problem in immunocompromised patients. The clinical manifestations vary and can range from colonization in allergic bronchopulmonary disease to active infection in local aetiologic agents. Many factors influence the virulence and pathogenic capacity of the microorganisms, such as enzymes including extracellular phospholipases, lipases and proteinases, dimorphic growth in some Candida species, melanin production, mannitol secretion, superoxide dismutase, rapid growth and affinity to the blood stream, heat tolerance and toxin production. Infection is confirmed when histopathologic examination with special stains demonstrates fungal tissue involvement or when the aetiologic agent is isolated from sterile clinical specimens by culture. Both acquired and congenital immunodeficiency may be associated with increased susceptibility to systemic infections. Fungal infection is difficult to treat because antifungal therapy for Candida infections is still controversial and based on clinical grounds, and for molds, the clinician must assume that the species isolated from the culture medium is the pathogen. Timely initiation of antifungal treatment is a critical component affecting the outcome. Disseminated infection requires the use of systemic agents with or without surgical debridement, and in some cases immunotherapy is also advisable. Preclinical and clinical studies have shown an association between drug dose and treatment outcome. Drug dose monitoring is necessary to ensure that therapeutic levels are achieved for optimal clinical efficacy. The objectives of this review are to discuss opportunistic fungal infections, diagnostic methods and the management of these infections. PMID:24718393

  10. Role of Eosinophil Granulocytes in Allergic Airway Inflammation Endotypes.

    PubMed

    Amin, K; Janson, C; Bystrom, J

    2016-08-01

    Eosinophil granulocytes are intriguing members of the innate immunity system that have been considered important defenders during parasitic diseases as well as culprits during allergy-associated inflammatory diseases. Novel studies have, however, found new homoeostasis-maintaining roles for the cell. Recent clinical trials blocking different Th2 cytokines have uncovered that asthma is heterogeneous entity and forms different characteristic endotypes. Although eosinophils are present in allergic asthma with early onset, the cells may not be essential for the pathology. The cells are, however, likely disease causing in asthma with a late onset, which is often associated with chronic rhinosinusitis. Assessment of eosinophilia, fraction exhaled nitric oxide (FeNO) and periostin are markers that have emerged useful in assessing and monitoring asthma severity and endotype. Current scientific knowledge suggests that eosinophils are recruited by the inflammatory environment, activated by the innate interleukin (IL)-33 and prevented from apoptosis by both lymphocytes and innate immune cells such as type two innate immune cells. Eosinophils contain four specific granule proteins that exhibit an array of toxic and immune-modulatory activates. The granule proteins can be released by different mechanisms. Additionally, eosinophils contain a number of inflammatory cytokines and lipid mediators as well as radical oxygen species that might contribute to the disease both by the recruitment of other cells and the direct damage to supporting cells, leading to exacerbations and tissue fibrosis. This review aimed to outline current knowledge how eosinophils are recruited, activated and mediate damage to tissues and therapies used to control the cells. PMID:27167590

  11. Corneal Ulcer Caused by the New Fungal Species Sarcopodium oculorum

    PubMed Central

    Guarro, Josep; Höfling-Lima, Ana Luisa; Gené, Josepa; De Freitas, Denise; Godoy, Patricio; Zorat-Yu, Maria Luisa; Zaror, Luis; Fischman, Olga

    2002-01-01

    We describe a case of keratitis caused by a new species of the hyphomycetous genus Sarcopodium, S. oculorum. The corneal ulcer developed after 5 months of treatment with corticosteroids in a Brazilian boy diagnosed with allergic conjunctivitis. Fungal hyphae and conidia were detected in corneal scrapings, and repeated cultures were positive for this fungus. The infection was resolved with natamycin and ketoconazole. Eleven antifungals were tested against this fungus, and all except flucytosine and fluconazole showed in vitro activity. PMID:12149384

  12. Fungal Skin Infections

    MedlinePlus

    ... Fungal Skin Infections Overview of Fungal Skin Infections Candidiasis Overview of Dermatophytoses (Ringworm, Tinea) Athlete's Foot Jock ... are caused by yeasts (such as Candida —see Candidiasis ) or dermatophytes, such as Epidermophyton, Microsporum, and Trichophyton ( ...

  13. [Use of Myrtol standardized in the treatment of children with acute rhinosinusitis].

    PubMed

    Karpova, E P; Tulupov, D A; Emel'yanova, M P

    2016-01-01

    The present study included 60 children at the age from 6 to 10 years undergoing a course of out-patient and in-patient treatment of acute rhinosinusitis (ARS). Thirty of these patients were given Myrtol standardised in the dose of 120 mg thrice daily for 7 days, in addition to traditional therapy.With convincing objective data for acute bacterial rhinosinusitis (in accordance with the criteria of EP3OS 2012), antibacterial preparations were prescribed to the children. The remaining patients received either conventional (symptomatic, irrigation) therapy or systemic antimicrobial agents. The analysis of characteristics of the visual-analog scale reflecting the severity of rhinorrhea, basal congestion, and coughing has demonstrated a significant (р<0,05) difference between the two groups of children in terms of manifestations of the clinical symptoms within days 7 and 14 after the onset of the treatment. For basal congestion, the difference was apparent as soon as day 3 after the beginning of therapy. The duration of the treatment with intranasal vasoconstrictive medications used for symptomatic therapy by the patients given Myrtol standardized was 2.2±0.4 days in comparison with 3.6±0.5 days in the control group. None of the patients treated with GeloMyrtol exhibited any adverse reaction attributable to the action of the medication in being studied. The study has demonstrated that using Myrtol standardized for the treatment of the uncomplicated forms of acute rhinosinusitis in children is clinically effective, safe, and convenient method for the management of ARS in children. And it can be recommended for the wide practical application.

  14. Comparison of the Allergic Responses Induced by PeniciIlium chrysogenum and House Dust Mite Extracts in a Mouse Model

    EPA Science Inventory

    A report by the Institute of Medicine suggested that more research is needed to better understand mold effects on allergic disease, particularly asthma development. We compared the ability of the fungal Penicillium chrysogenum (PCE) and house dust mite (HDM) extracts to induce al...

  15. Allergic Contact Dermatitis

    PubMed Central

    Nelson, Jenny L.

    2010-01-01

    Epicutaneous patch testing is the gold standard method for the diagnosis of allergic contact dermatitis. Despite this knowledge, many clinical dermatologists do not offer patch testing in their offices or offer testing with only a limited number of allergens. Introduced in 1995, the Thin-Layer Rapid Use Epicutaneous Test originally contained 23 allergens and one control. In 2007, five additional allergens were added. This United States Food and Drug Administration-approved patch testing system made patch testing more convenient, and after its introduction, more dermatologists offered patch testing services. However, the number of allergens in the Thin-Layer Rapid Use Epicutaneous Test remains relatively low. Every two years, the North American Contact Dermatitis Group collects and reports the data from patch testing among its members to a standardized series of allergens. In 2005-2006, the Group used a series of 65 allergens. Of the top 30 allergens reported in 2005-2006, 10 were not included in the Thin-Layer Rapid Use Epicutaneous Test. Knowledge of and testing for additional allergens such as these may increase patch testing yield. PMID:20967194

  16. Fungal stealth technology.

    PubMed

    Rappleye, Chad A; Goldman, William E

    2008-01-01

    Medically important fungi range from commensal organisms that cause opportunistic infections to primary fungal pathogens that can cause disease in immunocompetent hosts. Host phagocyte-expressed pattern-recognition receptors represent one obstacle to infection, and the extent to which fungal cells can evade detection by host receptors helps shape their pathogenic potential. This review highlights recently defined mechanisms employed by successful fungal pathogens to conceal their immunostimulatory molecular signatures from leukocyte receptors or to disrupt host response signals. Continued improvements in our understanding of these fungal stealth mechanisms should provide new options for future therapeutics to expose these fungal pathogens and limit their virulence capacity.

  17. The effect of thyme honey nasal spray on chronic rhinosinusitis: a double-blind randomized controlled clinical trial.

    PubMed

    Hashemian, Farnaz; Baghbanian, Neda; Majd, Zahra; Rouini, Mohammad-Reza; Jahanshahi, Javaneh; Hashemian, Farshad

    2015-06-01

    Chronic rhinosinusitis is a common disease which causes persisting inflammatory conditions of one or more sinuses. This study was designed to evaluate the effect of thyme honey nasal spray as an adjunctive medication on chronic rhinosinusitis after functional endoscopic sinus surgery. This was a randomized, placebo controlled, double-blind clinical study. 64 patients with chronic rhinosinusitis undergoing functional endoscopic sinus surgery were enrolled in this study. Patients were randomized and blinded to receive either placebo or thyme honey nasal spray in addition to the standard regimen postoperatively. Patients were visited on postoperative days 7, 30 and 60. The sino-nasal outcome test, endoscopic grading system and sinus CT-scan were scored before operation and on the day 60 after surgery. 54 patients completed the study. Significant improvement was observed in both treatment groups. There were no significant changes in SNOT-22, endoscopy and CT-scan scores between the two study groups. However, a greater reduction in endoscopic scores was shown in thyme honey group. The incidence of adverse effects was not significantly different between the groups, but synechiae formation and epistaxis were lower in treatment group. Thyme honey nasal spray seems to be a low-priced potential adjuvant remedy with excellent safety profile, to reduce inflammation and polyp formation and also fostering mucosal healing for patients suffering from chronic rhinosinusitis. However, further studies are recommended.

  18. New therapies for allergic rhinitis.

    PubMed

    Braido, Fulvio; Sclifò, Francesca; Ferrando, Matteo; Canonica, Giorgio Walter

    2014-04-01

    Because of its burden on patient's lives and its impact on asthma, allergic rhinitis must be treated properly with more effective and safer treatments. According to guidelines by Allergic Rhinitis and Its Impact on Asthma (ARIA), the classification, pathogenesis, and treatment of allergic rhinitis are well defined. Currently, second-generation antihistamines and inhaled steroids are considered the cornerstone of first-line therapy. However, new formulations of available drugs (e.g., loratadine and rupatadine oral solution, ebastine fast-dissolving tablets, and the combination of intranasal fluticasone propionate and azelastine hydrochloride), recently discovered molecules (e.g., ciclesonide, bilastine, and phosphodiesterase-4 inhibitors), immunologic targets (e.g., omalizumab), and unconventional treatments (e.g., homeopathic treatments) are currently under investigation and represent a new frontier in modern medicine and in allergic rhinitis management. The aim of this review is to provide an update on allergic rhinitis treatment, paying particular attention to clinical trials published within the past 20 months that assessed the efficacy and safety of new formulations of available drugs or new molecules.

  19. New therapies for allergic rhinitis.

    PubMed

    Braido, Fulvio; Sclifò, Francesca; Ferrando, Matteo; Canonica, Giorgio Walter

    2014-04-01

    Because of its burden on patient's lives and its impact on asthma, allergic rhinitis must be treated properly with more effective and safer treatments. According to guidelines by Allergic Rhinitis and Its Impact on Asthma (ARIA), the classification, pathogenesis, and treatment of allergic rhinitis are well defined. Currently, second-generation antihistamines and inhaled steroids are considered the cornerstone of first-line therapy. However, new formulations of available drugs (e.g., loratadine and rupatadine oral solution, ebastine fast-dissolving tablets, and the combination of intranasal fluticasone propionate and azelastine hydrochloride), recently discovered molecules (e.g., ciclesonide, bilastine, and phosphodiesterase-4 inhibitors), immunologic targets (e.g., omalizumab), and unconventional treatments (e.g., homeopathic treatments) are currently under investigation and represent a new frontier in modern medicine and in allergic rhinitis management. The aim of this review is to provide an update on allergic rhinitis treatment, paying particular attention to clinical trials published within the past 20 months that assessed the efficacy and safety of new formulations of available drugs or new molecules. PMID:24504526

  20. Chronic Maxillary Rhinosinusitis of Dental Origin: A Systematic Review of 674 Patient Cases

    PubMed Central

    Lechien, Jerome R.; Filleul, Olivier; Costa de Araujo, Pedro; Hsieh, Julien W.; Chantrain, Gilbert; Saussez, Sven

    2014-01-01

    Objectives. The aim of this systematic review is to study the causes of odontogenic chronic maxillary rhinosinusitis (CMRS), the average age of the patients, the distribution by sex, and the teeth involved. Materials and Methods. We performed an EMBASE-, Cochrane-, and PubMed-based review of all of the described cases of odontogenic CMRS from January 1980 to January 2013. Issues of clinical relevance, such as the primary aetiology and the teeth involved, were evaluated for each case. Results. From the 190 identified publications, 23 were selected for a total of 674 patients following inclusion criteria. According to these data, the main cause of odontogenic CMRS is iatrogenic, accounting for 65.7% of the cases. Apical periodontal pathologies (apical granulomas, odontogenic cysts, and apical periodontitis) follow them and account for 25.1% of the cases. The most commonly involved teeth are the first and second molars. Conclusion. Odontogenic CMRS is a common disease that must be suspected whenever a patient undergoing dental treatment presents unilateral maxillary chronic rhinosinusitis. PMID:24817890

  1. Endoscopic drainage of orbital subperiosteal hematoma secondary to acute rhinosinusitis in a child.

    PubMed

    Nomura, Kazuhiro; Honkura, Yohei; Ozawa, Daiki; Okumura, Yuri; Hidaka, Hiroshi; Ogawa, Takenori; Yamauchi, Daisuke; Watanabe, Kenichi; Katori, Yukio

    2014-01-01

    Acute rhinosinusitis is frequently associated with secondary orbital infection, most commonly subperiosteal abscess. Although orbital subperiosteal abscess is a deadly disease that might lead to blind and cavernous sinus thrombosis, recent review of literature showed that immediate surgical intervention might not always be necessary for subperiosteal abscess. Orbital inflammation secondary to sinusitis is common in children, whereas orbital subperiosteal hematoma secondary to sinusitis is extremely rare, with only 11 reported cases, including one case in children. All the cases were treated with surgical intervention. Here we present a 12-year-old girl with rhinosinusitis and proptosis. Emergent endoscopic sinus surgery with partial removal of the lamina papyracea revealed dark brown fluid in the subperiosteal space. The patient was symptom-free 2 weeks after surgery. The present case was treated exclusively via an endonasal approach, whereas all 11 previous cases of subperiosteal hematoma were treated with external incision. The endonasal approach is favorable, especially for young female patients. Our review of literature shows that sudden onset, afebrile, and few signs of inflammation on blood test in patients with subperiosteal lesion may indicate subperiosteal hematoma. Surgery rather than antibiotic administration should be considered for the treatment of suspected subperiosteal hematoma. Treatment through only the endonasal approach is possible even if the hematoma is located in the roof of the orbit. PMID:24965687

  2. Herbal drug BNO 1016 is safe and effective in the treatment of acute viral rhinosinusitis

    PubMed Central

    Jund, Rainer; Mondigler, Martin; Stammer, Holger; Stierna, Pontus; Bachert, Claus

    2015-01-01

    Abstract Conclusion: Daily intake of 480 mg of BNO 1016 for 15 days is an effective treatment in acute viral rhinosinusitis. Objectives: The pooled efficacy data of two similar randomized placebo-controlled clinical trials were analyzed. Safety was evaluated on the basis of the individual trials. Methods: The efficacy analysis was based on 589 patients. Treatment was performed orally with either 3 × 160 mg BNO 1016 (n = 294) or 3 × placebo (n = 295) for 15 days. In both trials patients underwent five visits to the investigational sites. Symptoms were evaluated according to the EPOS 2012 guideline. Ultrasonography was used to confirm the diagnosis at onset of treatment and the remission of symptoms at the last visit. Efficacy was evaluated by the investigator as the mean major symptom score (MSS) at the end of treatment (visit 5, day 14). Patients reported symptoms and social/emotional consequences of rhinosinusitis using a quality of life questionnaire (SNOT-20 GAV). Results: MSS improved during the treatment period by a mean of 10.02 ± 1.61 score points to 2.47 ± 2.55 for BNO 1016 and of 9.87 ± 1.52 to 3.63 ± 3.63 for placebo. Differences between treatment groups at end of therapy (1.16 ± 3.14 score points; p < 0.0001) and patient-assessed quality of life (p = 0.0015) were statistically significant in favor of BNO 1016. PMID:25496178

  3. Antibiotic efficacy in patients with a moderate probability of acute rhinosinusitis: a systematic review.

    PubMed

    Burgstaller, Jakob M; Steurer, Johann; Holzmann, David; Geiges, Gabriel; Soyka, Michael B

    2016-05-01

    The aim of this systematic review was to synthesize the results of original studies assessing antibiotic efficacy at different time points after initiating treatment in patients with a moderate probability of acute bacterial rhinosinusitis. We searched the Cochrane library for systematic reviews on the efficacy of antibiotic treatment in patients with acute rhinosinusitis (ARS). Only randomized controlled trials (RCTs) that compared treatment of any antibiotic with placebo were included. The synthesis of the results of six RCTs showed a benefit of antibiotic treatment compared to placebo for the rate of improvement after 3 [pooled odds ratio (OR) 2.78 (95 % confidence interval (CI) 1.39-5.58)] and 7 [OR 2.29 (95 % CI 1.19-4.41)] days after initiation in patients with symptoms and signs of ARS lasting for 7 or more days. After 10 days [pooled OR 1.36 (95 % CI 0.66-2.90)], improvement rates did not differ significantly between patients treated with or without antibiotics. Compared to placebo, antibiotic treatment relieves symptoms in a significantly higher proportion of patients within the first days of treatment. Reporting an overall average treatment efficacy may underestimate treatment benefits in patients with a self-limiting illness.

  4. Airborne and allergenic fungal spores of the Karachi environment and their correlation with meteorological factors.

    PubMed

    Hasnain, Syed M; Akhter, Tasneem; Waqar, Muhammad A

    2012-03-01

    Airborne fungal spores are well known to cause respiratory allergic diseases particularly bronchial asthma, allergic rhinitis, rhino-conjunctivitis and allergic broncho-pulmonary aspergillosis in both adults and children. In order to monitor and analyze airborne fungal flora of the Karachi environment, an aeromycological study was conducted using a Burkard 7-Day Recording Volumetric Spore Trap from January to December 2010. The data recorded from the Spore Trap was further analyzed for percent catch determination, total spores concentration, seasonal periodicities and diurnal variations. Cladosporium spp (44.8%), Alternaria spp. (15.5%), Periconia spp (6.1%), Curvularia spp (2.1%), Stemphylium spp (1.3%) and Aspergillus/Penicillium type (1%) emerged to be major components constituting more than 70% of the airborne fungal flora. Cladosporium, Curvularia and Stemphylium displayed a clear seasonal trend, while there were no clear seasonal trends for other fungal spore types. Diurnal variations were observed to be mainly having daytime maxima. Spearman Rank Correlation Coefficient analysis was conducted using various weather parameters. The various fungal types showed a negative correlation with heat index, dew point, wind velocity and wind chill. However, a positive correlation was found with humidity, rain and barometric pressure. In fact, Alternaria, Bipolaris and Periconia showed a negative correlation with temperature, while Cladosporium and Periconia showed a negative correlation with heat index, dew point, wind velocity and wind chill. The barometric pressure was positively correlated with Cladosporium. On the basis of these findings, it can be concluded that a number of fungal spores are present in the atmosphere of Karachi throughout the year, with certain atmospheric conditions influencing the release, dispersion, and sedimentation processes of some genera. It is expected that clinicians will use the identified fungal flora for diagnosis and treatment and

  5. Airborne and allergenic fungal spores of the Karachi environment and their correlation with meteorological factors.

    PubMed

    Hasnain, Syed M; Akhter, Tasneem; Waqar, Muhammad A

    2012-03-01

    Airborne fungal spores are well known to cause respiratory allergic diseases particularly bronchial asthma, allergic rhinitis, rhino-conjunctivitis and allergic broncho-pulmonary aspergillosis in both adults and children. In order to monitor and analyze airborne fungal flora of the Karachi environment, an aeromycological study was conducted using a Burkard 7-Day Recording Volumetric Spore Trap from January to December 2010. The data recorded from the Spore Trap was further analyzed for percent catch determination, total spores concentration, seasonal periodicities and diurnal variations. Cladosporium spp (44.8%), Alternaria spp. (15.5%), Periconia spp (6.1%), Curvularia spp (2.1%), Stemphylium spp (1.3%) and Aspergillus/Penicillium type (1%) emerged to be major components constituting more than 70% of the airborne fungal flora. Cladosporium, Curvularia and Stemphylium displayed a clear seasonal trend, while there were no clear seasonal trends for other fungal spore types. Diurnal variations were observed to be mainly having daytime maxima. Spearman Rank Correlation Coefficient analysis was conducted using various weather parameters. The various fungal types showed a negative correlation with heat index, dew point, wind velocity and wind chill. However, a positive correlation was found with humidity, rain and barometric pressure. In fact, Alternaria, Bipolaris and Periconia showed a negative correlation with temperature, while Cladosporium and Periconia showed a negative correlation with heat index, dew point, wind velocity and wind chill. The barometric pressure was positively correlated with Cladosporium. On the basis of these findings, it can be concluded that a number of fungal spores are present in the atmosphere of Karachi throughout the year, with certain atmospheric conditions influencing the release, dispersion, and sedimentation processes of some genera. It is expected that clinicians will use the identified fungal flora for diagnosis and treatment and

  6. Update on local allergic rhinitis.

    PubMed

    Altıntoprak, Niyazi; Kar, Murat; Bayar Muluk, Nuray; Oktemer, Tugba; Ipci, Kagan; Birdane, Leman; Aricigil, Mitat; Senturk, Mehmet; Bafaqeeh, Sameer Ali; Cingi, Cemal

    2016-08-01

    We here provide an update on the literature regarding local allergic rhinitis (LAR). In reviewing LAR, we have included an updated definition, classifications, mechanisms, comorbidities, and recommendations for diagnosis and treatment for LAR, as well as the defined research areas for future evidence-based studies. LAR is a localised nasal allergic response in the absence of systemic atopy characterised by local production of specific IgE (sIgE) antibodies, a TH2 pattern of mucosal cell infiltration during natural exposure to aeroallergens, and a positive nasal allergen provocation test response, with the release of inflammatory mediators. The localised allergic response of LAR is an important topic for the study of allergies. This review provides an update on the current knowledge of LAR. PMID:27368453

  7. Climate change and allergic disease.

    PubMed

    Bielory, Leonard; Lyons, Kevin; Goldberg, Robert

    2012-12-01

    Allergies are prevalent throughout the United States and impose a substantial quality of life and economic burden. The potential effect of climate change has an impact on allergic disorders through variability of aeroallergens, food allergens and insect-based allergic venoms. Data suggest allergies (ocular and nasal allergies, allergic asthma and sinusitis) have increased in the United States and that there are changes in allergies to stinging insect populations (vespids, apids and fire ants). The cause of this upward trend is unknown, but any climate change may induce augmentation of this trend; the subspecialty of allergy and immunology needs to be keenly aware of potential issues that are projected for the near and not so distant future.

  8. Complementary Therapies in Allergic Rhinitis

    PubMed Central

    Sayin, Ibrahim; Cingi, Cemal; Baykal, Bahadir

    2013-01-01

    Objective. To determine the prevalence of herbal treatment of allergic rhinitis. Methods. In this prospective study, patients who were diagnosed with perennial allergic rhinitis were questioned about their use of natural products/herbal therapies for their symptoms. Results. In total, 230 patients were enrolled. Overall, 37.3% of the patients stated that they had used natural products/herbal therapies at least once. Women were more likely than men to use herbal supplements (38.3% versus 32.4%). Ten different types of herbal supplements were identified, with stinging nettle (Urtica dioicath), black elderberry (Sambucus nigra), and Spirulina being the most common (12.6%, 6.1%, and 5.7%, resp.). Conclusion. This study found a high prevalence of herbal treatment usage for the relief of allergic rhinitis symptoms in Turkey. The herbal products identified in this study and in the literature are discussed. PMID:24324897

  9. Allergic contact dermatitis to adhesive bandages.

    PubMed

    Norris, P; Storrs, F J

    1990-01-01

    More than two billion Band-Aid Brand Sheer Strips are used in the United States yearly, yet allergic contact dermatitis resulting from their use is nearly nonexistent. We report four patients with allergic reactions to these strips. One patient reacted to tricresyl phosphate, the plasticizer in the vinyl backing; another patient was allergic to 2,5-di(tertiary-amyl)hydroquinone, the antioxidant in the adhesive. In the other two patients, the allergic contact dermatitis remains unexplained.

  10. Allergic diseases in the elderly

    PubMed Central

    2011-01-01

    Demographic distribution of the population is progressively changing with the proportion of elderly persons increasing in most societies. This entails that there is a need to evaluate the impact of common diseases, such as asthma and other allergic conditions, in this age segment. Frailty, comorbidities and polymedication are some of the factors that condition management in geriatric patients. The objective of this review is to highlight the characteristics of allergic diseases in older age groups, from the influence of immunosenescence, to particular clinical implications and management issues, such as drug interactions or age-related side effects. PMID:22409889

  11. Therapeutic strategies for allergic diseases

    NASA Astrophysics Data System (ADS)

    Barnes, Peter J.

    1999-11-01

    Many drugs are now in development for the treatment of atopic diseases, including asthma, allergic rhinitis and atopic dermatitis. These treatments are based on improvements in existing therapies or on a better understanding of the cellular and molecular mechanisms involved in atopic diseases. Although most attention has been focused on asthma, treatments that inhibit the atopic disease process would have application to all atopic diseases, as they often coincide. Most of the many new therapies in development are aimed at inhibiting components of the allergic inflammatory response, but in the future there are real possibilities for the development of preventative and even curative treatments.

  12. Management of Rhinitis: Allergic and Non-Allergic

    PubMed Central

    Tran, Nguyen P; Vickery, John

    2011-01-01

    Rhinitis is a global problem and is defined as the presence of at least one of the following: congestion, rhinorrhea, sneezing, nasal itching, and nasal obstruction. The two major classifications are allergic and nonallergic rhinitis (NAR). Allergic rhinitis occurs when an allergen is the trigger for the nasal symptoms. NAR is when obstruction and rhinorrhea occurs in relation to nonallergic, noninfectious triggers such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. There is a lack of concomitant allergic disease, determined by negative skin prick test for relevant allergens and/or negative allergen-specific antibody tests. Both are highly prevalent diseases that have a significant economic burden on society and negative impact on patient quality of life. Treatment of allergic rhinitis includes allergen avoidance, antihistamines (oral and intranasal), intranasal corticosteroids, intranasal cromones, leukotriene receptor antagonists, and immunotherapy. Occasional systemic corticosteroids and decongestants (oral and topical) are also used. NAR has 8 major subtypes which includes nonallergic rhinopathy (previously known as vasomotor rhinitis), nonallergic rhinitis with eosinophilia, atrophic rhinitis, senile rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal-induced rhinitis, and cerebral spinal fluid leak. The mainstay of treatment for NAR are intranasal corticosteroids. Topical antihistamines have also been found to be efficacious. Topical anticholinergics such as ipratropium bromide (0.03%) nasal spray are effective in treating rhinorrhea symptoms. Adjunct therapy includes decongestants and nasal saline. Investigational therapies in the treatment of NAR discussed include capsaicin, silver nitrate, and acupuncture. PMID:21738880

  13. Climate change and allergic disease.

    PubMed

    Shea, Katherine M; Truckner, Robert T; Weber, Richard W; Peden, David B

    2008-09-01

    Climate change is potentially the largest global threat to human health ever encountered. The earth is warming, the warming is accelerating, and human actions are largely responsible. If current emissions and land use trends continue unchecked, the next generations will face more injury, disease, and death related to natural disasters and heat waves, higher rates of climate-related infections, and wide-spread malnutrition, as well as more allergic and air pollution-related morbidity and mortality. This review highlights links between global climate change and anticipated increases in prevalence and severity of asthma and related allergic disease mediated through worsening ambient air pollution and altered local and regional pollen production. The pattern of change will vary regionally depending on latitude, altitude, rainfall and storms, land-use patterns, urbanization, transportation, and energy production. The magnitude of climate change and related increases in allergic disease will be affected by how aggressively greenhouse gas mitigation strategies are pursued, but at best an average warming of 1 to 2 degrees C is certain this century. Thus, anticipation of a higher allergic disease burden will affect clinical practice as well as public health planning. A number of practical primary and secondary prevention strategies are suggested at the end of the review to assist in meeting this unprecedented public health challenge.

  14. Asthma and Respiratory Allergic Disease

    EPA Science Inventory

    The pathogenesis of non-communicable diseases such as allergy is complex and poorly understood. The causes of chronic allergic diseases including asthma involve to a large extent, immunomodulation of the adaptive and particularly the innate immune systems and are markedly influen...

  15. Oral bepotastine: in allergic disorders.

    PubMed

    Lyseng-Williamson, Katherine A

    2010-08-20

    Oral bepotastine is a second-generation histamine H(1) receptor antagonist that also suppresses some allergic inflammatory processes. Numerous short- and long-term clinical trials and surveillance studies have shown that twice-daily bepotastine is an effective and generally well tolerated antihistamine in the treatment of patients with allergic rhinitis, chronic urticaria or pruritus associated with skin conditions (eczema/dermatitis, prurigo or pruritus cutaneus). Bepotastine 20 mg/day was significantly more effective than terfenadine 120 mg/day in patients with perennial allergic rhinitis, as evaluated by the final global improvement rating and several other endpoints in a phase III trial. In phase III trials in patients with chronic urticaria, bepotastine 20 mg/day was more effective than placebo in improving levels of itching and eruption, and as effective as terfenadine 120 mg/day with regard to the final global improvement rating and other endpoints. In a noncomparative trial in patients with pruritus associated with skin diseases, the majority of bepotastine recipients in the overall population, as well as in the specific skin disease subgroups (eczema/dermatitis, prurigo or pruritus cutaneus), had a final global improvement rating of moderate or greater. Bepotastine was generally well tolerated in adult and paediatric patients with allergic conditions.

  16. INDOOR MOLDS AND ALLERGIC POTENTIAL

    EPA Science Inventory

    Rationale: Damp/moldy environments have been associated with asthma exacerbation, but mold¿s role in allergic asthma induction is less clear. Recently, 5 molds were statistically associated with water-damaged asthmatic homes in the Cleveland area. The asthma exacerbation...

  17. Epidemiology of chronic rhinosinusitis, selected risk factors, comorbidities, and economic burden

    PubMed Central

    Beule, Achim

    2015-01-01

    Chronic rhinosinusitis (CRS) is a relevant and prevalent medical condition in Germany, Europe and the world. If analysed in detail, the prevalence of CRS shows regional and temporary variety. In this review, currently available data regarding the prevalence of CRS is therefore sorted by country and/or region, time point of data collection and the CRS-definition employed. Risk factors like smoking and gastroesophageal reflux are discussed regarding their influence on CRS prevalence. Moreover, comorbidities of CRS, like asthma, conditions of the cardiovascular system and depression are listed and their influence on CRS is discussed. Furthermore, data on CRS prevalence in special cohorts, like immunocompromised patients, are presented. To estimate the economic burden of CRS, current data e.g. from Germany and the USA are included in this review. PMID:26770285

  18. A comprehensive review of the nasal microbiome in chronic rhinosinusitis (CRS).

    PubMed

    Mahdavinia, M; Keshavarzian, A; Tobin, M C; Landay, A L; Schleimer, R P

    2016-01-01

    Chronic rhinosinusitis (CRS) has been known as a disease with strong infectious and inflammatory components for decades. The recent advancement in methods identifying microbes has helped implicate the airway microbiome in inflammatory respiratory diseases such as asthma and COPD. Such studies support a role of resident microbes in both health and disease of host tissue, especially in the case of inflammatory mucosal diseases. Identifying interactive events between microbes and elements of the immune system can help us to uncover the pathogenic mechanisms underlying CRS. Here we provide a review of the findings on the complex upper respiratory microbiome in CRS in comparison with healthy controls. Furthermore, we have reviewed the defects and alterations of the host immune system that interact with microbes and could be associated with dysbiosis in CRS. PMID:26510171

  19. Potential application of injectable chitosan hydrogel treated with siRNA in chronic rhinosinusitis therapy.

    PubMed

    Cao, Cheng; Yan, Chunhong; Hu, Zhiqiang; Zhou, Shao

    2015-11-01

    Chronic rhinosinusitis is a condition with severe clinical symptoms and limited therapeutic solutions. It has been reported that vascular endothelial growth factor (VEGF) can promote nasal epithelial cell growth and result in hyperplasia of the sinuses. Therefore, the downregulation of VEGF may inhibit the process of hyperplasia. In the present study, small interfering RNA (siRNA) targeting VEGF was used to silence the expression of VEGF, and injectable chitosan based hydrogel, which is suitable for sinus injection and exhibits long‑term retention, was prepared as the siRNA carrier. Human bronchial epithelial cells were cultured directly on the hydrogel to observe the biological performance in vitro. Further in vivo effects were investigated by the injection of the hydrogel into the sinus cavity. Following the introduction of siRNA introducing, the expression of VEGF in the bronchial epithelial cells was significantly suppressed at mRNA and protein levels. The number of living cells on the gel was significantly decreased, thus resulting in the inhibition of proliferation. However, the cytoskeletal arrangement of the remaining cells were not affected substantially. The hydrogel was able to retain the siRNA for an extended duration, which enabled a sustained supply of siRNA. The in vivo sinus mucosa analysis revealed that the siRNA was able to collocate with cells and the mucosa thickness was substantially decreased. In conclusion, the results of the present study suggested that injectable chitosan based hydrogel, treated with siRNA targeting VEGF, may be used as a convenient therapeutic option for chronic rhinosinusitis.

  20. Potential application of injectable chitosan hydrogel treated with siRNA in chronic rhinosinusitis therapy

    PubMed Central

    CAO, CHENG; YAN, CHUNHONG; HU, ZHIQIANG; ZHOU, SHAO

    2015-01-01

    Chronic rhinosinusitis is a condition with severe clinical symptoms and limited therapeutic solutions. It has been reported that vascular endothelial growth factor (VEGF) can promote nasal epithelial cell growth and result in hyperplasia of the sinuses. Therefore, the downregulation of VEGF may inhibit the process of hyperplasia. In the present study, small interfering RNA (siRNA) targeting VEGF was used to silence the expression of VEGF, and injectable chitosan based hydrogel, which is suitable for sinus injection and exhibits long-term retention, was prepared as the siRNA carrier. Human bronchial epithelial cells were cultured directly on the hydrogel to observe the biological performance in vitro. Further in vivo effects were investigated by the injection of the hydrogel into the sinus cavity. Following the introduction of siRNA introducing, the expression of VEGF in the bronchial epithelial cells was significantly suppressed at mRNA and protein levels. The number of living cells on the gel was significantly decreased, thus resulting in the inhibition of proliferation. However, the cytoskeletal arrangement of the remaining cells were not affected substantially. The hydrogel was able to retain the siRNA for an extended duration, which enabled a sustained supply of siRNA. The in vivo sinus mucosa analysis revealed that the siRNA was able to collocate with cells and the mucosa thickness was substantially decreased. In conclusion, the results of the present study suggested that injectable chitosan based hydrogel, treated with siRNA targeting VEGF, may be used as a convenient therapeutic option for chronic rhinosinusitis. PMID:26299569

  1. Increasing olfactory bulb volume due to treatment of chronic rhinosinusitis--a longitudinal study.

    PubMed

    Gudziol, V; Buschhüter, D; Abolmaali, N; Gerber, J; Rombaux, P; Hummel, T

    2009-11-01

    Differentiation of progenitor cells into neurons in the olfactory bulb depends on olfactory stimulation that can lead to an increase in olfactory bulb volume. In this study, we investigated whether the human olfactory bulb volume increases with increasing olfactory function due to treatment of chronic rhinosinusitis. Nineteen patients with chronic rhinosinusitis were investigated before and after treatment. For comparison, additional measurements were performed in 18 healthy volunteers. Volumetric measurements of the olfactory bulb were based on planimetric manual contouring of magnetic resonance scans. Olfactory function was evaluated separately for each nostril using tests for odour threshold, odour discrimination and odour identification. Measurements were performed on two occasions, 3 months apart. In healthy controls, the olfactory bulb volume did not change significantly between the two measurements. In contrast, the olfactory bulb volume in patients increased significantly from the initial 64.5 +/- 3.2 to 70.0 +/- 3.5 mm(3) on the left side (P = 0.02) and from 60.9 +/- 3.5 to 72.4 +/- 2.8 mm(3) on the right side (P < 0.001). The increase in olfactory bulb volume correlated significantly with an increase in odour thresholds (r = 0.60, P = 0.006, left side; r = 0.49, P = 0.03, right side), but not with changes in odour discrimination or odour identification. Results of this study support the idea that stimulation of olfactory receptor neurons impacts on the cell death in the olfactory bulb, not only in rodents but also in humans. To our knowledge, this is the first longitudinal study that describes an enlargement of the human olfactory bulb due to improvement of peripheral olfactory function. PMID:19773353

  2. Comparative Study of Diagnostic Nasal Endoscopy and CT Paranasal Sinuses in Diagnosing Chronic Rhinosinusitis.

    PubMed

    Lohiya, Sweta S; Patel, Seema V; Pawde, Apurva M; Bokare, Bhagyashree D; Sakhare, Prafulla T

    2016-06-01

    Evaluation of the accuracy of objective diagnostic modalities for chronic rhinosinusitis and their comparison to each other to reach the correct diagnosis with minimum cost and highest accuracy. Prospective diagnostic cohort study. Academic medical center. Subjects more than 10 years of age presenting for evaluation of chronic rhinosinusitis, not responding to 12 weeks of medical treatment, suffering from at least 2 or more of the following symptoms- nasal obstruction, anterior and or posterior nasal discharge, headache or facial pains, and abnormalities of smell were prospectively studied. All selected patients were subjected to nasal endoscopy and CT paranasal sinuses. Endoscopic findings were scored according to Lund Kennedy scoring system. Sinus CT scans were scored with the Lund Mackay scoring system. The clinical diagnosis of CRS was determined on the basis of the published adult sinusitis guideline criteria and nasal endoscopic findings were compared with the diagnostic gold standard CT. A total of 100 patients were studied. Endoscopy was able to diagnose 87 % as CRS based on Lund-Kennedy score ≥2. 93 % patients could be labeled as CRS based on Lund-Mackey score ≥4. On correlating endoscopy and CT PNS it was found that sensitivity was 88.04 %, specificity was 28.57 %, PPV was 94.19 %, NPV was 15.38 %. Positive likelihood ratio of 1.23 and negative likelihood ratio of 0.42 was found p value was found to be 0.10565, thereby confirming that there is no significant difference in diagnosing CRS by either modality. The addition of nasal endoscopy helps reduce the use of CT, reducing costs and radiation exposure. PMID:27340642

  3. Burden of serious fungal infections in Ukraine.

    PubMed

    Osmanov, Ali; Denning, David W

    2015-10-01

    Ukraine has high rates of TB, AIDS and cancer. We estimated the burden of fungal disease from epidemiology papers and specific populations at risk and fungal infection frequencies. HIV/AIDS cases and deaths (2012) and tuberculosis statistics were obtained from the State Service of Ukraine, while chronic obstructive pulmonary disease (COPD) cases were from M. Miravitlles et al., Thorax 64, 863-868 (2009). Annual estimates are 893,579 Ukrainian women get recurrent vaginal thrush (≥4× per year), 50,847 cases of oral candidiasis and 13,727 cases of oesophageal candidiasis in HIV, and 101 (1%) of 10,085 new AIDS cases develop cryptococcal meningitis, 6152 cases of Pneumocystis pneumonia (13.5 cases per 100,000). Of the 29,265 cases of active respiratory TB in 2012, it is estimated that 2881 new cases of chronic pulmonary aspergillosis (CPA) occurred and that the 5-year period prevalence is 7724 cases with a total CPA burden of 10,054 cases. Assuming adult asthma prevalence is ~2.9%, 28,447 patients with allergic bronchopulmonary aspergillosis (ABPA) are likely and 37,491 with severe asthma with fungal sensitisation. We estimate 2278 cases and 376 postsurgical intra-abdominal Candida infections. Invasive aspergillosis in immunocompromised patients is estimated at 303 patients annually; 930 cases in COPD patients. Ninety cases of mucormycosis (2 per 1,000,000) are estimated. In total, ~1,000,000 (2.2%) people in Ukraine develop serious fungal infections annually. PMID:26449513

  4. [Fungal flora in houses (author's transl)].

    PubMed

    Mallea, M; Renard, M; Charpin, J

    1982-01-01

    In certain cases, allergic respiratory phenomena appear to be connected with a particular dwelling place. This observations, if it is not explained by a specific allergen (eg. an animal), raises the possible contribution of domestic moulds. The author shows the results of a study on domestic moulds in 65 houses in the Bouches-du-Rhône by culture on Petri dishes. The species most often detected were Cladosporium, Penicillium, Aspergillus, Alternaria. In some houses identical fungi were found to those in the atmosphere, in others greater numbers were found inside than outside. The study of fungal spores is of great interest; it gives an idea of their numerical importance which can be considerable; in addition besides those fungi which are present in the routine battery of tests, it may show other species that should perhaps be considered in the diagnostic aetiology.

  5. Allergic contact dermatitis from carmine.

    PubMed

    Shaw, Daniel W

    2009-01-01

    A 28-year-old woman developed allergic contact dermatitis within 6 to 24 hours exclusively after using carmine-containing eyeshadows and lipsticks. She had both a positive patch test result and a positive antecubital repeated open application test result with carmine 2.5% in petrolatum. Thirty other patients had negative patch test results. Carmine is a widely used pigment derived from gravid cochineal insects. Carminic acid is the source of its color. Only two previous publications describing allergic contact dermatitis from carmine could be found. The ingredient in carmine causing these delayed hypersensitivity reactions has not been studied. In contrast, there are numerous reports of immediate hypersensitivity reactions from carmine, mostly from its use in foods and beverages but also from cosmetics and pharmaceuticals. These are immunoglobulin E-mediated reactions directed against cochineal proteins. PMID:19808007

  6. Allergic contact dermatitis from carmine.

    PubMed

    Shaw, Daniel W

    2009-01-01

    A 28-year-old woman developed allergic contact dermatitis within 6 to 24 hours exclusively after using carmine-containing eyeshadows and lipsticks. She had both a positive patch test result and a positive antecubital repeated open application test result with carmine 2.5% in petrolatum. Thirty other patients had negative patch test results. Carmine is a widely used pigment derived from gravid cochineal insects. Carminic acid is the source of its color. Only two previous publications describing allergic contact dermatitis from carmine could be found. The ingredient in carmine causing these delayed hypersensitivity reactions has not been studied. In contrast, there are numerous reports of immediate hypersensitivity reactions from carmine, mostly from its use in foods and beverages but also from cosmetics and pharmaceuticals. These are immunoglobulin E-mediated reactions directed against cochineal proteins.

  7. Allergic reactions to rubber condoms.

    PubMed

    Rademaker, M; Forsyth, A

    1989-06-01

    With the increased use of condoms, contact dermatitis to rubber is being seen more often. To develop a rubber condom suitable for use by rubber sensitive people, a "hypoallergenic" condom, which is washed in ammonia to reduce the residues of rubber accelerators, has been manufactured. Fifty patients allergic to various rubber accelerators were patch tested with an ordinary condom and the new washed condom. Fifty patients undergoing routine patch test investigation who were not allergic to rubber were also tested as controls. Twenty two of the rubber sensitive patients had a positive reaction to the new rubber condom compared with four of the control patients. Washing rubber condoms in ammonia does not appear to reduce the residues of rubber accelerators sufficiently for their use by rubber sensitive people. A non-allergenic condom is required.

  8. [Recent advances in allergic rhinitis].

    PubMed

    Liang, Meijun; Xu, Rui; Xu, Geng

    2015-02-01

    Allergic rhinitis (AR) clinically expressed by sneezing, rhinorrhea, nasal itching and congestion is an allergen-driven mucosal inflammatory disease which is modulated by immunoglobulin E. Epidemiological studies have indicated that prevalence of AR continues to increase, and it has been a worldwide health problem that places a significant healthcare burden on individuals and society. Given the evolving understanding of the process by which an allergen is recognized and the roles of mediators which account for AR progress, the pathogenesis of AR has become clearer. Current studies have demonstrated local allergic rhinitis (LAR) that patients with both sug- gestive symptoms of AR and a negative diagnostic test for atopy may have local allergic inflammation is a prevalent entity in patients evaluated with rhinitis, but further research remains needed. Management of AR includes aller- gen avoidance, pharmacological treatment and allergen-specific immunotherapy. Recently montelukast has exhibited previously undocumented anti-inflammatory properties, leukotriene receptor antagonists therefore may serve a more important role in the treatment of AR. Not only has immunotherapy proved its efficacy, but also been able to alter disease course and thereby mitigate progression to asthma. Thus immunotherapy can be initiated while receiving pharmacotherapy, especially in children with AR. As clinical guidelines, the ARIA (Allergic Rhinitis and its Impact on Asthma) provides basic principles of effective treatment of AR. Besides, choosing an appropriate treatment strategy should be based on the severity and chronicity of patient's symptom. The aim of this review was to provide an update mainly on the pathophysiology, epidemiology, and management of AR. PMID:26012287

  9. [Recent advances in allergic rhinitis].

    PubMed

    Liang, Meijun; Xu, Rui; Xu, Geng

    2015-02-01

    Allergic rhinitis (AR) clinically expressed by sneezing, rhinorrhea, nasal itching and congestion is an allergen-driven mucosal inflammatory disease which is modulated by immunoglobulin E. Epidemiological studies have indicated that prevalence of AR continues to increase, and it has been a worldwide health problem that places a significant healthcare burden on individuals and society. Given the evolving understanding of the process by which an allergen is recognized and the roles of mediators which account for AR progress, the pathogenesis of AR has become clearer. Current studies have demonstrated local allergic rhinitis (LAR) that patients with both sug- gestive symptoms of AR and a negative diagnostic test for atopy may have local allergic inflammation is a prevalent entity in patients evaluated with rhinitis, but further research remains needed. Management of AR includes aller- gen avoidance, pharmacological treatment and allergen-specific immunotherapy. Recently montelukast has exhibited previously undocumented anti-inflammatory properties, leukotriene receptor antagonists therefore may serve a more important role in the treatment of AR. Not only has immunotherapy proved its efficacy, but also been able to alter disease course and thereby mitigate progression to asthma. Thus immunotherapy can be initiated while receiving pharmacotherapy, especially in children with AR. As clinical guidelines, the ARIA (Allergic Rhinitis and its Impact on Asthma) provides basic principles of effective treatment of AR. Besides, choosing an appropriate treatment strategy should be based on the severity and chronicity of patient's symptom. The aim of this review was to provide an update mainly on the pathophysiology, epidemiology, and management of AR.

  10. Allergic contact dermatitis from cardamom.

    PubMed

    Mobacken, H; Fregert, S

    1975-06-01

    A case is presented of a confectioner with a chronic hand dermatitis and positive patch test reactions to cardamom and certain terpenoid compounds present in the dried ripe seeds of cardamom. Cardamom is a popular traditional flavouring agent for baked goods and confectionery. Dermatitis from skin exposure to cardamom has to the best of our knowledge not been reported. We report one case of allergic contact dermatitis to cardamom elicited by terpenes present in the seeds.

  11. Management of allergic Olympic athletes.

    PubMed

    Fitch, K D

    1984-05-01

    Twenty percent of the recent Australian Olympic athletes have had an allergic disorder. Because of the ban on all sympathomimetic drugs except some beta 2-agonists. Olympic team physicians have a major responsibility to ensure that no competitor is disqualified for infringing on the antidoping rules of the Medical Commission of the International Olympic Committee. Inadvertent contravention of these regulations may occur because numerous banned sympathomimetics are available to athletes and their coaches without medical prescription and are frequently contained in combination preparations. The unbroken 24 yr in which asthmatics have won Olympic medals have been both before and after the introduction of drug tests. Currently a comprehensive range of preventive and therapeutic medications are available for asthmatics to compete with minimal respiratory disadvantage. It was, however, during a period of unnecessary restriction that an American swimmer forfeited his gold medal because of prerace ingestion of a banned sympathomimetic agent. Should adverse air quality be encountered during the Los Angeles Olympics, allergic competitors will be among the most inconvenienced . Athletes with allergic rhinitis and sinusitis will be the most disadvantaged because sympathomimetic vasoconstrictors remain banned. It is strongly recommended that the Medical Commission of the International Olympic Committee meet with an appropriate body of experts (i.e., the American Academy of Allergy and Immunology) to review this ban on vasoconstrictor agents. PMID:6715736

  12. Immunotherapy of allergic contact dermatitis.

    PubMed

    Spiewak, Radoslaw

    2011-08-01

    The term 'immunotherapy' refers to treating diseases by inducing, enhancing or suppressing immune responses. As allergy is an excessive, detrimental immune reaction to otherwise harmless environmental substances, immunotherapy of allergic disease is aimed at the induction of tolerance toward sensitizing antigens. This article focuses on the historical developments, present state and future outlook for immunotherapy with haptens as a therapeutic modality for allergic contact dermatitis. Inspired by the effectiveness of immunotherapy in respiratory allergies, attempts were undertaken at curing allergic contact dermatitis by means of controlled administration of the sensitizing haptens. Animal and human experiments confirmed that tolerance to haptens can be induced most effectively when the induction of tolerance precedes attempted sensitization. In real life, however, therapy is sought by people who are already sensitized and an effective reversal of hypersensitivity seems more difficult to achieve. Decades of research on Rhus hypersensitivity led to a conclusion that immunotherapy can suppress Rhus dermatitis, however, only to a limited degree, for a short period of time, and at a high risk of side effects, which makes this method therapeutically unprofitable. Methodological problems with most available studies of immunotherapy of contact allergy to nickel make any definite conclusions impossible at this stage.

  13. Fungal Genomics Program

    SciTech Connect

    Grigoriev, Igor

    2012-03-12

    The JGI Fungal Genomics Program aims to scale up sequencing and analysis of fungal genomes to explore the diversity of fungi important for energy and the environment, and to promote functional studies on a system level. Combining new sequencing technologies and comparative genomics tools, JGI is now leading the world in fungal genome sequencing and analysis. Over 120 sequenced fungal genomes with analytical tools are available via MycoCosm (www.jgi.doe.gov/fungi), a web-portal for fungal biologists. Our model of interacting with user communities, unique among other sequencing centers, helps organize these communities, improves genome annotation and analysis work, and facilitates new larger-scale genomic projects. This resulted in 20 high-profile papers published in 2011 alone and contributing to the Genomics Encyclopedia of Fungi, which targets fungi related to plant health (symbionts, pathogens, and biocontrol agents) and biorefinery processes (cellulose degradation, sugar fermentation, industrial hosts). Our next grand challenges include larger scale exploration of fungal diversity (1000 fungal genomes), developing molecular tools for DOE-relevant model organisms, and analysis of complex systems and metagenomes.

  14. Airborne fungi in low and high allergic prevalence child care centers

    NASA Astrophysics Data System (ADS)

    Zuraimi, M. S.; Fang, L.; Tan, T. K.; Chew, F. T.; Tham, K. W.

    Fungi exposure has been linked to asthma and allergies among children. To determine the association between fungal exposure and wheeze and rhinitis symptoms, we examined concentrations of culturable indoor and outdoor fungi of various aerodynamic sizes in low and high allergic prevalence child care centers (CCCs) in Singapore. Environmental parameters were also performed for air temperature, relative humidity and ventilation rates, while information on CCC characteristics was collected via an inspection. Most commonly recovered fungi were Penicillium, Aspergillus, Geotrichum, Cladosporium and sterile mycelia with Geotrichum and sterile mycelia amounting to an average of 71.5% of the total airborne culturable fungi studied. Indoor and outdoor total culturable fungi concentrations and those in the size range of 1.1-3.3 μm were significantly higher in high allergic prevalence CCCs. When fungal types/genera were compared, indoor and outdoor Geotrichum and sterile mycelia of aerodynamic sizes 1.1-3.3 μm were found to be significantly elevated in high allergic prevalence CCCs. Indeed, average geometric mean diameters ( Dg, ave) of indoor and outdoor culturable fungi were consistently smaller in CCCs with high prevalence of allergies than those with low prevalence. We found significant associations of higher fungal concentrations, especially those with smaller aerodynamic sizes in CCCs situated near parks. There were no differences in fungal levels between CCCs with respect to their dampness profile mainly due to high CCC ventilation rates. Since particle size is a factor that determines where a fungi particle deposits in the respiratory tract, this study provides useful information in the etiology of wheeze and rhinitis symptoms among the CCC attending children.

  15. Fungal Vaccines and Immunotherapeutics

    PubMed Central

    Santos, Evelyn; Levitz, Stuart M.

    2014-01-01

    Concomitant with the increased prevalence of immunocompromised persons, invasive fungal infections have become considerably more frequent in the last 50 years. High mortality rates caused by invasive mycoses and high morbidity because of intractable mucosal infections have created an unmet need for innovative prophylactic and therapeutic strategies against fungal pathogens. Several immunotherapeutics and vaccines are in development to address this need, although one has yet to reach the clinic. This review focuses on past and current immunotherapeutic and vaccine strategies being tested to either prevent or treat fungal infections, as well as the challenges associated with their development. PMID:25368016

  16. Allergic disease as an association of steroid sulphatase deficiency.

    PubMed

    Sakura, N; Nishimura, S; Matsumoto, T; Ohsaki, M; Ogata, T

    1997-11-01

    Ten of 31 patients with steroid sulphatase (STS) deficiency were found to have an allergic disease (bronchial asthma, allergic rhinitis, or atopic dermatitis). STS deficiency may predispose patients to allergic disease.

  17. JGI Fungal Genomics Program

    SciTech Connect

    Grigoriev, Igor V.

    2011-03-14

    Genomes of energy and environment fungi are in focus of the Fungal Genomic Program at the US Department of Energy Joint Genome Institute (JGI). Its key project, the Genomics Encyclopedia of Fungi, targets fungi related to plant health (symbionts, pathogens, and biocontrol agents) and biorefinery processes (cellulose degradation, sugar fermentation, industrial hosts), and explores fungal diversity by means of genome sequencing and analysis. Over 50 fungal genomes have been sequenced by JGI to date and released through MycoCosm (www.jgi.doe.gov/fungi), a fungal web-portal, which integrates sequence and functional data with genome analysis tools for user community. Sequence analysis supported by functional genomics leads to developing parts list for complex systems ranging from ecosystems of biofuel crops to biorefineries. Recent examples of such 'parts' suggested by comparative genomics and functional analysis in these areas are presented here

  18. Fungal Biofilm Resistance

    PubMed Central

    Ramage, Gordon; Rajendran, Ranjith; Sherry, Leighann; Williams, Craig

    2012-01-01

    Fungal biofilm infections have become increasingly recognised as a significant clinical problem. One of the major reasons behind this is the impact that these have upon treatment, as antifungal therapy often fails and surgical intervention is required. This places a large financial burden on health care providers. This paper aims to illustrate the importance of fungal biofilms, particularly Candida albicans, and discusses some of the key fungal biofilm resistance mechanisms that include, extracellular matrix (ECM), efflux pump activity, persisters, cell density, overexpression of drug targets, stress responses, and the general physiology of the cell. The paper demonstrates the multifaceted nature of fungal biofilm resistance, which encompasses some of the newest data and ideas in the field. PMID:22518145

  19. Systemic opportunistic fungal infections.

    PubMed Central

    Vanbreuseghem, R.; Vroey, C. D.

    1979-01-01

    The clinical manifestations of "opportunistic" fungal infections in compromised hosts, asthenomycoses, differ from those caused by the same fungus in otherwise normal people. Examples are given on the field of dermatophytoses, aspergillosis, candidiasis and cryptococcosis. PMID:523345

  20. Fungal Nail Infection (Onychomycosis)

    MedlinePlus

    ... vinegar, vitamin E oil, Vicks® VapoRub®, or tea tree oil. When to Seek Medical Care Fungal nail ... Trusted Links Related diseases: Psoriasis View all diseases Community: Discussion Forum Skinmatters Blog About Us | Terms of ...

  1. Fungal Eye Infections

    MedlinePlus

    ... Zoonotic Infectious Disease Division of Foodborne, Waterborne, and Environmental Diseases Mycotic Diseases Branch Fungal Eye Infections Recommend on ... Zoonotic Infectious Disease Division of Foodborne, Waterborne, and Environmental Diseases Mycotic Diseases Branch File Formats Help: How do ...

  2. Evaluation of fungal flora in normal and diseased canine ears.

    PubMed

    Campbell, Jacquelyn J; Coyner, Kimberly S; Rankin, Shelley C; Lewis, Thomas P; Schick, Anthea E; Shumaker, Amy K

    2010-12-01

    This study was undertaken to characterize otic fungal flora encountered in normal dogs, atopic dogs with no clinical or cytological evidence of otitis and dogs with otitis externa. Forty-two normal dogs, 23 atopic dogs and 32 dogs with otitis were included in the study. Samples for otic fungal culture and cytology were obtained from all animals, for a total of 194 ears. Sixty-seven ear samples (34%) were culture positive for saprophytic fungal organisms, as follows: 43 (64%) Penicillium species, 13 (19%) Aspergillus species and the remaining 17% comprised of various other saprophytic fungal organisms. Cytological evidence of saprophytic fungal colonization or infection was not found in any animal. There was no relationship between positive saprophytic fungal culture and any study group. Thirty-three ear samples (17%) were positive for Malassezia pachydermatis. Cytological findings of Malassezia were significantly associated with positive culture for Malassezia (P = 0.006 left ear; P = 0.019 right ear). Furthermore, increased numbers of Malassezia led to a higher chance of positive culture (P = 0.003 left ear; P = 0.008 right ear; McNemar's test). Malassezia pachydermatis was more likely to be cultured from ears with increased cerumen. Ear type (erect or pendulous) was not significantly associated with positive culture for Malassezia or saprophytic fungal organisms. There was no relationship between positive Malassezia culture and any study group; however, Malassezia was more likely to be cultured from individual dogs in the atopic or otitis groups that also had other dermatological signs consistent with allergic dermatitis and/or pyoderma (P = 0.031 left ear; P = 0.005 right ear). PMID:20868397

  3. Fungal diagnostics in pneumonia.

    PubMed

    Lease, Erika D; Alexander, Barbara D

    2011-12-01

    Fungal pneumonia is increasingly common, particularly in highly immunosuppressed patients, such as solid organ or hematopoietic stem cell transplant recipients, and the diagnosis is evolving. Although standard techniques such as microscopy and culture remain the mainstays of diagnosis, relatively recent advances in serological and molecular testing are important additions to the field. This article reviews the laboratory tools used to diagnose fungal respiratory disease. PMID:22167394

  4. Fungal Diagnostics in Pneumonia

    PubMed Central

    Lease, Erika D.; Alexander, Barbara D.

    2014-01-01

    Fungal pneumonia is increasingly common, particularly in highly immunosuppressed patients, such as solid organ or hematopoietic stem cell transplant recipients, and the diagnosis is evolving. While standard techniques such as microscopy and culture remain the mainstay of diagnosis, relatively recent advances in serologic and molecular testing are important additions to the field. This chapter will review the laboratory tools used to diagnose fungal respiratory disease. PMID:22167394

  5. Standard methods for fungal brood disease research

    PubMed Central

    Jensen, Annette Bruun; Aronstein, Kathrine; Flores, José Manuel; Vojvodic, Svjetlana; Palacio, María Alejandra; Spivak, Marla

    2013-01-01

    Summary Chalkbrood and stonebrood are two fungal diseases associated with honey bee brood. Chalkbrood, caused by Ascosphaera apis, is a common and widespread disease that can result in severe reduction of emerging worker bees and thus overall colony productivity. Stonebrood is caused by Aspergillus spp. that are rarely observed, so the impact on colony health is not very well understood. A major concern with the presence of Aspergillus in honey bees is the production of airborne conidia, which can lead to allergic bronchopulmonary aspergillosis, pulmonary aspergilloma, or even invasive aspergillosis in lung tissues upon inhalation by humans. In the current chapter we describe the honey bee disease symptoms of these fungal pathogens. In addition, we provide research methodologies and protocols for isolating and culturing, in vivo and in vitro assays that are commonly used to study these host pathogen interactions. We give guidelines on the preferred methods used in current research and the application of molecular techniques. We have added photographs, drawings and illustrations to assist bee-extension personnel and bee scientists in the control of these two diseases. PMID:24198438

  6. Burden of serious fungal infections in Mexico.

    PubMed

    Corzo-León, D E; Armstrong-James, D; Denning, D W

    2015-10-01

    Serious fungal infections (SFIs) could be more frequent than are recognised. Estimates of the incidence and prevalence of SFIs are essential in order to identify public health problems. We estimated the rates of SFIs in Mexico, following a methodology similar to that used in prior studies. We obtained information about the general population and populations at risk. A systematic literature search was undertaken to identify epidemiological reports of SFIs in Mexico. When Mexican reports were unavailable, we based our estimates on international literature. The most prevalent SFIs in Mexico are recurrent vulvovaginal candidiasis (5999 per 100,000) followed by allergic bronchopulmonary aspergillosis (60 per 100,000), chronic pulmonary aspergillosis (15.9 per 100,000), fungal keratitis (10.4 per 100,000), invasive candidiasis (8.6 per 100,000) and SFIs in HIV (8.2 per 100,000); coccidioidomycosis (7.6 per 100,000), IA (4.56 per 100,000). These correspond to 2,749,159 people affected in any year (2.45% of the population), probably >10,000 deaths and 7000 blind eyes. SFIs affect immunocompromised and healthy populations. Most are associated with high morbidity and mortality rates. Validation of these estimates with epidemiological studies is required. The burdens indicate that an urgent need to improve medical skills, surveillance, diagnosis, and management of SFIs exists.

  7. [Pathogenesis of invasive fungal infections].

    PubMed

    Garcia-Vidal, Carolina; Carratalà, Jordi

    2012-03-01

    Invasive fungal infections remain a life-threatening disease. The development of invasive fungal disease is dependent on multiple factors, such us colonization and efficient host immune response. We aimed to review the pathogenesis of invasive fungal infections, in particular, those caused by Candida and Aspergillus. For this we propose, to describe the fungal characteristics, to detail the host defence mechanisms against fungus and to analyse the host risk factors for invasive fungal infection.

  8. Role of Interleukin-10 on Nasal Polypogenesis in Patients with Chronic Rhinosinusitis with Nasal Polyps

    PubMed Central

    Xu, Jun; Han, Ruining; Kim, Dae Woo; Mo, Ji-Hun; Jin, Yongde; Rha, Ki-Sang; Kim, Yong Min

    2016-01-01

    Background and Objectives Interleukin 10 (IL-10) is a potent anti-inflammatory cytokine. The dysregulation of IL-10 is associated with an enhanced immunopathologic response to infection, as well as with an increased risk for developing numerous autoimmune diseases. In this study, we investigated IL-10 expression in chronic rhinosinusitis with nasal polyps (CRSwNP) and assessed the possible role of IL-10 in the pathogenesis of CRSwNP. Materials and Methods Thirty-five patients with CRSwNP, 12 patients with chronic rhinosinusitis without NP (CRSsNP) and 10 control subjects were enrolled in this study. NP tissues and uncinated tissues (UT) were collected for analysis. Dispersed NP cells (DNPCs) were cultured in the presence or absence of IL-25 and IL-10, and a flow cytometric assay was performed to identify the constitutive cell populations of the DNPCs. Murine NP (n = 18) models were used for the in vivo experiments. Real-time PCR, immunohistochemistry, western blotting analysis and ELISA were performed to measure the expression levels of the selected inflammatory cytokines and inflammation-associated molecules. Results The mRNA expression levels of IL-10, IL-5, IL-17A, IL-25 and interferon gamma (IFN-γ) were significantly higher in the NP tissues than in the UT tissues. Strong positive correlations were observed between IL-10 and a variety of inflammatory cytokines (IL-5, IL-17A, IL-25, IFN-γ) and inflammation-associated molecules (B-cell activating factor; BAFF, CD19). Other than the IL-25 to IL-10 ratio, the expression ratios of the other measured inflammatory cytokines to IL-10 were significantly lower in the CRSwNP group than in the CRSsNP or control groups. Administrating IL-25 into the cultured DNPCs significantly increased the production of IL-10, but administrating IL-10 had no effect on the production of IL-25. Conclusion Increased expression of IL-10, IL-10 related inflammatory cytokine, and IL-10 related B cell activation indicated that IL-10, a potent

  9. Prevalence of Rhinovirus and Respiratory Syncytial Virus Among Patients With Chronic Rhinosinusitis

    PubMed Central

    Abshirini, Hassan; Makvandi, Manochher; Seyyed Ashrafi, Meghdad; Hamidifard, Mojtaba; Saki, Nader

    2015-01-01

    Background: Chronic rhinosinusitis (CRS) is one of the most common chronic illnesses, but the etiology and pathogenesis of CRS are not well understood. Few studies have been carried out on the role of viruses in patients with chronic sinusitis so far. Objectives: Regarding the high number of patients, we intended to evaluate the prevalence of rhinovirus and respiratory syncytial virus in patients with CRS. Doing so, we may pave the way for definitely achieving the causes and factors of the disease and consequently definite treatment of this debilitating disease in future studies. Patients and Methods: This cross-sectional study was carried out on 76 patients. Sample of the study consisted of patients with CRS who were candidates for functional endoscopic sinus surgery (FESS). The specimens were collected during FESS between February 2013 and December 2013. For this purpose, after entering into sinuses, the specimens were collected from their mucus. They were then placed in Dulbecco's modified Eagle's viral transport medium (DMEM). They were transferred to the virology lab of the university in a cold chain. The specimens were maintained in -70°C before examination. Reverse transcriptase-polymerase chain reaction (RT-PCR) was applied to explore the presence of rhinovirus and respiratory syncytial virus. Results: In this study, 76 patients with rhinosinusitis underwent FESS as qualified candidates. The sample of the study consisted of 48 males (63.2%) and 28 females (36.8%) with the mean age of 44.3 years and an age range of 19-76 years. Among the 76 patients, 53 were with polyps and 23 without polyps. Among the patients, 66 were candidates of FESS for the first time. Other 11 patients had previously undergone the surgery. The results from PCR indicated that 22 (28.94%) patients had rhinovirus and 9 (11.84%) had respiratory syncytial virus (RSV). A total of 25 patients (32.89%) had one of the two viruses. In 6 (7.89%) specimens, both viruses were reported

  10. Extrinsic allergic alveolitis and asthma in a sawmill worker: case report and review of the literature.

    PubMed

    Halpin, D M; Graneek, B J; Turner-Warwick, M; Newman Taylor, A J

    1994-03-01

    A 34 year old sawmill maintenance engineer developed a dry cough that was associated with widespread wheezes and crackles in his lungs. His symptoms worsened, with work related lethargy, fever, and breathlessness, and the loss of a stone in weight. At that time, while still at work, he had a neutrophil leucocytosis and increased concentration of gamma globulins. When seen subsequently some two months after stopping work, his chest radiograph and lung function tests were normal, but the cells recovered at bronchoalveolar lavage showed an increase in lymphocytes and mast cells, a pattern consistent with extrinsic allergic alveolitis. Serum precipitins were identified to extracts of sawdust, wood chips, and bark from the sawmill, and to eight species of mould grown from these samples. Specific IgG binding inhibition studies suggested that a common epitope present on Trichoderma koningii might be responsible for the cross reactivity of the patient's serum with the wood and fungal extracts. A diagnosis of wood associated extrinsic allergic alveolitis was made and since changing his job the patient has remained well. Wood associated allergic alveolitis has not previously been described in British sawmill workers, but has been reported in Sweden, with a prevalence of 5%-10% in exposed workers. A review of published data suggests extrinsic allergic alveolitis in wood workers is primarily caused by inhalation of the spores of contaminating fungi, but inhaled wood dust may exert a synergistic effect.

  11. Laser surgery for allergic rhinitis.

    PubMed

    Fukutake, T; Yamashita, T; Tomoda, K; Kumazawa, T

    1986-12-01

    The inferior turbinates of 140 patients with perennial allergic rhinitis were vaporized by a defocused carbon dioxide (CO2) laser beam, using specially designed handpieces. Among these patients, 131 showed improvement in subjective symptoms one month after laser surgery. Excellent or good results were obtained in 27 of 35 patients who were followed up more than one year after laser surgery. The histopathologic changes observed in the nasal mucous membrane after surgery were fibrous proliferation and scar formation in the superficial layer of the submucosa. This surgery can be done under surface anesthesia as an outpatient procedure, and it is painless, with no bleeding.

  12. Allergic Rhinitis: Mechanisms and Treatment.

    PubMed

    Bernstein, David I; Schwartz, Gene; Bernstein, Jonathan A

    2016-05-01

    The prevalence of allergic rhinitis (AR) has been estimated at 10% to 40%, and its economic burden is substantial. AR patients develop specific immunoglobulin E (IgE) antibody responses to indoor and outdoor environmental allergens with exposure over time. These specific IgE antibodies bind to high-affinity IgE receptors on mast cells and basophils. Key outcome measures of therapeutic interventions include rhinitis symptom control, rescue medication requirements, and quality-of-life measures. A comprehensive multiple modality treatment plan customized to the individual patient can optimize outcomes. PMID:27083101

  13. Fungal endocarditis: current challenges.

    PubMed

    Tattevin, Pierre; Revest, Matthieu; Lefort, Agnès; Michelet, Christian; Lortholary, Olivier

    2014-10-01

    Whilst it used to affect mostly intravenous drug users and patients who underwent valvular surgery with suboptimal infection control procedures, fungal endocarditis is now mostly observed in patients with severe immunodeficiency (onco-haematology), in association with chronic central venous access and broad-spectrum antibiotic use. The incidence of fungal endocarditis has probably decreased in most developed countries with access to harm-reduction policies (i.e. needle exchange programmes) and with improved infection control procedures during cardiac surgery. Use of specific blood culture bottles for diagnosis of fungal endocarditis has decreased due to optimisation of media and automated culture systems. Meanwhile, the advent of rapid techniques, including fungal antigen detection (galactomannan, mannan/anti-mannan antibodies and β-1,3-d-glucans) and PCR (e.g. universal fungal PCR targeting 18S rRNA genes), shall improve sensitivity and reduce diagnostics delays, although limited data are available on their use for the diagnosis of fungal endocarditis. New antifungal agents available since the early 2000s may represent dramatic improvement for fungal endocarditis: (i) a new class, the echinocandins, has the potential to improve the management of Candida endocarditis owing to its fungicidal effect on yeasts as well as tolerability of increased dosages; and (ii) improved survival in patients with invasive aspergillosis with voriconazole compared with amphotericin B, and this may apply to Aspergillus sp. endocarditis as well, although its prognosis remains dismal. These achievements may allow selected patients to be cured with prolonged medical treatment alone when surgery is considered too risky.

  14. Environmental Changes, Microbiota, and Allergic Diseases

    PubMed Central

    Kim, Byoung-Ju; Lee, So-Yeon; Kim, Hyo-Bin; Lee, Eun

    2014-01-01

    During the last few decades, the prevalence of allergic disease has increased dramatically. The development of allergic diseases has been attributed to complex interactions between environmental factors and genetic factors. Of the many possible environmental factors, most research has focused on the most commonly encountered environmental factors, such as air pollution and environmental microbiota in combination with climate change. There is increasing evidence that such environmental factors play a critical role in the regulation of the immune response that is associated with allergic diseases, especially in genetically susceptible individuals. This review deals with not only these environmental factors and genetic factors but also their interactions in the development of allergic diseases. It will also emphasize the need for early interventions that can prevent the development of allergic diseases in susceptible populations and how these interventions can be identified. PMID:25228995

  15. The value of herbal medicines in the treatment of acute non-purulent rhinosinusitis. Results of a double-blind, randomised, controlled trial.

    PubMed

    Tesche, Stefan; Metternich, Frank; Sonnemann, Uwe; Engelke, Jan-Christian; Dethlefsen, Uwe

    2008-11-01

    In a prospective, randomised, double-blinded controlled study, we compared the efficacy and safety of two different treatment options with the herbal medicines cineole and a combination of five different components for acute viral rhinosinusitis. One hundred and fifty patients with acute and viral rhinosinusitis (75 patients in each treatment group) were enrolled. The diagnosis rhinosinusitis was made according to a defined symptoms-sum-score which was based on rhinoscopic and clinical signs which are characteristic for rhinosinusitis. The primary endpoint was the amelioration of the symptoms-sum-score, which includes all relevant characteristics for rhinosinusitis as headache on bending, frontal headache, sensitivity of pressure points of trigeminal nerve, impairment of general condition, nasal obstruction, rhino-secretion, secretion quantity, secretion viscosity and fever in a treatment period of 7 days. The mean reduction of the symptoms-sum-score after 4 days was 6.7 (+/-3.4) and after 7 days 11.0 (+/-3.3) in the cineole group and 3.6 (+/-2.8) after 4 days and 8.0 (+/-3.0) after 7 days in the control group. The differences between both groups were clinically relevant and statistically significant after 4 and 7 days (P < 0.0001). This result is validated by the amelioration of the secondary endpoints headache on bending, frontal headache, sensitivity of pressure points of trigeminal nerve, impairment of general condition, nasal obstruction and rhino-secretion. These findings correlate with the statistically significant difference of the estimation of B-scan ultrasonography. It is safe to use both medications for 7 days in patients with acute viral rhinosinusitis. Treatment with cineole is clinically relevant and statistically significant, more effective in comparison to the alternative herbal preparation with five different components. PMID:18437408

  16. Air pollution and allergic disease.

    PubMed

    Kim, Haejin; Bernstein, Jonathan A

    2009-03-01

    Over the past several decades, there has been increased awareness of the health effects of air pollution and much debate regarding the role of global warming. The prevalence of asthma and allergic disease has risen in industrialized countries, and most epidemiologic studies focus on possible causalities between air pollution and these conditions. This review examines salient articles and summarizes findings important to the interaction between allergies and air pollution, specifically volatile organic compounds, global warming, particulate pollutants, atopic risk, indoor air pollution, and prenatal exposure. Further work is necessary to determine whether patients predisposed to developing allergic disease may be more susceptible to the health effects of air pollutants due to the direct interaction between IgE-mediated disease and air pollutants. Until we have more definitive answers, patient education about the importance of good indoor air quality in the home and workplace is essential. Health care providers and the general community should also support public policy designed to improve outdoor air quality by developing programs that provide incentives for industry to comply with controlling pollution emissions.

  17. Treating allergic rhinitis in pregnancy.

    PubMed

    Piette, Vincent; Daures, Jean-Pierre; Demoly, Pascal

    2006-05-01

    Numerous pregnant women suffer from allergic rhinitis, and particular attention is required when prescribing drugs to these patients. In addition, physiologic changes associated with pregnancy could affect the upper airways. Evidence-based guidelines on the management of allergic rhinitis have been published. Medication can be prescribed during pregnancy when the apparent benefit of the drug is greater than the apparent risk. Usually, there is at least one "safe" drug from each major class used to control symptoms. All glucocorticosteroids are teratogenic in animals but, when the indication is clear (for diseases possibly associated, such as severe asthma exacerbation), the benefit of the drug is far greater than the risk. Inhaled glucocorticosteroids (eg, beclomethasone or budesonide) have not been incriminated as teratogens in humans and are used by pregnant women who have asthma. A few H1-antihistamines can safely be used as well. Most oral decongestants (except pseudoephedrine) are teratogenic in animals. There are no such data available for intranasal decongestants. Finally, pregnancy is not considered to be a contraindication for the continuation of immunotherapy.

  18. Allergic contact dermatitis to preservatives.

    PubMed

    Timm-Knudson, Vickie L; Johnson, Janis S; Ortiz, Karel J; Yiannias, James A

    2006-04-01

    In summary, a wide variety of skin care products contain preservatives. Patients who are allergic to one of these preservatives may have either localized or widespread dermatitis. Affected patients may find it difficult to avoid thimerosal without the help of the health care provider because the use of these allergens is so widespread. Patch testing is an invaluable tool for patients who struggle with dermatitis. Antigen-avoidance lists that facilitate patient education about what products to avoid are available from the manufacturers of patch test allergens (for example, TRUE Test or Chemotechnique). These lists are helpful starting points for patients in that they provide general categories (for example, shampoos, soaps, or creams) of products that the patient should avoid. With these printed guidelines alone, patients must read skin care product labels carefully, looking for the names of their allergens as identified by patch tests as well as for any synonyms and cross-reactors of these allergens. Thus, patients may feel overwhelmed by hearing the names of allergens that are long and complex. After an allergen has been identified, the nurse can play a key role in helping patients understand their dermatitis and its management. Nurses are in a unique position to spend time educating patients about how to uncover the sources of specific allergens and, subsequently, how to avoid them. The Contact Allergen Replacement Database can help in this educational process by giving patients a shopping list of specific items that are free of the specific allergens causing their allergic contact dermatitis.

  19. Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment *

    PubMed Central

    Kang, Suzie Hyeona; Dalcin, Paulo de Tarso Roth; Piltcher, Otavio Bejzman; Migliavacca, Raphaella de Oliveira

    2015-01-01

    Although cystic fibrosis (CF) is an irreversible genetic disease, advances in treatment have increased the life expectancy of CF patients. Upper airway involvement, which is mainly due to pathological changes in the paranasal sinuses, is prevalent in CF patients, although many are only mildly symptomatic (with few symptoms). The objective of this literature review was to discuss the pathophysiology and current therapeutic management of chronic rhinosinusitis (CRS) in CF patients. The review was based on current evidence, which was classified in accordance with the Oxford Centre for Evidence-Based Medicine criteria. When symptomatic, CRS with nasal polyps can affect quality of life and can lead to pulmonary exacerbations, given that the paranasal sinuses can be colonized with pathogenic bacteria, especially Pseudomonas aeruginosa. Infection with P. aeruginosa plays a crucial role in morbidity and mortality after lung transplantation in CF patients. Although clinical treatment of the upper airways is recommended as initial management, this recommendation is often extrapolated from studies of CRS in the general population. When sinonasal disease is refractory to noninvasive therapy, surgery is indicated. Further studies are needed in order to gain a better understanding of upper airway involvement and improve the management of CRS in CF patients, with the objective of preserving lung function and avoiding unnecessary invasive procedures. PMID:25750676

  20. Transcriptome Analysis Reveals Distinct Gene Expression Profiles in Eosinophilic and Noneosinophilic Chronic Rhinosinusitis with Nasal Polyps

    PubMed Central

    Wang, Weiqing; Gao, Zhiqiang; Wang, Huaishan; Li, Taisheng; He, Wei; Lv, Wei; Zhang, Jianmin

    2016-01-01

    Chronic rhinosinusitis with nasal polyps (CRSwNP), one of the most prevalent chronic diseases, is characterized by persistent inflammation of sinonasal mucosa. However, the pathogenesis of CRSwNP remains unclear. Here, we performed next-generation RNA sequencing and a comprehensive bioinformatics analyses to characterize the transcriptome profiles, including mRNAs and long noncoding RNAs (lncRNAs), in patients with eosinophilic and noneosinophilic CRSwNP. A total of 1917 novel lncRNAs and 280 known lncRNAs were identified. We showed eosinophilic CRSwNP (ECRSwNP) and noneosinophilic CRSwNP (non-ECRSwNP) display distinct transcriptome profiles. We identified crucial pathways, including inflammatory, immune response and extracellular microenvironment, connected to the pathogenetic mechanism of CRSwNP. We also discovered key lncRNAs differentially expressed, including lncRNA XLOC_010280, which regulates CCL18 and eosinophilic inflammation. The qRT-PCR and in situ RNA hybridization results verified the key differentially expressed genes. The feature of distinct transcriptomes between ECRSwNP and non-ECRSwNP suggests the necessity to develop specific biomarkers and personalized therapeutic strategies. Our findings lay a solid foundation for subsequent functional studies of mRNAs and lncRNAs as diagnostic and therapeutic targets in CRSwNP by providing a candidate reservoir. PMID:27216292

  1. Medical therapy reduces microbiota diversity and evenness in surgically recalcitrant chronic rhinosinusitis

    PubMed Central

    Liu, Cindy M.; Soldanova, Katerina; Nordstrom, Lora; Dwan, Michael G.; Moss, Owain L.; Contente-Cuomo, Tania L.; Keim, Paul; Price, Lance B.; Lane, Andrew P.

    2014-01-01

    Background Chronic rhinosinusitis is a highly prevalent and heterogeneous condition frequently treated with antibiotics and corticosteroid therapy. However, the effect of medical therapy on sinus microbiota remains unknown. Methods We enrolled CRS participants (n = 6) with patent maxillary antrostomies and active mucosal inflammation, who had not received antibiotics or corticosteroids in the previous eight weeks. A pre- and post-treatment maxillary sinus swab was collected, from which DNA was extracted, pyrosequenced, and analyzed using Naïve Bayesian Classifier and ecological analyses. Results Four participants showed significant improvement in endoscopic appearance. The shifts in microbiota in response to therapy were highly individualized. There was no single common microbiota profile among participants with similar clinical outcomes, but overall there was significant decrease in microbiota diversity (t(5) = 2.05, p = 0.10) and evenness (t(5) = 2.28, p = 0.07) after treatment. Conclusions Our findings strongly correlate with earlier studies that examined the impact of antibiotics on human microbiota. We observed that post-treatment, participants frequently became colonized by taxa that are less susceptible to the prescribed antibiotics. Our findings highlight the challenge in seeking generalizable diagnostic and therapeutic options in CRS, particularly regarding microbiological response and outcomes. PMID:23843343

  2. The link between chronic rhinosinusitis and asthma: A questionnaire-based study.

    PubMed

    Huang, Chien-Chia; Wang, Chun-Hua; Fu, Chia-Hsiang; Huang, Chi-Che; Chang, Po-Hung; Chen, I-Wei; Lee, Ta-Jen

    2016-08-01

    Treatments for chronic rhinosinusitis (CRS) and asthma can affect both conditions, based on the united airway concept. This study aimed to evaluate the link between CRS and asthma, based on disease-specific quality of life measures.We performed a prospective cohort study to investigate the correlations between results from CRS- and asthma-specific questionnaires. Thirty-two patients with asthma and CRS were evaluated before and after undergoing nasal surgery at a tertiary medical center.There were significant correlations between the results from the Asthma Control Test (ACT) and the Sino-Nasal Outcome Test-22, as well as between the results of the ACT and Rhinoconjunctivitis Quality of Life Questionnaire, at both the preoperative and 3-month postoperative evaluations (P < 0.01). Moreover, nasal surgery improved the sinonasal symptoms, asthma control, and pulmonary function (P < 0.01).Increasingly severe sinonasal symptoms of CRS were associated with poor asthma control. Therefore, CRS and asthma should be considered and treated as common airway diseases. PMID:27495032

  3. Bacterial extract OM-85 BV protects mice against experimental chronic rhinosinusitis

    PubMed Central

    Tao, Yanli; Yuan, Tiejun; Li, Xuechang; Yang, Shuqin; Zhang, Fanping; Shi, Li

    2015-01-01

    Objectives: To investigate the therapeutic effects of OM-85 BV as an adjunctive treatment on experimental chronic rhinosinusitis (CRS) in mice. Methodology: Female BALB/c mice aged 8-12 weeks were sensitized and administrated by intranasal Aspergillus fumigatis (AF) three times per week for 1 week, 3 weeks, 2 months and 3 months (n = 10 each time point). The mice were randomly and equally assigned to four groups: normal control group, model group, OM-85-BV plus amoxicillin group, and isolated amoxicillin group. Inflammatory changes were determined by hematoxylin-eosin (HE) staining. The expression levels of suppressor of cytokine signaling (SOCS) 1, SOCS3, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ in samples were assessed by using real-time PCR (RT-PCR) and Western blotting. Results: There were significantly inflammatory and structural changes between the model and other groups. Compared to the model group, the mRNA expression levels of SOCS1, SOCS3, TNF-α, and IFN-γ were significantly decreased in OM-85-BV plus amoxicillin group and isolated amoxicillin group, along with the protein levels. Conclusion: The bacterial extract OM-85 BV is a low-cost alternatively adjunctive drug to treat CRS with simple oral administration, good safety, and few side effects. PMID:26261565

  4. Chronic rhinosinusitis and nasal polyposis in cystic fibrosis: update on diagnosis and treatment.

    PubMed

    Kang, Suzie Hyeona; Dalcin, Paulo de Tarso Roth; Piltcher, Otavio Bejzman; Migliavacca, Raphaella de Oliveira

    2015-01-01

    Although cystic fibrosis (CF) is an irreversible genetic disease, advances in treatment have increased the life expectancy of CF patients. Upper airway involvement, which is mainly due to pathological changes in the paranasal sinuses, is prevalent in CF patients, although many are only mildly symptomatic (with few symptoms). The objective of this literature review was to discuss the pathophysiology and current therapeutic management of chronic rhinosinusitis (CRS) in CF patients. The review was based on current evidence, which was classified in accordance with the Oxford Centre for Evidence-Based Medicine criteria. When symptomatic, CRS with nasal polyps can affect quality of life and can lead to pulmonary exacerbations, given that the paranasal sinuses can be colonized with pathogenic bacteria, especially Pseudomonas aeruginosa. Infection with P. aeruginosa plays a crucial role in morbidity and mortality after lung transplantation in CF patients. Although clinical treatment of the upper airways is recommended as initial management, this recommendation is often extrapolated from studies of CRS in the general population. When sinonasal disease is refractory to noninvasive therapy, surgery is indicated. Further studies are needed in order to gain a better understanding of upper airway involvement and improve the management of CRS in CF patients, with the objective of preserving lung function and avoiding unnecessary invasive procedures.

  5. Chronic Rhinosinusitis Patients Show Accumulation of Genetic Variants in PARS2

    PubMed Central

    Henmyr, Viktor; Lind-Halldén, Christina; Halldén, Christer; Säll, Torbjörn; Carlberg, Daniel; Bachert, Claus; Cardell, Lars-Olaf

    2016-01-01

    Genetic studies of chronic rhinosinusitis (CRS) have identified a total of 53 CRS-associated SNPs that were subsequently evaluated for their reproducibility in a recent study. The rs2873551 SNP in linkage disequilibrium with PARS2 showed the strongest association signal. The present study aims to comprehensively screen for rare variants in PARS2 and evaluate for accumulation of such variants in CRS-patients. Sanger sequencing and long-range PCR were used to screen for rare variants in the putative promoter region and coding sequence of 310 CRS-patients and a total of 21 variants were detected. The mutation spectrum was then compared with data from European populations of the 1000Genomes project (EUR) and the Exome Aggregation Consortium (ExAC). The CRS population showed a significant surplus of low-frequency variants compared with ExAC data. Haplotype analysis of the region showed a significant excess of rare haplotypes in the CRS population compared to the EUR population. Two missense mutations were also genotyped in the 310 CRS patients and 372 CRS-negative controls, but no associations with the disease were found. This is the first re-sequencing study in CRS research and also the first study to show an association of rare variants with the disease. PMID:27348859

  6. Eradication of superficial fungal infections by conventional and novel approaches: a comprehensive review.

    PubMed

    Kumar, Lalit; Verma, Shivani; Bhardwaj, Ankur; Vaidya, Shubha; Vaidya, Bhuvaneshwar

    2014-02-01

    During the last two decades, the occurrence of fungal infections either superficial or systemic has been increasing. Moreover, fungal infections become more difficult to treat when they show coupling with immunogenic diseases like AIDS. Superficial fungal infections are associated with skin, nail and eye and are less prominent to systemic infection. However, it may be dangerous if not treated properly. It is usually observed that conventional formulations including cream, powder, gels etc. are used to treat skin fungal infections even for the deep seated fungal infections. However, these formulations show various side-effects on the application site like burning, redness and swelling. Further, due to the immediate release of drug from these formulations they can stimulate the immune system of body generating high impact allergic reactions. Deep seated fungal infections like invasive aspergillosis and invasive candidiasis may be more difficult to treat because the drug released from conventional topical formulation can not reach at the target site due to the low penetration capacity. Similarly, in case of fungal infection of nail and eye, conventional formulations show problem of less bioavailability. Thus, to overcome the drawbacks of conventional therapy a lot of research works have been carried out to develop novel formulations of antifungal drugs to deliver them superficially. Novel formulations explored for the skin delivery of antifungal drugs include liposomes, niosomes, ethosomes, microemulsions, nanoparticles, microspheres and micelles. These formulations show extended or sustained release of drug, minimizing the side effect on application site, enhancing bioavailability and reducing the dosing frequency. Further, these formulations also show penetration into the deep skin to treat invasive fungal infections. Novel formulations explored in treatment of fungal infections of eye are liposomes and nanoparticles and whether for nail fungal infections

  7. Eradication of superficial fungal infections by conventional and novel approaches: a comprehensive review.

    PubMed

    Kumar, Lalit; Verma, Shivani; Bhardwaj, Ankur; Vaidya, Shubha; Vaidya, Bhuvaneshwar

    2014-02-01

    During the last two decades, the occurrence of fungal infections either superficial or systemic has been increasing. Moreover, fungal infections become more difficult to treat when they show coupling with immunogenic diseases like AIDS. Superficial fungal infections are associated with skin, nail and eye and are less prominent to systemic infection. However, it may be dangerous if not treated properly. It is usually observed that conventional formulations including cream, powder, gels etc. are used to treat skin fungal infections even for the deep seated fungal infections. However, these formulations show various side-effects on the application site like burning, redness and swelling. Further, due to the immediate release of drug from these formulations they can stimulate the immune system of body generating high impact allergic reactions. Deep seated fungal infections like invasive aspergillosis and invasive candidiasis may be more difficult to treat because the drug released from conventional topical formulation can not reach at the target site due to the low penetration capacity. Similarly, in case of fungal infection of nail and eye, conventional formulations show problem of less bioavailability. Thus, to overcome the drawbacks of conventional therapy a lot of research works have been carried out to develop novel formulations of antifungal drugs to deliver them superficially. Novel formulations explored for the skin delivery of antifungal drugs include liposomes, niosomes, ethosomes, microemulsions, nanoparticles, microspheres and micelles. These formulations show extended or sustained release of drug, minimizing the side effect on application site, enhancing bioavailability and reducing the dosing frequency. Further, these formulations also show penetration into the deep skin to treat invasive fungal infections. Novel formulations explored in treatment of fungal infections of eye are liposomes and nanoparticles and whether for nail fungal infections

  8. Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper.

    PubMed

    Bousquet, J; Anto, J M; Demoly, P; Schünemann, H J; Togias, A; Akdis, M; Auffray, C; Bachert, C; Bieber, T; Bousquet, P J; Carlsen, K H; Casale, T B; Cruz, A A; Keil, T; Lodrup Carlsen, K C; Maurer, M; Ohta, K; Papadopoulos, N G; Roman Rodriguez, M; Samolinski, B; Agache, I; Andrianarisoa, A; Ang, C S; Annesi-Maesano, I; Ballester, F; Baena-Cagnani, C E; Basagaña, X; Bateman, E D; Bel, E H; Bedbrook, A; Beghé, B; Beji, M; Ben Kheder, A; Benet, M; Bennoor, K S; Bergmann, K C; Berrissoul, F; Bindslev Jensen, C; Bleecker, E R; Bonini, S; Boner, A L; Boulet, L P; Brightling, C E; Brozek, J L; Bush, A; Busse, W W; Camargos, P A M; Canonica, G W; Carr, W; Cesario, A; Chen, Y Z; Chiriac, A M; Costa, D J; Cox, L; Custovic, A; Dahl, R; Darsow, U; Didi, T; Dolen, W K; Douagui, H; Dubakiene, R; El-Meziane, A; Fonseca, J A; Fokkens, W J; Fthenou, E; Gamkrelidze, A; Garcia-Aymerich, J; Gerth van Wijk, R; Gimeno-Santos, E; Guerra, S; Haahtela, T; Haddad, H; Hellings, P W; Hellquist-Dahl, B; Hohmann, C; Howarth, P; Hourihane, J O; Humbert, M; Jacquemin, B; Just, J; Kalayci, O; Kaliner, M A; Kauffmann, F; Kerkhof, M; Khayat, G; Koffi N'Goran, B; Kogevinas, M; Koppelman, G H; Kowalski, M L; Kull, I; Kuna, P; Larenas, D; Lavi, I; Le, L T; Lieberman, P; Lipworth, B; Mahboub, B; Makela, M J; Martin, F; Martinez, F D; Marshall, G D; Mazon, A; Melen, E; Meltzer, E O; Mihaltan, F; Mohammad, Y; Mohammadi, A; Momas, I; Morais-Almeida, M; Mullol, J; Muraro, A; Naclerio, R; Nafti, S; Namazova-Baranova, L; Nawijn, M C; Nyembue, T D; Oddie, S; O'Hehir, R E; Okamoto, Y; Orru, M P; Ozdemir, C; Ouedraogo, G S; Palkonen, S; Panzner, P; Passalacqua, G; Pawankar, R; Pigearias, B; Pin, I; Pinart, M; Pison, C; Popov, T A; Porta, D; Postma, D S; Price, D; Rabe, K F; Ratomaharo, J; Reitamo, S; Rezagui, D; Ring, J; Roberts, R; Roca, J; Rogala, B; Romano, A; Rosado-Pinto, J; Ryan, D; Sanchez-Borges, M; Scadding, G K; Sheikh, A; Simons, F E R; Siroux, V; Schmid-Grendelmeier, P D; Smit, H A; Sooronbaev, T; Stein, R T; Sterk, P J; Sunyer, J; Terreehorst, I; Toskala, E; Tremblay, Y; Valenta, R; Valeyre, D; Vandenplas, O; van Weel, C; Vassilaki, M; Varraso, R; Viegi, G; Wang, D Y; Wickman, M; Williams, D; Wöhrl, S; Wright, J; Yorgancioglu, A; Yusuf, O M; Zar, H J; Zernotti, M E; Zidarn, M; Zhong, N; Zuberbier, T

    2012-01-01

    Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.

  9. Burden of serious fungal infections in the Dominican Republic.

    PubMed

    Gugnani, Harish C; Denning, David W

    2016-01-01

    The Dominican Republic (DR) is the second largest Caribbean nation and, with Haiti, the DR accounts for nearly three-quarters of the cases of human immunodeficiency virus (HIV) infection in the Caribbean region and the highest rates of TB in the Americas. The present study estimated the burden of serious fungal infections and some other mycoses in the DR. The data were extracted from the World Health Organization Stop Tuberculosis (WHO STOP TB) program, the Joint United Nations Program on HIV/AIDS (UNAIDS), and searches for relevant literature via MEDLINE, PubMed, MedFacts, and so on. The chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA), and severe asthma with fungal sensitization (SAFS) rates were derived from the asthma and TB rates. When no data regarding mycoses were available, we used specific populations at risk and the frequencies of fungal infection in each of these populations to estimate the national prevalence. Among its population of 10,090,000, we estimated that 221,027 (2.2%) have a serious fungal infection, including 158,134 women with recurrent vulvovaginal candidiasis. We estimated high numbers of 25,150 for ABPA and 34,000 for severe asthma fungal sensitization (SAFS) (250 and 529/100,000, respectively). CPA was common, with an estimated 2122 cases, of which 707 followed pulmonary TB. The annual prevalence of CPA was estimated to be 1374 cases. Four cases of histoplasmosis and several cases of chromoblastomycosis have also been reported. Pityriasis versicolor and tinea capitis are frequent in children, and 11% have kerion. Local epidemiological investigations are urgently required to validate or modify these estimates of serious fungal infections in the DR.

  10. 38 CFR 3.380 - Diseases of allergic etiology.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Diseases of allergic... Specific Diseases § 3.380 Diseases of allergic etiology. Diseases of allergic etiology, including bronchial... progress nor as due to the inherent nature of the disease. Seasonal and other acute allergic...

  11. 38 CFR 3.380 - Diseases of allergic etiology.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Diseases of allergic... Specific Diseases § 3.380 Diseases of allergic etiology. Diseases of allergic etiology, including bronchial... progress nor as due to the inherent nature of the disease. Seasonal and other acute allergic...

  12. 38 CFR 3.380 - Diseases of allergic etiology.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Diseases of allergic... Specific Diseases § 3.380 Diseases of allergic etiology. Diseases of allergic etiology, including bronchial... progress nor as due to the inherent nature of the disease. Seasonal and other acute allergic...

  13. 38 CFR 3.380 - Diseases of allergic etiology.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Diseases of allergic... Specific Diseases § 3.380 Diseases of allergic etiology. Diseases of allergic etiology, including bronchial... progress nor as due to the inherent nature of the disease. Seasonal and other acute allergic...

  14. 38 CFR 3.380 - Diseases of allergic etiology.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Diseases of allergic... Specific Diseases § 3.380 Diseases of allergic etiology. Diseases of allergic etiology, including bronchial... progress nor as due to the inherent nature of the disease. Seasonal and other acute allergic...

  15. The inflammatory nature of allergic disease.

    PubMed

    Durham, S R

    1998-12-01

    The allergic inflammatory response in allergic rhinitis has been studied extensively owing to the high frequency of the condition, the significant morbidity it causes and the accessibility of the nasal tissue. The allergic inflammatory response is characterized by IgE synthesis, IgE-dependent mast cell activation and infiltration of the nasal mucosa by T lymphocytes and eosinophils. The immediate-phase response is mediated by a range of inflammatory mediators (such as histamine, leukotrienes and prostaglandins), resulting in vasodilatation, oedema, mucus secretion, itching and sneezing. Individuals who experience a late-phase response have further nasal symptoms 4-24 h after the initial challenge with allergen. Results of nasal biopsy studies indicate that the late-phase allergic response involves T-lymphocyte activation, production of TH2-type cytokines and tissue eosinophilia. Corticosteroids potently inhibit T-lymphocyte responses, and clinical studies in subjects with allergic rhinitis have demonstrated that they are extremely effective in blocking both early- and late-phase allergic reactions. Topical aqueous triamcinolone acetonide nasal spray represents a novel formulation of a topical corticosteroid for the treatment of allergic rhinitis. Data from controlled clinical studies indicate that it is effective in treating seasonal and perennial disease, is well tolerated, does not suppress adrenocortical function, is odourless, and can be administered as a once-daily dose. PMID:9988430

  16. [Allergic and irritative textile dermatitis].

    PubMed

    Elsner, P

    1994-01-22

    Textile dermatitis is only one example of adverse health effects due to clothing. It may present with a wide spectrum of clinical features, but the main mechanisms are irritant dermatitis, often observed in atopics intolerant to wool and synthetic fibers, and allergic contact dermatitis, usually caused by textile finishes and dyes. The newer azo dyes Disperse Blue 106 and 124 in particular are potent sensitizers that have caused significant problems, most recently in the form of "leggins dermatitis". Although severe textile dermatitis appears to be a rare event, more systematic population-based research is needed since many oligosymptomatic cases are probably overlooked. Criteria for healthy textiles are an optimum combination of efficacy (regulation of skin temperature and humidity and protection from environmental damage) and safety (lack of carcinogenicity, toxicity and allergenicity). If potentially allergenic substances are used in textiles, they should be declared as in the case of cosmetics.

  17. Maternal Influences over Offspring Allergic Responses

    PubMed Central

    2015-01-01

    Asthma occurs as a result of complex interactions of environmental and genetic factors. Clinical studies and animal models of asthma indicate offspring of allergic mothers have increased risk of development of allergies. Environmental factors including stress-induced corticosterone and vitamin E isoforms during pregnancy regulate the risk for offspring development of allergy. In this review, we discuss mechanisms for the development of allergic disease early in life, environmental factors that may impact the development of risk for allergic disease early in life, and how the variation in global prevalence of asthma may be explained, at least in part, by some environmental components. PMID:25612797

  18. [Definition and clinic of the allergic rhinitis].

    PubMed

    Spielhaupter, Magdalena

    2016-03-01

    The allergic rhinitis is the most common immune disorder with a lifetime prevalence of 24% and one of the most common chronic diseases at all--with tendency to rise. It occurs in childhood and influences the patients' social life, school performance and labour productivity. Furthermore the allergic rhinitis is accompanied by a lot of comorbidities, including conjunctivitis, asthma bronchiale, food allergy, neurodermatitis and sinusitis. For example the risk for asthma is 3.2-fold higher for adults with allergic rhinitis than for healthy people. PMID:27120868

  19. Allergic reactions to foods by inhalation.

    PubMed

    James, John M; Crespo, Jesús Fernández

    2007-06-01

    Although allergic reactions to foods occur most commonly after ingestion, inhalation of foods can also be an underlying cause of these reactions. For example, published reports have highlighted the inhalation of allergens from fish, shellfish, seeds, soybeans, cereal grains, hen's egg, cow's milk, and many other foods in allergic reactions. Symptoms have typically included respiratory manifestations such as rhinoconjunctivitis, coughing, wheezing, dyspnea, and asthma. In some cases, anaphylaxis has been observed. In addition, there have been many investigations of occupational asthma following the inhalation of relevant food allergens. This report reviews the current literature focusing on allergic reactions to foods by inhalation.

  20. [Definition and clinic of the allergic rhinitis].

    PubMed

    Spielhaupter, Magdalena

    2016-03-01

    The allergic rhinitis is the most common immune disorder with a lifetime prevalence of 24% and one of the most common chronic diseases at all--with tendency to rise. It occurs in childhood and influences the patients' social life, school performance and labour productivity. Furthermore the allergic rhinitis is accompanied by a lot of comorbidities, including conjunctivitis, asthma bronchiale, food allergy, neurodermatitis and sinusitis. For example the risk for asthma is 3.2-fold higher for adults with allergic rhinitis than for healthy people.

  1. Who Gets Fungal Infections?

    MedlinePlus

    ... infections can also happen in people without weak immune systems Fungal infections that are not life-threatening, such ... likely to cause an infection. People with weak immune systems Infections that happen because a person’s immune system ...

  2. [Emerging invasive fungal infections].

    PubMed

    Alvez, F; Figueras, C; Roselló, E

    2010-07-01

    The frequency and diversity of invasive fungal infections has changed over the last 25 years. The emergence of less common, but medically important fungi has increased, and the children at risk has expanded, with the inclusion of medical conditions such as cancer, mainly haematological malignancy or stem cell transplant, immunosuppressive therapy, prolonged neutropenia, and T-cell immunodeficiency. Among mould infections, fusariosis and phaeohyphomycosis (Dematiaceous fungi) have been increasingly reported in this group of patients. To successfully manage these challenging infections, it is imperative that paediatricians and sub-specialists remain aware of the optimal and timely diagnosis and therapeutic options. Unlike other common mycoses that cause human disease, there no simple antigen or serological tests available to detect these pathogens in tissue or blood. The outcome for these disseminate, and often refractory fungal infections in neutropenic patients and transplant recipients remains extremely poor, requiring early and aggressive therapy. Unfortunately there are no guidelines outlining the choices for optimal therapy in the treatment of paediatric invasive fungal infections do not exist, and on the other hand are limited paediatric data available comparing antifungal agents in children with proven, probable or suspected invasive fungal infection. The options for treatment rest mainly on some adult guidelines that comment on the treatment of these emerging and uncommon important fungi in children. Despite the sparse clinical trials available on treatment and its poor outcome, options for treatment of invasive fungal infections have increased with the advance of new antifungal agents, with improved tolerability and increased range of activity. The epidemiology, clinical manifestations, diagnosis and treatment of fusariosis and phaeohyphomycosis are discussed in this article.

  3. Intracranial mucocele formation in the context of longstanding chronic rhinosinusitis: A clinicopathologic series and literature review

    PubMed Central

    Brunworth, Joseph; Garg, Rohit; Shibuya, Terry; Keschner, David B.; Vanefsky, Marc; Lin, Tina; Choi, Soohoo; Stea, Richard; Thompson, Lester D. R.

    2013-01-01

    Chronic rhinosinusitis (CRS) can lead to serious long-term adverse sequelae, particularly if left untreated. The aim of this study was to describe a series of intracranial mucoceles (ICMs) that arose in the context of longstanding CRS combined with a review of the pertinent literature. A retrospective chart review was performed on all patients who developed ICMs in association with CRS between 2003 and 2012. The clinical presentation, radiographic features, surgical approach, intraoperative findings, and patient outcome were examined in the context of a literature review. Sixty-five cases of mucoceles were identified in patients with a history of CRS, of which seven (10.8%) were intracranial. Five patients were men and two were women with a mean age of 42.1 years. Headache, facial pressure, retro-orbital pain, and visual disturbances were the most common presenting symptoms. Five of the seven had previously undergone sinonasal surgery. Imaging studies showed ICMs involving the anterior cranial fossa, two of which were bilateral. Latency between onset of CRS and ICM detection ranged from 3 to 19 years (mean, 9.4 years). All patients underwent endoscopic transnasal drainage with three also requiring a concurrent, open neurosurgical procedure to access the intracranial component. There were no postoperative complications, and no recurrences were observed after a mean follow-up of 2.7 years. ICMs presenting as delayed complications of CRS are uncommon and constitute a surgical challenge. Open, external skull base approaches used in conjunction with transnasal endoscopic drainage procedures may be necessary to achieve successful management of this rare condition. PMID:24498523

  4. Efficacy of a Marine Bacterial Nuclease against Biofilm Forming Microorganisms Isolated from Chronic Rhinosinusitis

    PubMed Central

    Shields, Robert C.; Mokhtar, Norehan; Ford, Michael; Hall, Michael J.; Burgess, J. Grant; ElBadawey, Mohamed Reda; Jakubovics, Nicholas S.

    2013-01-01

    Background The persistent colonization of paranasal sinus mucosa by microbial biofilms is a major factor in the pathogenesis of chronic rhinosinusitis (CRS). Control of microorganisms within biofilms is hampered by the presence of viscous extracellular polymers of host or microbial origin, including nucleic acids. The aim of this study was to investigate the role of extracellular DNA in biofilm formation by bacteria associated with CRS. Methods/Principal Findings Obstructive mucin was collected from patients during functional endoscopic sinus surgery. Examination of the mucous by transmission electron microscopy revealed an acellular matrix punctuated occasionally with host cells in varying states of degradation. Bacteria were observed in biofilms on mucosal biopsies, and between two and six different species were isolated from each of 20 different patient samples. In total, 16 different bacterial genera were isolated, of which the most commonly identified organisms were coagulase-negative staphylococci, Staphylococcus aureus and α-haemolytic streptococci. Twenty-four fresh clinical isolates were selected for investigation of biofilm formation in vitro using a microplate model system. Biofilms formed by 14 strains, including all 9 extracellular nuclease-producing bacteria, were significantly disrupted by treatment with a novel bacterial deoxyribonuclease, NucB, isolated from a marine strain of Bacillus licheniformis. Extracellular biofilm matrix was observed in untreated samples but not in those treated with NucB and extracellular DNA was purified from in vitro biofilms. Conclusion/Significance Our data demonstrate that bacteria associated with CRS form robust biofilms which can be reduced by treatment with matrix-degrading enzymes such as NucB. The dispersal of bacterial biofilms with NucB may offer an additional therapeutic target for CRS sufferers. PMID:23441151

  5. Numerical optimization of targeted delivery of charged nanoparticles to the ostiomeatal complex for treatment of rhinosinusitis

    PubMed Central

    Xi, Jinxiang; Yuan, Jiayao Eddie; Si, Xiuhua April; Hasbany, James

    2015-01-01

    Background Despite the prevalence of rhinosinusitis that affects 10%–15% of the population, current inhalation therapy shows limited efficacy. Standard devices deliver <5% of the drugs to the sinuses due to the complexity of nose structure, secluded location of the sinus, poor ventilation, and lack of control of particle motions inside the nasal cavity. Methods An electric-guided delivery system was developed to guide charged particles to the ostiomeatal complex (OMC). Its performance was numerically assessed in an MRI-based nose–sinus model. Key design variables related to the delivery device, drug particles, and patient breathing were determined using sensitivity analysis. A two-stage optimization of design variables was conducted to obtain the best performance of the delivery system using the Nelder-Mead algorithm. Results and discussion The OMC delivery system exhibited high sensitivity to the applied electric field and electrostatic charges carried by the particles. Through the synthesis of electric guidance and point drug release, the new delivery system eliminated particle deposition in the nasal valve and turbinate regions and significantly enhanced the OMC doses. An OMC delivery efficiency of 72.4% was obtained with the optimized design, which is one order of magnitude higher than the standard nasal devices. Moreover, optimization is imperative to achieve a sound delivery protocol because of the large number of design variables. The OMC dose increased from 45.0% in the baseline model to 72.4% in the optimized system. The optimization framework developed in this study can be easily adapted for the delivery of drugs to other sites in the nose such as the ethmoid sinus and olfactory region. PMID:26257521

  6. The prevalence of bacterial infection in acute rhinosinusitis: A systematic review and meta-analysis

    PubMed Central

    Smith, Stephanie Shintani; Ference, Elisabeth Henderson; Evans, Charlesnika T.; Tan, Bruce K.; Kern, Robert C.; Chandra, Rakesh K.

    2014-01-01

    Objective To systematically assess the prevalence of bacterial infection in adults with acute rhinosinusitis (ARS) Data Sources PubMed and CINAHL databases Review Methods Electronic databases were systematically searched for relevant studies published up to June 2012. Results 29 articles, evaluating a total of 9,595 patients with a clinical diagnosis of ARS, were included in the study. 14 (48%) studies required radiographic confirmation of sinusitis, 1 (3%) required evidence of purulence, 10 (35%) required both for inclusion in the study population, and 4 (14%) required neither. The random effects model estimate of prevalence of bacterial growth on all cultures was 53.7% (CI 48.4%–59.0%), ranging from 52.5% (CI 46.7%–58.3%) in studies requiring radiographic confirmation of sinusitis to 61.1% (CI 54.0%–68.1%) in studies requiring neither radiographic evidence nor purulence on exam. Studies which obtained cultures from antral swab had a prevalence of bacterial growth of 61.0% (CI 54.7%–67.2%), while those utilizing endoscopic meatal sampling had a prevalence of 32.9% (CI 19.0%–46.8%). Conclusion Few studies evaluate the recovery of bacteria via culture in adults with a diagnosis of ABRS or ARS based on clinical criteria alone. With radiographic and/or endoscopic confirmation, antral puncture and endoscopically guided cultures produce positive bacterial cultures in approximately half of patients. Opportunities exist to improve diagnostic accuracy for bacterial infection in ARS. PMID:24723427

  7. Computed Tomography Scans as an Objective Measure of Disease Severity in Chronic Rhinosinusitis

    PubMed Central

    Likness, Micah M.; Pallanch, John F.; Sherris, David A.; Kita, Hirohito; Mashtare, Terry L.; Ponikau, Jens U.

    2014-01-01

    Objectives A truly objective method of measuring disease severity in chronic rhinosinusitis (CRS) has only recently existed. We evaluated computed tomography (CT) scans of CRS patients using this novel objective 3D computerized system and compared results with a novel 2D computerized analysis of a single coronal slice through the osteomeatal complex (OMC) and subjective methods including Lund-Mackay and Zinreich’s modified Lund-Mackay. Study Design Prospective multicenter study. Setting Two academic tertiary referral centers. Subjects and Methods Forty-six adults with a diagnosis of CRS underwent CT examination and received an intramuscular triamcinolone injection, dosage weight dependent, followed by CT scan 4 to 5 weeks later. Recruitment lasted 21 months. Scans were evaluated with all 4 scoring methods over 5 months. Results The Lin’s concordance class correlation (CCC) of the OMC method revealed the best correlation to the 3D volumetric computerized values (0.915), followed by the Zinreich (0.904) and Lund-Mackay methods (0.824). Posttreatment results demonstrated that both the OMC (0.824) and Zinreich’s (0.778) methods had strong agreement with the 3D volumetric methods and were very sensitive to change, whereas the Lund-Mackay (0.545) had only moderate agreement. Conclusion Computerized CT analysis provides the most comprehensive, objective, and reproducible method of measuring disease severity and is very sensitive to change induced by treatment intervention. A 2D coronal image through the OMC provides a valid, user-friendly method of assessing CRS and is representative of CRS severity in all sinuses. Zinreich’s subjective method correlated well overall, but the Lund-Mackay method lagged behind in disease representation and sensitivity to change. PMID:24301090

  8. Chronic rhinosinusitis and antibiotics: The good, the bad, and the ugly

    PubMed Central

    Kennedy, Joshua L.

    2013-01-01

    Background: Despite the recognition that bacteria are universally present in the sinuses of patients with chronic rhinosinusitis (CRS) no compelling role for a primary infectious etiology of CRS has been elucidated. CRS is a constellation of inflammatory diseases that typically involve either noneosinophilic or eosinophilic processes, distinct conditions that must be treated individually. Methods: The bacteria that are present in the sinuses may be innocuous bystanders but alternatively may contribute to the presence and severity of the disease through their ability to influence immune responses, function as immune adjuvants, provide antigens or superantigens that contribute to adaptive immune activation, or in forming the basis for the frequent acute superinfections. However, those bacteria that do contribute to the persistence and severity of CRS primarily reside in biofilms, and, as such, are not capable of being eradicated with antibiotics at the doses at which they can be used, even when local irrigation is considered. Results: Biofilms create an inhospitable environment for antibiotic potency by down-regulating the metabolic activity of their “core” bacteria, decreasing the oxygen concentration, and altering the pH at the core of the biofilm. Conclusion: Ultimately, if topical antibiotics are considered, they should be primarily focused on treating acute exacerbations and choices of antibiotics should optimally be based on endoscopic culture. This should be done with the recognition that while under certain circumstances antibiotics can ameliorate the severity of CRS, even if bacterial eradication were possible, this would not eliminate the underlying primary pathogenic mechanism or the natural history of these conditions. PMID:24274221

  9. The effect of diabetes mellitus on chronic rhinosinusitis and sinus surgery outcome

    PubMed Central

    Zhang, Zi; Adappa, Nithin D.; Lautenbach, Ebbing; Chiu, Alexander G.; Doghramji, Laurel; Howland, Timothy J.; Cohen, Noam A.; Palmer, James N.

    2014-01-01

    Objective Patients with diabetes mellitus (DM) are known to be liable to infection. However, the association between diabetes and chronic rhinosinusitis (CRS) has not been well studied. We sought to determine the effects of DM on CRS culture results and quality of life (QOL) after functional endoscopic sinus surgery (FESS). Methods We conducted a retrospective cohort study. Adult CRS patients undergoing FESS were recruited from 10/1/2007 to 12/31/2011. Patient demographics, comorbidities, medication use, Lund-Mackay CT scores were collected prior to FESS. Intraoperative culture was obtained. Preoperative and 1-, 3- and 6-month postoperative QOL was measured by the 22 item Sinonasal Outcome Test (SNOT-22) scores. A mixed effects model was performed for analysis. Results Among the 376 CRS patients included, 19 patients (5.05%) had DM. Compared to non-DM patients, DM patients were significantly more likely to have Pseudomonas aeruginosa (26.32% versus 7.56%, p=0.004) and gram negative rods (26.32% vs. 8.96%, p= 0.013), but there were no significant difference in the prevalence of Staphylococcus aureus; DM patients were also significantly more likely to have nasal polyps and gastroesophageal reflux disease. Additionally, DM patients had significantly less improvement of postoperative SNOT-22 scores from baseline to 6-month follow-up than non-DM patients (adjusted mean=11.14, 95% CI (0.14, 22.15), p=0.047) after adjusting for all the other risk factors for CRS. Conclusion DM patients may be prone to gram negative bacterial sinus infections, and have significantly worse short-term postoperative QOL. Special postoperative care may need to be considered in CRS patients with DM PMID:24415555

  10. Topical Drug Delivery in Chronic Rhinosinusitis Patients before and after Sinus Surgery Using Pulsating Aerosols

    PubMed Central

    Möller, Winfried; Schuschnig, Uwe; Celik, Gülnaz; Münzing, Wolfgang; Bartenstein, Peter; Häussinger, Karl; Kreyling, Wolfgang G.; Knoch, Martin

    2013-01-01

    Objectives Chronic rhinosinusitis (CRS) is a common chronic disease of the upper airways and has considerable impact on quality of life. Topical delivery of drugs to the paranasal sinuses is challenging, therefore the rate of surgery is high. This study investigates the delivery efficiency of a pulsating aerosol in comparison to a nasal pump spray to the sinuses and the nose in healthy volunteers and in CRS patients before and after sinus surgery. Methods 99mTc-DTPA pulsating aerosols were applied in eleven CRSsNP patients without nasal polyps before and after sinus surgery. In addition, pulsating aerosols were studied in comparison to nasal pump sprays in eleven healthy volunteers. Total nasal and frontal, maxillary and sphenoidal sinus aerosol deposition and lung penetration were assessed by anterior and lateral planar gamma camera imaging. Results In healthy volunteers nasal pump sprays resulted in 100% nasal, non-significant sinus and lung deposition, while pulsating aerosols resulted 61.3+/-8.6% nasal deposition and 38.7% exit the other nostril. 9.7+/-2.0 % of the nasal dose penetrated into maxillary and sphenoidal sinuses. In CRS patients, total nasal deposition was 56.7+/-13.3% and 46.7+/-12.7% before and after sinus surgery, respectively (p<0.01). Accordingly, maxillary and sphenoidal sinus deposition was 4.8+/-2.2% and 8.2+/-3.8% of the nasal dose (p<0.01). Neither in healthy volunteers nor in CRS patients there was significant dose in the frontal sinuses. Conclusion In contrast to nasal pump sprays, pulsating aerosols can deliver significant doses into posterior nasal spaces and paranasal sinuses, providing alternative therapy options before and after sinus surgery. Patients with chronic lung diseases based on clearance dysfunction may also benefit from pulsating aerosols, since these diseases also manifest in the upper airways. PMID:24040372

  11. Mixed T Helper Cell Signatures In Chronic Rhinosinusitis with and without Polyps

    PubMed Central

    Derycke, Lara; Eyerich, Stefanie; Van Crombruggen, Koen; Pérez-Novo, Claudina; Holtappels, Gabriele; Deruyck, Natalie; Gevaert, Philippe; Bachert, Claus

    2014-01-01

    In chronic rhinosinusitis (CRS) different phenotypes have been reported based on cytokine profile and inflammatory cell patterns. The aim of this study was to characterize the intracytoplasmatic cytokines ofTcells infiltrating theinflamed sinonasal mucosa. Methods Infiltrated T cells and tissue homogenates from sinonasal mucosal samples of 7 healthy subjects, 9 patients with CRS without nasal polyp (CRSsNP), 15 with CRS with nasal polyps (CRSwNP) and 5cystic fibrosis patients (CF-NP) were analyzed for cytokine expression using flow cytometry and multiplex analysis respectively. Intracytoplasmic cytokinesin T cells were analyzed after stimulation of nasal polyps with Staphylococcus aureus enterotoxin B for 24 hours. Results The number of T cellsper total living cells was significantly higher in patients with CRSwNP vs. CRSsNP and controls. 85% of the CD4+ Tcells showed to be memory T cells. The effector T cells present in all tissues have apredominantTh1 phenotype. Only in CRSwNP, a significantfraction of T cellsproduced the Th2 cytokinesIL-4 and IL-5, while nasal polyps from CF patients were characterized by a higher CD4/CD8 T cell ratio and an increased number of Th17 cells. 24 h stimulation with SEB resulted in a significant induction of CD4+ T cells producing IL-10 (Tr1 cells). Conclusion T cell cytokine patternsin healthy and inflamed sinonasal mucosa revealed that Th2 cells (IL-4 and IL-5 producing cells) are significantly increased in CRSwNP mucosal inflammation. Exposure to SEB stimulates Tr1 cellsthat may contribute to the Th2 bias in CRSwNP. PMID:24911279

  12. Aspirin or Nonsteroidal Anti-inflammatory Drug-Exacerbated Chronic Rhinosinusitis.

    PubMed

    Ledford, Dennis K; Lockey, Richard F

    2016-01-01

    Aspirin (ASA)-exacerbated respiratory disease (AERD) is characterized by upper airway congestion due to eosinophilic inflammation of the nasal and sinus membranes and nasal polyposis, associated with increased leukotriene production that is further accentuated by ASA or other nonsteroidal anti-inflammatory drug (NSAID) ingestion. It occurs in 5% to 10% of subjects with chronic rhinosinusitis (CRS) and in 15% to 40% of those with nasal polyposis. Although AERD with CRS is usually associated with asthma, this is not always the case. The eosinophilic airway inflammation and symptoms precede clinical reactions to ASA or other NSAIDs, but ultimately affected subjects experience worsening of symptoms with ingestion of ASA/NSAIDs. The endotypic mechanism for this worsening is related to a chronic increase in leukotriene and a decrease in prostaglandin production, particularly prostaglandin E2, that is further aggravated by the inhibition of cycloxgenase I. IgE does not likely play a role in the pathogenesis of the disease although nasal and sinus staphylococcal infection increases local IgE level and may increase total IgE and specific IgE levels. Genetic studies suggest that multiple genes may be involved, but the genetic abnormalities may differ in affected subjects from different ethnicities and candidate genes have not been confirmed in multiple studies. Genome-wide association studies have not been revealing. The phenotype is recognized by the mucosal inflammation and worsening of symptoms acutely with ASA/NSAID. There is clinical improvement with ASA desensitization followed by regular ingestion of ASA or other NSAIDs. Further understanding of this unique phenotype and endotype of CRS will likely improve the understanding of other eosinophilic airway diseases. PMID:27393773

  13. Economic Evaluation of Endoscopic Sinus Surgery versus Continued Medical Therapy for Refractory Chronic Rhinosinusitis

    PubMed Central

    Rudmik, Luke; Soler, Zachary M.; Mace, Jess C.; Schlosser, Rodney J.; Smith, Timothy L.

    2014-01-01

    Objective To evaluate the long-term cost-effectiveness of endoscopic sinus surgery (ESS) compared to continued medical therapy for patients with refractory chronic rhinosinusitis (CRS). Study Design Cohort-style Markov decision tree economic evaluation Methods The economic perspective was the US third party payer with a 30 year time horizon. The two comparative treatment strategies were: 1) ESS followed by appropriate postoperative medical therapy and 2) continued medical therapy alone. Primary outcome was the incremental cost per quality adjusted life year (QALY). Costs were discounted at a rate of 3.5% in the reference case. Multiple sensitivity analyses were performed including differing time-horizons, discounting scenarios, and a probabilistic sensitivity analysis (PSA). Results The reference case demonstrated that the ESS strategy cost a total of $48,838.38 and produced a total of 20.50 QALYs. The medical therapy alone strategy cost a total of $28,948.98 and produced a total of 17.13 QALYs. The incremental cost effectiveness ratio (ICER) for ESS versus medical therapy alone is $5,901.90 per QALY. The cost-effectiveness acceptability curve from the PSA demonstrated that there is 74% certainty that the ESS strategy is the most cost-effective decision for any willingness to pay threshold greater then $25,000. The time horizon analysis suggests that ESS becomes the cost-effective intervention within the 3rd year after surgery. Conclusion Results from this study suggest that employing an ESS treatment strategy is the most cost-effective intervention compared to continued medical therapy alone for the long-term management of patients with refractory CRS. PMID:25186499

  14. Staphylococcus epidermidis and biofilm-associated neutrophils in chronic rhinosinusitis. A pilot study.

    PubMed

    Marcinkiewicz, Janusz; Stręk, Paweł; Strus, Magdalena; Głowacki, Roman; Ciszek-Lenda, Marta; Zagórska-Świeży, Katarzyna; Gawda, Anna; Tomusiak, Anna

    2015-12-01

    A key role of bacterial biofilm in the pathogenesis of chronic rhinosinusitis (CRS) with (CRSwNP) and without nasal polyps (CRSsNP) is commonly accepted. However, the impact of some bacterial species isolated from inflamed sinus mucosa on biofilm formation is unclear. In particular, the role of Staphylococcus epidermidis as aetiological agents of CRS is controversial. Moreover, the effect of biofilm formation on neutrophil infiltration and activity in CRSwNP calls for explanation. In this study, biofilms were found in three of 10 patients (mean age = 46 ± 14) with CRS undergoing endoscopic sinus surgery by means of scanning electron microscopy. Unexpectedly, S. epidermidis was the primary isolated bacteria and was also found to be present in all biofilm-positive mucosa specimens, indicating its pivotal role in the pathogenesis of severe chronic infections associated with biofilm formation. We have also measured the activity of myeloperoxidase (MPO), the most abundant neutrophil enzyme, to demonstrate the presence of neutrophils in the samples tested. Our present results show that the level of MPO in CRS associated with biofilm is lower than that without biofilm. It may suggest either a low number of neutrophils or the presence of a type of neutrophils with compromised antimicrobial activity, described as biofilm-associated neutrophils (BAN). Finally, we conclude that further studies with a large number of CRS cases should be performed to establish the association between S. epidermidis and other frequently isolated bacterial species from paranasal sinuses, with the severity of CRS, biofilm formation and the infiltration of BAN.

  15. Staphylococcus epidermidis and biofilm-associated neutrophils in chronic rhinosinusitis. A pilot study.

    PubMed

    Marcinkiewicz, Janusz; Stręk, Paweł; Strus, Magdalena; Głowacki, Roman; Ciszek-Lenda, Marta; Zagórska-Świeży, Katarzyna; Gawda, Anna; Tomusiak, Anna

    2015-12-01

    A key role of bacterial biofilm in the pathogenesis of chronic rhinosinusitis (CRS) with (CRSwNP) and without nasal polyps (CRSsNP) is commonly accepted. However, the impact of some bacterial species isolated from inflamed sinus mucosa on biofilm formation is unclear. In particular, the role of Staphylococcus epidermidis as aetiological agents of CRS is controversial. Moreover, the effect of biofilm formation on neutrophil infiltration and activity in CRSwNP calls for explanation. In this study, biofilms were found in three of 10 patients (mean age = 46 ± 14) with CRS undergoing endoscopic sinus surgery by means of scanning electron microscopy. Unexpectedly, S. epidermidis was the primary isolated bacteria and was also found to be present in all biofilm-positive mucosa specimens, indicating its pivotal role in the pathogenesis of severe chronic infections associated with biofilm formation. We have also measured the activity of myeloperoxidase (MPO), the most abundant neutrophil enzyme, to demonstrate the presence of neutrophils in the samples tested. Our present results show that the level of MPO in CRS associated with biofilm is lower than that without biofilm. It may suggest either a low number of neutrophils or the presence of a type of neutrophils with compromised antimicrobial activity, described as biofilm-associated neutrophils (BAN). Finally, we conclude that further studies with a large number of CRS cases should be performed to establish the association between S. epidermidis and other frequently isolated bacterial species from paranasal sinuses, with the severity of CRS, biofilm formation and the infiltration of BAN. PMID:26765504

  16. Regulatory T cells in allergic diseases.

    PubMed

    Noval Rivas, Magali; Chatila, Talal A

    2016-09-01

    The pathogenesis of allergic diseases entails an ineffective tolerogenic immune response to allergens. Regulatory T (Treg) cells play a key role in sustaining immune tolerance to allergens, yet mechanisms by which Treg cells fail to maintain tolerance in patients with allergic diseases are not well understood. We review current concepts and established mechanisms regarding how Treg cells regulate different components of allergen-triggered immune responses to promote and maintain tolerance. We will also discuss more recent advances that emphasize the "dual" functionality of Treg cells in patients with allergic diseases: how Treg cells are essential in promoting tolerance to allergens but also how a proallergic inflammatory environment can skew Treg cells toward a pathogenic phenotype that aggravates and perpetuates disease. These advances highlight opportunities for novel therapeutic strategies that aim to re-establish tolerance in patients with chronic allergic diseases by promoting Treg cell stability and function. PMID:27596705

  17. Complementary and Alternative Treatment for Allergic Conditions.

    PubMed

    Qiu, Juan; Grine, Kristen

    2016-09-01

    This article explains the proposed pathophysiology, evidence of efficacy, and adverse effects of several complementary and alternative medicine modalities, for the treatment of allergic conditions, such as traditional Chinese medicine formula, herbal treatments, acupuncture, and homeopathy. PMID:27545740

  18. Japanese Guideline for Occupational Allergic Diseases 2014.

    PubMed

    Dobashi, Kunio; Akiyama, Kazuo; Usami, Atsushi; Yokozeki, Hiroo; Ikezawa, Zenro; Tsurikisawa, Naomi; Nakamura, Yoichi; Sato, Kazuhiro; Okumura, Jiro

    2014-09-01

    In 2013, a guideline for occupational allergic diseases was published for the first time in Japan. Occupational allergic diseases are likely to worsen or become intractable as a result of continuous exposure to high concentrations of causative antigens, and are socioeconomically important diseases with which the patients might sometimes lose jobs due to work interruptions. Guidelines for occupational allergic diseases have been published in many countries. This guideline consists of six chapters about occupational asthma, occupational allergic rhinitis, occupational skin diseases, hypersensitivity pneumonitis and occupational anaphylaxis shock, and legal aspects of these diseases. The guideline is characterized with the following basic structure: Clinical Questions (CQs) are set with reference to Minds (Medical Information Network Distribution Service), statements by the committee are correspondingly listed, recommended grades and evidence levels are defined, and then descriptions and references are indicated.

  19. Acute allergic angioedema of upper lip

    PubMed Central

    Mahendran, Kavitha; Padmini, Govindasway; Murugesan, Ramesh; Srikumar, Arthiseethalakshmi

    2016-01-01

    Mishaps can occur during dental procedures, some owing to inattention to detail and others are totally unpredictable. They usually include anaphylaxis or allergic reactions to materials used for restorative purposes or drugs such as local anesthetics. A patient reported to our department with moderate dental fluorosis, and the treatment was planned with indirect composite veneering. During the procedure while cementation acute allergic reaction occurred, the specific cause could not be identified after allergic testing. During the procedure while cementationacute allergic angioedema of upper lip. Anaphylaxis, urticaria, allergy, hereditary atopic eczema, cellulitis, cheilitis granulomatosa, and cheilitis glandularis. The patient was reassured and given prednisolone 10 mg and cetirizine 10 mg orally, once daily for 3 days after which the symptoms subsided. This paper will discuss the pathogenesis, classification, identification, and management of angioedema during dental procedures. PMID:27217646

  20. Acute allergic angioedema of upper lip.

    PubMed

    Mahendran, Kavitha; Padmini, Govindasway; Murugesan, Ramesh; Srikumar, Arthiseethalakshmi

    2016-01-01

    Mishaps can occur during dental procedures, some owing to inattention to detail and others are totally unpredictable. They usually include anaphylaxis or allergic reactions to materials used for restorative purposes or drugs such as local anesthetics. A patient reported to our department with moderate dental fluorosis, and the treatment was planned with indirect composite veneering. During the procedure while cementation acute allergic reaction occurred, the specific cause could not be identified after allergic testing. During the procedure while cementationacute allergic angioedema of upper lip. Anaphylaxis, urticaria, allergy, hereditary atopic eczema, cellulitis, cheilitis granulomatosa, and cheilitis glandularis. The patient was reassured and given prednisolone 10 mg and cetirizine 10 mg orally, once daily for 3 days after which the symptoms subsided. This paper will discuss the pathogenesis, classification, identification, and management of angioedema during dental procedures. PMID:27217646

  1. Allergic contact dermatitis to white petrolatum.

    PubMed

    Kang, Hee; Choi, Jun; Lee, Ai-Young

    2004-05-01

    White petrolatum is known for its nonsensitizing and nonirritating properties. Only a few cases of allergic contact dermatitis to white petrolatum have been reported. Although it is a rare event, the finding of contact sensitization to white petrolatum raises the potential problem of its usage of common topical agents or vehicles for patch testing. We herein report a case of allergic contact dermatitis to white petrolatum.

  2. [Epigenetics in allergic diseases and asthma].

    PubMed

    Castro-Rodríguez, José A; Krause, Bernardo J; Uauy, Ricardo; Casanello, Paola

    2016-01-01

    Allergic diseases and asthma are the result of complex interactions between genetic predisposition and environmental factors. Asthma is one of the most prevalent chronic disease among children. In this article we review some environmental factors like: allergen exposition, tobacco, bacteria, microbial components, diet, obesity and stress, which influences during intrauterine and infancy life in the epigenetic regulation of asthma and allergic diseases. The review has been done in three models: in-vitro, animal and human. PMID:27055949

  3. [Epigenetics in allergic diseases and asthma].

    PubMed

    Castro-Rodríguez, José A; Krause, Bernardo J; Uauy, Ricardo; Casanello, Paola

    2016-01-01

    Allergic diseases and asthma are the result of complex interactions between genetic predisposition and environmental factors. Asthma is one of the most prevalent chronic disease among children. In this article we review some environmental factors like: allergen exposition, tobacco, bacteria, microbial components, diet, obesity and stress, which influences during intrauterine and infancy life in the epigenetic regulation of asthma and allergic diseases. The review has been done in three models: in-vitro, animal and human.

  4. Nasal hyperreactivity and inflammation in allergic rhinitis

    PubMed Central

    Veld, C. de Graaf-in't; Wijk, R. Gerth van; Zijlstra, F. J.

    1996-01-01

    The history of allergic disease goes back to 1819, when Bostock described his own ‘periodical affection of the eyes and chest’, which he called ‘summer catarrh’. Since they thought it was produced by the effluvium of new hay, this condition was also called hay fever. Later, in 1873, Blackley established that pollen played an important role in the causation of hay fever. Nowadays, the definition of allergy is ‘An untoward physiologic event mediated by a variety of different immunologic reactions’. In this review, the term allergy will be restricted to the IgE-dependent reactions. The most important clinical manifestations of IgE-dependent reactions are allergic conjunctivitis, allergic rhinitis, allergic asthma and atopic dermatitis. However, this review will be restricted to allergic rhinitis. The histopathological features of allergic inflammation involve an increase in blood flow and vascular permeability, leading to plasma exudation and the formation of oedema. In addition, a cascade of events occurs which involves a variety of inflammatory cells. These inflammatory cells migrate under the influence of chemotactic agents to the site of injury and induce the process of repair. Several types of inflammatory cells have been implicated in the pathogenesis of allergic rhinitis. After specific or nonspecific stimuli, inflammatory mediators are generated from cells normally found in the nose, such as mast cells, antigen-presenting cells and epithelial cells (primary effector cells) and from cells recruited into the nose, such as basophils, eosinophils, lymphocytes, platelets and neutrophils (secondary effector cells). This review describes the identification of each of the inflammatory cells and their mediators which play a role in the perennial allergic processes in the nose of rhinitis patients. PMID:18475703

  5. Allergic Disease and Autoimmune Effectors Pathways

    PubMed Central

    Rottem, Menachem; Gershwin, M. Eric; Shoenfeld, Yehuda

    2002-01-01

    Allergy and autoimmunity result from dysregulation of the immune system. Until recently, it was generally accepted that the mechanisms that govern these disease processes are quite disparate; however, new discoveries suggest possible common pathogenetic effector pathways. This review illustrates the concomitant presentation of these conditions and the potential relationship or common mechanism in some cases, by looking at the key elements that regulate the immune response in both allergic and autoimmunite conditions: mast cells, antibodies, T cells, cytokines, and genetic determinants. The parallel appearance of allergic and autoimmune conditions in the some patients may reveal that such aberrations of the immune system have a common pathophysiologic mechanism. Mast cells, which play a key role in allergic reactions, and the wealth of inflammatory mediators they express, make it likely that they have profound effects on many autoimmune processes. Activation of protein kinases by inflammatory cytokines and environmental stresses may contribute to both allergic and autoimmune diseases. The presence of autoantibodies in some allergic conditions suggests an autoimmune basis for these conditions. Because of the central role T cells play in immune reactivity, the T-cell receptor (TCR) loci have long been considered important candidates for common disease susceptibility within the immune system such as asthma, atopy, and autoimmunity. Immunomodulation is the key to a successful treatment of allergic and autoimmune conditions. PMID:12885156

  6. Overview on the pathomechanisms of allergic rhinitis

    PubMed Central

    Mori, Sachiko; Ozu, Chika; Kimura, Satoko

    2011-01-01

    Allergic rhinitis a chronic inflammatory disease of the upper airways that has a major impact on the quality of life of patients and is a socio-economic burden. Understanding the underlying immune mechanisms is central to developing better and more targeted therapies. The inflammatory response in the nasal mucosa includes an immediate IgE-mediated mast cell response as well as a latephase response characterized by recruitment of eosinophils, basophils, and T cells expressing Th2 cytokines including interleukin (IL)-4, a switch factor for IgE synthesis, and IL-5, an eosinophil growth factor and on-going allergic inflammation. Recent advances have suggested new pathways like local synthesis of IgE, the IgE-IgE receptor mast cell cascade in on-going allergic inflammation and the epithelial expression of cytokines that regulate Th2 cytokine responses (i.e., thymic stromal lymphopoietin, IL-25, and IL-33). In this review, we briefly review the conventional pathways in the pathophysiology of allergic rhinitis and then elaborate on the recent advances in the pathophysiology of allergic rhinitis. An improved understanding of the immune mechanisms of allergic rhinitis can provide a better insight on novel therapeutic targets. PMID:22053313

  7. Current and future biomarkers in allergic asthma.

    PubMed

    Zissler, U M; Esser-von Bieren, J; Jakwerth, C A; Chaker, A M; Schmidt-Weber, C B

    2016-04-01

    Diagnosis early in life, sensitization, asthma endotypes, monitoring of disease and treatment progression are key motivations for the exploration of biomarkers for allergic rhinitis and allergic asthma. The number of genes related to allergic rhinitis and allergic asthma increases steadily; however, prognostic genes have not yet entered clinical application. We hypothesize that the combination of multiple genes may generate biomarkers with prognostic potential. The current review attempts to group more than 161 different potential biomarkers involved in respiratory inflammation to pave the way for future classifiers. The potential biomarkers are categorized into either epithelial or infiltrate-derived or mixed origin, epithelial biomarkers. Furthermore, surface markers were grouped into cell-type-specific categories. The current literature provides multiple biomarkers for potential asthma endotypes that are related to T-cell phenotypes such as Th1, Th2, Th9, Th17, Th22 and Tregs and their lead cytokines. Eosinophilic and neutrophilic asthma endotypes are also classified by epithelium-derived CCL-26 and osteopontin, respectively. There are currently about 20 epithelium-derived biomarkers exclusively derived from epithelium, which are likely to innovate biomarker panels as they are easy to sample. This article systematically reviews and categorizes genes and collects current evidence that may promote these biomarkers to become part of allergic rhinitis or allergic asthma classifiers with high prognostic value. PMID:26706728

  8. [Monoclonal antibody therapy for allergic asthma].

    PubMed

    Nishikawa, Masanori; Matsuse, Takeshi

    2002-03-01

    Allergic responses at the level of the respiratory system are mostly mediated by IgE-dependent mechanisms. The first selective anti-IgE therapy, a recombinant humanized monoclonal anti-IgE antibody(rhuMAb-E25), binds with high affinity to the Fc epsilon RI receptor binding site on IgE, thereby reducing the amount of free IgE available to bind to Fc epsilon RI receptors on mast cells and basophils. In addition, administration of rhuMAb-E25 indirectly reduces Fc epsilon RI receptor density on cells involved in allergic responses. rhuMAb-E25 has been shown to reduce allergic responses in atopic individuals and to improve symptoms and reduce rescue medication and corticosteroid use in patient with allergic asthma. The clinical effectiveness of rhuMAb-E25 supports the central role of IgE in allergic reaction and the viability of anti-IgE therapy as an effective immunological intervention for allergic asthma.

  9. Fungal diseases of horses.

    PubMed

    Cafarchia, Claudia; Figueredo, Luciana A; Otranto, Domenico

    2013-11-29

    Among diseases of horses caused by fungi (=mycoses), dermatophytosis, cryptococcosis and aspergillosis are of particular concern, due their worldwide diffusion and, for some of them, zoonotic potential. Conversely, other mycoses such as subcutaneous (i.e., pythiosis and mycetoma) or deep mycoses (i.e., blastomycosis and coccidioidomycosis) are rare, and/or limited to restricted geographical areas. Generally, subcutaneous and deep mycoses are chronic and progressive diseases; clinical signs include extensive, painful lesions (not pathognomonic), which resemble to other microbial infections. In all cases, early diagnosis is crucial in order to achieve a favorable prognosis. Knowledge of the epidemiology, clinical signs, and diagnosis of fungal diseases is essential for the establishment of effective therapeutic strategies. This article reviews the clinical manifestations, diagnosis and therapeutic protocols of equine fungal infections as a support to early diagnosis and application of targeted therapeutic and control strategies. PMID:23428378

  10. Fungal echinocandin resistance

    PubMed Central

    Walker, Louise A.; Gow, Neil A.R.; Munro, Carol A.

    2010-01-01

    The echinocandins are the newest class of antifungal agents in the clinical armory. These secondary metabolites are non-competitive inhibitors of the synthesis of β-(1,3)-glucan, a major structural component of the fungal cell wall. Recent work has shown that spontaneous mutations can arise in two hot spot regions of Fks1 the target protein of echinocandins that reduce the enzyme’s sensitivity to the drug. However, other strains have been isolated in which the sequence of FKS1 is unaltered yet the fungus has decreased sensitivity to echinocandins. In addition it has been shown that echinocandin-treatment can induce cell wall salvage mechanisms that result in the compensatory upregulation of chitin synthesis in the cell wall. This salvage mechanism strengthens cell walls damaged by exposure to echinocandins. Therefore, fungal resistance to echinocandins can arise due to the selection of either stable mutational or reversible physiological alterations that decrease susceptibility to these antifungal agents. PMID:19770064

  11. Fungal Sex and Pathogenesis

    PubMed Central

    Butler, Geraldine

    2010-01-01

    Summary: Human fungal pathogens are associated with diseases ranging from dandruff and skin colonization to invasive bloodstream infections. The major human pathogens belong to the Candida, Aspergillus, and Cryptococcus clades, and infections have high and increasing morbidity and mortality. Many human fungal pathogens were originally assumed to be asexual. However, recent advances in genome sequencing, which revealed that many species have retained the genes required for the sexual machinery, have dramatically influenced our understanding of the biology of these organisms. Predictions of a rare or cryptic sexual cycle have been supported experimentally for some species. Here, I examine the evidence that human pathogens reproduce sexually. The evolution of the mating-type locus in ascomycetes (including Candida and Aspergillus species) and basidiomycetes (Malassezia and Cryptococcus) is discussed. I provide an overview of how sex is suppressed in different species and discuss the potential associations with pathogenesis. PMID:20065328

  12. Fungal sex and pathogenesis.

    PubMed

    Butler, Geraldine

    2010-01-01

    Human fungal pathogens are associated with diseases ranging from dandruff and skin colonization to invasive bloodstream infections. The major human pathogens belong to the Candida, Aspergillus, and Cryptococcus clades, and infections have high and increasing morbidity and mortality. Many human fungal pathogens were originally assumed to be asexual. However, recent advances in genome sequencing, which revealed that many species have retained the genes required for the sexual machinery, have dramatically influenced our understanding of the biology of these organisms. Predictions of a rare or cryptic sexual cycle have been supported experimentally for some species. Here, I examine the evidence that human pathogens reproduce sexually. The evolution of the mating-type locus in ascomycetes (including Candida and Aspergillus species) and basidiomycetes (Malassezia and Cryptococcus) is discussed. I provide an overview of how sex is suppressed in different species and discuss the potential associations with pathogenesis. PMID:20065328

  13. Small intestinal fungal overgrowth.

    PubMed

    Erdogan, Askin; Rao, Satish S C

    2015-04-01

    Small intestinal fungal overgrowth (SIFO) is characterized by the presence of excessive number of fungal organisms in the small intestine associated with gastrointestinal (GI) symptoms. Candidiasis is known to cause GI symptoms particularly in immunocompromised patients or those receiving steroids or antibiotics. However, only recently, there is emerging literature that an overgrowth of fungus in the small intestine of non-immunocompromised subjects may cause unexplained GI symptoms. Two recent studies showed that 26 % (24/94) and 25.3 % (38/150) of a series of patients with unexplained GI symptoms had SIFO. The most common symptoms observed in these patients were belching, bloating, indigestion, nausea, diarrhea, and gas. The underlying mechanism(s) that predisposes to SIFO is unclear but small intestinal dysmotility and use of proton pump inhibitors has been implicated. However, further studies are needed; both to confirm these observations and to examine the clinical relevance of fungal overgrowth, both in healthy subjects and in patients with otherwise unexplained GI symptoms. Importantly, whether eradication or its treatment leads to resolution of symptoms remains unclear; at present, a 2-3-week course of antifungal therapy is recommended and may be effective in improving symptoms, but evidence for eradication is lacking. PMID:25786900

  14. Developments in Fungal Taxonomy

    PubMed Central

    Guarro, Josep; Gené, Josepa; Stchigel, Alberto M.

    1999-01-01

    Fungal infections, especially those caused by opportunistic species, have become substantially more common in recent decades. Numerous species cause human infections, and several new human pathogens are discovered yearly. This situation has created an increasing interest in fungal taxonomy and has led to the development of new methods and approaches to fungal biosystematics which have promoted important practical advances in identification procedures. However, the significance of some data provided by the new approaches is still unclear, and results drawn from such studies may even increase nomenclatural confusion. Analyses of rRNA and rDNA sequences constitute an important complement of the morphological criteria needed to allow clinical fungi to be more easily identified and placed on a single phylogenetic tree. Most of the pathogenic fungi so far described belong to the kingdom Fungi; two belong to the kingdom Chromista. Within the Fungi, they are distributed in three phyla and in 15 orders (Pneumocystidales, Saccharomycetales, Dothideales, Sordariales, Onygenales, Eurotiales, Hypocreales, Ophiostomatales, Microascales, Tremellales, Poriales, Stereales, Agaricales, Schizophyllales, and Ustilaginales). PMID:10398676

  15. Fungal toenail infections

    PubMed Central

    2014-01-01

    Introduction Fungal infections are reported to cause 23% of foot diseases and 50% of nail conditions in people seen by dermatologists, but are less common in the general population, affecting 3% to 12% of people. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral treatments for fungal toenail infections in adults? What are the effects of topical treatments for fungal toenail infections in adults? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 13 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review, we present information relating to the effectiveness and safety of the following interventions: amorolfine, butenafine, ciclopirox, fluconazole, itraconazole, terbinafine, tioconazole, and topical ketoconazole. PMID:24625577

  16. Fungal toenail infections

    PubMed Central

    2011-01-01

    Introduction Fungal infections are reported to cause 23% of foot diseases and 50% of nail conditions in people seen by dermatologists, but are less common in the general population, affecting 3% to 5% of people. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of oral treatments for fungal toenail infections? What are the effects of topical treatments for fungal toenail infections? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 12 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: amorolfine, butenafine, ciclopirox, fluconazole, griseofulvin, itraconazole, ketoconazole, mechanical debridement, terbinafine, and tioconazole. PMID:21846413

  17. Optimal management of allergic rhinitis.

    PubMed

    Scadding, Glenis K

    2015-06-01

    Allergic rhinitis (AR), the most common chronic disease in childhood is often ignored, misdiagnosed and/or mistreated. Undertreated AR impairs quality of life, exacerbates asthma and is a major factor in asthma development. It can involve the nose itself, as well as the organs connected with the nose manifesting a variety of symptoms. Evidence-based guidelines for AR therapy improve disease control. Recently, paediatric AR guidelines have been published by the European Academy of Allergy and Clinical Immunology and are available online, as are a patient care pathway for children with AR and asthma from the Royal College of Paediatrics and Child Health. Management involves diagnosis, followed by avoidance of relevant allergens, with additional pharmacotherapy needed for most sufferers. This ranges, according to severity, from saline sprays, through non-sedating antihistamines, oral or topical, with minimally bioavailable intranasal corticosteroids for moderate/severe disease, possibly plus additional antihistamine or antileukotriene. The concept of rhinitis control is emerging, but there is no universally accepted definition. Where pharmacotherapy fails, allergen-specific immunotherapy, which is uniquely able to alter long-term disease outcomes, should be considered. The subcutaneous form (subcutaneous immunotherapy) in children has been underused because of concerns regarding safety and acceptability of injections. Sublingual immunotherapy is both efficacious and safe for grass pollen allergy. Further studies on other allergens in children are needed. Patient, carer and practitioner education into AR and its treatment are a vital part of management. PMID:25838332

  18. Optimal management of allergic rhinitis

    PubMed Central

    Scadding, Glenis K

    2015-01-01

    Allergic rhinitis (AR), the most common chronic disease in childhood is often ignored, misdiagnosed and/or mistreated. Undertreated AR impairs quality of life, exacerbates asthma and is a major factor in asthma development. It can involve the nose itself, as well as the organs connected with the nose manifesting a variety of symptoms. Evidence-based guidelines for AR therapy improve disease control. Recently, paediatric AR guidelines have been published by the European Academy of Allergy and Clinical Immunology and are available online, as are a patient care pathway for children with AR and asthma from the Royal College of Paediatrics and Child Health. Management involves diagnosis, followed by avoidance of relevant allergens, with additional pharmacotherapy needed for most sufferers. This ranges, according to severity, from saline sprays, through non-sedating antihistamines, oral or topical, with minimally bioavailable intranasal corticosteroids for moderate/severe disease, possibly plus additional antihistamine or antileukotriene. The concept of rhinitis control is emerging, but there is no universally accepted definition. Where pharmacotherapy fails, allergen-specific immunotherapy, which is uniquely able to alter long-term disease outcomes, should be considered. The subcutaneous form (subcutaneous immunotherapy) in children has been underused because of concerns regarding safety and acceptability of injections. Sublingual immunotherapy is both efficacious and safe for grass pollen allergy. Further studies on other allergens in children are needed. Patient, carer and practitioner education into AR and its treatment are a vital part of management. PMID:25838332

  19. Allergic rhinoconjunctivitis: burden of disease.

    PubMed

    Blaiss, Michael S

    2007-01-01

    Even though there is no mortality associated with allergic rhinoconjunctivitis (AR), there is significant morbidity in sufferers of this condition. The exact number of patients with AR is difficult to ascertain, with studies showing ranges from 9 to 42% of the population. Recently, the Allergies in America survey found that 14.2% of the adult U.S. population has been diagnosed with AR. It is well established that AR has a profound influence on the patient's quality of life. Not only do people with AR complain of rhinorrhea, nasal congestion, sneezing, itching, and associated eye problems disturbing, but they also have impaired emotional wellbeing and social functioning. Costs are a major burden in AR studies showing at least $6 billion/year. Although most attention related to costs in AR have been evaluating direct costs due to physician consultation and medical treatment, it is now clear that indirect costs are a major aspect of total costs in AR, especially for American businesses. Indirect costs include absenteeism from work or school because of illness and decreased productivity when at work or presenteeism. AR should be treated seriously by the medical community. Proper treatment of AR patients should not only greatly improve their quality of life, but also bring down health care costs, especially indirect ones, associated with this condition. PMID:17883905

  20. The burden of allergic rhinitis.

    PubMed

    Nathan, Robert A

    2007-01-01

    Although formerly regarded as a nuisance disease, allergic rhinitis (AR) has a considerable effect on quality of life and can have significant consequences if left untreated. The total burden of this disease lies not only in impaired physical and social functioning but also in a financial burden made greater when considering evidence that AR is a possible causal factor in comorbid diseases such as asthma or sinusitis. Compared with matched controls, patients with AR have an approximate twofold increase in medication costs and 1.8-fold the number of visits to health practitioners. Hidden direct costs include the treatment of comorbid asthma, chronic sinusitis, otitis media, upper respiratory infection, and nasal polyposis. Nasal congestion, the most prominent symptom in AR, is associated with sleep-disordered breathing, a condition that can have a profound effect on mental health, including increased psychiatric disorders, depression, anxiety, and alcohol abuse. Furthermore, sleep-disordered breathing in childhood and adolescence is associated with increased disorders of learning performance, behavior, and attention. In the United States, AR results in 3.5 million lost workdays and 2 million lost schooldays annually. Patients struggle to alleviate their misery, frequently self-adjusting their treatment regimen of over-the-counter and prescription medications because of lack of efficacy, deterioration of efficacy, lack of 24-hour relief, and bothersome side effects. Ironically, health care providers overestimate patient satisfaction with therapy. Therefore, improvement in patient-practitioner communication may enhance patient adherence with prescribed regimens. PMID:17390749

  1. An unusual cause of fungal pneumonia.

    PubMed

    Dharmic, S; Nair, Shraddha; Harish, M

    2015-04-01

    A 65 year old female, known asthmatic on steroids intermittently, with no other co-morbidity presented with fever, breathlessness and cough with mucoid expectoration of ten days duration with bilateral crepts, went for Type II respiratory failure and was intubated followed by tracheostomy in view of prolonged ventilator support. In spite of high end antibiotics as per sputum culture sensitivity, weaning off the ventilator was not possible. Blood investigations revealed leucocytosis with neutrophilic predominance and IgE levels were within normal limits. CT chest showed multiple patchy consolidations of the right upper, middle and lower lobes with ground glass appearance and enlarged mediastinal lymph nodes. Work up for retrovirus, tuberculosis and Sputum for KOH mount was negative. No evidence of sputum and blood eosinophilia. BAL sample grew Curvularia species. Fluconazole 150mg OD was added. Serial imaging of the chest showed resolution of the consolidation and was weaned off the ventilator and was comfortable on room air. Pneumonia caused by Curvularia, in an immune competent patient is very rare. Even in broncho pulmonary involvement these fungi usually occur in allergic conditions as in ABPA than appearing as a solitary cause for lung infection. But if diagnosed and treated early, will respond well to triazoles. This case report highlights a unilateral fungal pneumonia with dramatic clinical improvement post treatment once the rare causative organism was identified. PMID:26015753

  2. Fungal allergy in asthma–state of the art and research needs

    PubMed Central

    2014-01-01

    Sensitization to fungi and long term or uncontrolled fungal infection are associated with poor control of asthma, the likelihood of more severe disease and complications such as bronchiectasis and chronic pulmonary aspergillosis. Modelling suggests that >6.5 million people have severe asthma with fungal sensitizations (SAFS), up to 50% of adult asthmatics attending secondary care have fungal sensitization, and an estimated 4.8 million adults have allergic bronchopulmonary aspergillosis (ABPA). There is much uncertainty about which fungi and fungal allergens are relevant to asthma, the natural history of sensitisation to fungi, if there is an exposure response relationship for fungal allergy, and the pathogenesis and frequency of exacerbations and complications. Genetic associations have been described but only weakly linked to phenotypes. The evidence base for most management strategies in ABPA, SAFS and related conditions is weak. Yet straightforward clinical practice guidelines for management are required. The role of environmental monitoring and optimal means of controlling disease to prevent disability and complications are not yet clear. In this paper we set out the key evidence supporting the role of fungal exposure, sensitisation and infection in asthmatics, what is understood about pathogenesis and natural history and identify the numerous areas for research studies. PMID:24735832

  3. Assessment of allergenicity to fungal allergens of Rohtak city, Haryana, India

    PubMed Central

    Kochar, Sanjeeta; Ahlawat, Manisha; Chaudhary, Dhruva

    2014-01-01

    Fungal spores are known as one of the important bioparticles causing allergic manifestation in human beings. Hence, knowledge of season and prevalence of the airborne allergens to which the patients are exposed is a prerequisite for proper diagnosis and treatment of allergic disorders in hypersensitive individuals. Keeping this in view, aerial survey was performed in the atmosphere of Rohtak city for 2 consecutive years (March 2008–February 2010), using a volumetric petri plate sampler. A total of 45 fungal spore types were recorded during the survey period. In the present study, February–April and July–November were identified as the peak seasons for Rohtak city. Cladosporium was the main contributor to the total fungal load with 25.14% followed by Alternaria (18.05%), Aspergillus niger (7.66%), Curvularia (5.31%), and Epicoccum (5.29%). Fifteen dominant viable fungal spore types were represented in the form of a fungal calendar. An attempt has also been made to assess the allergenicity of some of the fungal types recorded from the atmosphere of Rohtak city. The magnitude of variations observed in markedly positive skin reactions (2+ and above) varied from 17.3 to 2.3%. Penicillium oxalicum showed a markedly positive reaction in maximum number of patients (26; 17.3%) followed by Rhizopus nigricans (23; 15.3%). ELISA was performed with the sera of patients showing markedly positive skin reactions and the sera were classified into four groups based on percent binding. The majority of the sera showed 0–15% binding to different antigenic extracts, while sera showing >60% binding were least in number. Greater than 30% binding was observed against antigens of Rhizopus nigricans, Epicoccum purpurascens, Penicillium oxalicum, Curvularia lunata, Aspergillus flavus, Candida albicans and Neurospora sitophila. The concordance between positive skin reaction and serum-specific IgE antibodies ranged from 16.7 to 69.2%. PMID:24988378

  4. Fungal osteomyelitis and septic arthritis.

    PubMed

    Bariteau, Jason T; Waryasz, Gregory R; McDonnell, Matthew; Fischer, Staci A; Hayda, Roman A; Born, Christopher T

    2014-06-01

    Management of fungal osteomyelitis and fungal septic arthritis is challenging, especially in the setting of immunodeficiency and conditions that require immunosuppression. Because fungal osteomyelitis and fungal septic arthritis are rare conditions, study of their pathophysiology and treatment has been limited. In the literature, evidence-based treatment is lacking and, historically, outcomes have been poor. The most common offending organisms are Candida and Aspergillus, which are widely distributed in humans and soil. However, some fungal pathogens, such as Histoplasma, Blastomyces, Coccidioides, Cryptococcus, and Sporothrix, have more focal areas of endemicity. Fungal bone and joint infections result from direct inoculation, contiguous infection spread, or hematogenous seeding of organisms. These infections may be difficult to diagnose and eradicate, especially in the setting of total joint arthroplasty. Although there is no clear consensus on treatment, guidelines are available for management of many of these pathogens.

  5. Epigenetic regulation of asthma and allergic disease

    PubMed Central

    2014-01-01

    Epigenetics of asthma and allergic disease is a field that has expanded greatly in the last decade. Previously thought only in terms of cell differentiation, it is now evident the epigenetics regulate many processes. With T cell activation, commitment toward an allergic phenotype is tightly regulated by DNA methylation and histone modifications at the Th2 locus control region. When normal epigenetic control is disturbed, either experimentally or by environmental exposures, Th1/Th2 balance can be affected. Epigenetic marks are not only transferred to daughter cells with cell replication but they can also be inherited through generations. In animal models, with constant environmental pressure, epigenetically determined phenotypes are amplified through generations and can last up to 2 generations after the environment is back to normal. In this review on the epigenetic regulation of asthma and allergic diseases we review basic epigenetic mechanisms and discuss the epigenetic control of Th2 cells. We then cover the transgenerational inheritance model of epigenetic traits and discuss how this could relate the amplification of asthma and allergic disease prevalence and severity through the last decades. Finally, we discuss recent epigenetic association studies for allergic phenotypes and related environmental risk factors as well as potential underlying mechanisms for these associations. PMID:24932182

  6. Benzaldehyde suppresses murine allergic asthma and rhinitis.

    PubMed

    Jang, Tae Young; Park, Chang-Shin; Kim, Kyu-Sung; Heo, Min-Jeong; Kim, Young Hyo

    2014-10-01

    To evaluate the antiallergic effects of oral benzaldehyde in a murine model of allergic asthma and rhinitis, we divided 20 female BALB/c mice aged 8-10 weeks into nonallergic (intraperitoneally sensitized and intranasally challenged to normal saline), allergic (intraperitoneally sensitized and intranasally challenged to ovalbumin), and 200- and 400-mg/kg benzaldehyde (allergic but treated) groups. The number of nose-scratching events in 10 min, levels of total and ovalbumin-specific IgE in serum, differential counts of inflammatory cells in bronchoalveolar lavage (BAL) fluid, titers of Th2 cytokines (IL-4, IL-5, IL-13) in BAL fluid, histopathologic findings of lung and nasal tissues, and expressions of proteins involved in apoptosis (Bcl-2, Bax, caspase-3), inflammation (COX-2), antioxidation (extracellular SOD, HO-1), and hypoxia (HIF-1α, VEGF) in lung tissue were evaluated. The treated mice had significantly fewer nose-scratching events, less inflammatory cell infiltration in lung and nasal tissues, and lower HIF-1α and VEGF expressions in lung tissue than the allergic group. The number of eosinophils and neutrophils and Th2 cytokine titers in BAL fluid significantly decreased after the treatment (P<0.05). These results imply that oral benzaldehyde exerts antiallergic effects in murine allergic asthma and rhinitis, possibly through inhibition of HIF-1α and VEGF.

  7. Fungal mastoiditis in immunocompromised children.

    PubMed

    Slack, C L; Watson, D W; Abzug, M J; Shaw, C; Chan, K H

    1999-01-01

    The immunocompromised host is subject to a variety of opportunistic infections. Mycotic infections, including invasive fungal sinusitis, are a dreaded complication in immune deficient children. Fungal mastoiditis has rarely been described in this population. Our experience with 2 cases of fungal mastoiditis in immunocompromised children is reviewed. Case histories describing aggressive medical management with and without surgical intervention and a review of the literature are presented. PMID:9932592

  8. Fungal Genome Sequencing and Bioenergy

    SciTech Connect

    Baker, Scott E.; Thykaer, Jette; Adney, William S.; Brettin, T.; Brockman, Fred J.; D'haeseleer, Patrik; Martinez, Antonio D.; Miller, R. M.; Rokhsar, Daniel S.; Schadt, Christopher W.; Torok, Tamas; Tuskan, Gerald; Bennett, Joan W.; Berka, Randy; Briggs, Steve; Heitman, Joseph; Taylor, John; Turgeon, Barbara G.; Werner-Washburne, Maggie; Himmel, Michael E.

    2008-09-30

    To date, the number of ongoing filamentous fungal genome sequencing projects is almost tenfold fewer than those of bacterial and archaeal genome projects. The fungi chosen for sequencing represent narrow kingdom diversity; most are pathogens or models. We advocate an ambitious, forward-looking phylogenetic-based genome sequencing program, designed to capture metabolic diversity within the fungal kingdom, thereby enhancing research into alternative bioenergy sources, bioremediation, and fungal-environment interactions.

  9. Fungal Genome Sequencing and Bioenergy

    SciTech Connect

    Baker, Scott; Thykaer, Jette; Adney, William S; Brettin, Tom; Brockman, Fred; Dhaeseleer, Patrick; Martinez, A diego; Miller, R michael; Rokhsar, Daniel; Schadt, Christopher Warren; Torok, Tamas; Tuskan, Gerald A; Bennett, Joan; Berka, Randy; Briggs, Steven; Heitman, Joseph; Taylor, John; Turgeon, Gillian; Werner-Washburne, Maggie; Himmel, Michael E

    2008-01-01

    To date, the number of ongoing filamentous fungal genome sequencing projects is almost tenfold fewer than those of bacterial and archaeal genome projects. The fungi chosen for sequencing represent narrow kingdom diversity; most are pathogens or models. We advocate an ambitious, forward-looking phylogenetic-based genome sequencing program, designed to capture metabolic diversity within the fungal kingdom, thereby enhancing research into alternative bioenergy sources, bioremediation, and fungal-environment interactions. Published by Elsevier Ltd on behalf of The British Mycological Society.

  10. Fungal Genome Sequencing and Bioenergy

    SciTech Connect

    Schadt, Christopher Warren; Baker, Scott; Thykaer, Jette; Adney, William S; Brettin, Tom; Brockman, Fred; Dhaeseleer, Patrick; Martinez, A diego; Miller, R michael; Rokhsar, Daniel; Torok, Tamas; Tuskan, Gerald A; Bennett, Joan; Berka, Randy; Briggs, Steven; Heitman, Joseph; Rizvi, L; Taylor, John; Turgeon, Gillian; Werner-Washburne, Maggie; Himmel, Michael

    2008-01-01

    To date, the number of ongoing filamentous fungal genome sequencing projects is almost tenfold fewer than those of bacterial and archaeal genome projects. The fungi chosen for sequencing represent narrow kingdom diversity; most are pathogens or models. We advocate an ambitious, forward-looking phylogenetic-based genome sequencing program, designed to capture metabolic diversity within the fungal kingdom, thereby enhancing research into alternative bioenergy sources, bioremediation, and fungal-environment interactions.

  11. Preventing atopy and allergic disease.

    PubMed

    Heine, Ralf G

    2014-01-01

    Due to the recent exponential increase in food allergies and atopic disorders, effective allergy prevention has become a public health priority in many developed regions. Important preventive strategies include the promotion of breastfeeding and vaginal deliveries, judicious use of perinatal antibiotics, as well as the avoidance of maternal tobacco smoking. Breastfeeding for at least 6 months and introduction of complementary solids from 4-6 months are generally recommended. Complex oligosaccharides in breast milk support the establishment of bifidobacteria in the neonatal gut which stimulate regulatory T lymphocyte responses and enhance tolerance development. Maternal elimination diets during pregnancy or lactation are not effective in preventing allergies. If exclusive breastfeeding is not possible, (supplemental) feeding with a partially hydrolyzed whey-based formula or extensively hydrolyzed casein-based formula may reduce the risk of cow's milk allergy and atopic dermatitis in infants with a family history of atopy. By contrast, asthma and allergic rhinitis at 4-6 years of age are not prevented by this approach. Soy formula and amino acid-based formula have no proven role in allergy prevention. Perinatal supplementation with probiotics and/or prebiotics may reduce the risk of atopic dermatitis, but no reliable effect on the prevention of food allergy or respiratory allergies has so far been found. A randomized trial on maternal fish oil supplementation during pregnancy found that atopic dermatitis and egg sensitization in the first year of life were significantly reduced, but no preventive effect for food allergies was demonstrated. The role of vitamin D deficiency or excess as a risk factor for food allergy and atopic disorders requires further study.

  12. Preventing atopy and allergic disease.

    PubMed

    Heine, Ralf G

    2014-01-01

    Due to the recent exponential increase in food allergies and atopic disorders, effective allergy prevention has become a public health priority in many developed regions. Important preventive strategies include the promotion of breastfeeding and vaginal deliveries, judicious use of perinatal antibiotics, as well as the avoidance of maternal tobacco smoking. Breastfeeding for at least 6 months and introduction of complementary solids from 4-6 months are generally recommended. Complex oligosaccharides in breast milk support the establishment of bifidobacteria in the neonatal gut which stimulate regulatory T lymphocyte responses and enhance tolerance development. Maternal elimination diets during pregnancy or lactation are not effective in preventing allergies. If exclusive breastfeeding is not possible, (supplemental) feeding with a partially hydrolyzed whey-based formula or extensively hydrolyzed casein-based formula may reduce the risk of cow's milk allergy and atopic dermatitis in infants with a family history of atopy. By contrast, asthma and allergic rhinitis at 4-6 years of age are not prevented by this approach. Soy formula and amino acid-based formula have no proven role in allergy prevention. Perinatal supplementation with probiotics and/or prebiotics may reduce the risk of atopic dermatitis, but no reliable effect on the prevention of food allergy or respiratory allergies has so far been found. A randomized trial on maternal fish oil supplementation during pregnancy found that atopic dermatitis and egg sensitization in the first year of life were significantly reduced, but no preventive effect for food allergies was demonstrated. The role of vitamin D deficiency or excess as a risk factor for food allergy and atopic disorders requires further study. PMID:24504215

  13. Treatment of Allergic Rhinitis with Probiotics: An Alternative Approach

    PubMed Central

    Yang, Gui; Liu, Zhi-Qiang; Yang, Ping-Chang

    2013-01-01

    Allergic rhinitis is a skewed immune reaction to common antigens in the nasal mucosa; current therapy is not satisfactory and can cause a variety of complications. In recent decades, the incidence of allergic rhinitis is increasing every year. Published studies indicate that probiotics are beneficial in treating allergic rhinitis. This review aims to help in understanding the role of probiotics in the treatment of allergic rhinitis. We referred to the PubMed database as data source. This review focuses on the following aspects: The types of probiotics using in the treatment of allergic rhinitis, approaches of administration, its safety, mechanisms of action, treating results, and the perspectives to improve effectiveness of probiotics in the treatment of allergic rhinitis. This review reports the recent findings regarding the role of probiotics in the treatment of allergic rhinitis. Probiotics are a useful therapeutic remedy in the treatment of allergic rhinitis, but its underlying mechanisms remain to be further investigated. PMID:24083221

  14. Oleanolic acid controls allergic and inflammatory responses in experimental allergic conjunctivitis.

    PubMed

    Córdova, Claudia; Gutiérrez, Beatriz; Martínez-García, Carmen; Martín, Rubén; Gallego-Muñoz, Patricia; Hernández, Marita; Nieto, María L

    2014-01-01

    Pollen is the most common aeroallergen to cause seasonal conjunctivitis. The result of allergen exposure is a strong Th2-mediated response along with conjunctival mast cell degranulation and eosinophilic infiltration. Oleanolic acid (OA) is natural a triterpene that displays strong anti-inflammatory and immunomodulatory properties being an active anti-allergic molecule on hypersensitivity reaction models. However, its effect on inflammatory ocular disorders including conjunctivitis, has not yet been addressed. Hence, using a Ragweed pollen (RWP)-specific allergic conjunctivitis (EAC) mouse model we study here whether OA could modify responses associated to allergic processes. We found that OA treatment restricted mast cell degranulation and infiltration of eosinophils in conjunctival tissue and decreased allergen-specific Igs levels in EAC mice. Th2-type cytokines, secreted phospholipase A2 type-IIA (sPLA2-IIA), and chemokines levels were also significantly diminished in the conjunctiva and serum of OA-treated EAC mice. Moreover, OA treatment also suppressed RWP-specific T-cell proliferation. In vitro studies, on relevant cells of the allergic process, revealed that OA reduced the proliferative and migratory response, as well as the synthesis of proinflammatory mediators on EoL-1 eosinophils and RBL-2H3 mast cells exposed to allergic and/or crucial inflammatory stimuli such as RWP, sPLA2-IIA or eotaxin. Taken together, these findings demonstrate the beneficial activity of OA in ocular allergic processes and may provide a new intervention strategy and potential therapy for allergic diseases.

  15. Allergic reaction after rubber dam placement.

    PubMed

    de Andrade, E D; Ranali, J; Volpato, M C; de Oliveira, M M

    2000-03-01

    In the last few years allergic reactions to natural rubber latex (NRL) have increased in dental practice affecting both the dental team and patients. Some case reports discuss the potential risks of hypersensitivity to NRL products. An adverse patient reaction after dental rubber dam placement is reported. About 1 min after the isolation of the tooth with a rubber dam the patient presented signs and symptoms of hypersensitivity. Oxygen and intravenous hydrocortisone were administered and the patient kept under observation. After 2 h she had stable vital signs and no more allergics symptoms. It is unclear whether components of the NRL dam or the cornstarch powder incorporated with the rubber dam was responsible for the allergic reaction. Dentists must be aware of the health problem and be prepared for an adequate management in dental practice.

  16. Contact-Allergic Reactions to Cosmetics

    PubMed Central

    Goossens, An

    2011-01-01

    Contact-allergic reactions to cosmetics may be delayed-type reactions such as allergic and photo-allergic contact dermatitis, and more exceptionally also immediate-type reactions, that is, contact urticaria. Fragrances and preservative agents are the most important contact allergens, but reactions also occur to category-specific products such as hair dyes and other hair-care products, nail cosmetics, sunscreens, as well as to antioxidants, vehicles, emulsifiers, and, in fact, any possible cosmetic ingredient. Patch and prick testing to detect the respective culprits remains the golden standard for diagnosis, although additional tests might be useful as well. Once the specific allergens are identified, the patients should be informed of which products can be safely used in the future. PMID:21461388

  17. [Housing conditions and allergic sensitization in children].

    PubMed

    Heinrich, J; Hölscher, B; Wjst, M

    1998-09-01

    Genetic predisposition and indoor exposure to allergens-especially during the very early childhood years are major factors for the development of allergic diseases later in life. The present study analyzed the association between allergic sensitization in children aged 5 to 14 years and residing since birth in homes of different building types. A cross-sectional study of 811 children aged 5 to 14 years who resided in the same home since birth investigated indoor factors using a questionnaire and allergic sensitization assessed by skin prick test. The prevalence of allergic sensitization was compared between children who lived since birth in five different building types. After adjustment for age, gender, parental education and study area the odds of allergic sensitization were higher among children who lived in prefabricated concrete slab buildings built after 1970 (OR 1.56, 95% CI: 1.02-2.38) and among children who lived in new brick buildings (OR 1.75, 95% CI: 0.88-3.47) than among children who lived in old brick buildings. Moreover, the odds of pollen sensitization was higher among children who lived in the new building types (prefabricated slab buildings: OR 1.68, 95% CI: 1.04-2.72; new brick buildings: OR 1.48, 95% CI: 0.64-3.42) while living in timber-framed houses was associated with a higher odds of sensitization against mites (OR 1.63, 95% CI: 0.77-3.44). The step by step inclusion of single indoor factors like type of heating, numbers of building storeys, number of persons per room, environmental tobacco smoke, use of gas for cooking purposes, dampness of the home or visible moulds in the logistic regression model only marginally changed the odds ratios. Modern living conditions are associated with a higher odds of allergic sensitization. PMID:9789357

  18. Allergic reactions to insect stings and bites.

    PubMed

    Moffitt, John E

    2003-11-01

    Insect stings are an important cause of anaphylaxis. Anaphylaxis can also occur from insect bites but is less common. Insect venoms contain several well-characterized allergens that can trigger anaphylactic reactions. Effective methods to diagnose insect sting allergy and assess risk of future sting reactions have been developed. Management strategies using insect avoidance measures, self-injectable epinephrine, and allergen immunotherapy are very effective in reducing insect-allergic patients' risk of reaction from future stings. Diagnostic and management strategies for patients allergic to insect bites are less developed.

  19. Allergic and immunologic reactions to food additives.

    PubMed

    Gultekin, Fatih; Doguc, Duygu Kumbul

    2013-08-01

    For centuries, food additives have been used for flavouring, colouring and extension of the useful shelf life of food, as well as the promotion of food safety. During the last 20 years, the studies implicating the additives contained in foods and medicine as a causative factor of allergic reactions have been proliferated considerably. In this review, we aimed to overview all of the food additives which were approved to consume in EU and find out how common and serious allergic reactions come into existence following the consuming of food additives.

  20. [New pets, allergens and allergic dermatitis].

    PubMed

    Brajon, D; Waton, J; Schmutz, J-L; Barbaud, A

    2014-10-01

    The number of household pets increased greatly during the twentieth century, with the numbers of new pets (NP, i.e. any pet other than cats and dogs) rising especially sharply over the last decade. Contact with such animals, whose owners do not always know how to look after them properly, expose the population to new risks such as trauma, infection and allergy. While the most common allergies are respiratory, allergic skin reactions, both immediate and delayed, may also result from contact with these new allergens. The animal itself or its environment may be the cause. Herein, we review NPs and reports of allergic dermatitis associated with them.

  1. Allergic Reactions to Pine Nut: A Review.

    PubMed

    Cabanillas, B; Novak, N

    2015-01-01

    Pine nut is a nutrient-rich food with a beneficial impact on human health. The many bioactive constituents of pine nut interact synergistically to affect human physiology in a favorable way. However, pine nut can trigger dangerous allergic reactions. Severe anaphylactic reactions to pine nut accounted for most of the 45 cases reported in the scientific literature. Pine nut allergy seems to be characterized by low IgE cross-reactivity with other commonly consumed nuts and a high monosensitization rate. The present review provides updated information on allergic reactions to pine nut, molecular characterization of its allergens, and potential homologies with other nut allergens.

  2. Fungal biodiversity to biotechnology.

    PubMed

    Chambergo, Felipe S; Valencia, Estela Y

    2016-03-01

    Fungal habitats include soil, water, and extreme environments. With around 100,000 fungus species already described, it is estimated that 5.1 million fungus species exist on our planet, making fungi one of the largest and most diverse kingdoms of eukaryotes. Fungi show remarkable metabolic features due to a sophisticated genomic network and are important for the production of biotechnological compounds that greatly impact our society in many ways. In this review, we present the current state of knowledge on fungal biodiversity, with special emphasis on filamentous fungi and the most recent discoveries in the field of identification and production of biotechnological compounds. More than 250 fungus species have been studied to produce these biotechnological compounds. This review focuses on three of the branches generally accepted in biotechnological applications, which have been identified by a color code: red, green, and white for pharmaceutical, agricultural, and industrial biotechnology, respectively. We also discuss future prospects for the use of filamentous fungi in biotechnology application.

  3. Allergic contact dermatitis from octisalate and cis-3-hexenyl salicylate.

    PubMed

    Shaw, Daniel W

    2006-09-01

    A 62-year-old woman developed allergic contact dermatitis from sunscreens containing octisalate (octyl salicylate, 2-ethylhexyl salicylate) and from a fragrance containing cis-3-hexenyl salicylate. Results of patch testing and provocative use testing confirmed that she was allergic to octisalate. Provocative use testing indicated that she was also allergic to cis-3-hexenyl salicylate.

  4. DOSE-DEPENDENT ALLERGIC ASTHMA RESPONSES TO PENICILLIUM CHRYSOGENUM

    EPA Science Inventory

    ABSTRACT
    Indoor mold has been associated with development of allergic asthma. Penicillium chrysogenum, a common indoor mold, is known to have several allergens and its viable conidia can induce allergic responses in a mouse model of allergic penicilliosis. The hypothesis o...

  5. Kounis syndrome secondary to allergic reaction following shellfish ingestion.

    PubMed

    Zavras, G M; Papadaki, P J; Kokkinis, C E; Kalokairinov, K; Kouni, S N; Batsolaki, M; Gouvelou-Deligianni, G V; Koutsojannis, C

    2003-09-01

    Two cases of allergic angina and allergic myocardial infarction (Kounis syndrome) secondary to shellfish ingestion are described. The patients had pre-existing quiescent coronary artery disease (type II variant of the syndrome) and the allergic reaction following eating shellfish seemed to have triggered the development of an acute myocardial infarction. The clinical implications are also discussed.

  6. Managing acute invasive fungal sinusitis.

    PubMed

    Dwyhalo, Kristina M; Donald, Carrlene; Mendez, Anthony; Hoxworth, Joseph

    2016-01-01

    Acute invasive fungal sinusitis is the most aggressive form of fungal sinusitis and can be fatal, especially in patients who are immunosuppressed. Early diagnosis and intervention are crucial and potentially lifesaving, so primary care providers must maintain a high index of suspicion for this disease. Patients may need to be admitted to the hospital for IV antifungal therapy and surgical debridement.

  7. Characterizing Aeroallergens by Infrared Spectroscopy of Fungal Spores and Pollen

    PubMed Central

    Zimmermann, Boris; Tkalčec, Zdenko; Mešić, Armin; Kohler, Achim

    2015-01-01

    Background Fungal spores and plant pollen cause respiratory diseases in susceptible individuals, such as asthma, allergic rhinitis and hypersensitivity pneumonitis. Aeroallergen monitoring networks are an important part of treatment strategies, but unfortunately traditional analysis is time consuming and expensive. We have explored the use of infrared spectroscopy of pollen and spores for an inexpensive and rapid characterization of aeroallergens. Methodology The study is based on measurement of spore and pollen samples by single reflectance attenuated total reflectance Fourier transform infrared spectroscopy (SR-ATR FTIR). The experimental set includes 71 spore (Basidiomycota) and 121 pollen (Pinales, Fagales and Poales) samples. Along with fresh basidiospores, the study has been conducted on the archived samples collected within the last 50 years. Results The spectroscopic-based methodology enables clear spectral differentiation between pollen and spores, as well as the separation of confamiliar and congeneric species. In addition, the analysis of the scattering signals inherent in the infrared spectra indicates that the FTIR methodology offers indirect estimation of morphology of pollen and spores. The analysis of fresh and archived spores shows that chemical composition of spores is well preserved even after decades of storage, including the characteristic taxonomy-related signals. Therefore, biochemical analysis of fungal spores by FTIR could provide economical, reliable and timely methodologies for improving fungal taxonomy, as well as for fungal identification and monitoring. This proof of principle study shows the potential for using FTIR as a rapid tool in aeroallergen studies. In addition, the presented method is ready to be immediately implemented in biological and ecological studies for direct measurement of pollen and spores from flowers and sporocarps. PMID:25867755

  8. The characteristics of indoor and outdoor fungi and their relation with allergic respiratory diseases in the southern region of Turkey.

    PubMed

    Arikoglu, Tugba; Batmaz, Sehra Birgul; Coşkun, Taner; Otag, Feza; Yildirim, Didem Derici; Kuyucu, Semanur

    2016-06-01

    Indoor and outdoor fungal exposure has been shown to be associated with the development of allergic respiratory diseases. The aim of the study was to investigate the types and concentrations of airborne fungi inside and outside homes and evaluate the association between fungal levels and allergic diseases in the southern region of Turkey. A total of 61 children admitted with respiratory complaints to the pediatric allergy clinic between September 2007 and November 2008 were included in this study. The air samples were obtained using the Air IDEAL volumetric air sampler longitudinally for 1 year. A comprehensive questionnaire was used for medical history and housing conditions. Skin prick test was performed to determine fungal sensitivity and spirometric indices were employed. The predominant indoor fungal species were Cladosporium (69.3 %), Penicillium (18.9 %), Aspergillus (6.5 %), and Alternaria (3.1 %). A strong correlation between indoor and outdoor fungal levels was detected for the Cladosporium species (p < 0.001, r = 0.72) throughout the year. Living in a detached home (p = 0.036) and the presence of cockroaches (p = 0.005) were associated with total indoor fungal levels. The presence of cockroaches (aOR 3.5; 95 % CI 0.95-13.10, p = 0.059) was also associated with fungal sensitization at the edge of significance. The statistical cutoff values of indoor and outdoor Cladosporium levels to predict symptomatic asthma were found to be >176 CFU/m(3) (p = 0.003, AUC 0.696; sensitivity 65.5 %; specificity 68.7 %) and >327 CFU/m(3) (p = 0.038; AUC 0.713; sensitivity 66.6 %; specificity 76.9 %), respectively. Children with respiratory symptoms are exposed to a considerable level of fungi inside and outside their homes. The prevention of fungal exposure may provide valuable intervention for respiratory diseases.

  9. Allergic Contact Dermatitis to Eye Drops

    PubMed Central

    Bhat, Yasmeen Jabeen; Zeerak, Sumaya; Hassan, Iffat

    2015-01-01

    Allergic contact dermatitis (ACD) occurs due to a milieu of allergens and involves different anatomical sites, including eyelids, and periorbital areas. Topically applied ophthalmic drugs are a potential cause of ACD of the periorbital region. Here we describe the report of a patient who developed ACD to eye drop preparations. PMID:26677304

  10. Study of Allergic Rhinitis in Childhood

    PubMed Central

    Balatsouras, Dimitrios G.; Koukoutsis, George; Ganelis, Panayotis; Fassolis, Alexandros; Korres, George S.; Kaberos, Antonis

    2011-01-01

    Allergic rhinitis is common among children and quite often represents a stage of the atopic march. Although sensitization to food and airborne allergens may appear in infancy and early childhood, symptoms of the disease are usually present after age 3. The aim of this study was to determine the most frequent food and indoor and outdoor respiratory allergens involved in allergic rhinitis in children in the region of Piraeus. The study was performed in the outpatient clinic of otolaryngologic allergy of a general hospital. Fifty children (ranged 6–14 ) with symptoms of allergic rhinitis and positive radioallergosorbent test (RAST) for IgE antibodies or skin prick tests were included in the study. Thirty six (72%) of the subjects of the study had intermittent allergic rhinitis. The most common aeroallergens determined were grass pollens and Parietaria, whereas egg and milk were the food allergens identified. The detection of indoor and outdoor allergens in the region of Piraeus, based on skin prick tests and RAST tests, showed high incidence of grasses and food allergens, which is similar to other Mediterranean countries. PMID:21760801

  11. Silibinin attenuates allergic airway inflammation in mice

    SciTech Connect

    Choi, Yun Ho; Jin, Guang Yu; Guo, Hui Shu; Piao, Hong Mei; Li, Liang chang; Li, Guang Zhao; Lin, Zhen Hua; Yan, Guang Hai

    2012-10-26

    Highlights: Black-Right-Pointing-Pointer Silibinin diminishes ovalbumin-induced inflammatory reactions in the mouse lung. Black-Right-Pointing-Pointer Silibinin reduces the levels of various cytokines into the lung of allergic mice. Black-Right-Pointing-Pointer Silibinin prevents the development of airway hyperresponsiveness in allergic mice. Black-Right-Pointing-Pointer Silibinin suppresses NF-{kappa}B transcriptional activity. -- Abstract: Allergic asthma is a chronic inflammatory disease regulated by coordination of T-helper2 (Th2) type cytokines and inflammatory signal molecules. Silibinin is one of the main flavonoids produced by milk thistle, which is reported to inhibit the inflammatory response by suppressing the nuclear factor-kappa B (NF-{kappa}B) pathway. Because NF-{kappa}B activation plays a pivotal role in the pathogenesis of allergic inflammation, we have investigated the effect of silibinin on a mouse ovalbumin (OVA)-induced asthma model. Airway hyperresponsiveness, cytokines levels, and eosinophilic infiltration were analyzed in bronchoalveolar lavage fluid and lung tissue. Pretreatment of silibinin significantly inhibited airway inflammatory cell recruitment and peribronchiolar inflammation and reduced the production of various cytokines in bronchoalveolar fluid. In addition, silibinin prevented the development of airway hyperresponsiveness and attenuated the OVA challenge-induced NF-{kappa}B activation. These findings indicate that silibinin protects against OVA-induced airway inflammation, at least in part via downregulation of NF-{kappa}B activity. Our data support the utility of silibinin as a potential medicine for the treatment of asthma.

  12. Bilastine: in allergic rhinitis and urticaria.

    PubMed

    Carter, Natalie J

    2012-06-18

    Bilastine is an orally administered, second-generation antihistamine used in the symptomatic treatment of seasonal or perennial allergic rhinoconjunctivitis and urticaria. In two well designed phase III trials, 14 days' treatment with bilastine was associated with a significantly lower area under the effect curve (AUEC) for the reflective total symptom score (TSS) than placebo in patients with symptomatic seasonal allergic rhinitis. Additionally, reflective nasal symptom scores were significantly lower in bilastine than placebo recipients in patients with a history of seasonal allergic rhinitis who were challenged with grass pollen allergen in a single-centre, phase II study. Neither bilastine nor cetirizine was effective in the treatment of perennial allergic rhinitis with regard to the mean AUEC for reflective TSS in another well designed phase III trial. However, results may have been altered by differences in some baseline characteristics and placebo responses between study countries. In another well designed phase III trial, compared with placebo, bilastine was associated with a significantly greater change from baseline to day 28 in the mean reflective daily urticaria symptom score in patients with chronic urticaria. There were no significant differences in primary endpoint results between bilastine and any of the active comparators used in these trials (i.e. cetirizine, levocetirizine and desloratadine). Bilastine was generally well tolerated, with a tolerability profile that was generally similar to that of the other second-generation antihistamines included in phase III clinical trials. PMID:22686617

  13. Treatment of allergic rhinitis during pregnancy.

    PubMed

    Demoly, Pascal; Piette, Vincent; Daures, Jean-Pierre

    2003-01-01

    Allergic rhinitis is a frequent problem during pregnancy. In addition, physiological changes associated with pregnancy can affect the upper airways. Evidence-based guidelines on the management of allergic rhinitis have recently been published, the most recent being the Allergic Rhinitis and its Impact on Asthma (ARIA)--World Health Organization consensus. Many pregnant women experience allergic rhinitis and particular attention is required when prescribing drugs to these patients. Medication can be prescribed during pregnancy when the apparent benefit of the drug is greater than the apparent risk. Usually, there is at least one drug from each major class that can be safely utilised to control symptoms. All glucocorticosteroids are teratogenic in animals but, when the indication is clear (for diseases possibly associated, such as severe asthma exacerbation), the benefit of the drug is far greater than the risk. Inhaled glucocorticosteroids (e.g. beclomethasone or budesonide) have not been incriminated as teratogens in humans and are used by pregnant women who have asthma. A few histamine H(1)-receptor antagonists (H(1)-antihistamines) can safely be used as well. Most oral decongestants (except pseudoephedrine) are teratogenic in animals. There are no such data available for intra-nasal decongestants. Finally, pregnancy is not considered as a contraindication for the continuation of allergen specific immunotherapy.

  14. Evaluation of allergic response using dynamic thermography

    NASA Astrophysics Data System (ADS)

    Rokita, E.; Rok, T.; Tatoń, G.

    2015-03-01

    Skin dynamic termography supplemented by a mathematical model is presented as an objective and sensitive indicator of the skin prick test result. Termographic measurements were performed simultaneously with routine skin prick tests. The IR images were acquired every 70 s up to 910 s after skin prick. In the model histamine is treated as the principal mediator of the allergic reaction. Histamine produces vasolidation and the engorged vessels are responsible for an increase in skin temperature. The model parameters were determined by fitting the analytical solutions to the spatio-temporal distributions of the differences between measured and baseline temperatures. The model reproduces experimental data very well (coefficient of determination = 0.805÷0.995). The method offers a set of parameters to describe separately skin allergic reaction and skin reactivity. The release of histamine after allergen injection is the best indicator of allergic response. The diagnostic parameter better correlates with the standard evaluation of a skin prick test (correlation coefficient = 0.98) than the result of the thermographic planimetric method based on temperature and heated area determination (0.81). The high sensitivity of the method allows for determination of the allergic response in patients with the reduced skin reactivity.

  15. Novel delivery systems for anti-allergic agents: allergic disease and innovative treatments.

    PubMed

    Lopes, Carla M; Coelho, Pedro B; Oliveira, Rita

    2015-01-01

    Anti-allergic agents are used to treat a great variety of diseases which usually involve an inflammation reaction. These compounds act by inhibiting the release and the effects of inflammatory mediators (e.g. histamine) in the target tissue. The purpose of anti-allergy therapy is to deliver the drug to its local of action in a therapeutic concentration, minimizing the undesired side effects. In order to solve some of the anti-allergic agents' physicochemical drawbacks and the limitations associated to conventional pharmaceutical formulations (e.g. poor solubility and absorption, skin permeation, stability), novel drug delivery systems, such as cyclodextrins, liposomes, micelles, microemulsions, nano and microparticles, have been developed. Depending on the allergic condition, several administration routes are used to deliver anti-allergic agents, each with its own disadvantages to overcome. In the literature, there are a vast number of papers concerning novel delivery systems for anti-allergic agents, making it difficult to evaluate the information and the promising outcomes. The aim of the present review article is to compile the recent (i.e. in the new millennium) improvements of novel drug delivery technology focusing on the achievement of anti-allergic therapeutic delivery. The potential intrinsic benefits of these systems will reflect an increased therapeutic adherence and better patients' life quality. A critical prospect of future clinical trial directions will also be discussed. PMID:25895551

  16. Liposomal Nasal Spray versus Guideline-Recommended Steroid Nasal Spray in Patients with Chronic Rhinosinusitis: A Comparison of Tolerability and Quality of Life

    PubMed Central

    Eitenmüller, Anna; Böhm, Myriam; Glowania, Andreas; Pfaar, Oliver; Mösges, Ralph; Klimek, Ludger

    2014-01-01

    Objective. To investigate the tolerability and impact on quality of life of liposomal nasal spray compared to guideline-recommended steroid-based therapy in patients with chronic rhinosinusitis. Symptom reduction and use of antisymptomatic medication were also examined. Methods. In this monocenter, prospective, controlled, open, and noninterventional study, 60 patients with chronic rhinosinusitis were treated with liposomal nasal spray and 30 patients received steroid-based therapy. The study comprised five visits occurring at intervals of two to four weeks. Efficacy was determined according to the sinusitis symptom score documented daily. The polyp score was recorded at the initial and final visits. Tolerability was determined through the Nasal Spray Evaluation Questionnaire, and quality of life was ascertained with the SNOT-20 Score. Results. Both treatments achieved a significant reduction of sinusitis symptoms (P < 0.05) and also rhinoscopic improvement (P < 0.05). The majority of patients assessed the treatments as “good” or “very good,” and the quality of life improved significantly (P < 0.05). There was no significant difference in symptom reduction, QoL, and endoscopic exams between both treatments. Conclusion. The treatment of chronic rhinosinusitis with liposomal nasal spray results in a similar, significant reduction of symptoms and significant improvement in quality of life as guideline-recommended treatment and is therefore a comparable alternative. PMID:24963305

  17. Mold and human health: separating the wheat from the chaff.

    PubMed

    Pettigrew, H David; Selmi, Carlo F; Teuber, Suzanne S; Gershwin, M Eric

    2010-04-01

    The term "mold" is utilized to define the ubiquitous fungal species commonly found in household dust and observed as visible multicellular filaments. Several well-defined human diseases are known to be caused or exacerbated by mold or by exposure to their byproducts. Among these, a solid connection has been established with infections, allergic bronchopulmonary aspergillosis, allergic fungal rhinosinusitis, hypersensitivity pneumonitis, and asthma. In the past decades, other less-defined and generally false conditions have also been ascribed to mold. We will herein review and critically discuss the available evidence on the influence of mold on human health.

  18. Toxic and other non-IgE-mediated effects of fungal exposures.

    PubMed

    Nordness, Mark E; Zacharisen, Michael C; Fink, Jordan N

    2003-09-01

    There are more than 100000 recognized species of fungi, comprising 25% of the biomass of the earth. Allergic, IgE-induced, manifestations of airborne fungi are common, whereas non-IgE manifestations are rare. Recently, much focus has been placed on the non-IgE-mediated effects of various molds, including hypersensitivity pneumonitis, infectious disease, and mycotoxicoses. Hypersensitivity pneumonitis is a clinical syndrome associated with systemic and interstitial lung disease that occurs in susceptible individuals following fungal inhalation. Most fungi are not pathogenic to man; however, certain fungi are capable of infecting immunocompetent individuals. Although mycotoxins and exposure to mycotoxins ("toxic mold syndrome") are implicated in causing numerous, nonspecific, systemic symptoms, currently, there is no scientific evidence to support the allegation that human health is affected by inhaled mycotoxins. However, if mold is discovered in a home, school, or office setting, the source should be investigated and appropriate remediation undertaken to minimize structural damage and potential allergic sensitization. PMID:12906783

  19. ALLERGIC DISEASES AND ASTHMA IN ADOLESCENTS.

    PubMed

    Adamia, N; Jorjoliani, L; Khachapuridze, D; Katamadze, N; Chkuaseli, N

    2015-06-01

    The goal of our research was to find out, whether asthma phenotyping, based on presence of accompanying allergic diseases is significant for asthma classification or not. Research was conducted on the basis of questioning of random and representative cohorts of Tbilisi children's population, by cross-section method of epidemiological research. Special extended screening questionnaire was developed for epidemiological study of allergic diseases. Diagnostic criterion for allergy was analyzed and representative cohort was selected. Research was conducted in 2010-2014 period. Studied population included 1450 children from 2 to 17 years age representing Tbilisi general population (of them, 850 girls and 600 boys). As a result of research the following findings were made: asthma was confirmed where at least two of the listed was present: diagnosis of asthma made by doctor, asthma symptoms and consumption of drugs against asthma. Allergic rhinitis was confirmed, where more than one of the listed symptoms was present and children should not have caught cold, rhinorrhea, nasal obstruction or snore, combined or IgE with some inhalation allergen. Atopic dermatitis was confirmed if the subject had atopic dermatitis at a time of interview or clinical study. Markers of asthma severity were based on number of asthma episodes and number of symptoms, or regular consumption of corticosteroids, number of missed days at school and answer of subjects to the question: for the past year what was the degree of discomfort attributable to asthma ("very high" - "absolutely not"). Allergic sensitization was assessed based on the skin prick-test and test of specific immunoglobulin E in serum and was deemed positive where the average diameter of blebs in skin prick tests was 3 mm larger than negative control and IgE-0,35kU/l. Lung function was assessed by means of respirometers, by evaluating maximal forced expiration data and flow-volume curves. Allergic rhinitis was regarded as the most

  20. DIFFERENTIAL ALLERGIC AND NEUROTROPHIN RESPONSES TO FUNGAL COMPONENT EXTRACTS IN BALB/C MICE

    EPA Science Inventory

    Metarhizium anisopliae mycelium (MYC), conidia (CON) and inducible protease (IND) extracts were combined to produce the antigen MACA to screen for allergenic potential. Involuntary aspiration (IA) exposure to MACA in BALB/c mice has caused immune, inflammatory and physiological ...

  1. Oleanolic Acid Controls Allergic and Inflammatory Responses in Experimental Allergic Conjunctivitis

    PubMed Central

    Martínez-García, Carmen; Martín, Rubén; Gallego-Muñoz, Patricia; Hernández, Marita; Nieto, María L.

    2014-01-01

    Pollen is the most common aeroallergen to cause seasonal conjunctivitis. The result of allergen exposure is a strong Th2-mediated response along with conjunctival mast cell degranulation and eosinophilic infiltration. Oleanolic acid (OA) is natural a triterpene that displays strong anti-inflammatory and immunomodulatory properties being an active anti-allergic molecule on hypersensitivity reaction models. However, its effect on inflammatory ocular disorders including conjunctivits, has not yet been addressed. Hence, using a Ragweed pollen (RWP)-specific allergic conjunctivitis (EAC) mouse model we study here whether OA could modify responses associated to allergic processes. We found that OA treatment restricted mast cell degranulation and infiltration of eosinophils in conjunctival tissue and decreased allergen-specific Igs levels in EAC mice. Th2-type cytokines, secreted phospholipase A2 type-IIA (sPLA2-IIA), and chemokines levels were also significantly diminished in the conjunctiva and serum of OA-treated EAC mice. Moreover, OA treatment also suppressed RWP-specific T-cell proliferation. In vitro studies, on relevant cells of the allergic process, revealed that OA reduced the proliferative and migratory response, as well as the synthesis of proinflammatory mediators on EoL-1 eosinophils and RBL-2H3 mast cells exposed to allergic and/or crucial inflammatory stimuli such as RWP, sPLA2-IIA or eotaxin. Taken together, these findings demonstrate the beneficial activity of OA in ocular allergic processes and may provide a new intervention strategy and potential therapy for allergic diseases. PMID:24699261

  2. Cancer Patients and Fungal Infections

    MedlinePlus

    ... mould-related diseases in immunocompromised patients. Journal of Antimicrobial Chemotherapy 2011;66:i5-i14. Ribaud P. Fungal ... al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer: 2010 Update ...

  3. Estimated Burden of Serious Fungal Infections in Jamaica by Literature Review and Modelling

    PubMed Central

    Gugnani, HC; Denning, DW

    2015-01-01

    ABSTRACT Objective: Jamaica is one of the largest countries in the Caribbean with a population of 2 706 500. Prevalence of human immunodeficiency virus (HIV) in Jamaica is high, while that of tuberculosis (TB) is recorded to be low. In this study, we have estimated the burden of serious fungal infections and some other mycoses in Jamaica. Methods: All published papers reporting on rates of fungal infections in Jamaica and the Caribbean were identified through extensive search of the literature. We also extracted data from published papers on epidemiology and from the World Health Organization (WHO) TB Programme and UNAIDS. Chronic pulmonary aspergillosis (CPA), allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitization (SAFS) rates were derived from asthma and TB rates. Where there were no available data on some mycoses, we used specific populations at risk and frequencies of fungal infection of each to estimate national prevalence. Results: Over 57 600 people in Jamaica probably suffer from serious fungal infections each year, most related to ‘fungal asthma’ (ABPA and SAFS), recurrent vulvovaginal candidiasis and AIDS-related opportunistic infections. Histoplasmosis is endemic in Jamaica, though only a few clinical cases are known. Pneumocystis pneumonia is frequent while cryptococcosis and aspergillosis are rarely recorded. Tinea capitis was common in children. Recurrent vulvovaginal candidiasis is very common (3154/100 000) and candidaemia occurs. Subcutaneous mycoses such as chromoblastomycosis and mycetoma also seem to be relatively common. Conclusion: Local epidemiological studies are urgently required to validate or modify these estimates of serious fungal infections in Jamaica. PMID:26426178

  4. Allergic rhinitis in children : diagnosis and management strategies.

    PubMed

    Berger, William E

    2004-01-01

    The incidence of allergic rhinitis has been increasing for the last few decades, in keeping with the rising incidence of atopy worldwide. Allergic rhinitis has a prevalence of up to 40% in children, although it frequently goes unrecognized and untreated. This can have enormous negative consequences, particularly in children, since it is associated with numerous complications and comorbidities that have a significant health impact on quality of life. In fact, allergic rhinitis is considered to be a risk factor for asthma. There are numerous signs of allergic rhinitis, particularly in children, that can alert an observant clinician to its presence. Children with severe allergic rhinitis often have facial manifestations of itching and obstructed breathing, including a gaping mouth, chapped lips, evidence of sleep deprivation, a long face, dental malloclusions, and the allergic shiner, allergic salute, or allergic crease. The medical history is extremely important as it can reveal information regarding a family history of atopy and the progression of atopy in the child. It is also important to identify the specific triggers of allergic rhinitis, because one of the keys to successful management is the avoidance of triggers. A tripartite treatment strategy that embraces environmental control, immunotherapy, and pharmacologic treatment is the most comprehensive approach. Immunotherapy has come to be viewed as potentially prophylactic, capable of altering the course of allergic rhinitis. The most recent guidelines for the management of allergic rhinitis issued by the WHO recommend a tiered approach that integrates diagnosis and treatment, in which allergic rhinitis is subclassified both by frequency, as either intermittent or persistent, and by severity, as either mild or moderate to severe. Oral or topical antihistamines and intranasal corticosteroids are the mainstay of pharmacologic therapy for allergic rhinitis, depending upon its severity, and several agents have been

  5. Biosynthesis of Fungal Indole Alkaloids

    PubMed Central

    Xu, Wei; Gavia, Diego J.; Tang, Yi

    2014-01-01

    This review provides a summary of recent research advances in elucidating the biosynthesis of fungal indole alkaloids. Different strategies used to incorporate and derivatize the indole/indoline moieties in various families of fungal indole alkaloids will be discussed, including tryptophan-containing nonribosomal peptides and polyketide-nonribosomal peptide hybrids; and alkaloids derived from other indole building blocks. This review also includes discussion regarding the downstream modifications that generate chemical and structural diversity among indole alkaloids. PMID:25180619

  6. Traversing the fungal terpenome

    PubMed Central

    Quin, Maureen B.; Flynn, Christopher M.; Schmidt-Dannert, Claudia

    2014-01-01

    Fungi (Ascomycota and Basidiomycota) are prolific producers of structurally diverse terpenoid compounds. Classes of terpenoids identified in fungi include the sesqui-, di- and triterpenoids. Biosynthetic pathways and enzymes to terpenoids from each of these classes have been described. These typically involve the scaffold generating terpene synthases and cyclases, and scaffold tailoring enzymes such as e.g. cytochrome P450 monoxygenases, NAD(P)+ and flavin dependent oxidoreductases, and various group transferases that generate the final bioactive structures. The biosynthesis of several sesquiterpenoid mycotoxins and bioactive diterpenoids has been well-studied in Ascomycota (e.g. filamentous fungi). Little is known about the terpenoid biosynthetic pathways in Basidiomycota (e.g. mushroom forming fungi), although they produce a huge diversity of terpenoid natural products. Specifically, many trans-humulyl cation derived sesquiterpenoid natural products with potent bioactivities have been isolated. Biosynthetic gene clusters responsible for the production of trans-humulyl cation derived protoilludanes, and other sesquiterpenoids, can be rapidly identified by genome sequencing and bioinformatic methods. Genome mining combined with heterologous biosynthetic pathway refactoring has the potential to facilitate discovery and production of pharmaceutically relevant fungal terpenoids. PMID:25171145

  7. Structural Analysis of Fungal Cerebrosides

    PubMed Central

    Barreto-Bergter, Eliana; Sassaki, Guilherme L.; de Souza, Lauro M.

    2011-01-01

    Of the ceramide monohexosides (CMHs), gluco- and galactosyl-ceramides are the main neutral glycosphingolipids expressed in fungal cells. Their structural determination is greatly dependent on the use of mass spectrometric techniques, including fast atom bombardment-mass spectrometry, electrospray ionization, and energy collision-induced dissociation mass spectrometry. Nuclear magnetic resonance has also been used successfully. Such a combination of techniques, combined with classical analytical separation, such as high-performance thin layer chromatography and column chromatography, has led to the structural elucidation of a great number of fungal CMHs. The structure of fungal CMH is conserved among fungal species and consists of a glucose or galactose residue attached to a ceramide moiety containing 9-methyl-4,8-sphingadienine with an amidic linkage to hydroxylated fatty acids, most commonly having 16 or 18 carbon atoms and unsaturation between C-3 and C-4. Along with their unique structural characteristics, fungal CMHs have a peculiar subcellular distribution and striking biological properties. Fungal cerebrosides were also characterized as antigenic molecules directly or indirectly involved in cell growth or differentiation in Schizophyllum commune, Cryptococcus neoformans, Pseudallescheria boydii, Candida albicans, Aspergillus nidulans, Aspergillus fumigatus, and Colletotrichum gloeosporioides. Besides classical techniques for cerebroside (CMH) analysis, we now describe new approaches, combining conventional thin layer chromatography and mass spectrometry, as well as emerging technologies for subcellular localization and distribution of glycosphingolipids by secondary ion mass spectrometry and imaging matrix-assisted laser desorption ionization time-of-flight. PMID:22164155

  8. Silencing Nociceptor Neurons Reduces Allergic Airway Inflammation.

    PubMed

    Talbot, Sébastien; Abdulnour, Raja-Elie E; Burkett, Patrick R; Lee, Seungkyu; Cronin, Shane J F; Pascal, Maud A; Laedermann, Cedric; Foster, Simmie L; Tran, Johnathan V; Lai, Nicole; Chiu, Isaac M; Ghasemlou, Nader; DiBiase, Matthew; Roberson, David; Von Hehn, Christian; Agac, Busranour; Haworth, Oliver; Seki, Hiroyuki; Penninger, Josef M; Kuchroo, Vijay K; Bean, Bruce P; Levy, Bruce D; Woolf, Clifford J

    2015-07-15

    Lung nociceptors initiate cough and bronchoconstriction. To elucidate if these fibers also contribute to allergic airway inflammation, we stimulated lung nociceptors with capsaicin and observed increased neuropeptide release and immune cell infiltration. In contrast, ablating Nav1.8(+) sensory neurons or silencing them with QX-314, a charged sodium channel inhibitor that enters via large-pore ion channels to specifically block nociceptors, substantially reduced ovalbumin- or house-dust-mite-induced airway inflammation and bronchial hyperresponsiveness. We also discovered that IL-5, a cytokine produced by activated immune cells, acts directly on nociceptors to induce the release of vasoactive intestinal peptide (VIP). VIP then stimulates CD4(+) and resident innate lymphoid type 2 cells, creating an inflammatory signaling loop that promotes allergic inflammation. Our results indicate that nociceptors amplify pathological adaptive immune responses and that silencing these neurons with QX-314 interrupts this neuro-immune interplay, revealing a potential new therapeutic strategy for asthma. PMID:26119026

  9. [Probiotics in allergic diseases of childhood].

    PubMed

    Hauer, A

    2006-08-31

    The increase in allergic diseases in children in the industrialized countries is attributed, among things, to the "exaggerated hygiene" in early childhood typical of western lifestyle, since insufficient microbial exposure in this phase would appear to promote the development of allergies ("hygiene hypothesis"). Experimental data and initial results of clinical studies show that the immune system of infants can be stimulated by the endogenous intestinal flora. Probiotics, (apathogenic organisms present in human intestinal flora) have a very similar effect: Infants at risk of developing atopy, who, in the first 6 months of life received a special probiotic, contracted atopic dermatitis after two years only half as frequently as a control group of infants. Therapeutic effects were also observed in this clinical condition. For no other allergic manifestations have reports so far been published on the successful use of probiotics for prevention or treatment.

  10. Neurology of allergic inflammation and rhinitis.

    PubMed

    Canning, Brendan J

    2002-05-01

    Afferent nerves, derived from the trigeminal ganglion, and postganglionic autonomic nerves, derived from sympathetic and parasympathetic ganglia expressing many different neurotransmitters, innervate the nose. Reflexes that serve to optimize the air-conditioning function of the nose by altering sinus blood flow, or serve to protect the nasal mucosal surface by mucus secretion, vasodilatation, and sneezing, can be initiated by a variety of stimuli, including allergen, cold air, and chemical irritation. Activation of nasal afferent nerves can also have profound effects on respiration, heart rate, blood pressure, and airway caliber (the diving response). Dysregulation of the nerves in the nose plays an integral role in the pathogenesis of allergic rhinitis. Axon reflexes can precipitate inflammatory responses in the nose, resulting in plasma extravasation and inflammatory cell recruitment, while allergic inflammation can produce neuronal hyper-responsiveness. Targeting the neuronal dysregulation in the nose may be beneficial in treating upper airway disease. PMID:11918862

  11. Allergic colitis in monozygotic preterm twins.

    PubMed

    Baldassarre, Maria Elisabetta; Cappiello, Annarita; Laforgia, Nicola; Vanderhoof, Jon

    2013-02-01

    Allergic colitis (AC) typically develops in the first weeks or months of life and is characterized by the presence of red blood in the stools of healthy breastfed or formula fed infants. In this paper, we describe a case of rectal bleeding in monozygotic preterm twins that was resolved with the introduction of a cow's milk protein-free diet (CMPFD). The occurrence of this disorder in monozygotic twins raises the question as to whether the underlying abnormality in the immune regulation, which leads to poor acquisition of tolerance to cow's milk proteins, might be inherited or environmentally acquired. The case also highlights the use of the probiotic Lactobacillus GG (LGG) in the treatment of allergic colitis. PMID:23098248

  12. Allergic contact dermatitis to fragrances. Part 1.

    PubMed

    Arribas, M P; Soro, P; Silvestre, J F

    2012-12-01

    Fragrances are a large group of substances and the second most common cause of allergic contact dermatitis in Spain. These potential allergens are extremely common and the general population is subject to continuous exposure on a daily basis. While the fragrance markers included in the current Spanish standard patch test series are good, there is room for improvement. New markers that have emerged in recent years have proven to be of value in standard series used in other countries. Diagnosing fragrance allergy has taken on even greater importance since the European Union added 26 fragrances to its list of mandatory ingredients to be specified on product labels. The aim of this review is to provide an update on allergic contact dermatitis to fragrances. We examine the main sources of exposure and clinical manifestations of this condition and propose a diagnostic and treatment protocol.

  13. Allergic contact dermatitis to fragrances: part 2.

    PubMed

    Arribas, M P; Soro, P; Silvestre, J F

    2013-01-01

    Allergic contact dermatitis due to fragrances usually manifests as subacute or chronic dermatitis because fragrances are found in a wide range of products to which patients are repeatedly exposed. The typical patient is a middle-aged woman with dermatitis on her hands and face, although other sites may be affected depending on the allergen and the product in which it is found. The standard patch test series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) contains 4 fragrance markers: balsam of Peru, fragrance mix i, fragrance mix ii, and lyral. Testing with a specific fragrance series is recommended in patients with a positive result to any of these 4 markers. The use of a specific fragrance series and new legislation obliging manufacturers to specify the fragrances used in their products, will help to improve the management of allergic contact dermatitis due to fragrances.

  14. Silencing nociceptor neurons reduces allergic airway inflammation

    PubMed Central

    Talbot, Sébastien; Abdulnour, Raja-Elie E.; Burkett, Patrick R.; Lee, Seungkyu; Cronin, Shane J.F.; Pascal, Maud A.; Laedermann, Cedric; Foster, Simmie L.; Tran, Johnathan V.; Lai, Nicole; Chiu, Isaac M.; Ghasemlou, Nader; DiBiase, Matthew; Roberson, David; Von Hehn, Christian; Agac, Busranour; Haworth, Oliver; Seki, Hiroyuki; Penninger, Josef M.; Kuchroo, Vijay K.; Bean, Bruce P.; Levy, Bruce D.; Woolf, Clifford J.

    2015-01-01

    Summary Lung nociceptors initiate cough and bronchoconstriction. To elucidate if these fibers also contribute to allergic airway inflammation we stimulated lung nociceptors with capsaicin and observed increased neuropeptide release and immune cell infiltration. In contrast, ablating Nav1.8+ sensory neurons or silencing them with QX-314, a charged sodium channel inhibitor that enters via large pore ion channels to specifically block nociceptors, substantially reduced ovalbumin or house dust mite-induced airway inflammation and bronchial hyperresponsiveness. We also discovered that IL-5, a cytokine produced by activated immune cells, acts directly on nociceptors to induce release of vasoactive intestinal peptide (VIP). VIP then stimulates CD4+ and resident innate lymphoid type 2 cells, creating an inflammatory signaling loop that promotes allergic inflammation. Our results indicate that nociceptors amplify pathological adaptive immune responses and that silencing these neurons with QX-314 interrupts this neuro-immune interplay, revealing a potential new therapeutic strategy for asthma. PMID:26119026

  15. Allergic contact dermatitis: Patient diagnosis and evaluation.

    PubMed

    Mowad, Christen M; Anderson, Bryan; Scheinman, Pamela; Pootongkam, Suwimon; Nedorost, Susan; Brod, Bruce

    2016-06-01

    Allergic contact dermatitis resulting from exposure to a chemical or chemicals is a common diagnosis in the dermatologist's office. We are exposed to hundreds of potential allergens daily. Patch testing is the criterion standard for diagnosing the causative allergens responsible for allergic contact dermatitis. Patch testing beyond standard trays is often needed to fully diagnose patients, but not all dermatology practices have access to this testing procedure or these allergens. In order to adequately evaluate patients, physicians must understand the pathophysiology of the disease process and be well versed in the proper evaluation of patients, indications for patch testing, proper testing procedure, and other diagnostic tools available and be aware of new and emerging allergens. PMID:27185421

  16. Mast Cells in Allergic Diseases and Mastocytosis

    PubMed Central

    Marquardt, Diana L.; Wasserman, Stephen I.

    1982-01-01

    Mast cells with their stores of vasoactive and chemotactic mediators are central to the pathogenesis of allergic diseases. The cross-linking of receptorbound IgE molecules on the surface of mast cells initiates a complex chain of events, including calcium ion influx, phospholipid methylation and turnover and cyclic nucleotide metabolism, ultimately resulting in the release of mediators of immediate hypersensitivity. These mast cell mediators are important in smooth muscle reactivity, in the recruitment of eosinophilic and neutrophilic leukocytes and in the generation of secondary chemical mediators. Histologic evidence of mast cell degranulation, biochemical evidence of mast cell mediators in blood and tissues and clinical evidence of signs and symptoms reproducible by these mediators have strongly supported the crucial role of mast cells in asthma, urticaria, anaphylaxis, rhinitis and mastocytosis. Because of their unique location at host environment interfaces, mast cells may both participate in allergic diseases and promote homeostasis. ImagesFigure 1.Figure 2.Figure 3. PMID:6293204

  17. Recurrent acute rhinosinusitis: a single blind clinical study of N-acetylcysteine vs ambroxol associated to corticosteroid therapy.

    PubMed

    Macchi, A; Terranova, P; Castelnuovo, P

    2012-01-01

    The aim of rhinosinusitis treatment is to restore sinusal eutrophism and to normalize ventilation and mucociliary transport. Frequently the improvement of sinusal physiological conditions is associated with a reduction of infections and pulmonary symptoms. The treatment of these diseases often requires the combination of medical and surgical strategies. In particular, the aim of the medical therapy is multiple: to treat the infection (with antibiotics), to reduce the mucosal swelling (with corticosteroids) and to improve mucus drainage (with mucolytics or muco-regulators). The use of atomized nasal douche, as a washing of the nasal fossas, is chosen because of its local action minimizing systemic adverse effects. The surgical treatment is secondary to medical failure, and it is focused on clearing the sinusal ostia in the sphenoethmoidal recess and the osteomeatal complex. In case of recurrent sinonasal diseases the importance of the surgical operation is represented by the fact that the medical treatment better reaches the target in the sinusal space. This study is focused on the primary medical treatment of acute recurrent rhinosinusitis. The patients who immediately needed surgical treatment were excluded from the study (because of the presence of an anatomical obstruction of the osteomeatal complex and/or the sphenoethmoidal recess, hence non-susceptible to improvement by medical therapy alone), and these patients were immediately addressed to undergo a CT scan examination in order to be involved in a future surgical programme. The medical treatment for those forms which do not require antibiotics (i.e. when infections are not involved), is based on the use of topical corticosteroids. While there are controversies on the real efficacy of adding mucolytic agents to the steroids, they are commonly prescribed in clinical practice, with the rationale of reducing viscosity and improving clearance of mucus in order to help the restoration of the physiological sinus

  18. Recurrent acute rhinosinusitis: a single blind clinical study of N-acetylcysteine vs ambroxol associated to corticosteroid therapy.

    PubMed

    Macchi, A; Terranova, P; Castelnuovo, P

    2012-01-01

    The aim of rhinosinusitis treatment is to restore sinusal eutrophism and to normalize ventilation and mucociliary transport. Frequently the improvement of sinusal physiological conditions is associated with a reduction of infections and pulmonary symptoms. The treatment of these diseases often requires the combination of medical and surgical strategies. In particular, the aim of the medical therapy is multiple: to treat the infection (with antibiotics), to reduce the mucosal swelling (with corticosteroids) and to improve mucus drainage (with mucolytics or muco-regulators). The use of atomized nasal douche, as a washing of the nasal fossas, is chosen because of its local action minimizing systemic adverse effects. The surgical treatment is secondary to medical failure, and it is focused on clearing the sinusal ostia in the sphenoethmoidal recess and the osteomeatal complex. In case of recurrent sinonasal diseases the importance of the surgical operation is represented by the fact that the medical treatment better reaches the target in the sinusal space. This study is focused on the primary medical treatment of acute recurrent rhinosinusitis. The patients who immediately needed surgical treatment were excluded from the study (because of the presence of an anatomical obstruction of the osteomeatal complex and/or the sphenoethmoidal recess, hence non-susceptible to improvement by medical therapy alone), and these patients were immediately addressed to undergo a CT scan examination in order to be involved in a future surgical programme. The medical treatment for those forms which do not require antibiotics (i.e. when infections are not involved), is based on the use of topical corticosteroids. While there are controversies on the real efficacy of adding mucolytic agents to the steroids, they are commonly prescribed in clinical practice, with the rationale of reducing viscosity and improving clearance of mucus in order to help the restoration of the physiological sinus

  19. [Allergic contact dermatitis due to prednicarbate].

    PubMed

    Senff, H; Kunz, R; Köllner, A; Kunze, J

    1991-01-01

    Two female patients developed an allergic contact dermatitis after using Dermatop cream and -ointment for several weeks. Patch tests were positive with the reagent prednicarbate itself. No cross reactions to other glucocorticosteroids were observed. Type-IV-sensitization to glucocorticosteroids should be considered if chronic dermatitis does not improve, or even becomes worse, in spite of adequate therapy. With regard to possible cross reactions or multiple sensitization, epicutaneous tests with other glucocorticosteroids are necessary.

  20. Role of Cysteinyl Leukotrienes in Allergic Rhinitis.

    PubMed

    Shirasaki, Hideaki; Himi, Tetsuo

    2016-01-01

    Cysteinyl leukotrienes (CysLTs) are lipid mediators that have been implicated in the pathogenesis of allergic rhinitis. Pharmacological studies using CysLTs indicate that two classes of receptor exist: CysLT1 receptor (CysLT1R) and CysLT2 receptor (CysLT2R). The CysLT1R is a high-affinity leukotriene D4 receptor with lower affinity for leukotriene C4 that is sensitive to the CysLT1R antagonist currently used to treat asthma and allergic rhinitis. Our previous immunohistochemical and autoradiographic studies have demonstrated the presence of anti-CysLT1R antibodies labeled in eosinophils, mast cells, macrophages, neutrophils and vascular endothelial cells in human nasal mucosa. Furthermore, we have revealed that the novel radioactive CysLT1R antagonist [3H]-pranlukast bound specifically to CysLT1R in human inferior turbinates and its binding sites were localized to vascular endothelium and the interstitial cells. These data suggest that the major targets of CysLT1R antagonists in allergic rhinitis are the vascular bed and infiltrated leukocytes such as mast cells, eosinophils and macrophages. Clinical trials have demonstrated that CysLT1R antagonists are as effective as antihistamines for the treatment of allergic rhinitis; however, they are less effective than intranasal steroids. The use of CysLT1R antagonists in combination with antihistamines has generally resulted in greater efficacy than when these agents were used alone. PMID:27115997

  1. Conflicting sensory relationships. Encounters with allergic people.

    PubMed

    Raffaetà, Roberta

    2012-01-01

    Increasingly, people employ the term 'allergy' to define various pathological conditions, although the biomedical community lacks a consensus on a definition of the term. It has become a widespread and convenient label for diverse conditions, often going beyond biomedical diagnosis. The aim of this paper is to explore how allergic people narrate their illness experiences, focusing specifically on the relationship between words, senses and bodies. This paper is based on an ethnographic study in a medium-sized north Italian city conducted from 2004 to 2008, starting in a public hospital Allergy Unit, and then developing through snowball recruitment and referral methods. Interviews were conducted with 37 allergic people, four allergologists and four nurses. Allergic people's narratives constantly drew upon two main concepts: weakness and pollution. These are interpreted as sensorial dimensions expressing a conflicting relationship with the outside environment. It is argued that in times of marked individualism and social transformations, bodily states are of fundamental importance and the mobilisation of sensory concepts is an attempt to give order and meaning to a world that is perceived as constituted by threatening aspects, polluted and out of order.

  2. Clinical Distinctness of Allergic Rhinitis in Patients with Allergy to Molds

    PubMed Central

    Kołodziejczyk, Krzysztof

    2016-01-01

    Introduction. Molds are a very diverse group of allergens. Exposure and sensitization to fungal allergens can promote the development and worsening of allergic rhinitis (AR). Objective. The natural course of allergic rhinitis was compared between a group of patients with allergy to molds and patients with AR to other allergens as the control groups. Material and Methods. The study group consisted of 229 patients, with a mean age of 27.4 ± 6.5 yrs. The study group was compared to groups of AR patients with allergy to house dust mites or pollens or with multivalent allergy. Allergic sensitization was assessed using the skin prick test (SPT) with a panel of 15 allergens to molds and other common inhalant allergens. Specific IgEs against all tested allergens were measured. Nasal fractional exhaled nitric oxide (FeNO) level was assessed with a chemiluminescence analyzer (NIOX MINO) and compared between groups. Cluster analysis was performed for determine models of AR in whole population. Results. Patients with allergy to mold have had AR with a higher blockage of nose than in the patients with other allergies. Alternaria alternata (59% of examined), Cladosporium herbarum (40%), and Aspergillus fumigatus (36%) were the predominant allergens in the study group. Patients with allergy to mold were more often present in two clusters: there were patients with more frequent accompanying asthma and high level of FeNO. Conclusion. Patients with allergy to molds have a significantly greater predisposition for bronchial asthma and high concentration of FeNO. PMID:27340656

  3. Exposure to ambient bioaerosols is associated with allergic skin diseases in Greater Taipei residents.

    PubMed

    Kallawicha, Kraiwuth; Chuang, Ying-Chih; Lung, Shih-Chun Candice; Han, Bor-Cheng; Ting, Yi-Fang; Chao, Hsing Jasmine

    2016-09-01

    Allergic skin diseases may result from various types of chemical and biological allergens. This study investigated the association between ambient bioaerosol exposure and allergic skin diseases by using the exposure data obtained from land use regression models and interpolated data. Data on daily average outpatient visits for atopic dermatitis (ICD-9-CM 691.8) and contact dermatitis and other eczema (ICD-9-CM 692.9) between November 2011 and August 2012 were obtained from the National Health Insurance Research Database. A generalized estimating equation was used to analyze the associations between the skin diseases and ambient bioaerosol levels. The results indicated that during the study period, contact dermatitis and other eczema were more prevalent than atopic dermatitis in the study area. Most cases were observed in districts of Taipei City and 3 major districts of New Taipei City, namely Xinzhuang, Banqiao, and Xindian. In univariate analysis, most bioaerosols were positively associated with both skin diseases. After adjustment for air pollution and sociodemographic factors, exposure to total fungal spores was significantly associated with atopic dermatitis in males (relative risk [RR] = 1.12; 95% confidence interval [CI] = 1.05-1.19). Contact dermatitis and other eczema had significant relationships with Cladosporium in males (RR = 1.07; 95% CI = 1.02-1.14) and with Aspergillus/Penicillium in females (RR = 1.04; 95% CI = 1.02-1.07). Meteorological parameters, namely wind speed, temperature, and rainfall, were also significantly associated with skin diseases. Our findings reveal that exposure to ambient bioaerosols is a significant and independent risk factor for allergic skin diseases. PMID:27389548

  4. Fungal pathogens of Proteaceae.

    PubMed

    Crous, P W; Summerell, B A; Swart, L; Denman, S; Taylor, J E; Bezuidenhout, C M; Palm, M E; Marincowitz, S; Groenewald, J Z

    2011-12-01

    Species of Leucadendron, Leucospermum and Protea (Proteaceae) are in high demand for the international floriculture market due to their brightly coloured and textured flowers or bracts. Fungal pathogens, however, create a serious problem in cultivating flawless blooms. The aim of the present study was to characterise several of these pathogens using morphology, culture characteristics, and DNA sequence data of the rRNA-ITS and LSU genes. In some cases additional genes such as TEF 1-α and CHS were also sequenced. Based on the results of this study, several novel species and genera are described. Brunneosphaerella leaf blight is shown to be caused by three species, namely B. jonkershoekensis on Protea repens, B. nitidae sp. nov. on Protea nitida and B. protearum on a wide host range of Protea spp. (South Africa). Coniothyrium-like species associated with Coniothyrium leaf spot are allocated to other genera, namely Curreya grandicipis on Protea grandiceps, and Microsphaeropsis proteae on P. nitida (South Africa). Diaporthe leucospermi is described on Leucospermum sp. (Australia), and Diplodina microsperma newly reported on Protea sp. (New Zealand). Pyrenophora blight is caused by a novel species, Pyrenophora leucospermi, and not Drechslera biseptata or D. dematoidea as previously reported. Fusicladium proteae is described on Protea sp. (South Africa), Pestalotiopsis protearum on Leucospermum cuneiforme (Zimbabwe), Ramularia vizellae and R. stellenboschensis on Protea spp. (South Africa), and Teratosphaeria capensis on Protea spp. (Portugal, South Africa). Aureobasidium leaf spot is shown to be caused by two species, namely A. proteae comb. nov. on Protea spp. (South Africa), and A. leucospermi sp. nov. on Leucospermum spp. (Indonesia, Portugal, South Africa). Novel genera and species elucidated in this study include Gordonomyces mucovaginatus and Pseudopassalora gouriqua (hyphomycetes), and Xenoconiothyrium catenata (coelomycete), all on Protea spp. (South Africa).

  5. Allergic sensitization: host-immune factors

    PubMed Central

    2014-01-01

    Allergic sensitization is the outcome of a complex interplay between the allergen and the host in a given environmental context. The first barrier encountered by an allergen on its way to sensitization is the mucosal epithelial layer. Allergic inflammatory diseases are accompanied by increased permeability of the epithelium, which is more susceptible to environmental triggers. Allergens and co-factors from the environment interact with innate immune receptors, such as Toll-like and protease-activated receptors on epithelial cells, stimulating them to produce cytokines that drive T-helper 2-like adaptive immunity in allergy-prone individuals. In this milieu, the next cells interacting with allergens are the dendritic cells lying just underneath the epithelium: plasmacytoid DCs, two types of conventional DCs (CD11b + and CD11b-), and monocyte-derived DCs. It is now becoming clear that CD11b+, cDCs, and moDCs are the inflammatory DCs that instruct naïve T cells to become Th2 cells. The simple paradigm of non-overlapping stable Th1 and Th2 subsets of T-helper cells is now rapidly being replaced by that of a more complex spectrum of different Th cells that together drive or control different aspects of allergic inflammation and display more plasticity in their cytokine profiles. At present, these include Th9, Th17, Th22, and Treg, in addition to Th1 and Th2. The spectrum of co-stimulatory signals coming from DCs determines which subset-characteristics will dominate. When IL-4 and/or IL-13 play a dominant role, B cells switch to IgE-production, a process that is more effective at young age. IgE-producing plasma cells have been shown to be long-lived, hiding in the bone-marrow or inflammatory tissues where they cannot easily be targeted by therapeutic intervention. Allergic sensitization is a complex interplay between the allergen in its environmental context and the tendency of the host’s innate and adaptive immune cells to be skewed towards allergic inflammation

  6. Escaping the trap of allergic rhinitis.

    PubMed

    Rossi, Oliviero; Massaro, Ilaria; Caminati, Marco; Quecchia, Cristina; Fassio, Filippo; Heffler, Enrico; Canonica, Giorgio Walter

    2015-01-01

    Rhinitis is often the first symptom of allergy but is frequently ignored and classified as a nuisance condition. Ironically it has the greatest socioeconomic burden worldwide caused by its impact on work and on daily life. However, patients appear reticent to seek professional advice, visiting their doctor only when symptoms become 'intolerable' and often when their usual therapy proves ineffective. Clearly, it's time for new and more effective allergic rhinitis treatments. MP29-02 (Dymista®; Meda, Solna, Sweden) is a new class of medication for moderate to severe seasonal and perennial allergic rhinitis if monotherapy with either intranasal antihistamine or intranasal corticosteroids is not considered sufficient. MP29-02 is a novel formulation of azelastine hydrochloride (AZE) and fluticasone propionate (FP). It benefits not only from the incorporation of two active agents, but also from a novel formulation; its lower viscosity, smaller droplet size, larger volume (137 μl) and wider spray angle ensure optimal coverage of, and retention on the nasal mucosa and contribute to its clinical efficacy. In clinical trials, patients treated with MP29-02 experienced twice the symptom relief as those treated with FP and AZE, who in turn exhibited significantly greater symptom relief than placebo-patients. Indeed, the advantage of MP29-02 over FP was approximately the same as that shown for FP over placebo. The advantage of MP29-02 was particularly evident in those patients for whom nasal congestion is predominant, with MP29-02 providing three times the nasal congestion relief of FP (p = 0.0018) and five times the relief of AZE (p = 0.0001). Moreover, patients treated with MP29-02 achieved each and every response up to a week faster than those treated with FP or AZE alone and in real life 1 in 2 patients reported the perception of well-controlled disease after only 3 days. MP29-02's superiority over FP was also apparent long-term in patients with perennial

  7. Environmental risk factors and allergic bronchial asthma.

    PubMed

    D'Amato, G; Liccardi, G; D'Amato, M; Holgate, S

    2005-09-01

    The prevalence of allergic respiratory diseases such as bronchial asthma has increased in recent years, especially in industrialized countries. A change in the genetic predisposition is an unlikely cause of the increase in allergic diseases because genetic changes in a population require several generations. Consequently, this increase may be explained by changes in environmental factors, including indoor and outdoor air pollution. Over the past two decades, there has been increasing interest in studies of air pollution and its effects on human health. Although the role played by outdoor pollutants in allergic sensitization of the airways has yet to be clarified, a body of evidence suggests that urbanization, with its high levels of vehicle emissions, and a westernized lifestyle are linked to the rising frequency of respiratory allergic diseases observed in most industrialized countries, and there is considerable evidence that asthmatic persons are at increased risk of developing asthma exacerbations with exposure to ozone, nitrogen dioxide, sulphur dioxide and inhalable particulate matter. However, it is not easy to evaluate the impact of air pollution on the timing of asthma exacerbations and on the prevalence of asthma in general. As concentrations of airborne allergens and air pollutants are frequently increased contemporaneously, an enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of allergic respiratory allergy and bronchial asthma. Pollinosis is frequently used to study the interrelationship between air pollution and respiratory allergy. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc) can affect both components (biological and chemical) of this interaction. By attaching to the surface of pollen grains and of plant-derived particles of paucimicronic size, pollutants could modify not only the morphology of these antigen-carrying agents but also their allergenic

  8. Environmental risk factors and allergic bronchial asthma.

    PubMed

    D'Amato, G; Liccardi, G; D'Amato, M; Holgate, S

    2005-09-01

    The prevalence of allergic respiratory diseases such as bronchial asthma has increased in recent years, especially in industrialized countries. A change in the genetic predisposition is an unlikely cause of the increase in allergic diseases because genetic changes in a population require several generations. Consequently, this increase may be explained by changes in environmental factors, including indoor and outdoor air pollution. Over the past two decades, there has been increasing interest in studies of air pollution and its effects on human health. Although the role played by outdoor pollutants in allergic sensitization of the airways has yet to be clarified, a body of evidence suggests that urbanization, with its high levels of vehicle emissions, and a westernized lifestyle are linked to the rising frequency of respiratory allergic diseases observed in most industrialized countries, and there is considerable evidence that asthmatic persons are at increased risk of developing asthma exacerbations with exposure to ozone, nitrogen dioxide, sulphur dioxide and inhalable particulate matter. However, it is not easy to evaluate the impact of air pollution on the timing of asthma exacerbations and on the prevalence of asthma in general. As concentrations of airborne allergens and air pollutants are frequently increased contemporaneously, an enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of allergic respiratory allergy and bronchial asthma. Pollinosis is frequently used to study the interrelationship between air pollution and respiratory allergy. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc) can affect both components (biological and chemical) of this interaction. By attaching to the surface of pollen grains and of plant-derived particles of paucimicronic size, pollutants could modify not only the morphology of these antigen-carrying agents but also their allergenic

  9. Respiratory effects of air pollution on allergic disease

    SciTech Connect

    Pierson, W.E.; Koenig, J.Q. )

    1992-10-01

    Allergic patients have an increased susceptibility to the adverse effects of both natural and man-made air pollutants. This goes for both indoor and outdoor air pollutants and manifests itself with biochemical, cellular, and pathophysiologic expressions of adverse health effects in allergic individuals. Also occupationally induced allergic diseases will remain very important. This area has been reviewed recently by Cullen et al. Since allergic patients comprise somewhere between 15% and 20% of the population, this increased susceptibility is of crucial importance not only for medical care and research but for legislative and regulatory consideration to protect these vulnerable individuals.108 references.

  10. Genetic Variation in Genes Encoding Airway Epithelial Potassium Channels Is Associated with Chronic Rhinosinusitis in a Pediatric Population

    PubMed Central

    Mentch, Frank; Grant, Struan F. A.; Desrosiers, Martin; Hakonarson, Hakon; Toskala, Elina

    2014-01-01

    Background Apical potassium channels regulate ion transport in airway epithelial cells and influence air surface liquid (ASL) hydration and mucociliary clearance (MCC). We sought to identify whether genetic variation within genes encoding airway potassium channels is associated with chronic rhinosinusitis (CRS). Methods Single nucleotide polymorphism (SNP) genotypes for selected potassium channels were derived from data generated on the Illumnia HumanHap550 BeadChip or Illumina Human610-Quad BeadChip for 828 unrelated individuals diagnosed with CRS and 5,083 unrelated healthy controls from the Children's Hospital of Philadelphia (CHOP). Statistical analysis was performed with set-based tests using PLINK, and corrected for multiple testing. Results Set-based case control analysis revealed the gene KCNMA1 was associated with CRS in our Caucasian subset of the cohort (598 CRS cases and 3,489 controls; p = 0.022, based on 10,000 permutations). In addition there was borderline evidence that the gene KCNQ5 (p = 0.0704) was associated with the trait in our African American subset of the cohort (230 CRS cases and 1,594 controls). In addition to the top significant SNPs rs2917454 and rs6907229, imputation analysis uncovered additional genetic variants in KCNMA1 and in KCNQ5 that were associated with CRS. Conclusions We have implicated two airway epithelial potassium channels as novel susceptibility loci in contributing to the pathogenesis of CRS. PMID:24595210

  11. Primary immunodeficiencies underlying fungal infections

    PubMed Central

    Lanternier, Fanny; Cypowyj, Sophie; Picard, Capucine; Bustamante, Jacinta; Lortholary, Olivier; Casanova, Jean-Laurent; Puel, Anne

    2014-01-01

    Purpose of review We review the primary immunodeficiencies underlying an increasing variety of superficial and invasive fungal infections. We also stress that the occurrence of such fungal infections should lead physicians to search for the corresponding single-gene inborn errors of immunity. Finally, we suggest that other fungal infections may also result from hitherto unknown inborn errors of immunity, at least in some patients with no known risk factors. Recent findings An increasing number of primary immunodeficiencies are being shown to underlie fungal infectious diseases in children and young adults. Inborn errors of the phagocyte NADPH oxidase complex (chronic granulomatous disease), severe congenital neutropenia and leukocyte adhesion deficiency type I confer a predisposition to invasive aspergillosis and candidiasis. More rarely, inborn errors of IFN-γ immunity underlie endemic mycoses. Inborn errors of IL-17 immunity have recently been shown to underlie chronic mucocutaneous candidiasis, whereas inborn errors of CARD9 immunity underlie deep dermatophytosis and invasive candidiasis. Summary Chronic mucocutaneous candidiasis, invasive candidiasis, invasive aspergillosis, deep dermatophytosis, pneumocystosis, and endemic mycoses can all be caused by primary immunodeficiencies. Each type of infection is highly suggestive of a specific type of primary immunodeficiency. In the absence of overt risk factors, single-gene inborn errors of immunity should be sought in children and young adults with these and other fungal diseases. PMID:24240293

  12. [Impact off treatment with intranasal electrophoresis of vanadium on the allergic reactivity and immunological indices of patients with allergic rhinitis].

    PubMed

    Tsiclauri, Sh

    2010-02-01

    67 patients were investigated. From these patients, 35 had been persistent form of Allergic Rhinitis and 32 - intermittent form of pathology. It has been established, that in patients with Allergic Rhinitis the treatment with intranasal electrophoresis of vanadium strenghthens T-cellulal immunity, has a desensitization action, increases non-specific resistance of the organism and has a normalizing influence on the indices of humoral immunity. The above shown positive shift were more pronounced in patients with intermittent form of Allergic Rhinitis.

  13. Map kinases in fungal pathogens.

    PubMed

    Xu, J R

    2000-12-01

    MAP kinases in eukaryotic cells are well known for transducing a variety of extracellular signals to regulate cell growth and differentiation. Recently, MAP kinases homologous to the yeast Fus3/Kss1 MAP kinases have been identified in several fungal pathogens and found to be important for appressorium formation, invasive hyphal growth, and fungal pathogenesis. This MAP kinase pathway also controls diverse growth or differentiation processes, including conidiation, conidial germination, and female fertility. MAP kinases homologous to yeast Slt2 and Hog1 have also been characterized in Candida albicans and Magnaporthe grisea. Mutants disrupted of the Slt2 homologues have weak cell walls, altered hyphal growth, and reduced virulence. The Hog1 homologues are dispensable for growth but are essential for regulating responses to hyperosmotic stress in C. albicans and M. grisea. Overall, recent studies have indicated that MAP kinase pathways may play important roles in regulating growth, differentiation, survival, and pathogenesis in fungal pathogens. PMID:11273677

  14. Directed Evolution of Fungal Laccases

    PubMed Central

    Maté, Diana; García-Ruiz, Eva; Camarero, Susana; Alcalde, Miguel

    2011-01-01

    Fungal laccases are generalists biocatalysts with potential applications that range from bioremediation to novel green processes. Fuelled by molecular oxygen, these enzymes can act on dozens of molecules of different chemical nature, and with the help of redox mediators, their spectrum of oxidizable substrates is further pushed towards xenobiotic compounds (pesticides, industrial dyes, PAHs), biopolymers (lignin, starch, cellulose) and other complex molecules. In recent years, extraordinary efforts have been made to engineer fungal laccases by directed evolution and semi-rational approaches to improve their functional expression or stability. All these studies have taken advantage of Saccharomyces cerevisiae as a heterologous host, not only to secrete the enzyme but also, to emulate the introduction of genetic diversity through in vivo DNA recombination. Here, we discuss all these endeavours to convert fungal laccases into valuable biomolecular platforms on which new functions can be tailored by directed evolution. PMID:21966249

  15. Induction of CXC chemokines in A549 airway epithelial cells by trypsin and staphylococcal proteases − a possible route for neutrophilic inflammation in chronic rhinosinusitis

    PubMed Central

    Sachse, F; von Eiff, C; Stoll, W; Becker, K; Rudack, C

    2006-01-01

    While various microorganisms have been recovered from patients with chronic rhinosinusitis, the inflammatory impact of virulence factors, in particular proteases from Staphylococcus aureus and coagulase negative staphylococci on the nasal epithelium, has not yet been investigated. Expression of CXC chemokines was determined in the epithelium of patients with chronic rhinosinusitis by immunohistochemistry. In a cell culture system of A549 respiratory epithelial cells, chemokine levels were quantified by enzyme-linked immunosorbent assay (ELISA) after stimulation with supernatants originating from three different staphylococcal strains or with trypsin, representing a serine protease. Inhibition experiments were performed with prednisolone, with the serine protease inhibitor 4-(2-aminoethyl)-benzenesulphonylfluoride (AEBSF) and with the nuclear transcription factor (NF)-κΒ inhibitor (2E)-3-[[4-(1,1-dimethylethyl)phenyl]sulphonyl]-2-propenenitrite (BAY) 11–7085. Electromobility shift assays (EMSA) were used to demonstrate NF-κB-dependent protein synthesis. CXC chemokines interleukin (IL)-8, growth-related oncogene alpha (GRO-α) and granulocyte chemotactic protein-2 (GCP-2) were expressed in the patients’ epithelium whereas epithelial cell-derived neutrophil attractant 78 (ENA-78) was rarely detected. In A549 cells, chemokines IL-8, ENA-78 and GRO-α but not GCP-2 were induced by trypsin and almost equal levels were induced by staphylococcal supernatants. IL-8, GRO-α and ENA-78 synthesis was suppressed almost completely by AEBSF and BAY 11–7085, whereas prednisolone reduced chemokine levels differentially dependent on the supernatant added. CXC chemokines were detectable in the epithelium of patients with chronic rhinosinusitis. Staphylococcal serine proteases induced CXC chemokines in A549 cells, probably by the activation of proteases activated receptors, and thus might potentially be involved in neutrophilic inflammation in chronic sinusitis. PMID:16734624

  16. Clinical and allergic sensitization characteristics of allergic rhinitis among the elderly population in Istanbul, Turkey.

    PubMed

    Ozturk, Ayse Bilge; Ozyigit, Leyla Pur; Olmez, Merve Ozata

    2015-04-01

    Prevalence of allergic rhinitis (AR) in elderly population in Turkey is not known. Studies on the prevalence and features of allergy in older adults are needed to identify safe and effective diagnostic/therapeutic methods for elderly AR patients. We aimed to identify the clinical and allergic characteristics of sensitization to aeroallergens among individuals aged ≥60 years with allergic rhinitis admitted to an allergy outpatient clinic in Istanbul. Of 109 patients, 33.9 % were atopic. Sixty-five percent of subjects were sensitized to Dermatophagoides pteronyssinus, 17 % to a grass-pollen mixture, 8 % to Aspergillus fumigatus, and 8 % to Blattella germanica. There was no difference between mono- and polysensitized patients in terms of the duration of rhinitis and symptom severity. No significant difference was observed between the two groups according to age, sex, smoking status, AR onset (<40 or ≥40 years), or duration/severity of disease. There was no significant difference between the two groups in the prevalence of asthma and conjunctivitis, (p = 0.256). Atopic dermatitis/eczema was more prevalent in those with AR (p = 0.046). Clinical characteristics of AR in the elderly could be different from those in non-allergic patients, and the prevalence of allergy may be higher than expected.

  17. Chitin synthesis and fungal pathogenesis

    PubMed Central

    Lenardon, Megan D; Munro, Carol A; Gow, Neil AR

    2010-01-01

    Chitin is an essential part of the carbohydrate skeleton of the fungal cell wall and is a molecule that is not represented in humans and other vertebrates. Complex regulatory mechanisms enable chitin to be positioned at specific sites throughout the cell cycle to maintain the overall strength of the wall and enable rapid, life-saving modifications to be made under cell wall stress conditions. Chitin has also recently emerged as a significant player in the activation and attenuation of immune responses to fungi and other chitin-containing parasites. This review summarises latest advances in the analysis of chitin synthesis regulation in the context of fungal pathogenesis. PMID:20561815

  18. Fungal laryngitis in immunocompetent patients.

    PubMed

    Ravikumar, A; Prasanna Kumar, S; Somu, L; Sudhir, B

    2014-01-01

    The diagnosis of fungal laryngitis is often overlooked in immunocompetent patients because it is commonly considered a disease of the immunocompromised. Further confusion is caused by clinical and histological similarity to more common conditions like Leukoplakia. Demonstration of hyperkeratosis particularly if associated with intraepithelial neutrophils on biopsy should trigger a search for fungus using specialized stains. These patients usually present with hoarseness of voice. Pain is present inconsistently along with dysphagia and odynophagia. We present three cases of fungal laryngitis in immunocompetent patients out of which one underwent microlaryngeal surgery with excision biopsy. All these patients responded well with oral antifungal therapy.

  19. Immune allergic response in Asperger syndrome.

    PubMed

    Magalhães, Elizabeth S; Pinto-Mariz, Fernanda; Bastos-Pinto, Sandra; Pontes, Adailton T; Prado, Evandro A; deAzevedo, Leonardo C

    2009-11-30

    Asperger's syndrome is a subgroup of autism characterized by social deficits without language delay, and high cognitive performance. The biological nature of autism is still unknown but there are controversial evidence associating an immune imbalance and autism. Clinical findings, including atopic family history, serum IgE levels as well as cutaneous tests showed that incidence of atopy was higher in the Asperger group compared to the healthy controls. These findings suggest that atopy is frequent in this subgroup of autism implying that allergic inflammation might be an important feature in Asperger syndrome.

  20. Idiosyncratic allergic reaction to textured saline implants.

    PubMed

    Sabbagh, W H; Murphy, R X; Kucirka, S J; Okunski, W J

    1996-04-01

    In the literature, multiple conditions, including hematomas, self-limited cutaneous eruptions, and generalized systemic complaints, have been attributed to breast implants. We report the first case of idiosyncratic allergic reaction to the textured surface of a mammary prosthesis. The reaction was documented by patch testing of the textured surface compared with smooth-surface silicone controls. Symptoms resolved with removal of the implants and have not recurred after insertion of smooth-walled implants. Whereas the physiology of this condition remains unclear at this time, it is important to recognize the possibility of a delayed hypersensitivity reaction when considering reconstruction with a textured breast implant.

  1. Oscar Wilde's skin disease: allergic contact dermatitis?

    PubMed

    Nater, J P

    1992-07-01

    During the last years of his life, Oscar Wilde (1856-1900) suffered from a suppurating otitis media as well as from an unidentified skin disease. The eruption was localized to his face, arms, chest and back and itched severely. A new theory is suggested, based on the fact that Wilde almost certainly used a dye to conceal his rapidly graying hair. He sensitized himself to p-phenylenediamine and developed a stubborn allergic contact dermatitis. Patch testing, the only proof of such a diagnosis, had not yet been devised.

  2. Allergic acute coronary syndrome (Kounis syndrome)

    PubMed Central

    Chhabra, Lovely; Masrur, Shihab; Parker, Matthew W.

    2015-01-01

    Anaphylaxis rarely manifests as a vasospastic acute coronary syndrome with or without the presence of underlying coronary artery disease. The variability in the underlying pathogenesis produces a wide clinical spectrum of this syndrome. We present three cases of anaphylactic acute coronary syndrome that display different clinical variants of this phenomenon. The main pathophysiological mechanism of the allergic anginal syndromes is the inflammatory mediators released during a hypersensitivity reaction triggered by food, insect bites, or drugs. It is important to appropriately recognize and treat Kounis syndrome in patients with exposure to a documented allergen. PMID:26130889

  3. Diagnosis and treatment of allergic rhinitis.

    PubMed

    Smith, L J

    1995-10-01

    Allergic rhinitis is frequently seen by primary care providers. Symptoms include rhinorrhea, itching of nose and eyes, nasal congestion, and sneezing. They occur when the patient is exposed to antigens stimulating mediator release. History is essential to assist differential diagnosis and provide education. This article reviews common findings of the physical exam, diagnostic testing, and differential diagnosis. The first line of treatment is avoidance, followed by medications such as antihistamines, decongestants, and nasal steroids. If these treatments are not effective, then referral to an allergist is necessary for further workup and possible treatment with immunotherapy.

  4. Allergic sensitization to ornamental plants in patients with allergic rhinitis and asthma.

    PubMed

    Aydin, Ömür; Erkekol, Ferda Öner; Misirloigil, Zeynep; Demirel, Yavuz Selim; Mungan, Dilşad

    2014-01-01

    Ornamental plants (OPs) can lead to immediate-type sensitization and even asthma and rhinitis symptoms in some cases. This study aimed to evaluate sensitization to OPs in patients with asthma and/or allergic rhinitis and to determine the factors affecting the rate of sensitization to OPs. A total of 150 patients with asthma and/or allergic rhinitis and 20 healthy controls were enrolled in the study. Demographics and disease characteristics were recorded. Skin-prick tests were performed with a standardized inhalant allergen panel. Skin tests by "prick-to-prick" method with the leaves of 15 Ops, which are known to lead to allergenic sensitization, were performed. Skin tests with OPs were positive in 80 patients (47.1%). There was no significant difference between OP sensitized and nonsensitized patients in terms of gender, age, number of exposed OPs, and duration of exposure. Skin test positivity rate for OPs was significantly high in atopic subjects, patients with allergic rhinitis, food sensitivity, and indoor OP exposure, but not in patients with pollen and latex allergy. Most sensitizing OPs were Yucca elephantipes (52.5%), Dieffenbachia picta (50.8%), and Euphorbia pulcherrima (47.5%). There was significant correlation between having Saintpaulia ionantha, Croton, Pelargonium, Y. elephantipes, and positive skin test to these plants. Sensitivity to OPs was significantly higher in atopic subjects and patients with allergic rhinitis, food allergy, and indoor OP exposure. Furthermore, atopy and food sensitivity were found as risk factors for developing sensitization to indoor plants. Additional trials on the relationship between sensitization to OPs and allergic symptoms are needed. PMID:24717779

  5. Stem Cell Transplant Patients and Fungal Infections

    MedlinePlus

    ... Foodborne, Waterborne, and Environmental Diseases Mycotic Diseases Branch Stem Cell Transplant Patients and Fungal Infections Recommend on Facebook ... Mold . Top of Page Preventing fungal infections in stem cell transplant patients Fungi are difficult to avoid because ...

  6. METALS, PARTICLES AND IMPACT UPON PULMONARY ALLERGIC RESPONSES

    EPA Science Inventory


    The increase in allergic asthma over the past few decades has prompted investigations into whether air pollution may affect either the incidence or severity of allergic lung disease. Population studies have demonstrated that as air pollution rises, symptoms, medication use a...

  7. Allergic contact dermatitis from ethylhexyl salicylate and other salicylates.

    PubMed

    Mortz, Charlotte Gotthard; Thormann, Henrik; Goossens, An; Andersen, Klaus Ejner

    2010-01-01

    Allergic contact dermatitis (ACD) from salicylates present in topical products is uncommon. Most publications about ACD from salicylates are case reports describing only a few patients. Cross-reactivity between salicylates is not commonly reported. This article describes allergic contact dermatitis from ethylhexyl salicylate used as an ultraviolet filter and fragrance compound and reviews the published literature on contact allergy to salicylates.

  8. Association between exposure to antimicrobial household products and allergic symptoms

    PubMed Central

    Hong, Soyoung; Kwon, Ho-Jang; Choi, Won-Jun; Lim, Wan Ryung; Kim, Jeonghoon; Kim, KyooSang

    2014-01-01

    Objectives Antimicrobial chemicals are used in a variety of household and personal care products. Exposure to antimicrobial household products has been hypothesized to lead to allergic diseases in children. Methods We investigated antimicrobial household product exposure and allergic symptoms in Korean children. An antimicrobial exposure (AE) score was derived. To examine the symptoms of allergic diseases (current wheeze, current rhinitis, and current eczema) in the past 12 months, we used a questionnaire based on the core module of the International Study of Asthma and Allergies in Children. Complete data for the analysis were available for 25,805 of the 35,590 (72.5%) children. Results The prevalence of current allergic diseases was as follows: wheeze, 5.6%; allergic rhinitis, 32.6%; and eczema, 17.7%. The mean (standard deviation) AE score was 14.3 (9.3) (range: 0-40). Compared with subjects with a low AE score (reference), subjects with a high AE score (fourth quartile) were more likely to have symptoms of wheezing and allergic rhinitis (adjusted odds ratio [aOR] for wheezing 1.24, 95% confidence interval [CI], 1.05-1.45, p for trend=0.24; aOR for allergic rhinitis 1.30, 95% CI, 1.20-1.40, p<0.01). Conclusions These findings suggest that frequent use of antimicrobial household products was associated with current wheeze and current allergic rhinitis. PMID:25420879

  9. Fetal distress during a maternal systemic allergic reaction.

    PubMed

    Klein, V R; Harris, A P; Abraham, R A; Niebyl, J R

    1984-09-01

    Systemic allergic reactions to food ingestion rarely result in life-threatening situations. When these reactions occur during pregnancy, however, the accompanying physiologic changes may result in fetal distress. A case of repetitive late decelerations in the fetal heart rate during a maternal allergic reaction is presented. Prompt and aggressive medical management brought about total resolution of maternal and fetal compromise.

  10. Protective immune responses to fungal infections.

    PubMed

    Rivera, A

    2014-09-01

    The incidence of fungal infections has been on the rise over several decades. Fungal infections threaten animals, plants and humans alike and are thus of significant concern to scientists across disciplines. Over the last decade, significant advances on fungal immunology have lead to a better understanding of important mechanisms of host protection against fungi. In this article, I review recent advances of relevant mechanisms of immune-mediated protection to fungal infections.

  11. Differential allergy responses to Metarhizium anisopliae fungal component extracts in BALB/c mice.

    PubMed

    Ward, Marsha D W; Chung, Yong Joo; Haykal-Coates, Najwa; Copeland, Lisa B

    2009-03-01

    Intratracheal aspiration (IA) exposure to Metarhizium anisopliae crude antigen (MACA), which is composed of equal protein amounts of mycelium (MYC), conidia (CON) and inducible proteases/chitinases (IND) extracts/filtrates, has resulted in responses characteristic of human allergic asthma in mice. The study objective was to evaluate the potential of each component extract to induce allergic/asthma-like responses observed in this mouse model. BALB/c mice received 4 IA exposures to MACA, CON, MYC, IND, or bovine serum albumin (BSA; negative control) or appropriate vehicle control or inflammatory control over a 4-wk period. Mice were assessed by whole-body plethysmography for immediate airway responses and airway hyperresponsiveness to methacholine (Mch) challenge (PenH). Serum and bronchoalveolar lavage fluid (BALF) were collected 3 d after the final exposure. Additionally, BALF neurotrophin levels and extract protease and chitinase activity levels were evaluated. Western blot analysis showed that each component contained different IgE-reactive proteins. All fungal extract exposures resulted in elevated BALF total and differential cell counts, IgE and IgA and total serum IgE compared to HBSS and BSA controls. MYC-exposed mice had the highest responses except for neutrophil influx, which was highest in MACA and IND exposures. However, the MYC-exposed mice had significantly lower PenH values compared to other treatments. By comparison IND and MACA induced significantly higher PenH values. Additionally, IND had substantially higher protease activity levels but induced the lowest neurotrophin levels compared to the other fungal exposures. In this allergic asthma model extract chitinase activity was not associated with allergic responses. In summary, multiple exposures to any of the M. anisopliae component extracts induced allergic/asthma-like responses in BALB/c mice but the response magnitude was different for each component and each appears to contain unique Ig

  12. The impact of diet on asthma and allergic diseases.

    PubMed

    Julia, Valerie; Macia, Laurence; Dombrowicz, David

    2015-05-01

    The incidence of allergic diseases is increasing, both in developed and developing countries, concomitantly with the rise in living standards and the adoption of a 'western lifestyle'. For two decades, the hygiene hypothesis - which proposes that the lack of early childhood exposure to infectious agents increases susceptibility to allergic diseases in later life - provided the conceptual framework for unravelling the mechanisms that could account for the increased incidence of allergic diseases. In this Review, we discuss recent evidence that highlights the role of diet as a key factor influencing immune homeostasis and the development of allergic diseases through a complex interplay between nutrients, their metabolites and immune cell populations. Although further investigations are still required to understand these complex relationships, recent data have established a possible connection between metabolic homeostasis and allergic diseases.

  13. [Prevention of allergic diseases in childhood: from theory to reality].

    PubMed

    2016-06-01

    Allergic diseases have an increasing worldwide prevalence and a great impact on the health related costs. The research is focused on the study of etiological and risk factors of allergic diseases that can potentially be modified with primary, secondary and tertiary prevention strategies. Many of these measures do not have a definitively proven effect taking place in a controlled context different to what happens in real life. This paper aims to review the latest evidence on prevention of allergic diseases considering certainties and unresolved issues and focuses mainly on environmental, dietary, pharmacological and immunological preventive strategies for different levels of prevention. It is imperative to have a better understanding of genetic and environmental factors that cause allergic diseases to optimize preventive measures that are effective in reversing the increasing trend in the prevalence of allergic illnesses in childhood.

  14. Fungal endophyte diversity in Sarracenia

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Fungal endophytes were isolated from four species of the carnivorous pitcher plant genus Sarracenia: S. minor, S. oreophila, S. purpurea, and S. psittacina. Twelve taxa of fungi, eight within the Ascomycota and four within the Basidiomycota, were identified based on PCR amplification and sequencing ...

  15. DEMONSTRATION BULLETIN: FUNGAL TREATMENT BULLETIN

    EPA Science Inventory

    Fungal treatment technology uses white rot fungi (lignin degrading fungi) to treat organic contaminated soils in situ. Organic materials inoculated with the fungi are mechanically mixed into the contaminated soil. Using enzymes normally produced for wood degradation as well as ot...

  16. Do lipids influence the allergic sensitization process?

    PubMed Central

    Bublin, Merima; Eiwegger, Thomas; Breiteneder, Heimo

    2014-01-01

    Allergic sensitization is a multifactorial process that is not only influenced by the allergen and its biological function per se but also by other small molecular compounds, such as lipids, that are directly bound as ligands by the allergen or are present in the allergen source. Several members of major allergen families bind lipid ligands through hydrophobic cavities or electrostatic or hydrophobic interactions. These allergens include certain seed storage proteins, Bet v 1–like and nonspecific lipid transfer proteins from pollens and fruits, certain inhalant allergens from house dust mites and cockroaches, and lipocalins. Lipids from the pollen coat and furry animals and the so-called pollen-associated lipid mediators are codelivered with the allergens and can modulate the immune responses of predisposed subjects by interacting with the innate immune system and invariant natural killer T cells. In addition, lipids originating from bacterial members of the pollen microbiome contribute to the outcome of the sensitization process. Dietary lipids act as adjuvants and might skew the immune response toward a TH2-dominated phenotype. In addition, the association with lipids protects food allergens from gastrointestinal degradation and facilitates their uptake by intestinal cells. These findings will have a major influence on how allergic sensitization will be viewed and studied in the future. PMID:24880633

  17. Consensus document on allergic conjunctivitis (DECA).

    PubMed

    Sánchez-Hernández, M C; Montero, J; Rondon, C; Benitez del Castillo, J M; Velázquez, E; Herreras, J M; Fernández-Parra, B; Merayo-Lloves, J; Del Cuvillo, A; Vega, F; Valero, A; Panizo, C; Montoro, J; Matheu, V; Lluch-Bernal, M; González, M L; González, R; Dordal, M T; Dávila, I; Colás, C; Campo, P; Antón, E; Navarro, A

    2015-01-01

    Allergic conjunctivitis (AC) is an inflammatory disease of the conjunctiva caused mainly by an IgE-mediated mechanism. It is the most common type of ocular allergy. Despite being the most benign form of conjunctivitis, AC has a considerable effect on patient quality of life, reduces work productivity, and increases health care costs. No consensus has been reached on its classification, diagnosis, or treatment. Consequently, the literature provides little information on its natural history, epidemiological data are scarce, and it is often difficult to ascertain its true morbidity. The main objective of the Consensus Document on Allergic Conjunctivitis (Documento dE Consenso sobre Conjuntivitis Alérgica [DECA]), which was drafted by an expert panel from the Spanish Society of Allergology and Spanish Society of Ophthalmology, was to reach agreement on basic criteria that could prove useful for both specialists and primary care physicians and facilitate the diagnosis, classification, and treatment of AC. This document is the first of its kind to describe and analyze aspects of AC that could make it possible to control symptoms.

  18. Toxocara canis and the allergic process

    PubMed Central

    Zaia, Mauricio Grecco; de Oliveira, Sandra Regina Pereira; de Castro, Cynthia Aparecida; Soares, Edson Garcia; Afonso, Ana; Monnazzi, Luis Gustavo S; Peitl, Oscar; Faccioli, Lúcia Helena; Anibal, Fernanda de Freitas

    2015-01-01

    The protective effect of infectious agents against allergic reactions has been thoroughly investigated. Current studies have demonstrated the ability of some helminths to modulate the immune response of infected hosts. The objective of the present study was to investigate the relationship between Toxocara canis infection and the development of an allergic response in mice immunised with ovalbumin (OVA). We determined the total and differential blood and bronchoalveolar lavage fluid cells using BALB/c mice as a model. To this end, the levels of interleukin (IL)-4, IL-5 and IL-10 and anti-OVA-IgE were measured using an ELISA. The inflammatory process in the lungs was observed using histology slides stained with haematoxylin and eosin. The results showed an increase in the total number of leukocytes and eosinophils in the blood of infected and immunised animals at 18 days after infection. We observed a slight lymphocytic inflammatory infiltrate in the portal space in all infected mice. Anti-OVA-IgE levels were detected in smaller proportions in the plasma of immunised and infected mice compared with mice that were only infected. Therefore, we concluded that T. canis potentiates inflammation in the lungs in response to OVA, although anti-OVA-IgE levels suggest a potential reduction of the inflammatory process through this mechanism. PMID:26517650

  19. Probiotics in Treatment of Allergic Rhinitis

    PubMed Central

    2010-01-01

    Many randomized controlled trials (RCTs) have been done on role of probiotics as a treatment modality in allergic rhinitis. We conducted a review on the same. A systematic search of published literature was done. RCTs comparing effect of probiotics with placebo were included. A predefined set of outcome measures were assessed. Continuous data were expressed as pooled standardized mean difference (SMD) with 95% confidence interval (CI). Dichotomous data were expressed as odds ratio with 95% CI. P value < 0.05 was considered significant. RevMan version 5 was used for all the analyses. Seven RCTs were eligible for inclusion. Probiotic intake improved quality of life score in patients with allergic rhinitis [SMD -1.17 (95% CI -1.47, -0.86; P < 0.00001)]. Other parameter that improved with probiotic intake was decrease in the number of episodes of rhinitis per year. There was no significant change in blood or immunologic parameters in the probiotic group, SMD -0.10 (95% CI -0.26, 0.06; P = 0.22). Adverse events were not significant. Probiotic therapy might be useful in rhinitis, but the present data do not allow any treatment recommendations. PMID:23282801

  20. Emerging Antigens Involved in Allergic Responses

    PubMed Central

    Platts-Mills, Thomas A.E.; Commins, Scott P.

    2013-01-01

    New allergic diseases can “emerge” because of exposure to a novel antigen, because the immune responsiveness of the subject changes, or because of a change in the behavior of the population. Novel antigens have entered the environment as new pests in the home (e.g., Asian lady beetle or stink bugs), in the diet (e.g., prebiotics or wheat isolates), or because of the spread of a biting arthropod (e.g., ticks). Over the last few years, a significant new disease has been identified, which has changed the paradigm for food allergy. Bites of the tick, Amblyomma americanum, are capable of inducing IgE antibodies to galactose-alpha-1,3-galactose, which is associated with two novel forms of anaphylaxis. In a large area of the southeastern United States, the disease of delayed anaphylaxis to mammalian meat is now common. This disease challenges many previous rules about food allergy and provides a striking model of an emerging allergic disease. PMID:24095162

  1. Toxocara canis and the allergic process.

    PubMed

    Zaia, Mauricio Grecco; Oliveira, Sandra Regina Pereira de; Castro, Cynthia Aparecida de; Soares, Edson Garcia; Afonso, Ana; Monnazzi, Luis Gustavo S; Peitl Filho, Oscar; Faccioli, Lúcia Helena; Anibal, Fernanda de Freitas

    2015-09-01

    The protective effect of infectious agents against allergic reactions has been thoroughly investigated. Current studies have demonstrated the ability of some helminths to modulate the immune response of infected hosts. The objective of the present study was to investigate the relationship between Toxocara canis infection and the development of an allergic response in mice immunised with ovalbumin (OVA). We determined the total and differential blood and bronchoalveolar lavage fluid cells using BALB/c mice as a model. To this end, the levels of interleukin (IL)-4, IL-5 and IL-10 and anti-OVA-IgE were measured using an ELISA. The inflammatory process in the lungs was observed using histology slides stained with haematoxylin and eosin. The results showed an increase in the total number of leukocytes and eosinophils in the blood of infected and immunised animals at 18 days after infection. We observed a slight lymphocytic inflammatory infiltrate in the portal space in all infected mice. Anti-OVA-IgE levels were detected in smaller proportions in the plasma of immunised and infected mice compared with mice that were only infected. Therefore, we concluded that T. canis potentiates inflammation in the lungs in response to OVA, although anti-OVA-IgE levels suggest a potential reduction of the inflammatory process through this mechanism. PMID:26517650

  2. Allergic diseases: the price of civilisational progress

    PubMed Central

    Sowa, Paweł; Rutkowska-Talipska, Joanna; Sulkowski, Stanisław; Rutkowski, Ryszard

    2014-01-01

    Atopic disorders are a major global health problem. The prevalence of asthma, allergic rhinitis and atopic dermatitis has been increasing over the last four decades, both in the industrialized and developing countries. It seems to be related to changes in the social structure, increasing industrialization, pollution and dietary changes. Many hypotheses link the allergy epidemic to stringent hygiene, dominance of a westernized lifestyle and an accelerated pace of life. Dietary antioxidants, lipids, sodium, vitamin D seem also to be implicated. We endeavour to review the most relevant theories with a special emphasis on the hygiene, antioxidative, lipid and air pollution hypotheses. It is however important to note that none of them explains all the aspects of unprecedented rise in the prevalence of allergic disorders. A complex interplay between host's immune response, invading pathogens, diversity of environmental factors and genetic background seems to be of a particular importance. Current allergy epidemic is multifactorial and basic and epidemiologic studies are warranted to further our understanding of this phenomenon. PMID:25097472

  3. Acute allergic interstitial pneumonitis induced by hydrochlorothiazide.

    PubMed Central

    Biron, P; Dessureault, J; Napke, E

    1991-01-01

    OBJECTIVE: To examine the clinical features of 4 unpublished cases and 26 published cases of acute allergic interstitial pneumonitis induced by hydrochlorothiazide (HCT). DATA SOURCES: The unpublished cases were found in the database of the Drug Adverse Reaction Program, Health Protection Branch, Department of National Health and Welfare, and the database of the Programme conjoint de pharmacovigilance, in Quebec. The published cases were retrieved from MEDLINE and EMBASE. STUDY SELECTION: Reported cases were selected if they were sufficiently documented. All published cases were selected because a differential diagnosis had been made in each one. DATA SYNTHESIS: The onset was acute and dramatic; the average time to onset of symptoms was 44 minutes. Sex was a predominant risk factor, since 27 (90%) of the 30 patients were women. The average age was 56 years; thus, most of the women were postmenopausal. Over two-thirds of the patients had one to three positive prechallenges or rechallenges, 3 of the 52 documented adverse events occurred after a voluntary rechallenge, some were life-threatening and necessitated mechanical ventilation, and 1 was fatal. Treatment was supportive; avoidance of HCT was the only prevention. CONCLUSION: Acute allergic interstitial pneumonitis due to HCT is extremely rare and potentially fatal. Such a reaction can be diagnosed only if the clinician suspects it when presented with a case of unexplained acute pulmonary edema. PMID:2049694

  4. Epidemiology and current status of allergic rhinitis, asthma, and associated allergic diseases in Korea: ARIA Asia-Pacific workshop report.

    PubMed

    Park, Hae Sim; Choi, Gil Soon; Cho, Joong Sang; Kim, You-Young

    2009-01-01

    The prevalence of allergic rhinitis and asthma has recently increased in Korea, and both conditions are recognized as major chronic respiratory diseases requiring active intervention. The prevalence of rhinitis among asthmatic patients is high, ranging from 60 to 80%, and could seriously affect asthma severity and outcome. We suggest that allergic rhinitis should be properly evaluated in asthmatic patients to achieve better asthma control.

  5. Health Utility Outcomes in Patients Undergoing Medical Management for Chronic Rhinosinusitis – A Prospective Multi-Institutional Study

    PubMed Central

    Luk, Lauren J.; Steele, Toby O.; Mace, Jess C.; Soler, Zachary M.; Rudmik, Luke; Smith, Timothy L.

    2015-01-01

    Background A health utility value represents an individual’s preference for living in a specific health state and is used in cost-utility analyses. This study investigates the impact of continuing medical therapy on health utility outcomes in patients with chronic rhinosinusitis (CRS). Methods The Medical Outcomes Study Short Form-6D (SF-6D) was administered to patients prospectively enrolled in a longitudinal study examining treatment outcomes for CRS. Patients were prescribed robust, initial medical therapy and then elected to continue with medical therapy (n=40) or undergo endoscopic sinus surgery (ESS), followed by medical therapy (n=152). Patients observed through treatment crossover to ESS were also evaluated (n=20). Health utility values (SF-6D) were generated at baseline, 6-months, and 12-months follow-up for both cohorts and evaluated using repeated measures ANOVA. Results Treatment crossover patients were found to have a significantly higher prevalence of previous sinus surgery compared to medical management (χ2=6.91; p=0.009) and surgical intervention (χ2=8.11; p=0.004) subgroups. Mean baseline utility value for the medical therapy cohort was significantly better compared to the ESS cohort (0.76[0.12] versus 0.70[0.15]; p=0.023). Significant improvement in health utility was reported in the ESS cohort (F(2)=37.69; p<0.001), while values remained stable, without significant improvement, in both the medical therapy cohort (F(2)=0.03; p=0.967) and treatment crossover cohort (F(2)=2.36; p=0.115). Conclusions Patients electing continued medical management report better baseline health utility compared to patients electing ESS. Patients electing ESS demonstrate significant improvement in health utility while those electing continued medical management demonstrate stable health utility over 12 months. PMID:26140502

  6. High rates of detection of respiratory viruses in the nasal washes and mucosae of patients with chronic rhinosinusitis.

    PubMed

    Cho, Gye Song; Moon, Byung-Jae; Lee, Bong-Jae; Gong, Chang-Hoon; Kim, Nam Hee; Kim, You-Sun; Kim, Hun Sik; Jang, Yong Ju

    2013-03-01

    Respiratory viral infections are often implicated as triggers of chronic rhinosinusitis (CRS) flare-ups. However, there is a paucity of respiratory viral surveillance studies in CRS patients, and such studies could elucidate the potential role of viruses in promoting symptoms and aggravating mucosal inflammation. Therefore, a prospective case-control study was conducted to determine the prevalence of respiratory viruses in CRS patients and non-CRS controls. Nasal lavage fluids and turbinate epithelial cells were collected prospectively from 111 CRS patients and 50 controls. Multiplex PCR was used to identify common respiratory viruses in both sample types and the infection rate was compared between groups. Respiratory viruses were detected in 50.5% of lavage samples and in 64.0% of scraping samples from CRS patients. The overall infection rate was significantly different in CRS patients and controls (odds ratio, 2.9 in lavage and 4.1 in scraping samples). Multiple viral infections were detected more frequently in lavage samples from CRS patients than those from controls (P < 0.01; odds ratio, 7.7). Rhinovirus was the most prevalent virus and the only virus with a significantly different infection rate in CRS patients and controls in both samples (odds ratio, 3.2 in lavage and 3.4 in scraping samples). This study detected a higher prevalence of respiratory viruses in CRS patients than controls, suggesting that there may be significant associations between inflammation of CRS and respiratory viruses, particularly rhinovirus. Further studies should investigate the exact role of highly prevalent respiratory viruses in CRS patients during symptomatic aggravation and ongoing mucosal inflammation.

  7. Improving Patient Care Via Development of a Protein-Based Diagnostic Test for Microbe-Specific Detection of Chronic Rhinosinusitis

    PubMed Central

    Das, Subinoy; Rosas, Lucia E.; Jurcisek, Joseph A.; Novotny, Laura A.; Green, Kari B.; Bakaletz, Lauren O.

    2014-01-01

    Objectives The hypothesis is that signature bacterial proteins can be identified in sinus secretions via high-throughput, proteomic based techniques. Non-typeable Haemophilus influenzae (NTHI) is the most common bacterial pathogen associated with sinusitis and will serve as a proof of principle pathogen for identifying biomarkers. Study Design In vitro and in vivo studies using proteomic based analysis of cultures of NTHI and a novel, experimental chinchilla polymicrobial sinusitis model. Methods Nano-liquid chromatography/tandem mass spectrometry (nano-LC-MS/MS) was performed to annotate the secretome from an NTHI biofilm. A model of NTHI induced sinusitis was developed in a chinchilla and NTHI proteins were detected in chinchilla secretions. A reference standard RT-PCR based assay was adapted to allow for sensitivity and specificity testing of the identified signature biomarkers in human patients. Results Outer membrane proteins P2 (OMP-P2) and P5 (OMP-P5) were identified as promising candidates for detection of NTHI biofilms and positively detected in nasopharyngeal secretions of chinchillas experimentally infected with NTHI. An RT-PCR based test for the presence of NTHI biofilms demonstrated 100% sensitivity and 100% specificity when tested against 8 unique strains commonly found in human bacterial rhinosinusitis. Conclusions Proteomic analysis was successful in identifying signature proteins for possible use as a biomarker for CRS. OMP-P2 and OMP-P5 were validated as promising candidates and were positively detected from nasopharyngeal secretions from chinchillas experimentally infected with NTHI. Collectively, these data support the use of OMP-P2 and OMP-P5 as biomarkers for a human clinical trial to develop a point of care medical diagnostic test to assist in the diagnosis and treatment of CRS. PMID:23904321

  8. Immunological profiling in chronic rhinosinusitis with nasal polyps reveals distinct VEGF and GMCSF signatures during symptomatic exacerbations

    PubMed Central

    Divekar, Rohit D.; Samant, Shefali; Rank, Matthew A.; Hagan, John; Lal, Devyani; O’Brien, Erin K.; Kita, Hirohito

    2015-01-01

    Background The mechanisms and immune pathways associated with chronic rhinosinusitis (CRS) are not fully understood. Immunological changes during acute exacerbation of CRS may provide valuable clues to the pathogenesis and perpetuation of the disease. Objective To characterize local and systemic immune responses associated with acute worsening of sinonasal symptoms during exacerbation in CRS with nasal polyps (CRSwNP) compared to controls. Methods This was a noninterventional prospective study of individuals with CRSwNP and normal controls. Subjects underwent a baseline visit with collection of nasal secretions, nasal washes, and serum specimens. Within 3 days of acute worsening of sinonasal symptoms, subjects underwent a study visit, followed by a post-visit 2 weeks later. The Sinonasal Outcome Test-22 (SNOT-22) scores and immunological parameters in the specimens were analyzed using a novel, unsupervised learning method and by conventional univariate analysis. Results Both CRSwNP patients and control subjects showed a significant increase in SNOT-22 scores during acute exacerbation. Increased nasal levels of IL-6, IL-5, and eosinophil major basic protein were observed in CRSwNP patients. A network analysis of serum specimens revealed changes in a set of immunological parameters, which are distinctly associated with CRSwNP but not with controls. In particular, systemic increases in VEGF and GM-CSF levels were notable and were validated by a conventional analysis. Conclusions CRSwNP patients demonstrate distinct immunological changes locally and systemically during acute exacerbation. Growth factors VEGF and GM-CSF may be involved in the immunopathogenesis of subjects with CRS and nasal polyps experiencing exacerbation. PMID:25429844

  9. The bitter taste receptor T2R38 is an independent risk factor for chronic rhinosinusitis requiring sinus surgery

    PubMed Central

    Adappa, Nithin D.; Zhang, Zi; Palmer, James N.; Kennedy, David W.; Doghramji, Laurel; Lysenko, Anna; Reed, Danielle R.; Scott, Thomas; Zhao, Nina W.; Owens, David; Lee, Robert J.; Cohen, Noam A.

    2014-01-01

    Background The bitter taste receptor T2R38 was recently described to play a role in upper airway innate mucosal defense. When activated by bacterial quorum-sensing molecules, T2R38 stimulates the ciliated epithelial cells to produce nitric oxide (NO), resulting in bactericidal activity and an increase in mucociliary clearance (MCC). Polymorphisms within the T2R38 gene (TAS2R38) confer variability in activation of the receptor yielding dramatic differences in upper airway defensive responses (NO production and accelerated MCC) to microbial stimulation based on genotype. Our objective was to determine whether the non protective TAS2R38 polymorphisms, which render the receptor inactive, correlate with medically recalcitrant chronic rhinosinusitis (CRS) necessitating surgical intervention in the context of known risk factors, and thus identify whether the TAS2R38 genotype is an independent risk factor for patients undergoing functional endoscopic sinus surgery (FESS). Methods CRS patients undergoing primary FESS were prospectively genotyped for TAS2R38. Chi-square analysis was performed on the genotype distribution with respect to other risk factors, including allergies, asthma, nasal polyposis, aspirin sensitivity, diabetes, and smoking exposure. Results Seventy primary FESS patients were genotyped demonstrating a statistically significant skewing from the expected distribution of the general population (p < 0.0383). CRS patients with a particular polymorphism seemed less likely to have allergies, asthma, nasal polyposis, aspirin sensitivity, and diabetes, but this did not demonstrate statistical significance. Conclusion Our investigation suggests that TAS2R38 genotype is an independent risk factor for patients failing medical therapy, necessitating surgical intervention. PMID:24302675

  10. The Chemical Basis of Fungal Bioluminescence.

    PubMed

    Purtov, Konstantin V; Petushkov, Valentin N; Baranov, Mikhail S; Mineev, Konstantin S; Rodionova, Natalja S; Kaskova, Zinaida M; Tsarkova, Aleksandra S; Petunin, Alexei I; Bondar, Vladimir S; Rodicheva, Emma K; Medvedeva, Svetlana E; Oba, Yuichi; Oba, Yumiko; Arseniev, Alexander S; Lukyanov, Sergey; Gitelson, Josef I; Yampolsky, Ilia V

    2015-07-01

    Many species of fungi naturally produce light, a phenomenon known as bioluminescence, however, the fungal substrates used in the chemical reactions that produce light have not been reported. We identified the fungal compound luciferin 3-hydroxyhispidin, which is biosynthesized by oxidation of the precursor hispidin, a known fungal and plant secondary metabolite. The fungal luciferin does not share structural similarity with the other eight known luciferins. Furthermore, it was shown that 3-hydroxyhispidin leads to bioluminescence in extracts from four diverse genera of luminous fungi, thus suggesting a common biochemical mechanism for fungal bioluminescence.

  11. Fungal Exopolysaccharide: Production, Composition and Applications

    PubMed Central

    Mahapatra, Subhadip; Banerjee, Debdulal

    2013-01-01

    Fungal exopolysaccharides (EPSs) have been recognized as high value biomacromolecules for the last two decades. These products, including pullulan, scleroglucan, and botryosphaeran, have several applications in industries, pharmaceuticals, medicine, foods etc. Although fungal EPSs are highly relevant, to date information concerning fungal biosynthesis is scarce and an extensive search for new fugal species that can produce novel EPSs is still needed. In most cases, the molecular weight variations and sugar compositions of fungal EPSs are dependent to culture medium composition and different physical conditions provided during fermentation. An inclusive and illustrative review on fungal EPS is presented here. The general outline of the present work includes fungal EPS production, their compositions and applications. An emphasis is also given to listing out different fungal strains that can produce EPSs. PMID:24826070

  12. Acute rhinosinusitis (ARS). Diagnosis and treatment of adults in general practice.

    PubMed

    Hansen, Jens Georg

    2014-02-01

    relevant diagnose will be based on use of CRP alone, as the test can be made easily and fast while the patient is in the clinic compared to the use of ESR. The disease is over-diagnosed in general practice. In only 53% of patients, who the GP suspected of having acute sinusitis, was there detected pus or mucopus at the sinus puncture, furthermore the patients' statements that they had had sinusitis was significantly negatively associated with current acute maxillary sinusitis. Almost all patients are prescribed topical treatment to the nose in the form of vasoconstrictor, and 50-70% also antibiotics. The most common bacteria that can be isolated are S. pneumoniae and H. influenzae. For many years the first drug of choice has been penicillin V, and treatment with penicillin V has followed Scandinavian recommendations. However, the resistance patterns in respect of H. influenzae have changed over the years and if the dominant flora is H. influenzae, then oral penicillin is not sufficient anymore, and should be replaced by amoxicillin with or without clavulanate. It is reported that the MIC of penicillin V is too high, such that oral dosage cannot provide sufficiently high concentrations. However, in daily clinical practice the doctor does not have the possibility to decide whether the infection is caused by either S. pneumoniae or H. influenzae, unless a sinus puncture is performed and it is not considered as a standard procedure. The recommended treatment is therefore starting with penicillin V, and at treatment failure switching to amoxicillin with or without clavulanate. It is well known that URTI's can exacerbate a chronic pulmonary disease - like asthma - in allergic patients, but this influence is also demonstrated as described in article 6 where ARS in adults without any sign of chronic lung disease or allergy is accompanied by a temporary reduction lung function. Future research should focus on the use of CRP in general practice, analysing cost-effectiveness of the

  13. Airway Fibrinogenolysis and the Initiation of Allergic Inflammation

    PubMed Central

    Millien, Valentine Ongeri; Lu, Wen; Mak, Garbo; Yuan, Xiaoyi; Knight, J. Morgan; Porter, Paul; Kheradmand, Farrah

    2014-01-01

    The past 15 years of allergic disease research have produced extraordinary improvements in our understanding of the pathogenesis of airway allergic diseases such as asthma. Whereas it was previously viewed as largely an immunoglobulin E-mediated process, the gradual recognition that T cells, especially Type 2 T helper (Th2) cells and Th17 cells, play a major role in asthma and related afflictions has inspired clinical trials targeting cytokine-based inflammatory pathways that show great promise. What has yet to be clarified about the pathogenesis of allergic inflammatory disorders, however, are the fundamental initiating factors, both exogenous and endogenous, that drive and sustain B- and T-cell responses that underlie the expression of chronic disease. Here we review how proteinases derived from diverse sources drive allergic responses. A central discovery supporting the proteinase hypothesis of allergic disease pathophysiology is the role played by airway fibrinogen, which in part appears to serve as a sensor of unregulated proteinase activity and which, when cleaved, both participates in a novel allergic signaling pathway through Toll-like receptor 4 and forms fibrin clots that contribute to airway obstruction. Unresolved at present is the ultimate source of airway allergenic proteinases. From among many potential candidates, perhaps the most intriguing is the possibility such enzymes derive from airway fungi. Together, these new findings expand both our knowledge of allergic disease pathophysiology and options for therapeutic intervention. PMID:25525732

  14. Airway Epithelial Regulation of Allergic Sensitization in Asthma

    PubMed Central

    Poynter, Matthew E.

    2012-01-01

    While many of the contributing cell types and mediators of allergic asthma are known, less well understood are the factors that influence the development of allergic responses that lead to the development of allergic asthma. As the first airway cell type to respond to inhaled factors, the epithelium orchestrates downstream interactions between dendritic cells (DCs) and CD4+ T cells that quantitatively and qualitatively dictate the degree and type of the allergic asthma phenotype, making the epithelium of critical importance for the genesis of allergies that later manifest in allergic asthma. Amongst the molecular processes of critical importance in airway epithelium is the transcription factor, nuclear factor-kappaB (NF-κB). This review will focus primarily on the genesis of pulmonary allergies and the participation of airway epithelial NF-κB activation therein, using examples from our own work on nitrogen dioxide (NO2) exposure and genetic modulation of airway epithelial NF-κB activation. In addition, the mechanisms through which Serum Amyloid A (SAA), an NF-κB-regulated, epithelial-derived mediator, influences allergic sensitization and asthma severity will be presented. Knowledge of the molecular and cellular processes regulating allergic sensitization in the airways has the potential to provide powerful insight into the pathogenesis of allergy, as well as targets for the prevention and treatment of asthma. PMID:22579987

  15. Treatment strategies designed to minimize medical complications of allergic rhinitis.

    PubMed

    Fireman, P

    1997-01-01

    Perennial and seasonal allergic rhinitis affect many million Americans and account for close to $2 billion annually in medical costs and lost productivity. The symptoms of allergic rhinitis, including sneezing, rhinorrhea, nasal congestion, and pruritus are, at best, very annoying and may be quite debilitating in some patients, causing irritability, insomnia, and fatigue. Moreover, allergic rhinitis is often not self-limiting and can contribute to serious medical complications such as sinusitis and otitis. Aggressive medical management of allergic rhinitis is important in the therapy for chronic sinusitis and otitis media and may prevent progression to more serious disease. Accurate diagnosis and initiation of environmental control measures to reduce exposure to causative factors should accompany initiation of pharmacotherapy. Antihistamines form the cornerstone of pharmacologic therapy, and use of the newer nonsedating antihistamines such as loratadine, terfenadine, and astemizole is not associated with the sedation produced by the classic antihistamines. Both loratadine and terfenadine are available in combination with a decongestant. Topical intranasal corticosteroids are another important component of pharmacologic management of allergic rhinitis. Allergen immunotherapy (hyposensitization) is used in those patients not adequately managed with pharmacotherapy. The relative safety and convenient dosing schedule of the newer medications should be accompanied by enhanced patient compliance and, hence, better control of allergic symptoms, halting progression of allergic rhinitis to serious medical complications. PMID:9129750

  16. Xanthii Fructus inhibits allergic response in the ovalbumin-sensitized mouse allergic rhinitis model

    PubMed Central

    Gwak, Nam-Gil; Kim, Eun-Young; Lee, Bina; Kim, Jae-Hyun; Im, Yong-Seok; Lee, Ka-Yeon; Jun-Kum, Chang; Kim, Ho-Seok; Cho, Hyun-Joo; Jung, Hyuk-Sang; Sohn, Youngjoo

    2015-01-01

    Background: Xanthii Fructus (XF) is widely used in traditional anti-bacterial and anti-inflammatory Asian medicine. Allergic rhinitis is a common inflammatory disease characterized by markedly increased levels of anti-inflammatory factors and the recruitment of inflammatory cells into the nasal mucosa. We investigated the effects of XF in the allergen-induced rhinitis model. Materials and Methods: Following ovalbumin (OVA)/alum intraperitoneal injection on days 0, 7 and 14, the BALB/c mice (albino, laboratory-bred strain of the house mice) were challenged intranasally with OVA for 10 days a week after the last sensitization. The number of sneezes was recorded for 10 days; additionally, the levels of cytokines, histamine, immunoglobulin E (IgE) and OVA-specific serum IgE were estimated. Eosinophil infiltration, thickness of nasal mucosa and expression of caspase-1 were determined by immunohistochemistry. We also evaluated the effect of XF on the phosphorylation of nuclear factor kappa-B (NF-κB) and inhibitor of nuclear factor kappa B-alpha (IκB-α) in human mast cell-1 (HMC-1), by Western blotting. Results: The administration of XF significantly decreased sneezing and the serum levels of histamine, IgE, OVA-specific IgE, and cytokines such as tumor necrosis factor-alpha (TNF-α), interleukine-1 beta (IL-1β), IL-5, IL-6, monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein-2 (MIP-2). XF inhibited the changes in thickness of the nasal septum, influx of eosinophils and expression of capase-1. In addition, XF inhibited the phosphorylation of IκB-α and NF-κB in phorbol-myristate-acetate plus calcium ionophore A23187 (A23187) stimulated HMC-1. Conclusion: This study suggests that XF acts a potent anti-allergic drug which alleviates the allergic responses in ovalbumin-sensitized mouse allergic rhinitis model. PMID:26664025

  17. Protective effects of surfactant protein D treatment in 1,3-β-glucan-modulated allergic inflammation.

    PubMed

    Fakih, Dalia; Pilecki, Bartosz; Schlosser, Anders; Jepsen, Christine S; Thomsen, Laura K; Ormhøj, Maria; Watson, Alastair; Madsen, Jens; Clark, Howard W; Barfod, Kenneth K; Hansen, Soren; Marcussen, Niels; Jounblat, Rania; Chamat, Soulaima; Holmskov, Uffe; Sorensen, Grith L

    2015-12-01

    Surfactant protein D (SP-D) is a pulmonary collectin important in lung immunity. SP-D-deficient mice (Sftpd(-/-)) are reported to be susceptible to ovalbumin (OVA)- and fungal allergen-induced pulmonary inflammation, while treatment with exogenous SP-D has therapeutic effects in such disease models. β-Glucans are a diverse group of polysaccharides previously suggested to serve as fungal ligands for SP-D. We set out to investigate if SP-D could interact with 1,3-β-glucan and attenuate allergic pulmonary inflammation in the presence of 1,3-β-glucan. Allergic airway disease was induced in Sftpd(-/-) and Sftpd(+/+) mice by OVA sensitization and subsequent challenge with OVA, 1,3-β-glucan, or OVA/1,3-β-glucan together. Mice in the combined treatment group were further treated with a high dose of recombinant fragment of human SP-D (rfhSP-D). We demonstrated direct interaction between SP-D and 1,3-β-glucan. OVA-induced mucous cell metaplasia was increased in Sftpd(-/-) mice, supporting previously reported protective effects of endogenous SP-D in allergy. OVA-induced parenchymal CCL11 levels and eosinophilic infiltration in bronchoalveolar lavage were unaffected by 1,3-β-glucan, but were reversed with rfhSP-D treatment. 1,3-β-Glucan treatment did, however, induce pulmonary neutrophilic infiltration and increased TNF-α levels in bronchoalveolar lavage, independently of OVA-induced allergy. This infiltration was also reversed by treatment with rfhSP-D. 1,3-β-Glucan reduced OVA-induced mucous cell metaplasia, T helper 2 cytokines, and IFN-γ production. rfhSP-D treatment further reduced mucous metaplasia and T helper 2 cytokine secretion to background levels. In summary, rfhSP-D treatment resulted in attenuation of both allergic inflammation and 1,3-β-glucan-mediated neutrophilic inflammation. Our data suggest that treatment with high-dose SP-D protects from mold-induced exacerbations of allergic asthma. PMID:26432866

  18. Protective effects of surfactant protein D treatment in 1,3-β-glucan-modulated allergic inflammation.

    PubMed

    Fakih, Dalia; Pilecki, Bartosz; Schlosser, Anders; Jepsen, Christine S; Thomsen, Laura K; Ormhøj, Maria; Watson, Alastair; Madsen, Jens; Clark, Howard W; Barfod, Kenneth K; Hansen, Soren; Marcussen, Niels; Jounblat, Rania; Chamat, Soulaima; Holmskov, Uffe; Sorensen, Grith L

    2015-12-01

    Surfactant protein D (SP-D) is a pulmonary collectin important in lung immunity. SP-D-deficient mice (Sftpd(-/-)) are reported to be susceptible to ovalbumin (OVA)- and fungal allergen-induced pulmonary inflammation, while treatment with exogenous SP-D has therapeutic effects in such disease models. β-Glucans are a diverse group of polysaccharides previously suggested to serve as fungal ligands for SP-D. We set out to investigate if SP-D could interact with 1,3-β-glucan and attenuate allergic pulmonary inflammation in the presence of 1,3-β-glucan. Allergic airway disease was induced in Sftpd(-/-) and Sftpd(+/+) mice by OVA sensitization and subsequent challenge with OVA, 1,3-β-glucan, or OVA/1,3-β-glucan together. Mice in the combined treatment group were further treated with a high dose of recombinant fragment of human SP-D (rfhSP-D). We demonstrated direct interaction between SP-D and 1,3-β-glucan. OVA-induced mucous cell metaplasia was increased in Sftpd(-/-) mice, supporting previously reported protective effects of endogenous SP-D in allergy. OVA-induced parenchymal CCL11 levels and eosinophilic infiltration in bronchoalveolar lavage were unaffected by 1,3-β-glucan, but were reversed with rfhSP-D treatment. 1,3-β-Glucan treatment did, however, induce pulmonary neutrophilic infiltration and increased TNF-α levels in bronchoalveolar lavage, independently of OVA-induced allergy. This infiltration was also reversed by treatment with rfhSP-D. 1,3-β-Glucan reduced OVA-induced mucous cell metaplasia, T helper 2 cytokines, and IFN-γ production. rfhSP-D treatment further reduced mucous metaplasia and T helper 2 cytokine secretion to background levels. In summary, rfhSP-D treatment resulted in attenuation of both allergic inflammation and 1,3-β-glucan-mediated neutrophilic inflammation. Our data suggest that treatment with high-dose SP-D protects from mold-induced exacerbations of allergic asthma.

  19. DemaDb: an integrated dematiaceous fungal genomes database

    PubMed Central

    Kuan, Chee Sian; Yew, Su Mei; Chan, Chai Ling; Toh, Yue Fen; Lee, Kok Wei; Cheong, Wei-Hien; Yee, Wai-Yan; Hoh, Chee-Choong; Yap, Soon-Joo; Ng, Kee Peng

    2016-01-01

    Many species of dematiaceous fungi are associated with allergic reactions and potentially fatal diseases in human, especially in tropical climates. Over the past 10 years, we have isolated more than 400 dematiaceous fungi from various clinical samples. In this study, DemaDb, an integrated database was designed to support the integration and analysis of dematiaceous fungal genomes. A total of 92 072 putative genes and 6527 pathways that identified in eight dematiaceous fungi (Bipolaris papendorfii UM 226, Daldinia eschscholtzii UM 1400, D. eschscholtzii UM 1020, Pyrenochaeta unguis-hominis UM 256, Ochroconis mirabilis UM 578, Cladosporium sphaerospermum UM 843, Herpotrichiellaceae sp. UM 238 and Pleosporales sp. UM 1110) were deposited in DemaDb. DemaDb includes functional annotations for all predicted gene models in all genomes, such as Gene Ontology, EuKaryotic Orthologous Groups, Kyoto Encyclopedia of Genes and Genomes (KEGG), Pfam and InterProScan. All predicted protein models were further functionally annotated to Carbohydrate-Active enzymes, peptidases, secondary metabolites and virulence factors. DemaDb Genome Browser enables users to browse and visualize entire genomes with annotation data including gene prediction, structure, orientation and custom feature tracks. The Pathway Browser based on the KEGG pathway database allows users to look into molecular interaction and reaction networks for all KEGG annotated genes. The availability of downloadable files containing assembly, nucleic acid, as well as protein data allows the direct retrieval for further downstream works. DemaDb is a useful resource for fungal research community especially those involved in genome-scale analysis, functional genomics, genetics and disease studies of dematiaceous fungi. Database URL: http://fungaldb.um.edu.my PMID:26980516

  20. The activity of recent anti-allergic drugs in the treatment of seasonal allergic rhinitis.

    PubMed

    Wang, D; Clement, P; Smitz, J; De Waele, M

    1996-01-01

    Two experiments were performed during the pollen season to study the activity of different antiallergic drugs in the treatment of seasonal allergic rhinitis. Nasal allergen challenge (NAC) was performed to mimic an acute attack of allergic rhinitis and to objectively evaluate the effect of the drugs on the early-phase reaction during the season. The first study assessed the effect of H1 (Cetirizine 10 mg a day) and of a combination of H1 (Cetirizine 10 mg) plus H2 (Cimetidine 800 mg a day) antagonists on nasal symptoms, mediator release and eosinophil count in a group of 16 patients with seasonal allergic rhinitis. During the same season a second study compared in a randomized way (2 parallel groups) the effect of Budesonide (Rhinocort Aqua) and Azelastine (Allergodil nasal spray) in a group of 14 patients. Results showed that both antihistamines, applied topically of dosed orally, reduced sneezing even when significant increases of histamine concentration in nasal secretions were evidenced immediately after NAC. When a combination of Cetirizine and Cimetidine was administered, a significant (p < 0.01) reduction of nasal airway resistance and increase of nasal airflow after NAC were demonstrated as well. In addition, topical application of Budesonide showed a strong (p < 0.01) effect on the infiltration and activation of eosinophils during the season, and on tryptase release after NAC. These effects lasted at least for one week after therapy. PMID:8669268

  1. The activity of recent anti-allergic drugs in the treatment of seasonal allergic rhinitis.

    PubMed

    Wang, D; Clement, P; Smitz, J; De Waele, M

    1996-01-01

    Two experiments were performed during the pollen season to study the activity of different antiallergic drugs in the treatment of seasonal allergic rhinitis. Nasal allergen challenge (NAC) was performed to mimic an acute attack of allergic rhinitis and to objectively evaluate the effect of the drugs on the early-phase reaction during the season. The first study assessed the effect of H1 (Cetirizine 10 mg a day) and of a combination of H1 (Cetirizine 10 mg) plus H2 (Cimetidine 800 mg a day) antagonists on nasal symptoms, mediator release and eosinophil count in a group of 16 patients with seasonal allergic rhinitis. During the same season a second study compared in a randomized way (2 parallel groups) the effect of Budesonide (Rhinocort Aqua) and Azelastine (Allergodil nasal spray) in a group of 14 patients. Results showed that both antihistamines, applied topically of dosed orally, reduced sneezing even when significant increases of histamine concentration in nasal secretions were evidenced immediately after NAC. When a combination of Cetirizine and Cimetidine was administered, a significant (p < 0.01) reduction of nasal airway resistance and increase of nasal airflow after NAC were demonstrated as well. In addition, topical application of Budesonide showed a strong (p < 0.01) effect on the infiltration and activation of eosinophils during the season, and on tryptase release after NAC. These effects lasted at least for one week after therapy.

  2. The anatomical and functional relationship between allergic conjunctivitis and allergic rhinitis

    PubMed Central

    Bielory, Leonard

    2013-01-01

    There are numerous anatomic connections between the allergic conjunctivitis and allergic rhinitis. The most obvious reason is the physical connection via the nasolacrimal apparatus. However, a closer look at innervation, circulatory, lymphatic, and neurogenic systems reveals much more than a physical connection. The eye is richly innervated by parasympathetic nerves that enter the eyes after traveling in conjunction with the parasympathetic input to the nasal cavity. Parasympathetic innervation governing the tear film and nasal secretion can intersect at the pterygopalatine ganglion. Neurogenic inflammation affects both the eye and the nose as evidenced by the presence of the same neurogenic factors. Venous flow is in the SOV area connecting the eye and the nose, once thought to be without valves. In the past, this thinking is the basis for concern about the danger triangle of the face. Recent literature has shown otherwise. Although valves are present, there are still pathways where bidirectional flow exists and a venous connection is made. The most likely area for venous communication is the pterygoid plexus and cavernous sinus. The venous flow and connections also offers a pathway for allergic shiners. Understanding the mutual connections between the nasal mucosa and the ocular surface can also affect treatment strategies. PMID:24498515

  3. Abietic acid attenuates allergic airway inflammation in a mouse allergic asthma model.

    PubMed

    Gao, Yi; Zhaoyu, Liu; Xiangming, Fang; Chunyi, Lin; Jiayu, Pan; Lu, Shen; Jitao, Chen; Liangcai, Chen; Jifang, Liu

    2016-09-01

    Abietic acid (AA), one of the terpenoids isolated from Pimenta racemosa var. grissea, has been reported to have anti-inflammatory and immunomodulatory effects. However, the anti-allergic effects of AA remain unclear. The aim of this study was to investigate the anti-allergic effects of AA in an ovalbumin (OVA)-induced asthma murine model. The model of mouse asthma was established by induction of OVA. AA (10, 20, 40mg/kg) was administered by oral gavage 1h after the OVA treatment on days 21 to 23. At 24h after the last challenge, bronchoalveolar lavage fluid (BALF) and lung tissues were collected to assess pathological changes, cytokines production, and NF-κB expression. The results showed that AA attenuated lung histopathologic changes, inflammatory cells infiltration, and bronchial hyper-responsiveness. AA also inhibited OVA-induced the nitric oxide (NO), IL-4, IL-5, IL-13, and OVA-specific IgE production, as well as NF-κB activation. In conclusion, the current study demonstrated that AA exhibited protective effects against OVA-induced allergic asthma in mice and the possible mechanism was involved in inhibiting NF-κB activation. PMID:27318791

  4. Motivating patient adherence to allergic rhinitis treatments.

    PubMed

    Bender, Bruce G

    2015-03-01

    Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcutaneous or sublingual, stop treatment within the first year. Although research into interventions to improve AR adherence is lacking, lessons learned from adherence interventions in other chronic health conditions can be applied to AR. Two well-established, overriding models of care-the chronic care model and patient-centered care-can improve adherence. The patient-centered care model includes important lessons for allergy providers in their daily practice, including understanding and targeting modifiable barriers to adherence. Additionally, recent studies have begun to leverage health information and communication technologies to reach out to patients and promote adherence, extending patient-centered interventions initiated by providers during office visits.

  5. Therapeutic targets in allergic eye disease.

    PubMed

    Bielory, L

    2001-01-01

    The objective of this article is to provide an overview of the present state of treatment of ocular allergy. Immuno-ophthalmology arose in the portion of this past century when investigators uncovered the uniqueness of the lens proteins and that it could induce an immunological response otherwise know as phacoanaphylaxis. Further studies have shown many similarities between the eye and other organ systems, but one of the most profound problems was the spring "catarrh" that involved the eyes and nose, i.e., rhinoconjunctivitis. Treatment over the past 10 years has expanded with the better understanding of the allergic response at the conjunctival surface. Allergen immunotherapy remains a cornerstone of treatment. In fact, the very first report of the use of immunotherapy in 1911 "measured the patient's resistance during experiments ... of pollen extracts to excite a conjunctival reaction" (Noon L, and Cantar BO, Lancet 1572-1573, 1911).

  6. Rhinolith misdiagnosed as allergic rhinitis: case report

    PubMed Central

    Aljfout, Qais; Saraireh, Mohammad; Maita, Abdullah

    2016-01-01

    Foreign body neglected in the nasal cavity for many years leads to the formation of a rhinolith, which gradually increases in size. Nasal obstruction and persistent foul smelling nasal discharge usually are the main presenting symptoms, although some might be silent. This paper presents and discuss a case of 19-year-old female patient whose main complaint was nasal obstruction for many years and treated as allergic rhinitis. Diagnosis was confirmed with computed tomography scan, and it was removed endoscopically without complications. We think that proper examination, which includes endoscopic evaluation, should be done to reach the diagnosis. A computed tomography scan confirmed the diagnosis and helped in planning the best treatment option. PMID:27053994

  7. [Allergic contact dermatitis in beauty parlor clients].

    PubMed

    Gottlöber, P; Gall, H; Bezold, G; Peter, R U

    2001-05-01

    Occupational contact dermatitis in hair dressers and beauticians has increased in importance in the past years. Type IV-allergies against glyceryl monothioglycate components of permanent waves are most common. Other occupational allergens include bleach components such as ammonium persulfate and hair dye ingredients such as p-phenylenediamine (PPD) and p-toluylene-diamine (PTD) base. Allergies to hair dyes in customers of hair dressers have rarely been observed. Two female patients developed allergic contact dermatitis of the scalp and face after repeated use of Polycolor intensivtönung schwarz and of Movida color. We also review the current literature on type IV-allergies to components of hair dressing products components.

  8. Allergic contact dermatitis from shellac in mascara.

    PubMed

    Le Coz, Christophe-J; Leclere, Jean-Marie; Arnoult, Elisabeth; Raison-Peyron, Nadia; Pons-Guiraud, Annick; Vigan, Martine

    2002-03-01

    We report 6 cases of allergic contact dermatitis of the eyelids due to mascara. Allergy occurred in women aged 17-34 years, between September 1999 and June 2001. The main ingredient responsible for allergy was shellac, which gave positive patch test reactions in 5/5 patients. This resinous substance is mainly used in cosmetics, food and industry. The exact nature of the hapten remains unknown, and its presence and level in shellac can vary with the source and the treatments applied to it. One patient was also sensitized to quaternium-22, a quaternary ammonium compound in the cosmetic. These reports underline the rôle of networks, such as REVIDAL-GERDA, in monitoring the emergence of contact allergens and disseminating such information among the medical community.

  9. Allergic contact dermatitis caused by cosmetic products.

    PubMed

    González-Muñoz, P; Conde-Salazar, L; Vañó-Galván, S

    2014-11-01

    Contact dermatitis due to cosmetic products is a common dermatologic complaint that considerably affects the patient's quality of life. Diagnosis, treatment, and preventive strategies represent a substantial cost. This condition accounts for 2% to 4% of all visits to the dermatologist, and approximately 60% of cases are allergic in origin. Most cases are caused by skin hygiene and moisturizing products, followed by cosmetic hair and nail products. Fragrances are the most common cause of allergy to cosmetics, followed by preservatives and hair dyes; however, all components, including natural ingredients, should be considered potential sensitizers. We provide relevant information on the most frequent allergens in cosmetic products, namely, fragrances, preservatives, antioxidants, excipients, surfactants, humectants, emulsifiers, natural ingredients, hair dyes, sunscreens, and nail cosmetics.

  10. Motivating patient adherence to allergic rhinitis treatments.

    PubMed

    Bender, Bruce G

    2015-03-01

    Patient nonadherence significantly burdens the treatment of allergic rhinitis (AR). Fewer than half of prescribed doses of intranasal corticosteroid medication are taken. The challenges for immunotherapies are even greater. While sustained treatment for 3 to 5 years is required for full benefit, most patients receiving immunotherapy, either subcutaneous or sublingual, stop treatment within the first year. Although research into interventions to improve AR adherence is lacking, lessons learned from adherence interventions in other chronic health conditions can be applied to AR. Two well-established, overriding models of care-the chronic care model and patient-centered care-can improve adherence. The patient-centered care model includes important lessons for allergy providers in their daily practice, including understanding and targeting modifiable barriers to adherence. Additionally, recent studies have begun to leverage health information and communication technologies to reach out to patients and promote adherence, extending patient-centered interventions initiated by providers during office visits. PMID:25956611

  11. Jackfruit anaphylaxis in a latex allergic patient.

    PubMed

    Wongrakpanich, Supakanya; Klaewsongkram, Jettanong; Chantaphakul, Hiroshi; Ruxrungtham, Kiat

    2015-03-01

    Several fruits have been reported to crossreact with latex antigen in latex allergy patients but little is known regarding tropical fruits in particular. Here we report the case of a 34-year old nurse who developed anaphylaxis following the ingestion of dried jackfruit (Artocarpus heterophyllus). The patient had a history of chronic eczema on both hands resulting from a regular wear of latex gloves. She and her family also had a history of atopy (allergic rhinitis and/or atopic dermatitis). The results of skin prick tests were positive for jackfruit, latex glove, kiwi and papaya, but the test was negative for banana. While we are reporting the first case of jackfruit anaphylaxis, further research needs to be conducted to identify the mechanisms underlying it. In particular, in-vitro studies need to be designed to understand if the anaphylaxis we describe is due to a cross reactivity between latex and jackfruit or a coincidence of allergy to these 2 antigens. PMID:25840636

  12. [Allergic contact dermatitis in beauty parlor clients].

    PubMed

    Gottlöber, P; Gall, H; Bezold, G; Peter, R U

    2001-05-01

    Occupational contact dermatitis in hair dressers and beauticians has increased in importance in the past years. Type IV-allergies against glyceryl monothioglycate components of permanent waves are most common. Other occupational allergens include bleach components such as ammonium persulfate and hair dye ingredients such as p-phenylenediamine (PPD) and p-toluylene-diamine (PTD) base. Allergies to hair dyes in customers of hair dressers have rarely been observed. Two female patients developed allergic contact dermatitis of the scalp and face after repeated use of Polycolor intensivtönung schwarz and of Movida color. We also review the current literature on type IV-allergies to components of hair dressing products components. PMID:11405157

  13. Jackfruit anaphylaxis in a latex allergic patient.

    PubMed

    Wongrakpanich, Supakanya; Klaewsongkram, Jettanong; Chantaphakul, Hiroshi; Ruxrungtham, Kiat

    2015-03-01

    Several fruits have been reported to crossreact with latex antigen in latex allergy patients but little is known regarding tropical fruits in particular. Here we report the case of a 34-year old nurse who developed anaphylaxis following the ingestion of dried jackfruit (Artocarpus heterophyllus). The patient had a history of chronic eczema on both hands resulting from a regular wear of latex gloves. She and her family also had a history of atopy (allergic rhinitis and/or atopic dermatitis). The results of skin prick tests were positive for jackfruit, latex glove, kiwi and papaya, but the test was negative for banana. While we are reporting the first case of jackfruit anaphylaxis, further research needs to be conducted to identify the mechanisms underlying it. In particular, in-vitro studies need to be designed to understand if the anaphylaxis we describe is due to a cross reactivity between latex and jackfruit or a coincidence of allergy to these 2 antigens.

  14. [Allergic contact eczema from epoxy resin].

    PubMed

    Calzado, Leticia; Ortiz-de Frutos, Francisco J; del Prado Sánchez-Caminero, María; Galera, Carmen María; Valverde, Ricardo; Vanaclocha, Francisco

    2005-11-01

    Epoxy resins are plastics that are widely used as electrical insulation, in coatings, and as adhesives and paints. They have strong sensitizing power and are one of the main causes of allergic contact eczema, both in the workplace and elsewhere. We present the case of a worker at a plastics/chemical plant, who handled aeronautical components in the process of manufacturing fuselage parts. He consulted his physician because of eczematous lesions on his fingers, hands and forearms which had developed over a two-year period and were clearly related to his work. The standard battery of skin tests was performed, along with the plastics and adhesives series and tests using the products from his workplace. Positivity was shown to epoxy resins (standard battery) and to the products from his workplace, which included different fiberglass and carbon fiber sheets impregnated with epoxy resins and epoxy adhesives.

  15. Allergic contact dermatitis to Aloe vera.

    PubMed

    Ferreira, Márcia; Teixeira, Marta; Silva, Elvira; Selores, Manuela

    2007-10-01

    We present the case of a 72-year-old woman observed for dermatitis on the legs followed by apperance of erythema on the eyelids. She had a past history of peripheral venous insufficiency and had been using self home-made Aloe vera juice over the legs for relief from pain. Patch tests showed positive reactions to the leaf of Aloe, the macerated Aloe jelly, and nickel sulfate. Although most manufacturers process Aloe products avoiding its irritant extracts, and probably as a consequence reports of allergic reactions are rare, one must remember that the growing popularity on the use of Aloe products may stimulate its use 'as is' by the patients. Furthermore, it is important to specifically ask patients about the use of these products, because they consider it as innocuous and thus would not spontaneously provide such information.

  16. Fungal Infections: The Stubborn Cases

    PubMed Central

    Adam, John E.

    1982-01-01

    Despite development of numerous antifungal preparations, mycotic infections persist, because of inaccurate diagnosis leading to inappropriate therapy, drug failure, non-compliance or resistance of the organism to antifungal medication. Direct KOH examination is the simplest method of proving the existence of a fungus. Fungal infections tend to be overdiagnosed; disorders which do not improve with three to four weeks of treatment should be reassessed before being labelled ‘stubborn’. Griseofulvin is effective treatment for all dermatophytes, but has certain side effects. Newer topical antifungals are also effective, but no single drug cures all fungal infections. ImagesFig. 1Fig. 2Fig. 3Fig. 4Fig. 5Fig. 6Fig. 7Fig. 8 PMID:20469387

  17. Structural aspects of fungal allergens.

    PubMed

    Crameri, Reto

    2015-03-01

    Despite the increasing number of solved crystal structures of allergens, the key question why some proteins are allergenic and the vast majority is not remains unanswered. The situation is not different for fungal allergens which cover a wide variety of proteins with different chemical properties and biological functions. They cover enzymes, cell wall, secreted, and intracellular proteins which, except cross-reactive allergens, does not show any evidence for structural similarities at least at the three-dimensional level. However, from a diagnostic point of view, pure allergens biotechnologically produced by recombinant technology can provide us, in contrast to fungal extracts which are hardly producible as standardized reagents, with highly pure perfectly standardized diagnostic reagents.

  18. Fungal endophyte diversity in Sarracenia.

    PubMed

    Glenn, Anthony; Bodri, Michael S

    2012-01-01

    Fungal endophytes were isolated from 4 species of the carnivorous pitcher plant genus Sarracenia: S. minor, S. oreophila, S. purpurea, and S. psittacina. Twelve taxa of fungi, 8 within the Ascomycota and 4 within the Basidiomycota, were identified based on PCR amplification and sequencing of the internal transcribed spacer sequences of nuclear ribosomal DNA (ITS rDNA) with taxonomic identity assigned using the NCBI nucleotide megablast search tool. Endophytes are known to produce a large number of metabolites, some of which may contribute to the protection and survival of the host. We speculate that endophyte-infected Sarracenia may benefit from their fungal associates by their influence on nutrient availability from within pitchers and, possibly, by directly influencing the biota within pitchers.

  19. MicroRNA regulation of allergic inflammation and asthma.

    PubMed

    Pua, Heather H; Ansel, K Mark

    2015-10-01

    Allergic diseases are prevalent and clinically heterogeneous, and are the pathologic consequence of inappropriate or exaggerated type 2 immune responses. In this review, we explore the role of microRNAs (miRNAs) in regulating allergic inflammation. We discuss how miRNAs, acting through target genes to modulate gene expression networks, impact multiple facets of immune cell function critical for type 2 immune responses including cell survival, proliferation, differentiation, and effector functions. Human and mouse studies indicate that miRNAs are significant regulators of allergic immune responses. Finally, investigations of extracellular miRNAs offer promise for noninvasive biomarkers and therapeutic strategies for allergy and asthma.

  20. Allergic response to metabisulfite in lidocaine anesthetic solution.

    PubMed Central

    Campbell, J. R.; Maestrello, C. L.; Campbell, R. L.

    2001-01-01

    True allergies to local anesthetics are rare. It is common for practitioners to misdiagnose a serious adverse event to local anesthetics as an allergic reaction. The most likely causes for an allergic response are the preservative, antioxidant, or metabolites and not the anesthetic itself. This case report illustrates the need for practitioners to understand the many potential allergens in local anesthetics and to correctly diagnose patients that are truly allergic to the local anesthetic. Images Figure 1 Figure 2 Figure 3 Figures 4 and 5 PMID:11495401

  1. The Treatment of Allergic Respiratory Disease During Pregnancy.

    PubMed

    Namazy, Jai; Schatz, M

    2016-01-01

    Pregnancy may be complicated by new-onset or preexisting asthma and allergic rhinitis.This article reviews the recognition and management of asthma and allergic rhinitis during pregnancy, paying close attention to the general principles of allergy and use of asthma medication during pregnancy. Both allergic rhinitis and asthma can adversely affect both maternal quality of life and, in the case of maternal asthma, perinatal outcomes. Optimal management is thus important for both mother and baby. This article reviews the safety of asthma and allergy medications commonly used during pregnancy.

  2. Superficial fungal infections in children.

    PubMed

    Hawkins, Danielle M; Smidt, Aimee C

    2014-04-01

    Superficial fungal infections can involve the hair, skin, and nails. Most affected children are healthy, although immunosuppression is a risk factor for more severe presentation. Causative organisms typically are members of the Trichophyton, Microsporum, and Epidermophyton genera (dermatophytes), can be acquired from other infected humans, animals, or soil, and illicit a host inflammatory response. Nondermatophyte infections include pityriasis versicolor. In this article, the most common clinical presentations, diagnostic recommendations, and treatment algorithms for dermatophyte and nondermatophyte mycoses in children and adolescents are described.

  3. Subseafloor basalts as fungal habitats

    NASA Astrophysics Data System (ADS)

    Ivarsson, M.; Bengtson, S.

    2013-12-01

    The oceanic crust makes up the largest potential habitat for life on Earth, yet next to nothing is known about the abundance, diversity and ecology of its biosphere. Our understanding of the deep biosphere of subseafloor crust is, with a few exceptions, based on a fossil record. Surprisingly, a majority of the fossilized microorganisms have been interpreted or recently re-interpreted as remnants of fungi rather than prokaryotes. Even though this might be due to a bias in fossilization the presence of fungi in these settings can not be neglected. We have examined fossilized microorganisms in drilled basalt samples collected at the Emperor Seamounts in the Pacific Ocean. Synchrotron-radiation X-ray tomography microscopy (SRXTM) studies has revealed a complex morphology and internal structure that corresponds to characteristic fungal morphology. Chitin was detected in the fossilized hyphae, which is another strong argument in favour of a fungal interpretation. Chitin is absent in prokaryotes but a substantial constituent in fungal cell walls. The fungal colonies consist of both hyphae and yeast-like growth states as well as resting structures and possible fruit bodies, thus, the fungi exist in vital colonies in subseafloor basalts. The fungi have also been involved in extensive weathering of secondary mineralisations. In terrestrial environments fungi are known as an important geobiological agent that promotes mineral weathering and decomposition of organic matter, and they occur in vital symbiosis with other microorganisms. It is probable to assume that fungi would play a similar role in subseafloor basalts and have great impact on the ecology and on biogeochemical cycles in such environments.

  4. Fungal genome resources at NCBI

    PubMed Central

    Robbertse, B.; Tatusova, T.

    2011-01-01

    The National Center for Biotechnology Information (NCBI) is well known for the nucleotide sequence archive, GenBank and sequence analysis tool BLAST. However, NCBI integrates many types of biomolecular data from variety of sources and makes it available to the scientific community as interactive web resources as well as organized releases of bulk data. These tools are available to explore and compare fungal genomes. Searching all databases with Fungi [organism] at http://www.ncbi.nlm.nih.gov/ is the quickest way to find resources of interest with fungal entries. Some tools though are resources specific and can be indirectly accessed from a particular database in the Entrez system. These include graphical viewers and comparative analysis tools such as TaxPlot, TaxMap and UniGene DDD (found via UniGene Homepage). Gene and BioProject pages also serve as portals to external data such as community annotation websites, BioGrid and UniProt. There are many different ways of accessing genomic data at NCBI. Depending on the focus and goal of research projects or the level of interest, a user would select a particular route for accessing genomic databases and resources. This review article describes methods of accessing fungal genome data and provides examples that illustrate the use of analysis tools. PMID:22737589

  5. Systems Biology of Fungal Infection

    PubMed Central

    Horn, Fabian; Heinekamp, Thorsten; Kniemeyer, Olaf; Pollmächer, Johannes; Valiante, Vito; Brakhage, Axel A.

    2012-01-01

    Elucidation of pathogenicity mechanisms of the most important human-pathogenic fungi, Aspergillus fumigatus and Candida albicans, has gained great interest in the light of the steadily increasing number of cases of invasive fungal infections. A key feature of these infections is the interaction of the different fungal morphotypes with epithelial and immune effector cells in the human host. Because of the high level of complexity, it is necessary to describe and understand invasive fungal infection by taking a systems biological approach, i.e., by a comprehensive quantitative analysis of the non-linear and selective interactions of a large number of functionally diverse, and frequently multifunctional, sets of elements, e.g., genes, proteins, metabolites, which produce coherent and emergent behaviors in time and space. The recent advances in systems biology will now make it possible to uncover the structure and dynamics of molecular and cellular cause-effect relationships within these pathogenic interactions. We review current efforts to integrate omics and image-based data of host-pathogen interactions into network and spatio-temporal models. The modeling will help to elucidate pathogenicity mechanisms and to identify diagnostic biomarkers and potential drug targets for therapy and could thus pave the way for novel intervention strategies based on novel antifungal drugs and cell therapy. PMID:22485108

  6. Heat shock protein 70 and anti–heat shock protein 70 antibodies in nasal secretions of patients with chronic rhinosinusitis

    PubMed Central

    Tsybikov, Namjil N.; Egorova, Elena V.; Kuznik, Boris I.; Fefelova, Elena V.

    2016-01-01

    Background: The issue of heat shock protein (HSP) 70 and anti-HSP70 antibodies in chronic rhinosinusitis (CRS) has never been explored. Objective: To determine the nasal secretion (NS) levels of HSP70 and anti-HSP70 antibodies in patients with CRS with nasal polyps (CRSwNP) and patients with CRS without nasal polyps (CRSsNP), and to evaluate their associations with CRS clinical severity and correlation with NS interleukin (IL), IL-5 and interferon λ. Methods: CRS severity was determined by Lund-Mackay scores. Levels of immunoglobulin E (IgE), IL-4, IL-5, interferon λ, HSP70, and anti-HSP70 antibody levels in NS were measured by enzyme-linked immunosorbent assay. Results: Forty-six patients with CRSsNP (25 women [54.3%] and 21 men [45.7%], mean [standard deviation {SD}]) age, 34.1 ± 12.3 years; 54 patients with CRSwNP (24 women [44.4%] and 30 men [55.6%], mean [SD] age, 37.9 ± 17.5 years). A group of 40 healthy subjects served as controls. Compared with the controls (with a mean [SD] NS HSP70 level of 0.05 ± 0.03 μg/mL), mean [SD] NS HSP70 levels in both the CRSsNP group (0.16 ± 0.07 μg/mL) and CRSwNP group (0.21 ± 0.10 μg/mL) were increased (p < 0.001). Similarly, the mean (SD) NS anti-HSP70 antibody levels were significantly higher in patients with CRSwNP (0.25 ± 0.09 optical density value [ODV]) compared with CRSsNP (0.13 ± 0.04 ODV) (p < 0.001) and healthy controls (0.14 ± 0.02 ODV) (p < 0.001). NS HSP70 in subjects with CRSwNP showed a significant positive correlation with the Lund-Mackay score (r = 0.31; p < 0.05). NS levels of either HSP70 or anti-HSP70 antibodies were strongly correlated with NS IL-4 in the CRSwNP group (r = 0.62, p < 0.001; and r = 0.69, p < 0.001, respectively). Conclusion: NS concentrations of HSP70 and secretory IgA anti HSP70 antibodies are increased in CRSwNP (but not in CRSsNP) and correlate positively with the Lund-Mackay score, NS IL-4, and NS IL-5. PMID:27103555

  7. Impacts of Co-Existing Chronic Rhinosinusitis on Disease Severity and Risks of Exacerbations in Chinese Adults with Bronchiectasis

    PubMed Central

    Guan, Wei-jie; Gao, Yong-hua; Li, Hui-min; Yuan, Jing-jing; Chen, Rong-chang; Zhong, Nan-shan

    2015-01-01

    Background Mounting evidence supports the notion of “one airway, one disease.” Objective To determine whether chronic rhinosinusitis (CRS) poses adverse impacts on Chinese adults with bronchiectasis. Methods We enrolled 148 consecutive adults with clinically stable bronchiectasis. CRS diagnosed based on the 2012 EP3OS criteria. We systematically evaluated the bronchiectasis etiology, radiology, lung function, sputum bacteriology, airway inflammatory biomarkers, Bronchiectasis Severity Index, cough sensitivity and healthcare resource utilization. All patients were prospectively followed-up for 1 year to examine the frequency of bronchiectasis exacerbations (BEs). Results Forty-seven patients (31.8%) were diagnosed as having CRS. Bronchiectasis etiologies did not vary statistically between CRS and no-CRS group. There was a trend towards non-statistically higher Bronchiectasis Severity Index [6.4±3.4 vs. 5.0(6.0), P = 0.19], a higher proportion of patients with BEs needing hospitalization before enrollment (48.9% vs. 29.7%, P = 0.13), poorer FVC [78.2±19.8% vs. 82.2(16.8)%, P = 0.54] and FEV1 [68.2±24.8% vs. 74.8(21.2)%, P = 0.29], a higher prevalence of Pseudomonas aeruginosa isolated (36.2% vs. 26.7%, P = 0.27) or colonized in sputum (36.2% vs. 21.8%, P = 0.12) and greater capsaicin cough sensitivity [C2: 3.9(123.0) μmol/L vs. 11.7(123.0) μmol/L, P = 0.81; C5: 62.5(996.0) μmol/L vs. 250.0(973.0) μmol/L, P = 0.32]. Patients with CRS had significantly greater risks of experiencing BEs during follow-up (P = 0.02 for negative binominal regression test). Conclusion Chinese adults with bronchiectasis appear to have a lower prevalence of CRS than that in western countries. There was a trend towards greater adverse impacts on bronchiectasis in patients with CRS. Studies with greater sample sizes might help to resolve this issue. In future clinical practice, physicians should be vigilant to the screening of concomitant CRS in bronchiectasis so as to better improve

  8. Polymorphisms in RYBP and AOAH Genes Are Associated with Chronic Rhinosinusitis in a Chinese Population: A Replication Study

    PubMed Central

    Zhang, Yuan; Endam, Leandra Mfuna; Filali-Mouhim, Abdelali; Zhao, Liping; Desrosiers, Martin; Han, Demin; Zhang, Luo

    2012-01-01

    Background The development of CRS is believed to be the result of combined interactions between the genetic background of the affected subject and environmental factors. Objectives To replicate and extend our recent findings from genetic association studies in chronic rhinosinusitis (CRS) performed in a Canadian Caucasian population in a Chinese population. Methods In a case-control replication study, DNA samples were obtained from CRS with (n = 306; CRSwNP) and without (n = 332; CRSsNP) nasal polyps, and controls (n = 315) in a Chinese population. A total of forty-nine single nucleotide polymorphisms (SNPs) selected from previous identified SNPs associated with CRS in Canadian population, and SNPs from the CHB HapMap dataset were individually genotyped. Results We identified two SNPs respectively in RYBP (rs4532099, p = 2.15E–06, OR = 2.59) and AOAH (rs4504543, p = 0.0001152, OR = 0.58) significantly associated with whole CRS cohort. Subgroup analysis for the presence of nasal polyps (CRSwNP and CRSsNP) displayed significant association in CRSwNP cohorts regarding to one SNP in RYBP (P = 3.24E–006, OR = 2.76). Evidence of association in the CRSsNP groups in terms of 2 SNPs (AOAH_rs4504543 and RYBP_rs4532099) was detected as well. Stratifying analysis by gender demonstrated that none of the selected SNPs were associated with CRSwNP as well as CRSsNP. Meanwhile 3 SNPs (IL1A_rs17561, P = 0.005778; IL1A_rs1800587, P = 0.009561; IRAK4_rs4251513, P = 0.03837) were associated with serum total IgE level. Conclusions These genes are biologically plausible, with roles in regulation of transcription (RYBP) and inflammatory response (AOAH). The present data suggests the potential common genetic basis in the development of CRS in Chinese and Caucasian population. PMID:22723975

  9. Adverse allergic reaction to Technetium-99m methylene diphosphonate

    SciTech Connect

    Spicer, J.A.; Preston, D.F.; Stephens, R.L.

    1985-04-01

    Adverse allergic reactions to radiopharmaceuticals are rare but have been documented in the literature. This report presents data consistent with a definite adverse reaction to the radiopharmaceutical (/sup 99m/Tc)MDP.

  10. [Allergic conjunctivitis from cellular involvement to medical practice].

    PubMed

    Nicodin, Aurora

    2007-01-01

    The paper presents some notes about the type of cellularity involved in principal ocular allergy determinate by an allergic mechanism and tries a correspondence with a logical and target treatment, with maximum efficiency.

  11. Exposure to particulate hexavalent chromium exacerbates allergic asthma pathology

    SciTech Connect

    Schneider, Brent C.; Constant, Stephanie L.; Patierno, Steven R.; Jurjus, Rosalyn A.; Ceryak, Susan M.

    2012-02-15

    Airborne hexavalent chromate, Cr(VI), has been identified by the Environmental Protection Agency as a possible health threat in urban areas, due to the carcinogenic potential of some of its forms. Particulate chromates are produced in many different industrial settings, with high levels of aerosolized forms historically documented. Along with an increased risk of lung cancer, a high incidence of allergic asthma has been reported in workers exposed to certain inhaled particulate Cr(VI) compounds. However, a direct causal association between Cr(VI) and allergic asthma has not been established. We recently showed that inhaled particulate Cr(VI) induces an innate neutrophilic inflammatory response in BALB/c mice. In the current studies we investigated how the inflammation induced by inhaled particulate Cr(VI) might alter the pathology of an allergic asthmatic response. We used a well-established mouse model of allergic asthma. Groups of ovalbumin protein (OVA)-primed mice were challenged either with OVA alone, or with a combination of OVA and particulate zinc chromate, and various parameters associated with asthmatic responses were measured. Co-exposure to particulate Cr(VI) and OVA mediated a mixed form of asthma in which both eosinophils and neutrophils are present in airways, tissue pathology is markedly exacerbated, and airway hyperresponsiveness is significantly increased. Taken together these findings suggest that inhalation of particulate forms of Cr(VI) may augment the severity of ongoing allergic asthma, as well as alter its phenotype. Such findings may have implications for asthmatics in settings in which airborne particulate Cr(VI) compounds are present at high levels. -- Highlights: ► Allergic asthma correlated with exposure to certain inhaled particulate chromates. ► Direct causal association between Cr(VI) and allergic asthma not established. ► Cr exacerbated pathology and airway hyperresponsiveness in an OVA-challenged mouse. ► Particulate Cr

  12. [The modern strategies for the treatment of allergic rhinitis].

    PubMed

    Nosulya, E V; Kim, I A

    2016-01-01

    The present literature review had the objective to analyze the published data concerning the effectiveness of intranasal administration of antihistamine preparations and intranasal glucocorticoids for the treatment of allergic rhinitis. Special emphasis is placed on the clinical significance and the further prospects for the application of a fixed combination of these medications including azelastineplusmometasonefuroateas the first choice therapy of moderately severe and severe manifestations of allergic rhinitis. PMID:27213663

  13. Immediate allergic cross-reactivity to levobupivacaine and ropivacaine.

    PubMed

    Calderon, A L; Diot, N; Benatir, F; Christin, F; Hautin, E; Truc, C; Allaouchiche, B; Boselli, E

    2013-02-01

    Allergic reactions to amide local anaesthetic agents are rare. We report the case of a 74-year-old man who suffered anaphylaxis, presenting with cardiovascular collapse, immediately after receiving regional anaesthesia on two separate occasions, the first involving the use of levobupivacaine and the second using ropivacaine. Skin testing revealed positive reactions to both levobupivacaine and ropivacaine, and negative reactions to articaine and lidocaine. Severe allergic reactions can be caused by the amide local anaesthetic drugs, levobupivacaine and ropivacaine.

  14. Allergic contact dermatitis to propolis in a violin maker.

    PubMed

    Lieberman, Heather D; Fogelman, Joshua P; Ramsay, David L; Cohen, David E

    2002-02-01

    Allergy to colophony is well noted in the literature, however, there have been few case reports of allergic contact dermatitis to propolis in musicians and instrument makers. We report a case of a stringed instrument craftsman who developed allergic contact dermatitis to propolis, a component of Italian varnish. A review of the components, applications, and the clinical manifestations of hypersensitivity reactions to propolis are presented. PMID:11807465

  15. Invasive fungal infections after natural disasters.

    PubMed

    Benedict, Kaitlin; Park, Benjamin J

    2014-03-01

    The link between natural disasters and subsequent fungal infections in disaster-affected persons has been increasingly recognized. Fungal respiratory conditions associated with disasters include coccidioidomycosis, and fungi are among several organisms that can cause near-drowning pneumonia. Wound contamination with organic matter can lead to post-disaster skin and soft tissue fungal infections, notably mucormycosis. The role of climate change in the environmental growth, distribution, and dispersal mechanisms of pathogenic fungi is not fully understood; however, ongoing climate change could lead to increased disaster-associated fungal infections. Fungal infections are an often-overlooked clinical and public health issue, and increased awareness by health care providers, public health professionals, and community members regarding disaster-associated fungal infections is needed.

  16. Invasive Fungal Infections after Natural Disasters

    PubMed Central

    Benedict, Kaitlin

    2014-01-01

    The link between natural disasters and subsequent fungal infections in disaster-affected persons has been increasingly recognized. Fungal respiratory conditions associated with disasters include coccidioidomycosis, and fungi are among several organisms that can cause near-drowning pneumonia. Wound contamination with organic matter can lead to post-disaster skin and soft tissue fungal infections, notably mucormycosis. The role of climate change in the environmental growth, distribution, and dispersal mechanisms of pathogenic fungi is not fully understood; however, ongoing climate change could lead to increased disaster-associated fungal infections. Fungal infections are an often-overlooked clinical and public health issue, and increased awareness by health care providers, public health professionals, and community members regarding disaster-associated fungal infections is needed. PMID:24565446

  17. Invasive fungal infections after natural disasters.

    PubMed

    Benedict, Kaitlin; Park, Benjamin J

    2014-03-01

    The link between natural disasters and subsequent fungal infections in disaster-affected persons has been increasingly recognized. Fungal respiratory conditions associated with disasters include coccidioidomycosis, and fungi are among several organisms that can cause near-drowning pneumonia. Wound contamination with organic matter can lead to post-disaster skin and soft tissue fungal infections, notably mucormycosis. The role of climate change in the environmental growth, distribution, and dispersal mechanisms of pathogenic fungi is not fully understood; however, ongoing climate change could lead to increased disaster-associated fungal infections. Fungal infections are an often-overlooked clinical and public health issue, and increased awareness by health care providers, public health professionals, and community members regarding disaster-associated fungal infections is needed. PMID:24565446

  18. Surgical management of fungal endophthalmitis resulting from fungal keratitis

    PubMed Central

    Gao, Yan; Chen, Nan; Dong, Xiao-Guang; Yuan, Gong-Qiang; Yu, Bin; Xie, Li-Xin

    2016-01-01

    AIM To report the fungal organisms, clinical features, surgical treatment strategies, and outcomes of patients with culture-proven exogenous fungal endophthalmitis (EFE) secondary to keratitis, and evaluate the role of surgery in the treatment. METHODS The clinical records of 27 patients (27 eyes) with culture-proven EFE resulting from fungal keratitis treated at Shandong Eye Institute from January 2007 to January 2015 were retrospectively reviewed. Information about fungal culture results, clinical features, surgical procedures, and final visual acuity was obtained. RESULTS There were 39 positive culture results from samples of cornea, hypopyon, vitreous and lens capsule, accounting for 56%, 26%, 15% and 2.5%, respectively. Fusarium was identified in 44% (12/27) of the eyes, followed by Aspergillus in 22% (6/27). Posterior segment infection was involved in 78% (21/27) of the patients. The corneal infection was larger than 3 mm ×3 mm in 89% (24/27) of the patients, and 22% (6/27) of them had the entire cornea, and even the sclera involved. Three eyes had silicone oil tamponade, and two eyes had retinal detachment. Twenty-two eyes (81.5%) underwent penetrating keratoplasty (PKP), and over half of them (54.5%) were operated within 3d from the onset of antifungal therapy. Fourteen eyes (52%) underwent intracameral antifungal drug injection, and three of them required repeated injections. Fifteen eyes (55.6%) underwent pars plana vitrectomy (PPV). The rate of the eyes undergoing PPV as the initial surgical procedure was 60% (9/15), lower than 77% in PKP. Intravitreal injection was given in 59% of the eyes (16/27), and 75% of them required repeated injections. The final visual acuity was 20/100 or better in 37% of the eyes, and better than counting fingers in 55.6% of the eyes. Five eyes (18.5%) were eviscerated. In the two eyes with concurrent retinal detachment, one achieved retinal reattachment, and the other was eviscerated. In the three eyes with silicone oil

  19. Sublingual immunotherapy for pediatric allergic rhinitis: The clinical evidence.

    PubMed

    Poddighe, Dimitri; Licari, Amelia; Caimmi, Silvia; Marseglia, Gian Luigi

    2016-02-01

    Allergic rhinitis is estimated to affect 10%-20% of pediatric population and it is caused by the IgE-sensitization to environmental allergens, most importantly grass pollens and house dust mites. Allergic rhinitis can influence patient's daily activity severely and may precede the development of asthma, especially if it is not diagnosed and treated correctly. In addition to subcutaneous immunotherapy, sublingual immunotherapy (SLIT) represents the only treatment being potentially able to cure allergic respiratory diseases, by modulating the immune system activity. This review clearly summarizes and analyzes the available randomized, double-blinded, placebo-controlled trials, which aimed at evaluating the effectiveness and the safety of grass pollen and house dust mite SLIT for the specific treatment of pediatric allergic rhinitis. Our analysis demonstrates the good evidence supporting the efficacy of SLIT for allergic rhinitis to grass pollens in children, whereas trials regarding pediatric allergic rhinitis to house dust mites present lower quality, although several studies supported its usefulness. PMID:26862501

  20. The effects of pollutants on the allergic immune response.

    PubMed

    Kemeny, D M

    2000-11-01

    An increase in the prevalence of allergy and allergic diseases has taken place in the industrialised countries. Allergic diseases represent a major health problem, and appear linked to affluence and modern lifestyle. In the 20th century air pollution from industrial sources largely has been replaced by diesel exhaust and other traffic pollution. Further, the indoor environment in which we spend most of our time has changed dramatically. In order to understand the contribution of pollution and other environmental changes to the development of allergy, we need to understand the biologic processes that underlie allergic immune responses. In the present paper, immune regulatory pathways that control the allergic immune response are delineated. Castor bean dust causes widespread allergic sensitisation. The investigations that made clear the importance of CD8 T cells for the regulation of IgE production were triggered by studies of castor bean allergy. A special focus is in this review placed on the regulatory role of CD8 T cells in the development of the allergic immune response.

  1. Immunoregulatory Role of HLA-G in Allergic Diseases

    PubMed Central

    Contini, Paola; Negrini, Simone; Ciprandi, Giorgio; Puppo, Francesco

    2016-01-01

    Allergic diseases are sustained by a T-helper 2 polarization leading to interleukin-4 secretion, IgE-dependent inflammation, and mast cell and eosinophil activation. HLA-G molecules, both in membrane-bound and in soluble forms, play a central role in modulation of immune responses. Elevated levels of soluble HLA-G (sHLA-G) molecules are detected in serum of patients with allergic rhinitis to seasonal and perennial allergens and correlate with allergen-specific IgE levels, clinical severity, drug consumption, and response to allergen-specific immunotherapy. sHLA-G molecules are also found in airway epithelium of patients with allergic asthma and high levels of sHLA-G molecules are detectable in plasma and bronchoalveolar lavage of asthmatic patients correlating with allergen-specific IgE levels. Finally, HLA-G molecules are expressed by T cells, monocytes-macrophages, and Langerhans cells infiltrating the dermis of atopic dermatitis patients. Collectively, although at present it is difficult to completely define the role of HLA-G molecules in allergic diseases, it may be suggested that they are expressed and secreted by immune cells during the allergic reaction in an attempt to suppress allergic inflammation. PMID:27413762

  2. The relationship between autoimmunity and specific immunotherapy for allergic diseases

    PubMed Central

    Bozek, Andrzej; Kołodziejczyk, Krzysztof; Bednarski, Piotr

    2015-01-01

    The aim of this study was to perform a 20-year post-specific immunotherapy (SIT) observational evaluation for an assessment of any manifestations of autoimmune disease or the appearance of autoantibodies in serum. In total, 1,888 patients (902 women and 986 men) were observed. The mean age of the patients was 34.1±12.4 y at the start of the prospective observation after finishing SIT. New incidences of autoimmune disease and/or the presence of autoantibodies in serum were monitored. The SIT group was compared with control groups consisting of allergic patients who had very received SIT and with non-allergic subjects. There were no significant differences in the autoimmune disease prevalence between the allergic patients with or without SIT. However, significantly higher prevalence of 4 different autoimmune diseases (AID) were observed in the non-allergic patients during the same period. Additionally, the incidence of 8 different autoantibodies was significantly higher in non-allergic patients than in control subjects. Hashimoto disease was the most common autoimmune disease observed. The results of this long-term observational study indicated a lack of a significant prevalence of new instances of autoimmune disease during 20 y of observation post-SIT and at a rate lower than that of non-allergic control subjects, suggesting that SIT is safe in this regard in the long term. PMID:26431066

  3. Immunoregulatory Role of HLA-G in Allergic Diseases.

    PubMed

    Murdaca, Giuseppe; Contini, Paola; Negrini, Simone; Ciprandi, Giorgio; Puppo, Francesco

    2016-01-01

    Allergic diseases are sustained by a T-helper 2 polarization leading to interleukin-4 secretion, IgE-dependent inflammation, and mast cell and eosinophil activation. HLA-G molecules, both in membrane-bound and in soluble forms, play a central role in modulation of immune responses. Elevated levels of soluble HLA-G (sHLA-G) molecules are detected in serum of patients with allergic rhinitis to seasonal and perennial allergens and correlate with allergen-specific IgE levels, clinical severity, drug consumption, and response to allergen-specific immunotherapy. sHLA-G molecules are also found in airway epithelium of patients with allergic asthma and high levels of sHLA-G molecules are detectable in plasma and bronchoalveolar lavage of asthmatic patients correlating with allergen-specific IgE levels. Finally, HLA-G molecules are expressed by T cells, monocytes-macrophages, and Langerhans cells infiltrating the dermis of atopic dermatitis patients. Collectively, although at present it is difficult to completely define the role of HLA-G molecules in allergic diseases, it may be suggested that they are expressed and secreted by immune cells during the allergic reaction in an attempt to suppress allergic inflammation. PMID:27413762

  4. Human fungal pathogens: Why should we learn?

    PubMed

    Kim, Jeong-Yoon

    2016-03-01

    Human fungal pathogens that cause invasive infections are hidden killers, taking lives of one and a half million people every year. However, research progress in this field has not been rapid enough to effectively prevent or treat life-threatening fungal diseases. To update recent research progress and promote more active research in the field of human fungal pathogens, eleven review articles concerning the virulence mechanisms and host interactions of four major human fungal pathogens-Candida albicans, Cryptococcus neoformans, Aspergillus fumigatus, and Histoplasma capsulatum-are presented in this special issue. PMID:26920875

  5. Regulation of the fungal secretome.

    PubMed

    McCotter, Sean W; Horianopoulos, Linda C; Kronstad, James W

    2016-08-01

    The ability of countless representatives of the Kingdom Fungi to adapt to and proliferate in diverse environments is facilitated by regulation of their secretomes to respond to changes in environmental conditions and to mediate interactions with other organisms. Secretome changes often fulfill common functions of nutrient acquisition, facilitation of host/symbiont interactions, cell wall modification, and optimization of the enzyme suite to adapt to new environmental resources. In this review, we expand on our recent work on signaling and the secretome in the pathogenic fungus Cryptococcus neoformans to consider a range of selected examples of regulation of fungal secretomes. These examples include the impact of carbon source and aspects of the response to plant and animal hosts. Additionally, the influence of key protein kinases (e.g., Pka1, Snf1) and transcription factors (e.g., Rim101/PacC) is highlighted to illustrate some underlying regulatory factors influencing the secretome. Although there is a wealth of information about fungal secretomes from both experimentation and genome sequence mining, there are also major gaps in our knowledge about the complete composition of fungal secretomes and mechanisms of dynamic change. For example, a more comprehensive understanding of the composition and regulation of the secretome will require consideration of the emerging roles of unconventional secretion and extracellular vesicles in delivering proteins outside the cell. Overall, changes in the secretome are well documented in diverse fungi and the underlying mechanisms are currently under investigation; however, there remain unknown steps in the regulation of secretory pathways and gaps in understanding the regulation of unconventional secretion, which warrant further research. PMID:26879194

  6. Topical therapy for fungal infections.

    PubMed

    Kyle, Amber A; Dahl, Mark V

    2004-01-01

    Fungi often infect the skin surface and subsequently invade the stratum corneum to avoid being shed from the skin surface by desquamation. Pharmacologic agents applied to the surface of the skin in the form of creams, lotions, or sprays, readily penetrate into the stratum corneum to kill the fungi (fungicidal agents), or at least render them unable to grow or divide (fungistatic agents). Thus, topical therapies work well to rid the skin of topical fungi and yeasts. Azole drugs such as miconazole, clotrimazole, and ketoconazole are fungistatic, limiting fungal growth but depending on epidermal turnover to shed the still-living fungus from the skin surface. Allylamines and benzylamines such as terbinafine, naftifine, and butenafine are fungicidal, actually killing the fungal organisms. Fungicidal drugs are often preferred over fungistatic drugs for treatment of dermatophytic fungal infections, since treatment times as short as one application daily for 1 week are associated with high cure rates. Furthermore, patients often stop treatments when the skin appears healed, usually after about a week of treatment. If this short-term treatment is stopped, fungi recur more often when fungistatic, rather than fungicidal, drugs have been used. Yeast infections such as those caused by Candida albicans respond less well to allylamine drugs. The azole drugs are often preferred for these types of infections. Nail infections are difficult to cure with topical therapies because the infections usually occur under the nail instead of on top of it and products penetrate poorly, if at all, through the nail plate. Infections of hair follicles, nails, and widespread infections often require systemic treatments. Antifungal agents are compounded into many different types of vehicles. Patients often prefer to treat weeping infections with spray formulations. Most physicians prescribe branded products in cream or lotion bases. Cost is a factor dictating prescription choice, especially since

  7. Fungal spores: hazardous to health?

    PubMed Central

    Sorenson, W G

    1999-01-01

    Fungi have long been known to affect human well being in various ways, including disease of essential crop plants, decay of stored foods with possible concomitant production of mycotoxins, superficial and systemic infection of human tissues, and disease associated with immune stimulation such as hypersensitivity pneumonitis and toxic pneumonitis. The spores of a large number of important fungi are less than 5 microm aerodynamic diameter, and therefore are able to enter the lungs. They also may contain significant amounts of mycotoxins. Diseases associated with inhalation of fungal spores include toxic pneumonitis, hypersensitivity pneumonitis, tremors, chronic fatigue syndrome, kidney failure, and cancer. PMID:10423389

  8. Immune response to fungal infections.

    PubMed

    Blanco, Jose L; Garcia, Marta E

    2008-09-15

    The immune mechanisms of defence against fungal infections are numerous, and range from protective mechanisms that were present early in evolution (innate immunity) to sophisticated adaptive mechanisms that are induced specifically during infection and disease (adaptive immunity). The first-line innate mechanism is the presence of physical barriers in the form of skin and mucous membranes, which is complemented by cell membranes, cellular receptors and humoral factors. There has been a debate about the relative contribution of humoral and cellular immunity to host defence against fungal infections. For a long time it was considered that cell-mediated immunity (CMI) was important, but humoral immunity had little or no role. However, it is accepted now that CMI is the main mechanism of defence, but that certain types of antibody response are protective. In general, Th1-type CMI is required for clearance of a fungal infection, while Th2 immunity usually results in susceptibility to infection. Aspergillosis, which is a disease caused by the fungus Aspergillus, has been the subject of many studies, including details of the immune response. Attempts to relate aspergillosis to some form of immunosuppression in animals, as is the case with humans, have not been successful to date. The defence against Aspergillus is based on recognition of the pathogen, a rapidly deployed and highly effective innate effector phase, and a delayed but robust adaptive effector phase. Candida albicans, part of the normal microbial flora associated with mucous surfaces, can be present as congenital candidiasis or as acquired defects of cell-mediated immunity. Resistance to this yeast is associated with Th1 CMI, whereas Th2 immunity is associated with susceptibility to systemic infection. Dermatophytes produce skin alterations in humans and other animals, and the essential role of the CMI response is to destroy the fungi and produce an immunoprotective status against re-infection. The resolution

  9. The role of heparanase in pulmonary cell recruitment in response to an allergic but not non-allergic stimulus.

    PubMed

    Morris, Abigail; Wang, Bo; Waern, Ida; Venkatasamy, Radhakrishnan; Page, Clive; Schmidt, Eric P; Wernersson, Sara; Li, Jin-Ping; Spina, Domenico

    2015-01-01

    Heparanase is an endo-β-glucuronidase that specifically cleaves heparan sulfate proteoglycans in the extracellular matrix. Expression of this enzyme is increased in several pathological conditions including inflammation. We have investigated the role of heparanase in pulmonary inflammation in the context of allergic and non-allergic pulmonary cell recruitment using heparanase knockout (Hpa-/-) mice as a model. Following local delivery of LPS or zymosan, no significant difference was found in the recruitment of neutrophils to the lung between Hpa-/- and wild type (WT) control. Similarly neutrophil recruitment was not inhibited in WT mice treated with a heparanase inhibitor. However, in allergic inflammatory models, Hpa-/- mice displayed a significantly reduced eosinophil (but not neutrophil) recruitment to the airways and this was also associated with a reduction in allergen-induced bronchial hyperresponsiveness, indicating that heparanase expression is associated with allergic reactions. This was further demonstrated by pharmacological treatment with a heparanase inhibitor in the WT allergic mice. Examination of lung specimens from patients with different severity of chronic obstructive pulmonary disease (COPD) found increased heparanase expression. Thus, it is established that heparanase contributes to allergen-induced eosinophil recruitment to the lung and could provide a novel therapeutic target for the development of anti-inflammatory drugs for the treatment of asthma and other allergic diseases.

  10. Skin Testing for Allergic Rhinitis: A Health Technology Assessment

    PubMed Central

    2016-01-01

    Background Allergic rhinitis is the most common type of allergy worldwide. The accuracy of skin testing for allergic rhinitis is still debated. This health technology assessment had two objectives: to determine the diagnostic accuracy of skin-prick and intradermal testing in patients with suspected allergic rhinitis and to estimate the costs to the Ontario health system of skin testing for allergic rhinitis. Methods We searched All Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, CRD Health Technology Assessment Database, Cochrane Central Register of Controlled Trials, and NHS Economic Evaluation Database for studies that evaluated the diagnostic accuracy of skin-prick and intradermal testing for allergic rhinitis using nasal provocation as the reference standard. For the clinical evidence review, data extraction and quality assessment were performed using the QUADAS-2 tool. We used the bivariate random-effects model for meta-analysis. For the economic evidence review, we assessed studies using a modified checklist developed by the (United Kingdom) National Institute for Health and Care Excellence. We estimated the annual cost of skin testing for allergic rhinitis in Ontario for 2015 to 2017 using provincial data on testing volumes and costs. Results We meta-analyzed seven studies with a total of 430 patients that assessed the accuracy of skin-prick testing. The pooled pair of sensitivity and specificity for skin-prick testing was 85% and 77%, respectively. We did not perform a meta-analysis for the diagnostic accuracy of intradermal testing due to the small number of studies (n = 4). Of these, two evaluated the accuracy of intradermal testing in confirming negative skin-prick testing results, with sensitivity ranging from 27% to 50% and specificity ranging from 60% to 100%. The other two studies evaluated the accuracy of intradermal testing as a stand-alone tool for diagnosing allergic rhinitis, with

  11. α-Tocopherol supplementation of allergic female mice inhibits development of CD11c+CD11b+ dendritic cells in utero and allergic inflammation in neonates

    PubMed Central

    Abdala-Valencia, Hiam; Berdnikovs, Sergejs; Soveg, Frank W.

    2014-01-01

    α-Tocopherol blocks responses to allergen challenge in allergic adult mice, but it is not known whether α-tocopherol regulates the development of allergic disease. Development of allergic disease often occurs early in life. In clinical studies and animal models, offspring of allergic mothers have increased responsiveness to allergen challenge. Therefore, we determined whether α-tocopherol blocked development of allergic responses in offspring of allergic female mice. Allergic female mice were supplemented with α-tocopherol starting at mating. The pups from allergic mothers developed allergic lung responses, whereas pups from saline-treated mothers did not respond to the allergen challenge, and α-tocopherol supplementation of allergic female mice resulted in a dose-dependent reduction in eosinophils in the pup bronchoalveolar lavage and lungs after allergen challenge. There was also a reduction in pup lung CD11b+ dendritic cell subsets that are critical to development of allergic responses, but there was no change in several CD11b− dendritic cell subsets. Furthermore, maternal supplementation with α-tocopherol reduced the number of fetal liver CD11b+ dendritic cells in utero. In the pups, there was reduced allergen-induced lung mRNA expression of IL-4, IL-33, TSLP, CCL11, and CCL24. Cross-fostering pups at the time of birth demonstrated that α-tocopherol had a regulatory function in utero. In conclusion, maternal supplementation with α-tocopherol reduced fetal development of subsets of dendritic cells that are critical for allergic responses and reduced development of allergic responses in pups from allergic mothers. These results have implications for supplementation of allergic mothers with α-tocopherol. PMID:25015974

  12. Evaluation of anti-allergic properties of caffeic acid phenethyl ester in a murine model of systemic anaphylaxis

    SciTech Connect

    Park, Sae-Gwang; Lee, Da-Young; Seo, Su-Kil; Lee, Soo-Woong; Kim, Se-Kwon; Jung, Won-Kyo; Kang, Mi-Seon; Choi, Yung Hyun; Yea, Sung Su; Choi, Inhak Choi, Il-Whan

    2008-01-01

    Caffeic acid phenethyl ester (CAPE) is an active component of honeybee propolis extracts. It has several positive effects, including anti-inflammatory, anti-oxidation, anti-cancer, anti-bacterial, anti-viral, anti-fungal, and immunomodulatory effects. In particular, the suppressive effect of NF-{kappa}B may disrupt a component of allergic induction. The principal objective of this experimental study was to evaluate the effects of CAPE on the active systemic anaphylaxis induced by ovalbumin (OVA) challenge in mice. Mice were intraperitoneally sensitized and intravenously challenged with OVA. Histopathological analysis, nuclear factor (NF)-{kappa}B activation, and the plasma levels of histamine and total IgE after allergen challenge were evaluated. After challenges, all of the sham-treated mice developed anaphylactic symptoms, increased plasma levels of histamine and OVA-specific IgE, marked vascular leakage, NF-{kappa}B activation, platelet-activating factor (PAF) production, and histological changes including pulmonary edema and hemorrhage in the renal medullae within 20 min. By way of contrast, a reduction in the plasma levels of histamine and OVA-specific IgE and an inhibition of NF-{kappa}B activation and PAF release were observed in the CAPE-treated mice. In addition, a significant prevention of hemoconcentration and OVA-induced pathological changes were noted. These results indicate that CAPE demonstrates an anti-allergic effect, which may be the result of its protective effects against IgE-mediated allergy.

  13. The effects of meteorological factors on airborne fungal spore concentration in two areas differing in urbanisation level

    NASA Astrophysics Data System (ADS)

    Oliveira, M.; Ribeiro, H.; Delgado, J. L.; Abreu, I.

    2009-01-01

    Although fungal spores are an ever-present component of the atmosphere throughout the year, their concentration oscillates widely. This work aims to establish correlations between fungal spore concentrations in Porto and Amares and meteorological data. The seasonal distribution of fungal spores was studied continuously (2005-2007) using volumetric spore traps. To determine the effect of meteorological factors (temperature, relative humidity and rainfall) on spore concentration, the Spearman rank correlation test was used. In both locations, the most abundant fungal spores were Cladosporium, Agaricus, Agrocybe, Alternaria and Aspergillus/Penicillium, the highest concentrations being found during summer and autumn. In the present study, with the exception of Coprinus and Pleospora, spore concentrations were higher in the rural area than in the urban location. Among the selected spore types, spring-autumn spores ( Coprinus, Didymella, Leptosphaeria and Pleospora) exhibited negative correlations with temperature and positive correlations both with relative humidity and rainfall level. On the contrary, late spring-early summer (Smuts) and summer spores ( Alternaria, Cladosporium, Epicoccum, Ganoderma, Stemphylium and Ustilago) exhibited positive correlations with temperature and negative correlations both with relative humidity and rainfall level. Rust, a frequent spore type during summer, had a positive correlation with temperature. Aspergillus/Penicillium, showed no correlation with the meteorological factors analysed. This knowledge can be useful for agriculture, allowing more efficient and reliable application of pesticides, and for human health, by improving the diagnosis and treatment of respiratory allergic disease.

  14. Allergic reaction to mint leads to asthma.

    PubMed

    Szema, Anthony M; Barnett, Tisha

    2011-01-01

    Respiratory and cutaneous adverse reactions to mint can result from several different mechanisms including IgE-mediated hypersensitivity, delayed-type hypersensitivity (contact dermatitis), and nonimmunologic histamine release. Reactions to cross-reacting plants of the Labiatae family, such as oregano and thyme, as well as to the chemical turpentine, may clue the clinician in on the diagnosis of mint allergy. Contact dermatitis can result from menthol in peppermint. Contact allergens have been reported in toothpastes, which often are mint-flavored. Allergic asthma from mint is less well-recognized. A case of a 54-year-old woman with dyspnea on exposure to the scent of peppermint is presented in whom mint exposure, as seemingly innocuous as the breath of others who had consumed Tic Tac candies, exacerbated her underlying asthma. This case highlights the importance of testing with multiple alternative measures of specific IgE to mint, including skin testing with mint extract, and skin testing with fresh mint leaves. Additionally, this cases suggests that asthma can result from inhaling the scent of mint and gives consideration to obtaining confirmatory pre- and postexposure pulmonary function data by both impulse oscillometry and spirometry. PMID:22852115

  15. Allergic contact dermatitis to para-phenylenediamine.

    PubMed

    Jenkins, David; Chow, Elizabeth T

    2015-02-01

    Exposure to hair dye is the most frequent route of sensitisation to para-phenylenediamine (PPD), a common contact allergen. International studies have examined the profile of PPD, but Australian-sourced information is lacking. Patients are often dissatisfied with advice to stop dyeing their hair. This study examines patients' characteristics, patch test results and outcomes of PPD allergy from a single Australian centre, through a retrospective analysis of patch test data from 2006 to 2013 at the Liverpool Hospital Dermatology Department. It reviews the science of hair dye allergy, examines alternative hair dyes and investigates strategies for hair dyeing. Of 584 patients, 11 were allergic to PPD. Our PPD allergy prevalence rate of 2% is at the lower end of international reported rates. About half these patients also react to para-toluenediamine (PTD). Affected patients experience a significant lifestyle disturbance. In all, 78% tried alternative hair dyes after the patch test diagnosis and more than half continued to dye their hair. Alternative non-PPD hair dyes are available but the marketplace can be confusing. Although some patients are able to tolerate alternative hair dyes, caution is needed as the risk of developing an allergy to other hair dye ingredients, especially PTD, is high.

  16. Allergic reaction to mint leads to asthma

    PubMed Central

    Barnett, Tisha

    2011-01-01

    Respiratory and cutaneous adverse reactions to mint can result from several different mechanisms including IgE-mediated hypersensitivity, delayed-type hypersensitivity (contact dermatitis), and nonimmunologic histamine release. Reactions to cross-reacting plants of the Labiatae family, such as oregano and thyme, as well as to the chemical turpentine, may clue the clinician in on the diagnosis of mint allergy. Contact dermatitis can result from menthol in peppermint. Contact allergens have been reported in toothpastes, which often are mint-flavored. Allergic asthma from mint is less well-recognized. A case of a 54-year-old woman with dyspnea on exposure to the scent of peppermint is presented in whom mint exposure, as seemingly innocuous as the breath of others who had consumed Tic Tac candies, exacerbated her underlying asthma. This case highlights the importance of testing with multiple alternative measures of specific IgE to mint, including skin testing with mint extract, and skin testing with fresh mint leaves. Additionally, this cases suggests that asthma can result from inhaling the scent of mint and gives consideration to obtaining confirmatory pre- and postexposure pulmonary function data by both impulse oscillometry and spirometry. PMID:22852115

  17. Gut Microbiota and Allergic Disease. New Insights.

    PubMed

    Lynch, Susan V

    2016-03-01

    The rapid rise in childhood allergies (atopy) in Westernized nations has implicated associated environmental exposures and lifestyles as primary drivers of disease development. Culture-based microbiological studies indicate that atopy has demonstrable ties to altered gut microbial colonization in very early life. Infants who exhibit more severe multisensitization to food- or aero-allergens have a significantly higher risk of subsequently developing asthma in childhood. Hence an emerging hypothesis posits that environment- or lifestyle-driven aberrancies in the early-life gut microbiome composition and by extension, microbial function, represent a key mediator of childhood allergic asthma. Animal studies support this hypothesis. Environmental microbial exposures epidemiologically associated with allergy protection in humans confer protection against airway allergy in mice. In addition, gut microbiome-derived short-chain fatty acids produced from a high-fiber diet have been shown to protect against allergy via modulation of both local and remote mucosal immunity as well as hematopoietic antigen-presenting cell populations. Here we review key data supporting the concept of a gut-airway axis and its critical role in childhood atopy. PMID:27027953

  18. Current concept of allergic skin reactions.

    PubMed

    Polak, L

    1980-10-01

    Synopsis On the basis of literature and experimental work the present views on the mechanism of the development of allergic skin reactions of the contact type are reviewed. Precursors of effector cells originating from stem cells are stimulated by the antigenic complex formed by the application of the hapten to the skin. Autologous skin proteins and macrophages play an important role in this preparatory and antigen recognition phases. Activated T lymphocytes proliferate in the draining lymph node and differentiate into effector and memory cells. The former react to a repeated application of the hapten with release of mediators inducing a skin inflammatory reaction. The latter produce further effector cells thus enhancing the degree of contact sensitivity (booster effect). The hapten application also activates a specific control mechanism consisting of lymphocytes with the same specificity but adverse activity. These cells, called suppressors, restrict the development of further effector cells thus limiting the degree of contact sensitivity. Elimination of suppressor cells leads to an enhancement of the degree of contact sensitivity whereas an intended extreme activation of these cells induces a state of specific immunological unresponsiveness (tolerance).

  19. Olfaction in allergic rhinitis: A systematic review.

    PubMed

    Stuck, Boris A; Hummel, Thomas

    2015-12-01

    Olfactory dysfunction is a key symptom in patients with allergic rhinitis (AR). Despite the implications for quality of life, relatively few articles have tested olfactory function in their investigations. The current systematic review aimed to investigate the following 2 questions: (1) What does AR do to human olfaction? (2) How effective is the treatment of AR in restoring the sense of smell? A comprehensive literature search was performed, and human studies of any design were included. A total of 420 articles were identified, and 36 articles were considered relevant. Data indicate that the frequency of olfactory dysfunction increases with the duration of the disorder, and most studies report a frequency in the range of 20% to 40%. Although olfactory dysfunction does not appear to be very severe in patients with AR, its presence seems to increase with the severity of the disease. There is very limited evidence that antihistamines improve olfactory function. In addition, there is limited evidence that topical steroids improve the sense of smell, especially in patients with seasonal AR. This is also the case for specific immunotherapy. However, many questions remain unanswered because randomized controlled trials are infrequent and only a few studies rely on quantitative measurement of olfactory function.

  20. Validation of the applicability of the traditional Chinese version of the University of Pennsylvania Smell Identification Test in patients with chronic rhinosinusitis

    PubMed Central

    Jiang, Rong-San; Kuo, Li-Te; Wu, Shang-Heng; Su, Mao-Chang

    2014-01-01

    The 40-item University of Pennsylvania Smell Identification Test (UPSIT) is the most widely used smell test in the world. Presently, culturally modified versions of this test are available in multiple languages. A traditional Chinese version of the UPSIT (UPSIT-TC) has been developed for administration in Taiwan. The purpose of this study was to investigate the validity and reliability of the UPSIT-TC in Taiwanese patients with chronic rhinosinusitis (CRS). The phenylethyl alcohol (PEA) odor detection threshold test, the North American version of UPSIT (UPSIT-NA), and the UPSIT-TC were administered to 40 healthy subjects and to 100 CRS patients before and after functional endoscopic sinus surgery (FESS). The UPSIT-TC showed good internal consistency (Cronbach's alpha = 0.887, 0.886, and 0.870 at three test occasions) and test–retest reliability (p < 0.001). The scores of UPSIT-TC were significantly correlated to the PEA thresholds (p < 0.001). The UPSIT-TC scores were significantly higher than those of the UPSIT-NA (p = 0.028) when analysis was performed with logistic regression with independent variables including test occasions (before or after FESS), test methods (UPSIT-NA or UPSIT-TC), status of polyp (with or without), and PEA thresholds (improved or did not improve). In addition, there were significant between-group differences in UPSIT-TC scores including healthy versus CRS, CRS with polyps versus CRS without polyps, and PEA thresholds improved versus PEA thresholds which did not improve. The UPSIT-TC is reliable and valid for measuring olfactory function in Taiwanese patients with rhinosinusitis. In addition, the UPSIT-TC clearly resulted in better performance than that of UPSIT-NA. PMID:25199144