[Effect of nasal provocation tests on bronchial patency in allergic rhinitis and asthma].
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Allergens↗
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High prevalence of current asthma and active smoking effect among the elderly.
BACKGROUND: Although asthma is a common cause of morbidity in adults, relatively few objectively measured population studies of asthma prevalence in adult populations have been conducted. OBJECTIVE: To evaluate the prevalence of asthma, based on both a questionnaire and methacholine bronchial provocation test, and to determine the risk factors of asthma prevalence in an adult population. METHODS: A total of 2,467 adults, who were randomly selected from metropolitan urban, non-metropolitan urban and rural areas, responded to the modified ISAAC questionnaire, and underwent methacholine bronchial provocation tests and skin prick tests to locally common aeroallergens. RESULTS: The prevalence of current asthma based on the questionnaire and the methacholine challenge was 2.0% in adults younger than 40, 3.8% in 40- to 54-year-olds, 7.7% in 55- to 64-year-olds and 12.7% in those aged 65 or higher. For subjects of 55-64 years, active smoking was found to be significantly related with the prevalence of current asthma and bronchial hyper-responsiveness, although smoking was positively associated with percentage predictive value of forced expiratory volume of 1 s (FEV1). CONCLUSION: The prevalence of current asthma is common among the elderly, and active smoking may play an important role in the development of asthma and bronchial hyper-responsiveness among the elderly.
Adult↗
[Relationship between bronchial hyperresponsiveness and the peripheral obstruction in stable asthmatic children].
OBJECTIVE: Asthma is the most common chronic respiratory disease of children. The association between asthma and bronchial hyperresponsiveness (BHR) has been well-demonstrated. The objective of the study was to investigate relationship between the bronchial responsiveness and the peripheral obstruction in stable asthmatic children. METHODS: Thirty-nine children with stable asthma, 28 boys and 11 girls with a mean age of 128 (77 - 197) months, received the bronchial provocation test by the maximal expiratory flow-volume (MEFV) curve measurement. The children were divided into two groups: one with maximal mid-expiratory flow (MMEF) < 80% (n = 15) and the other with MMEF >/= 80% (n = 24). Positive rates of bronchial provocation test were compared between groups of MMEF < 80% and >/= 80% and between the children whose relief duration was </= 12 months (n = 26) and > 12 months (n = 13). Statistical analysis was performed by using Chi-square, rank sum test or t test (SPSS10.0), P values < 0.05 were considered significant. RESULTS: In the 39 stable asthmatic children, 15 (38%) were detected MMEF < 80% and 28 (72%) had BHR. There was no significant difference in BHR between the children with MMEF < 80% and those with MMEF >/= 80% (P > 0.05). There was no significant difference in BHR between the children whose relief duration was </= 12 months and > 12 months (P > 0.05), either. CONCLUSIONS: The stable asthmatic children still had peripheral obstruction and BHR, which indicated the presence of airway inflammation. There was no significant difference in BHR between the children whose relief duration was </= 12 months and > 12 months.
Asthma↗
The late bronchus-obstructive response to bronchial challenge with pigeon faeces and its correlation with precipitating antibodies (IgG) in the serum of patients having long-term contact with pigeons.
From a total of 160 patients with allergic bronchial asthma or chronic asthmatic bronchitis, eighteen (11.3%) patients reported being regularly exposed to pigeons. In these eighteen patients, bronchial provocation tests with pigeon faeces were performed and the precipitating antibodies (IgG) in their serum against pigeon faeces and serum were estimated. Of the eighteen patients, seven (39%) demonstrated a 'late bronchus-obstructive response' to pigeon faeces. Three patients developed only an 'isolated late response' and in the other four patients the late response occurred as a part of the 'dual response'. In the seven patients with the positive late bronchial response, the precipitating antibodies in their serum to pigeon faeces were positive in five (71%) and to pigeon serum in two (28%) of them. The late skin responses to pigeon faeces were positive in five (71%) patients, the blood eosinophilia increased in six (86%) of them, a slight pyrexia occurred in two (28%) and general malaise symptoms appeared in six (86%) of them. None of these patients developed changes on the chest X-ray during the late response. The remaining eleven patients did not develop any bronchial response to pigeon faeces challenge, although in six (55%) of them the late skin responses were positive, and two (18%) had precipitating antibodies in the serum to pigeon faeces and one (9%) to pigeon serum. It is concluded that positive precipitating antibodies in the serum to pigeon faeces and serum are important parameters for detection of pigeon breeder's disease in exposed individuals, however confirmation of this diagnosis should be provided by the bronchial provocation tests.
Adolescent↗
Association of beta2-adrenoreceptor polymorphisms with nocturnal cough among atopic subjects but not with atopy and nonspecific bronchial hyperresponsiveness.
BACKGROUND: The reports from in vitro studies that beta(2)-adre-nergic receptor (B2AR) polymorphisms are associated with agonist-promoted downregulation have evoked considerable research interest for the roles of these polymorphisms to the pathogenesis of asthma. OBJECTIVE: We sought to evaluate the association between asthma phenotypes and B2AR polymorphisms at 2 sites (Arg16 --> Gly16 and Gln27 --> Glu27) in the general population. METHODS: Four hundred forty unrelated Korean adults were randomly selected, and asthma phenotypes were determined with a questionnaire, immunoassay, skin prick testing, and methacholine bronchial provocation testing. Genotypes of B2AR polymorphisms were determined with PCR-based methods. RESULTS: No significant association was found between B2AR alleles and haplotypes and total IgE levels, skin test responses to aeroallergens, and bronchial responsiveness to methacholine. Among the atopic subjects, however, numbers of both Arg16 alleles and Arg16-Gln27 haplotypes were negatively associated with nocturnal cough, and in contrast, Gly16-Gln27 was positively associated with it. CONCLUSION: B2AR polymorphisms may play an important role in the expression of nocturnal cough in atopic subjects but not in the expression of atopy and bronchial hyperresponsiveness in a general population.
Adult↗
[The allergic reaction to acid protease released by Candida albicans].
The species of Candida albicans (C. albicans) are known to colonize mucocutaneous regions as part of the endogenous flora. C. albicans is also known as an important allergen in human allergic diseases. However, the major allergen of C. albicans has not been identified yet. Acid protease released from C. albicans (CAAP) cleaves IgA or the secretory component to enable C. albicans to colonize on the mucous membrane. In this study, using CAAP and crude Candida antigen as challenging antigens, we carried out conjunctival provocation tests (CPT) on 68 adult bronchial asthmatic patients who showed immediate positive skin reactions to crude Candida antigen. In several patients we performed serum IgE antibody (RAST), histamine release from peripheral leukocytes (HRT) and bronchial provocation tests (BPT) to CAAP. Six of the 8 patients who showed positive CPT to crude Candida antigen (75%) showed positive CPT responses to CAAP. On the other hand, only 1 of the 59 patients who showed negative CPT to crude Candida antigen (1.7%) showed positive CPT reactions to CAAP. Two female patients showed positive RAST and HRT to both crude Candida and CAAP. They also showed positive CPT and BPT. One patient had positive RAST results but negative HRT, CPT and BPT results. These results show that CAAP is an important allergen for atopic patients allergic to C. albicans.
Adult↗
Occupational asthma caused by alpha-amylase inhalation: clinical and immunologic findings and bronchial response patterns.
Inhalation of dust from different enzymes can be the cause of occupational asthma in exposed workers. alpha-Amylase, derived from Aspergillus oryzae, is one of these enzymes, although there are few studies in the medical literature that refer to its allergologic properties and to clinical studies in sensitized patients. The results obtained in a study performed in 83 pharmaceutical-industry workers exposed to powdered alpha-amylase are described in this article. The existence of sensitization to this enzyme was demonstrated in 26 of the workers by positive skin tests. Specific IgE values were significantly higher in workers with positive skin tests than in workers with negative skin tests (p less than 0.001). The bronchial provocation test with alpha-amylase was positive in six of the 14 patients challenged, and only immediate bronchial responses were observed; the same type of response was obtained by nasal provocation. One of the workers had a positive response to oral provocation with this enzyme, presenting abdominal, skin, and respiratory symptoms a few minutes after ingestion. Consequently, we consider that the bronchial asthma presented by the workers was due to an immediate-type, IgE-dependent, immunologic mechanism.
Adult↗
[Challenge provocation tests and nonspecific bronchial hyperreactivity in occupational asthma].
The aim of the study is to determine the interest of realistic challenge (nasal and bronchial) in occupational respiratory symptoms appearing during work. 75 patients were included in the study. The protocol included prick tests, measuring total and specific IgE, spirometry and metacholine test to assess bronchial hyperreactivity (BHR), realistic challenge by rhinomanometry and plethysmography measuring NR (nasal resistance) and RWA (Airway resistance). The test was considered positive if the RWA and/or NR were increased by 100%. 68% of the tests were positives in rhinomanometry and/or plethysmography. There is an BHR in 68% cases of occupational asthma. There is a quite strong correlation between the positivity of the realistic tests and the existence of a non specific BHR.
Asthma↗
Mercurialis annua pollen: a new source of allergic sensitization and respiratory disease.
Sensitization to Mercurialis annua pollen in 13 patients admitted for allergy study of asthma, rhinitis, or rhinoconjunctivitis is described. Twelve of these patients were also sensitized to other common aeroallergens. In five patients, a relationship was found between exposure to M. annua pollen and elicitation of symptoms. All patients were prick test and RAST positive to an extract of M. annua pollen. Nasal provocation test proved positive in 10 of 12 patients, and bronchial provocation test was positive in the only patient in whom it was performed. Two late responses were recorded. Immunoblotting of the 13 sera revealed two different groups of relevant allergens; one of isoelectric point 10.2, reacting with 12 of the 13 sera, and the other allergen of isoelectric point 5.0 to 5.5, reacting with 11 of the 13 sera. M. annua pollen is able to induce both sensitization and clinical disease in atopic patients. Since sensitization to this pollen accounts for 8.5% of total positive skin tested patients in the same period, we believe M. annua pollen should be considered as a relevant allergen and thus included in skin test batteries. Some patients labeled as having "intrinsic" asthma or rhinitis might be sensitized to this and other previously unknown allergens.
Adolescent↗
Asthma-like symptoms, atopy, and bronchial responsiveness in furniture workers.
OBJECTIVES: To study the role of individual and occupational risk factors for asthma in furniture workers. METHODS: 296 workers were examined (258 men, 38 women) with a questionnaire of respiratory symptoms and diseases, baseline spirometry, bronchial provocative test with methacholine, and skin prick tests. Non-specific bronchial hyperreactivity was defined as when a provocative dose with a fall of 20% in forced expiratory volume in 1 second (PD20FEV1) was < 0.8 mg and atopy in the presence of at least one positive response to skin prick tests. Workers were subdivided into spray painters (exposed to low concentrations of diisocyanates and solvents), woodworkers (exposed to wood dusts), and assemblers (control group). RESULTS: The prevalences of attacks of shortness of breath with wheezing and dyspnoea were higher in spray painters (13.5% and 11.5% respectively) than in woodworkers (7.7% and 6.3%) or in assemblers (1.6% and 1.6%); prevalences of chronic cough, asthma, and rhinitis were also slightly but not significantly higher in spray painters and in woodworkers than in assemblers. The difference in the prevalence of respiratory symptoms among the job titles was due to the atopic subjects, who showed a higher prevalence of chronic cough, wheeze, shortness of breath with wheeze, dyspnoea, and asthma in spray painters than in the other groups. The prevalence of non-specific bronchial hyperreactivity in subjects who performed bronchial provocative tests was 17.7%, with no significant difference among groups. Asthma symptoms were significantly associated with non-specific bronchial hyperreactivity. Asthma-like symptoms plus non-specific bronchial hyperreactivity was found in 4% of assemblers, 10% of woodworkers, and 13.3% of spray painters (chi 2 = 2.6, NS). Multiple logistic analysis taking into account individual (smoke, atopy, age) and occupational (job titles) risk factors confirmed that spray painters had higher prevalence of chronic cough than assemblers, and a trend in increasing the prevalence of shortness of breath with wheeze, dyspnoea, and asthma. CONCLUSIONS: Painters in the furniture industry, particularly atopic subjects, are at higher risk of asthma-like symptoms than other job titles. In these workers asthma-like symptoms are more sensitive than non-specific bronchial hyperreactivity in detecting a negative effect of the occupational exposure.
Adult↗
Inhaled synthetic surfactant abolishes the early allergen-induced response in asthma.
Allergen-induced inhibition of pulmonary surfactant in asthma may promote airway oedema and consequently potentiate the severity of the asthmatic response. A randomised, single-blind, cross-over study of an inhaled synthetic phospholipid dry-powder surfactant (Pumactant) was conducted in atopic, asthmatic subjects with previously documented early and late asthmatic responses (EAR and LAR) to an inhaled allergen. This was conducted to evaluate the role of exogenous surfactant administration on EAR and LAR. A total of seven subjects had complete evaluable data and received the full dose of Pumactant. Asthmatic subjects inhaled two separate doses of 400 mg Pumactant prior to an allergen exposure. The first dose was administered 8 h in advance and the second dose 30 min in advance. The dosage occurred through a purpose-built administration device. This was followed by a standard bronchial-provocation test, and forced expiratory volume in one second (FEV1) was measured at regular intervals over a 10-h period. Pumactant was well tolerated and, surprisingly, abolished the EAR but not the LAR in all seven subjects. The mean area under the curve between 0-2 h (EAR) following bronchial provocation test was 0.08 for the Pumactant treatment group (PT) and 13.29 for the no treatment (NT) group. The maximum drop in FEV1 for EAR was 4.19% and 23.98% in the PT and the NT group, respectively. The demonstration of inhibition of the early asthmatic response by exogenous surfactant, provides the first evidence that pulmonary surfactant dysfunction may also contribute to the very early asthmatic response to allergen. Exogenous surfactant administration could serve as a useful adjunct in controlling the early allergen-induced symptoms in patients with allergic asthma.
1,2-Dipalmitoylphosphatidylcholine↗
Influence of the previous deep inspiration on the spirometric measurement of provoked bronchoconstriction in asthma.
The measurement of the forced expiratory volume in one second (FEV1) after a maximal inspiration is often used to assess the effect of inhaled bronchoconstrictor agents. In persons with asthma, a deep inspiration transiently alters the bronchial tone in a variable way. This may result in a variable decrease of FEV1 despite a similar degree of pharmacologically induced bronchospasm. In 71 patients with asthma we induced a comparable increase (approximating 200%) in airway resistance (Raw) with aerosolized carbachol. We then measured the change in Raw induced by one deep inspiration; when Raw had returned to the value observed before deep inspiration, the FEV1 was measured. A significant correlation (r = 0.74; p less than 0.001) was found between the transient changes in Raw induced by a deep inspiration (ranging individually from a 33% increase to a 70% decrease) and the decrease in FEV1 (from 0 to 70%). The decrease in FEV1 was greatest in patients in whom a deep inspiration increased Raw and least in those in whom Raw decreased. The initial and post-carbachol Raw values of the 17 patients exhibiting a less than 20% decrease in FEV1 were similar to those of the 54 patients with a decrease in FEV1 of more than 20%. Because a prior deep inspiration prevents changes in FEV1 in some patients with asthma, the use of the FEV1 for bronchial provocation tests can be misleading.
Asthma↗
[Differential cell count of sputum in patients with asthma challenged with allergen provocation].
Inhalation of hypertonic saline aerosol is a noninvasive method of obtaining sputum for examination of inflammatory processes in the airways. The aim of our investigation was to evaluate the effect of the bronchial provocation test with Dermatophagoides pteronyssinus on both total and differential cell counts in the sputum of allergic asthma patients. The studies were carried out on 20 mild or moderate allergic asthmatics. In each case the studies were performed on three consecutive days. Sputum was induced on the first day of the study, the next day the bronchial provocation test with the allergen was performed and on the last day the sputum induction was repeated again. Twenty-four hours after the allergen challenge an increase in the total cell count and in eosinophils and a decrease in the percentage of macrophages were found in the induced sputum. The above changes were more marked in the patients demonstrating the dual asthmatic reaction after allergen challenge.
Adult↗
Pollen immunotherapy reduces the development of asthma in children with seasonal rhinoconjunctivitis (the PAT-study).
BACKGROUND: Children with allergic rhinitis are likely to develop asthma. OBJECTIVE: The purpose of this investigation was to determine whether specific immunotherapy can prevent the development of asthma and reduce bronchial hyperresponsiveness in children with seasonal allergic rhinoconjunctivitis. METHODS: From 6 pediatric allergy centers, 205 children aged 6 to 14 years (mean age, 10.7 years) with grass and/or birch pollen allergy but without any other clinically important allergy were randomized either to receive specific immunotherapy for 3 years or to an open control group. All subjects had moderate to severe hay fever symptoms, but at inclusion none reported asthma with need of daily treatment. Symptomatic treatment was limited to loratadine, levocabastine, sodium cromoglycate, and nasal budesonide. Asthma was evaluated clinically and by peak flow. Methacholine bronchial provocation tests were carried out during the season(s) and during the winter. RESULTS: Before the start of immunotherapy, 20% of the children had mild asthma symptoms during the pollen season(s). Among those without asthma, the actively treated children had significantly fewer asthma symptoms after 3 years as evaluated by clinical diagnosis (odds ratio, 2.52; P <.05). Methacholine bronchial provocation test results improved significant in the active group (P <.05). CONCLUSION: Immunotherapy can reduce the development of asthma in children with seasonal rhinoconjunctivitis.
Adolescent↗
[Possibility of using thermography for evaluation of allergic reaction after nasal provocation test in bronchial asthma].
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Adult↗
[Correlations between the prick test and aspecific bronchial reactivity in atopic patients].
Aspecific bronchial provocation test with Methacholine plays an outstanding role in the diagnostic routine of asthmatic disease, in order to accomplish a correct interpretation of the relation between A.B.I. and bronchial asthma. All researches give a special prominence to the bronchial reactivity distribution among the population, and point out that the distribution curve of response to aspecific challenge shows itself as an unimodal curve, since there is no clinic group (neither that one including subjects defined asthmatic from a clinic or anamnestic point of view) which clearly separates from the rest. A further important consideration indicates that a positive response to the test is not specific of bronchial asthmatic subjects, but it can also occur in patients affected with other pathologies such as chronic bronchitis, allergic rhinitis, and so on. Our study aimed, therefore, to evaluate the correlations occurring between skin sensitivity and aspecific bronchial reactivity in 5 groups of atopic patients (affected with: (1) asthma; (2) asthma + rhinitis; (3) asthma + rhinitis + conjunctivitis; (4) rhinitis + conjunctivitis; (5) rhinitis). In doing such correlations we also considered some other factors like sex, smoking habit, town or country provenance. Sensitiveness, specificity, and predicting value of Prick-test in comparison with Methacholine test have been analysed as well. The results so obtained show that no correlation occurs between Prick-test and Aspecific Bronchial Test in the groups of tested subjects. Test sensitiveness increases in the groups of patients affected with associated pathologies, and depends on factors like sex, smoking habit, town or country provenance.
Asthma↗
[Reactivity of the bronchi as a function of their initial state in children with asthma].
The aim of the study was to assess the effect of peripheral bronchial base-line status on the result of the bronchial provocation test. The study was carried out on a group of 65 children with bronchial asthma. Bronchial reactivity was assessed utilizing the carbachol provocation test. Higher reactivity was seen in children with initially lower indices of peripheral bronchial flow (MEF50, MEF25) (PC20 = 3,789 +/- 0.014 mg/ml) in comparison with children with normal indices (PC20 = 74,608 +/- 0,038 mg/ml) (p < 0.001). A linear correlation was found between the results of bronchial provocation (PC) and initial standardized small airway flow values (MEF50 - r = 0.56, p < 0.001; MEF25 - r = 0.49, p < 0.001). The correlation between bronchial provocation and initial FEV1/VC was weaker (r = 0.39 p < 0.01). The authors conclude that demonstration of decreased flow in peripheral, small airways utilizing MEF values enable to predict a positive result of bronchial provocation tests.
Administration, Inhalation↗
A mononuclear cell-derived histamine releasing factor in asthmatic patients. II. Activity in vivo.
In an attempt to study the role of lymphokines in asthma, lymphocytes from asthmatic patients were stimulated in vitro with skin test-positive allergen (dust mite) or with non-specific mitogen-phytohaemagglutinin for 4 h, then washed carefully and cultured alone for 16 h. Cell-free supernatants were subsequently collected and applied in the basophil histamine release test in vitro and in bronchial provocation test and skin prick test in vivo. Supernatant of non-stimulated lymphocytes from asthmatic patients released significant amounts of histamine from basophils. Stimulation of lymphocytes with specific allergen or phytohaemagglutinin augmented the supernatant-induced histamine release. Lymphocyte supernatants from the majority of patients also induced bronchoconstriction and elicited skin wheal and flare reaction in vivo.
Asthma↗