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Medical Journal Review

May 2016

WAO Reviews - Editors' Choice

1. A novel arctigenin-containing latex glove prevents latex allergy by inhibiting type I/IV allergic reactions

Wang YX, Xue DT, Liu M, Zhou ZM, Shang J. A novel arctigenin-containing latex glove prevents latex allergy by inhibiting type I/IV allergic reactions. Chinese Journal of Natural Medicines 2016; 14(3): 185-195. (doi:10.1016/S1875-5364(16)30015-2)

Abstract

Wang and colleagues aimed at developing a natural compound with anti-allergic effect as well as stability under latex glove manufacturing conditions and investigated whether its anti-allergic effect could be maintained after its addition into the latex. The effects of nine natural compounds on growth of the RBL-2H3 cells and mouse primary spleen lymphocytes were determined using MTT assay. The compounds examined included glycyrrhizin, osthole, tetrandrine, tea polyphenol, catechin, arctigenin, oleanolic acid, baicalin and oxymatrine. An ELISA assay was used for the in vitro anti-type I/IV allergy screening; in this process β-hexosaminidase, histamine, and IL-4 released from RBL-2H3 cell lines and IFN-γ and IL-2 released from mouse primary spleen lymphocytes were used as screening indices. The physical stability of eight natural compounds and the dissolubility of arctigenin, selected based on the in vitro pharnacodynamaic screening and the stability evaluation were detected by HPLC. The in vivo pharmacodynamic confirmation of arctigenin and final latex product was evaluated with a passive cutaneous anaphylaxis model and an allergen-specific skin response model. Nine natural compounds showed minor growth inhibition on RBL-2H3 cells and mouse primary spleen lymphocytes.

While baicalin and arctigenin had the best anti-type I and IV allergic effects among the natural compounds based on the in vitro pharmacodynamic screening, arctigenin and catechin had the best physical stability under various manufacturing conditions.

Arctigenin was then selected for further evaluation and showed anti-type I and IV allergic effects both in vitro and in vivo, with good stability under latex glove manufacturing conditions and a persistent anti-allergic effect after being added into the latex to prevent latex allergy.

2. Antibiotics are the most commonly identified cause of perioperative hypersensitivity reactions

Kuhlen JL, Camargo CA, Balekian DS, Blumenthal KG, Guyer A, Morris T, Long A, Banerji A. Antibiotics are the most commonly identified cause of perioperative hypersensitivity reactions. Journal of Allergy and Clinical Immunology: In Practice 2016; published online ahead of print, March 30. (doi:10.1016/j.jaip.2016.02.008)

Abstract

It is well known that hypersensitivity reactions (HSRs) during the perioperative period are unpredictable and can be life threatening. Prospective studies for the evaluation of perioperative HSRs are lacking, and data on causative agents vary between different studies. This study, Kuhlen and colleagues, prospectively determined the success of a comprehensive allergy evaluation plan for patients with HSRs during anesthesia, including identification of a causative agent and outcomes during subsequent anesthesia exposure.  To do so, they evaluated all patients referred for a perioperative HSR

between November 2013 and March 2015, from a Boston teaching hospital, using a standardized protocol including a comprehensive allergy history and skin testing (ST) within 6 months of HSR. Twenty five patients completed this evaluation with 52 percent (13 of 25) being female with a median age of 52 (interquartile range 43-66) years. The most frequently observed HSR systems were cutaneous (68%), cardiovascular (64%), and pulmonary (24%). A culprit drug, defined as a positive ST, was identified in 36% (9 of 25) of patients, with the most common agent identified being cefazolin (6 of 9). Tolerance of subsequent anesthesia was generally achieved (88%) in patients undergoing this protocol.

3. Association of changes in air quality with bronchitic symptoms in children in California, 1993-2012

Berhane K, Chang CC, McConnell R, Gauderman J, Avol E et al. Association of changes in air quality with bronchitic symptoms in children in California, 1993-2012. Journal of the American Medical Association 2016; 315(14): 1491-1501. (doi:10.1001/jama.2016.3444)

Abstract

It is believed that ambient air pollutants are a cause of childhood bronchitic symptoms.  In this study, by Berhane and colleagues, they examined whether improvements in ambient air quality in Southern California were associated with reductions in bronchitic symptoms in children by performing a longitudinal study of 4602 children (age range,

5-18 years) from 3 cohorts (conducted during 1993-2001, 1996-2004, and 2003-2012) in 8 Southern California communities. A multilevel logistic model was used to estimate

the association of changes in pollution levels [average concentrations of nitrogen dioxide, ozone, particulate matter with an aerodynamic diameter of less than 10 μm (PM10) and less than 2.5 μm (PM2.5)] with bronchitic symptoms. They found that decreases in ambient pollution levels were associated with statistically significant decreases in bronchitic symptoms in children. The authors note that although their study design does not establish causality, the findings support potential benefit of air pollution reduction on asthma control.

4. Cell therapy for prophylactic tolerance in immunoglobulin e-mediated allergy

Baranyi U, Farkas AM, Hock K, Mahr B, Linhart B et al. Cell therapy for prophylactic tolerance in immunoglobulin e-mediated allergy. EBioMedicine 2016; article in press. (doi:10.1016/j.ebiom.2016.03.028)

Full Text, Open Access

Cell therapy is an emerging approach with high potential for preventing and treating inflammatory illness, including those that are IgE mediated. In this proof of concept study, Baranyi and colleagues, using a mouse model, explored the development of a cell-based therapy inducing permanent allergen-specific immunological tolerance for preventing IgE-mediated allergy. In their study, wild-type mice were treated with allergen-expressing bone marrow cells under a short course of tolerogenic immunosuppression (mTOR inhibition and costimulation blockade). Bone marrow was retrieved from a novel transgenic mouse expressing the major grass pollen allergen Phl p 5 as a membrane-anchored protein (BALB/c-Tg[Phlp5-GFP] , here mPhl p 5). After transplantation recipients were IgE-sensitized at multiple time points with Phl p 5 and control allergen. They found that mice treated with mPhl p 5 bone marrow did not develop Phl p 5-specific IgE (or other isotypes) despite repeated administration of the allergen, while mounting and maintaining a strong humoral response towards the control allergen.

5. Circulating microRNAs as biomarkers in patients with allergic rhinitis and asthma

Panganiban RP, Wang Y, Howrylak J, Chinchilli VM, Craig TJ, August A, Ishmael FT. Circulating microRNAs as biomarkers in patients with allergic rhinitis and asthma. Journal of Allergy and Clinical Immunology 2016; article in press. (doi:10.1016/j.jaci.2016.01.029)

Abstract

Circulating microRNAs (miRNAs) might serve as noninvasive biomarkers to diagnose and characterize asthma and allergic rhinitis (AR).  This makes sense, as miRNAs are emerging as important regulatory molecules that appear to be involved in the pathogenesis of various inflammatory diseases. In this study, Panganiban, and colleagues evaluated whether miRNAs are differentially expressed in the blood of asthmatic patients compared with those in the blood of nonasthmatic patients with AR and nonallergic nonasthmatic subjects. To do so, they measured the expression of plasma miRNAs by using real-time quantitative PCR in 35 asthmatic patients, 25 nonasthmatic patients with AR, and 19 nonallergic nonasthmatic subjects. Via this subject pool, they identified 30 miRNAs which fit into 5 different expression pattern groups that were differentially expressed among healthy, allergic, and asthmatic subjects. Among asthmatic patients, miRNA expression profiles identified 2 subtypes that differed by high or low peripheral eosinophil levels. They further found that circulating miR-125b, miR-16, miR-299-5p, miR-126, miR-206, and miR-133b levels were most predictive of allergic and asthmatic status.  One cannot help but notice the possibilities with use of this method.  As concluded by the authors, circulating miRNAs are uniquely expressed in patients with AR and asthmatic patients and thus have potential for use as noninvasive biomarkers to diagnose and better characterize these diseases.