Selective IgA Deficiency and Allergy: A Fresh Look to an Old Story

Selective IgA deficiency (SIgAD) is the most common human primary immune deficiency (PID). It is classified as a humoral PID characterized by isolated deficiency of IgA (less than 7 mg/dL but normal serum IgG and IgM) in subjects greater than 4 years of age. Intrinsic defects in the maturation of B cells and a perturbation of Th cells and/or cytokine signals have been hypothesized to contribute to SIgAD pathogenesis. The genetic basis of IgA deficiency remains to be clarified. Patients with SIgAD can be either asymptomatic or symptomatic with clinical manifestations including allergy, autoimmunity and recurrent infections mainly of the respiratory and gastrointestinal tract. Studies analyzing allergy on SIgAD patients showed prevalence up to 84%, supporting in most cases the relationship between sIgAD and allergic disease. However, the prevalence of allergic disorders may be influenced by various factors. Thus, the question of whether allergy is more common in SIgAD patients compared to healthy subjects remains to be defined. Different hypotheses support an increased susceptibility to allergy in subjects with SIgAD. Recurrent infections due to loss of secretory IgA might have a role in the pathogenesis of allergy, and vice versa. Perturbation of microbiota also plays a role. The aim of this review is to examine the association between SIgAD and atopic disease and to update readers on advances over time at this important interface between allergy and SIgAD.

Epithelial Barrier: Protector and Trigger of Allergic Disorders

The epithelial barrier has been classically considered as only the first line of defense against irritants, pathogens, and allergens, but it is now known that it also plays an essential role in the immunological response against exogenous agents. In fact, recent reports postulate the epithelial barrier hypothesis as a possible explanation for the increasing incidence and severity of allergic diseases. The epithelial barrier preserves the isolation of the inner tissues from potential external threats. Moreover, a coordinated interaction between epithelial and immune cells ensures the unique immune response taking place in mucosal tissues and that is has been reported to be dysregulated in allergic diseases. Herein, we and others have demonstrated that in severe allergic phenotypes, the epithelial barrier experiments several histological modifications and increased in immune cells infiltration, leading to its dysfunction. This is common in atopic dermatitis, asthma, and/or food allergy. However, the precise role of the epithelial barrier in the mucosal biology during allergic diseases progression is not well understood yet. In this review, we aim to compile recent knowledge regarding the histological structure and immunological function of the epithelial barrier and to shed light on the role of this compartment in the onset, and progression of allergic diseases.

EARLY CHILDHOOD ALLERGY LINKED WITH DEVELOPMENT OF ATTENTION DEFICIT HYPERACTIVITY DISORDER AND AUTISM SPECTRUM DISORDER

Background: Previous studies reported controversial results regarding the association between allergic disorders and ADHD/ASD. The aim of this article is to investigate whether allergic disorders are associated with ADHD/ASD in a large cohort of pediatric patients. Methods: A retrospective study using the pediatric (0-18 year) database (ICD-9-CM codes) of Clalit Health Services during the years (2000-2018). Diagnosis of all disorders was made by specialist physicians. Results: 117,022 consecutive non-selective allergic children diagnosed with one or more allergic disorder (asthma, rhinitis. conjunctivitis, skin, food, or drug allergy) and 116,968 non-allergic children were enrolled to our study. The mean follow-up period was 11±6 years. The presence of allergic disorders in early childhood (mean age of allergic diagnosis 4.5± 4.3 years) in boys as well as in girls, significantly increased the risk to develop ADHD (O.R 2.45, CI 2.39-2.51; P<0.0001), ASD (O.R 1.17, CI 1.08-1.27; P<0.0001) or both ADHD+ASD (O.R 1.5, CI 1.35-1.79; P<0.0001). Children with more than one allergic comorbidity revealed a much higher risk. In a multivariable analysis (adjusted for age at study entry, number of yearly visits and gender) the risk of allergic children to develop ADHD and ADHD+ASD, but not ASD alone, remained significantly higher. Conclusion: Allergic disorder in early childhood significantly increased the risk to develop ADHD, and to a less extend ASD, in later life.

Interprofessional collaboration to manage allergic disorders in rural areas of Himachal Pradesh

Background: Allergic disorders are common and affect a large population even in rural areas. Medical care is not easily accessible to rural population especially in hilly terrain. Health camps are effective method to deliver medical care in such areas. Interprofessional collaboration involving various professions who work together as a team for management of various disorders is being studied and practiced recently. Aims and Objectives: To study the impact of interprofessional collaboration at these rural health camps to control allergies prevalent in the rural areas of the region. Methodology: Around 18 interprofessional health camps involving doctors of various disciplines – ENT, pulmonary medicine, skin, eyes, yoga experts, health and sanitation workers, public health, lab technicians, pharmacist and nursing staff were held in rural areas with an attempt to manage allergic disorders prevalent there as a team. The treatment was provided as a collaboration of various professions. Results: 608 patients of allergic disorders were identified at these camps which were more prevalent in younger and middle age group and females. The common allergens were dust mite mix, pine mix, cockroach and grass pollen. Nasal allergies were more common followed by skin and pulmonary allergies. On follow up, allergies were more controlled (48%) in patients who followed interprofessional advise and treatment as compared to (5%) in those who didn’t follow the same. Conclusion: Allergic disorders can be best managed by a holistic approach of treatment involving various professions. Health camps through interprofessional approach are an excellent method to provide medical care to rural population in difficult hilly terrain. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 96-100

Fexofenadine HCl Microspheres – Can it be the First Line therapy for Allergic Disorders ?

Fexofenadine HCl is a second-generation antihistamine which is commonly used for allergic disorders. But it has low bioavailability. Intranasal corticosteroids (INCs) and Immunotherapy and Allergen Specific Immunotherapy (ASIT) are now commonly being suggested for the treatment of allergic disorders. Despite the fact that current treatment alternatives have been in use for decades, patient quality of life has remained static. The treatment options are not much explored for their respective adverse effects. Therefore, they are in desperate need of research. Fexofenadine HCl is available in the form of a suspension, tablet, or capsule. In our current study, we have explored whether microspheres can be the perfect dosage form of Fexofenadine HCl to treat allergic disorders considering the pharmacokinetics of the drug, available dosage forms options and the probable side effects of the current therapies.

Molecular Mechanisms of Eosinophilic Esophagitis

Food hypersensitivity is a group of diseases arising from a specific immune response that reproduces on exposure to a given food. The current understanding of molecular mechanisms and immunopathology of non-IgE-mediated/mixed food hypersensitivity, e.g., eosinophilic esophagitis, contains many gaps in knowledge. This review aims to provide a modern classification and identify the primary diseases of non-IgE-mediated/mixed food hypersensitivity reactions, delineate the distinctive molecular features, and discuss recent findings in the immunopathology of eosinophilic esophagitis that may become a basis to develop valid biomarkers and novel therapies for this disease. Eosinophilic esophagitis is a recently recognized allergic-mediated disease with eosinophil-predominant esophagus inflammation. Its pathogenesis is a complicated network of interactions and signaling between epithelial, mesenchymal, and immune cells on molecular and intercellular levels. Alterations produced by overactivation of some cytokine signaling pathways, e.g., IL-13 or thymic stromal lymphopoietin (TSLP), were evolved and observed in this review from the viewpoints of molecular, genetic, epigenetic, and transcriptomic changes. Despite substantial experimental data, the reliable and representative mechanism of eosinophilic esophagitis pathogenesis has yet to show itself. So, the place of esophagitis between mixed and non-IgE-mediated allergic disorders and between eosinophilic gastrointestinal disorders currently seems vague and unclear.

Atopic Dermatitis: Case Series of Individualized Homoeopathic Treatment

Atopic dermatitis is a common, chronic, intensely pruritic, relapsing inflammatory skin disease that affects both children and adults. Atopic dermatitis is often the originating of a series of allergic disorders, mentioned as the "atopic march".There are numerous risk factors correlated with AD development. However, only two have always been related, and they are (1) family history of atopy and (2) loss of function mutations in the FLG gene. Topical anti-inflammatory therapy with topical corticosteroids or topical calcineurin inhibitors treatment are available in conventional therapy but sometimes it has been reported that patients are also benefited from Homoeopathic treatment. Four patients who presented at the outpatient department at National Institute of Homoeopathy, Saltlake, Kolkata with Atopic dermatitis and a family history of asthma, allergic rhinitis were treated with constitutional homoeopathic medicine. Details of consultations, treatment and assessment are summarized. A constitutional treatment thus eliminates the symptoms locally and internally as well as long-lasting relief from complaints. Common remedies include Mercuris Solubilis, Sulphur. This case series shows positive results of homoeopathy in the treatment of Atopic dermatitis. Key words: Atopic dermatitis, Family history, Individualized Homoeopathic treatment, Case series, repertorisation.

Non-IgE-Mediated Gastrointestinal Food Protein-Induced Allergic Disorders. Clinical Perspectives and Analytical Approaches

Non-IgE-mediated gastrointestinal food allergy (non-IgE-GI-FA) is the name given to a series of pathologies whose main entities are food protein-induced allergic proctocolitis (FPIAP), food protein-induced enteropathy (FPE), and food protein-induced enterocolitis syndrome (FPIES). These are more uncommon than IgE-mediated food allergies, their mechanisms remain largely unknown, and their diagnosis is mainly done by clinical history, due to the lack of specific biomarkers. In this review, we present the latest advances found in the literature about clinical aspects, the current diagnosis, and treatment options of non-IgE-GI-FAs. We discuss the use of animal models, the analysis of gut microbiota, omics techniques, and fecal proteins with a focus on understanding the pathophysiological mechanisms of these pathologies and obtaining possible diagnostic and/or prognostic biomarkers. Finally, we discuss the unmet needs that researchers should tackle to advance in the knowledge of these barely explored pathologies.