IntroductionApproximately 5-10% of the general population report an antibiotic allergy. It has been reported that labeling of medical records with antibiotic hypersensitivity are often incorrect. As a result, antibiotic treatment choice will be increasingly difficult resulting in prolonged hospital visit, increased use of broad-spectrum antibiotics, increased frequency of side effects and the development of antibiotic resistance.AimThe primary aim was to investigate to what extent medical records were labelled with antibiotic allergy and whether these labels were adequately documented. The secondary aim was to investigate the difference in the impact of the label on the doctors’ choice of antibiotics depending on whether the doctor worked at a clinic of infectious diseases or not.MethodsA retrospective cohort study based on medical records labeled with antibiotic allergy in patients admitted to the Clinic of Infectious Diseases and the Emergency Ward at the Clinic of Medicine between 1st of January to 30th of June 2018.ResultsOf the total 1720 patients there were 132 (7,7%) patients marked with antibiotic allergy. Of these, only 21 patients (15.8%) were correctly labelled. There was no significant difference in the impact of the label on the choice of prescription between the two wards.ConclusionA substantial number of medical journals have a label for antibiotic allergy and the quality of the label is often poor with only 21 (15.8%) correct documented labels. We argue the need of education on antibiotic allergy and how to label and medical records.

In my thesis I deal with the pollen of allergenic plants, the origin and proces of allergy to plant pollen and the inclusion of these topics in the teaching of plant biology in high schools. In the theoretical part I focus on topic of pollen allergy. First, I generally describe allergy and its origin, causes of allergic diseases, environmental factors and the development of allergic disease. I also briefly address the naming and registration of allergens and I also mention the so-called cross-allergy. Great emphasis is placed on pollen allergy, which is devoted to a larger unit, divided into individual subchapters dealing with the physiological function of the nose, followed by an allergic reaction of type I, an allergic reaction that occurs on the nasal mucosa. Furthermore, subchapters mentioning the classification of allergic rhinitis, diagnosis and pharmacotherapy, including additions to the drug groups used in the treatment of pollen allergy. Another larger unit is devoted to the structure of the plant's blossom as a source of allergen, which includes the anatomy of the blossom parts and a description of the pollen grain. The anatomical description of the blossom is followed by a practical part, first created by a tabular overview with selected allergenic plants. Each plant causing the allergy...

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Allergic and hypersensitivity reactions such as anaphylaxis and asthma exacerbations may occur during air travel. Although the exact incidence of in-flight asthma and allergic emergencies is not known, we have concerns that this subject has not received the attention it warrants. There is a need to provide passengers at risk and airlines with the necessary measures to prevent and manage these emergencies. A review of the epidemiology, management and approaches to prevention of allergic and asthma emergencies during air travel is presented with the goal of increasing awareness about these important, potentially preventable medical events.

β-(1,3)-Glucan is present in mould cell walls and frequently detected in house dust mite (HDM) faeces. β-Glucan exposure is thought to be associated with pulmonary allergic inflammation in mouse and man, although the published data are inconsistent. Here, we show that highly purified β-glucan exacerbates HDM-induced eosinophilic, T helper 2 type airway responses by acting as an adjuvant, promoting activation, proliferation and polarisation of HDM-specific T cells (1-Derβ T cells). We therefore provide definitive evidence that β-glucan can influence allergic pulmonary inflammation.

Exposure to Poaceae airborne pollen (PAP) has been shown to induce allergic reactions in individuals sensitive to PAP. Patient care for individuals sensitive to PAP can be aided by knowledge of PAP profiles. Air samples were collected using a Rotorod M40 rotation impact sampler from February 2005 to September 2017. Air samples were collected daily, excluding weekends and winter months, and are expressed in grains per cubic meter (g/m3). Light microscopy at 400x magnification was used to analyze samples. Pollen was classified according to the classifications provided by the American Academy of Allergy Asthma and Immunology and the National Allergy Bureau. Detection of PAP onset averaged on day 84 (March 25th); end day averaged on day 285 (October 12th); average duration was 202 days; average peak level onset was on day 146 (May 26th) and the average peak level was 135 g/m3. Average number of days during Poaceae season with 1 to 19 g/m^3 detected was 95; with 20 to 39 g/m^3 was 7; with 40 to 59 g/m^3 was 4; and with 60 g/m^3 or more was 2. Day of onset of PAP trended to be 1.6 days earlier in the year over the course of our data collection, with R2= 0.3476. Poaceae airborne pollen in Johnson City, Tennessee was noticeable for almost 7 months out of the year. We can assume the riskiest months of the year are from March to October with the highest risk period being the end of May.

Objective: While most allergic responses to food are directed against protein epitopes and occur within 30 minutes of ingesting the allergen, recent studies suggest that delayed reactions may occur, sometimes mediated by IgE antibodies directed against carbohydrate moieties. The objective of this review is to summarize the clinical features and management of delayed hypersensitivity reactions to mammalian meat mediated by IgE antibodies to galactose-alpha 1,3-galactose (alpha-gal), an oligosaccharide.Methods: A PubMed search was conducted with MeSH terms: galactosyl-(1,3) galactose, oligosaccharides, cetuximab, allergy/hypersensitivity, and anaphylaxis. Reported cases with alpha-gal-mediated reactions were reviewed. This research study was approved by the Institutional Review Board of East Tennessee State University.Results: Thirty-two cases of adults presenting with red-meat induced allergy thought to be related to oligosaccharides have been reported in the literature so far, making this a rare and evolving syndrome. Most of these patients demonstrated delayed reactions to beef, as was seen in the case reported by us in this manuscript. IgE specific to alpha-gal was identified in most patients with variable response to skin testing with beef and pork. Inhibition studies in some cases showed that the IgE antibodies to beef were directed towards alpha-gal in the meat rather than the protein. The patients often reported history of tick bites, the significance of which is unclear at present. Reactions to cetuximab, a monoclonal antibody, are mediated by a similar mechanism, with IgE antibodies directed against an alpha-gal moiety incorporated in the drug structure.Conclusion: Alpha-gal is an oligosaccharide recently incriminated in delayed anaphylactic reactions to mammalian meats such as to beef, pork, and lamb. It appears that anaphylactic reactions to the anti-cancer biological agent, cetuximab, may be linked mechanistically to the same process. More studies are required to understand the underlying molecular basis for these delayed reactions in specific, and their broader implications for host defense in general.

B cells get help in the antibody response by presenting processed antigen to helper T cells. We asked whether the antigen presenting B cell must induce T helper functions before receiving help, or whether B cell activation is a direct consequence of T cell antigen recognition on the B cell surface. Although antigen-dependent increases in B cell c-myc expression occur as early as two hours after conjugation, the B cell response depends on induction of a contact-dependent helper function in the T cell, which is inhibitable by cyclosporin A. Induction but not delivery of contact help is blocked by anti-class II MHC antibody, indicating that the delivery of T cell help is not Ag dependent or MHC restricted. Also, contact with activated helper T cells induces a different pattern of immediate early gene expression from signals transduced through the B cell antigen receptor. Egr-1 is rapidly upregulated in response to mitogenic signals induced by receptor crosslinking on murine B lymphocytes, and its expression closely correlates with B cell proliferation in several models of B cell activation and tolerance. We compared egr-1 expression during B cell stimulation with Fab'2 and IgG anti-Ig, since it is known that Fab'2 anti-Ig is mitogenic while IgG is not, due to a dominant inhibitory effect of crosslinking the B cell FcγRII to membrane Ig. While mitogenic doses of Fab'2 anti-Ig induce large and rapid increases in egr-1 expression, intact anti-Ig results in only small increases in egr-1 mRNA, comparable to that seen with submitogenic concentrations of Fab'2 anti-Ig. However, when IL-4 is added as a comitogen to induce B cell proliferation with submitogenic concentrations of Fab'2 anti-Ig or IgG anti-Ig, no concomitant increases in egr-1 are observed. The regulation of egr-1 therefore, is similar to that of c-myc in this system, since neither correlates with IL-4 induced DNA synthesis.

La dermatite allergique de contact (DAC) est une réaction inflammatoire aiguë, médiée par les cellules dendritiques (DCs) survenant suite à l’exposition répétée de la peau avec une molécule allergisante. La prévalence estimée des cas de DAC aux substances parfumantes est de 1,7 % à 4,1 % dans la population générale. Les molécules allergisantes sont des molécules appelées haptènes, qui vont se conjuguer avec des protéines de l’épiderme ou du derme. C’est le cas du cinnamaldéhyde (CinA), une molécule retrouvée dans la cannelle. Le linalol et le limonène sont des terpènes présents dans la lavande et l’orange, qui vont s’autoxyder au contact de l’air pour former des allergènes puissants, tels que les hydroperoxydes allyliques. Le premier objectif de cette thèse a été d’étudier le mécanisme d’action de ces terpènes et leurs hydroperoxydes allyliques respectifs sur la lignée cellulaire THP-1, qui sert de substitut aux cellules dendritiques. Le rôle du facteur de transcription Nrf2, majeur dans la lutte contre le stress oxydant, a également été investigué.Les consommateurs de produits cosmétiques sont exposés à de faibles concentrations de molécules allergisantes, mais plusieurs fois par jour ou par semaine. Nous avons souhaité étudier l’exposition répétée à de faibles doses d’haptène sur la peau.Les kératinocytes jouent également un rôle dans la DAC : ce sont les premières cellules qui vont rencontrer la molécule allergisante dans la peau. La deuxième partie de ce travail a été d’étudier l’impact d’une exposition répétée de CinA à de faible concentration sur ces KCs et plus particulièrement sur la différenciation de l’épiderme, en utilisant un modèle organotypique de peau en 3D. / Allergic contact dermatitis (ACD) represents a severe health problem. It is a dendritic cells (DCs) mediated skin disease caused by repeated exposure to an allergenic compound. ACD cases of fragrances in general population is estimated from 1.7 % to 4.1%. Contact sensitizers are compounds termed haptens and they will form a conjugate with epidermis and dermis proteins. Example is cinnamaldehyde (CinA), a molecule found in cinnamon. Linalool and limonene are terpenes found in lavender and oranges. In contact with the air, they will autoxidize to form highly allergenic compounds: allylic hydroperoxides. The first aim of this thesis was to study the mechanism of action of those terpenes and their respective allylic hydroperoxides on THP-1 cell-line, described as a surrogate of DCs. The transcription factor Nrf2 is playing a major role in oxidative stress and was also investigated.Consumers of cosmetic products are exposed to low quantities of allergenic compounds, but several times a day or a week. We wanted to study repeated exposure of low concentration of haptens on the skin.KCs also play a key role in ACD: they are the first cells that will encounter the allergenic compound in the skin. The second aim of this thesis was to study the impact of repeated exposure of low concentrations of CinA on those KCs and more particularly on the epidermis differenciation, using a 3D organotypic culture of skin.

京都大学 / 0048 / 新制・課程博士 / 博士(農学) / 甲第19770号 / 農博第2166号 / 新制||農||1040(附属図書館) / 学位論文||H28||N4986(農学部図書室) / 32806 / 京都大学大学院農学研究科食品生物科学専攻 / (主査)教授 河田 照雄, 教授 保川 清, 教授 橋本 渉 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DGAM