One of the most common reasons people seek primary care and emergency care is to reduce the symptoms of allergies, such as hay fever. To meet this high demand, several recent FDA-approved methods for treating seasonal and perennial allergies have been developed, including sublingual immunotherapy tablets. Furthermore, no longer must a patient endure allergy shots; this can now be delivered sublingually. Although this method has been shown to have high safety and efficacy, very few clinicians actually utilize this form of therapy. The purpose of this paper is describe the use of sublingual immunotherapy among Nurse Practitioners (NPs) and discuss barriers that may prevent its use. Nurse Practitioners working in primary care settings were surveyed regarding their use of sublingual immunotherapy. Although many nurse practitioners treat patients with allergic disease, not one participant reported using sublingual immunotherapy. This discussion outlines some of the reasons NPs are not currently utilizing this method of allergy treatment and the findings are compared with the extant literature. This paper culminates in an evidence-based algorithm to outline best practices for utilizing sublingual immunotherapy to reduce allergy symptoms.

Spleen tyrosine kinase (Syk) plays a critical role in regulation of immune and inflammatory responses. This thesis investigated the role of Syk in the development of the asthma phenotype in acute and chronic mouse models of allergic airways inflammation. Airway hyperresponsiveness (AHR) to methacholine and inflammation increased significantly in HDM-induced compared with the saline control mice. We demonstrated that in vivo inhibition of Syk by selective Syk inhibitors, and genetic deletion of Syk using conditional Syk knockout mice attenuated AHR despite of inflammatory cell influx in the lung. Histological analysis showed airway remodeling in the chronic model, which was attenuated to some degree by deletion of Syk. This study identified a role of Syk in airway hyperresponsiveness and remodeling without significantly affecting leukocyte recruitment in HDM model of airways disease. My results support the improvement of therapeutic strategies in asthma by targeting the Syk pathway.

Spleen tyrosine kinase (Syk) plays a critical role in regulation of immune and inflammatory responses. This thesis investigated the role of Syk in the development of the asthma phenotype in acute and chronic mouse models of allergic airways inflammation. Airway hyperresponsiveness (AHR) to methacholine and inflammation increased significantly in HDM-induced compared with the saline control mice. We demonstrated that in vivo inhibition of Syk by selective Syk inhibitors, and genetic deletion of Syk using conditional Syk knockout mice attenuated AHR despite of inflammatory cell influx in the lung. Histological analysis showed airway remodeling in the chronic model, which was attenuated to some degree by deletion of Syk. This study identified a role of Syk in airway hyperresponsiveness and remodeling without significantly affecting leukocyte recruitment in HDM model of airways disease. My results support the improvement of therapeutic strategies in asthma by targeting the Syk pathway.

Allergic airway disease, i.e. allergic rhinitis (AR) and asthma, is a common health problem. The prevalence is increasing in most countries of the world. Traffic-related air pollution has been found to induce and enhance allergic airway disease, but the underlying mechanisms are not known. Oxylipins are fatty acid metabolites, of which several have been linked to asthmatic airway inflammation. Oxylipin profiles have previously been investigated in bronchoalveolar lavage (BAL), mainly reflecting the peripheral lung, but not in bronchial wash (BW), which better reflect the proximal airways. The airway epithelium is covered by a respiratory tract lining fluid (RTLF) The RTLF contains antioxidants to protect from oxidative stress, which may be caused by exposure to air pollution. Previous studies have reported diminished levels of the antioxidant ascorbate (vitamin C) in the RTLF of patients with asthma. Little is known about the regulation of vitamin C in the lung. The aim of this thesis was to investigate airway inflammatory responses to diesel exhaust exposure in patients with AR and allergic asthma; to evaluate oxylipin profiles in different regions of the lung in patients with allergic asthma; and to study the distribution of vitamin C transporters in the airways of patients with allergic asthma. Diesel exhaust (PM10 100 μg/m3 for 2 h) induced a neutrophilic airway inflammation in healthy individuals evaluated 18 h after exposure. Patients with AR and asthma did not respond with an enhanced airway inflammation. However, a small increase in myeloperoxidase was found in BAL from patients with AR, as well as decreases in epithelial tryptase and BW stem cell factor. This indicates that other mechanisms than classical inflammation are responsible for the increased sensitivity to traffic-related air pollution in patients with allergic airway disease. Oxylipin baseline profiles differed between peripheral and proximal airways in both allergic asthmatics and healthy individuals. Total oxylipin concentrations, and five individual oxylipins, primarily from the lipoxygenase (LOX) pathway, were elevated in BW from asthmatics compared to healthy controls, supported by immunohistochemical staining of 15-LOX-1 in the bronchial epithelium. This suggests that lung compartment-specific sampling should be considered in future studies. Sodium dependent vitamin C transporter 2 (SVCT2) was, for the first time, found present in the human lung epithelium, localised mainly within goblet cells. A negative correlation between SVCT2+ goblet cells and vitamin C suggests that these cells may play a hitherto unknown function in ascorbate re-uptake and recycling at the air-lung interface.

Astma yra lėtinė kvėpavimo takų uždegimo liga. Mokslininkai neabejoja, jog 2-o tipo T limfocitai pagalbininkai bei eozinofilinis kvėpavimo takų uždegimas yra astmos patogenezės pagrindas. Tačiau šis mechanizmas ne visuomet gali paaiškinti astmos metu esančio kvėpavimo takų uždegimo bei klinikinių simptomų įvairumą, eigos ypatumus ir net skirtingą atsaką į gydymą. Eksperimentiniai tyrimai su gyvūnais parodė 17-o tipo T limfocitų pagalbininkų (Th17) svarbą alerginės astmos vystymuisi. Todėl šio mokslinio tyrimo tikslas buvo įvertinti Th17 limfocitų vaidmenį sergant alergine astma. Tyrimo metu sergantiesiems alergine astma nustatytas didesnis Th17 limfocitų kiekis periferiniame kraujyje bei didesnė interleukino (IL)-17 koncentracija serume ir indukuotuose skrepliuose, lyginant su sveikais asmenimis. Be to, bronchų provokacija su Dermatophagoides pteronyssinus alergenu sukėlė Th17 limfocitų ir IL-17 kiekio padidėjimą praėjus 7 ir 24 val.po jos, ypatingai ryškų sergantiems alergine astma su ankstyva ir vėlyva bronchų obstrukcija. Atlikto tyrimo rezultatai parodė, kad Dermatophagoides pteronyssinus alergenas sukelia vietinį ir sisteminį Th17 limfocitų imuninį atsaką kuris yra susiję su vėlyvos fazės kvėpavimo takų uždegimu. / Allergic asthma is a chronic inflammatory disease of the airways associated with the response of predominant type 2 helper T lymphocytes to an inhaled allergen. However, differences in inflammation and clinical symptoms of this disease not always can be explained by this mechanism. Recent animal model studies have shown the importance of type 17 helper T lymphocytes (Th17) in the development of allergic asthma. The role of these cells in causing allergen-induced airway inflammation as well as systemic inflammatory response in human is still not well defined. Therefore, we investigated the peripheral blood Th17 lymphocyte response to inhaled Dermatophagoides pteronyssinus (D. pteronyssinu) allergen in patients with allergic asthma. The present study has shown that patients with allergic asthma have a higher percentage of peripheral blood Th17 lymphocytes and elevated serum as well as induced sputum interleukin-17 levels compared with healthy subjects. Moreover, all studied allergic asthma patients, especially with early- and late-phase asthmatic reaction, showed an enhanced airway and systemic Th17 lymphocyte response 7 h and 24 h after bronchial challenge. We documented an enhanced local and systemic Th17 lymphocyte response to inhaled D. pteronyssinus in association with late-phase allergen-induced airway inflammation in patients with allergic asthma.

Darbo tikslas – įvertinti dermatitu sergančių pacientų įsijautrinimą kontaktiniams alergenams ir su juo susijusius veiksnius. Darbo uždaviniai: 1. Nustatyti įsijautrinimo kontaktiniams alergenams dažnumą tarp dermatitu sergančių pacientų. 2. Įvertinti įsijautrinimo kontaktiniams alergenams dažnumo sąsajas su tiriamųjų amžiumi, lytimi ir profesija. 3. Nustatyti įsijautrinimo kontaktiniams alergenams klinikos ypatumus. 4. Įvertinti įsijautrinimo kontaktiniams alergenams sąsajas su atopiniu dermatitu, lėtine (-ėmis) kojos (-ų) opa (-omis) ir kitais veiksniais. Išvados: 1. Kontaktiniams alergenams įsijautrinę pusė dermatitu sergančių pacientų, dažniausiai – metalui nikeliui (17,1 proc.). Iš aromatinių medžiagų dažniausias yra įsijautrinimas Peru balzamui (8 proc.). Į pagrindinį alergenų rinkinį neįtrauktini retai (0,1 proc.) nustatyti alergenai: gumų medžiagos merkaptobenzotiazolas ir N-zopropil-N’-fenil-parafenilendiaminas. 2. Įsijautrinimas kontaktiniams alergenams jaunesniems nei 40 metų dermatitu sergantiems pacientams pasireiškia du kartus dažniau nei vyresniems, o moterims – du kartus dažniau nei vyrams. Žemės ūkio ir miškininkystės darbuotojai kontaktiniams alergenams įsijautrinę tris kartus dažniau nei kiti dirbantieji. Vertinant atskirus alergenus, jaunesni nei 40 metų pacientai dažniau nei vyresni yra įsijautrinę nikeliui, kobaltui ir kvaterniumui-15, o 40 metų ir vyresni – Peru balzamui, kanifolijai, aromatų mišiniui I, lanolinui, seskviterpenlaktonams ir... [toliau žr. visą tekstą] / The aim of the study: To evaluate contact sensitization and its associated factors in patients with dermatitis. The objectives of the study: 1. To determine the frequency of sensitization to contact allergens in patients with dermatitis. 2. To evaluate associations between the frequency of sensitization to contact allergens and age, sex and occupation in patients with dermatitis. 3. To determine clinical features of contact sensitization. 4. To evaluate associations between sensitization to contact allergens and atopic dermatitis, chronic leg ulcers and other factors. CONCLUSIONS 1.Half of the patients with dermatitis were sensitized to contact allergens, most frequently to metal nickel (17.1%). From the fragrances, bal¬sam of Peru was the most frequent contact allergen (8%). Rare allergens that should not be included in the baseline series are the substances present in the composition of rubber – mercaptobenzothiazole and N-isopropyl-N'-phenyl-p-phenylene diamine (IPPD). 2.Patients under 40 years of age are two times more frequently sensitized than the older ones. In women contact allergy is twice as more frequent as in men. Agricultural and forestry workers are sensitized to contact allergens three times as more often as other employees. What regards individual allergens, among patients under 40 years of age sensitization to nickel, cobalt and quaternium-15 is more prevalent than in the older ones. Among patients who are 40 years of age and over contact sensitization to... [to full text]

Darbe aprašoma blusų sandara, jų vystymas ir paplitimas, taip pat labiausiai paplitusių alerginių dermatitų patogenezė bei simptomai. Atlikto tyrimo rezultatai, kad būtų aiškiau, pateikiami diagramomis su trumpu jų aprašymu, jie apibendrinami ir padaromos išvados. / Thesis describes the structure of the fleas, their development and distribution, as well as the most common allergic dermatitis pathogenesis and symptoms. The research results are clearly presented charts with a short description of it, they are summarized and lead to conclusions.

[Truncated abstract] The dramatic increase in the expression of allergic diseases such as asthma and allergy over the last 20-30 years has highlighted the urgent need to identify causative factors. It was hypothesised that direct immune interactions between mother and fetus contribute to the cytokine milieu of pregnancy, thus influencing immune maturation after birth. Further it was speculated that the cytokine responses produced as a result of maternalfetal interactions are Th-2 skewed in women allergic disease, which programmes their offspring towards developing an allergic phenotype after birth. To test this hypothesis a cohort of 169 pregnant women were recruited at 20 weeks gestation and defined as allergic or non-allergic based on both clinical history and skin prick test sensitisation. These women and their infants were followed up throughout pregnancy (20 weeks, 30 weeks, 36 weeks gestation and 6 weeks post-partum) and up to 2.5 years of age. Mixed lymphocyte reactions (MLR) were used to measure maternal cytokine (IL-6, IL-10, IL-13 and IFN-) and lymphoproliferative responses to fetal alloantigens at each pregnancy time-point. Human leukocyte antigen (HLA) typing of mothers and infants were performed to assess the effect of HLA mismatch on maternal MLR responses to their fetus. After delivery, mononuclear cells (MNC) were isolated from cord blood (CB) and stimulated with allergens, mitogen and toll-like receptor (TLR) ligands. .... As IL-6 also participates in adaptive immunity by promoting Th-2 differentiation it is proposed that the production of IL-6 as a results of maternal encounters with paternal antigens during pregnancy, contribute to the Th-2 skewed responses observed universally in most infants at birth. Associations between maternal-fetal interaction and clinical outcomes in infancy: Although clinical signs of allergy in infancy were not the main outcome measure of this thesis, there were interesting, yet complex relationships between the production of these maternal cytokines towards the fetus and allergic disease at infant follow-ups. Increased maternal IFN-¿ to fetal alloantigen was associated with asthma at 2.5 years and a trend towards recurrent wheeze at 12 months. In contrast decreased maternal IL-13 production was associated with IgE mediated food allergy at 12 months. Adjusting for maternal allergy and other potential confounders including infant gender, method of delivery, HLA mismatch, and paternal allergy did not account for these relationships. Further follow-ups of these infants are required to determine if these relationship last in to early childhood. In conclusion, the findings of this thesis provides further support for the hypothesis that immune responses at birth are programmed prenatally, and that this programming has implications later in life. Importantly, the placenta is the immunologically active interface between mother and fetus during pregnancy. Therefore it is emphasised that there is a crucial need for future research to focus on early immune programming at the placental level before the aetiological pathways of immune mediated diseases can be fully elucidated.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.