Exercise-induced anaphylaxis (EIA) is a rare severe disease in which patients express asthmatic and allergic symptoms. Little is known about EIA and its pathology. This manuscript presents an hypothesis that combined hormonal (estrogen and progesterone) contraceptive use and stress during puberty alter the immune system and predispose the adult female to EIA. Presented here is what is known about asthma, a much more common disease, and a pilot, experimental paradigm in which EIA is induced in Syrian hamsters. Asthmatic and allergic cases are much more prevalent in pubescent and adult females than in adult males. Women express higher levels of lung inflammation at stages of their lives when estrogen and progesterone levels are at their lowest (i.e., the follicular phase of the menstrual cycle and menopause). Combined birth control pills have been utilized by doctors to treat asthmatic women. Contraceptive treatments maintain steady levels of estrogen and progesterone throughout the menstrual cycle. It is hypothesized that if female hamsters are given constant levels of hormones as well as ovalbumin and exercise challenges during puberty and then have the hormones taken away during adulthood, they will produce abnormal lung sounds and corresponding pathological histology. To test this hypothesis, female Syrian hamsters were treated with ovalbumin, exercise challenge, both and none (the control). They were also treated to maintain constant levels of estrogen and progesterone during puberty. Although the results were inconclusive, the model may demonstrate that constant ovarian hormones, ovalbumin sensitization, and exercise challenges permanently strain the immune system of females in adulthood.

Objective: Serious morbidity and mortality following snakebite injuries are common in tropical regions of the world. Although antivenom administration is clinically effective, it carries an important risk of early anaphylactic reactions, ranging from relatively benign nausea, vomiting, and urticaria to life-threatening angioedema, bronchospasm and hypotension. Currently, no adequately powered study has demonstrated significant benefit from the use of any prophylactic drug. A high rate of anaphylactic reactions observed during a trial of three different antivenoms in Ecuador prompted adoption of premedication with intravenous (IV) hydrocortisone and diphenhydramine together with dilution and slower administration of antivenom. Design: In a rural mission hospital in Eastern Ecuador, 53 consecutive snakebite victims received a new antivenom regimen in 2004-2006, comprising prophylactic drugs and IV infusion of diluted antivenom over 60 min. They were compared to an historical control cohort of 76 patients treated in 1997-2002 without prophylactic drugs and with IV "push" injection of undiluted antivenom over 10 min. All these patients had incoagulable blood on admission and all were treated with Brazilian Instituto Butantan polyspecific antivenom. Results: Baseline characteristics of the historical control and premedicated groups were broadly similar. In the historical group, early reaction rates were as follows: 51% of patients had no reaction; 35% had mild reactions; 6% moderate; and 6% severe. In the premedicated/slow IV group, 98% of patients had no reaction; 0 mild; 0 moderate; and 2% severe. The difference in reaction rates was statistically significant (p < 0.001). Conclusions: Premedication with intravenous hydrocortisone and diphenhydramine together with dilution of antivenom and its administration by IV infusion over 60 min appeared to reduce both the frequency and severity of anaphylactic reactions. A randomized blinded controlled trial is needed to confirm these encouraging preliminary findings.

Indiana University-Purdue University Indianapolis (IUPUI) / Follicular T helper (TFH) and regulatory (TFR) cells are two key classes of CD4+ T cells found in germinal centers (GCs). The primary role of TFH cells is to help B cells form GCs to produce high-affinity antibodies during an infection while the role of TFR cells remains controversial. The transcriptional repressor Bcl6 is essential for the differentiation of TFH, TFR and GCB cells and understanding signaling pathways that induce Bcl6 and TFH cell differentiation are important. We observed that Bcl6 is highly up-regulated in activated CD4 T cells following glucose deprivation by a pathway involving the metabolic sensor AMP kinase. The transcription factor Blimp1 represses both TFH cell differentiation and Bcl6 expression, and we show the major role of Blimp1 on TFH cell differentiation is to repress Bcl6 expression and not other genes in the TFH differentiation pathway. We also found Bcl6 positively regulates expression of the key TFH cell receptor PD-1 by inhibiting the repression of PD-1 by the transcription factor Tbet. The roles of TFH and TFR cells in controlling allergen-specific IgE were investigated using a peanut allergy model and strains of mice with alterations in the TFH and TFR pathways. We found TFR cells unexpectedly play an essential role in promoting and maintaining IgE production and anaphylaxis, as well as the GC reaction. Compared to control mice, TFR-deficient mice lacked circulating peanut-specific IgE and anaphylactic responses were significantly weakened. Mechanistically, TFR cells require Blimp1 controlled IL-10 to promote GCB cell survival and IgE production. Blocking IL-10 signals mimicked the loss of IgE levels in TFR-deficient mice and rescued mice from anaphylaxis. Overall, these studies have defined novel roles of Bcl6, TFH and TFR cells in regulating antibody production by the GC reaction, and provide greater understanding of how allergic immune responses are controlled. / 2019-11-21

No description available.

No description available.

Yes / Hymenoptera venom allergy is a potentially life‐threatening allergic reaction following a honeybee, vespid, or ant sting. Systemic‐allergic sting reactions have been reported in up to 7.5% of adults and up to 3.4% of children. They can be mild and restricted to the skin or moderate to severe with a risk of life‐threatening anaphylaxis. Patients should carry an emergency kit containing an adrenaline autoinjector, H1‐antihistamines, and corticosteroids depending on the severity of their previous sting reaction(s). The only treatment to prevent further systemic sting reactions is venom immunotherapy. This guideline has been prepared by the European Academy of Allergy and Clinical Immunology's (EAACI) Taskforce on Venom Immunotherapy as part of the EAACI Guidelines on Allergen Immunotherapy initiative. The guideline aims to provide evidence‐based recommendations for the use of venom immunotherapy, has been informed by a formal systematic review and meta‐analysis and produced using the Appraisal of Guidelines for Research and Evaluation (AGREE II) approach. The process included representation from a range of stakeholders. Venom immunotherapy is indicated in venom‐allergic children and adults to prevent further moderate‐to‐severe systemic sting reactions. Venom immunotherapy is also recommended in adults with only generalized skin reactions as it results in significant improvements in quality of life compared to carrying an adrenaline autoinjector. This guideline aims to give practical advice on performing venom immunotherapy. Key sections cover general considerations before initiating venom immunotherapy, evidence‐based clinical recommendations, risk factors for adverse events and for relapse of systemic sting reaction, and a summary of gaps in the evidence. / European Union's Seventh Framework Programme FP7. Grant Number: 601763

We have investigated the role of the metabotropic glutamate receptor 7 (mGluR7) and the gastrin releasing peptide receptor (Grpr) population that are involved at different levels of itch transmission. We found that mGuR7 deficient mice displayed an anaphylaxis-like behavior when provoked with histamine. Analysis of blood revealed elevated plasma levels of histamine and mouse mast cell protease-1 (mMCP1), two indicators of anaphylaxis, in mGluR7 deficient mice compared with control mice. Inhibition of the neurokinin 1 receptor, by preventing binding of the corresponding ligand substance P (SP), prior to provocation with histamine prevented the development of anaphylaxis in mGluR7 deficient animals. However, blocking GRPR (gastrin releasing peptide receptor) only resulted in decreased itch levels in mGluR7 deficient mice but did not prevent the systemic anaphylaxis-like behavior. Our findings indicate that mGluR7 normally functions as a brake on histaminergic itch that is mediated through GRPR as well as anaphylaxis through Substance P. Grpr has previously been shown to mediate both histaminergic and non-histaminergic itch but little is known about the GRPR neuronal population. We used a BAC cloning strategy to construct a Grpr-Cre line, which we crossed with the reporter lines tdTomato and Viaat-egfp as well as with Vglut2-lox. We could conclude that Grpr-Cre neurons are mainly excitatory interneurons located in lamina II-IV, that convey itch using VGLUT2-mediated glutamatergic transmission to the next, currently unknown, step in the labeled line of chemical itch. To eventually deduce the function of the endogenous opioids dynorphin and enkephalin, which are hypothesized to be involved in gating pain and itch in the spinal cord, we constructed two Cre lines using BAC cloning that targeted the precursor proteins preprodynorphin and preproenkephalin, respectively. Preprodynorphin-Cre neurons were mainly located in lamina II-IV and overlapped to 47% with Vglut2 mRNA, while the co-expression with the inhibitory markers Viaat-egfp and PAX2 was 13% and 28% respectively in the spinal cord. Preproenkephalin neurons were more localized to lamina III in the dorsal horn, furthermore single cell analysis showed that they overlapped to 94% with Vglut2 mRNA while 7% and 13% expressed Viaat-egfp and PAX2 respectively.

Children with life threatening food allergies live with the constant threat of a fatal reaction, and caregivers must always be prepared to treat with an epinephrine auto-injector (EAI). This interpretive phenomenological study explored parents’ perceptions and lived experiences with prescribed EAI use for their child. The purposive sample included 10 parents of five children under 12 years of age, diagnosed with a food allergy and prescribed with an EAI who recently experienced anaphylaxis. Eight main themes emerged: perception of anaphylaxis, life challenges, isolation, anxiety, hesitation, guilt, influence of health care, and lessons learned. Parents described multiple life challenges and feelings of isolation, anxiety and hesitation during a reaction that lead to subsequent guilt. Handling reactions correctly provided parents with confidence to treat subsequent reactions. Witnessing the effects of an EAI and receiving positive feedback from health care providers further strengthened their confidence to quickly and competently intervene in future reactions. / February 2017

Anaphylaxis is a rapid, life-threatening hypersensitivity reaction. Until recently, it was mainly attributed to histamine released by mast cells activated by allergen crosslinking (XL) of FcεRI-bound allergen-specific IgE. However, recent reports established that anaphylaxis could also be triggered by basophil, macrophage and neutrophil secretion of platelet activating factor subsequent to FcγR stimulation by IgG/Ag complexes. I have investigated the contribution of Fyn and Lyn tyrosine kinases to FcγRIIb and FcγRIII signaling in the context of IgG-mediated passive systemic anaphylaxis (PSA). I found that mast cell IgG XL induced Fyn, Lyn, Akt, Erk, p38 and JNK phosphorylation. Additionally, IgG XL of mast cells, basophils and macrophages resulted in Fyn- and Lyn-regulated mediator release in vitro. FcγR–mediated activation was enhanced in Lyn-deficient (KO) cells, but decreased in Fyn KO cells, compared to wild type cells. More importantly, Lyn KO mice displayed significantly exacerbated PSA features while no change was observed for Fyn KO mice, compared to wild type littermates. Intriguingly, this work establishes that mast cells account for the majority of serum histamine in IgG-induced PSA. Taken together, these findings establish pivotal roles for Fyn and Lyn in the regulation of PSA and highlight their unsuspected functions in IgG-mediated pathologies.

A prevalência de alergias vem aumentando no mundo todo, em especial a asma alérgica que é considerada uma síndrome inflamatória pulmonar, que em sua forma clássica está associada ao descontrole da atividade de células T helper (Th) 2. As terapias correntes são em sua maioria sintomáticas. Porém, a imunoterapia específica (SIT, do inglês Specific-Immunotherapy ) é potencialmente curativa. A SIT consiste na adminsitração do alérgeno específico repetidamente em doses crescentes com o objetivo de promover a dessensibilização do paciente. O presente trabalho, utilizando a ovoalbumina (OVA) como alérgeno em modelo de asma alérgica experimental, investigou protocolos profiláticos e terapêuticos de SIT. Durante a realização do protocolo profilático, os animais foram sensibilizados com OVA adsorvida em hidróxido de alumínio (Alum) associada com diferentes agonistas de receptores do tipo toll (TLR, do inglês toll-like receptors ). O agonista de TLR 9 (CpG) foi o mais eficiente em inibir a sensibilização alérgica quando comparado aos demais agonistas de TLR testados. Esta inibição do desenvolvimento da inflamação alérgica pulmonar por CpG foi dependente da molécula IL-10 e da sinalização via MyD88 nas células dendríticas. Além disso, sabendo que a SIT terapêutica, administrada pela via subcutânea é capaz de desencadear uma reação anafilática, encapsulamos a OVA em lipossoma catiônico 1,2-dioleoil-3-trimetilamônio-sulfato (DOTAP) com o intuito de aumentar a segurança da formulação e paralelamente potencializar o efeito do CpG. Os resultados verificaram que o encapsulamento da OVA diminuiu a reação anafilática cutânea e sistêmica induzida por este alérgeno. Verificamos também que a SIT com alérgeno/CpG encapsulados no DOTAP (OVA&#43CpG/DOTAP ou BT&#43CpG/DOTAP) promove uma significativa inibição da inflamação alérgica pulmonar e produção de IgE Total. Essa inibição da alergia pulmonar foi associada com o aumento da produção de IL-10, mas não de IFN-g no lavado bronco-alveolar (BAL). Notavelmente, o efeito terapêutico inibitório de OVA&#43CpG/DOTAP não foi verificado em animais deficientes para as moléculas de MyD88, IL-10 ou IFN-g. Verificamos que a SIT terapêutica também era dependente da sinalização via MyD88 nas células dendríticas. Além disso, ao utilizarmos animais reconstituídos com células de animais doadores alérgicos, verificamos que o efeito terapêutico da SIT não foi encontrado em animais reconstituídos com células de animais IFN-gKO, e que animais reconstituídos com células de animais IL-10KO apresentavam aumento de IL-10 no BAL. A transferência de células de medula óssea de animais C57BL/6 (WT), mas não de animais IFN-gKO, tratados com OVA&#43CpG/DOTAP foi capaz de reverter o quadro inflamatório alérgico de animais WT e induzir o aumento de IL-10 no BAL. Esses resultados contribuem para a elucidação dos mecânismos envolvidos na ação anti-inflamatória da SIT e potenciais utilizações do CpG e DOTAP em processos alérgicos. / The prevalence of allergies is increasing worldwide, especially allergic asthma that is considere a pulmonary inflammatory syndrome, which in its classic form is associated with the lack of control of T helper cell (Th) 2 activity. Current therapies are mostly symptomatic. However, specific immunotherapy (SIT) is potentially curative. SIT consists of administering the specific allergen repeatedly in increasing doses in order to promote patient desensitization. The present study, using ovalbumin (OVA) as an allergen in an experimental allergic asthma model, investigated prophylactic and therapeutic SIT protocols. During the prophylactic protocol, the animals were sensitized with OVA adsorbed on aluminum hydroxide (Alum) associated with different toll-like receptors (TLR) agonists. The TLR 9 agonist (CpG) was the most efficient in inhibiting allergic sensitization when compared to the other TLR agonists tested. This inhibition mediated by CpG of the development of the allergic lung inflammation was dependent on the IL-10 molecule and the MyD88 signaling in dendritic cells. In addition, knowing that the therapeutic SIT, administered by the subcutaneous route is capable of triggering an anaphylactic reaction, we encapsulated OVA in 1,2-dioleoyl-3-trimethylammonium sulphate (DOTAP), a cationic liposome, in order to increase the safety of the formulation and in parallel potentiate the effect of CpG. The results showed that OVA encapsulation reduced the cutaneous and systemic anaphylactic reaction induced by this allergen. We also verified that SIT with the allergen and CpG encapsulated in DOTAP (OVA&#43 CpG/DOTAP or BT&#43CpG/DOTAP) promotes a significant inhibition of lung allergic inflammation and Total IgE production. This inhibition of lung inflammation was associated with increased production of IL-10 but not of IFN-g in the bronchoalveolar lavage (BAL). Notably, the inhibitory therapeutic effect of OVA&#43CpG/DOTAP was abrogate in animals deficient in the MyD88 or IL-10 or IFN-g molecules. We found that therapeutic SIT was also dependent on MyD88 signaling on dendritic cells. In addition, when we used animals reconstituted with cells from allergic donor animals, we found that the therapeutic effect of SIT was not found in animals reconstituted with cells from IFN-gKO animals, and that animals reconstituted with IL-10KO animal cells had increased IL -10 in the BAL. The transfer of bone marrow cells from C57BL/6 (WT) animals but not from IFN-gKO animals treated with OVA&#43CpG/DOTAP was able to reverse the lung allergic inflammation of WT animals and induce the increase of IL-10 in the BAL. These results contribute to the elucidation of the mechanisms involved in the anti-inflammatory effect of the SIT and potential uses of CpG and DOTAP in allergic processes.