Exercise-induced anaphylaxis (EIA) and food-dependent, exercise-induced anaphylaxis (FDEIA) are rare but potentially life-threatening clinical syndromes in which association with exercise is crucial. The range of triggering physical activities is broad, including as mild an effort as a stroll. EIA is not fully repeatable (ie, the same exercise may not always result in anaphylaxis in a given patient). In FDEIA, the combined ingestion of sensitizing food and exercise is necessary to precipitate symptoms. Clinical features and management do not differ significantly from other types of anaphylaxis. The pathophysiology of EIA and FDEIA is not fully understood. Different hypotheses concerning the possible influence of exercise on the development of anaphylactic symptoms are taken into consideration. These include increased gastrointestinal permeability, blood flow redistribution, and most likely increased osmolality. This article also describes current diagnostic and therapeutic possibilities, including changes in lifestyle and preventive properties of antiallergic drugs as well as acute treatment of these dangerous syndromes.
Alternaria alternata is mainly an outdoor fungus whose spores disseminate in warm, dry air, so in temperate climates, their count peaks in the summers. Alternaria may also be found in damp, insufficiently ventilated houses, where its allergenic properties cocreate the sick building syndrome. Mold-induced respiratory allergies and research on Alternaria both have a lengthy history: the first was described as early as 1698 and the second dates back to 1817. However, the two were only linked in 1930 when Alternaria spores were found to cause allergic asthma. The allergenic extracts from Alternaria hyphae and spores still remain in use but are variable and insufficiently standardized as they are often a random mixture of allergenic ingredients and coincidental impurities. In contrast, contemporary biochemistry and molecular biology make it possible to obtain pure allergen molecules. To date, 16 allergens of A. alternata have been isolated, many of which are enzymes: Alt a 4 (disulfide isomerase), Alt a 6 (enolase), Alt a 8 (mannitol dehydrogenase), Alt a 10 (alcohol dehydrogenase), Alt a 13 (glutathione-S-transferase), and Alt a MnSOD (Mn superoxide dismutase). Others have structural and regulatory functions: Alt a 5 and Alt a 12 comprise the structure of large ribosomal subunits and mediate translation, Alt a 3 is a molecular chaperone, Alt a 7 regulates transcription, Alt a NTF2 facilitates protein import into the nucleus, and Alt a TCTP acts like a cytokine. The function of four allergenic proteins, Alt a 1, Alt a 2, Alt a 9, and Alt a 70 kDa, remains unknown.
The aim of the study was to evaluate the sensitivity and specificity of allergen-induced basophil CD164 upregulation in patients with seasonal allergic rhinitis caused by allergy to grass pollens. This study was performed in 24 patients with allergy to grass pollens, and in 25 healthy controls. The protocol for allergen-induced basophil CD164 upregulation consisted of whole blood samples processing and staining with anti-CCR3/anti-CD164 antibodies added to a buffer at the beginning of stimulation. We observed dose-dependent allergen-induced basophil CD164 upregulation with 100% of specificity in both used allergen concentrations (12 and 1.2 ng/ml). Higher allergen concentration resulted in 100% and lower concentration in only 70.83% sensitivity. We have observed in the patients statistically significant correlations between anti-IgE stimulation and both allergen concentrations (for 12 ng/ml, r = 0.71, p < 0.0001; and for 1.2 ng/ml, r = 0.64, p < 0.001). We conclude that assessment of allergen-induced basophil CD164 upregulation is a very useful method for in vitro determination of allergy to grass pollens. This method seems to be a very promising tool in laboratory testing of allergies to other allergens.
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