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A cross sectional study on assessing the knowledge, attitude and perception towards allergic reactions of paracetamol in Malaysia

Dellemin NA, Zahari Z, Ahmad Hassali MA, Rashid SA

Pak J Pharm Sci, 2020 May;33(3):1057-1061.
PMID: 33191229

Recent years, the prevalence of paracetamol allergy becomes great concerns. However, data on knowledge, attitude and perception towards allergic reactions of paracetamol are lacking. This study aimed to investigate knowledge, attitude, and perception towards allergic reactions of paracetamol (KAP-ARP). A cross-sectional survey was conducted using a validated self-administered questionnaire around Pasar Siti Khadijah, Kelantan from February 2016 to January 2017 among the general population. A total of 177 respondents participated in this study. The mean percentage scores for knowledge, attitude and perception towards allergic reactions of paracetamol were 31.7% (SD 23.6), 53.1% (SD 19.2) and 53.3% (SD 23.9), respectively. This study revealed that respondents demonstrated a poor level of knowledge, a fair level of attitude and negative perception towards allergic reactions of paracetamol. These results may lay a basis for conducting a study of knowledge, attitude and perception towards allergic reactions among general population in other different setting or around Malaysia.

Matched MeSH terms: Drug Hypersensitivity/etiology*
Fulltext Identification of tropomyosin and arginine kinase as major allergens of Portunus pelagicus (blue swimming crab)

Rosmilah M, Shahnaz M, Zailatul HM, Noormalin A, Normilah I

Trop Biomed, 2012 Sep;29(3):467-78.
PMID: 23018510

Crab is an important source of food allergen. Tropomyosin represents the main crab allergen and is responsible for IgE cross-reactivity between various species of crustaceans. Recently, other new crab allergens including arginine kinase have been identified. However, information on allergens of the local Portunidcrab is not available. Thus, the aim of this study was to identify the major allergens of Portunus pelagicus (blue swimming crab) using the allergenomics approach. Raw and cooked extracts of the crab were prepared from the crab meat. Protein profile and IgE binding pattern were demonstrated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting using sera from 30 patients with crab allergy. The major allergens of the crab were then identified by two-dimensional electrophoresis (2-DE), followed by mass spectrometry analysis of the peptide digests. The SDS-PAGE of raw extract revealed approximately 20 protein fractions over a wide molecular weight range, while cooked extract demonstrated fewer protein bands. The raw extract also demonstrated a higher number of IgE reactive bands than the cooked extract. A heat-resistant protein of 36 kDa has been identified as the major allergen in both raw and cooked extracts. In addition, a heat-sensitive protein of 41 kDa was also recognized as a major allergen in raw crab. The 2-DE gel profile of the raw extract demonstrated about >100 distinct proteins spots and immunoblotting of the 2-DE profile demonstrated at least 12 different major IgE reactive spots with molecular masses between 13 to 250 kDa and isoelectric point (pI) values ranging from 4.0 to 7.0. The 36 and 41 kDa proteins were identified as the crab tropomyosin and arginine kinase, respectively by mass spectrometry. Therefore, this study confirmed that tropomyosin and arginine kinase are the major allergens of the local Portunid crab, P. pelagicus.

Matched MeSH terms: Food Hypersensitivity/immunology*
Fulltext Early gut colonization by Bifidobacterium breve and B. catenulatum differentially modulates eczema risk in children at high risk of developing allergic disease

Ismail IH, Boyle RJ, Licciardi PV, Oppedisano F, Lahtinen S, Robins-Browne RM, et al.

Pediatr Allergy Immunol, 2016 12;27(8):838-846.
PMID: 27590263 DOI: 10.1111/pai.12646

BACKGROUND: An altered compositional signature and reduced diversity of early gut microbiota are linked to development of allergic disease. We investigated the relationship between dominant Bifidobacterium species during the early post-natal period and subsequent development of allergic disease in the first year of life.
METHODS: Faecal samples were collected at age 1 week, 1 month and 3 months from 117 infants at high risk of allergic disease. Bifidobacterium species were analysed by quantitative PCR and terminal restriction fragment length polymorphism. Infants were examined at 3, 6 and 12 months, and skin prick test was performed at 12 months. Eczema was diagnosed according to the UK Working Party criteria.
RESULTS: The presence of B. catenulatum at 3 months was associated with a higher risk of developing eczema (ORadj = 4.5; 95% CI: 1.56-13.05, padj = 0.005). Infants colonized with B. breve at 1 week (ORadj = 0.29; 95% CI: 0.09-0.95, padj = 0.04) and 3 months (ORadj = 0.15; 95% CI: 0.05-0.44, padj = 0.00001) had a reduced risk of developing eczema. Furthermore, the presence of B. breve at 3 months was associated with a lower risk of atopic sensitization at 12 months (ORadj = 0.38; 95% CI: 0.15-0.98, padj = 0.05). B. breve colonization patterns were influenced by maternal allergic status, household pets and number of siblings.
CONCLUSIONS: Temporal variations in Bifidobacterium colonization patterns early in life are associated with later development of eczema and/or atopic sensitization in infants at high risk of allergic disease. Modulation of the early microbiota may provide a means to prevent eczema in high-risk infants.

Matched MeSH terms: Hypersensitivity/epidemiology*
Fulltext Risk of eczema, wheezing and respiratory tract infections in the first year of life: A systematic review of vitamin D concentrations during pregnancy and at birth

Mustapa Kamal Basha MA, Majid HA, Razali N, Yahya A

PLoS One, 2020;15(6):e0233890.
PMID: 32542014 DOI: 10.1371/journal.pone.0233890

BACKGROUND: Allergic conditions and respiratory tract infections (RTIs) are common causes of morbidity and mortality in childhood. The relationship between vitamin D status in pregnancy (mothers), early life (infants) and health outcomes such as allergies and RTIs in infancy is unclear. To date, studies have shown conflicting results.
OBJECTIVE: This systematic review aims to gather and appraise existing evidence on the associations between serum vitamin D concentrations during pregnancy and at birth and the development of eczema, wheezing, and RTIs in infants.
DATA SOURCES: PubMed, MEDLINE, ProQuest, Scopus, CINAHL, Cochrane Library and Academic Search Premier databases were searched systematically using specified search terms and keywords.
STUDY SELECTION: Articles on the associations between serum vitamin D concentrations during pregnancy and at birth and eczema, wheezing, and RTIs among infants (1-year-old and younger) published up to 31 March 2019 were identified, screened and retrieved.
RESULTS: From the initial 2678 articles screened, ten met the inclusion criteria and were included in the final analysis. There were mixed and conflicting results with regards to the relationship between maternal and cord blood vitamin D concentrations and the three health outcomes-eczema, wheezing and RTIs-in infants.
CONCLUSION: Current findings revealed no robust and consistent associations between vitamin D status in early life and the risk of developing eczema, wheezing and RTIs in infants. PROSPERO registration no. CRD42018093039.

Matched MeSH terms: Hypersensitivity/epidemiology*
Immunochemical characterization of edible bird's nest allergens

Goh DL, Chua KY, Chew FT, Liang RC, Seow TK, Ou KL, et al.

J Allergy Clin Immunol, 2001 Jun;107(6):1082-7.
PMID: 11398089

BACKGROUND: We have previously described anaphylaxis induced by edible bird's nest (BN) and demonstrated that this condition is IgE mediated.
OBJECTIVES: This study aimed at describing the immunochemical properties of the BN allergens. Comparative studies between 3 commercially available sources (according to the country of origin) of BN were also made.
METHODS: Crude extracts of commercially available processed BN from Sarawak (Malaysia), Thailand, and Indonesia and fresh unprocessed BN from the caves of Sarawak were obtained by means of aqueous extraction. Specific IgE toward these sources were determined by using fluorescence allergosorbent tests (FASTs). Cross-reactivity studies between the 3 sources of commercially available processed BN were carried out by means of FAST inhibition. Immunochemical characterization by means of IgE immunoblot, periodate treatment, and heat stability studies were carried out on fresh unprocessed BN from Sarawak.
RESULTS: Serum from allergic patients showed differences in IgE binding to the 3 sources of commercially available BN, with the highest levels of specific IgE recorded with the Sarawak source (P

Matched MeSH terms: Food Hypersensitivity/etiology*
Red man syndrome during administration of prophylactic antibiotic against infective endocarditis

Ngeow WC, Chai WL, Moody AB

J Ir Dent Assoc, 2000;46(3):92-4.
PMID: 11323942

Red man syndrome (RMS) is the occurrence flushing, pruritus, chest pain, muscle spasm or hypotension during vancomycin infusion. It usually happens as a result of rapid infusion of the drug but may also occur after slow administration. The frequency and severity of this phenomenon diminish with repeated administration of vancomycin. A case is presented whereby RMS occurred while prophylactic antibiotic against infective endocarditis was administered.

Matched MeSH terms: Drug Hypersensitivity/etiology*
The effects of exclusion of dietary egg and milk in the management of asthmatic children: a pilot study

Yusoff NA, Hampton SM, Dickerson JW, Morgan JB

J R Soc Promot Health, 2004 Mar;124(2):74-80.
PMID: 15067979 DOI: 10.1177/146642400412400211

Current understanding of the use of exclusion diets in the management of asthma in children is limited and controversial. The aim of this study was to examine the effects of excluding eggs and milk on the occurrence of symptoms in children with asthma and involved 22 children aged between three and 14 years clinically diagnosed as having mild to moderate disease. The investigation was single blind and prospective, and parents were given the option of volunteering to join the 'experiment' group, avoiding eggs, milk and their products for eight weeks, or the 'control' group, who consumed their customary food. Thirteen children were recruited to the experimental group and nine to the control group. A trained paediatrician at the beginning and end of the study period assessed the children. A seven-day assessment of food intake was made before, during and immediately after the period of dietary intervention in both groups. A blood sample was taken from each child for determination of food specific antibodies and in those children who could do so, the peak expiratory flow rate (PEFR) was measured. Based on the recommended nutrient intake (RNI), the mean percentage energy intake of the children in the experimental group was significantly lower (p < 0.05) in the experimental group. After the eight-week study period and compared with baseline values, the mean serum anti-ovalbumin IgG and anti-beta lactoglobulin IgG concentrations were statistically significantly reduced (p < 0.05) for both in the experimental group. In contrast, the values for anti-ovalbumin IgG in the control group were significantly increased and those for anti-beta lactoglobulin IgG were practically unchanged. The total IgE values were unchanged in both groups. Over the study period, the PEFR in those children in the experimental group able to perform the test was significantly increased, but no such change was noted in the children in the control group who could do the test. These results suggest that even over the short time period of eight weeks, an egg- and milk-free diet can reduce atopic symptoms and improve lung function in asthmatic children.
Study site: Outpatient Department, Royal County Hospital and the Frimley Children’s Centre, United Kingdom

Matched MeSH terms: Milk Hypersensitivity/prevention & control
Characterization of glutathione S-transferase from dust mite, Der p 8 and its immunoglobulin E cross-reactivity with cockroach glutathione S-transferase

Huang CH, Liew LM, Mah KW, Kuo IC, Lee BW, Chua KY

Clin Exp Allergy, 2006 Mar;36(3):369-76.
PMID: 16499649

Sensitization to mite and cockroach allergens is common, and diagnosis and therapy of allergy can be further complicated by the presence of allergen isoforms and panallergens. Purified recombinant and native allergens are useful for studies to resolve such problems.

Matched MeSH terms: Hypersensitivity/immunology
Molecular cloning and immunoglobulin E reactivity of a natural rubber latex lecithinase homologue, the major allergenic component of Hev b 4

Sunderasan E, Bahari A, Arif SA, Zainal Z, Hamilton RG, Yeang HY

Clin Exp Allergy, 2005 Nov;35(11):1490-5.
PMID: 16297147 DOI: 10.1111/j.1365-2222.2005.02371.x

BACKGROUND:
Hev b 4 is an allergenic natural rubber latex (NRL) protein complex that is reactive in skin prick tests and in vitro immunoassays. On SDS-polyacrylamide gel electrophoresis (SDS-PAGE), Hev b 4 is discerned predominantly at 53-55 kDa together with a 57 kDa minor component previously identified as a cyanogenic glucosidase. Of the 13 NRL allergens recognized by the International Union of Immunological Societies, the 53-55 kDa Hev b 4 major protein is the only candidate that lacks complete cDNA and protein sequence information.

OBJECTIVE:
We sought to clone the transcript encoding the Hev b 4 major protein, and characterize the native protein and its recombinant form in relation to IgE binding.

METHODS:
The 5'/3' rapid amplification of cDNA ends method was employed to obtain the complete cDNA of the Hev b 4 major protein. A recombinant form of the protein was over-expressed in Escherichia coli. The native Hev b 4 major protein was deglycosylated by trifluoromethane sulphonic acid. Western immunoblots of the native, deglycosylated and recombinant proteins were performed using both polyclonal antibodies and sera from latex-allergic patients.

RESULTS:
The cDNA encoding the Hev b 4 major protein was cloned. Its open reading frame matched lecithinases in the conserved domain database and contained 10 predicted glycosylation sites. Detection of glycans on the Hev b 4 lecithinase homologue confirmed it to be a glycoprotein. The deglycosylated lecithinase homologue was discerned at 40 kDa on SDS-PAGE, this being comparable to the 38.53 kDa mass predicted by its cDNA. Deglycosylation of the lecithinase homologue resulted in the loss of IgE recognition, although reactivity to polyclonal rabbit anti-Hev b 4 was retained. IgE from latex-allergic patients also failed to recognize the non-glycosylated E. coli recombinant lecithinase homologue.

CONCLUSION:
The IgE epitopes of the Hev b 4 lecithinase homologue reside mainly in its carbohydrate moiety, which also account for the discrepancy between the observed molecular weight of the protein and the value calculated from its cDNA.

Matched MeSH terms: Drug Hypersensitivity/immunology
Fulltext Cholecystokinin hyperresponsiveness in functional dyspepsia

Chua AS, Keeling PW

World J Gastroenterol, 2006 May 07;12(17):2688-93.
PMID: 16718754 DOI: 10.3748/wjg.v12.i17.2688

Functional dyspepsia (FD) is a common disorder of yet uncertain etiology. Dyspeptic symptoms are usually meal related and suggest an association to gastrointestinal (GI) sensorimotor dysfunction. Cholecystokinin (CCK) is an established brain-gut peptide that plays an important regulatory role in gastrointestinal function. It inhibits gastric motility and emptying via a capsaicin sensitive vagal pathway. The effects on emptying are via its action on the proximal stomach and pylorus. CCK is also involved in the regulation of food intake. It is released in the gut in response to a meal and acts via vagal afferents to induce satiety. Furthermore CCK has also been shown to be involved in the pathogenesis of panic disorder, anxiety and pain. Other neurotransmitters such as serotonin and noradrenaline may be implicated with CCK in the coordination of GI activity. In addition, intravenous administration of CCK has been observed to reproduce the symptoms in FD and this effect can be blocked both by atropine and loxiglumide (CCK-A antagonist). It is possible that an altered response to CCK may be responsible for the commonly observed gastric sensorimotor dysfunction, which may then be associated with the genesis of dyspeptic symptoms.

Matched MeSH terms: Food Hypersensitivity/physiopathology
The role of macrophages in the induction of murine immune response to Actinobacillus actinomycetemcomitans

Sosroseno W, Herminajeng E

J Med Microbiol, 2002 Jul;51(7):581-8.
PMID: 12132775

The aim of this study was to determine the role of macrophages in the Actinobacillus actinomycetemcomitans-induced murine immune response. BALB/c mice were given carrageenan solution by intraperitoneal injection before immunisation with heat-killed A. actinomycetemcomitans. Mice immunised with antigens and phosphate-buffered saline served as positive and negative controls, respectively. One week after the last immunisation, the delayed-type hypersensitivity (DTH) response was assessed by measurement of footpad swelling. Serum IgG and IgM anti-A. actinomycetemcomitans antibody levels and culture supernate levels of interferon (IFN)-gamma were determined by ELISA. The diameter of abscess formation was determined every 5 days. Sham-immunised spleen cells were transferred to carrageenan-untreated recipients (groups A and B) and to carrageenan-treated recipients (group D). Antigen-immunised spleen cells were transferred to carrageenan-untreated (group C) and carrageenan-treated (group E) recipients. The carrageenan-treated recipients in groups F and G received macrophages from antigen- and sham-immunised mice respectively. All mice except those in group A were immunised with antigen 24 h after cell transfer. After 1 week, a partial suppression of DTH response, reduced levels of IFN-gamma, serum IgG and IgM anti-A. actinomycetemcomitans antibodies and delayed healing were seen in carrageenan-treated mice when compared with the positive control. The immune response to A. actinomycetemcomitans in groups A, B and D was lower than that in groups C and E. Healing of the lesion in the former groups was also delayed when compared with the latter groups. The immune response and the healing of the lesion could be partially restored in carrageenan-treated mice that received antigen-pulsed macrophages (group F) but not in those that received naive macrophages (group G). These results suggest that macrophages play a partial role in the induction of the murine immune response to A. actinomycetemcomitans.

Matched MeSH terms: Hypersensitivity, Delayed/immunology
Fulltext Malaysian cockle (Anadara granosa) allergy: Identification of IgE-binding proteins and effects of different cooking methods

Zailatul HM, Rosmilah M, Faizal B, Noormalin A, Shahnaz M

Trop Biomed, 2015 Jun;32(2):323-34.
PMID: 26691261 MyJurnal

The purpose of this study was to evaluate the effect of different cooking methods on the allergenicity of cockle and to identify proteins most frequently bound by IgE antibodies using a proteomics approach. Raw, boiled, fried and roasted extracts of the cockle were prepared. The protein profiles of the extracts were obtained by separation using sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and 2-dimensional gel electrophoresis (2-DE). IgE-immunoblotting was then performed with the use of individual sera from patients with cockle allergy and the major IgE-binding proteins were analyzed by mass-spectrometry. SDS-PAGE of raw extract showed 13 protein bands. Smaller numbers of protein bands were detected in the boiled, fried and roasted extracts. The 2-DE gel profile of the raw extract further separated the protein bands to ~50 protein spots with molecular masses between 13 to 180 kDa and isoelectric point (pI) values ranging from 3 to 10. Immunoblotting of raw extract exhibited 11 IgE-binding proteins with two proteins of 36 and 40 kDa as the major IgE-binding proteins, while the boiled extract revealed 3 IgE-binding proteins. Fried and roasted extracts only showed a single IgE-binding protein at 36 kDa. 2-DE immunoblotting of raw extract demonstrated 5 to 20 IgE reactive spots. Mass spectrometry analysis led to identification of 2 important allergens, tropomyosin (36 kDa) and arginine kinase (40 kDa). Heated extracts showed a reduction in the number of IgE-reactive bands compared with raw extract, which suggest that thermal treatment can be used as a tool in attempting to reduce cockle allergenicity. The degree of allergenicity of cockle was demonstrated in the order raw > boiled > fried ≈ roasted. Two important allergens reacting with more than 50% of patients' sera identified using mass spectrometric approaches were tropomyosin and arginine kinase. Thus, allergens found in this study would help in component based diagnosis, management of cockle allergic patients and to the standardisation of allergenic test products as tools in molecular allergology.

Matched MeSH terms: Food Hypersensitivity*
Whole genome sequencing identifies genetic variants associated with co-trimoxazole hypersensitivity in Asians

Wang CW, Tassaneeyakul W, Chen CB, Chen WT, Teng YC, Huang CY, et al.

J Allergy Clin Immunol, 2021 04;147(4):1402-1412.
PMID: 32791162 DOI: 10.1016/j.jaci.2020.08.003

BACKGROUND: Co-trimoxazole, a sulfonamide antibiotic, is used to treat a variety of infections worldwide, and it remains a common first-line medicine for prophylaxis against Pneumocystis jiroveci pneumonia. However, it can cause severe cutaneous adverse reaction (SCAR), including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. The pathomechanism of co-trimoxazole-induced SCAR remains unclear.
OBJECTIVE: We aimed to investigate the genetic predisposition of co-trimoxazole-induced SCAR.
METHODS: We conducted a multicountry case-control association study that included 151 patients with of co-trimoxazole-induced SCAR and 4631 population controls from Taiwan, Thailand, and Malaysia, as well as 138 tolerant controls from Taiwan. Whole-genome sequencing was performed for the patients and population controls from Taiwan; it further validated the results from Thailand and Malaysia.
RESULTS: The whole-genome sequencing study (43 case patients vs 507 controls) discovered that the single-nucleotide polymorphism rs41554616, which is located between the HLA-B and MICA loci, had the strongest association with co-trimoxazole-induced SCAR (P = 8.2 × 10-9; odds ratio [OR] = 7.7). There were weak associations of variants in co-trimoxazole-related metabolizing enzymes (CYP2D6, GSTP1, GCLC, N-acetyltransferase [NAT2], and CYP2C8). A replication study using HLA genotyping revealed that HLA-B∗13:01 was strongly associated with co-trimoxazole-induced SCAR (the combined sample comprised 91 case patients vs 2545 controls [P = 7.2 × 10-21; OR = 8.7]). A strong HLA association was also observed in the case patients from Thailand (P = 3.2 × 10-5; OR = 3.6) and Malaysia (P = .002; OR = 12.8), respectively. A meta-analysis and phenotype stratification study further indicated a strong association between HLA-B∗13:01 and co-trimoxazole-induced drug reaction with eosinophilia and systemic symptoms (P = 4.2 × 10-23; OR = 40.1).
CONCLUSION: This study identified HLA-B∗13:01 as an important genetic factor associated with co-trimoxazole-induced SCAR in Asians.

Matched MeSH terms: Drug Hypersensitivity/genetics*
Andrographolide prevented toluene diisocyanate-induced occupational asthma and aberrant airway E-cadherin distribution via p38 MAPK-dependent Nrf2 induction

Sulaiman I, Tan K, Mohtarrudin N, Lim JCW, Stanslas J

Pulm Pharmacol Ther, 2018 12;53:39-51.
PMID: 30244166 DOI: 10.1016/j.pupt.2018.09.008

Toluene diisocyanate (TDI) is a major cause of chemical-induced occupational asthma, which contributes about 15% of global asthma burden. Resistance and compounded side effects associated with the use of corticosteroid in asthma necessitate the search for alternative drugs. Andrographolide (AGP), a naturally occurring diterpene lactone is known to exhibit various bioactivities. Its ability to ameliorate cardinal features of allergic asthma was previously suggested in an eosinophilic asthma endotype. However, its potential antiasthma activity and mechanism of action in a neutrophilic occupational asthma model, as well as its effect on epithelial dysfunction remain unknown. BALB/c mice were dermally sensitised with 0.3% TDI or acetone olive oil (AOO) vehicle on day 1 and 8, followed by 0.1% TDI intranasal challenge on days 15, 18 and 21. Endpoints were evaluated via bronchoalveolar lavage fluid (BALF) cell analysis, 2',7'-dichlorofluorescein diacetate (DCFDA) assays, immunoblotting, immunohistochemistry and methacholine challenge test. Decreases in total and differential leukocyte counts of BALF were recorded in AGP-treated animals. The compound dose-dependently reduced intracellular de-esterification of DCFDA, thus suggesting AGP's potential to inhibit intracellular reactive oxygen species (ROS). Mechanistically, the treatment prevented TDI-induced aberrant E-cadherin distribution and restored airway epithelial β-catenin at cell to cell contact site. Furthermore, AGP ameliorated TDI induced pulmonary collagen deposition. In addition, the treatment significantly upregulated pulmonary HO-1, Nrf2 and phospho-p38 levels. Airway hyperresponsiveness was markedly suppressed among AGP-treated animals. Collectively, these findings suggest AGP's protective function against TDI-induced airway epithelial barrier dysfunction and oxidative lung damage possibly through the upregulation of adherence junction proteins and the activation of p38/Nrf2 signalling. This study elucidates the therapeutic potential of AGP in the control and management of chemical-induced allergic asthma. To the best of our knowledge, the potential anti-asthma activity of AGP in TDI-induced occupational asthma has not been reported previously.

Matched MeSH terms: Respiratory Hypersensitivity/prevention & control
Fulltext Lignosus rhinocerotis Cooke Ryvarden ameliorates airway inflammation, mucus hypersecretion and airway hyperresponsiveness in a murine model of asthma

Johnathan M, Muhamad SA, Gan SH, Stanslas J, Mohd Fuad WE, Hussain FA, et al.

PLoS One, 2021;16(3):e0249091.
PMID: 33784348 DOI: 10.1371/journal.pone.0249091

Lignosus rhinocerotis Cooke. (L. rhinocerotis) is a medicinal mushroom traditionally used in the treatment of asthma and several other diseases by the indigenous communities in Malaysia. In this study, the effects of L. rhinocerotis on allergic airway inflammation and hyperresponsiveness were investigated. L. rhinocerotis extract (LRE) was prepared by hot water extraction using soxhlet. Airway hyperresponsiveness (AHR) study was performed in house dust mite (HDM)-induced asthma in Balb/c mice while airway inflammation study was performed in ovalbumin (OVA)-induced asthma in Sprague-Dawley rats. Treatment with different doses of LRE (125, 250 and 500 mg/kg) significantly inhibited AHR in HDM-induced mice. Treatment with LRE also significantly decreased the elevated IgE in serum, Th2 cytokines in bronchoalveolar lavage fluid and ameliorated OVA-induced histological changes in rats by attenuating leukocyte infiltration, mucus hypersecretion and goblet cell hyperplasia in the lungs. LRE also significantly reduced the number of eosinophils and neutrophils in BALF. Interestingly, a significant reduction of the FOXP3+ regulatory T lymphocytes was observed following OVA induction, but the cells were significantly elevated with LRE treatment. Subsequent analyses on gene expression revealed regulation of several important genes i.e. IL17A, ADAM33, CCL5, IL4, CCR3, CCR8, PMCH, CCL22, IFNG, CCL17, CCR4, PRG2, FCER1A, CLCA1, CHIA and Cma1 which were up-regulated following OVA induction but down-regulated following treatment with LRE. In conclusion, LRE alleviates allergy airway inflammation and hyperresponsiveness, thus suggesting its therapeutic potential as a new armamentarium against allergic asthma.

Matched MeSH terms: Respiratory Hypersensitivity/drug therapy
Fulltext Immunomodulatory effect of papaya, mata kucing, dang shen and pu-erh tea on cytokines profile

Nur Ramziahrazanah Jumat, Pei Shin Chai, Chiew Yee Loh, Sharmili Vidyadaran, Zainina Seman

Malaysian Journal of Medicine and Health Sciences, 2019;15(108):21-21.
MyJurnal

Introduction: Immune response against viral infections and tumors not only requires the recruitment of immune cells but also cytokines. Cytokine dysregulation is associated with inflammatory diseases such as cancer, autoimmune diseases, infections and allergy. Intake of fruit and vegetables are known not only to reduce inflammation but may also provide protection against various diseases. Methods: Effects of selected fruits and herbs on cytokines profile of IL-8, IL-1β, IL-6, IL-10, TNF and IL-12p70 were examined using the CBA flow cytometric assay. Peripheral blood mononuclear cells (PBMC) obtained from blood samples of twelve healthy subjects aged 20 to 30 years [males = 6 and females = 6] were treated with papaya, mata kucing, dang shen and pu-erh tea, respectively, for 6 and 48 hours at various concentrations. In vivo effects was further tested on healthy volunteers [males = 2, females = 4] by 2-days consumption of papaya following 2-days washout period without papaya. The diet of volunteers was controlled with fixed meals. Results:In vitro results after 6 hours of culture showed that papaya-treated PBMC significantly increased IL-8, IL-1β and IL-6 but reduced IL-10. Mata kucing-treated PBMC significantly increased IL-8 but reduced IL-6 while pu-erh tea significantly reduced IL-8, IL-1β, IL-6 and TNF. Cytokine analysis for dang shen-treated PBMC was only conducted at 48 hours. After 48 hours, papaya extract significantly reduced IL-8, IL-6 (8000 μg/ml), IL-10 and TNF. Significant increase of IL-6 was observed at 4000 and 16000 μg/ml. Mata kucing extract significantly increased IL-1β, IL-6 but reduced TNF. Significant increase of TNF was observed at 16000 μg/ml. Dang shen and pu-erh tea reduced IL-8, IL-1β, IL-6, IL-10 and TNF. However, in vivo papaya consumption did not show any significant changes and levels were low. Conclusion: This study showed fruits such as papaya and mata kucing had both stimulatory and inhibitory effect on various pro-inflammatory cytokines while effect of herbs such as dang shen and pu-erh tea were inhibitory. Immunomodulatory studies of natural food such as fruits and herbs may provide better understanding and subsequently improve management of inflammatory diseases.

Matched MeSH terms: Hypersensitivity
Prevalence of Atopic Dermatitis and Pattern of Drug Therapy in Malaysian Children

Goh YY, Keshavarzi F, Chew YL

Dermatitis, 2018 5 16;29(3):151-161.
PMID: 29762208 DOI: 10.1097/DER.0000000000000376

BACKGROUND: Atopic dermatitis (AD) is a chronic relapsing, noncontagious skin inflammation characterized by dry skin and itch. Mutation in filaggrin gene leads to defective skin barrier, allowing entry of allergen and eliciting immunological response.
OBJECTIVES: The aims of this study were to investigate the prevalence of AD in Malaysian children and to understand the pattern of drug therapy. Such information could be useful to establish the relationship between ethnicity and family history of atopy and the development of associated signs and symptoms.
METHODS: A cross-sectional survey was conducted among children attending kindergartens and nurseries. Standardized questionnaires were filled out by parents.
RESULTS: Overall prevalence of AD was 13.4%. Of 384 participants recruited, the highest prevalence was observed in males, Malays, participants younger than 2 years, and those with atopic background such as asthma, hay fever, and family history of atopic diseases. Calamine and white soft paraffin were the preferred choice of nonprescription drugs, whereas topical hydrocortisone seemed to be the preferred choice of prescription drug in the management of AD.
CONCLUSIONS: The overall prevalence is comparable to that reported in the International Study of Asthma and Allergies in Childhood Phase One. There is an association between ethnicity and AD prevalence. Topical corticosteroids and emollients are the mainstay of AD management among Malaysians.

Matched MeSH terms: Hypersensitivity
Clinical experience in using CD20 monoclonal antibody in treating severe systemic lupus erythematosus

Mohd Shahrir MS, Abdul Halim AG, Soehardy Z, Kong NCT

APLAR Journal of Rheumatology, 2007;10(2):112-116.
DOI: 10.1111/j.1479-8077.2007.00270.x

Background and method: This clinical experience involved the treatment of resistant systemic lupus erythematosus (SLE) patients with CD20 monoclonal antibody. Five patients failed conventional therapy, two developed complications and one needed rituximab as an emergency measure. Four patients had lupus nephritis, three had autoimmune hemolytic anemia, two had immune thrombocytopenia and one had lupoid hepatitis. The patients were aged 14-49 years, (mean 28.63). Three were Malays, two Chinese, two Indian and one Turkish; six were females. Mean disease duration was 63.25 months and mean total rituximab dose received was 2812.50 mL. Results: Hemoglobin levels improved from 9.3 ± 5.7 to 13.1 ± 8.6 g/dL for two SLE patients with autoimmune hemolytic anemia after 34 weeks (P = 0.180). Platelet counts improved from 25 ± 17 to 198 ± 97 × 10 9/high powered field from 0 to 10 weeks for three SLE patients with immune thrombocytopenia (P = 0.109). In the lupus nephritis patients on rituximab, serum albumin improved from 24.5 ± 23.2 to 37.5 ± 31.8 mmol/L (n = 3) from week 0 to week 17 (P = 0.100). Urine protein creatinine ratio improved from 0.55 ± 0.23 to 0.08 ± 0.03 g/mmol creatinine (P = 0.068) from week 0 to week 13. C3 and C4 improved from 90.8 ± 36.5 to 120.7 ± 37.9 (P = 0.07) and 21.6 ± 10.1-27.3 ± 16.2 mg/dL (P = 0.27), respectively, and Systemic Lupus Erythematosus Activity Disease Index was reduced from 17.9 ± 11.2 to 6.3 ± 6.8 (P = 0.375) after 8 weeks. Two patients developed drug reactions to rituximab. Conclusion: All of the patients responded to rituximab on top of their conventional therapy. © 2007 Asia Pacific League of Associations for Rheumatology and Blackwell Publishing Asia Pty Ltd.

Matched MeSH terms: Drug Hypersensitivity
Fulltext Seasonal quality variation and environmental risks associated with the consumption of surface water: implication from the Landzun Stream, Bida Nigeria

Daramola J, M Ekhwan T, Adepehin EJ, Mokhtar J, Lam KC, Er AC

Heliyon, 2019 Jul;5(7):e02121.
PMID: 31384682 DOI: 10.1016/j.heliyon.2019.e02121

Water constitutes a major environmental and public health concerns worldwide. A large proportion of global water consumption is sourced from surface water. The dependency level on surface water is higher in developing countries, especially in rural-to-semi-urban areas, where subsurface water is not accessible. Presented in this paper is a spatiotemporal and hydrochemical quality assessment of the spring-originated Landzun Stream in Bida, Nigeria; which is usually consumed in its untreated state. Water samples were systematically collected in eighteen locations along the stream channel in both rainy and dry seasons at an equidistance interval of 500m. On-site and laboratory measurement of important physical and hydrochemical parameters were carried out using standard procedures. Water temperature in the rainy season (34-37 °C) slightly exceeds measured values in the dry season (29-33 °C). 72.22% (rainy) and 83.33% (dry) of collected samples did not meet the odourless requirement for drinking water. Similarly, estimated percentages of 66.67 and 94.44 of collected samples in rainy and dry seasons respectively have a taste. Contrary to data in the rainy season, 89%, 11%, 67% and 56% of the dry season's samples were enriched in magnesium (Mg), lead (Pb), potassium (K) and iron (Fe) respectively above the 2018 World Health Organisation guidelines for drinking water. This study further established that seasonal variation plays a major role in altering the aesthetic surface water quality. The intake of untreated surface water is a vehicle for potential water-borne diseases and allergies, hence alternative sources of drinking water for the populace dependent on the Landzun Stream is recommended to reduce risks and possible dangers of consuming the stream water.

Matched MeSH terms: Hypersensitivity
Fulltext Therapeutic plasma exchange (TPE) for semi-critical neurology presentations in a non-acute neurology set-up: clinical practice and challenges

Fu KS, Wong PY, Hiew FL

BMJ Neurol Open, 2020;2(1):e000020.
PMID: 33681775 DOI: 10.1136/bmjno-2019-000020

Introduction: Therapeutic plasma exchange (TPE) for semi-critical neurological manifestations can be managed in non-acute setting instead of critical care unit. In 2014, we established a non-acute neurology TPE unit for semi-critical haemodynamically stable patients. In this study, we aimed to evaluate the technical and safety parameters from the first 3 years of service.
Materials and methods: We analysed prospectively collected TPE data for patients treated with centrifugation TPE at our non-acute neurology TPE unit in Kuala Lumpur Hospital between May 2015 and June 2018.
Results: A total of 245 TPE procedures were performed in 55 patients for nine neurological indications, predominantly the central nervous system (79%). Twenty four per cent (n=13) had category I and 73% (n=40) had category II indication (American Society for Apheresis (ASFA) 2019). Others (4%) were not in ASFA indications. Neuromyelitis optica spectrum disorders accounted for half (51%) of the total patients. Twenty-three (41.8%) patients experienced adverse events, with hypotensive episodes being the the most common (n=12/55, 21.8%). Five (9.1%) patients had catheter-related blood stream infection, correlating with higher exchange plasma volume (p=0.023). Symptomatic hypocalcaemia was less common (n=5/55, 9.1%) and allergic reaction to human albumin was rare (n=1/55, 1.8%). Four technical errors detected. Three involved centrifugation sets manufacturing defects and one involved error in centrifugation set installation. Seven (2.9%) procedures were terminated: 5 for adverse effects and 2 for technical errors.
Conclusion: Performing TPE among semi-critical patients with neurology manifestations in basic non-acute set-up proved safe, with predictable complications. This set-up reduced the reliance on critical care services for TPE procedures.

Matched MeSH terms: Hypersensitivity

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