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   Table of Contents - Current issue
Coverpage
July-December 2018
Volume 32 | Issue 2
Page Nos. 41-83

Online since Friday, October 12, 2018

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EDITORIAL  

Allergen immunotherapy: What does the future hold? p. 41
Shailendra Nath Gaur
DOI:10.4103/ijaai.ijaai_23_18  
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REVIEW ARTICLE Top

Future modalities in allergen immunotherapy: A brief overview p. 43
SN Gaur
DOI:10.4103/ijaai.ijaai_20_18  
Allergen immunotherapy (AIT) is the only disease-modifying modality for the treatment of allergic diseases. The well-known and approved formulations are subcutaneous immunotherapy (SCIT), sublingual immunotherapy (SLIT) and allergoids. The drawbacks of the conventional AIT such as the risk of anaphylaxis led to the development of allergoids, Future approaches in AIT may permit (1) shorter treatment regimens, (2) improved safety, (3) improved compliance and (4) newer indications for AIT, which are discussed in the article.
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ORIGINAL ARTICLES Top

A study of skin sensitivity to various allergens by skin prick test in patients of bronchial asthma and allergic rhinitis p. 47
Rishi Kumar Sharma, Yash Mathur, Gaurav Chhabra, Atul Luhadia, Shanti Kumar Luhadia, Gaurav Dhandoria
DOI:10.4103/ijaai.ijaai_9_18  
Background: Bronchial asthma (BA) and allergic rhinitis (AR) are among the most common allergic disorders. Identification of specific causative allergens is of paramount importance for further management. Aims: This study aims (1) to find out the prevalence of various allergens leading to AR and/or BA through skin prick test (SPT), (2) to identify the trigger factors in these patients, (3) to study correlations of allergens and seasonal variations in patients suffering from AR and/or BA. Materials and Methods: A total of 134 patients were collected from outpatient department and inpatient department of Respiratory Medicine Department of Geetanjali Medical College and Hospital, Udaipur, from January 2016 to December 2017. The diagnosis of BA and AR was made according to the GINA and ARIA guidelines, respectively. SPT was done with 78 different types of aeroallergens, which included 23 types of pollens, 6 types of fungi, 10 types of insects, 6 types of dusts, 6 types of dander, 3 fabrics, 2 feathers, and 22 food allergens. Patients who had taken short-acting oral antihistaminics, beta-blockers, steroids, tricyclic antidepressants or any other drug that could affect the test within one week prior to testing were excluded. Also, patients on long-acting oral antihistaminics within four weeks of testing and pregnant women were excluded. Results: A total of 134 patients consisting of 73 (54.48%) males and 61 (45.52%) females, in the age group of 5–65 years, were included in the study. The maximum numbers of patients (50; 37.31%) were between the age group of 20 and 35 years. The maximum number of patients (94; 70.15%) had a duration of suffering from >1 years. AR was found in 60 (44.78%), BA associated with AR was found in 39 (29.1%), while BA alone was found in 35 (26.12%). In 54% of patients, triggers were found for exacerbation of their symptoms, the most common being air pollution (48%) followed by cold exposure (20%), physical activity (12%), irritants (9%), smoke (7%), and fumes and odors (4%). A total of 10,452 SPTs were done, out of which 265 (%) showed positive reactions. The positivity for pollens was seen in 116 (43.77%) patients followed by insects [79 (29.81%)], fungi [22 (8.3%)], house dust mite [15 (5.66%)], dusts [11 (4.15%)], fabrics [10 (3.77%)], danders [9 (3.4%)], and feathers [3 (1.13%)], respectively. Food allergens showed no significant reactions to SPT. Conclusions: Our study showed that insects were the most common allergen in BA patients, while pollens were the most common allergen in patients of AR with or without BA. Intermittent symptoms were common with pollen allergy.
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Prevalence of respiratory symptoms in automobile spray painters of Mumbai: A cross-sectional study p. 54
Shweta Kishor Nahar, Mohd Adil Ashraf
DOI:10.4103/ijaai.ijaai_10_18  
Background: Spray painting poses health hazards that affect the respiratory system. During spray painting, workers are exposed to different paint components. Toluene diisocyanates, methylene diisocyanates, and hexamethylene diisocyanates are commonly used isocyanates in the spray painting. The major route of occupational exposure to isocyanates is the inhalation of the vapor or aerosol that can sensitize workers. The short- and long-term consequences of the respiratory system can be raised from these occupations. Hence, the aim and objective of this study were to find the prevalence of respiratory symptoms in automobile spray painters of Mumbai and to study the use of safety measures in automobile spray painters. Materials and Methods: The study was a cross-sectional study. A total of 50 automobile spray painters were selected based on inclusion criteria. The self-made validated questionnaire was used as an outcome measure. Results: About 90% of the automobile spray painters have reported respiratory symptoms in their occupation among which 88% had the most prevalent symptom of breathlessness followed by 84% workers had the symptom of coughing. Nearly 60% of workers were aware about the safety measures, but only 33% were using the safety measures during work. Conclusion: The study showed a high prevalence of respiratory symptoms. The lack of awareness and the use of safety measures had increased the severity of the symptoms.
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Air pollution and respiratory dysfunction among adolescents: A case–control study from North West India p. 59
Vikramjeet Singh, Varun Kaul, Rekha Harish, Nirlep Kaur, Seema Rai, Shilpa Bansal, Sunil Kumar Raina
DOI:10.4103/ijaai.ijaai_6_18  
Introduction: Children are vulnerable to the effects of air pollution because of immature organ system and immune system. Air pollutants can lead to both upper and lower respiratory tract symptoms. Methodology: Adolescents in the age group of 10–19 years children from residential areas with established maximal and low pollution levels as reported by State Pollution Control Board were included in the study using age-, sex-, weight-, and height-matched case–control study design. For the assessment of respiratory dysfunction, the values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, and forced expiratory flow (FEF) 25%–75% were included in this study. Odds ratio with 95% confidence interval was calculated to ascertain the strength of association. Results: The distribution of abnormalities for a restrictive pattern in males in polluted group was 42% as compared to 29% in low polluted group (P = 0.007). The mean values of pulmonary function parameters FVC, FEV1, FEV1/FVC, and FEF 25%–75% (expressed as percentage of predicted values) were compared in two groups, a deficit of approximately 4.5%, 6%, 1.06%, and 3.4% was observed in males versus 4.9%, 6.3%, 2.44%, and 2.4%, respectively for females. Conclusion: There is a statistically significant difference in the pulmonary functions in the polluted versus less polluted areas with the children being affected in a harmful manner in the former areas.
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Study on impact of air pollution on asthma among school going children residing in urban Agra p. 65
Devendra Kumar Singh, Santosh Kumar, Gajendra Vikram Singh, Benhur Joel Shadrach, SK Kaushal, Rishabh Goel
DOI:10.4103/ijaai.ijaai_14_18  
Background: Air pollution is one of the world's most serious environmental problems. Air pollution has many negative health effects on the general population, especially children, individuals with underlying chronic disease, and the elderly. The aims of this study were to evaluate the effects of traffic-related pollution on the exacerbation of asthma and development of respiratory infections in schoolgoing children in Agra, suffering from asthma compared with healthy subjects, and to estimate the association between incremental increases in principal pollutants and the incidence of respiratory symptoms. Materials and Methods: We enrolled 702 children aged 6–18 years in this prospective study. A total of 342 children with asthma and 360 healthy subjects were monitored for 6 months from September 2013 to February 2014. Clinical data were combined with the results obtained using an air pollution monitoring system of the five most common pollutants. A total of 328 children with asthma and 345 healthy subjects completed follow-up. Results: Children with asthma reported significantly more days of fever (P <0.001) and cough (P < 0.001), episodes of rhinitis (P = 0.087), asthma attacks (P < 0.001), episodes of pneumonia (P < 0.003), and hospitalizations (P = 0.01). In the asthma cohort, living close to the street with a high traffic density was a risk factor for asthma exacerbations (odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.13–2.84), whereas living near green areas was found to be protective (OR = 0.50; 95% CI, 0.31–0.80). Conclusion: There is a significant association between traffic-related pollution and the development of asthma exacerbations and respiratory infections in children suffering from asthma. These findings suggest that environmental control may be crucial for respiratory health in children with the underlying respiratory disease.
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Effects of inhalational anti-asthmatic medications on oral health between 7 and 14 years of age p. 70
Sapna Konde, Manisha Agarwal, Rachna Chaurasia
DOI:10.4103/ijaai.ijaai_16_18  
Introduction: Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. The World Health Organization considers asthma as the most important chronic respiratory disease of the childhood. Aim: The aim of this study was to observe the changes in oral health and salivary pH, of asthmatic children aged between 7 and 14 years, treated with different combinations of inhaled medication. Materials and Methods: A total of 120 children aged between 7 and 14 years were divided into two groups of which 60 were asthmatic children and the rest 60 were nonasthmatic which were served as control group. Dental caries was assessed using decayed missing filled tooth (DMFT) index for permanent teeth and decayed extracted filled tooth (DEFT) index for primary teeth. Oral hygiene status was determined by simplified oral hygiene index (OHI-S) and modified (OHI-S) index for primary teeth. The resting salivary pH was estimated using pH strips and comparison was made between both groups. Results: The mean value of dental caries (DMFT and DEFT) was found to be significantly higher among study group compared to control group (P < 0.05), while for salivary pH, it was significantly lower among the study group compared to control (P < 0.05), whereas oral hygiene status was statistically not significant in relation to anti-asthmatic medications. Conclusions: Children with asthma have higher caries prevalence, lower salivary pH compared to the control group, which can be due to use of anti-asthmatics medications.
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Clinical, radiological, and microbiological profile of pulmonary aspergillosis in treated cases of pulmonary tuberculosis p. 74
Shubhra Jain, Yogendra Singh Rathore, Vinod Joshi, Narendra Khippal
DOI:10.4103/ijaai.ijaai_18_18  
Context: Clinical studies about detailed spectrum of aspergillosis in treated tuberculosis (TB) patients are lacking. Hence, a study was undertaken at the Institute of Respiratory Disease, Jaipur, Rajasthan, India. Treated patients of pulmonary TB having any symptom such as hemoptysis, cough with expectoration, weight loss, and whose chest X-ray showed residual cavitation were enrolled for the study. Aims: This study aimed to determine the prevalence of pulmonary aspergillosis in treated cases of pulmonary TB and to study the social, demographical, and clinical characteristics of these patients. Settings and Design: A descriptive type of observational study was conducted at the Department of Respiratory Medicine in a tertiary care center of Rajasthan. Subjects and Methods: This descriptive type of observational study was conducted on seventy patients, whose sputum or bronchial wash showed isolation of Aspergillus. Demographic details, predisposing factors, and clinical findings were noted. Statistical Analysis Used: Data collected were entered into Excel spreadsheet and quantitative data were expressed as number and percentage. Results: The presentation of pulmonary aspergillosis in treated cases of pulmonary TB varies from aspergilloma (57%) to chronic necrotizing pulmonary aspergillosis (36%) to allergic bronchopulmonary aspergillosis (7%). The most common symptom was recurrent hemoptysis. Most of the patients were farmers by occupation, but no significant comorbid illness was seen. X-ray chest missed about 70% of cases. The most common species were Aspergillus fumigatus; others were Aspergillus terreus (13%), Aspergillus flavus (13%), and Aspergillus niger (7%). Conclusions: All treated cases of pulmonary TB presenting with recurrent hemoptysis and/or cough with expectoration should be evaluated in detail for pulmonary aspergillosis as chest X-ray alone can miss the diagnosis.
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CASE REPORT Top

Hypersensitivity vasculitis in a young adult p. 78
Zareen Mohamed
DOI:10.4103/ijaai.ijaai_11_18  
This is a case report of a case of hypersensitive vasculitis in a young man. After a comprehensive history and analysis of his symptoms, the symptoms were triggered probably after exposure to yellow fever vaccine. The patient's symptoms were brought under control after starting on immunosuppressive medication.
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LETTER TO EDITOR Top

Detection of immunoglobulin A deficiency in celiac disease suspects p. 82
Yashwant Kumar
DOI:10.4103/ijaai.ijaai_17_18  
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