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   Table of Contents - Current issue
Coverpage
January-June 2019
Volume 33 | Issue 1
Page Nos. 1-59

Online since Wednesday, June 12, 2019

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EDITORIAL  

Homologous allergens: A regulatory and clinical perspective p. 1
SN Gaur
DOI:10.4103/ijaai.ijaai_13_19  
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REVIEW ARTICLES Top

Environmental triggers in allergic diseases: An overview p. 4
AB Singh
DOI:10.4103/ijaai.ijaai_5_19  
Allergy and asthma are increasing all over the world including India. The most effective method of management of allergic diseases is prevention and avoidance where ever possible natural history of allergy is influenced by many triggering Biological and non biological agents. Identification of these triggers such as pollen, moulds, mites and insect debris etc., are major factors for secondary prevention of environmental allergens. It is suggested in this brief review that educational programs should focus on avoidance of these triggers for effective management in addition to other forms of therapy.
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Allergy asthma practice in India: Beyond the guidelines “Shivpuri Oration 2017” p. 8
PA Mahesh
DOI:10.4103/ijaai.ijaai_3_19  
This article summarizes two decades of allergy and asthma research in Mysore, South India, encompassing epidemiologic, mechanistic and biomarker studies as well as diagnostic and prognostic studies. The deficiencies of some of the current guidelines in the diagnosis and treatment of allergic diseases. Two of the most important considerations for future guidelines are to adopt the concept of progression of allergic disease and discuss plans to prevent or mitigate them to reduce the burden of morbidity as well as the enormous costs that go along with disease progression. The other is to consider serial spirometry for the diagnosis of asthma and COPD in difficult to diagnose subjects. The future directions for research in the field are discussed.
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An Indian perspective on dust mites p. 14
SN Gaur
DOI:10.4103/ijaai.ijaai_9_19  
Dust mites are the most important group of indoor allergens. The dust mites have been classified as house dust mites and storage mites, however, with recent knowledge the different dust mite species are now labelled as “domestic mites.” The dust mites have been isolated at numerous Indian locations and their sensitization in Indian population has also been documented. In view of high sensitization in India, it is important to recognize the role of dust mites and their allergens in the precipitation of allergic diseases including allergic rhinitis and asthma. Allergies to dust mites can be confirmed by a classical clinical history of perennial, early morning and indoor symptoms substantiated by a positive skin prick test to these allergens. Further management of allergies to mites is possible using appropriate allergen avoidance measures and allergen immunotherapy. Multifaceted avoidance measures can be used, but, allergen avoidance by the means of an allergen impermeable bed encasings has the best evidence and is recommended in different guidelines. Allergen immunotherapy, the disease-modifying modality, has been proven to efficacious for house dust mite allergies.
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ORIGINAL ARTICLES Top

A cross-sectional study of skin prick test to Aspergillus fumigatus antigen in asthmatic patients seen at a tertiary healthcare center p. 19
Jayanthi Savio, Priya Ramachandran, Vinutha Jairaj, Uma Devaraj, George D'Souza
DOI:10.4103/ijaai.ijaai_31_18  
INTRODUCTION: Asthma is a significant public health problem. The severity of asthma varies from patient to patient and the reasons for this are not fully understood. Atopy is known to play an important part in the pathogenesis of asthma. Sensitization to aeroallergens like house dust mite, animal dander from pets and environmental fungi are evaluated in asthmatics. Severe asthma seems to be associated to environmental fungi with sensitization especially to Aspergillus species. AIMS AND OBJECTIVE: The study aimed at determining the prevalence of Cutaneous Sensitization to Aspergillus species by Skin Prick Test (SPT) in moderate- severe asthmatics. MATERIAL AND METHODS: This study was done on 205 clinically diagnosed asthmatic patients, between September 2012 and August 2013. SPT and spirometry was done in all subjects along with a detailed history. RESULTS: The prevalence rate of Aspergillus sensitized patients is 59.5%. Observations of this study also suggest that the severity of asthma is more in Aspergillus sensitized patients when compared to non-sensitized patients and the duration of asthma was more in Non sensitized. There was no significant association between AEC, total IgE levels and Aspergillus species culture positivity in Aspergillus sensitized patients. Aspergillus terreus was the predominant fungal isolate from both SPT positive and negative patient. There was no significant correlation of fungal culture with SPT. CONCLUSIONS: High levels of Aspergillus sensitization is seen in south Indian subjects and is associated with greater severity and shorter duration of asthma.
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Comparative study of effectiveness of autologous serum and histaglobulin in autologous serum skin test positive and negative cases of chronic urticaria p. 25
Anamika Chaudhari, Hita Mehta, Neha Agrawal
DOI:10.4103/ijaai.ijaai_33_18  
AIMS AND OBJECTIVES: The aim of our study is to compare the effectiveness of autologous serum therapy (AST) with histaglobulin in patients of chronic urticaria. MATERIALS AND METHODS: This was a prospective, comparative, randomized controlled, single-blinded study. Based on inclusion and exclusion criteria, patients were selected and divided into two groups by randomization. Autologous serum skin test was done in each patient irrespective of their groups. Group A (n = 30) received AST and Group B (n = 30) received histaglobulin. Patients' assessment was done every week for urticaria activity score (UAS) for 8 weeks. STATISTICAL ANALYSIS: We used Mann–Whitney test to compare the means between two groups. Wilcoxon signed-rank test was used to compare pre- and posttreatment UAS scores. RESULTS: Both therapies reduced UAS significantly (P = 0.01) at 8 weeks, and the reduction was observed every week. AST reduced UAS more than histaglobulin. However, within intergroup, difference was not significant. All patients had reduced severity of urticaria; however, complete remission (UAS = 0) was observed in three patients of Group A. CONCLUSION: Group A (AST) showed statistically significant improvement than Group B (histaglobulin), but both showed a reduction in UAS with a longer treatment-free interval.
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A clinico-epidemiological study on urticaria cases in various tertiary care hospitals affiliated to a medical college in Mangalore, India p. 32
Nitin Joseph, Akriti Suman, Siddhika Dangayach, Khushboo Sahni, Piyush Chaturvedi, NN Ramachandran
DOI:10.4103/ijaai.ijaai_36_18  
BACKGROUND: Urticaria affects one in every five persons in the population. OBJECTIVES: This study was done to study the risk factors, clinical presentation, and management practices among patients with urticaria. METHODS: Information from the medical case records of confirmed cases of urticaria at a government and private tertiary care hospital over the recent 4 years were recorded in a semi-structured pro forma. RESULTS: Mean age of 115 patients was 31.2 ± 20.7 years. Majority of patients (69, 60%) had acute urticaria. The most common risk factors of urticaria in this study were allergy to food substances (27, 23.5%) and allergy to medications (18, 15.6%), followed by insect bites (16, 13.9%). Family history of urticaria was present in 8 (7%) patients. The most common symptom in urticaria was pruritus (68, 59.1%) and the most common sign was hives (40, 34.8%). Lesions were present all over the body in 52 (45.2%) and were bilateral in distribution in 59 (51.3%) patients. Sixty-eight (59.1%) and 69 (60%) urticaria patients were prescribed nonsedating and second-generation antihistamine (sgAH) drugs, respectively. Among chronic urticaria (CU) cases, 35 (76.1%) each received nonsedating and sgAH. Systemic steroids and topical steroid creams were prescribed in 21 (18.3%) and 7 (6.1%) urticaria patients, respectively. Mean duration of application of the topical steroid creams was 10 ± 4.8 days. Leukotriene antagonists were used in the management of greater proportion of patients (54.5%) with dermographism in comparison to 16.1% without dermographism (P < 0.001). CONCLUSION: The study reported few important risk factors and certain common clinical presentation in urticaria. Second-generation nonsedating type of antihistamine drugs was the most preferred drug for the management of urticaria.
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Applicability of established regression equations in the prediction of peak expiratory flow rate in Indian adults p. 39
Himel Mondal, Shaikat Mondal, Amita Kumari Panigrahi, Sarika Mondal
DOI:10.4103/ijaai.ijaai_25_18  
BACKGROUND: Peak expiratory flow rate (PEFR) helps in the assessment of airflow limitation. Its relationship with age and height has been established in several previous studies with different sample size in different regions from India. A large-scale study (in 2014) established a set of regression equations with a national level reference regression equation. AIM: The aim of this study was to check the applicability of established regression equations in the prediction of PEFR in apparently healthy young adults. MATERIALS AND METHODS: A cross-sectional study was conducted with 104 young adults (males = 55, females = 49). PEFR (L/min) was measured using computerized spirometer. Established regression equations from the previous study were used to predict PEFR from the age and height of the participants. Measured PEFR values were compared with predicted values by the paired t-test with α = 0.05. Further, the prediction was considered “comparable” if the value was <±10% of the measured value. RESULTS: Measured versus predicted mean PEFR (from regression equation established for adult Indian national) for male was 481.99 ± 63.52 L/min versus 496.04 ± 20.70 L/min (P = 0.096) and female was 365.19 ± 61.36 L/min versus 336.82 ± 13.78 L/min (P < 0.001). In male, 54.55% and in female, 44.90% was comparable prediction from regression equation established for Indian adult national. CONCLUSION: Estimated PEFR in male showed fair comparable prediction and female showed poor comparable prediction. Further studies, including all Indian states with a large sample, may help in the establishment of more accurate prediction equations.
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Bronchial asthma: Prevalence and risk factors among children in urban population from Raipur, Chhattisgarh p. 45
Vandana Kumari, Tushar Bharat Jagzape
DOI:10.4103/ijaai.ijaai_26_18  
OBJECTIVES: Bronchial asthma is an important chronic disease in children leading to school absenteeism, hospitalization, economic and psychological stress in the family. Worldwide, the prevalence of asthma is on rise. There is a paucity of information on the prevalence of bronchial asthma in childhood in Central India. Hence, this community-based study was conducted with an objective to estimate the prevalence of asthma and identify associated risk factors in children between 6 and 14 years of age. MATERIALS AND METHODS: This cross-sectional study using modified International Study of Asthma and Allergies in Childhood questionnaire was conducted in the urban area of Raipur, Chhattisgarh, India. The calculated study sample of 175 children in the age group of 6–14 years was recruited using multistage random sampling. RESULTS: Of 175 (88 males and 87 females), 13.14% (23) of the participants had wheezing at any time in the past and 5.14% had wheezing in the past 1 year (asthma prevalence). The prevalence was slightly more (5.9%) in 6–9 years. Boys had more prevalence (5.6%) than girls (4.6%). However, more girls were affected (5.4% vs. 3.7%) in the age group of 10–14 years. Major risk factors with statistically significant “P” values were allergic rhinitis (66.6%) (Relative Risk (RR) = 6.9), family history of bronchial asthma (66%) (RR = 4.6), maternal asthma (33.3%) (RR = 6.9), and upper socioeconomic class (55.5%) (RR = 2.9%). Important triggers were inhalants, cold exposure, exercise, irritants, and infections. CONCLUSION: The prevalence of asthma in children was 5.14%. The significant risk factors were allergic rhinitis and family history of asthma, specifically maternal asthma.
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Characteristics of bronchial asthma with persistent airflow limitation p. 51
Deependra Kumar Rai, Shiv Kumar, Alok Ranjan, Ravi Kirti
DOI:10.4103/ijaai.ijaai_35_18  
BACKGROUND: Asthma is a chronic inflammatory disorder of airway characterized by variable symptoms and variable airflow limitation. There are many patients developed persistent airflow limitation in due course of disease due to many factors. The present study was conducted to characterize this phenotype and to identify the factors which are implicated in causing persistent airflow limitation. MATERIALS AND METHODS: We recruited consecutive 164 patients aged <40 years (to exclude chronic obstructive pulmonary disease [COPD]), diagnosed, and treated as bronchial asthma in our asthma clinic for at least 6 months. We took all clinical, lung function detail and compared between asthma with or without persistent airflow limitation. The patients were assigned to the group with persistent airflow obstruction if they presented postbronchodilator forced expiratory volume in 1 s (FEV1) or FEV1/forced vital capacity values <70% predicted. RESULTS: A total of 114 patients included in the study and 42 (36.84%) patients had persistent airflow limitation. The patients with persistent airflow limitation have a higher age and more proportion of patients were male. History of allergic rhinitis is an important risk factor found associated with asthma with persistent airflow limitation (P≤ 0.001). 26.19% of patients with persistent airflow limitation had a history of symptom since childhood and generally having a longer disease duration compared to patient without airflow limitation (P < nonsignificant). Reversibility criteria (>12% and >200 ml increase in FEV1) was fulfilled by only 26.7% of the study patients. The factors such as onset of disease after 18 years, history of atopy, serum IgE level, family history of asthma, and biomass fuel exposure did not differ between groups with or without airflow limitation. CONCLUSIONS: Bronchial asthma is more having a COPD such as spirometry features if it has been started since childhood, longer disease duration, and history of allergic rhinitis. Reversibility in spirometry, which is specific for asthma diagnosis, is found only in one-fourth of the patients.
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CASE REPORT Top

Angina bullosa hemorrhagica: A rare case report in known asthmatic on inhaled corticosteroids p. 56
Sonal Suresh Arsude, Bhagyashree Babanrao Supekar, Ankita Sunilrao Jire
DOI:10.4103/ijaai.ijaai_24_18  
Angina bullosa hemorrhagica (ABH) is characterized by development of acute onset of painless solitary or multiple blood-filled vesicles or bullae in oral mucosa which are not attributed to blood dyscrasias, vesiculobullous disorder, and systemic diseases. These lesions rupture spontaneously to form ragged, often painless, superficial erosions that heal spontaneously within 1 week without scarring. Trauma appears to be the most common identifiable precipitating factor. We report a case of ABH to emphasize the importance of recognition of this relatively rare benign condition and to differentiate it from other dermatological and systemic causes of oral blisters.
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BOOK REVIEW Top

Hand Book on Adverse Drug Reactions in T B Treatment p. 59
SN Gaur
DOI:10.4103/ijaai.ijaai_7_19  
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