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ORIGINAL ARTICLES
Monitoring of indoor particulate matter during burning of mosquito coil, incense sticks and dhoop
Raj Kumar, Nitesh Gupta, Deepak Kumar, Anil Kumar Mavi, Kamal Singh, Manoj Kumar
July-December 2014, 28(2):68-73
DOI:10.4103/0972-6691.140770  
Background: Indoor combustion source, like incenses, are commonly used for aesthetic and religious purposes in various indoor as well as outdoor environments. The combustion leads to the production of a large amount of smoke, which can pose a health risk due to inhalation exposure of particulate matter (PM). Objective: Monitoring of PM (PM 10 , PM 2.5 , and PM 1 ) during the preburning, burning and postburning phases of incenses (agarbatti and dhoop) and mosquito coil in the indoor environment. Materials and Methods: The monitoring of PM was carried out using the Grimm Portable Laser Aerosol Spectrometer and dust monitor model 1.108/1.109. The substances used were mosquito coil, incense (sandal), incense (floral sticks) and dhoop. The data were analyzed using the SPSS statistical package version 14.0 for windows (SPSS, Chicago, IL, USA), using one-way analysis of variance to compare the PM 10 , PM 2.5 and PM 1.0 concentration levels. Results: The mean concentrations of PM 10 (1879.7 μ/m 3 ), PM 2.5 (1775.4 μ/m 3 ) and PM 1 (1300.1 μ/m 3 ) during burning phase were highest for dhoop. The mean concentrations of PM 10 , PM 2.5 and PM 1 during burning of mosquito coil were 259.2 μ/m 3 , 232.4 μ/m 3 and 214.0 μ/m 3 respectively. The burning of incense (flora) had PM 10 (854.1 μ/m 3 ), PM 2.5 (779.8 μ/m 3 ) and PM 1 (699.8 μ/m 3 ), which were higher, in comparison to burning of incense (sandal). The particulate emission during the burning of dhoop (PM 10, PM 2.5, PM 1 ) was significantly higher (P < 0.05) than incense (sandal and flora) and mosquito coil. The concentrations of PM 10 , PM 2.5 and PM 1 even during postburning phase were significantly higher for dhoop in comparison to other three products, resulting in prolonged exposure even after the cessation of burning phase. Conclusion: The study suggests burning of dhoop, incense sticks and mosquito coil in the indoor environment emit quiet higher respirable PM, which may accumulate on prolonged exposure and lead to respiratory illnesses.
  15,550 236 2
Comparison of blood absolute eosinophil count and nasal smear eosinophils with symptoms and severity of clinical score in patients of allergic rhinitis
Anand K Patel, Tapan P Nagpal
July-December 2014, 28(2):74-77
DOI:10.4103/0972-6691.140774  
Introduction: Allergic rhinitis is one of the most common chronic conditions with a significant impact on the quality of life. The association between eosinophils and allergic disease has been known for many years. Nasal smear eosinophilia (NSE) (normal septal motion [NSM]) is a valuable test for the diagnosis of allergic rhinitis. Objective: The objective was to compare NSM and blood absolute eosinophil count (AEC) with the severity of the clinical score and to see the levels in patients with different symptoms and different group of patients with allergic rhinitis. Materials and Methods: In this prospective study, all patients aged more than 12 years presented to our institute; with a clinical diagnosis of allergic rhinitis were enrolled after taking written consent. Then, all patients were subjected for blood AEC and nasal smear for eosinophils. Results: There was a good correlation of NSE with severity of clinical score. There was no correlation of blood AEC with severity of clinical score and majority (94.29%) of the patients had no eosinophilia. The mean values of blood AEC, NSE, and clinical severity score were much higher in group of patients having nasal and respiratory system involvements as compared to only nasal and nasal with ocular system involvement. Conclusions: Nasal smear cytology is a simple, economical, and semi-invasive procedure having good correlation with severity of clinical score should be used routinely. There is a need to revise the normal standard value and grading of blood AEC.
  6,974 311 -
Prevalance of skin reactivity to fungal antigens in patients of nasobronchial allergy of Jalandhar and neighbouring area in Punjab
VP Jerath, Megha Sood, Richa Nishchal
July-December 2012, 26(2):73-76
DOI:10.4103/0972-6691.112551  
Atmospheric allergens play an important role in the pathogenesis of naso-bronchial allergy. It is important to know the prevalence of allergens in one's area.for proper diagnosis and effective management The data of positive reaction to fungi on 1500 patients of nasobronchial allergy has been included in this study. Allergy test (skin testing with intradermal injection of antigen) was conducted on patients and the results were interpreted by comparing the wheal produced by the test substance in relation to the control. While analyzing the results 60 patients were excluded because of (±) or one plus (+) cutaneous reaction to fungal antigens. Topping the list, cladosporium was positive in 158 patients (11%) followed by Alternaria tenuis in 144 (10%), Curvularia lunata in 108 (75%), Helminthosporium sp. in 115 (8%). Moderate positives were Rhizopus nigricans in 92 (6.4%) patients, Candida albicans in 86 (6%), Aspergillus fumigatus in 86 (6%), Mucor mucedo in 83 (5.8%), Aspergillus niger in 81 (5.6%), Phoma batae 79 patients (5.5%), Aspergillus tamarii 72 (5.5%), Trichoderma 72 (5%). The low positives were Penicillium in 50 patients(3.5%), Aspergillus flavus 43 (3%), Nigerospora 41 (2.5%), Neurospora sitophila 41 (2.5%), Epicoccum purpurascens 31 (22%), Aspergillus versicolor 30 (2%) and Fusarium solani 28 (2%) patients. Information about fungal antigen positivity is being provided in the present article, which would serve as a reference to the physicians dealing with allergy patients as well as those studying environmental sciences.
  5,973 107 1
REVIEW ARTICLES
Allergen immunotherapy: Basic concepts
Ghulam Hassan, Surya Kant, Ved Prakash, Ajay Kumar Verma, S Saheer, Abhijeet Singh, Arpita Singh, Naredra Nath Jena, Nisar A Wani
January-June 2013, 27(1):9-18
DOI:10.4103/0972-6691.116606  
Allergen-specific immunotherapy is the therapeutic approach for allergic disorders with dysregulated immune responses, working through down-regulation of predominant T-cell and IgE mediated reactions by inducing immune tolerance by long-lived decrease in allergen-specific T-cell responsiveness through administration of allergen extracts in incremental doses. The potential candidates include mainly those with uncontrolled symptoms despite avoidance measures and medication use. Traditionally, immunotherapy is administered subcutaneously, although sublingual, mucosal, intranasal, intrabronchial, intralymphatic, and epicutaneous routes are also in existence. Currently, it has an established role in the treatment of allergic rhinitis, allergic conjunctivitis, allergic asthma, and insect sting hypersensitivity. Other disorders demonstrating significant improvement on immunotherapy include atopic dermatitis, food allergies, etc., Newer therapies, such as anti-IgE (omalizumab) used in combination with immunotherapy, have improved the safety and efficacy of immunotherapy. Future studies involving scientific research with the aim of improving patient outcome using safer forms of immunotherapy through recombinant technology, including allergens with reduced allergenicity and T-cell epitope based allergy vaccines without reducing immunogenicity, are in process.
  4,706 357 1
ORIGINAL ARTICLES
Risk factors for asthma hospitalization and emergency department visit in Nigeria: The role of symptoms frequency and drug utilization
Olufemi Olumuyiwa Desalu, Joseph Olusesan Fadare, Adekunle Olatayo Adeoti, Adebowale Olayinka Adekoya
July-December 2013, 27(2):129-133
DOI:10.4103/0972-6691.124395  
Background: Substantial proportion of the economic cost of asthma care is due to hospitalization and emergency department (ED) visit. The objective of our study was to identify the role of frequency of asthma symptoms and drug utilization as risk factors for asthma related hospitalization and ED visit among adult patients in selected hospitals in Nigeria. Patients and Methods: We carried out a cross sectional study of a sample of adult patients in selected hospitals in Nigeria. Demographic, clinical information, and use of asthma medications were obtained from the patients that were hospitalized or visited ED and those not hospitalized or visited ED in previous 12 months. Results: A total of 102 patients participated in the study. Fifty (49.0%) of the patients were hospitalized or visited the ED and 52 (51.0%) were neither hospitalized nor visited ED. Asthma patients who experienced frequent nocturnal symptoms (relative risk (RR)-3.50, 95% confidence interval ( C I) 2.05-4.96), frequent use of rescue medication (RR-2.89, 95% CI 1.66-4.12), increased daytime (RR-2.32, 95% CI 1.32-3.32), and nasal symptoms (RR-2.30, 95% CI 1.11-3.48) were more likely to be hospitalized or visited ED. Patients who used oral theophylline (RR-2.19, 95% CI 1.35-2.33) without doctor's prescription were two times more likely to be hospitalized or visited ED. The use of inhaled corticosteroids (ICS, RR-0.69, 95% CI 0.45-0.99) and oral corticosteroids (OCS; RR-0.73, 95% CI 0.00-1.59) were not associated asthma related hospitalization and ED visit. Conclusion: There is a need for pragmatic interventions in patients who reported increased asthma and nasal symptoms, increased use of rescue medication, and nonprescription use of oral theophylline in order to prevent acute asthma hospitalization and emergency visit.
  4,799 78 -
CASE REPORTS
Urticaria as a manifestation of Hodgkin's lymphoma
Zareen Mohamed
July-December 2015, 29(2):88-91
DOI:10.4103/0972-6691.178275  
A 45-year-old Indian gentleman presented to our allergy clinic with symptoms of hives and intense pruritus for the past 8 months. He complained of considerable burning type of itching, which was only partially controlled with antihistamines. He was thoroughly investigated, and his hives were found to be a skin manifestation of Hodgkin's lymphoma. He subsequently underwent chemotherapy and is now in clinical remission.
  3,931 42 -
ABSTRACTS
ICAAICON 2011 - Abstracts of papers presented (not peer reviewed)

January-June 2012, 26(1):25-40
  3,740 117 -
ORIGINAL ARTICLES
Identification of different pigeon allergens and its trigger toward increase in inner city Asthma
Sudha Shrikant Deo, Pramod V. Niphadkar, Sujatha Ramesh, Naveen Arora, Amol M. Kakade, Chaitali Mulay, Umakant L. Nadkar, Meghna Repal, Sonali Prabhudesai, Varsha Pandya
January-June 2014, 28(1):40-46
DOI:10.4103/0972-6691.134224  
Background: Upon exposure, allergic reactions to breathing pigeon feces are common. The dust of dried droppings irritates the nasal passages, causing sneezing, coughs, excess mucus and shortness of breath, dizziness and a sense of vertigo. Hence exposure to pigeon allergens in the surroundings has led to increase in hypersensitivity reactions due to pigeon proteins present in their feathers and droppings. Aims and Objectives: The aim and objective of the following study is to investigate the role of pigeon droppings in the increase of inner city asthma. To study the different allergens present in the pigeon droppings. Materials and Methods: A total of 500 asthmatics were screened for hypersensitivity reactions toward protein extracts from pigeon droppings. 100 asthmatic patients were selected showing 3+ reactions by skin scratch test and an induration of more than 5 mm with inflammation. Total immunoglobulin E (IgE) as well as specific IgE quantitated by enzyme-linked immunosorbent assay (ELISA) and circulating immunoglobulin G (IgG) antibody toward pigeon allergens was studied by western blot. Results: Totally 87 asthmatic patients and 23 healthy normal showed reactivity toward allergens of pigeon feathers and droppings by skin test with induration of 1.48 ± 0.12** in patients (P < 0.000) and 0.17 ± 0.81 in healthy controls. Reactivity shown toward pigeon dropping allergen was 13 ± 0.121 in patients and that shown by healthy controls being 0.26 ± 0.094*(P < 0.001), which was also statistically significant. The total IgE was 1906.84 ± 3696.27 IU/ml in patients **(P < 0.0001) when compared to healthy controls 86.21 ± 50.18 IU/ml. Specific IgE detected in patients toward allergens was 0.31 ± 0.10 OD. *(P < 0.001) to that of normal being 0.19 ± 0.06 OD. Patients serum reacted to 129 kD and 43 kD protein extract of pigeon dropping by western blotting and total IgG by ELISA was 1802.0 ± 66.5 mg/dl in patients (P < 0.016). The normal range being 581-1630 mg/dl. The pulmonary function test by spirometry was 60%, 40% lesser when compared with healthy normals. Conclusions: Observed results showed an increase in the hypersensitivity reactions toward the pigeon allergens and increase in the antibody levels of IgG in circulation. This probably may have added to the increase in asthma cases in our city.
  3,549 101 -
ABSTRACTS
ICAAICON 2012 - Abstracts

January-June 2013, 27(1):57-83
  3,379 190 -
CASE REPORTS
Anti golgi antibodies and cryoglobulins
Moushumi Lodh, Debakanta Pradhan, Manoranjan Sahoo, Shantanu Das
January-June 2012, 26(1):16-19
DOI:10.4103/0972-6691.104441  
Systemic autoimmune diseases are probably the greatest masqueraders in clinical medicine and dependence on laboratory testing is very high. Some of the antibodies directed to cytoplasmic autoantigens are well characterized, such as anti-mitochrondial, anti-ribosomal, anti-microsomal and anti-Golgi complex autoantibodies. Anti-Golgi autoantibodies are polyclonal and often mainly of the IgG isotype. We have detected cytoplasmic anti-Golgi antibody (AGA) and cryoglobulins in a 52 year old female admitted for hematuria and altered consciousness. She was a type 2 diabetes mellitus in urosepsis, with positive rheumatoid factor. Serum from the patient reacted to the Golgi complex by an indirect immunofluorescence technique on HEp-2 cells. The patient tested negative for viral serology and ANA. There were features of joint pain, absence of skin rashes, positive rheumatoid factor, negative ANA, positive anti Golgi antibodies along with features of sepsis. This led us to the diagnosis of Sjogren syndrome presenting with uremic encephalopathy and interstitial pneumonia. A positive anti Golgi antibody pattern must be looked for in an ANA negative patient with suspicious clinical features. We also review the earlier case reports on anti golgi antibodies available.
  3,201 74 -
REVIEW ARTICLES
Involvement of microRNA in Asthma: New perspective in respiratory biology
Balaram Ghosh
January-June 2013, 27(1):3-8
DOI:10.4103/0972-6691.116603  
A new insights have come from studies in Caenorhabditis elegans, in which researchers have identified a new endogenous class of small noncoding RNA (22-25 nucleotides), termed as microRNAs (miRNAs) as developmental regulators. Here, we discuss some recent studies demonstrating the role of miRNAs in asthma, with the anticipation that these studies were likely to influence treatment, diagnosis, and management of asthma and other inflammatory disorders. use of miRNAs as a therapy, the use of miRNAs holds great promise as a new treatment. Future of miRNA-based therapy in case of pulmonary disorders, such as asthma, chronic obstructive pulmonary disease (COPD), acute lung injury (ALI), and acute respiratory distress syndrome (ARDS) seems to be promising as indicated by animal studies.
  2,531 184 1
ORIGINAL ARTICLES
The impact of anemia and hemoglobin level as a risk factor for asthma and allergic diseases
Abdulbari Bener, Mohammad S Ehlayel, Qutayba Hamid
July-December 2015, 29(2):72-78
DOI:10.4103/0972-6691.178271  
Aim: To determine the association between anemia and asthma among children as case-control and also investigate the effect of hemoglobin (Hb) on asthma and atopy markers. Settings: The case-control study was performed during a period between March 2012 and October 2013, on asthmatics and controls (<14 years) at Pediatric Allergy-Immunology Clinics and Primary Health Care Clinics, Qatar. Subjects and Methods: A total of 520 cases and 520 controls matched by age, gender, and ethnicity. Sociodemographic and clinical data were collected through physician diagnosis and questionnaire. Their health status was assessed by past or present clinical manifestations, family history, physical examination, body mass index (BMI), anemia, Hb level, calcium, and phosphorus. Results: About 56.3% of asthmatic and 51.9% of controls were males and 43.7% of asthmatic and 48.1% of controls were females. The mean age (± standard deviation, in years) for asthmatic versus controls was 9.3 ± 3.28 versus 10.2 ± 3.38. Anemia was more prevalent in asthmatics than controls. Lower Hb levels were associated with more allergic disease and elevated serum IgE. The study revealed that Hb level, iron and ferritin deficiencies were considerably higher in asthmatic children compared to healthy children. There was a significant difference found in the mean values of Hb levels between asthmatic (10.58 ± 3.05 g/dL) and control children (11.75 ± 3.10) (P = 0.006). Besides, mean IgE was statistically significantly higher in asthmatic compared to control children (P < 0.001). There was a significant correlation between Hb level and total IgE in asthmatic compared to controls (r = 0.295 vs. r = 0.268, P = 0.001). The analysis revealed that the predictors for development of asthma in children were serum iron deficiency (P < 0.001), phosphorus (P < 0.001), parental consanguinity (P = 0.046), breastfeeding < 6 months (P < 0.001), BMI (P = 0.005), less physical activity (P < 0.001), family history of asthma (P = 0.028), and ferritin (P < 0.001). White blood cell count (P < 0.001), serum IgE level (P < 0.001), and serum calcium level (P < 0.001) were considered as the main risk factors after adjusting for age, gender, and other variables. Conclusion: The study findings showed a high prevalence of iron deficiency among children with asthma and allergic diseases. Serum Hb levels were lower in asthma, allergic rhinitis, and atopic dermatitis children. Hb level and anemia were strong contributors for asthma and allergic diseases.
  2,491 151 -
Role of vitamin D supplementation in allergic rhinitis
Datt Modh, Ashish Katarkar, Bhaskar Thakkar, Anil Jain, Pankaj Shah, Krupal Joshi
January-June 2014, 28(1):35-39
DOI:10.4103/0972-6691.134223  
Background: Allergic rhinitis (AR) is the most common type of chronic rhinitis, affecting 10-20% of the population. Severe AR has been associated with significant impairments in quality of life, sleep, and work performance. A role for vitamin D in the regulation of immune function was first proposed after the identification of vitamin D receptors in lymphocytes. It has since been recognized that the active form of vitamin D, 1α, 25(OH) 2D3, has direct affects on naïve and activated helper T-cells, regulatory T-cells, activated B-cells and dendritic cells. There is a growing researches linking vitamin D (serum 25(OH) D, oral intake and surrogate indicators such as latitude) to various immune-related conditions, including allergy, although the pattern of this relationship is still yet to establish. Such effects of vitamin D can significantly affect the outcome of allergic responses like in AR. Aims and Objectives: To evaluate nasal symptom scores in patients of AR, pre- and post-treatment with and without supplementation of vitamin D. Materials and Methods: Vitamin D levels were assessed in 21 patients with AR diagnosed clinically and evaluated prospectively during the period of 1 year. Pre- and post-treatment vitamin D3 serum levels measured and documented. They received oral vitamin D (chole-calciferol; 1000 IU) for a given period. The results were compared with the patients having AR - treated conventionally without supplementation of vitamin D. Results: Improvement in the levels of serum vitamin D levels were significant in post-treatment patients (P = 0.0104). As well as clinical improvement in terms of reduction in the total nasal symptom score was also significant in the post-treatment patients (P < 0.05). Conclusion: Supplementation of vitamin D in such patients alters natural course of AR toward significant clinical improvement.
  2,404 196 1
REVIEW ARTICLES
Sublingual swallow immunotherapy
Komarla Nagendra Prasad
July-December 2013, 27(2):102-107
DOI:10.4103/0972-6691.124391  
Allergen Specific Immunotherapy (ASI) in the form of subcutaneous route (SCIT) used over a century and is currently under used for management of IgE mediated allergy disorders. SCIT Meta analysis showed very promising results and sustained effect for a long period from 7 years to 12 years on stopping the therapy. The adverse events are not common and application for day to day practice currently restricted among trained physicians. Allergy prone subjects adherence to SCIT is very less and drop outs are more either due to invasive injections, the long term dosage, cumbersome to wait at the clinic after the injection or due to local and systemic reactions. Alternate route suggested by WAO, ARIA and EAACI is Sublingual (SLIT) for better compliance and to increase the adherence of the therapy. SLIT Meta analysis showed its efficacy is equivalent to SCIT with mild to moderate tolerable adverse events without discontinuation of dosage schedules.SLIT becomes successful in the hands of trained physicians who initiate the effective dose for effective response which is crucial. The quality of standardised allergen extracts and the appropriate dose is to generate clinical response is very important. Selection of allergens for therapy by taking care of proteolysis which degrade in combination of heterogeneous allergens and time of administration is very critical. SLIT is friendly with children less than 6 years, SCIT restricted below 6 years. SLIT in the form of drops, tablets and Stripe is currently used and SLIT kept below the tongue before food for 2 to 5 minutes and swallow. The prescribed tailor made dosage consumed on daily basis at a regular time shows better results. At present the SLIT is a personal Medicine. SLIT is popular among European countries and US FDA is in the process of evaluation of clinical trials.
  2,410 150 -
CASE REPORTS
A rare case of allergic bronchopulmonary aspergillosis in a patient with chronic obstructive pulmonary disease
Kshitij Agarwal, Anuradha Chowdhary, SN Gaur
January-June 2012, 26(1):20-24
DOI:10.4103/0972-6691.104442  
Allergic bronchopulmonary aspergillosis (ABPA) is known to complicate asthma and cystic fibrosis, but an association of ABPA with chronic obstructive pulmonary disease (COPD) has also been found lately. The mechanism through which ABPA operates is still an enigma. With the discovery of ABPA in COPD, interest in the theory that asthma and COPD could share a common etiology has been rekindled. Herein, we present the case of a 60-year-old male, diagnosed case of COPD, who reported exacerbations during the monsoons, which mandated frequent courses of systemic steroids. He was diagnosed to have co-existing ABPA based on positive skin tests to Aspergillus niger, A. flavus, A. fumigatus, and A. tamarii and raised serum total IgE and specific IgE against Aspergillus spp. His CT scan showed centrilobular and panacinar emphysema along with central bronchiectasis. The spirometry showed a significant response to bronchodilators. The patient fulfilled all the minimal essential requirements for the diagnosis of ABPA, except asthma. The patient responded well to systemic steroids. This report makes an important observation that species of Aspergillus other than A. fumigatus could be instrumental in causing ABPA in patients with COPD, unlike that seen in asthma. The possible etiologic mechanisms underlying the development of ABPA in COPD and also the evolution of ABPA from its serological to bronchiectasis variant are discussed in this report.
  2,425 101 3
ORIGINAL ARTICLES
Cultural factors impacting asthma management in Asian Indian children
Naveen Mehrotra, Maya Ramagopal, Sunita Dodani
July-December 2014, 28(2):63-67
DOI:10.4103/0972-6691.140761  
Introduction: Asthma is the most common chronic disease found in young children. Asian Indians are second largest Asian immigrant population and the fastest growing group in the United States. As this segment of the population in the US grows and utilizes the health care system, more physicians will encounter increased burden of asthma cases. Objective: To outline the cultural factors and health beliefs in the Asian Indian population which impact the care and outcome of these patients. Methods: Three cases are described in which the care of the child with asthma had been impacted due to cultural factors or limitations resulting from health beliefs. The common cultural factors researched in the reported literature along with the experiences of various physicians are outlined. Result: Reported beliefs include concern and denial in Asian Indian mothers when given a diagnosis of asthma in their child. Due to the fear of use of preventive medications such as inhaled corticosteroids and not being completely confident in the medical system, they may not feel comfortable with the recommendations that are made for control of their asthma. Conclusion: Enhanced knowledge with empowerment of the provider will improve communication and compliance of the patient and an improved collaboration between the patient and health care provider leading to better health outcomes in Asian Indian patients with asthma.
  2,179 221 -
REVIEW ARTICLE
Respiratory allergic diseases and therapeutic intervention using allergen-specific immunotherapy
Shailendra N Gaur
July-December 2012, 26(2):50-60
DOI:10.4103/0972-6691.112548  
Bronchial asthma and allergic rhinitis are the most common respiratory allergic disease mediated through type-1 immune reaction. The imbalance of TH1 and TH2 cells is responsible for increased immunoglobulin E (IgE) level and release of immune mediators, producing symptoms in the particular genetically predetermined target organ. Pharmacotherapy is effective in controlling the symptoms of allergic diseases, but withdrawal of medication leads to reappearance of symptoms in a short span of time. The therapeutic modality, namely allergen-specific immunotherapy, corrects the TH1 and TH2 imbalance and thus effects the natural course of allergic disease prescribed in addition to the pharmacotherapy. Immunotherapy has also been found to prevent development of newer allergies and progression of rhinitis to asthma. The subcutaneous immunotherapy with perennial subcutaneous injections and stepwise procedure is the standard and established method. Here, the injections are started with a very high dilution of antigen and then slowly increased to the optimal maintenance dose. However, precautions should be taken to take care of the related side-effects, including anaphylaxis. Patient education and use of this therapy only by trained physicians is mandatory, and it should be practiced at a center having facilities for the management of anaphylaxis. There are various trials in the literature to support improvement by immunotherapy. In Indian studies, favourable results were noted in symptom score, skin sensitivity, airway reactivity (PC20), specific immunoglobulin (Ig) E, Ig G1 and Ig G4. Researches are aimed on a safer and more acceptable route of administration of the allergen. The sublingual route for immunotherapy has been used from 1986 and, till today, has been found to be equally effective and safe. Considering the difference in geo-environmental variation in India from the western world, an Indian guideline for practice of allergen immunotherapy was published in 2009, where consideration was given to the Indian environment, pattern of seasons, presence of different/newer allergens, affordability and feasibility of certain tests in the Indian context.
  2,187 187 -
REVIEW ARTICLES
Airway epithelial cells: Barrier and much more
Sagar Laxman Kale, Naveen Arora
July-December 2013, 27(2):95-101
DOI:10.4103/0972-6691.124390  
Airway epithelial cells were first considered as a barrier to the inhaled environmental bioparticles, but recent evidences show that they have a more vital role to play in the pathophysiology of Airway diseases. Many of the factors present in the inhaled air interact with the receptors expressed on the epithelial cells leading to their activation. Activated epithelial cells then secrete a range of mediators that help in mediating the inflammation. These mediators contain the chemokines that act as chemoattractants and recruit inflammatory cells like neutrophils, macrophages, mast cells, eosinophils, and Th-2 cells that further exacerbate the intensity of inflammation. Some of the inhaled substances like protease enzymes can also disrupt the barrier of epithelium and gain an entry to the immune cells of the body leading to their activation. Bronchial asthma, chronic obstructive pulmonary disease, and acute respiratory distress syndrome represent a broad range of conditions involving pulmonary inflammation. This review takes into account the role of epithelial cells in initiating allergic reactions at mucosal surfaces.
  2,205 115 5
ORIGINAL ARTICLES
Glycyrrhiza glabra versus Boswellia carterii in chronic bronchial asthma: A comparative study of efficacy
Faruk H Al-Jawad, Rafi AM Al-Razzuqi, Hashim M Hashim, Nisreen JM Al-Bayati
January-June 2012, 26(1):6-8
DOI:10.4103/0972-6691.104437  
Bronchial asthma is a clinical syndrome with variable causes. It characterizes by episodes of broncho-constriction which leads to shortness of breath. In traditional medicine, some medicinal plants have been used to cure the asthmatic symptoms. We evaluate the bronchorelaxant effect of Boswellia carterii (Olibanum) and Glycyrrhiza glabra (Licorice) then to choose the better. 54 patients with chronic bronchial asthma were participated. After clinical assessment, estimation of pulmonary function tests and serum electrolytes: calcium, magnesium, potassium and selenium were done before and after the study. Boswellia carterii was given to 18 patients and glycyrrhiza glabra to another 18 patients while prednisolone was given to another 18 patients as control for 21 days. The results showed that the tested plants had significant elevation in the values of forced expiratory volume in first second (FEV1%) as (72.45±5.83 vs 61.33±6.04 and 81.10±11.07 vs 62.30±7.22) for olibanum and licorice respectively. Also, elevation in the values of forced volume capacity (FVC) with marked reduction in asthmatic attacks as (2.63±0.82 vs 0.72±0.16, 3.60±0.02 vs 1.08±0.08, and 2.25±0.16 vs 1.05± 0.15) for olibanum licorice and prednisolone respectively, but showed better symptomatic improvement with licorice as compared to olibanum. The results prove the superiority of glycyrrhiza glabra over boswellia carterii for chronic bronchial asthma.
  2,192 117 -
Pattern of skin sensitivity to various aeroallergens in patients of bronchial asthma and/or allergic rhinitis in India
Raj Kumar, Nirupam Sharan, Manoj Kumar, Indu Bisht, SN Gaur
July-December 2012, 26(2):66-72
DOI:10.4103/0972-6691.112550  
Nine hundred and eighteen patients with bronchial asthma and/or allergic rhinitis including 548 (59.69%) males and 370 (40.31%) females with a mean age of 30.10 years were studied for skin sensitivity to various aeroallergens by skin prick test. The maximum numbers of patients (261; 28.43%) were between age group of 20 to 29 years. Patients diagnosed with bronchial asthma were 191 (20.81%), allergic rhinitis were 305 (33.22%), and both bronchial asthma and allergic rhinitis were 422 (45.97%). Significant skin positive reactions (2+ and above) were found in 657 (71.57%) subjects, which included 130 (14.16%) of bronchial asthma patients, 208 (22.66%) of allergic rhinitis patients, and 319 (34.75%) of both. The younger adults aged 20-29 years were the most commonly affected group with 197 (21.46%) significant skin positive patients. Insects (43.90%) followed by various types of weed pollens (21.79%), tree pollens (15.14%), dust (14.49%), house dust mite (12.42%), fungal spores (11.98%), grass pollens (7.73%), kapok cotton (2.18%), silk (1.31%), and wool (0.76%) were the offending allergens. Among individual allergens, most common aeroallergen was moth (33%), and least common was ehretia (0.54%). Among grass pollens, Cynodon (3.05%) was most common, and least common grass pollen aeroallergen was Pennisetum (1.74%). Among weed pollens, Ageratum (5.45%) was most common, and least common was Chenopodium album (1.53%). Among tree pollens, Holoptelia (5.01%), was most common, and least common was Ehretia (0.54%). Among dust, the wheat dust (8.28%) was the most common, followed by house dust (7.08%), and least common was paper dust (1.53%). Among the fungal spores, Aspergillus fumigatus (4.25%) were the most common, and least common was Candida (1.09%). Among insects, moth (33%) followed by mosquito (31.92%) were the most common, and least common was rice weevil (12.75%). When compared with the pattern of our study, there was significantly increased in sensitization to various allergens.
  1,972 227 3
CASE REPORTS
Churg Strauss syndrome
Abhinav Sharma, Jagdishchandra Agrawat, Arti Julka, Hanmant G Varudkar, Parag Sharma
January-June 2012, 26(1):11-13
DOI:10.4103/0972-6691.104439  
The patient is a known case of Asthma with marked peripheral eosinophilia developed recurrent haemoptysis and lung infiltrates. Bronchoscopic lavage and FNAC of lung showed pulmonary eosinophilia. Due to raised IgE levels and strongly positive pANCA, the case was diagnosed as Churg Strauss syndrome. He responded well to corticosteroids with complete resolution and is presently on the tapering doses.
  2,042 117 -
Fluorodeoxyglucose positron emission tomography in tropical pulmonary eosinophilia presenting as interstitial lung disease
Ketaki Satish Barve, Sandip Basu, Jyotsna M Joshi
January-June 2013, 27(1):52-54
DOI:10.4103/0972-6691.116610  
The role of fluorodeoxyglucose positron emission tomography (FDG-PET) is being increasingly recognized and investigated as a functional imaging technique to explore nonmalignant thoracic disorders. We report a case of a 72-year-old woman who presented as interstitial lung disease (ILD) due to tropical pulmonary eosinophilia (TPE). FDG-PET helped in confirming disease activity and response to treatment with diethyl carbamazine (DEC). The role of FDG-PET in TPE has not been reported previously.
  1,964 82 1
ORIGINAL ARTICLES
Assessment of inhalation technique of bronchial asthma and chronic obstructive pulmonary disease patients attending tertiary care hospital in Jaipur, Rajasthan
Roopam Sehajpal, Astha Koolwal, Suresh Koolwal
July-December 2014, 28(2):78-82
DOI:10.4103/0972-6691.140777  
Context: Prevalence of chronic obstructive pulmonary diseases (COPD) and bronchial asthma is on the rise all over the world. Inhalation therapy is the most recommended and efficient therapy for these respiratory diseases, but incorrect inhalation technique can cause poor disease control and increase the burden on health care resources. Aims: The aim was to evaluate the inhalation technique of COPD and bronchial asthma patients using pressurized metered dose inhaler and to investigate the determinants of incorrect inhalation technique. Settings and Design: Hospital-based cross-sectional study. Subjects and Methods: Consecutive nonrandom sampling method was used to enroll study subjects. Basic sociodemographic information of the study subjects was collected. The inhalation technique was visually observed and scored on checklist. Statistical Analysis Used: Chi-square test and Fisher exact test. Results: Among the 85 patients observed, 64 (75.29%) were males. Correct technique was observed in only 18 (21.17%) patients. The step at which maximum number of patients committed mistake was exhalation (65.88%) followed by breath holding (45.88%). No significant correlation was found between accuracy of the technique and the guide who taught the technique, age, sex, education status, or area of residence of the patients. A significant correlation (P = 0.002) was found between duration of device usage and correctness technique. Conclusions: It was found that substantial errors were made in the inhalation technique hence proper training and follow-up of the patients is required to achieve the desired effects of the inhaled medications.
  1,828 211 -
Association between asthma and attention-deficit hyperactivity disorders in children: Potential risk factors
Abdulbari Bener, Mohammad S. Ehlayel, Hale Zeynep Bener
January-June 2014, 28(1):19-26
DOI:10.4103/0972-6691.134212  
Background: Childhood asthma is common in children. It might be associated with behavioral abnormalities of inattention, irritability, or hyperactivity. These abnormalities form the major components of attention deficit hyperactivity disorder (ADHD). Allergic diseases and ADHD are common pediatric conditions associated with learning difficulties and sleep disturbances. There are conflicting research data regarding the association between ADHD and atopic disorders. Aim: The objective of this study was to examine the potential risk factors, especially investigate vitamin D deficiency a strong contributing factor in asthmatic children with ADHD. Design: This was a case-control study. Settings: Hamad General Hospital, Rumeilah Hospital, School Health and Primary Health Care Clinics, Qatar. Subjects and Methods: A total of 520 asthmatic children with ADHD and 520 controls aged 5-16 years old controls were enrolled in this study and matched with age and ethnicity. The study was conducted between June 2011 and September 2013. Data based questionnaire, clinical manifestations, family history, body mass index (BMI), and clinical biochemistry variables including serum 25(OH) vitamin D, calcium, phosphorus, magnesium was obtained. Univariate and multivariate statistical analyses were performed. Results: Severe vitamin D deficiency was significantly higher among asthmatic children with ADHD compared with the healthy controls (18.1% vs. 10.4%; P < 0.001). Furthermore, the proportion of overweight (24.1% vs. 18.1%) and obesity (8.2% vs. 5.4%) was significantly higher among asthmatic children with ADHD than healthy controls (P < 0.001). Mean values of vitamin D (17.25 ± 10.53 vs. 23.91 ± 9.82; P < 0.001), serum iron (81.46 ± 13.61 vs. 87.23 ± 12.46; P < 0.001), hemoglobin (11.68 ± 2.11 vs. 12.87 ± 2.15; P < 0.001), magnesium (0.77 ± 0.12 vs. 0.83 ± 0.13; P = 0.013), potassium (4.22 ± 0.53 vs. 4.58 ± 0.55; P < 0.001), phosphorous (1.53 ± 0.12 vs. 1.66 ± 0.14; P < 0.001) were significantly lower among asthmatic children with ADHD than in controls. There was a significant correlation between vitamin D deficiency and with age (r = −0.224, P = 0.001); calcium (r = 0.256, P = 0.001); phosphorous (r = 0.316, P = 0.001); magnesium (r = 0.288, P = 0.001); and BMI (r = 0.452, P = 0.001) in asthmatic with ADHD children. Vitamin D deficiency (odds ratio [OR] =3.27; P < 0.001), serum iron deficiency (OR = 2.81; P = 0.008), physical inactivity (OR = 2.67; P = 0.005), ferritin (OR = 2.53; P < 0.001) and serum calcium level (OR = 2.04; P < 0.001) were significant leading predictors in asthmatic children with ADHD. Conclusion: The present study revealed that vitamin D was a significant contributing factor in asthmatic children with ADHD followed by serum iron deficiency and physical inactivity compared with healthy controls.
  1,909 120 1
CASE REPORTS
A case of bronchial asthma and allergic rhinitis exacerbated during Cannabis pollination and subsequently controlled by subcutaneous immunotherapy
Raj Kumar, Nitesh Gupta
July-December 2013, 27(2):143-146
DOI:10.4103/0972-6691.124399  
The prevalence of bronchial asthma and allergic rhinitis has been on the rise in India. Cannabis is reported to be one of the allergenically important airborne pollen identified by the clinico-immunologic evaluation in the spring season in India. We report a case of 38-year-old male patient with typical clinical manifestations of bronchial asthma and allergic rhinitis that classically exacerbates during the pollination period of Cannabis. On evaluation, the patient was found to be significantly sensitized to Cannabis sativa. Subsequent subcutaneous immunotherapy leads to marked improvement in control of asthma as well as improved quality-of-life.
  1,942 84 2
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