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   Table of Contents - Current issue
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July-December 2020
Volume 34 | Issue 2
Page Nos. 53-125

Online since Friday, November 20, 2020

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EDITORIALS  

Speculation of life after COVID-19 p. 53
Ankur Garg, Sharad Bagri, Mohan Bandhu Gupta, SN Gaur
DOI:10.4103/ijaai.ijaai_49_20  
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Role of Bacille Calmette-Guérin in offering protection against COVID-19 p. 55
Sharad Bagri, Ankur Garg, Mohan Bandhu Gupta, SN Gaur
DOI:10.4103/ijaai.ijaai_50_20  
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REVIEW ARTICLE Top

Interleukin types and its application Highly accessed article p. 57
Jacqueline Arokiaraj, Alisha Mugunthan, Praveen Kumar Gupta
DOI:10.4103/ijaai.ijaai_11_20  
Interleukins (ILs) were the first expressed by leukocytes that aid in the communication between cells. There have been extensive studies on various types of IL, and it was found that they help in motility, cell growth, and differentiation. They have been grouped into four major groups based upon their structural features. This article explores the characteristics of various IL where studies on each type and its associated autoimmune diseases have been reviewed. This article also highlights on the recent advances and applications in the field.
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ORIGINAL ARTICLES Top

Allergic sensitization in nasobronchial allergy patients and its correlation with total immunoglobulin E level p. 63
V Kumar, Deependra Kumar Rai, H Shekhar
DOI:10.4103/ijaai.ijaai_7_20  
INTRODUCTION: Bronchial asthma (BA) and allergic rhinitis (AR) are immunoglobulin (Ig) E-mediated hypersensitivity phenomena. The objective of the study is to assess the association between total serum IgE level and skin prick test (SPT) in Indian patients who presented with different nasobronchial allergy symptoms. MATERIALS AND METHODS: This was an observational prospective study conducted in the Allergy and Asthma Clinic, Motihari, Bihar. A total of 183 patients diagnosed as BA and AR undergo SPT against different allergens between January 2017 and July 2018. Serum total IgE was measured in all patients. All statistical analyses were performed using statistical software SPSS version 20 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant. RESULTS: The study patients included 95 males and 88 females (total 183) with a mean age of 27.15 ± 12.64 years. SPT was positive in 99 out of 183 (54.09%) study patients. BA and AR were associated with skin sensitization in 30.60% and 15.30% of patients, respectively, while 54.09% of patients were associated with both AR and asthma. Forty-four out of 99 (44.44%) patients were sensitized to single allergen, while 40.40% and 15.15% of patients were sensitized to 2–5 allergens and >5 allergens, respectively. Except 11 patients, all the study patients had high total IgE level (>150 IU/ml). More than half of the study patients (51.36%) were associated with more than 1000 serum total IgE level. Total IgE level was not affected with the number of allergen sensitization. SPT-positive patients had higher IgE value than SPT-negative patients but statistically not significant (P > 0.05), and there was also poor correlation between SPT result and serum total IgE level (r = 0.102). CONCLUSION: SPT should be performed in all clinical allergic patients irrespective of serum total IgE level.
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Sensitivity to common aeroallergens in asthma patients in Delhi-National Capital Region p. 68
Manoj Kumar, Rajesh Kumar Gupta, Sonam Spalgais, Raj Kumar
DOI:10.4103/ijaai.ijaai_14_20  
BACKGROUND: Skin prick test (SPT) is the “gold standard” in the assessment of sensitivity to inhalant allergens. SPT is performed with antigen extracts from India and evaluated according to the Standard Indian Guidelines. OBJECTIVE: The aim of this study was to determine sensitivity by skin prick test in asthma patients in metropolitical city of Delhi-National Capital Region (NCR). MATERIALS AND METHODS: This is a prospective study of skin prick test with aeroallergens in asthma patients and their combination with clinical diagnosis. Two hundred asthma patients consisting of 81 (40.5%) males and 119 (59.5%) females with a mean age of 30.51 ± 9.85 years aged between 12 and 60 years were selected for study from Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute, Delhi, between 2017 and 2018. Fifty-eight different common aeroallergen tests were tested through skin prick test (SPT) in patients of bronchial asthma. The sensitivity of all common aeroallergens was analyzed by MS Excel 2010. RESULTS: A significant (2+ and above) skin-positive reaction against aeroallergens was found in 114 (57%) asthma patients. The younger adults aged 21-30 years were the foremost commonly affected group with 84 (43.5%). Among individual allergens, the most common aeroallergens showed a significant positive skin reaction, which were cockroaches 68 (34%) and moth 63 (32.5%), followed by mosquito 61 (30.5%), housefly 55 (27.5%), rice weevil 41 (20.5%), and house dust mite (HDM) 22 (11.0%). CONCLUSION: In the present study, we found that insects (cockroaches, housefly, mosquito, and rice weevil) and HDM are the most common skin sensitive aeroallergens in Delhi-NCR. The sensitization was the most common in the younger age group patients.
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Clinical profile and environmental risk factors of asthma in children at a tertiary care teaching hospital in the sub-Himalayan belt of Northern India p. 74
Neha Rehalia, Jyoti Sharma, Sanjeev Chaudhary
DOI:10.4103/ijaai.ijaai_4_20  
OBJECTIVES: To describe the clinical profile of patient with bronchial asthma, to determine the presence of environmental risk factors among them and to determine the relationship between environmental risk factors to the severity of asthma. METHODS: It was a descriptive observational study done at a tertiary care teaching hospital in sub-Himalyan belt of Northern India. Children aged 1-18 years,who presented to hospital with diagnosis of asthma were included in the study after obtaining informed consent. RESULTS: Prevalence of asthma in children age 0-18 years was 1.6 % in this study.Mean age was 8.60±4.40 years with male preponderance. Majority of patients (68.3%) had onset of symptoms before 5 years of age. Fifty nine percent were malnourished and 53% had history of atopy. Majority of children were born vaginally (81.5%) with 91.5% of them were born at term with normal birthweight (90%) Asthma was more common in 2nd order birth (50.7%) and majority (60.7%) were bottle fed in first 6 months of life. Family history of atopy or asthma was present in 86% of the ptients. Eighty percent of patients had history of exacerbations episode after exposure to dust, 81.8% had seasonal variation of asthma with 52.3% exacerbations in winter. Seventy five percent had history of exacerbations during crop harvesting time.Seventy two percent had history of smoke producing fuel at home.Sixty percent had history of exposure to cigarette or other tobacco product smoke and 21.5% of pts had pets at home.Strong relationship was found between use of power and perfumes and exacerbations and exacerbation after exposure to cold air with uncontrolled asthma. CONCLUSIONS: Male gender, malnourished and bottle fed children are prone for developing asthma. Presence of atopy, most commonly allergic rhinitis in early life predisposes children to asthma later in life. Exposure to cold air, dust during harvesting season and use of powder and perfumes are important risk factors for development of asthma.
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Relationship between total serum immunoglobulin E level and total eosinophils count with skin reactivity in children with allergic rhinitis and asthma in North Indian population p. 81
Radhey Shyam Sharma, Ravi Sharma, Rajiv KR Bansal
DOI:10.4103/ijaai.ijaai_13_20  
CONTEXT: Various epidemiological studies have shown association among total serum immunoglobulin E (IgE) levels, blood eosinophilia, skin test reactivity, and allergy prevalence, the details of these associations has still not well determined specially in the Indian population. AIMS: The aim of this study is to determine the correlation between total serum IgE level, total eosinophils counts (TECs), and skin prick test (SPT) for common aeroallergens in children with allergic rhinitis (AR) and asthma. SETTINGS AND DESIGN: A prospective, cross sectional, and observational study conducted at Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India, between October 2018 and June 2019. MATERIALS AND METHODS: A total of 140 children of age 6–18 years diagnosed with AR and Asthma were enrolled. SPT using 18 aeroallergens were performed with the measurement of total serum IgE level and TEC. RESULTS: Among the total cases, around 77% (n = 108) were having positive skin test for one or more allergens, most common allergen was house dust mite. Total serum IgE level was strongly related with skin reactivity in both AR and asthma groups (correlation coefficient = 0.68), and a fair correlation was also observed between TEC and SPT grade in our all study participants (r = 0.48). CONCLUSION: Our study suggested a close relationship between total serum IgE and TEC and skin test reactivity in children with AR and asthma.
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Role of immunological mediators in the follow-up of asthma and allergic rhinitis patients on allergen immunotherapy p. 87
Raj Kumar, Parul Mrigpuri, Indu Bisht, Kamal Singh, Manoj Kumar, Sonam Spalgais
DOI:10.4103/ijaai.ijaai_12_20  
BACKGROUND: Bronchial asthma (BA) is characterized by chronic airway inflammation. Many studies have shown a significant overlap between BA and allergic rhinitis (AR). Specific allergen immunotherapy (AIT) is effective for the treatment of BA and AR. Only limited studies have evaluated the role of immunological parameters to assess the response in patients on AIT. Hence, this study was done to assess the role of interleukin-4 (IL-4), IL-5, and IL-6 in the follow-up of patients of BA and AR on AIT. MATERIALS AND METHODS: This study was conducted on diagnosed cases of BA, AR, and BA with AR attending the outpatient department who were started on subcutaneous immunotherapy as per the standard Indian guidelines. Blood samples were collected at the beginning of the treatment and every 3 months thereafter for a period of 51 months, and serum IL-4, IL-5, and IL-6 levels were measured. RESULTS: In this study, 170 patients were enrolled over a period of 51 months. Out of 170, 80 (47.1%) patients had completed 1 year of treatment with AIT at the end of 51 months of follow-up. Significant reduction was observed in IL-4, IL-5, and IL-6 levels during the treatment with AIT over a period of 12 months. CONCLUSION: Our study suggests a possible role of IL-4, IL-5, and IL-6 in the follow-up of BA and AR patients; however, further studies are needed in this area.
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Clinicopathological, epidemiological, and immunological relationship between allergic rhinitis and bronchial asthma p. 92
Md Anas, Mohammad Shameem, Zeeshan Ahmad
DOI:10.4103/ijaai.ijaai_3_20  
INTRODUCTION: Allergic rhinitis and bronchial asthma are thought to be sequela of the same allergic airway disease. The relationship between both diseases has been confirmed by various clinicopathological epidemiological and immunological studies. In this study, we tried to establish a different relationship between both diseases and strengthen the concept of “One-airway one disease.” MATERIALS AND METHODS: A total of 100 patients visiting ear, nose, and throat and respiratory medicine outpatient department were taken. They were divided into two groups of fifty each and were studied for various mediators of inflammation. Group 1 consisted of patients of allergic rhinitis and Group 2 consisted of patients of bronchial asthma. RESULTS: Most of the patients in Group 1 were in the age group of 21–30 years (40%) and in Group 2, in the age group of 11–20 years (38%) with a mean age 28.4 ± 1.3 years. The most common symptoms in Group 1 patients were sneezing (90%) and rhinorrhea (68%) and in Group 2 wheezing (86%), followed by shortness of breath (66%). The most common sign in Group 1 was B/L inferior turbinate hypertrophy (70%), while in Group 2, it was rhonchi (76%). Mean absolute eosinophil count was 575.35 in Group 1 and was 446.61 in Group 2. Nasal smear for eosinophil was positive for 86% of patients in Group 1 and bronchial lavage showed eosinophilia in 64% of Group 2 patients. Mean total serum immunoglobulin E was 777.23 IU/ml in Group 1 and 662.08 IU/ml in Group 2. The incidence of bronchial asthma in patients of allergic rhinitis was 36%, while the incidence of allergic rhinitis in patients in bronchial asthma was 74%. CONCLUSION: Thus, in our study, we found that both the diseases were closely linked clinicopathologically epidemiologically as well as immunologically pointing toward the concept one-airway one disease.
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Clinical significance of fungal sensitization in bronchial asthma: A prospective cross-sectional study at a tertiary care center p. 98
Jitendra Kumar Sharma, Shubhra Jain, Vinod Joshi, Narendra Khippal
DOI:10.4103/ijaai.ijaai_6_20  
INTRODUCTION: The link between fungi and asthma has been extensively investigated. However, the role of fungal allergens as the primary extrinsic factor leading to asthma severity has been incompletely explored. An all-new variant of asthma has been described recently which has been named severe asthma with fungal sensitisation (SAFS). It is characterised by the presence of severe asthma and are sensitized to one or more fungi but have normal or slightly elevated IgE concentration. In this study ALQ test and spirometry was done to assess the severity of asthma. ALQ test is a simple self administered questionnaire, designed to help individuals with breathing problems to determine if they have asthma or for those already diagnosed with asthma if their asthma is under control. METHODS: A prospective observational study was done over a period of 6 months. Name, age, and demographic details collected from all bronchial asthma patients. Using SPT, the sensitization status to fungus was identified in clinically diagnosed bronchial asthma cases and asthma Severity with fungal sensitisation was analysed on the basis of asthma life quality test questionnaire and spirometry. RESULTS: Out of hundred patients studied 60 of the patients were male. Mean duration of asthma was 5years. 40 patients were positive for fungal sensitization by SPT. The most common fungus was Curvularia Lulata followed by aspergillus. 30 patients were positive for aspergillus fungus (ALQ score > 16.5 and mean FEV1 was 28±2) as compared to the 10 patients who were positive for other than aspergillus fungus( ALQ score <16.5 and mean was FEV1 65 ±2 ) severe asthma. Fungal sensitization was found to be significantly associated with uncontrolled asthma. 75% of fungal sensitized patients had uncontrolled asthma as compared to 5% of the non fungal sensitized patients. CONCLUSION: There was high prevalence of sensitization to all fungal allergens. Among all the fungal allergens, aspergillus sensitization is most commonly associated with severe asthma.
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Severity of asthma and Vitamin D status in children: A case–control study in a tertiary care center p. 103
Veena Anand, Induprabha P Yadev, S Bindusha
DOI:10.4103/ijaai.ijaai_8_20  
OBJECTIVE: Studies to find the relation between asthma severity and Vitamin D yielded controversial reports. The objective of the present study is to find the association between severity of asthma and Vitamin D status in children. MATERIALS AND METHODS: This case–control study was conducted in a tertiary teaching hospital. Details were obtained from children with asthma in the age group of 2–12 years who were under follow-up in the respiratory clinic. They were categorized into two groups according to the Global Initiative for Asthma criteria. Those with moderate-to-severe asthma were grouped as cases, and those with mild asthma were grouped as controls. Vitamin D estimation was done, and levels were analyzed with different levels of asthma severity. RESULTS: Among 140 children with childhood asthma studied, 64 (45.7%) had mild asthma and 76 (54.3%) had moderate-to-severe asthma. Vitamin D was insufficient in 55 (72.4%) cases and 30 (46.9%) controls. There was a significant correlation between severity of asthma and Vitamin D levels (P = 0.001) and peripheral eosinophilia (P = 0.02). Logistic regression analysis showed that Vitamin D insufficiency could increase the risk for severe asthma, which remained after adjustment for potential confounders (odds ratio: 2.81 with 95% confidence interval: 1.36–5.82). CONCLUSION: Screening for Vitamin D insufficiency is suggested for children with severe asthma. Vitamin D supplementation could avoid increasing steroid dose/adding new drugs as controllers.
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A study on respiratory morbidities among school children post Diwali in Bangalore city p. 107
Giriyanna Gowda, Sunil Maragowdanahalli Gurupadaswamy, Sweta Balappa Athani
DOI:10.4103/ijaai.ijaai_21_20  
BACKGROUND: Diwali is a Hindu festival celebrated every year in the month of October/November throughout India. The burning of firecrackers during the festival releases a large number of air pollutants leading rise in ambient air pollution. Children are at risk of exposing to these chemicals and have shown an increased incidence of respiratory morbidities. OBJECTIVE: The objective of this study is to identify the magnitude of respiratory morbidities among school children post Diwali in Bengaluru city. SETTING AND DESIGN: A cross-sectional study was conducted from November 2018 to January 2019 among school children aged between 10 and 16 years. METHODOLOGY: Schools coming under the urban field Practice area of Medical College and consenting for the study were selected by the simple random sampling. Students willing to participate from each school were selected by the simple random sampling. Each student was interviewed using the pretested semistructured questionnaire. STASTICAL ANALYSIS USED: Data were entered and analyzed using Epi-info 7.2.2.1. Descriptive statistics such as mean, standard deviation (SD), and proportions and inferential statistics such as the Chi-square test were used. RESULTS: A total of 637 participants were interviewed, of which 308 (48.35%) were boys and 329 (51.65%) were girls. The mean age of the study participants was 12.53 ± 1.65 years (mean ± SD). It was observed that 263 (41.28%) children were suffering from one or other respiratory morbidities. One hundred and thirty-five (21.19%) children were suffering from upper respiratory tract infection and 138 (21.66%) had lower respiratory tract infections. One hundred twenty-three (19.31%) suffered from allergic rhinitis, of which 59 (47.93%) had an exacerbation following Diwali. Twenty-seven (4.24%) were asthmatic, of which 17 (62.96%) experienced an exacerbation after Diwali. CONCLUSION: There is a high burden of respiratory morbidities among children following Diwali festival in Bangalore city.
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Knowledge assessment among caregivers about various allergic disorders in a hospital-based pediatric outpatient department in North India p. 112
Paramita Paul, Yatish Singh, Neeraj Gupta, Poojan Agarwal, Anil Sachdev, Dhiren Gupta
DOI:10.4103/ijaai.ijaai_30_20  
CONTEXT: Various types of allergic disorders are increasing worldwide. The diagnostic and treatment facilities are limited compared to their vast magnitude. Lack of awareness among caregivers and beneficiaries could be one of the critical factors for inadequate management especially in developing countries. AIM: This study aims to evaluate the knowledge among caregivers about various allergic disorders in a pediatric setup. SUBJECTS AND METHODS: Caregivers of children, presenting for their illness at pediatric outpatient department of a tertiary care hospital of North India, were recruited over 6 months' period using a 22-item prevalidated questionnaire. STATISTICAL ANALYSIS USED: Sigma Plot Software version 12. RESULTS: Among the 1000 participants, majority (94%) had some knowledge about allergy. Doctors were major source (55%) of information. More than half (53%) believed it to be contagious. House dust (70%) and food additives (24%) were considered major allergens. Seasonal variations (54%) and environmental pollution (48%) were considered the most common aggravating factors while steam inhalation (14%), yoga (11%), and air purifiers (10%) helped in symptom reduction. Skin and respiratory symptoms were a common knowledge amongst many study participants. Only 8% were aware about skin tests for allergy diagnosis. Alternative medicine was the treatment of choice among two-third of people. Oral route was preferred over inhaled medicines. CONCLUSION: The current study highlights limited knowledge and existence of misconceptions regarding allergic disorders in general population necessitating the need to improvise awareness campaigns.
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CASE REPORTS Top

A Case series of ABPA with rare radiological presentation p. 117
Sudhir Kumar, Deependra Kuamr Rai, Subhash Kumar
DOI:10.4103/ijaai.ijaai_19_20  
Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically mediated lung disease that occurs in response to Aspergillus fumigatus which affects primarily asthmatic and cystic fibrosis patients. Central bronchiectasis is a classical radiological presentation of ABPA, but the presentation as total collapse of the lung, pneumothorax, lung mass, or fibrocavitary disease has been rarely described. First case was a 50-year-old nonsmoker male who presented radiologically as complete collapse of left lung. The second case was 54-year-old nonsmoker male presented with breathlessness and chest radiograph showed right-sided pneumothorax which expand after chest tube insertion. The third case a 35-year-old female who treated as bronchial asthma and refer to us for provisional diagnosis of malignancy after saw chest radiograph. The last case was a 22-year-old male who had typical symptoms and radiologically features of pulmonary tuberculosis. All these patients were treated by antitubercular drug, but later, all four case turn out as ABPA. This case series highlights the rare radiological presentation of ABPA (pneumothorax, lung collapse, lung mass, and fibrocavitary), and identifying these diseases in the early stage can prevent the development of end-stage pulmonary fibrosis.
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Heiner's syndrome: Exploring beyond milk p. 123
Ritika Chhawchharia, Neeraj Gupta, Poojan Agarwal, Anil Sachdev
DOI:10.4103/ijaai.ijaai_54_20  
Milk protein allergy, by non-IgE-mediated immune mechanisms, can present with nonspecific alveolar hemorrhage (Heiner's syndrome). We present the case of a 9-month-old infant with hemoptysis and diffuse pulmonary infiltrates who tested positive for milk, rice, and egg-white allergy on skin prick testing. The child responded to specific dietary elimination with reappearance of symptoms on accidental rice exposure. The present case highlights the need for exploring food allergies, other than milk, as a probable culprit in cases of unexplained hemoptysis.
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