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.

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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.

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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.

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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.

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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.

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The practice of Allergy and Immunotherapy is not streamlined in our country and there were no guidelines till we published in 2009 in IJAAI. The guidelines are updated now incorporating the additional information after 2009. The purpose of bringing out these guidelines was to maintain the uniformity in the methods of diagnosis and management i.e. Immunotherapy in the country. Because of different soil conditions, temperature, different allergens, different seasonal variations etc, it was the felt the need to have separate guidelines for India, although such guidelines are available from other organisations. These guidelines are based on available guidelines with modifications/alterations at appropriate places keeping in mind the situation in our country.

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Polyserositis is defined as general inflammation of serous membranes associated with serous effusion due to many causes. In this case, we report polyserositis as a complication of connective tissue disorder. A 56-year-old female with a history of hypertension, hypothyroidism, and bipolar disorder having dyspnea along with pleural effusion which was repeatedly tapped and treated on suspicion of tuberculosis. She became better on steroid treatment and her respiratory distress resolved.

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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.

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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.

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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.

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Inhaled therapy is the cornerstone in the management of obstructive airway diseases (OADs). Nebulization is often used for the delivery of bronchodilators and corticosteroids among the elderly and children. The present pandemic of coronavirus disease 2019 (COVID-19), caused by a newly identified, highly contagious, novel coronavirus, called severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is responsible for great morbidity and mortality globally. There is a great concern regarding person-to-person transmissibility of this virus. There is also a great concern of viral transmission of this virus to the health-care personnel and the bystanders through aerosol-generating procedures including frequently used nebulization therapy. Most of the patients with OAD, during the current pandemic, who were undergoing nebulization therapy, on getting infected with SARS-CoV-2 or on its suspicion, have been shifted to other handheld devices out of fear of transmission of infection. Presently, there exist not enough evidences either on the safety or on the risk of transmissibility of SARS-CoV-2 during nebulization in COVID-19 patients. In addition, there are concerns about nebulization in OAD cases even in the absence of COVID-19 and about the use of inhaled or systemic corticosteroids in these cases. We have made some observations based on all the current information available related to these issues, which may help provide some guidance in the use of nebulizer therapy and also discussed the measures to be taken to minimize the risk of infection, if any, during the procedure.

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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.

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Asthma guidelines are instituted to improve patient care. The extent to which physicians adhere to guidelines will depend on their understanding of such guidelines. This study was designed to evaluate physicians' understanding of the Global Initiative for Asthma (GINA) guidelines. A cross-sectional survey was carried out among physicians in the University of Calabar Teaching Hospital. Thirty-one multiple choice questions based on the GINA guidelines covering seven core areas were administered on 104 physicians, including 74 Internists, 24 Family Physicians and six Respiratory Physicians. Total scores and subscores were calculated for each respondent. A good understanding of the guidelines was determined by at least 50% correct answers. The average total score for the test was 39.5 ± 1.4% (mean ± SEM). Respiratory Physicians recorded the highest total score of 67.2 ± 2.1%. Respiratory Physicians recorded significantly higher scores than Internists in questions related to education, prevention and disease control (P < 0.05). They also recorded significantly higher scores than all other specialties in questions related to diagnosis, pharmacology and therapy (P < 0.05). Only 32 respondents reported attending a Continuing Medical Education program after graduation, and this was a significant predictor of good understanding after controlling for other variables; OR 4.5, (95% CI 1.3-15.6), P = 0.017. Only 20.2% displayed a good understanding of the GINA guidelines. The findings of this survey provide some explanation for the poor level of asthma control seen in daily practice, due in part to poor understanding of asthma management guidelines. Well-structured educational interventions targeting knowledge gaps will improve the understanding of the guidelines.

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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.

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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.

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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.

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Background: Atopy is the major factor predisposing for the development of allergic airway diseases. Immunoglobulin E (IgE) levels of children having atopy are elevated as compared with nonatopic children. Serum total IgE levels can be utilized as a surrogate marker for the presence of atopy. Objective: To study the presence of atopy by estimation of serum IgE levels in children having allergic rhinitis and to determine the proportion of concomitant allergic conditions in these children. Methods: From May 2012 to April 2013, 134 children aged 6-14 years having allergic rhinitis as diagnosed on the basis of their response to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire were included in the study. Children were screened for concomitant atopic disorders, viz., asthma, atopic eczema, and conjunctivitis on the basis of their response to ISAAC questionnaire. Total serum IgE levels were determined for all subjects. Results: Total IgE levels of study subjects were found to be increased in 114 (85.07%) out of 134 children (cut-off value = 100 IU/mL). Mean serum IgE of the study subjects was 312.18 (95% confidence interval, 253.1-385.1) IU/mL. Children having persistent allergic rhinitis had higher mean IgE levels of 392.18 IU/mL as compared to 199.08 IU/mL (P < 0.01) for children having intermittent allergic rhinitis. One hundred and twenty-two (91.0%) children had concomitant asthma. Persistent allergic rhinitis was found to be significantly associated with family history of smoking (P < 0.01) and family history of atopy (P = 0.02). Conclusion: Significant number of children having allergic rhinitis had increased levels of serum IgE. Hence, total serum IgE can be considered as a supportive and suggestive indicator of atopy in children presenting with allergic rhinitis.

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Anti-centriolar pattern of staining by indirect immunofluorescence (IIF) on human epithelial type 2 (Hep2) cells is rarely observed, mostly in association with scleroderma and scleroderma-like connective tissue disorders. This paper describes four patients with anti-centriole antibody positivity along with a review of the available literature. In this retrospective study, a total of four cases whose serum showed the centriolar pattern on Hep2 cell lines during IIF examination were reviewed. The presence of anti-centriole antibody in the serum should herald the diagnosis of scleroderma spectrum; Raynaud's phenomenon and pulmonary arterial hypertension should be specifically looked for. In the absence of features of autoimmunity, patients should be screened for Mycoplasma infection.

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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.

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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.

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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.

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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.

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Aims and Objective: The aim was to compare efficacy and safety of olopatadine with levocetirizine in patients of chronic idiopathic urticaria (CIU). Materials and Methods: This was a prospective, open, parallel, comparative randomized study. After assessing inclusion and exclusion criteria, patients were randomized and divided into two treatment groups: Group A (n = 77) received levocetirizine 5 mg once a day orally, and Group B (n = 77) received olopatadine 5 mg twice a day orally for 6 weeks. Patients were evaluated in terms of parameters under study that is, urticarial activity score (UAS), dermatological life quality index (DLQI), visual analog scale (VAS) (daytime sedation), and adverse drug reactions monitoring at every (2 weeks) visit. Statistical Analysis: We used the Student's t-test and the analysis of covariance for comparison of the results and the Chi-square test for comparison of incidence of adverse effects . Results: Both drugs reduced UAS significantly (P < 0.05) at all visits and olopatadine reduced UAS more than levocetirizine at 2 weeks (P < 0.05). Both drugs altered VAS at all visits significantly; however, inter-group differences were not significant. Each drug reduced DLQI score significantly. Levocetirizine reduced more DLQI than olopatadine, but the difference was not significant (P > 0.05). Olopatadine was associated with more side-effect profile, and most common side-effect was somnolence in both groups. Conclusion: Levocetirizine is a marginally superior drug as compared with olopatadine for long-term treatment of CIU in Indian population.

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