Approach to Diagnosis and Treatment of Allergy to Alternaria alternata in Patients with Chronic Obstructive Pulmonary Disease and Perennial Allergic Rhinitis

CLINICAL RESEARCH
Alexander P. Nazarenko*; G.I. Nazarenko; A.G. Kuznetsov

The P.L. Shupyk National Medical Academy of Postgraduate Education (NMAPE); Clinic of Immunology and Allergology "Forpost"; Kyiv, Ukraine 

*Corresponding author: Alexander P. Nazarenko, Director of Clinic of Immunology and Allergology "Forpost"; Kyiv, Ukraine.  E-mail: director@forpost.ua

Published: June 25, 2015. DOI: 10.21103/Article5(2)_CR4

Abstract: 

The aim of our study was to determine the degree of sensitization to Alternaria alternata in patients with chronic obstructive pulmonary disease (COPD) and perennial allergic rhinitis (PAR), and evaluate the effectiveness of SIT in patients sensitized to Alternaria alternata.

Material and Methods: All patients were divided into two groups. Group 1 included 130 patients (53 women and 77 men) with COPD aged from 24 to 50 years. Group 2 included 162 patients (90 women and 72 men) with PAR aged from 15 to 46 years. The allergen-specific IgE to fungi of the genera: Alternaria alternata, Aspergillus fumigatus, and Penicillinum notatum, as well as the allergen-specific serum IgG antibodies to Alt a 1 of Alternaria alternata were determined. To perform subcutaneous SIT, we used purified major Alt a 1 allergen of Alternaria alternate.

Results: Our study showed that specific IgE antibodies to Alt a 1 were found in 38% and 44.6% patients with COPD and PAR, respectively. Allergen-specific immunotherapy (SIT) induced the IgG response against Alt a 1. The concentration of specific IgG antibodies to Alt a 1 increased approximately 8-fold in COPD patients and 15-fold in PAR patients after 8 months of treatment.

Keywords: 
Chronic obstructive pulmonary disease (COPD); perennial allergic rhinitis (PAR); Alternaria alternate; allergen-specific immunotherapy (SIT).
References: 
  1. Żukiewicz-Sobczak WA. The role of fungi in allergic diseases. Postepy Dermatol Alergol 2013; 30(1):42–45.
  2. Asturias JA,  Ibarrola I, Ferrer A, Andreu C, Lopez-Pascual E, Quiralte J, et al. Diagnosis of Alternaria alternata sensitization with natural and recombinant Alt a 1allergens. J Allergy Clin Immunol 2005; 115:1210-7.
  3. Andersson M, Downs S, Mitakakis T, Leuppi J, Marks G. Natural exposure to Alternaria spores induces allergic rhinitis symptoms in sensitized children. Pediatr Allergy Immunol 2003; 14(2):100-5.
  4. Aden E, Weber B, Bossert J, Teppke M, Frank E, Wahl R et al. Standardization of Alternaria alternata: Extraction and quantification of Alt a 1 by using an mAb-based 2-site binding assay. J Allergy Clin Immunol 1999; 104:128-35.
  5. Mokhtari Amirmajdi M, Mokhtari Amirmajdi NA, Eftekharzadeh Mashhadi I, Jabari Azad F, Tavakol Afshari J, Shakeri MTIran. Alternaria in patients with allergic rhinitis. J Allergy Asthma Immunol 2011; 10(3):221-6.
  6.  Samaha HMS,  Elsaid AR, NasrEldin E. Total serum IgE level in COPD patients. Egypt J of Chest Diseas Tubercul 2015; doi:10.1016/j.ejcdt.2015.02.005
  7. Jamieson DB, Matsui EC,  Belli A, McCormack MC,  Peng E, Pierre-Louis S,  et al. Effects of allergic phenotype on respiratory symptoms and exacerbations in patients with chronic obstructive pulmonary disease Am. J. Respir. Crit. Care Med., 188 (2013), pp. 187–192
  8.  Bourdin A,  Serre I, Flamme H,  Vic P,  Neveu D, Aubas P, et al.Can endobronchial biopsy analysis be recommended to discriminate between asthma and COPD in routine practice? Thorax, 59 (2004), pp. 488–493.
  9. Jin J, Liu X, and Sun Y. The prevalence of increased serum IgE and Aspergillus sensitization in patients with COPD and their association with symptoms and lung function. Respiratory Research 2014, 15:130. doi:10.1186/s12931-014-0130-1
  10. Han MK, Agusti A, Calverley PM, Celli BR, Criner G, Curtis JL, et al. Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med 2010, 182:598-604.
  11. Jamieson DB, Matsui EC, Belli A, McCormack MC, Peng E, Pierre-Louis S, Curtin-Brosnan J, Breysse PN, Diette GB, Hansel NN: Effects of allergic phenotype on respiratory symptoms and exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2013, 188:187-192.
  12.  Celli BR, MacNee W, and committee members. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J 2004; 23: 932–946.
  13. Rohde G, Gevaert P, Holtappels G, Borg I, Wiethege A, Arinir U et al. Increased IgE-antibodies to Staphylococcus aureusenterotoxins in patients with COPD. Respiratory Medicine 2004; 98:858–64.
  14. Cortellini G, Spadolini I, Patella V, Fabri E, Santucci A, Severino M. Sublingual immunotherapy for Alternaria-induced allergic rhinitis: a randomized placebo-controlled trial. Ann of Allergy, Asthma and Immunol 2010; 105(5):382-86.
  15. Wachholz P.A, Durham S.R. Mehanisms of immunotherapy: IgG revizited.  Cur Opin Allergy Clin Immun 2004; 4(4):313-18.
  16. Moote W, Kim H. Allergen-specific immunotherapy. Allergy Asthma Clin Immunol. 2011; 7(Suppl 1): S5. doi:  10.1186/1710-1492-7-S1-S5.
  17. Frew AJ. Allergen immunotherapy. J Allergy Clin Immunol 2010; 125 (2 Suppl 2):S306–13.
  18. Canadian Society of Allergy and Clinical Immunology. Immunotherapy Manual. Fall. 2010.
  19. Allergen immunotherapy: a practice parameter second update. Joint Task Force on Practice Parameters; American Academy of Allergy, Asthma and Immunology; American College of Allergy, Asthma and Immunology; Joint Council of Allergy, Asthma and Immunology. J Allergy Clin Immunol 2007; 120(3 Suppl):S25–85. 

The fully formatted PDF version is available.       

Download Article

Int J Biomed. 2015; 5(2):71-75. © 2015 International Medical Research and Development Corporation. All rights reserved.