RESUMEN
Vocal cord dysfunction (also called paradoxical vocal cord motion) or paradoxical vocal fold motion (PVFM) is an event elicited by specific and nonspecific triggers in which its diagnosis is limited by the restricted number of available functional tests. This study was designed to appreciate the contribution of the spirometric changes elicited by the allergen-specific nasal provocation test (NPT) performed with Dermatophagoides pteronyssinus for the diagnosis of PVFM in subjects with known sensitization to this allergen. In total, 63 subjects with allergic rhinitis who had previously been shown to be sensitized to D. pteronyssinus and who had experienced one or more episodes of inspiratory shortness of breath underwent two spirometric tests, one before (pre-NPT) and another 15 minutes after the allergen-specific NPT (post-NPT). The forced inspiratory vital capacity (FIVC), forced inspiratory volume in 2 seconds (FIV2), and the ratio between the FIV in 1 second and FIVC (FIV1/FIVC) were measured by spirometry. The morphology of the post-NPT inspiratory loop was compared with the pre-NPT inspiratory loop. We found that 18 subjects (28.5%) showed alterations suggestive of PVFM on post-NPT spirometry (e.g., truncation and/or flattening of the inspiratory loop). The mean differences between the pre-NPT and post-NPT values for the whole group were significant using a two-tailed paired t-test for the FIVC (4.1; 95% confidence interval [CI95%], 1.4-6.8), FIV1/FIVC ratio (2.7; CI95%, 0.05-5.3), and FIV2 (7.2; CI95%, 3.4-11). Allergen-specific NPT combined with spirometry is useful to show allergen-specific laryngeal hyperresponsiveness in allergic subjects with PVFM. Brazilian clinical trial registry platform (Plataforma Brasil, CAAE 07971212.0.0000.5480).
Asunto(s)
Disnea/diagnóstico , Pruebas de Provocación Nasal , Rinitis Alérgica Perenne/diagnóstico , Espirometría , Disfunción de los Pliegues Vocales/diagnóstico , Adolescente , Adulto , Animales , Antígenos Dermatofagoides/inmunología , Brasil , Dermatophagoides pteronyssinus/inmunología , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
OBJECTIVE: To explore the use of ß-lactoglobulin polymerized using microbial transglutaminase and heating to identify whether protein polymerization could reduce in vivo allergenicity and maintain in vitro and ex vivo immunoreactivity for use in tolerance-induction protocols. METHODS: Based on previous protocols applied in mice and children, we performed in vivo challenges (using a skin prick test) with native and polymerized ß-lactoglobulin in adult patients with an IgE-mediated allergy to plactoglobulin. In vitro humoral immunoreactivity was analyzed using immunoblotting. Cell-mediated immunoreactivity was analyzed using ex vivo challenges with native and polymerized ß-lactoglobulin and monitored by leukocyte adherence inhibition tests. RESULTS: The skin tests demonstrated that there was a significant reduction in immediate cutaneous reactivity after polymerization. Polymerization did not decrease the immunoblotting detection of s-IgE specific to ß-lactoglobulin. Cell-mediated immunoreactivity, as assessed by ex vivo challenges and leukocyte adherence inhibition tests, did not exhibit significant differences between leukocytes challenged with native versus polymerized ß-lactoglobulin. CONCLUSIONS: The polymerization of ß-lactoglobulin decreased in vivo allergenicity and did not decrease in vitro humoral or ex vivo cell-mediated immunoreactivity. Therefore, we conclude that inducing polymerization using transglutaminase represents a promising technique to produce suitable molecules for the purpose of designing oral/ sublingual tolerance induction protocols for the treatment of allergies.
Asunto(s)
Cisteína/inmunología , Tolerancia Inmunológica/inmunología , Lactoglobulinas/inmunología , Hipersensibilidad a la Leche/inmunología , Transglutaminasas/inmunología , Adolescente , Adulto , Anciano , Alérgenos/inmunología , Estudios de Casos y Controles , Cisteína/química , Femenino , Calefacción , Humanos , Immunoblotting , Inmunoglobulina E/sangre , Prueba de Inhibición de Adhesión Leucocitaria , Masculino , Persona de Mediana Edad , Hipersensibilidad a la Leche/prevención & control , Polimerizacion , Pruebas Cutáneas , Estadísticas no Paramétricas , Transglutaminasas/química , Adulto JovenRESUMEN
OBJECTIVE: To explore the use of β-lactoglobulin polymerized using microbial transglutaminase and heating to identify whether protein polymerization could reduce in vivo allergenicity and maintain in vitro and ex vivo immunoreactivity for use in tolerance-induction protocols. METHODS: Based on previous protocols applied in mice and children, we performed in vivo challenges (using a skin prick test) with native and polymerized β-lactoglobulin in adult patients with an IgE-mediated allergy to plactoglobulin. In vitro humoral immunoreactivity was analyzed using immunoblotting. Cell-mediated immunoreactivity was analyzed using ex vivo challenges with native and polymerized β-lactoglobulin and monitored by leukocyte adherence inhibition tests. RESULTS: The skin tests demonstrated that there was a significant reduction in immediate cutaneous reactivity after polymerization. Polymerization did not decrease the immunoblotting detection of s-IgE specific to β-lactoglobulin. Cell-mediated immunoreactivity, as assessed by ex vivo challenges and leukocyte adherence inhibition tests, did not exhibit significant differences between leukocytes challenged with native versus polymerized β-lactoglobulin. CONCLUSIONS: The polymerization of β-lactoglobulin decreased in vivo allergenicity and did not decrease in vitro humoral or ex vivo cell-mediated immunoreactivity. Therefore, we conclude that inducing polymerization using transglutaminase represents a promising technique to produce suitable molecules for the purpose of designing oral/ sublingual tolerance induction protocols for the treatment of allergies.