Day 1 :
Keynote Forum
Hugo P S Van Bever
National University of Singapore, Singapore
Keynote: Childhood food allergy and intolerance
Biography:
Hugo P S Van Bever has completed his medical studies at the State University of Ghent, Belgium (1971-1978) and did his training in Pediatrics at Children’s Hospital, State University of Ghent, Belgium (1978-1983). Following that he became Resident in Pediatric Allergy and Pulmonology, University of Antwerp, Belgium (1984-1993). He was the Associate Professor in Pediatric Allergy and Pulmonology, University of Antwerp, Belgium (1993-1997) and Professor in Pediatric Allergy and Pulmonology, University of Antwerp, Belgium (1997-2001). He was also the Head of the Department of Pediatrics, University of Antwerp, Belgium. He has joined the National University Singapore as Professor, Senior Consultant and Head of Pediatric Allergy and Immunology, the Department of Pediatrics in June 2002. He is currently an active Member of the Board of APAPARI, in which he is responsible for research and education in pediatric allergy, organizing APAPARI workshops in different Asian countries.
Abstract:
Since the beginning of this century, Food Allergy (FA) has been increasing worldwide and its increase is considered as the second allergy wave. Common foods involved in Singapore are egg (infants), peanuts (preschoolers-rapidly increasing) and seafood (older children-cross-reactivity with house dust mites). Mechanisms are diverse (especially in cow’s milk allergy). The best studied model is the IgE-mediated FA. New findings on FA include the role of transcutaneous sensitization (in children with eczema) and studies on primary prevention of FA, showing that early exposure (and not avoidance) might be the way to go. FA is still a difficult and confusing issue, mainly because FA is still surrounded with many stories, non-scientific data and superstition, leading to misdiagnosis and mistreatment. Furthermore, various concepts of FA are understood wrongly and therefore, approached wrongly, including its difference with food intolerance (usually being an enzymatic problem). In Singapore, often parents come to the clinic with the request to test their child for food allergy because of vague symptoms such as bad school results, sleep problems or tummy pain. Most of these children have no FA and other causes (often psychological causes) are involved. Sometimes parents persist in their search for FA, ending up with all kind of non-scientific diagnostic tests and extensive diets (on the internet), leading to malnutrition and more psychological distress in the child. Moreover, obtaining an accurate picture of the burden of FA is hampered by a lack of uniform, population-based methodologies that incorporate the gold-standard diagnostic method, which is the double-blind, placebo-controlled oral food challenge. For example, self-reported FA ranged from 3% to 35%, which likely reflects study limitations of self-report, varied definitions of FA, and true population variation. Prevalence studies based on incorporation of appropriate food challenges are limited. However, based on these criteria the true prevalence of FA is estimated to be between 1% and 8%, being higher in children than in adults. FA should be approached scientifically. Only this approach will help children and parents appropriately and will avoid useless interventions (extensive diets) which can have a negative effect on the child’s general health.
Keynote Forum
Hongwen Zhang
Second Xiangya Hospital of Central South University, China
Keynote: Clinical classification and treatment of cesarean scar pregnancy
Biography:
Hongwen Zhang is a Professor at The Second Xiangya Hospital of Central South University, Head of the Gynecology and Obstetrics Department. He has nearly 40 years of clinical experience, skilled in gynecologic inflammation, female diseases, gynecological oncology, uteroscope and laparoscope surgery. He is first to perform research on cesarean scar pregnancy in China, then, concluded the clinical classification and treatment of cesarean scar pregnancy.
Abstract:
Without timely discovery and treatment, early live Cesarean Scar Pregnancy (CSP) can cause hemorrhage, uterine rupture or excision and in extreme cases, loss of fertility or death. This study explored the significance of early diagnosis and treatment algorithms for early live CSP. Twenty-three (23) patients with early live CSP who were hospitalized at the Second Xiangya Hospital of Central South University from June 2012 to July 2013 were retrospectively analyzed. The patients were selected according to the number of days since the last menstrual period, the color Doppler ultrasound results, the β-HCG values and the thickness of the lower uterine myometrium. Ultrasound-guided evacuation and Foley balloon compression hemostasis were conducted directly in the lower uterine segment to stop the bleeding. All 23 patients were cured and their uteri and fertility were conserved. Timely and proper treatment algorithms can yield satisfactory outcomes in the treatment of CSP.
- Asthma | Allergy and Immunology | Asthma Stages | Public Health Emergency Medicine
Location: Seletar Room 1, Level 3
Session Introduction
Nan Wang
Xi’an Jiaotong University, China
Title: The MRGPRX2 related pseudo-allergy was inhibited by several compounds from traditional Chinese medicine
Biography:
Nan Wang is an Associate Professor in Xi’an Jiaotong University. She has her expertise in allergic disease and anti-allergy drug discovery. She is currently focused on allergic asthma and mast cell related diseases.
Abstract:
Pseudo-allergic reactions; adverse, non-immunologic, anaphylaxis-like sudden onset reactions mediated through an IgE-independent pathway are activated by various basic compounds and occur at least as frequently as IgE-mediated reactions to drugs. A large family of G protein coupled receptors (Mas-related genes, MRGPRS) is closely related to pseudo-allergies. However, few therapies can directly target pseudo-allergies and related MRGPRS. Chinese herbal medicine has a long history in China and is still widely used owing to its specific therapeutic effect, broad indications, safety and convenience. Cell Membrane Chromatography (CMC) is an effective new method to directly screen and identify the target components from a complex system and has been widely used in recent years. Isoliquiritigenin (ISO) and Saikosaponin A (SSA) were screen from traditional Chinese medicine injection using a mast cell CMC system. We examined the effect of SSA and ISO on both IgE-independent and IgE-dependent responses using PCA and active systemic anaphylaxis models as well as in vitro cultured mast cells. We also evaluated whether the anti-allergy effect is related to MRGPRS by using in vitro MRGPRX2-expressing HEK293 cells. Both SSA and ISO could also dose-dependently inhibit C48/80-induced MRGPRX2-expressing HEK293 cell activation. This study provided a new sight on pseudo-allergy and its therapy.
Seung Heon Shin
Catholic University of Daegu, South Korea
Title: Effect of microencapsulated essential oil from Chamaecyparis obtusa on monocyte-derived dendritic cell activation and CD4+ T cell polarization
Biography:
Seung Heon Shin has graduated from Kyung Pook National University, School of Medicine, Daegu, South Korea. He is working as a Professor of Otorhinolaryngology, Catholic University of Daegu, School of Medicine, South Korea. He is a Member of Korean Society of Otorhinolaryngology Head & Neck Surgery, Korean Rhinology Society, International Rhinologic Society and Korean Society of Allergy & Asthma.
Abstract:
The essential oil of Chamaecyparis obtusa (C. obtusa) which is used in soap, toothpaste and aromatic agents has been known to have anti-inflammatory properties. In this study, we investigated the effects of microencapsulated C. obtusa essential oil on airborne fungus-induced Dendritic Cell (DC) activation and Th immune responses. We stimulated monocyte-derived DCs with Alternaria alternate and Lipopolysaccharide (LPS). To determine the anti-inflammatory effects, we pre-treated DCs with various concentrations of microencapsulated C. obtusa essential oil and collected the supernatants to measure Interleukin-6 (IL-6) and Tumor Necrosis Factor-alpha (TNF-α) and we determined the expression of cell surface molecules. The effects of the essential oil on CD4+ T cells polarization was determine by culturing stimulated DCs and autologous CD4+ T cells. Alternaria enhanced the production of IL-6 and TNF-α from DCs, and pretreating DCs with 0.001, 0.01, and 0.05% of the essential oil significantly inhibited their production. Increased CD80 and CD86 expression by Alternaria was significantly inhibited with 0.05% of the essential oil. Alternaria-induced IL-5, IL-10, and interferon-gamma from CD4+ T cells were significantly inhibited with C. obtusa essential oil in a dose dependent manner. C. obtusa influenced both Alternaria- and LPS-induced Th1 and Th2 polarization of CD4+ T cells. These results suggest a novel pharmacological use for C. obtusa essential oil to treat inflammatory airway diseases.
Agata Wawrzyniak
Military Institute of Medicine, Poland
Title: The influence of Environmental Tobacco Smoke (ETS) on immune response in children with asthma
Biography:
Agata Wawrzyniak is a Physician at the Department of Pediatrics, Nephrology and Allergology, Military Institute of Medicine, Poland. She is currently pursuing specialization in Pediatrics. Her scientific interests are focused on the immunology of allergic diseases.
Abstract:
Introduction: There has been an increase incidence of allergic diseases over the past several decades. For this reason, potentially modifiable factors that may influence the on immunological processes should be sought.
Aim: The aim of the study was to evaluate the influence of ETS on the immune response in asthma: Blood lymphocyte phenotype (CD3, CD4, CD8, CD19, CD16/56, CD3 anti HLA-DR), T-regulatory (Treg) percentage and cytokine profile (anti-inflammatory: IL-4, IL-10, TGF-β and proinflammatory: IL-1, IL-2, IL-6, IL-17A, IL-22, TNF and IFN).
Material & Methods: The study group consisted of 43 children with stable atopic asthma. The control group consisted of 37 children without atopic disease. ETS was assessed by measuring urinary cotinine concentration by ELISA. The phenotype of peripheral blood lymphocytes, percentage of Treg and interleukin concentration were determined by the cytometric method.
Results: The following results were obtained; higher levels of cytokine IL-1 and lower IL-4 were observed in children with asthma ETS (+) compared to children with asthma ETS (-) (respectively 0.40±0.58 pg/ml vs. 0.08±0.24 pg/ml, p=0.02; 1.19±0.72 pg/ml vs. 0.68±0.77 pg/ml, p=0.04). In the control group, higher levels of IL-4 were found in children ETS (+) compared to children ETS (-) (4.84±8.9 pg/ml vs. 1.53±0.8 pg/ml, p=0.05). Lower percentage of Treg were found in children with asthma ETS (+) compared to healthy children ETS (+) (0.68%±0.31 pg/ml vs. 1.02±0.43 pg/ml; p=0.03).
Conclusion: Exposure to tobacco smoke has immunomodulatory effects; exposure to tobacco smoke in children with asthma may be associated with the development of worse prognostic neutrophilic inflammation. Exposure to tobacco smoke of healthy children may be associated with the development of eosinophilic inflammation, which in the future may lead to allergies.
- Special Session
Location: Seletar Room 1, Level 3
Session Introduction
Hugo P S Van Bever
National University of Singapore, Singapore
Title: Approach to urticaria in children
Biography:
Hugo P S Van Bever has completed his medical studies at the State University of Ghent, Belgium (1971-1978) and did his training in Pediatrics at Children’s Hospital, State University of Ghent, Belgium (1978-1983). Following that he became Resident in Pediatric Allergy and Pulmonology, University of Antwerp, Belgium (1984-1993). He was the Associate Professor in Pediatric Allergy and Pulmonology, University of Antwerp, Belgium (1993-1997) and Professor in Pediatric Allergy and Pulmonology, University of Antwerp, Belgium (1997-2001). He was also the Head of the Department of Pediatrics, University of Antwerp, Belgium. He has joined the National University Singapore as Professor, Senior Consultant and Head of Pediatric Allergy and Immunology, the Department of Pediatrics in June 2002. He is currently an active Member of the Board of APAPARI, in which he is responsible for research and education in pediatric allergy, organizing APAPARI workshops in different Asian countries.
Abstract:
Studies in children have shown that urticaria occurs in about 5% to 7% of non-selected preschool children and in 17% of young children suffering from an underlying atopic disease. Acute urticaria (i.e. less than six weeks) is more frequently seen in young people and children and is usually linked to atopy, while chronic urticaria more frequently occurs in adults, mainly in middle-aged, non-allergic women. If chronic urticaria presents in children, an underlying immunologic or auto-immune disorder should be ruled out. A direct etiological cause can be suspected in >50% of acute urticaria, while this is only the case in about 20% in chronic urticaria. Acute urticaria in children can be caused by a number of triggers including allergens (food and inhalants), medication and infections (viral, bacterial and parasitic infections). There is still some confusion on the classification of urticaria. Most authors divide into three main types: Acute, chronic and physical but other classifications have been proposed. Children with chronic urticaria, in particular those having systemic symptoms (fever, weight loss, joint pain), deserve a diagnostic work-up. In these children it is important to rule out systemic diseases, malignancy, endocrine disorders and chronic infections. In children with persistent and severe painful lesions, without pruritus, urticarial vasculitis needs to be ruled out by skin biopsy. In older children suffering from (recurrent) angioedema without concomitant urticaria and sometimes presenting are recurrent attacks of abdominal pain, C1 esterase inhibitor deficiency should be excluded, even if the family history is negative (i.e. acquired deficiency). Except for the patients for whom an avoidable cause can be identified (such as food), treatment of urticaria is symptomatic. Treatment depends on the severity of symptoms. Scattered or mild hives are self-limited and usually require no treatment or at most a mild antihistamine as needed. In a number of comparative trials between the various non-sedating (2nd generation) agents, no significant difference in efficacy has been noted. All the agents have good safety profiles in children. Cetirizine has the most extensive safety profile in infants, showing efficacy in acute urticaria. In cases of severe urticaria immuno-modulatory treatments might be necessary such as systemic corticosteroids or anti-IgE.
- Pediatric Pulmonology | Internal Medicine | Pulmonary and Critical Care
Location: Seletar Room 1, Level 3
Session Introduction
Agnieszka Lipinska-Opalka
Military Institute of Medicine, Poland
Title: The influence of external factors: Vitamin D level and passive smoking on the severity of atopic dermatitis in children
Biography:
Agnieszka Lipinska-Opalka is a Physician in Allergology, Nephrology and Pediatric Department in the course of Pediatric Residency. She earned a Medical degree from the Medical University of Lublin, Poland. Her scientific interests include all aspects of allergic diseases with particular interests in immuno-pathogenesis of atopic dermatitis.
Abstract:
Background: Atopic Dermatitis (AD) is one of the most common inflammatory skin diseases in children and poses a significant burden on their quality of life. Due to these facts and worldwide rising in the prevalence of allergic diseases, there is an urgent need to look for new factors affecting the course of atopic dermatitis in children.
Aim: The aim was to assess, whether vitamin D level and Exposure to Tobacco Smoke (ETS) have an influence on the course of atopic dermatitis in children and their immune system (natural regulatory T cells, lymphocytes: CD3, CD4, CD8, CD4/CD8, CD19, CD16/56, CD3 anti-HLA-DR).
Methods: The study consisted of 49 children with atopic dermatitis. The course of disease was evaluated by SCORing Atopic Dermatitis (SCORAD) index. Vitamin D concentration was determined by chemiluminescent immunoassay technology, ETS was assessed by measuring urinary cotinine concentration by ELISA. The flow cytometry was used to evaluate the phenotype of lymphocytes.
Results: The vitamin D level was significantly lower in moderate and severe AD compared with mild (p=0.02). There was no significant correlation between ETS and the course of disease. A higher percentage of Natural killer T (NKT) cells was found in children with low concentration of vitamin D in serum compared to patients with optimal level (p=0.04). There were no significant differences in the course of atopic dermatitis between patients exposed to tobacco smoke and non-ETS group. A lower percentage of CD3 and CD4 lymphocytes was observed in patients with atopic dermatitis exposed to passive smoking compared to not exposed children (respectively p=0.04 and p=0.03).
Conclusion: The data suggest that vitamin D deficiency may be inversely associated with severity of atopic dermatitis in children. The study revealed that passive exposure to tobacco smoke may impair the number of CD3 and CD4 lymphocytes in children with atopic dermatitis.
Silvio Manfredo Vieira
Yale University, USA
Title: Spontaneous translocation of a gut pathobiont drives autoimmunity
Biography:
Silvio Manfredo Vieira is a creative and independent Scientist with a robust background in the field of immunology, pharmacology, therapeutics and autoimmunity. He has a strong experience in drug discovery projects and a proficiency in developing and implementing strategies to identify and validate novel biomarkers for investigational therapies in the application of disease understanding. He has expertise in human and translational research and a deep experience in cellular and molecular immunology.
Abstract:
Regardless of the multiple associations between microbiota and immune mediate diseases, its contribution to the pathogenesis of autoimmunity is largely unknown. Here we show that a gut commensal, E. gallinarum reaches lymphocytes beyond the gut barrier, as well as liver and spleen, in the (NZWxBXSB) F1 model of autoimmunity. Oral vancomycin treatment prevented mortality in this model, suppressed growth of E. gallinarum in tissues, lowered pathogenic autoantibodies, Th17 and Tfh cells. Hepatocyte-commensal co-cultures revealed induction of IFN-, TNF-, IL-1, AhR, CYP1A1 and CYP1A2. E. gallinarum monocolonization in C57BL/6 germ-free animals also led to translocation and induction of autoantibodies as well as increase Plasmacytoid Dendritic Cells (pDCs) and Th17 responses in small intestinal lamina propria. Additionally E. gallinarum altered ileal molecules related to barrier function (occludin, claudins, PLVAP, Axin2), the mucus layer (mucin, FUT2), antimicrobial defense (REG3B, DEFA2) and inflammation (CXCR2, AhR/CYP1A1, ENPP3). Species-specific PCR of liver biopsies from Autoimmune Hepatitis (AIH) and Systemic lupus erythematosus (SLE) patients also revealed E. gallinarum, suggesting similar processes in humans. Outstandingly, human hepatocyte-commensal co-culture demonstrated production of autoimmune-promoting factors. Consistent with enhanced adaptive immune responses to E. gallinarum, AIH and SLE patients showed increased serum titers against its RNA, which may act as a potential TLR7/8 stimulus. Collectively, these data indicate that a human pathobiont translocates spontaneously to promote autoimmunity in genetically predisposed hosts, broadening our understanding of autoimmune host-microbiota interactions.
Biography:
Abstract:
Interferon gamma (IFN)-γ confers crucial immune surveillance positively for immunomodulation (such as macrophage activation, antigen presentation and T cell differentiation), antimicrobial [such as antiviral replication, microbial killing and Major Histocompatibility Complex (MHC) induction] and anticancer activity (such as growth inhibition, cytotoxicity and immune priming). Patients with adult-onset immunodeficiency, negative in Human Immunodeficiency Virus (HIV) infection, show defects in IFN-γ signaling and immune surveillance against mycobacterial infection. In addition to genetic defects, the presence of neutralizing anti-IFN-γ autoantibody (autoAb) is speculated. In the first part, detection of anti-IFN-γ autoAb and characterization of its neutralizing activity were carried out. First, Enzyme-linked Immunosorbent Assay (ELISA)-based colorimetric assays and immunoblotting was utilized for detecting autoAbs. Antibody-antigen reactivity and epitope clarification showed different patterns among these patients. Results showed the blockade of IFN-γ-activated Signal Transducer and Activator of Transcription (STAT)-1 activation and Interferon Regulatory Factor (IRF1) transactivation by patient serum containing autoAbs. Furthermore, IFN-γ-regulated inflammation, chemokine production and cytokine production after T cell activation were also blocked. These results provide potential methods for detecting anti-IFN-γ autoAb and for characterizing the blockade effects of autoAbs on IFN-γ signaling and bioactivity. For the second part, the blockade effect of that antibody on IFN-γ-regulated antimicrobial activity will be detected. We will perform a model of monocyte-derived type-1 macrophage by using Phorbol-12-Myristate-13-Acetate (PMA) and IFN-γ induction. Furthermore, blockade effect of type-1 macrophage differentiation and bacterial phagocytosis/killing by anti-IFN-γ autoAbs will be performed by detection of inhibition on cell marker expression, attachment/engulfment phase and Reactive Oxygen Species (ROS)/Nitric oxide (NO) production. The results provide evidence of blockade effects of IFN-γ against antimicrobial activity by anti-IFN-γ autoAbs.
Sharipova О Ð
Samarkand State Medical Institute, Uzbekistan
Title: Evaluation of sexual development in patients with chronic bronchitis
Biography:
Sharipova O A has completed her PhD from Tashkent Pediatric Medical Institute, Uzbekistan. She is working as an Associate Professor of the Department of Pediatrics and Medical Genetics. She has published more than 30 papers in Uzbekistan and international reputed journals.
Abstract:
The study included 84 children with chronic bronchitis in the age from 11 to 16 years. Of these, 37 (35.7%) were girls and 47 (64.3%) were boys. To check the status of sexual development in boys we carried out genitometric analysis and evaluation of the stages of sexual development by J.M. Tanner (1967). It has been revealed that the boys with chronic bronchitis have reliable lessening in size of penis and testicles. When evaluating the sexual development of girls we paid attention to the pubis and axillary hair distribution, the growth of the mammary glands, for a period of menarche. It is revealed that by the age of 16 in 8 (25%) patients with chronic bronchitis mammary glands were at Ma3 stage and in 24 (75%) did not exceed Tanner II degree. By the age of 16 the sexual body hair was in P2Ax2 stage in 26 (81.3%) and in P3Ax2 stage was only in 6 (18.7%) sick girls. Only 5 (15.6%) girls aged 14-16 had steady menstrual cycle. Thus, our findings allow us to draw a conclusion about the negative impact of chronic bronchitis on sexual development, which requires the development of purposeful practical measures in this direction. In general, all patients maintained a sequence of development of secondary sexual characteristics, but the rates of development of secondary sexual characteristics in comparison with healthy peers are different, i.e. in patients with chronic bronchitis process of puberty occur gradually and does not complete until the end of puberty.