Skin Test Reactivity to Indoor Allergens Correlates with Asthma Severity in Jeddah, Saudi Arabia

<p>Abstract</p> <p>Background</p> <p>There is increased emphasis on the role of indoor allergens in asthma.</p> <p>Objective</p> <p>To examine the spectrum of skin test reactivity (sensitization) to indoor allergens and its correlation with asthma severity in Jeddah, Saudi Arabia.</p> <p>Methods</p> <p>Asthmatic patients referred to the allergy clinic at King Abdulaziz University Hospital (KAUH) in Jeddah were studied. Measures of clinical severity were adopted from national and international asthma guidelines. The degree of sensitization was assessed by the wheal size (positive ≥ 3 mm) from standard skin-prick tests for the following common indoor inhalant allergens: house dust mites <it>(Dermatophagoides pteronyssinus [Dp] and Dermatophagoides farinae [Df])</it>, cat, and cockroach.</p> <p>Results</p> <p>Skin test results from 113 of 151 (74.8%) asthmatic patients were positive for one or more allergens. The patients' ages ranged between 9 and 63 years (mean, 30 ± 13 years), and females constituted 65.5%. The predominant asthma severity level was moderate persistent (55.8%), followed by mild persistent (33.6%). The prevalences of sensitization to indoor allergens were as follows: <it>Dp</it>, 87% (3-25 mm [mean, 7 mm]); <it>Df</it>, 84% (3-20 mm [mean, 7 mm]); cat, 44% (3-15 mm [mean, 6 mm]); and cockroach, 33% (3-12 mm [mean, 4 mm]). Higher asthma severity levels were significantly correlated with the number of allergens with positive sensitization (<it>R </it>= 0.3, <it>p </it>< .001) and with the degree of sensitization to house dust mites (<it>Dp </it>[degrees of freedom {<it>df</it>} = 16, <it>p </it>< .001] and <it>Df </it>[<it>df </it>= 17, <it>p </it>< .01]) but not to cat (<it>df </it>= 10, <it>p </it>< .24) or cockroach (<it>df </it>= 8, <it>p </it>< .36).</p> <p>Conclusions</p> <p>Immunoglobulin E-mediated skin test reactivity to indoor allergens, particularly to house dust mites, was common in asthmatic patients from Jeddah at KAUH. Increased sensitization was associated with higher levels of asthma severity, which is compatible with the literature. This emphasizes the importance of identifying sensitization to relevant indoor allergens in the clinical evaluation of asthmatic persons.</p

Phytopharmacy Research in the Context of Saudi Arabian Healthcare – the Example of Nigella sativa L. Efficacy on Asthma Inflammation and Outcomes

BACKGROUND: Clinical research using herbal medicines requires specific considerations such as production method, which leads to chemical and pharmacological variability. Asthma is a leading chronic respiratory disease, remains sub-optimally controlled despite conventional costly treatments. Nigella sativa L. (NS) is a traditional herbal treatment for asthma, but lacking well-established scientific evidence. Objectives To develop an integrated research strategy incorporating preclinical and clinical research focusing on NS use in asthma by employing a chemically and pharmacologically well-characterised NS preparation in a well-designed clinical trial. METHODS: Distinct NS preparations were chemically characterised for thymoquinone (main active compound) concentration by High Performance Liquid Chromatography. Human T-lymphocyte, monocyte and A549 epithelial cells were utilised to assess the in-vitro anti-inflammation/immunomodulatory activity of NS preparations. The most potent and suitable NS preparation was clinically evaluated for efficacy as add-on treatment for asthmatics in a phase-II randomised double-blind placebo-controlled clinical trial (RDBPCT). Asthma Control Test (ACT) was the primary outcome. Pulmonary function, blood eosinophils and serum inflammatory markers were secondary outcomes. RESULTS AND DISCUSSION: Ten different NS preparations were obtained, showing variability in thymoquinone concentration and in-vitro anti-inflammatory/immunomodulatory activities. Two thymoquinone-rich oily preparations (a super critical fluid extract and a commercial product registered in Saudi Arabia) showed the best in-vitro activity via inhibiting inflammatory cytokines in human cellular models. In the RDBPCT including 80 asthmatics, the commercial product capsules showed significant improvements in ACT, eosinophilia and some serum cytokines without serious side effects. CONCLUSION: This project addressed important requirements to optimise clinical research using herbal medicines particularly for NS in asthma. Preclinical research on the chemistry and activity of the investigational NS product were the basis for the clinical trial. The RDBPCT revealed a higher level of evidence for the add-on NS treatment in asthma within the Saudi healthcare. This strategy is suggested for future clinical phytotherapeutic research

Comparative Immunomodulatory Activity of Nigella sativa L. Preparations on Proinflammatory Mediators: A Focus on Asthma

Introduction: A range of traditional and commercial preparations of NS is frequently used in the treatment of several inflammatory diseases. Often, these preparations have poor preclinical characterization that may lead to variable pharmacological effects.Objective: To assess the in vitro effects of different chemically defined preparations of NS on some asthma-related mediators of inflammation.Methods: Different NS preparations were obtained by either seed extraction with a spectrum of solvents ranging from lipophilic to hydrophilic, or commercial products were collected. The TQ concentration of NS was analyzed by HPLC. Immunomodulatory activity was assessed by the release of mediators (IL-2, IL-6, PGE2) in primary human T-lymphocytes, monocytes, and A549 human lung epithelial cells.Results: Ten distinct NS preparations showed variability in TQ concentration, being highest in the oily preparations extract-7 (2.4% w/w), followed by extract-10 (0.7%w/w). Similarly, the release of mediators was varied, being greatest in extract-7 and 10 via significantly (&lt;0.05) suppressing IL-2, IL-6, and PGE2 in T-lymphocytes as well as IL-6 and PGE2 in monocytes. Also, PGE2 release in A549 cells was significantly enhanced by both extracts.Conclusion: The TQ concentration and in vitro activity were variable among the different NS preparations. TQ-rich oily NS preparations produced potent favorable immunomodulation in asthma inflammation and can be used in future studies

Medicinal benefits of Nigella sativa in bronchial asthma: A literature review

Nigella sativa L. (NS) seeds, known as black seed, is a spice and a traditional herbal medicine used in various diseases including bronchial asthma. This review aimed to assess the studies supporting the medicinal use of NS in asthma and to highlight future research priorities. Various medical databases were searched for the effects of NS and its active secondary metabolites in asthma inflammation and outcomes. There were fourteen preclinical studies describing multiple effects of NS in animal or cellular models of asthma including bronchodilation, anti-histaminic, anti-inflammatory, anti-leukotrienes and immunomodulatory effects. Furthermore, seven clinical studies showed improvements in different asthma outcomes including symptoms, pulmonary function and laboratory parameters. However, often these studies are small and used ill-defined preparations. In conclusion, NS could be therapeutically beneficial in alleviating airway inflammation and the control of asthma symptoms, but the evidence remains scanty and is often based on poorly characterised preparations. Accordingly, well-designed large clinical studies using chemically well characterised NS preparation are required. Keywords: Nigella sativa, Black seed, Asthma, Traditional medicine, Clinical studie

Asthma care: Structural foundations at primary health care at Al-Qassim region, Saudi Arabia

<b>BACKGROUND: </b> Proper structural foundations for asthma care at primary health care centers [PHCCs], are of essential importance, regarding its management. <b> OBJECTIVE: </b> To assess the adherence of PHCCs to the recommended structural foundation for asthma care. <b> MATERIALS AND METHODS: </b> 35 PHCCs were selected in a cluster random fashion. A questionnaire for structural standards was designed, based on the Saudi national protocol for the management of asthma (SNPMA). A physician and a nurse, each from PHCC, were trained for data collection.<b> </b> Structural facilities deficiency was arbitrarily classified into: least deficient (>75&#x0025;), moderate to severe deficient (25-75&#x0025;) and most deficient (&#60; 25&#x0025;).<b> RESULTS: </b> The<b> </b> total population registered, was 131190 [urban: 85701 (65.4&#x0025;), rural: 45489 (34.6&#x0025;)]. Total registered asthmatics was 4093 [urban: 2585 (63.1&#x0025;), rural: 1508 (36.9&#x0025;)]. The asthma prevalence rate did not differ significantly between urban (3&#x0025;) and rural (3.3&#x0025;) areas<b> . </b> Structural facilities distribution for asthma care, did not significantly vary among urban and rural PHCCs and none of them fulfilled 100&#x0025; of the desired standards. The least deficient, were the availability of asthma register and salbutamol, in its various forms. The moderately to severely deficient were the SNPMA, peak flow meter (PFM), nebulizer system, Theophylline and systemic corticosteroid. However, they were most deficient in trained doctors and nurses, record charts for Peak flow meter, spacer, educational material and inhalers of corticosteroid or cromoglycate.<b> CONCLUSION: </b> Proper structural foundations for asthma care at PHCCs, at AL-Qassim region, were below the desired national standards. They were most deficient in trained doctors and nurses, record charts for PFM, spacers, educational material and anti-inflammatory inhalers. Future health directorate strategies have to provide such beneficial interventions for proper asthma care

The Prevalence and Trends of the Early Introduction of Cow Milk to Newborns at Tertiary Care Center: A Risk of Atopy

Although all health organizations recommend exclusive breastfeeding (EBF), few neonates meet these recommended goals. The early intake of cow milk formulas (CMFs) has been linked to several childhood illnesses, including atopic diseases. Therefore, this study aimed to evaluate the prevalence of early exposure to CMFs in the nursery of a tertiary care hospital in Jeddah, Kingdom of Saudi Arabia. A retrospective review was conducted on the medical records of feeding practices of neonates born in King Abdulaziz University Hospital (KAUH) at Jeddah, Kingdom of Saudi Arabia. Two months from each year (May and December) were selected over the last five years. Approval from the ethical research committee at KAUH was obtained. Eight hundred and ninety-four different neonate files were reviewed. Four hundred and eighty-seven (54.5%) were males. Out of the total of 894, 838 (93.7%) newborns experienced an early introduction to CMFs, 797 (89.1%) received mixed CMF and breast milk, 41 (4.6%) received CMF only, and 56 (6.3%) received exclusive breastfeeding (EBF). Surprisingly, EBF has declined over time, from 39% in May 2016 to 1% in December 2020. The prevalence of early exposure to CMF was very high in newborns at KAUH nursery, and this prevalence was trending upwards. Extensive teaching programs on EBF and allergy prevention for mothers and related health care providers are highly recommende

The prevalence of allergic rhinitis and atopic markers in obstructive sleep apnea

Allergic rhinitis (AR) related inflammation might worsen the severity of obstructive sleep apnea (OSA), however, the relationship between the two disorders remains controversial. Our aim was to determine the prevalence of AR and atopic markers in OSA. This cross-sectional study recruited participants with sleep-related complaints referred to a sleep center from February 2013 to June 2014. The diagnosis of OSA was based on the Berlin questionnaire (BQ) followed by confirmatory polysomnography (PSG). The diagnosis of AR was made via focused history and clinical examination and was confirmed by measuring atopic markers. OSA was diagnosed in 97 out of 157 adults attending the sleep clinic (61.8%). There was a high prevalence of AR (52.6%) among OSA individuals. This was not significantly different from the frequency in the non-OSA individuals (p = 0.5). Elevated total immunoglobulin E (IgE; >100 K/μL), eosinophil count, and positive Phadiatop tests were found in individuals with OSA to be 37.1%, 11.3%, and 41.2%, respectively. Individuals without OSA have shown similar percentages. In our cohort, there was no significant difference in frequency of AR and atopy among participants with OSA compared to those without OSA