Allergy Screen和EUROLINE Atopy血清过敏原特异性IgE检测结果对比分析

目的对Allergy Screen与EUROLINE Atopy过敏原特异性免疫球蛋白E(specific immunoglobulin E,sIgE)检测结果进行一致性和等级相关性研究,为临床合理应用检测方法和解读检验结果提供依据。方法收集过敏性疾病患儿血清样本180份,其中男86例,女94例,年龄3~15岁。分别应用Allergy Screen法和EUROLINE Atopy法检测血清样本中树花粉、混合草、尘螨、猫毛、狗毛、屋尘、蟑螂、霉菌、牛奶、鸡蛋、牛肉、贝类、虾、蟹过敏原sIgE。结果两种检测方法Kappa分析得出:尘螨、牛奶、蟹三项一致性最高(Kappa值分别为0.846、0.845、0.813)。混合草、屋尘、蟑螂、霉菌、鸡蛋、虾等六种过敏原一致性较高(Kappa值分别为0.719、0.722、0.662、0.652、0.780、0.710)。树花粉、牛肉一致性中等(Kappa值分别为0.483、0.486)。猫毛、贝类一致性一般(Kappa值分别为0.392、0.389)。狗毛一致性较差(Kappa值为0.142)。两种检测方法过敏原sIgE的等级资料Spearman相关性分析显示:混合草、尘螨、屋尘、牛奶、鸡蛋、虾、蟹等7项相关性非常紧密(Spearman值分别为0.735、0.878、0.707、0.835、0.821、0.704、0.826),蟑螂、霉菌组合、牛肉等3项相关性紧密(Spearman值分别为0.670、0.689、0.445)。树花粉、猫毛、狗毛、贝类等4项相关性一般(Spearman值分别为0.389、0.324、0.237、0.311)。结论两种检测方法大部分项目过敏原sIgE不仅具有较强一致性,还具有非常紧密的等级相关性,二者均可用于一般过敏性疾病的筛查,临床医生和实验室应该综合分析,合理科学地选择检测方法。

鼻炎进程:从nonatopy到entopy,再到atopy

为了避免像把allergy翻译成变态反应给这个学科发展带来悲惨后果的发生,我决定文章使用entopy这个原汁原味的英文词汇,这个词的翻译还是留给后来的聪明之士吧!有些英文词汇真的很难翻译,简单的一个单词翻过来词不达意,比如说atopy和entopy,还有LAR等。为了避免逻辑上的错漏百出,澄清一下这几个词汇的内涵:①atopy,特应性状态,或变应原全身致敏状态(allergen sensitization),评估指标为皮肤点刺试验(SPT)阳性或血清sIgE阳性;atopy不等同于allergy,因为前者个体可能没有靶器官的相关症状,后者一定要有。②atopic rhinitis或atopic dermatitis,特应性鼻炎或特应性皮炎,伴随变应原全身致敏状态(atopy)的变应性鼻炎或皮炎,atopic等同于allergic,因为个体此时肯定有靶器官的相关症状才可以如此称呼。③entopy和LAR,非特应性状态或非变应原全身致敏状态下,个体出现与变应性鼻炎临床症状完全相同的疾病状态。评估指标为典型的鼻塞、喷嚏、流涕及鼻痒等症状,但SPT阴性或血清sIgE阴性。

伴有特应性素质的微小病变肾病的预后分析

目的 :探讨伴有特应性素质 (Atopy)的微小病变肾病 (MCNS)的病程和预后。方法 :对 45例伴有Atopy的 MCNS患儿进行了 4～ 10年 (7.5± 1.4年 )的随访。随访内容包括 :治疗效应、复发频度及最终预后等。结果 :该组患儿 6个月时频复发率为 5 7.8% ,高于 ISKDC无选择 MC群体 (2 8.6 % )。仅 5 %左右死于感染并发症或进展至慢性肾功能衰竭 ,与 ISKDC结果相仿。结论 :此型患儿具有较高的频复发率 ,但 90 %以上病例的远期预后良好 ,而对皮质类固醇初治无效应者提示预后较差 。

Pulmonary involvement and allergic disorders in inflammatory bowel disease

Inflammatory bowel disease (IBD) has been associated with either clinical or subclinical airway and parenchymal lung involvement and interstitial lung complications. Several studies have reported that atopy has a high prevalence in IBD patients. Overlapping allergic disorders seem to be present in both the respiratory and gastrointestinal systems. The purpose of this review is to update clinicians on recent available literature and to discuss the need for a highly suspicious approach by clinicians.

Food allergy in irritable bowel syndrome:The case of non-celiac wheat sensitivity

Irritable bowel syndrome(IBS) is one of the most common gastrointestinal disorders, having a prevalence of 12%-30% in the general population. Most patientswith IBS attribute their symptoms to adverse food reactions. We review the role of diet in the pathogenesis of IBS and the importance of dietary factors in the management of these patients. The MEDLINE electronic database(1966 to Jan 2015) was searched using the following keywords: "food", "diet", "food allergy", "food hypersensitivity", "food intolerance", "IBS", "epidemiology", "pathogenesis", "pathophysiology", "diagnosis", "treatment". We found 153 eligible papers; 80 were excluded because: not written in English, exclusive biochemical and experimental research, case reports, reviews, and research otherwise not relevant to our specific interest. We selected 73 papers: 43 original papers, 26 reviews and 4 letters to the editor. These papers focused on IBS pathogenesis, the association between IBS and atopy, and between IBS and food allergy, the relationship between IBS and non-celiac wheat sensitivity, the role of diet in IBS. Pending further scientific evidence, a cautious approach is advisable but the concept of food allergy should be included as a possible cause of IBS, and a dietary approach may have a place in the routine clinical management of IBS.

Helicobacter pylori infection and atopic diseases:Is there a relationship? A systematic review and meta-analysis

AIM: To review and conduct a meta-analysis of the existing literature on the relationship between Helicobacter pylori (H. pylori), atopy and allergic diseases.

Contribution of endoscopy in the management of eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a clinicopathological entity characterized by a set of symptoms similar to gastroesophageal reflux disease and eosinophilic infi ltration of the esophageal epithelium. EoE is an emerging worldwide disease as documented in many countries. Recent reports indicate that EoE is increasingly diagnosed in both pediatric and adult patients although the epidemiology of this new disease entity remains unclear. It is unclear whether EoE is a new disease or a new classification of an old esophageal disorder. Esophagogastroduodenoscopy (EGD) and biopsies with histological examination of esophageal mucosa are required to establish the diagnosis of EoE, verify response to therapy, assess disease remission, document and dilate strictures and evaluate symptom recurrence of EoE. Repeated endoscopies with biopsies are necessary for monitoring of disease progression and treatment effi cacy. EGD has a fundamental role in the diagnosis and management of EoE, forming an essential part of the investigation and follow-up of this condition. EoE is now considered a systemic disorder and not only a local condition with an important immunological back-ground. One of the aims of research in EoE is to study non-invasive markers, such as immune indicators found in plasma, that correlate with local presence of EoE in esophageal tissues. Studies over the next few years will provide new information about diagnosis, pathogenesis, endoscopic/histologic criteria, non-invasive markers, novel and more eff icacious treatments, as well as establishing natural history. Randomized clinical trials are urgently called for to inform non-invasive diagnostic tests, hallmarks of natural history and more eff icacious treatment approaches for patients with EoE. The collaboration between pediatric and adult clinical and experimental studies will be paramount in the understanding and management of this disease.

Helicobacter pylori and allergy: Update of research

Recently a lot of literature has been published about the possible preventive action of Helicobacter pylori(H. pylori) against allergy. The present review summarizes research data about the association between H. pylori and allergic diseases, as well as discusses possible hypotheses about the preventive action of H. pylori against atopy. There is evidence from observational studies to support a weak inverse association between prevalence of H. pylori infection and allergy. However, confounders like some unidentified socioeconomic factors, antibiotic use and others could bias the association. Although data from cohort studies point to a possible association of H. pylori with some of the allergic diseases, no definite proof for causal relationship has been clearly demonstrated yet. A biological mechanism proposed to explain the preventive action of H. pylori to allergy is reduced exposure to a major stimulus for the generation of Treg cells in individuals without H. pylori infection. In addition, H. pylori could be an indicator for changes in gut microbiome, reflecting the complex interaction between microbes and immune system.

Discrepancies between the responses to skin prick test to food and respiratory antigens in two subtypes of patients with irritable bowel syndrome

AIM:To compare the response to skin prick tests (SPTs) to food antigens (FAs) and inhalant allergens (IAs) in patients with two subtypes of irritable bowel syndrome (IBS) and healthy controls. METHODS:We compared the results of SPTs for IAs and FAs in 87 volunteers divided into three groups:diarrhea predominant IBS (D-IBS) GroupⅠ(n = 19), constipation predominant IBS (C-IBS) Group Ⅱ (n = 17), and normal controls Group Ⅲ (n = 51). RESULTS:Of the 285 tests (171 for FAs and 114 for IAs) performed in GroupⅠwe obtained 45 (26.3%) positive responses for FA and 23 (20.1%) for IA. Of the 153 tests for FA in Group Ⅱ, we obtained 66 (20.1%) positive responses, and of the 102 tests for IA, we obtained 20 (19.6%) positive responses. Of the 459 tests for FA performed in Group Ⅲ, we obtained 39 (84%) positive responses, and of the 306 for IA, we obtained 52 (16.9%) positive responses. The numbers of positive responses were not significantly different between the three groups, but in the D-IBS group, the number of SPTFA responses differed significantly from those for the other two groups (P < 0.01). CONCLUSION:Despite the small number of cases studied, the higher reactivity to FAs in GroupⅠcompared to Groups Ⅱ and Ⅲ adds new information, and suggests the presence of a possible alteration in intestinal epithelial function.

Eosinophilic ascites: A diagnostic and therapeutic challenge

Eosinophilic gastroenteritis(EGE) is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract. Depending on the dominant layer of infiltration it is classified into three types namely, mucosal, muscularis and subserosal. The most uncommon variant is the subserosal type characterized by primarily subserosal disease, eosinophilic ascites and peripheral hypereosinophilia. The clinical features are non-specific with history of atopic predisposition and allergy. Endoscopic biopsy is frequently non-diagnostic due to an uninvolved gastrointestinal mucosa rendering its diagnosis a challenge. The mainstay of diagnosis is peripheral hypereosinophilia and eosinophil-rich ascitic fluid on diagnostic paracentesis. Oral steroid therapy is usually the first line of treatment with dramatic response. Due to a propensity for relapse, steroid-sparing therapy should be considered for relapses of EGE. We report a case of subserosal EGE with diagnostic clinical features and treatment response and review the current strategy in the management of eosinophilic ascites.

Polymorphisms of TLR7 and TLR8 associated with risk of asthma and asthma-related phenotypes in a southeastern Chinese Han population

Objective： To evaluate the effects of polymorphisms in TLR7 and TLRS（as potential candidate genes） on asthma risk and asthma-related phenotypes. Methods： We consecutively recruited 318 unrelated adult asthmatic patients and 352 healthy volunteers from the same area of southeast China. Genotyping of each selected SNP was performed using multiplex PCR in conjunction with tagged array single base extension technology. We conducted case-control and case-only association studies between the selected SNPs in TLR7 and TLR8 and asthma or asthma-related phenotypes. Results： The T allele of rs5935436 SNP in TLR7 was protective from developing asthma in males （adjusted ORs = 0.126, 95% CIs = 0.016-0.995）. The CT/TT genotype of rs5935436 was less frequent in female asthmatics with allergic rhinitis （adjusted ORs = 0.18, 95% CIs = 0.04-0.90）. The homozygote AA of rs3761623 and GG of rs3764880 were positively associated with lower FEV1% and asthma severity in female asthmatics. These results were confirmed by haplotype analysis. Conclusion：TLR7 and TLR8 polymorphisms may play an important role in the pathogenesis of asthma that is gender-dependent. This could be clinically useful, both for identifying patients at risk of asthma and for preventing its occurrence.

The Benefits of Identifying and Treating Adrenal Suppression in Adult Difficult Asthmatics: A Case Series

We present 7 adults atopic asthmatics that were referred due to repeatedly relapsing asthma requiring oral courses of prednisolone. All were steroid responsive yet steroid dependant and were screened for adrenal insufficiency after changes to inhaled therapy and other standard anti-asthma treatments failed to improve the situation. All were deemed to be compliant. 4 used long-term intranasal steroids in addition to inhaled corticosteroids. No topical steroid creams were used by these patients. Adrenal suppression was examined via a 9 am cortisol level and a short synacthen test (using intravenous tetracosactide 250 mcg) along with measurement of ACTH (Adreno-Cortico-Trophic Hormone). The tests were performed in periods off prednisolone. We report the observed beneficial effects after treatment of the adrenal insufficiency with hydrocor-tisone acetate replacement therapy in these cases, and the benefit to their exacerbations, hospital admission and the requirement for prednisolone courses. These patients would have been stepped up to yet higher doses of inhaled steroids and even referred for anti-IgE treatment etc. Adrenal suppression is well described in the medical literature for asthmatics, but the beneficial outcomes of treating this are unknown. These 7 cases have been followed for up to 3 years since hydrocorti-sone replacement therapy. Most improved to a stable asthma without frequent exacerbations nor requirement for prednisolone and only 1 had a hospital admission.

New developments in transplant-acquired allergies

Transplant-acquired allergy(TAA) was firstly described as transplant-acquired food allergy(TAFA) after bone marrow transplantations and mostly observed in a transient form. The picture is complicated by numerous case reports of TAFA after the receipt of liver grafts from donors with no documented history of food allergy. The estimated prevalence of TAFA among young children in the literature has been documented in various studies ranging from 6% to 57%. Although TAA is mostly found to be associated with liver transplantation; it has been recently reported to be related with heart, intestinal, lung and even renal transplantations in adults. Previous reviews of published cases of liver TAA misleadingly emphasized the predominance of children and the absence of TAA in cardiac, pulmonary, and renal transplant recipients. In different studies, the male/female ratio is equal. Literature data suggest that children with TAFA typically present within the first year after surgery and are typically allergic to multiple foods. The pathogenesis of TAA is not still completely understood. Most of the studies support the concept that the functioning liver itself, and not only tacrolimus immunosuppression, is one of the main contributors to TAA in these patients. In the light of recent findings, other possible mechanisms can be summarized as following:(1) the recovery of delayed type hypersensitivity;(2) late manifestation of food allergy;(3) intestinal injury as well as inhibition of cellular energy productionby tacrolimus; and(4) transfer of food-specific IgE or lymphocytes. Thus, interplay between hematopoietic cells from the transplanted organ and recipient specific factors(e.g., younger age and atopic background) seem to underlie the development of TAA. Most patients will have symptomatic improvement following reduced immunosuppression and an appropriately restricted diet. Nevertheless, some studies suggest that atopic diseases occur in some of pediatric liver transplant recipients, with manifestations including food allergy, eczema, allergic rhinitis, and asthma. More studies would be needed including greater number of patients to determine whether TAA is transient or not in pediatric/adult solid organ recipients.

Subclinical hypothyroidism in atopic South Italian children

AIM:To verify if subclinical hypothyroidism(SCH) could be associated to atopy in children.METHODS:Seven hundred and thirty-two Caucasian children from South Italy presenting symptoms of allergic disease were enrolled and submitted to atopy,obesity,chronic low grade inflammation,and SCH work up.RESULTS:Four hundred and forty-five out of 705(63.12%) children affected by allergic disease were diagnosed as atopic and 260(36.88%) as not atopic.The SCH prevalence was 6.3%.Significant higher prevalence of SCH among atopic children with average(group 2) and high(group 3) low grade chronic inflammation compared to atopic children with mild(group 1)low grade chronic inflammation was present.Moreover,group 1 and group 2 presented an OR to show SCH of2.57(95%CI:1.55-6.26) and 2.96(95%CI:1.01-8.65),respectively.Both in atopic and not atopic children we found C3 serum levels significantly higher in group 3respect to group 2 and group 1.Noteworthy,among atopic patients,also total immunoglobulin E(IgE) serum levels,were significantly higher in group 3 compared to group 2 and group 1 children.In atopic children,C3 and total IgE serum values increased in parallel with the increase of C-reactive protein values,while in not atopic children this phenomenon was not evident.CONCLUSION:The possibility exists that an increasing atopic inflammation contributes to SCH occurrence.So far this is the first report in literature showing an association between SCH and atopy but further studies are needed to confirm our data.

Prevalence of the Respiratory Allergies among Adult Population in the City of Skopje in Relation to Climatic Change and Change in Pollen Micro Flora

Introduction: Climate change may have an impact of prevalence and severity of respiratory allergies causing changes in the concentrations, distribution, dispersion patterns, and allergenic potential of aeroallergens in the environment. Objective: To assess the prevalence of atopy, sensitization to common pollen allergens, and respiratory allergies (allergic rhinitis and asthma) among adult population in the city of Skopje in relation to changes in pollen distributions caused by climate change and particularly maximum temperature, in the period 1996-2010. Methods: Aeropalinological measurements in the city of Skopje were performed by volumetric method in the period 1996-2009. Serial cross-sectional studies on the prevalence of atopy, sensitization to common pollen allergens, allergic rhinitis and asthma in adults by standardized methodology were conducted in defined critical periods (1996, 2003, 2007/2008 and 2009/2010). Evaluation of examined subjects included completion of a questionnaire, skin prick tests (SPT) to common inhalant allergens, and lung function tests. Results: Data from aeropalinological measurements showed differences in the pollen concentrations, as well as in the duration of pollen season for some pollen types. The prevalence of atopics was similar in all critical periods, and the prevalence of sensitization to common pollen allergens was slightly higher in the last study than in the study performed in 1996. We registered increase in the prevalence of allergic rhinitis in the examined period (11.5% in 1996 to 17.4% in 2009/2010) followed by increase in the prevalence of rhinitics sensitized to common pollen allergens. The prevalence of allergic asthma was significantly higher in the study conducted in 2009/2010 than in the study conducted in 1996 (5.1% vs. 2.1%, P = 0.037) followed by slightly higher prevalence of asthmatics sensitized to common pollen allergens in the same period. Conclusions: Registered changes in the prevalence of sensitization to common pollen allergens, as well as in the prevalence of subjects with respiratory allergies sensitized to these allergens, even statistically non-significant, indicate the need of further monitoring and investigation in order to assess the association between climate change with change in pollen micro flora and related allergic disorders.

Can omalizumab be used effectively to treat severe conjunctivitis in children with asthma?A case example and review of the literature

A 14-year-old girl with poorly controlled asthma attended the difficult-to-treat asthma clinic for review.Although she has eosinophilia and significantly raised immunoglobulin E levels,she is not currently a candidate for omalizumab(Xolair).She also suffers from chronic urticaria,eosinophilic eosophagitis and severe conjunctivitis.You wonder if omalizumab would be effective in treating her multiple atopic conditions,in particular her troublesome conjunctivitis.PubMed was searched using the following search terms:(Omalizumab)or(Xolair)and(conjunctivitis).Searches were conducted in November 2020.Abstracts were selected for full text review if the study population identified asthma as a comorbidity.Non-paediatric studies and those that were not written in English were excluded.The use of omalizumab has the potential to be effective in the treatment of conjunctivitis associated with asthma and other atopic conditions.However,research is needed to address the question,in the form of multicenter,double-blind randomized control trials.

Impact of Immunoglobulin E and Airway Obstruction on Bronchiectasis

Introduction: Although an increased prevalence of airway obstruction, bronchial hyperreactivity and allergic diseases such as asthma has been associated with bronchiectasis, studies investigating role of atopy in bronchiectasis are few and controversial. We have therefore studied IgE level and reversible airways obstruction in bronchiectasis which have not previously been evaluated in bronchiectasis. Patients and Methods: This study was conducted at Department of Chest Diseases of Al-Azhar University, Assiut, Egypt from January 2012 to December 2013, all consecutive patients with bronchiectasis admitted to the department were enrolled to the study. Serum IgE, pulmonary function tests (PFT) and high resolution computerized tomography (HRCT) were done to all cases. Results: Patients with high IgE (32/50) had longer disease duration and frequent history of allergic diseases. They also had significantly worse FEV1 (49.38 ± 12.65;p = 0.041) and FEV1/FVC (60.89 ± 13.52, p = 0.015) values. Mean HRCT score was significantly higher in patients with high IgE than in patients with normal (18/50) IgE (23.6 ± 10.1 and 7.83 ± 2.43 respectively). IgE showed positive correlation (r = 0.266, p = 0.015) with HRCT scores. Furthermore, the mean increase in FEV1 after inhalation of salbutamol was significantly greater (p = 0.002) in high IgE patients. Conclusions: In conclusion, IgE level is significantly high in bronchiectasis and it may lead to worse pulmonary function and more HRCT extent. Appreciable reversible airways obstruction should be sought in all cases of bronchiectasis and treated appropriately.

过敏性鼻炎与变态反应性鼻炎命名的区别

前不久在审校一本英文版《耳鼻咽喉头颈外科学》的中译本时，与一位旅美华裔学者谈及变态反应性鼻炎（简称变应性鼻炎）章节，他对国内有关变应性鼻炎的名称不解。他说，国外只有allergic rhinitis一种名称，为何国内有过敏性鼻炎和变应性鼻炎两种称呼呢？Allergic rhinitis究竟译成哪种最为合适？多年来我国学者也经常两种名称混用，笔者参与制订的我国变应性鼻炎诊断和治疗指南就曾在文字上将两种名称等同。其实这个问题在国外也存在，早年国外文献有时也常将hypersensitivity和allergy混用，甚至与atopy（特应性）混用。国际变态反应组织（WAO）在2004年曾指出，名称的混用相当普遍，找到一个既有科学性又为临床和公众所接受的描述变态反应性特有特征的名词十分必要。

Expression of surface markers on peripheral CD4＋CD25^high T cells in patients with atopic asthma： role of inhaled corticosteroid

Background CD4^＋CD25^＋ regulatory T cells （Tregs） mediate immune suppression through cell-cell contact with surface molecules, particularly cytotoxic T lymphocyte-associated antigen 4 （CTLA-4）, glucocorticoid-induced tumor necrosis factor receptor family-related protein （GITR）, and transforming growth factor β （TGF-β）, but little is known about the exact role of Tregs in the pathogenesis of asthma. This study sought to characterize the expression of surface markers on peripheral blood mononuclear cells-derived Tregs in patients with atopic asthma and healthy subjects, and to investigate the effect of inhaled corticosteroid on them. Methods The expression of surface molecules on CD4^＋CD25^high Tregs was detected by flow cytometry. The effect of inhaled corticosteroid on expression of the surface molecules on Tregs was determined in vivo and in vitro. Total serum immunoglobulin E （IgE） and high-sensitivity C-reactive protein were measured by enzyme linked immunosorbent assay and latex enhanced immunoturbidimetric assay, respectively. Results Equivalent numbers of peripheral Tregs were found in patients with atopic asthma （stable and acute） and healthy subjects. Tregs preferentially expressed CTLA-4, GITR, toll-like receptor 4 （TLR4）, latency-associated peptide （LAP/FGF-β1）, and forkhead box P3 （FOXP3）. Patients with acute asthma had decreased numbers of CD4^＋CD25^highLAP^＋ T cells compared to healthy subjects and stable asthmatics. Inhaled corticosteroid enhanced the percentage of Tregs expressing LAP in vivo and in vitro dose-dependently. Furthermore, the percentages of Tregs expressing LAP were negatively correlated with total serum IgE levels and severity of asthma, but positively correlated with forced expiratory volume in one second percentage of the predicted value in patients with asthma. Conclusions The results suggest that membrane-bound TGF-β1 is a potential candidate for predicting the severity of asthma, and may contribute to the sustained remission of asthma. Strategies targeting Tregs on their surface markers, especially TGF-β1, are promising for future therapy of asthma.

How Much Do We Know about Atopic Asthma: Where Are We Now?

Asthma is a common disease in the worldwide and it affects over 3.5 million adults and children in the UK. Asthma is a chronic disease characterized by airway hyperresponsiveness, airway inflammation, airway remodelling and reversible airway obstruction. Inflammatory cells, cytokines, chemokines, adhesion molecules, and mediators are involved in pathogenesis of asthma. Chronic airway inflammation and remodelling are the major characters in asthma, which result in decreased pulmonary function. The precise processes are far understood at moment. Although corticosteroid therapy plus other exiting drugs （bronchodilators and oral leukotriene receptor antagonists） influences many different inflammatory and structural cell types and continues to be as the ＂gold standard＂ of therapy in asthma, many thousands have chronic, severe diseases and suffer daily symptoms which make their lives a misery. There remains a clear need for novel approaches to therapy, which will be informed by a clearer understanding of disease pathogenesis, particularly in the target organ where airway inflammation and remodelling, the hallmarks of asthma occur. Cellular ＆ Molecular Immunology.