Inhalation challenge test using pigeon eggs for chronic hypersensitivity pneumonitis
CLINICAL AND EXPERIMENTAL ALLERGY
Authors: Okuda, Ryo; Takemura, Tamiko; Mikami, Yu; Hagiwara, Eri; Iwasawa, Tae; Baba, Tomohisa; Kitamura, Hideya; Komatsu, Shigeru; Okudela, Koji; Ohashi, Kenichi; Ogura, Takashi
Abstract
Background Chronic hypersensitivity pneumonitis (CHP) remains a diagnostic challenge. The process of collecting and extracting serum and droppings from causative animals for the inhalation challenge test is complicated and the risk of inducing disease progression exists. Objective To investigate the utility and safety of an inhalation challenge test using pigeon eggs. Methods Pigeon eggs were pasteurized and mixed with a saline solution to produce an inhalation fluid. An inhalation challenge test was conducted on 19 patients with bird-related CHP and 17 patients with interstitial lung disease other than bird-related CHP. To identify antigens in pigeon eggs, the antigen-antibody responses of the pigeon eggs and serum from patients were evaluated using Western blotting. Results The mean changes in C-reactive protein, alveolar-arterial oxygen difference, erythrocyte sedimentation rate, and lactate dehydrogenase significantly increased by 0.32 mg/dL (P = .014), 7.8 Torr (P = .002), 1.4 mm/h (P = .012), and 5.4 U/mL (P = .0019), respectively, in bird-related CHP group compared to the control 24 hours after the inhalation challenge test. Furthermore, within 24 hours of the inhalation test, the mean forced vital capacity decreased by 2.3% in the bird-related CHP group compared with a decline of 0.05% in the control group (P = .035). Serum collected from seven bird-related CHP patients who underwent the inhalation challenge test and reacted to antigens with molecular weights of 37-75 KDa, and these molecular weights were consistent with egg albumin and globulin. Conclusion Since a mild response was observed after the inhalation challenge test using pigeon eggs, this test was an obvious candidate for diagnosing bird-related CHP.
Antibody dynamics to SARS-CoV-2 in asymptomatic COVID-19 infections
ALLERGY
Authors: Lei, Qing; Li, Yang; Hou, Hong-yan; Wang, Feng; Ouyang, Zhu-qing; Zhang, Yandi; Lai, Dan-yun; Banga Ndzouboukou, Jo-Lewis; Xu, Zhao-wei; Zhang, Bo; Chen, Hong; Xue, Jun-biao; Lin, Xiao-song; Zheng, Yun-xiao; Yao, Zong-jie; Wang, Xue-ning; Yu, Cai-zheng; Jiang, He-wei; Zhang, Hai-nan; Qi, Huan; Guo, Shu-juan; Huang, Sheng-hai; Sun, Zi-yong; Tao, Sheng-ce; Fan, Xiong-lin
Abstract
Background The missing asymptomatic COVID-19 infections have been overlooked because of the imperfect sensitivity of the nucleic acid testing (NAT). Globally understanding the humoral immunity in asymptomatic carriers will provide scientific knowledge for developing serological tests, improving early identification, and implementing more rational control strategies against the pandemic. Measure Utilizing both NAT and commercial kits for serum IgM and IgG antibodies, we extensively screened 11 766 epidemiologically suspected individuals on enrollment and 63 asymptomatic individuals were detected and recruited. Sixty-three healthy individuals and 51 mild patients without any preexisting conditions were set as controls. Serum IgM and IgG profiles were further probed using a SARS-CoV-2 proteome microarray, and neutralizing antibody was detected by a pseudotyped virus neutralization assay system. The dynamics of antibodies were analyzed with exposure time or symptoms onset. Results A combination test of NAT and serological testing for IgM antibody discovered 55.5% of the total of 63 asymptomatic infections, which significantly raises the detection sensitivity when compared with the NAT alone (19%). Serum proteome microarray analysis demonstrated that asymptomatics mainly produced IgM and IgG antibodies against S1 and N proteins out of 20 proteins of SARS-CoV-2. Different from strong and persistent N-specific antibodies, S1-specific IgM responses, which evolved in asymptomatic individuals as early as the seventh day after exposure, peaked on days from 17 days to 25 days, and then disappeared in two months, might be used as an early diagnostic biomarker. 11.8% (6/51) mild patients and 38.1% (24/63) asymptomatic individuals did not produce neutralizing antibody. In particular, neutralizing antibody in asymptomatics gradually vanished in two months. Conclusion Our findings might have important implications for the definition of asymptomatic COVID-19 infections, diagnosis, serological survey, public health, and immunization strategies.