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372 Textbook of Diagnostic and Therapeutic Procedures in Allergy
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Cross-reactivity is common among fungal allergens due to shared homologous B-cell epitopes.
Fungal allergens show cross-reactivity not only among members of the same phylum but also among
different phyla and among non-fungal phyla too. For example, Enolase is a common fungal allergen
that is also found in Cynodon dactylon and Hevea brasiliensis. Apart from this fungal allergens
have also been found to elicit auto-reactivity due to shared epitopes between fungal and human
proteins leading to antigenic mimicry. Cross-reactivity between human and fungal proteins has been
seen in manganese Superoxide Dismutase, thioredoxin, cyclophilin and acid ribosomal protein P2
(Appenzeller 1999).
The development of pollen allergy among different individuals depends upon diversified
risk factors which may be related to the host or environment as allergy is the outcome of
host-environment interaction. Host factors include atopy, gender (boys and adult females have
more bronchial hyperreactivity), low lung function, smoking and viral infections of the respiratory
tract (both upper and lower). Environmental factors include season, annual and diurnal variability,
air pollution, environmental temperature, thunderstorms and wind speed. Exacerbation of asthma
symptoms has been linked to high ambient pollen counts. Ghosh (2012) has demonstrated that
asthma-related health admissions were more than 40% of the annual admission rates during the
months of March and September when the pollen counts are higher. “September Epidemic” is also
an increase in asthma admissions in countries like Australia and Canada, primarily affecting school
children where the synergistic effect of rhinoviral infection and pollen exposure. Kitinoja (2020)
estimated that for 10 grains/m3 increase in pollen exposure, there is a 2% decrease in peak expiratory
flow values.
But only exposure to high pollen may not cause hay fever symptoms, as rural areas show a lower
prevalence of rhinitis and asthma though the people are exposed to more pollen. So, the dynamic
interactions among various factors as stated before needs to be present in order to culminate into the
manifestation of clinical allergic disease in a particular individual.
It has been also shown that exposure to various air pollutants increases the airway responsiveness
to aeroallergens. The airway mucosal damage caused by air pollutants increases the penetration
of aeroallergens into the mucosa and increases the interaction with the immune cells leading to
their activation. The gaseous pollutants modify the morphology of the proteins and increase their
allergenic potential. Diesel exhaust particles have been shown to cause enhanced IgE responses in
atopic individuals. These all lead to increased allergic diseases in urban areas in conjunction with
other factors.
Understanding aerobiology is an important aspect for allergists. This helps in choosing the right
pollen and fungal allergens for testing in patients with allergic rhinitis or allergic asthma. The
progress made in the field of aerobiology is impressive in the last two decades. This has enabled us
to understand the prevalence of various allergenic pollens and fungal spores.
The continuing research on the molecular epitopes of the major allergens of pollens and spores
is expanding our understanding of the pathologic mechanisms of pollinosis which will help in
imparting more refined immunotherapy to patients with respiratory allergic diseases.
Air spora – The population of biological particles present in the air.
Allergen – A substance capable of causing an allergic reaction.
Allergy – A reaction of the body’s immune system to the presence of a foreign substance
Bioaerosol – An aerosol of particles of biological origin or activity suspended in the air. Particle size
may range from aerodynamic diameters of ca. 0.5 to 100 μm.
Burkard trap – Seven-day recording volumetric spore trap used by many for the daily spore count.
Conclusion
Glossary of Abbreviations
Aerobiology for Clinicians 373
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Daily counts – Daily counts of pollen or spores, often for allergy sufferers.
Daily (diurnal) periodicity – The cycle of high and low production of pollen and spores during
the day.
Volumetric spore trap – The type of trap with which the volume of air sampled per unit of time is
known.
References
Agashe, S. N. 2006. Palynology and its Applications. Oxford and IBH publication Co. Pvt Ltd.
Anand Bahadur Singh and Chandni Mathur. 2012. An aerobiological perspective in allergy and asthma. Asia Pac
Allergy 2: 210–222.
Anonymous: All India Coordinated Project on Aeroallergens and Human Health. Report. Ministry of Environment
and Forests, New Delhi 2000.
Appenzeller, U., Meyer, C., Menz, G., Blaser, K. and Crameri, R. 1999. IgE-mediated reactions to autoantigens in
allergic diseases. Int. Arch. Allergy Immunol. 118: 193–196.
Black, P. N., Udy, A. A. and Brodie, S. M. 2000. Sensitivity to fungal allergens is a risk factor for life-threatening
asthma. Allergy 55(5): 501–504.
Brooks, J. P., Gerba, C. P. and Pepper, I. L. 2004. Bioaerosol emission, fate, and transport from municipal and animal
wastes. J. Residuals Sci. Technol. 1: 13–25.
Burge, H. A. 1989. Airborne allergenic fungi classification, nomenclature, and distribution. Immunol. Allergy Clin.
North Am. 9: 307–319.
Bush, R. K. and Portnoy, J. M. 2001. The role and abatement of fungal allergens in allergic diseases. Journal of
Allergy and Clinical Immunology 107(3): S430–S440.
Ghosh, D., Chakraborty, P., Gupta, J., Biswas, A., Roy, I., Das, S. et al. 2012. Associations between pollen counts,
pollutants, and asthma related hospital admissions in a high-density Indian metropolis. J. Asthma 49: 792–9.
Gravesen, S., Nielsen, P. A., Iversen, R. and Nielsen, K. F. 1999. Microfungal contamination of damp buildings—
examples of risk constructions and risk materials. Environ. Health Perspect. 107(suppl 3): 505–508.
Heiss, S., Fischer, S., Muller, W. D., Weber, B., Hirschwehr, R., Spitzauer, S., Kraft, D. and Valenta, R. 1996.
Identification of a 60 kd cross-reactive allergen in pollen and plant-derived food. J. Allergy Clin. Immunol.
98: 938–947.
Hyde, H. A. 1972. Atmospheric pollen and spores in relation to allergy. Clin. Allergy 2: 153–179.
Kitinoja, M. A., Hugg, T. T., Siddika, N., Rodriguez Yanez, D., Jeakkola, M. S. and Jeakkola, J. J. K. 2020. Short-term
exposure to pollen and the risk of allergic and asthmatic manifestations: a systematic review and meta-analysis.
BMJ Open 10: e029069.
Magyar, D. 2007. Aeromycological aspects of mycotechnology. pp. 226–263. In: Rai, M. K. (ed.), Mycotechnology:
Current Trends and Future Prospects. New Delhi: I.K. International Publishing House.
Simon-Nobbe, B., Denk, U., Pöll, V., Rid, R. and Breitenbach, M. 2008. The spectrum of fungal allergy. Int. Arch.
Allergy Immunol. 145: 58–86.
Singh, A. B. and Kumar, P. 2003. Aeroallergens in clinical practice of allergy in India. An overview. Ann. Agric
Environ. Med. 10: 131–136.
Tilak, S. T. and Pande, B. N. 2005. Current trends in aero mycological research. pp. 281–510. In: Rai, M. K. and
Deshmukh, S. K. (eds.). Fungi: Diversity and Biotechnology. Jogpur: Scientific Publishers.
Wagner, S. and Breiteneder, H. 2002. The latex-fruit syndrome. Biochem. Soc. Trans. 30(Pt 6): 935–40.
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Index
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A
Acupuncture 342–347, 352
Adjuvants 207, 211, 216
Aerobiology 361–372
Agammaglobulinemia 180, 183, 193, 194, 203
Airway smooth muscle 80, 86
Allergen 17, 23–25, 30
Allergic 138, 140, 143–145, 149, 150, 156, 158
Allergic fungal rhinosinusitis 65, 66
Allergic rhinitis 343–352
Allergoids 207, 211, 216
Allergy 116, 300, 302, 304, 306–308, 311–313, 315, 317,
318, 321, 328–330, 342, 346, 348, 350, 352, 335, 337,
361, 363–366, 370–372
Allergy prick skin test 34–36
Allergy Skin Testing 34
Alternative and complementary medicine 329–337,
342–352
Angioedema 121–126, 130–133, 135
Ant 301–303, 305, 308, 317, 321
Anterior rhinomanometry 36, 37
Area Under the Curve 8, 9, 15
Asthma 219–228, 232, 234, 238, 240–242, 244, 246, 264,
344, 346–352
Asthma exacerbation 80, 82, 83
Atopic dermatitis 138, 147, 150–153, 158, 220, 227, 228,
232, 234, 262, 264, 345, 346, 349, 350, 352
B
Biologics 220, 222, 224, 226, 228, 229, 234, 236, 238,
239, 241
Bioresonance 356
Bronchial thermoplasty 80–82, 85, 86
C
CAP 108
Cat allergy 287
Central compartment atopic disease 65
Challenge 87–97
Chronic disease 333
Chronic urticaria 122, 124, 127, 131, 133, 241–244, 344
Complement 180, 181, 184-186, 197
Complete Blood Count 17, 29
Concha bullosa 61, 62
Contact dermatitis 138, 141, 143, 145, 156, 158
C-Reactive Protein 17, 27–29
Cytotoxic testing 357, 358
D
Danger level 90–96
Dermatographia 124, 125
Dermatophagoides farina 281
Dermatophagoides pteronyssinus 281
Dilatation 117
Direct provocation tests 175
Disease prevalence 3–6, 8, 10
Dliluents 211
Drug allergy 163, 164, 166–171
Drug desensitization 169
Dysphagia 116
E
Eczematous 138, 139, 148, 153
Endoscopy 116
Eosinophil 21–23, 29
Eosinophilic disorders 244–245
Erythrocyte sedimentation rate 17, 27, 30
Extracts 301, 302, 304–309, 311, 312, 317–321
F
Food additives 358, 359
Food allergy 348, 350, 352
Fractional exhaled nitric oxide 50, 57
Fungal spores 361, 363–366, 368, 370–372
Fungus ball 63, 64, 66
G
Gastro-Oesophageal Reflux (GERD) 119
H
Haller air cell 62
Herbal medicine 342, 345, 347, 350, 352
Herbs 342, 345, 347–352
HEPA air filter 286
Hereditary angioedema 257–262
Hymenoptera 300–308, 310, 312, 315, 317, 321
Hypereosinophilic syndrome 244–245
Hypersensitivity 308, 317, 319
Hypersensitivity reactions 163, 164, 169, 171, 175
Hypoallergenic 287, 288
I
IgE 34, 36–39, 108–113
Immune modulation 334
376 Textbook of Diagnostic and Therapeutic Procedures in Allergy
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ImmunoCap 111
Immunodeficiencies 245
Immunodeficiency 179, 180, 182, 183, 186, 188, 191, 193,
195, 202, 203
Immunoglobulin E 17, 23, 27, 30
Immunoglobulin therapy 245–249
Immunotherapy 207, 209–211, 213, 214, 216, 300,
305–307, 311–313, 317–321
Inborn Errors of Immunity 179, 203
Insect 285, 291, 293, 300–308, 310–313, 315–319, 321
Integrative medicine 342
Intra lymphatic immunotherapy 215
Intradermal Skin Test 35, 39
Inverted papilloma 67, 68
Irritant 138, 140, 141, 143–146, 158
J
Janus kinase inhibitors 230, 234–238
K
Kinesiology 355, 356
L
Likelihood ratio 3, 8, 10, 11, 15
Lung oscillometry 54–57
M
Methacholine challenge testing 52
Molds 281, 291, 292
Monoclonal antibody therapy 219–234, 238–241, 242–245
Mucocele 63, 65–68
Pollen 361–363, 366–372
Pollen calendar 370
Polyposis 64, 65
Predictive value 3–6, 15
Prick Skin Test 34–36
Probiotics 207, 216
Pulmonary function 42–57
R
RAST 108, 114
Reactive airway disease 51–53
Receiver operator characteristics 8, 9, 15
Rhinoscopy 70–79
Rhinoscope 70, 75
RIST 108, 114
Rush oral immunotherapy 103
S
Samplers 366–370
Sensitivity 3–9, 11
Sensitization 34–37, 39, 87
Serology 309, 310
Severe asthma 81, 82
Skin prick test 167
Skin test 306–310, 315
Skin titration 357
Slow sub-lingual route 102
Specificity 3–9, 11
Spirometry 42–48, 50–54, 56, 57
Stinging 300–302, 318, 321
Subcutaneous immunotherapy 207, 214, 216
Sublingual immunotherapy 207, 216
N
Nasal eosinophilia 37, 38
Nasal polyposis 65, 238–241
Nasal provocation 36, 40
Nasal septum 71, 72
Neutrophil defects 181, 183, 184, 195
NSAID associated nasal 65
O
Onodi air cell 62
Oral immunotherapy 98, 106, 216
P
Patch testing 138–140, 142, 148, 158
Peak expiratory flow rate 43, 58
Peptides 207
Periodic fever syndromes 251, 253, 254, 256, 257
Perioperative anaphylaxis 169, 173
Pharynx 70, 72, 74–76
T
T cell deficiency 181, 182, 191
Threshold of reactivity 87–89, 97, 99, 102, 106
Traditional Chinese Medicine 342, 353
Traditional medicine 347–351
Tryptase 17, 23–27, 166, 172, 307, 312, 313, 319, 321
Turbinates 72, 73, 75, 76
U
Urticaria 121–135, 344–346
V
Venom 30, 302, 304–313, 315, 317–321
Volatile Organic Compounds 293, 294
W
WAO 108, 114
Waterfall plots 11–13
About the Editors
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Pudupakkam K. Vedanthan
Pudupakkam K. Vedanthan (PK) is the lead editor of the Textbook of Diagnostic and Therapeutic
Procedures in Allergy. He is a native of Mysuru, India and a graduate of Government Medical
College, University of Mysore. He was awarded the 10th rank in the Pre University Course and
distinctions in Physiology, Pharmacology and Pathology. He served as a lecturer in Pathology at
his Almamater before moving to USA in 1971. He completed his residency in Pediatrics at Rhode
Island Hospital at Brown University and Fellowship in allergy & Immunology at National Asthma
Center, Denver, Colorado. He is board certified by the American Boards of Pediatrics and Allergy,
Asthma and Immunology. He served for 35 years in Consultation practice in Colorado, as well as
maintained academic affiliation with University of Colorado, Denver where he has been a Clinical
Professor of Medicine for the past two decades. He has published in both national and international
journals and has been active in the academic circle in various capacities. He was the lead editor
for the Textbook of Allergy for the clinician published by the CRC Press in 2014 and 2019. He has
contributed to Colorado Medical Society (CMS), Association of American Physicians of Indian
origin (AAPI) in several capacities. His major contribution has been in Global medicine since he
established a medical charity namely ‘International Asthma Services (IAS)’ (www.saahns.org) in
1992. IAS has been active in several developing countries like India, Sri Lanka, Mauritius, Kenya,
Russia, Myanmar, Philippines, Argentina, Nepal conducting CMEs for health professionals and
Asthma allergy Awareness camps for patients and their families and public in general. IAS has also
partnered with major medical institutions in establishing formal PG diploma courses in allergy,
asthma and immunology offered at Vellore Tamil Nadu, Delhi, Kolkata, and Bangalore INDIA and
Barbados, West Indies. These courses have been sponsored/endorsed by the American Academy,
Asthma & Immunology (AAAAI), and the Center for Global Health, College of Preventive Medicine,
University of Colorado at Anschutz campus, Aurora, Colorado, USA. Nearly 1500 specialists have
been trained under this program. Dr. PK has also been involved in providing voluntary medical care
to the refugee population through Colorado Alliance for Health Education & Promotion (CAHEP),
Denver, Colorado for the past three decades. He has also recently initiated the PRAANA Charitable
Allergy Asthma clinics Initiative to serve the needy and sick in India, Nepal, Kenya and Barbados.
In recognition of these activities, IAS was recognized in 2015 by the Centre for Global Health,
School of Public Health, University of Colorado with the prestigious award of ‘Excellence in Global
health’. He has been the recipient of AAAAI Special recognition award for the year 2021, AMA
Leadership award, UCD Distinguished Service award, Rotary ‘Service Above Self Award’, UCD
International Faculty award, Special Innovator award from the department of Medicine, University
of Colorado, Denver.
Harold S. Nelson
Dr. Nelson received an undergraduate degree in economics from Harvard College and later earned
a doctor of medicine degree from Emory University. He then completed a residency in internal
medicine at Letterman General Hospital and a fellowship in allergy/immunology at the University
of Michigan. Dr. Nelson has published over 450 articles and book chapters. He has served on the
Board of Regents of the American College of Allergy, Asthma, and Immunology (ACAAI), as well
378 Textbook of Diagnostic and Therapeutic Procedures in Allergy
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as on the Board of Directors of both the American Academy of Allergy, Asthma, and Immunology
(AAAAI) and the American Board of Allergy and Immunology (ABAI). He was a member of the
First, Second and Third Expert Panels of the NIH—NAEPP for developing the Guidelines for the
Diagnosis and Management of Asthma. Dr. Nelson has been honored with the ‘Fellow Distinguished
Award’ and ‘Gold-Headed Cane Award’ by the ACAAI; the ‘Distinguished Clinician Award’
‘Special Recognition Award’ and ‘Distinguished Service Award’ by the AAAAI; the ‘Outstanding
Clinician Award’ from the World Allergy Organization and the ‘Lifetime Achievement Award’ by
National Jewish Health. He has also been honored with named 428 Textbook of Allergy for the
Clinician lectureships at the annual meetings of the ACAAI 2008–2009, the AAAAI 2001–2013 and
the Western Society of Allergy and Immunology 2018–2022.
Hugo P.S. Van Bever
Hugo P.S. Van Bever 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 from 1978–1983. Following that he became Resident in Paediatric Allergy and
Pulmonology, University of Antwerp, Belgium from 1984–1993, Associate Professor in Paediatric
Allergy and Pulmonology, University of Antwerp, Belgium from 1993–1997 and Professor
in Paediatric Allergy and Pulmonology, University of Antwerp, Belgium from 1997. From
1997–2001 Hugo Van Bever was also the Head of the Department of Paediatrics,University of
Antwerp, Belgium. He joined the National University Singapore as Professor, Senior Consultant,
and Head of Paediatric Allergy and Immunology in the Department of Paediatrics in June 2002.
Since 2002 he has been an active member of the Board of The Asian Pacific Academy of Paediatric
Allergy, Respirology, and Immunology (APAPARI), in which he was responsible for research and
education in pediatric allergy, organizing APAPARI workshops in different Asian countries. From
2019 till May 2021, he was the President of APAPARI. He is also a board member of APAAACI
and committee member of the Immunotherapy Working Group of WAO. He has been Associate
Editor of The European Respiratory Journal (1993–1998). Currently, he is reviewer for The
European Journal of Paediatrics, Pediatrics, Paediatric Allergy and Immunology, Allergy, Paediatric
Pulmonology, The European Respiratory Journal, Paediatric Research, British Medical Journal, The
American Journal of Respiratory and Critical Care Medicine and Archives Diseases of Childhood.
Hugo Van Bever defended his PhD thesis successfully in June 1993 at the University of Antwerp.
The title of this thesis is: “Late asthmatic reactions in childhood asthma and Influence of specific
immunotherapy upon the late asthmatic reactionˮ. He has published more than 350 papers in national
and international journals. His current research is focused on eczema, food allergy, allergic rhinitis,
sublingual immunotherapy, and primary prevention of allergy. He runs clinics in NUH on pediatric
allergy, especially on asthma, allergic rhinitis, eczema, and food allergy.
Mandakolathur R. Murali
Mandakolathur R. Murali M.D. received his undergraduate (MBBS) and postgraduate (MD) degrees
in Internal Medicine at Stanley Medical College in Chennai, India. He was the recipient of the
Government Gold medal, in both the MBBS and MD, as a recognition of being the best outgoing
student of Madras University. He completed a residency in Internal Medicine and a fellowship in
Allergy and Clinical Immunology as well as the Assistant training program Director in Allergy and
Clinical Immunology at SUNY, Downstate Medical Center in Brooklyn, NY. He is boarded in Internal
Medicine, Allergy and Clinical Immunology as well as Diagnostic and Laboratory Immunology.
He was a full-time faculty in Allergy and Clinical Immunology at SUNY Brooklyn till 1992, and
then served as the Director of Allergy Clinic as well as training program Director in Allergy and
Immunology at SUNY Stony Brook in N.Y. Since 2002, he is the Director of Clinical Immunology
laboratory at Massachusetts General Hospital, serving as full time faculty in departments of Medicine
and Pathology, in the division of Rheumatology, Allergy and Clinical Immunology. He holds the
rank of an Assistant Professor of Medicine at Harvard Medical School in Boston. Since 1979 he
About the Editors 379
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has been involved in teaching clinical and laboratory medicine to medical students, residents and
fellows and has been recognized with several teaching awards at all 3 institutions he has served. He
is a senior clinician with expertise in allergic and immunologic disorders and autoimmunity. His
research interests and publications include immunopathology of autoimmune diseases, complement
disorders, immunodeficiency diseases and evaluation of monoclonal gammopathies. He has been a
member of the in-training exam committee of the AAAAI for over 25 years. He has contributed to
chapters on immunodeficiency diseases, mechanisms of allergic diseases, complement disorders,
cryoglobulins as well as evaluation of autoantibodies in systemic autoimmune diseases.
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