1. Introduction
Asthma is one of the most common chronic diseases in the world. It is estimated that around 300 million people in the world currently have asthma [1]. Asthma has become more common in both children and adults around the world in recent decades. The increase in the prevalence of this disease has been associated with an increase in atopic sensitization, and is paralleled by similar increases in other allergic disorders such as eczema and rhinitis [1]. The rate of asthma increases as communities adopt western lifestyles and become urbanized. With the projected increase in the proportion of the world's population that is urban from 45% to 59% in 2025, there is likely to be a marked increase in the number of asthmatics worldwide over the next two decades [2]. Nevertheless the prevalence of asthma in rural developing countries has been under estimated for many years [3]. In many areas of the world persons with asthma do not have access to basic asthma medications or medical care and are not included in any statistical survey [4]. Increasing the economic wealth and improving the distribution of resources between and within countries represent important priorities to enable better health care to be provided. The burden of asthma in many countries is of sufficient magnitude to warrant its recognition as a priority disorder in government health strategies. Particular resources need to be provided to improve the care of disadvantaged groups with high morbidity. Resources also need to be provided to address preventable factors [1, 2]. It is estimated that asthma accounts for about 1 in every 250 deaths worldwide. Many of the deaths are preventable, being due to suboptimal long-term medical care and delay in obtaining help during the final attack. The economic cost of asthma is considerable both in terms of direct medical costs (such as hospital admissions and cost of pharmaceuticals) and indirect medical costs (such as time lost from work and premature death) [1]. Therefore there is a greater understanding of the factors that cause asthma which may lead to novel public health and pharmacological measures to reduce the prevalence of asthma seems to be a worldwide priority.
Among the many factors influencing the prevalence of asthma in developing countries from the tropics are geo-helminthic infections [3], including those caused by
2. Immunological aspects of asthma
It is well accepted that asthma is a chronic inflammatory disorder of the bronchial mucosa [11]. The symptoms include chest tightness, wheeze, and cough, and often variable obstruction of airflow through the bronchi. The clinical manifestation of asthma is the result of three events within the airways: reversible obstruction, airway hyper-reactivity and inflammation. Among these factors, airway inflammation is believed to play a major role in the development of the disease [11].
The bronchial inflammation process of asthma is stimulated by cells of the innate immune system (dendritic cells, mast cells, eosinophils, neutrophils, macrophages and NK-cells) and of the adaptive immune system (CD4 + T-lymphocytes, and antigen-specific IgE secreting B-lymphocytes). The innate and adaptive cells are of Th2 class, secreting the cytokines IL-13 and IL-4 prominently or responding to these cytokines through their transduction molecule STAT6 [12, 13]. Thus, the input of these cells into the bronchus and the release or secretion of many mediators (e.g. heparin, reactive lipids or eicosanoids, and enzymes including tryptase and chitinase) lead to increased permeability of blood vessels and consequent edema, increased mucus production, and exaggerated smooth muscle contraction [13] causing airflow obstruction and the symptoms described above. Also, continued inflammation results in remodeling of the airway in which it is thought that TGF-β cytokine may drive the metaplasia of the epithelium, increased vascularity, thickening of the basement membrane, and muscular hypertrophy, leading to lasting airflow obstruction and breathlessness [14, 15].
The induction of adaptive immunity requires antigen-presenting cells (APCs). It is well known that dendritic cells (DCs) are the main type of APC involved in the induction of Th2 responses to allergens in asthma [16]. In the lung, DCs can be found throughout the conducting airways, interstitium, vasculature and pleura and in bronchial lymph nodes. Lung DCs express many receptors, including Toll-like receptors, Nod-like receptors and C-type lectin receptors up regulate the expression of several co-stimulatory molecules (such as CD80 and CD86) and chemokines (such as CCL17 and CCL22) that attract T cells, eosinophils and basophils into the lungs[16-19]. In humans, monocyte-derived conventional DCs promote Th2 responses by secreting pro-inflammatory cytokines and up-regulating the expression of co-stimulatory molecules after antigen stimulation[20] suggesting that lung DCs are necessary for Th2 cell stimulation during airway inflammation.
As mentioned above, various inflammatory cells, such as basophils, eosinophils and mast cells are recruited to airways after allergen challenge. Although the main focus in asthma has been on their roles as inflammatory cells, increasing data suggest that these cells also function as APCs to initiate or enhance Th2 responses. Basophils, which are circulating granulocytes that express the high-affinity IgE receptor FcεRI, amplify immediate hypersensitivity responses by releasing histamine-containing granules and by producing large quantities of IL-4 [13]. Moreover, several studies have highlighted a crucial previously unknown role for basophils as APCs that drive Th2 responses through their expression of major histocompatibility complex (MHC) class II and co stimulatory molecules [21]. Also it has been proposed that MHC class II- dependent interactions between basophils, which are prominent at sites of allergic inflammation, and CD4+ T cells may have an important role in the induction of Th2-mediated inflammation [22, 23]. Another circulating granulocyte that is prominent at sites of allergic inflammation is the eosinophil. After being stimulated, eosinophils have an important pro-inflammatory role by producing leukotrienes, as well as Th1 cytokines (interferon-γ and IL-2) and Th2 cytokines (IL-4, IL-5, IL-10, IL-13 and TNF-α which contribute to airway inflammation [11]. In addition, eosinophils, like basophils, can also function as APCs [24]. Other relevant components of airway inflammation are the mast cells which express FcεRI and c-Kit and reside in tissues near mucosal surfaces and blood vessels. Mast cells can initiate immediate hypersensitivity reactions by de-granulating in response to both adaptive (IgE-mediated) and innate immune signals. For example, mast cells can be activated through cross-linking of antigen-specific IgE bound to FcεRI [25] or in response to Toll-like receptor agonists, or to cytokines such as IL-33 [26]. In addition to producing histamine and leukotrienes, mast cells produce cytokines (IL-1, IL-3, IL-4, IL-5, IL-6, IL-8, IL-10, IL-13, IL-16, tumor necrosis factor and transforming growth factor-β) and chemokines (such as IL-8, lymphotactin, CCL1 (TCA-3), CCL5 (RANTES), CCL2 (MCP-1) and CCL3 (MIP1-α)[27].
An important mediator of airway inflammation is Nitric Oxide (NO) which it is a diffusible gas that can activate biochemical process either on the same cell that produced it or on neighboring cells [28]. NO is synthesized from L-arginine by enzyme nitric oxide synthase (NOS), of which there are three isoforms : NOS I or neuronal NOS (nNOS) was originally isolated from rat and porcine cerebellum; NOS II or inducible NOS (iNOS) from activated macrophages; NOS III or endothelial NOS (eNOS) from endothelial cells [28]. High NO levels could be harmful for asthmatic patients because at elevated concentrations, NO lead to the formation of reactive nitrogen species (RNS) and subsequent oxidation and nitration of proteins, which negatively affect protein functions that are biologically relevant to chronic inflammation in the asthmatic bronchial tissues [28,29]. In asthmatic patients, NO is mainly produced by iNOS expressed in bronchial epithelial cells and some inflammatory cells [30]. NO is also produced by neutrophils and macrophages in response to IFN-γ and a second signal provided by a PAMP ligand or TNF-α. iNOS expression is induced by these signals, this enzyme promotes the oxidation of the guadino nitrogen of L-arginine, resulting in the production of NO and citruline [31]. In addition, other mechanisms have been associated with NO production. It has been demonstrated that the ligation of CD23 (low affinity receptor for IgE FcεRII) on human macrophages is a strong inducer of NO [32]. Indeed, the cross-linking of CD23 by IgE, (IgE -immune complexes or by specific monoclonal antibodies) induces pro-inflammatory response, including NO production [33]. Therefore, allergic sensitization inside the lower airways may account for NO production. In this context, it has been reported that aeroallergen sensitization correlated with exhaled NO (eNO) in mild to moderated asthmatic subjects [34]. Also, the late-phase influx of eosinophils may contribute to NO production at the respiratory mucosa.
3. Stimulation of airway inflammation by helminths parasites
It is important to point out that there are close similarities between the allergic inflammatory responses stimulated in the host by environmental allergens (described above) with the immune responses elicited by parasite antigens. Gut inflammation stimulated by intestinal nematode also include innate (mastocytes, basophils and eosinophils) and adaptive cells of Th2 class which secret preferentially IL-13 and IL-4 cytokines. Pro- inflammatory cells like mastocytes and eosinophils stimulated by these cytokines may release many mediators (heparin, reactive lipids or eicosanoids, and enzymes including tryptase and chitinase) leading to increased permeability of blood vessels, increased mucus production and smooth muscle contraction [35]. Also, inflammation induced by most helminths in the host is associated with NO production through somatic and excretory-secretory antigens of adult worm and larvae [36- 40]. These mechanisms may contribute to make a hostile microenvironment in the gut for the parasites promoting worm expulsion.
The capacity of helminths, to stimulate inflammatory responses has been well documented and they are probably related to the complex lifecycle and the antigenic composition of this nematode. For example, there is evidence that after penetration of the intestinal mucosa
The mechanisms by which these parasites induce airway inflammation are still not well elucidated. High levels of polyclonal and specific IgE against adult stages of the parasite are a characteristic of
Regardless of the intrinsic allergenic potential of these parasites, there are evidences that active infection can potentiate the allergic response to non-related antigens. For example, it has been shown that antigenic extracts of
4. Epidemiological studies showing a positive association between helminthic infections and asthma
Human immune response to infections with helminths parasites may differ according to the profile of the infection. As mentioned above, acute or seasonal infections may include primary infections and repeated or intermittent infections without long period of continuous infections and may result from infrequent short exposures or intermittent exposure after treatment in endemic areas [3, 5]. It has been proposed that mild, seasonal helminthic infections stimulate preferentially inflammatory Th2 type immune responses among parasitized populations [3, 81] characterized by the production of high levels of serum specific IgE and allergic reactivity toward parasite soluble antigens [82] which may lead to the development of bronchial hyper reactivity and asthma [83, 84] particularly among atopic individuals [85]. This situation may be reflected on the increased prevalence of asthma and allergic diseases observed in many low and middle-income countries [86, 87] undergoing parasite eradication programs [5, 6]. For example, epidemiological studies carried out in different rural communities in China, have shown a strong association between Ascaris lumbricoides infection and the development of asthma [88]. These early results are consistent with a meta-analysis of many of studies investigating the association between the presence of geohelminth eggs in stool samples and asthma providing some evidence for parasite-specific effects [7]. In this work in which thirty-three studies were taken in account,
5. The other side of the coin: Chronic helminthic infection may suppress allergic manifestation and the development of asthma
Because parasites are in constant attack by a range of effective immune mechanisms, they have developed effective evasion mechanisms which may vary from simple avoidance to a more active modulation of the immune response in order to establish a non inflammatory environment that allows the parasite to survive. Nematode parasites may enhance survival by directing the immune response to that of a less appropriate type. For example interference with the Th1/-Th2 response balance, the production of high levels of regulatory cytokines such as IL-10 and TGF- β which may lead to a general suppression of T and B cell responses and also mimicry of host proteins which direct the immune response to tolerance have been reported [93]. It has been proposed that because these suppressing mechanisms are not parasite- specific, they may affect the development of allergic reactions in chronically exposed populations [94, 95]. It has been proposed that the effect of geo-helminths on the suppression of atopy is more important early in life causing a deviated Th2 immune phenotype that is not changed later in life, after elimination of the infection [96]. Moreover, there is evidence that maternal helminthic infections could affect infant immunity [97, 98] raising the possibility that the immunologic effects of infection start in the fetus. Further, the inverse association between chronic helminthic infections and allergic disorders among school children from different rural populations from Venezuela, Gambia, Ethiopia, Taiwan, Ecuador and Ghana has been well documented [99].
The exact mechanisms by which these parasites dampen allergic responses are probably multiple. Chronic helminthic infections may protect against allergic disease because of their profound suppression of the host immune system, leading to a general T-cell hypo responsiveness that is facilitated by the activity of regulatory T (Treg) and B cells and the modulation effects of innate immune cells such as macrophages, dendritic cells (DCs) and local stromal cells, resulting in an anti-inflammatory environment characterized by increased levels of interleukin (IL)-10 and transforming growth factor (TGF)-β [100]. In humans, several studies have shown that Treg cell activity (both by natural CD4+CD25+FoxP3+ and adaptive CD4+IL10+ Tr1 cells) protects against allergic disease [100,101, 102]. Indeed, successful allergen specific immunotherapy in humans which leads to a reduction in allergic symptoms has been associated with the emergence of IL-10–producing Treg cells which may be involved in the increase in IgG4 and IgA responses and a simultaneous decrease in IgE [103]. Several studies carried out in distinct experimental models have revealed a number of active molecules in extracts of helminths that can modulate the immune system of the host. Early work conducted by Itami et al [104] have demonstrated that high molecular weight components purified by gel filtration chromatography from an
6. Future challenges and research perspectives
As mentioned above, the prevalence of asthma in rural developing countries has been under estimated for many years and in many areas of the world in which persons with asthma do not have access to basic asthma medications or medical care and are not included in any statistical survey. Thus adequate control of asthma in developing countries would require improvements in health care and the development of technologies to obtain the information needed to identify high-risk groups (disease mapping) [3]. This goal would be difficult to achieve if countries do not allocate resources to enable better health care. On the other hand, since many years several global efforts have been made to address the health effects of human parasitism by helminths which results from poverty and exert a well known detrimental impact on the health status of children continuously exposed to these parasites. The World Health Assembly (WHA) has adopted several resolutions calling for the control or elimination of these diseases, and for the implementation of a number of large-scale control and elimination programs. However, despite such WHA/WHO resolutions, the control of morbidity and the elimination of these infections are still a big challenge for global health programs. Some of the identified obstacles include the current scarcity of tools for updated disease mapping, the development of new anthelmintic drugs and vaccines, the improvement of sensitive diagnostic tools and the monitoring of the progress of control interventions and quantification of changes in incidence of infection and disease [116]. However and according to the WHA/WHO resolution, mass chemotherapy have been widely implemented in rural areas of many developing countries in which sanitary limitations are far to be overcome [6]. Under these conditions, this approach would reduce worm burdens without elimination of the infection in endemic areas, which gradually will change the profile of the infection from a chronic pattern, with moderate to heavy worm burdens [5] to a more mild and seasonal pattern [5], thereby disrupting the regulatory, anti-inflammatory effect of chronic infections on the immune response, allowing allergic sensitization in atopic parasitized individuals [117, 118]. Thus, the development of diagnosis protocols facilitating rapid identification of atopic individuals among rural populations is an immediate challenge to achieve control of parasites without affecting the health status of a significant proportion of these populations. On the other hand, the presence of respiratory symptoms as a consequence of inflammation due to the parasite migratory phase in non atopic individuals [8] must also be considered. For these purposes, large birth cohort studies designed according to specific epidemiological objectives and based on results from cross-sectional studies, small longitudinal and pilot intervention studies would help to elucidate the role of the many parameters involved in host- parasite interactions contributing to the pathogenesis of asthma. Also, the identification of conserved features of helminth products that interact with innate immune cells to co-ordinate adaptive anti-parasite responses as well as of potent parasite derived allergens is a key challenge to improve the technology used in the diagnosis and monitoring of allergic diseases in the tropics. Noteworthy is the cross-reactivity of helminth antigens with environmental allergens which may explain the high prevalence of IgE sensitization to invertebrate allergens leading to the development of asthma and other allergic diseases [61]. Finally, the identification and characterization of individual helminth-derived immunomodulatory molecules that selectively induce regulatory immune responses will provide potential candidates for immunotherapy [119] and must be the subject for future research programs.
References
- 1.
Trends in asthma prevalence, health care use, and mortality in the United States,Akinbami L. J Moorman J. E Bailey C Liu X 2001 2010 NCHS data brief,94 Hyattsville, MD: National Center for Health Statistics. 2012. - 2.
National Heart Lung, and Blood Institute, National Institutes of Health. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. NIH Publication07-4051 07 4051 2007 - 3.
Asthma in Latin America: a public health challenge and research opportunity. AllergyCooper P. J Rodrigues L. C Cruz A. A Barreto M. L 2009 64 5 17 - 4.
Trends in Childhood Asthma: Prevalence, Health Care Utilization, and Mortality, PediatricsAkinbami L J Schoendorf K C 2002 - 5.
Bundy DAP. The Global Atlas of Helminth Infection: Mapping the Way Forward in Neglected Tropical Disease Control,Brooker S Hotez P. J 2010 PLoS Negle Trop Dis; 4: e779. - 6.
Clements ACA, Bundy DAP (Brooker S 2006 Global epidemiology, ecology and control of soil-transmitted helminth infections. Adv Parasitol 2006;62 221 261 - 7.
Asthma and current intestinal parasite infection: systematic review and meta-analysis. Am J Respir Crit Care MedLeonardi-bee J Pritchard D Britton J 2006 174 514 523 - 8.
Nonatopic asthma is associated with helminth infections and bronchiolitis in poor children. Eur Respir JPereira M. U Sly P. D Pitrez P. M 2007 29 1154 1160 - 9.
da Silva ER, Sly, PD, de Pereira, MU. Intestinal helminth infestation is associated with increased bronchial responsiveness in children. Pediatr Pulmonol2008 43 662 665 - 10.
Scrivener S Yemaneberhan H Zebenigus M Tilahun D Girma S Ali S 2001 Independent effects of intestinal parasite infection and domestic allergen exposure on the risk of wheeze in Ethiopia: a nested case-control study. Lancet,358 1493 1499 - 11.
Pathogenesis of asthma. Clin Exp AllergyHolgate S. T 2008 38 872 897 - 12.
Comparative roles of IL-4, IL-13, and IL-4R in dendritic cell maturation and CD4+ Th2 cell function. J ImmunolWebb D. C Cai Y Matthaei K. I Foster P. S 2007 178 219 227 - 13.
Van Den Heuvel R, Witters H, Nelissen I & Schoeters G. The allergic cascade: review of the most important molecules in the asthmatic lung. Immunol LettBloemen K Verstraelen S 2007 113 6 18 - 14.
Elliot JG & Carroll NG. The relationship of reticular basement membrane thickness to airway wall remodeling in asthma. Am J Respir Crit Care MedJames A. L Maxwell P. S Pearce-pinto G 2002 166 1590 1595 - 15.
The soluble form of a disintegrin and metalloprotease 33 promotes angiogenesis: implications for airway remodeling in asthma. J Allergy Clin ImmunolPuxeddu I Pang Y. Y Harvey A 2008 121 1400 6 - 16.
Biology of lung dendritic cells at the origin of asthma. ImmunityLambrecht B. N Hammad H 2009 31 412 424 - 17.
In vivo depletion of lung CD11c+ dendritic cells during allergen challenge abrogates the characteristic features of asthma. J Exp MedVan Rijt L. S Jung S Kleinjan A Vos N Willart M Duez C Hoogsteden H. C Lambrecht B. N 2005 201 981 991 - 18.
Dendritic cells are required for the development of chronic eosinophilic airway inflammation in response to inhaled antigen in sensitized mice. J ImmunolLambrecht B. N Salomon B Klatzmann D Pauwels R. A 1998 160 4090 4097 - 19.
Myeloid dendritic cells induce TH2 responses to inhaled antigen, leading to eosinophilic airway inflammation. J Clin InvestLambrecht B. N De Veerman M Coyle A. J Gutierrez-ramos J. C Thielemans K Pauwels R. A 2000 106 551 559 - 20.
Between a cough and a wheeze: dendritic cells at the nexus of tobacco smoke-induced allergic airway sensitization. Mucosal ImmunolRobays L. J Maes T Joos G. F Vermaelen K. Y 2009 2 206 219 - 21.
A mechanism for the initiation of allergen-induced T helper type 2 responses. Nat. Immunol.Sokol C. L Barton G. M Farr A. G Medzhitov R. A 2008 9 310 8 - 22.
MHC class II-dependent basophil-CD4+ T cell interactions promote TH2 cytokine-dependent immunity. Nat Immunol.Perrigoue J. G Saenz S. A Siracusa M. C Allenspach E. J Taylor B. C Giacomin P. R Nair M. G Du Y Zaph C Van Rooijen N Comeau M. R Pearce E. J Laufer T. M Artis D 2009 10 697 705 - 23.
[23] Basophils contribute to TH2-IgE responses in vivo via IL-4 production and presentation of peptide-MHC class II complexes to CD4+ T cells. Nat Immunol.Yoshimoto T Yasuda K Tanaka H Nakahira M Imai Y Fujimori Y Nakanishi K 2009 10 706 712 - 24.
Immunoregulatory roles of eosinophils: a new look at a familiar cell. Clin Exp Allergy.Akuthota P Wang H. B Spencer L. A Weller P. F 2008 38 1254 1263 - 25.
, mast cells, basophils, and eosinophils. J Allergy Clin Immunol 2006; 117:S450-S456. ,Prussin C .Metcalfe DD Ig E - 26.
IL-33 synergizes with IgE-dependent and IgE-independent agents to promote mast cell and basophil activation. Inflamm ResSilver M. R Margulis A Wood N Goldman S. J Kasaian M Chaudhary D 2010 59 207 218 - 27.
Mast cells, FcεRI, and IL-13 are required for development of airway hyperresponsiveness after aerosolized allergen exposure in the absence of adjuvant. J ImmunolTaube C Wei X Swasey C. H Joetham A Zarini S Lively T Takeda K Loader J Miyahara N Kodama T Shultz L. D Donaldson D. D Hamelmann E. H Dakhama A Gelfand E. W 2004 172 6398 6406 - 28.
Nitric oxide metabolishm in asthma pathophysiology. Bioch Biophys ActaGhosh S Erzurum S. C 2011 1810 1008 16 - 29.
The late, but not early, asthmatic response is dependent on IL-5 and correlates with eosinophil infiltration. J Clin InvestCieslewicz G Tomkinson A Adler A Duez C Schwarze J Takeda K Larson K. A Lee J. J Irvin C. G Gelfand E. W 1999 104 301 308 - 30.
Induction of nitric oxide synthase in asthma. Lancet.Hamid Q Springall D. R Riveros-moreno V Chanez P Howarth P Redington A Bousquet J Godard P Holgate S Polak J. M 1993 342 1510 3 - 31.
Reactive oxygen and nitrogen intermediated in the relationship between mammalian hosts and the microbial pathogens. Proc Natl Acad Sci USANathan C Shiloh M. U 2000 - 32.
Evidence for a role of Fc epsilon RII/CD23 in the IL-4 induce nitric oxide production by normal human mononuclear phagocytes. Cell ImmunolMossayi P. E Sarfati D Yamaoka K Aubry J. P Bonnefoy J. Y Dugas B Kolb J. P 1995 - 33.
CD23/FcεRII:signaling and clinical implication.Int Rev Immunol.Mossalayi M. D Arock M Debré P 1997 16 129 46 - 34.
[34] Lemanske RF Jr, Wecjsler ME, Icitovic M,Zimmerman RR Jr, Wasserman S. Aeroallergen sensitization correlates with PC(20) and exhaled nitric oxide in subjects with mild to moderated asthma. J Allergy Clin ImmunolCraig T. J King T. S 2008 121 671 7 - 35.
Immune and genetic aspects of asthma, allergy and parasitic worm infections: evolutionary links. Parasite ImmunologyHopkin J 2009 - 36.
Involvement of Nitric Oxide and Its Up/Down Stream Molecules in the immunity against parasitic Infections. Brazilian J Infect DisNahrevanian H 2009 13 440 448 - 37.
Helminth infections are associated with protection from cerebral malaria and increased nitrogen derivatives concentrations in Thailand. Am J Trop Med HygNacher M Singhasivanon P Traore B Vannaphan S Gay F Chindanond D Franetich J. F Mazier D Looareesuwan S 2002 66 304 9 - 38.
Ait Aissa S Amri M, Bouteldja R, Wietzerbin J, Touil-Boukoffa C. Alterations in interferon-gamma and nitric oxide levels in human echinococcosis. Cell Mol Biol (Noisy-le-grand)2006 52 65 70 - 39.
Production of nitric oxide (NO) in human hydatidosis: relationship between nitrite production and interferon-gamma levels. BiochimieTouil-boukoffa C Bauvois B Sancéau J Hamrioui B Wietzerbin J 1998 80 739 44 - 40.
RJ. Characterization of a putative nitric oxide synthase in the neuromuscular system of the parasitic nematode, Ascaris suum. ParasitologyBascal Z. A Cunningham J. M Holden-dye L O Shea M Walker 2001 122 2 219 31 - 41.
Macedo MS & Macedo-Soares MF. Early stages of Ascaris suum induce airway inflammation and hyperreactivity in a mouse model. Parasite ImmunolEnobe C. S Araffljo C. A Perini A Martins M. A 2006 28 453 461 - 42.
Whiteman GV & Perelmutter L. Pulmonary infiltrates, asthma and eosinophilia due to Ascaris suum infestation in man. N Engl J MedPhills J. A Harrold A. J 1972 286 965 970 - 43.
Loeffler W 1956 Transient lung infiltrations with blood eosinophilia. Int Arch Allergy Appl Immunol 1956;8 54 59 - 44.
Ascariasis. In Guerrant RL, Walker DH, Weller PF (ed), Tropical infectious diseases: principles, pathogens & practice, 3rd ed. Churchill Livingstone, Philadelphia, PA.,Diemert D. J 2011 794 798 - 45.
Holland CV Ascaris and ascariasis. Microbes InfectDold C 2011 13 632 637 - 46.
Eosinophilia,. In Guerrant RL, Walker DH, Weller PF (ed), Tropical infectious diseases: principles, pathogens & practice, 3rd ed. Churchill Livingstone, Philadelphia, PA..Wilson M. E Weller P. F 2011 939 949 - 47.
The idiopathic hypereosinophilic syndrome. BloodWeller P. F Bubley G. J 1994 1994 83 2759 - 48.
Pulmonary,infiltrates, asthma and eosinophilia due to Ascaris suum infestation in man. N Engl J MedPhills J. A Harrold A. J Whiteman G. V Perelmutter L 1972 1972 286 965 - 49.
Weller P. F 1994 Parasitic pneumonias. In Pennington J (ed), Respiratory infections: diagnosis and management, 3rd ed. Raven Press, New York, NY, 1994;695 714 - 50.
Strongyloidiasis. In Guerrant RL, Walker DH, Weller PF (ed), Tropical infectious diseases: principles, pathogens&practice, 3rd ed. Churchill Livingstone Philadelphia, PA.,Siddiqui A. A Genta R. M Maguilnik I Berk S. L 2011 805 812 - 51.
Eosinophilic Pneumonias. Clin Microbiol RevPraveen A Weller P. F 2012 - 52.
Di Prisco MC, Lopez RI, Garcia N. Allergic reactivity of children of different socioeconomic levels in tropical populations. Int Archs Allergy ImmunolHagel I Lynch N. R 1993 101 209 214 - 53.
Di prisco MC. Bronchial challenge of tropical asthmatics with Ascaris lumbricoides. J Invest Allergol Clin ImmunolLynch N. R Isturiz G Sanchez Y 1992 2 97 105 - 54.
Novel classes of fatty acid and retinol binding proteins from nematodes. Biochem. J,Mcdermott L Cooper A Kennedy M W 1999 192 69 77 - 55.
The ABA-1 allergen of Ascaris lumbricoides: sequence polymorphism, stage and tissue-specific expression, lipid binding function, and protein biophysical properties. ParasitologyXia Y Spence H J Moore J Heaney N Mcdermott L Cooper A Watson D G Mei B Komuniecki R Kennedy M W 2000 - 56.
Sequence-divergent units of the ABA-1 polyprotein array of the nematode Ascaris suum have similar fatty-acid- and retinol-binding properties but different binding-site environments. Biochem JMoore J Mcdermott L Price N. C Kelly S. M Cooper A Kennedy M. W 1999 340 337 343 - 57.
The polyprotein lipid binding proteins of nematodes. Biochim Byophis ActaKennedy M. W 2000 - 58.
Allergen-specific IgE and IgG4 are markers of resistance and susceptibility in a human intestinal nematode infection. Microbes InfectTurner J. D Faulkner H Kamgno J Kennedy M W Behnke J Boussinesq M Bradley J E 2005 2005 7 990 996 - 59.
The specificity of the antibody response to internal antigens of Ascaris: Heterogeneity in infected human and MHC (H-2) control of the repertoire in mice. Clin Exp ImmunolKennedy M. W Tomlinson L. A Fraser E. M Christie J. F 1990 80 219 224 - 60.
Association between total immunoglobulin E and antibody responses to naturally acquired Ascaris lumbricoides infection and polymorphisms of immune system-related LIG4, TNFSF13B and IRS2 genes. Clin Exp ImmunolAcevedo N Mercado D Vergara C Sánchez J Kennedy M W Jiménez S Fernández A. M Gutiérrez M Puerta L Caraballo L 2009 157 282 290 - 61.
IgE cross-reactivity between Ascaris and domestic mite allergens: the role of tropomyosin and the nematode polyprotein ABA-1. AllergyAcevedo N Sánchez J Erler A Mercado D Briza P Kennedy M Fernandez A Gutierrez M Chua K. Y Cheong N Jiménez S Puerta L Caraballo L 2009 64 1635 1643 - 62.
Tropomyosin: an invertebrate pan-allergen. Int Arch ImmunolReese G Ayuso R Lehrer S. B 1999 119 247 258 - 63.
Immunologic responses to common antigens in helminthic infections and allergic disease. Curr Opin Allergy Clin ImmunolArruda L. K Santos A. B 2005 5 399 402 - 64.
Cross-reactive IgE antibody responses to tropomyosins from Ascaris lumbricoides and cockroach. J Allergy Clin ImmunolSantos A. B Rocha G. M Oliver C Ferriani V. P Lima R. C Palma M. S Sales V. S Alberse R C Chapman M. D Arruda L. K 2008 121 1040 1046 - 65.
Helminths and allergy: the example of tropomyosin. Trends parasitolSereda M. J Hartmann S Lucius R 2008 24 272 278 - 66.
Chitinolytic activities in Heligmosomoides polygyrus and their role in egg hatching. Mol Biochem ParasitolArnold K Brydon L. J Chappell L. H Gooday G. W 1993 - 67.
Tager ANM, Luster AD, Rooijen N, Voehringer D, Locksley RM. Chitin Induces Tissue Accumulation of Innate Immune Cells Associated with Allergy. Nature,Reese T. A Liang H. E 2007 447 92 96 - 68.
Chitin, chitinases and chitinase-like proteins in allergic inflammation and tissue remodeling Yonsei Med JLee C. G 2009 28 22 30 - 69.
Chitinase-like protein and asthma. N Engl J MedKuepper M Bratke K Virchow J. C 2008 358 1073 1075 - 70.
Proteases in helminthic parasites. Vet ResTrap C Boireau P 2000 31 461 471 - 71.
The innate allergenicity of helminth parasites. Clin Rev Allergy ImmunolFalcone F. H Loukas A Quinnell R. J Pritchard D. I 2004 26 61 72 - 72.
Mast cells, basophils, and eosinophils acquire constitutive IL-4 and IL-13 transcripts during lineage differentiation that are sufficient for rapid cytokine production. J ImmunolGessner A Mohrs K Mohrs M 2005 174 1063 1072 - 73.
Basophils express a type 2 cytokine profile on exposure to proteases from helminths and house dust mites. J Leukoc BiolPhillips C Coward W. R Pritchard D. I Hewitt C. R 2003 73 165 171 - 74.
A mechanism for the initiation of allergen-induced T helper type 2 responses. Nat ImmunolSokol C. L Barton G. M Farr A. G Medzhitov R 2008 9 310 318 - 75.
Protease-activated receptors: protease signaling in the gastrointestinal tract. Curr Opin PharmacolAmadesi S Bunnett N 2004 4 551 556 - 76.
Potentiation of the reaginic (IgE) antibody response to ovalbumin in the guinea pig with a soluble metabolic product from Ascaris suum. J ImmunolStromberg B. E 1980 125 833 836 - 77.
Effect of Ascaris suum and other adjuvants on the potentiation of the IgE response in guinea-pigs. ImmunologyMarretta J Casey F. B 1979 37 609 613 - 78.
Riches PL & Maizels RM. Proteins secreted by the parasitic nematode Nippostrongylus brasiliensis act as adjuvants for Th2 responses. Eur J Immunol 2000;Holland M. J Harcus Y. M 30 1977 1977 1987 - 79.
Kennedy MW & Lawrence CE. Modulation of a heterologous immune response by the products of Ascaris suum. Infect ImmunPaterson J. C Garside P 2002 70 6058 6067 - 80.
Di Prisco MC, Lopez R, Rojas E. Modulation of the allergic reactivity of slum children by helminthic infection. Paras ImmunolHagel I Lynch N. R Perez M 1993 15 311 315 - 81.
Human allergy and geohelminth infections: a review of the literature and a proposed conceptual model to guide the investigation of possible causal associations. British Medical BulletinCooper P. J Barreto M. L Rodrigues L. C 2006 and80 203 218 - 82.
Di Prisco MC, Lopez RI, Garcia N. Allergic reactivity of children of different socioeconomic levels in tropical populations. Int Archs Allergy ImmunolHagel I Lynch N. R 1993 101 209 214 - 83.
Di Priso MC. Asthma in the tropics: the importance of parasitic infection. In “Asthma: a link between environment, immunology and the airways.” H. Neffen, C. Baena-Cagnani, L. Fabbri, S. Holgate, P. O´Byrne (eds).Lynch N. R Hagel I 74 77 Hogrefe & Huber, Gottingen,1999 - 84.
Infection by Ascaris lumbricoides and bronchial hyper-reactivity: an outstanding association in Venezuelan school children from endemic areas. Acta TropHagel I Cabrera M Hurtado M. A et al 2007 103 231 241 - 85.
Di Prisco MC, Escudero JE, Corao LA, Sandia JA, Ferreira LJ, Botto C, Perez M, Le Souef PN. Relationship between helminthic infection and IgE response in atopic and non-atopic children in a tropical environment. J Allergy Clin ImmunolLynch N. R Hagel I Palenque M. E 1998 - 86.
Williams H; ISAAC Phase Three Study Group. Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multi country cross-sectional surveys. LancetAsher M. I Montefort S Björkstén B Lai C. K Strachan D. P Weiland S. K 2006 368 733 743 - 87.
and the ISAAC Phase Three Study Group. Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC). ThoraxPearce N Aït-khaled N Beasley R Mallol J Keil U Mitchell E Robertson C 2007 62 758 766 - 88.
Ascaris lumbricoides Infection Is Associated with Increased Risk of Childhood Asthma and Atopy in Rural China.Am. J. Respir Crit Care MedPalmer L Celedón J. C Weiss S. T Wang B Fang Z Xu X 2002 165 1489 1493 - 89.
Sensitization to Ascaris lumbricoides and severity of childhood asthma in Costa Rica. J Allergy Clin ImmunolHunninghake G. M Soto-quiros M. E Avila L Ly N. P Liang C Sylvia J. S Klanderman B. J Silverman E. K Celedón J. C et al 2007 119 654 661 - 90.
Sensitization to Ascaris lumbricoides and asthma severity in children. Rev Med Chir Soc Med Nat IasiRîpa C Bahnea R. G Cojocaru I Luca M. C Leon M Luca M 2011 115 387 91 - 91.
Di Prisco MC, Clinical improvement of asthma after anthelminthic treatment in a tropical situation. Am J Respir Crit Care MedLynch N. R Palenque M Hagel I 1997 156 50 57 - 92.
Di Prisco M, Alvarez N, Rojas E.. Bronchoconstriction in helminthic infection. Int. Arch Allergy ImmunolLynch N. R Hagel I Perez M 1992 98 77 79 - 93.
Immunology of human helminth infection. Int. Arch. Allergy ImmunolAllen J. E Maizels R. M 1996 109 3 10 - 94.
Ascaris lumbricoides-induced suppression of total and specific IgE responses in atopic subjects is interleukinMatera G Giancotti A Scalise S Pulicari M. C Maselli R Piizzi C Pelaia G Tancrè V Muto V Doldo P Cosco V Cosimo P Capicotto R Quirino A Scalzo R Liberto M. C Parlato G Focà A 10 independent and associated with an increase of CD25(+) cells. Diagn Microbiol Infect Dis.2008 - 95.
A Immunity, immunoregulation and the ecology of trichuriasis and ascariasis. Parasite ImmunolBradley J. E Jackson J 2004 26 429 441 - 96.
Barreto ML; Social Change, Asthma and Allergy in Latin America.: Early infection with Trichuris trichiura and allergen skin test reactivity in later childhood. Clin Exp AllergyRodrigues L. C Newcombe P. J Cunha S. S Alcantara-neves N. M Genser B Cruz A. A Simoes S. M Fiaccone R Amorim L Cooper P. J 2008 - 97.
Cooper PJ: Evidence for in utero sensitization to Ascaris lumbricoides in newborns of mothers with ascariasis. J Infect DisGuadalupe I Mitre E Benitez S Chico M. E Nutman T. B 2009 - 98.
Determinants of the relationship between cytokine production in pregnant women and their infants. PLoS OneDjuardi Y Wibowo H Supali T Ariawan I Bredius R. G Yazdanbakhsh M Rodrigues L. C Sartono E 2009 e7711. - 99.
Yazdanbakhsh M: Chronic helminth infections modulate allergen-specific immune responses: protection against development of allergic disorders? Ann MedSmits H. H 2007 - 100.
Immune tolerance in allergy. Curr Opin ImmunolAkdis M 2009 - 101.
Mempel M Larbi J, Badusche M,Loliger C, Adjei A, Gachelin G, Fleischer B, Hoerauf A, regulatory-1 cells are associated with immunosuppression in a chronic helminth infection (onchocerciasis). Microbes InfectSatoguina J 2002 - 102.
Antigen-specific cellular hyporesponsiveness in a chronic human helminth infection is mediated by T(h)3/T(r)Doetze A Satoguina J Burchard G Rau T Löliger C Fleischer B Hoerauf A 1 type cytokines IL-10 and transforming growth factor-beta but not by a T(h)1 to T(h)2 shift. Int Immunol2000 - 103.
The role of IgG antibodies in allergy and immunotherapy. AllergyAalberse R 2011 66 28 30 - 104.
Itami DM Oshiro, TM, Araujo CA, Perini A, Martins MA, Macedo MS, Macedo-Soares, MF. Modulation of murine experimental asthma by Ascaris suum components. Clin Exp Allergy2005 35 873 879 - 105.
PAS-1, a protein affinity purified from Ascaris suum worms, maintains the ability to modulate the immune response to a bystander antigen. Immunol Cell BiolOshiro T. M Enobe C. S Araújo C. A Macedo M. S Macedo-soares M. F 2006 84 138 144 - 106.
[106] Proteinase inhibitors and helminth parasite infection. Parasite ImmunolKnox D. P 2007 29 57 71 - 107.
Modulation of host immune responses by nematode cystatins. Int. J Parasitol.Hartmann S Lucius R 2003 33 1291 1302 - 108.
Bm-CPI-2, a cystatin homolog secreted by the filarial parasite Brugia malayi, inhibits class II MHC-restricted antigen processing. Curr BiolManoury B Gregory W. F Maizels R. M Watts C 2001 - 109.
Phosphorylcholine substituents in nematodes: structures, occurrence and biological implications. Biol ChemLochnit G Dennis R. D Geyer R 2000 381 839 847 - 110.
Modulation of macrophage cytokine production by ES-62, a secreted product of the filarial nematode Acanthocheilonema viteae. J ImmunolGoodridge H. S Wilson E. H Harnett W Campbell C. C Harnett M. M Liew F. Y 2001 167 940 945 - 111.
W. Hyporesponsiveness of murine B lymphocytes exposed to the filarial nematode secreted product ES-62 in vivo. ImmunologyWilson E. H Deehan M. R Katz E Brown K. S Houston K. M O Grady J Harnett M. M Harnett 2003 109 238 245 - 112.
Modulation of the host immune system by phosphorylcholine-containing glycoproteins secreted by parasitic filarial nematodes. Biochim Biophys ActaHarnett W Harnett M. M 2001 1539 7 15 - 113.
Inhibition of Fc epsilon RI-mediated mast cell responses by ES-62, A product of parasitic filarial nematodes. Nat MedMelendez A. J Harnett M. M Pushparaj P. N Wong W. S Tay H. K Mc Sharyy C. P Harnett W 2007 13 1375 1381 - 114.
Recognition of schistosome glycolipids by immunoglobulin E: possible role in immunity. Recognition of schistosome glycolipids by immunoglobulin E: possible role in immunity. Infect ImmunVan Der Kleij D Tielens A. G Yazdanbakhsh M 1999 67 5946 5950 - 115.
Antibody responses to Ascaris-derived proteins and glycolipids: the role of phosphorylcholine. Parasite ImmunolVan Riet E Wuhrer M Wahyuni S Retra K Deelder A. M Tielens A. G Van Der Kleij D Yazdanbakhsh M 2006 28 363 371 - 116.
A Research Agenda for Helminth Diseases of Humans: The Problem of Helminthiases. PLoS Negl Trop DisLustigman S Prichard R. K Gazzinelli A Grant W. N Boatin B. A Mc Carthy J Basanez M. G 2012 e1582.doi:10.1371/journal.pntd.0001582. - 117.
van den Bigelaar AHJ van Ree R, Rodrigues LC, Lell B, Deelder AM, Kremsner PG, Yazdanbakhsh M. Decreased atopy in children infected with Schistosoma hematobium: a role for parasite-induced interleukin-10. Lancet2000 356 1723 1727 - 118.
Di Prisco MC, Lopez R, Alvarez N. Effect of anthelmintic treatment on the allergic reactivity of children in a tropical slum. J Allergy Clin ImmunolLynch N. R Hagel I Perez M 1993 92 404 411 - 119.
Ascaris lumbricoides: An overview of therapeutics targets. Infectious Disorders-Drug TargetsHagel I Giusti T 2010 10 349 367