Allergy and Clinical ImmunologyAllergy and Clinical Immunology in the Czech Republic in the Czech Republic

Anna Šedivá,Anna Šedivá,Institute of Immunology, Institute of Immunology, Second Medical Faculty Second Medical Faculty University Hospital Motol, University Hospital Motol, Prague, Czech RepublicPrague, Czech Republic

„Combating Allergy and Astma in Europe: Issues and Perspectives“, on 17th November in Brussels.

Allergy and Clinical Allergy and Clinical Immunology Immunology

The field of allergy and clinical immunology is one of the fastest growing areas among medical sciences in the Czech Republic. Both allergy and immunology are building up on the long time tradition in our countries.

Lodinová-Zádníková R, Cukrowska B, Tlaskalova-Hogenova H.: Oral administration of probiotic Escherichia coli after birth reduces frequency of allergies and repeated infections later in life (after 10 and 20 years).Int Arch Allergy Immunol. 2003 Jul;131(3):209-11

Allergic diseases in the Czech Allergic diseases in the Czech RepublicRepublic

Population 10 millions

Current prevalence of allergy in general is almost 32% according to the latest available statistical data, with asthma 8% and atopic dermatitis 12%, with even higher number in the youngest age groups.

%% 1996 2001 2006

Alergy 16.9 24.7 31.8

Alergic

Rhinitis

5.7 13.7 15.1

Asthma 3.8 6.7 8.2

Major problems and potential contribution to European research

growing number of patients

increasing problems in young age – genetic and pathogenetic studies

environmental factors

improved diagnostics and therapies

Increasing number of Increasing number of patientspatients

Contribution to international cohorts:Contribution to international cohorts:CIPA – Czech Initiative for AsthmaCIPA – Czech Initiative for Asthma

CARO – Czech Alliance for Chronic Respiratory CARO – Czech Alliance for Chronic Respiratory Diseases Diseases

PRACTALL and ERS Task Force on childhood PRACTALL and ERS Task Force on childhood wheezingwheezing

Allergy. 2008 Jan;63(1):5-34. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report.Bacharier LB, Boner A, Carlsen KH, Eigenmann PA, Frischer T, Götz M, Helms PJ, Hunt J, Liu A, Papadopoulos N, Platts-Mills T, Pohunek P, Simons FE, Valovirta E, Wahn U, Wildhaber J; European Pediatric Asthma Group

Eur Respir J. 2008 Oct;32(4):1096-110. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach.Brand PL, Baraldi E, Bisgaard H, Boner AL, Castro-Rodriguez JA, Custovic A, de Blic J, de Jongste JC, Eber E, Everard ML, Frey U, Gappa M, Garcia-Marcos L, Grigg J, Lenney W, Le Souëf P, McKenzie S, Merkus PJ, Midulla F, Paton JY, Piacentini G, Pohunek P, Rossi GA, Seddon P, Silverman M, Sly PD, Stick S, Valiulis A, van Aalderen WM, Wildhaber JH, Wennergren G, Wilson N, Zivkovic Z, Bush A.

Genetic and pathogenetic Genetic and pathogenetic studiesstudies

Hum Immunol. 2008 Apr-May;69(4-5):306-13. Hum Immunol. 2008 Apr-May;69(4-5):306-13. Haplotype analysis of the endothelial nitric Haplotype analysis of the endothelial nitric oxide synthase gene in asthma.oxide synthase gene in asthma.J Hum Genet. 2007;52(2):152-8. J Hum Genet. 2007;52(2):152-8. Interleukin-18 Interleukin-18 and its three gene polymorphisms relating to and its three gene polymorphisms relating to allergic rhinitis. allergic rhinitis. J Hum Genet. 2006;51(11):977-83. J Hum Genet. 2006;51(11):977-83. Polymorphisms of the Polymorphisms of the CD14CD14 gene and atopic gene and atopic phenotypes in Czech patients with IgE-mediated phenotypes in Czech patients with IgE-mediated allergy.allergy.Holla LI et al.: Holla LI et al.: Department of Pathophysiology, Department of Pathophysiology, Medical Faculty, Masaryk University Brno, Brno, Medical Faculty, Masaryk University Brno, Brno, Czech RepublicCzech Republic

Severe form of atopic dermatitis in childhood: Severe form of atopic dermatitis in childhood: clinical outcome and cytokine gene clinical outcome and cytokine gene polymorphisms - a prospective studypolymorphisms - a prospective study. . Pediatric Pediatric Allergy adn Immunology, submitted. Allergy adn Immunology, submitted. Kayserová JKayserová J.., , ŠediváŠedivá A. et al.: Institute of Immunology, University A. et al.: Institute of Immunology, University Hospital Motol, Prague, Czech Republic Hospital Motol, Prague, Czech Republic

Expulsion the Celts by the expansion of German tribes and of the Roman Empire

Bohemia

Macek Jr et al. Am J Hum Genet 49: A2703, 1991

Environmental factorsEnvironmental factors

Air polution:Air polution: Mutat Res. 2001 Sep 20;496(1-2):207-28Mutat Res. 2001 Sep 20;496(1-2):207-28Biomarkers of genotoxicity of urban air pollution. Overview and Biomarkers of genotoxicity of urban air pollution. Overview and descriptive data from a molecular epidemiology study on populations descriptive data from a molecular epidemiology study on populations exposed to moderate-to-low levels of polycyclic aromatic hydrocarbons: exposed to moderate-to-low levels of polycyclic aromatic hydrocarbons: the AULIS project.the AULIS project.KyrtopoulosKyrtopoulos SA SA, , GeorgiadisGeorgiadis P P, , AutrupAutrup H H, , DemopoulosDemopoulos NA NA, , FarmerFarmer P P, , HaugenHaugen A A, , KatsouyanniKatsouyanni K K, , LambertLambert B B, , OvreboOvrebo S S, , SramSram R R, , StephanouStephanou G G, , Topinka JTopinka J..

Institute of Experimental Medicine, Prague, Czech Republic.Institute of Experimental Medicine, Prague, Czech Republic.New study in 2008: 200 children from urban and rural areas New study in 2008: 200 children from urban and rural areas

Food allergy: Food allergy: Proteomics. 2008 Apr;8(8):1677-91. Proteomics. 2008 Apr;8(8):1677-91. Proteomic analysis of wheat proteins Proteomic analysis of wheat proteins recognized by IgE antibodies of allergic patients.recognized by IgE antibodies of allergic patients.

Int Arch Allergy Immunol. 2002 Jun;128(2):77-89.Int Arch Allergy Immunol. 2002 Jun;128(2):77-89. Mucosal immunity: its role in Mucosal immunity: its role in defense and allergy.defense and allergy.

Department of Immunology and Gnotobiology, Institute of Microbiology Department of Immunology and Gnotobiology, Institute of Microbiology v.v.i, Czech Academy of Sciences, Prague, Czech Republicv.v.i, Czech Academy of Sciences, Prague, Czech Republic

Improved diagnostics Improved diagnostics and therapiesand therapiesApplication of global protocolsApplication of global protocols

Focus on compound resolve diagnostic and therapy with recombinant allergens, followed with functional basophil activation tests (BAT) and specific IgG investigation as a marker of successful immunomodulation therapy. University Centre for Allergology and Clinical Immunology, Medical faculty of Masaryk University, St. Anne University Hospital, Brno, Czech Republic

Sedivá A, Kayserová J, Vernerová E, Poloucková A, Sedivá A, Kayserová J, Vernerová E, Poloucková A, Capková S, Spísek R, Bartůnková J. Capková S, Spísek R, Bartůnková J. Anti-CD20 (rituximab) treatment for atopic eczema.Anti-CD20 (rituximab) treatment for atopic eczema.J Allergy Clin Immunol. 2008 Jun;121(6):1515-6J Allergy Clin Immunol. 2008 Jun;121(6):1515-6

DC in allergyDC in allergy

exprese DC-SIGN

0

20000

40000

60000

80000

pacienti kontroly

MF

I

iDC

LPS

polyIC

OVA

B40

iDC + OVA: OVA (red),DC-SIGN (green)

The role of dendritic cells in allergic responseDendritic cells in allergic patients, morphology and function of moDCs in response to ligands and allergensPotential role of lectins as receptors for allergens

Allergic patients have an increased expression of DC-SIGN on iDC, with subsequent significant decrease induced by OVA or birch allergen, associated, however, with increaded IL-6 production in patients compared to controlsOVA binds C lectin receptor on DCs

Combatting Allergy Combatting Allergy and Asthmaand Asthma

Global InitiativeGlobal Initiative