Abstract: BACKGROUND: Rhinomanometry has been used earlier in patients with allergic rhinitis (AR) for quantification of nasal airway resistance (NR). Although there is a difference between subjective symptoms and NR of mild and moderate-severe forms of AR, it is not known if there is a difference between intermittent and persistent categories of AR, and if this difference correlates with the subjective nasal symptoms scores or not. OBJECTIVES: To elucidate any such difference and to look for the impact of Vitamin D deficiency on NR as various studies have shown an association between AR and Vitamin D deficiency. METHOD: A total of 145 (87 males; 58 females) patients, aged 10–70 years, diagnosed clinically with moderate–severe AR as per AR and its Impact on Asthma guidelines were recruited and were categorized into intermittent and persistent groups. SNOT-22 score was calculated in all the patients. Active anterior rhinomanometry (AAR) and posterior rhinomanometry were used to measure inspiratory and expiratory NR in intermittent and persistent groups and also as per Vitamin D levels in these groups. RESULTS: There was no significant difference between the intermittent and persistent categories for NR or SNOT-22 scores. There was no significant correlation between the SNOT-22 score and any of the NR parameter in either group. However, there was a significant difference in inspiratory and expiratory NR during AAR between intermittent and persistent groups of patients with severe Vitamin D deficiency ( P ≤ 0.0001). CONCLUSION: There is no difference in objective NR or SNOT-22 score between intermittent and persistent categories of patients with moderately severe AR and there is no correlation between this objective and subjective score within these groups. However, if there is severe Vitamin D deficiency, the NR during AAR differs significantly between intermittent and persistent groups of patients with moderately severe AR.
BACKGROUND: Yoga is being increasingly recognized as a complementary approach to managing chronic health conditions like asthma. However, its effect on inflammatory biomarkers, lung function, anxiety, and sleep quality needs to be further explored. Our study concurrently investigates multiple health parameters that are needed to provide more robust evidence for the effectiveness of yoga as a therapeutic intervention. OBJECTIVE: The objective of this study was to evaluate the impact of yoga interventions on the biochemical inflammatory markers (interleukin [IL-6] and periostin), lung functions, sleep quality, and psychological well-being in asthma patients. MATERIALS AND METHODS: This was a single-center, open-label, randomized controlled trial. A total of 191 asthma patients were randomized (1:3) into a control group (n = 48) receiving standard treatment and a yoga group (n = 143) receiving standard treatment plus a structured yoga program thrice weekly for 8 weeks. RESULTS: Forty participants from the yoga group completed the study. Significant improvements were seen in forced vital capacity, forced expiratory volume in 1 s, Asthma Control (Asthma Control Test [ACT]), anxiety (Beck Anxiety Inventory [BAI]), and sleep quality (Pittsburgh Sleep Quality Index [PSQI]) among those in the yoga group (P < 0.05). There was a drop in levels of IL-6 and periostin levels in the intervention group. When comparing the two groups, statistically significant improvements were found in ACT, BAI, and PSQI favoring the yoga group, while lung function and biochemical markers did not show significant differences between the groups. CONCLUSION: Adjunct yoga therapy in asthma patients significantly improves lung function, asthma control, anxiety, and sleep quality and also leads to reductions in inflammatory biomarker levels compared to standard treatment alone. Yoga may serve as a beneficial complementary approach to enhance the quality of life in asthma management.
Bronchial asthma is a chronic inflammatory airway disorder characterized by variable respiratory symptoms and reversible airflow obstruction. Although inhaled pharmacotherapy remains the cornerstone of asthma management, many patients, especially in low- and middle-income countries, continue to have inadequate control due to modifiable environmental, behavioral and psychosocial factors. The Dr. R. K. Modi Memorial Oration (2025), delivered by the author emphasized that no-pharmacological strategies are not optional add-ons but essential complements to controller medications. Evidence from India and across the world demonstrates that structured nonpharmacological interventions – including allergen and trigger avoidance, smoking cessation, optimal management of comorbidities, yoga and pranayama, breathing retraining, pulmonary rehabilitation, dietary optimization, vaccination, and patient education – significantly improve symptom control, lung function, oxidative stress markers, and quality of life, while reducing exacerbations and healthcare utilization. This narrative review synthesizes available evidence, with special emphasis on Indian data and oration-linked studies, to present a comprehensive, human-centered overview of nonpharmacological management of bronchial asthma. The article highlights how a rational integration of these strategies with guideline-directed pharmacotherapy can substantially improve long-term outcomes and address India-specific challenges related to pollution, biomass use, allergen burden, underdiagnosis, inhaler hesitancy, and comorbidity clustering.
Bronchial asthma is a chronic airway condition affecting about 10%–12% of adults and 15% of children worldwide. Treatment guidelines vary by asthma nature and severity. This study aimed to elaborate on different treatments and strategies for asthmatic patients and identify new treatment options for suboptimal, controlled, or uncontrolled cases of asthma. A literature review on asthma was conducted using MedLine, PubMed, Google Scholar, EBSCO, ScienceDirect, and Scopus. Data collection followed COOPED guidelines. The search used terms “asthma,” “controller,” “reliever,” “LABAs,” “SABAs,” and “leukotrienes.” Online and offline publications were used to gather information. Bronchial asthma is a chronic airway disorder characterized by wheezing, breathlessness, chest tightness, and cough. Nonpharmacotherapy and pharmacotherapy are effectively used in all asthma stages. Bronchial asthma is often poorly controlled, and 5% of cases resist conventional therapy. Mortality occurs in cases of exacerbation and frequent bronchodilator use without corticosteroids. The pragmatic approach differs based on the nature and severity of asthma. Stepwise therapies are among the most common therapeutic strategies for asthma management. Further trials are being conducted to identify new chemical entities that work on a single common pathway in asthma pathogenesis with possible minimum adverse effects.
BACKGROUND: Asthma is a heterogeneous airway disease with variable airflow limitation. Evidence suggests obesity may influence asthma severity and pulmonary function test (PFT) parameters, yet Indian data remain scarce. This study aimed to assess the impact of body mass index (BMI) on lung function and clinicodemographic characteristics of asthmatic patients. A retrospective analysis was conducted at the Department of Chest Medicine at a tertiary care hospital. METHODOLOGY: Data of 100 adult patients with clinically diagnosed asthma were retrieved from the PFT laboratory registry. Demographics, BMI, comorbidities, addictions, and occupations were documented. PFT indices (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], FEV1/FVC ratio, forced expiratory flow [FEF]25-75, peak expiratory flow rate (PEFR)) were analyzed pre and postbronchodilator across BMI categories (underweight, normal, overweight, and obese). Statistical significance was determined using Chi-square and analysis of variance tests. RESULTS: Of 100 patients, 55% were female and 45% male, with the majority aged 18–45 years. Homemakers (34%) and students (20%) were the predominant occupations. Most patients (52%) had normal BMI, while 27% were overweight, 12% underweight, and 9% obese. Comorbidities were uncommon (7% had diabetes, hypertension, or thyroid disorders). On PFT analysis, mean prebronchodilator FEV1 and FVC values significantly declined with increasing BMI (P = 0.006 and P = 0.004, respectively). Postbronchodilator improvement was seen across groups, but remained lowest among obese patients. FEF25-75 and PEFR also showed significant postbronchodilator variation (P = 0.03). CONCLUSION: Obesity adversely impacts lung function among asthmatics, with lower baseline and postbronchodilator FEV1 and FVC values. These findings emphasize the importance of weight management as part of asthma control strategies in clinical practice.
Stevens-Johnson syndrome (SJS) is a rare but potentially fatal mucocutaneous hypersensitivity reaction, most often drug induced. Anesthetic management in patients with a history of SJS is particularly challenging due to the heightened risk of severe allergic or anaphylactoid reaction. We present the case of a 20-year-old male with a previous episode of SJS undergoing symblepharon correction under monitored anesthesia care. Given the patient’s extensive drug allergy history, subcutaneous sensitivity testing was performed preoperatively to assess potential hypersensitivity to commonly used anesthetic agents. A mild localized reaction was noted only with ondansetron. The surgical procedure was completed uneventfully under local anesthesia. This case illustrates the importance of individualized anesthetic planning and highlights the cautious use of subcutaneous sensitivity testing as a preoperative safety measure in high-risk patients.
INTRODUCTION: Allergic bronchopulmonary aspergillosis (ABPA) is an allergic inflammatory response of the respiratory system due to colonization of the airway by Aspergillus fumigatus. ABPA usually occurs in patients with bronchial asthma and cystic fibrosis. AIM AND OBJECTIVES: Primary aim was to estimate the prevalence of ABPA in patient of bronchial asthma, and objectives were to determine socio-demographic profile and to assess the outcome of serological and radiological profile. MATERIALS AND METHODS: Our study was a hospital-based observational and cross-sectional, at department of Respiratory Medicine, among 200 bronchial asthma patients, and ISHAM criteria (2013) were used for ABPA diagnosis. Data were analyzed using SPSS Version 26.0. RESULTS: We observed 10.5% prevalence of ABPA in 200 asthma patients. The total males were 89 and females were 111. The mean age of patients and duration of asthma in ABPA patients were 32.62 and 9.81 years, respectively. Family history of asthma in ABPA and non-ABPA patients was in 71% and 46%, respectively. The mean absolute eosinophil count, serum total immunoglobulin E (IgE), and Aspergillus-specific IgE in ABPA patients were significantly higher compared to non-ABPA patients. Among ABPA patients, Chest X-ray was abnormal in 43% patients, and 81% patients had abnormal computed tomography thorax. CONCLUSION: ABPA is a quite prevalent entity among bronchial asthma patients and similar in clinical features with other infective disease which can mislead to other diagnosis like tuberculosis. There is a requirement for more multicentric studies for early and accurate diagnosis to reveal the true prevalence of ABPA in asthma patients.
BACKGROUND: Aeroallergens play an important role in the pathogenesis of respiratory allergic diseases. Identification of the most prevalent aeroallergens, to which the patients are sensitized, has an important role in the diagnosis and treatment of bronchial asthma (BA) and allergic rhinitis (AR) patients. Skin prick tests (SPTs) has an important role for this purpose. AIMS: The aims of this study were to identify the various aeroallergens by SPTs that give rise to BA and AR in patients, attending at a tertiary care center in central Rajasthan. SETTINGS AND DESIGN: This was a prospective study conducted in patients with BA and/or AR, attending the Department of Respiratory Medicine, Mahatma Gandhi Institute of Medical Science and Technology, Jaipur, Rajasthan, India. MATERIALS AND METHODS: This study was conducted between October 2023 and January 2025. A total of 130 patients were included in this study. All patients undergo clinical evaluation, routine blood investigations, chest radiography, X-ray paranasal sinus, and spirometry as a part of evaluation for allergic diseases. The SPTs were performed using a standard allergen extract panel in all the patients of our study. RESULTS: In our study, patients diagnosed with BA were 44 (33.8%), AR were 31 (23.8%) and having both BA and AR were 55 (42.3%). Pollens (78.5%) were the most common followed by insects (65.4%), housedust mites (40.8%), dusts (38.5%), and fungi (33.8%) were the offending aeroallergens. Among individual allergens, the most common aeroallergen was cockroach (50%) and the least common was cyperus (0.8%). CONCLUSIONS: The role of SPTs in diagnosis and guiding immunotherapy in allergic disorders is immense. This study will help for selecting the panel of most common aeroallergens for SPTs and will also help in finding the best species of allergens for immunotherapy in this area of central Rajasthan.
In the context of simian immunodeficiency virus (SIV) infection, this editorial commentary minireview addresses the roles of galectin-3, galectin-9, and interleukin-18 in monocyte activation and turnover. It places particular emphasis on their potential consequences for the emergence of cardiac pathology and encephalitis in human immunodeficiency virus (HIV)-positive individuals. The intricate relationship between these proteins and monocyte activation in HIV/SIV pathogenesis is examined, along with their correlation with neurocognitive impairment and cardiovascular illness. Strategies to prevent or treat these diseases in HIV-positive persons include targeted treatments and personalized medicine approaches that target these biomarkers and pathways.
Allergic conjunctival diseases (ACDs) are the common immunological inflammatory diseases of the anterior surface of the eye. Seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) are the most frequent causes of ACDs. Clinically presents as bilaterally conjunctival hyperemia, tearing, conjunctival chemosis, with pruritus. Atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC), and Giant papillary conjunctivitis can potentially induce deleterious effects on the anterior surface of the eyes can further progress to decease in visual acuity, photophobia, severe foreign body sensation, and corneal opacity. The clinical course, severity, duration, and comorbidities are varied in different types of ACDs. Moreover, ACDs commonly overlap with other anterior ocular diseases such as blepharitis, infections, and dry eye syndrome. ACDs are under-treated or mistreated by primary care physicians with topical and systemic corticosteroids. Accurate diagnosis is essential for the management of ACDs. Total immunoglobulin E (IgE) in tears, allergen-specific IgE, skin prick test, and patch test are done for IgE and non-IgE mediated diseases, while Schirmer’s test, tear osmolarity, and tear matrix metalloproteinase should be evaluated for dry eye syndrome. Topical antihistamine decongestant and mast cell stabilizer are the first choice of treatment for ACDs, but topical corticosteroids are still a major concern for adverse events. Topical calcineurin inhibitors (cyclosporin A and tacrolimus) are considered in severe cases of PAC and AKC. Allergen immunotherapy (AIT) should be considered only when IgE-mediated immunological reaction is evidenced. This review provides an overview of classification, immunopathology, and updated management of ACDs.
BACKGROUND: Asthma is a heterogeneous disease, characterized by chronic airway inflammation. Fungal sensitization is associated with a more severe asthma phenotype. Patients often present with poor asthma control, frequent exacerbations, and reduced pulmonary function. It involves a spectrum of disease ranging from simple asthma with fungal sensitization at one end to allergic bronchopulmonary aspergillosis (ABPA) at the more severe end, with variations in the underlying immune response. MATERIALS AND METHODS: This cross-sectional study aimed to determine the prevalence of severe asthma with fungal sensitization (SAFS) and ABPA patients in diagnosed patients of severe bronchial asthma using skin prick test. SPT-positive patients were then subjected to further investigations including total serum immunoglobulin E (IgE), specific IgE against Aspergillus fumigatus, specific IgG against A. fumigatus, chest X-ray, and high-resolution computed tomography (HRCT) of the thorax. RESULTS: A total of 100 severe asthma patients were studied during the study period. The age of the patients ranged between 18 and 58 years, the mean age was 36.00 ± 11.48 years, and the majority were female (52.0%). Breathlessness was the most common symptom, and A. fumigatus sensitization was found in 48% of patients with 95.83% normal chest X-ray and 75% normal HRCT of the thorax. Our study determined the prevalence of SAFS as 22% and of ABPA as 26%. CONCLUSION: Fungal sensitization, particularly to A. fumigatus, is frequently observed in patients with severe bronchial asthma and is associated with a significant occurrence of SAFS and ABPA. Early identification through routine screening can aid in timely diagnosis and targeted management, potentially improving disease control and long-term outcomes in this high-risk population.
Severe combined immunodeficiency (SCID) encompasses a group of inherited disorders characterized by defective T- and B-cell development, leading to life-threatening infections early in infancy. Reticular dysgenesis (RD) is a rare and severe form of SCID caused by mutations in the AK2 gene, resulting in profound neutropenia and lymphopenia. Affected infants are highly susceptible to viral, fungal, and early-onset severe bacterial infections. We report the case of a 3-month-old male infant who presented with fever, multiple skin lesions, and respiratory distress, initially appearing around the 20th day of life. Despite prolonged empirical treatment at an outside facility, the skin lesions progressed to necrotic ulcers resembling pyoderma gangrenosum. Laboratory investigations revealed persistent neutropenia, lymphopenia, and hypogammaglobulinemia. Whole exome sequencing confirmed a pathogenic AK2 mutation consistent with RD. Although there was a transient improvement with antimicrobial therapy and intravenous immunoglobulin, the infant eventually succumbed to overwhelming sepsis. This case highlights the importance of early recognition, genetic confirmation, and timely referral for hematopoietic stem cell transplantation in rare immunodeficiency syndromes like RD.
BACKGROUND: Strict use of personal protective equipment (PPE) and hand hygiene measures following the COVID-19 pandemic has resulted in increased incidence of adverse skin reactions among health care workers (HCWs). The aim of this study was to determine the prevalence and pattern of adverse skin reactions on face and hands due to PPE, and the various factors associated with its occurrence. METHODOLOGY: This was a cross-sectional analytical study conducted among doctors, nurses, laboratory technicians and housekeeping staff. RESULTS: Out of 256 HCWs enrolled in the study, 75 (29.3%) reported to have symptoms over hand, including dryness (51, 69.9%), itching and burning sensation. Housekeeping staff (41.3%) were found to be more prone to develop skin lesions on hands (P = 0.001). Atopy (P = 0.026) and handling of chemicals (P = 0.011) were found to be significant risk factors. 58 HCWs reported having symptoms on the face, including dryness (24), acneiform eruption (25), and erythema (21). Doctors (52.1%, P = 0.001), HCWs using same mask on more than 1 day (P = 0.005), and those using 3-ply mask were found to be more prone to occurrence of skin lesions on face. CONCLUSION: There is increased frequency of hand washing and disinfectant use, and increased duration of wearing disposable gloves and face masks after the onset of the pandemic. More than one-third of the participants had an adverse skin reaction on either hand or face or both. Factors contributing were duration of PPE used, frequency of hand hygiene measures, presence of atopy, reuse of masks, handling of irritants and specific job pattern.
CONTEXT: Moisturizers are widely used for skin hydration but can provoke allergic contact dermatitis due to various allergenic compounds. The moisturizer formulations – including emollients, humectants, preservatives, fragrances, and botanical extracts – heighten the risk for allergic reactions, especially among vulnerable populations. Regional regulatory differences and varying ingredient profiles further complicate safe product selection and allergy management. AIMS: The aim is to profile the allergenic compounds present in commercial moisturizers available in the Indian market. SETTINGS AND DESIGN: Secondary data analysis. SUBJECTS AND METHODS: The list of moisturizers was compiled from leading Indian e-commerce platforms, including products disclosing full ingredient lists. Allergenic compounds identified from published scientific literature were categorized as high or low-prevalence according to the North American Contact Dermatitis Group survey data. Statistical associations between total ingredient count and allergen presence were examined. RESULTS: Of 1185 products reviewed, 926 met the inclusion criteria. Among these, 96.8% contained at least one known allergen, with some products listing up to 15 allergens. In total, 134 unique allergens were identified (49 high prevalence, 91 low prevalence). Fragrances (35.8%) and perfumes (23.5%) constituted the most frequent high-prevalence allergens, alongside botanical extracts and propylene glycol. A statistically significant positive association was found between ingredient count and allergen number. Many low-prevalence allergens occurred commonly due to their widespread formulation use. CONCLUSIONS: Allergenic compounds are nearly ubiquitous in commercial Indian moisturizers, with both high- and low-prevalence allergens posing risks to consumers. These findings underscore the necessity for greater transparency, regulatory reform, and expanded allergen screening in product formulation and clinical care.
Allergic diseases, including asthma, allergic rhinitis, atopic dermatitis, and food allergies, have emerged as a major global health concern with rapidly increasing prevalence, particularly in urbanized and industrialized societies. Despite their high burden, allergy care remains underdeveloped in many regions due to limited awareness, a shortage of trained specialists, and a lack of dedicated infrastructure. The establishment of structured allergy practices offers an opportunity to bridge this gap by enabling early diagnosis, timely interventions, and advanced therapeutic approaches such as allergen immunotherapy and biologics. Essential components for setting up an allergy clinic include appropriate infrastructure, access to validated diagnostic tools, therapeutic facilities, trained staff, and robust emergency preparedness. Patient education and community awareness initiatives further enhance outcomes by empowering individuals in self-management and adherence. However, significant challenges remain, including the high costs of diagnostic kits, uneven insurance coverage, and a lack of standardized care protocols in low-and middle-income countries. Future developments in digital health, point-of-care diagnostics, and personalized medicine promise to transform the delivery of allergy care, making it more accessible and effective. This review outlines the rationale, essential components, challenges, and future directions in establishing allergy practices to address the growing global burden of allergic diseases.
Abstract: BACKGROUND: Allergic rhinitis is the most common form of non-infectious rhinitis and is associated with an IgE-mediated immune response to allergens. It has a negative impact on the quality of life of patients. Iron deficiency and anemia are associated with atopic diseases and good iron status prevents allergy. OBJECTIVES: To study level of serum ferritin in patients of allergic rhinitis and compare this with that of normal subjects. METHODOLOGY: This study was conducted in the department of Otorhinolaryngology, VIMSAR, Burla. The participants were subjected to clinical evaluation and haematological investigations including Complete blood count and Serum ferritin level. This was compared with that of matched healthy subjects taken as controls. The severity of allergic rhinitis was measured using ARIA classification. RESULTS: Among the 40 patients in each group, there were 29 female patients (72.5%) and 11 male patients (27.5%) with a mean age of 35.1 years. The incidence of iron deficiency was significantly higher in patients with allergic rhinitis compared with normal subjects. The average serum ferritin level in cases of AR was 12.03 ng/ml whereas the average level in control subjects was 124.2 ng/ml (p-value <0.0001 as determined by t-test). Also, we found statistically significant difference of serum ferritin level between mild and moderate/ severe cases of allergic rhinitis. CONCLUSION: Prevalence of iron deficiency in patients with allergic rhinitis is higher than in patients without atopic disease. Iron deficiency increases markedly with severity of allergic rhinitis. The level of serum ferritin can be used as a marker for determining the severity of allergic rhinitis.
Abstract: Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening disorder which occurs due to excessive immune response and high cytokine levels leading to tissue damage and organ failure. HLH can be primary and secondary. The etiology and presentation of secondary HLH remain diverse. Treatment of secondary HLH includes management of primary conditions and immunosuppressives. Several cases of secondary HLH due to tuberculosis (TB) have been reported in the past although their management beyond antitubercular therapy and follow-up was not reported. Here, we present a rare case report of secondary HLH and isolated cerebellar ataxia due to disseminated TB that responded to intravenous immunoglobulin in addition to antitubercular therapy and steroids. Patients showed complete response to therapy with normalization of hematological parameters and bone marrow findings. The patient was declared cured after 6 months of treatment.
