- Email: [email protected]
Effect of antioxidants and nutrients in patients with allergy and asthma
CORRESPONDENCE 763
J ALLERGY CLIN IMMUNOL VOLUME 134, NUMBER 3
Disclosure of potential conflict of interest: R. Agrawal is employed by the University of Virginia. J. A. Woodfolk has received research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases and the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases and from Danisco Dupont and is employed by the University of Virginia. The rest of the authors declare that they have no relevant conflicts of interest.
REFERENCES 1. Dreyfus DH. Gene silencing and related oligonucleotide therapies for TH2-promoting cytokines. J Allergy Clin Immunol 2014;134:762-3. 2. Romeo MJ, Agrawal R, Pomes A, Woodfolk JA. A molecular perspective on TH2-promoting cytokine receptors in patients with allergic disease. J Allergy Clin Immunol 2014;133:952-60. 3. Lively TN, Kossen K, Balhron A, Koya T, Zinnen S, Takeda K, et al. Effect of chemically modified IL-13 short interfering RNA on development of airway hyperresponsiveness in mice. J Allergy Clin Immunol 2008;121:88-94. 4. Darcan-Nicolaisen Y, Meinicke H, Fels G, Hegend O, Haberland A, Kuhl A, et al. Small interfering RNA against transcription factor STAT6 inhibits allergic airway inflammation and hyperreactivity in mice. J Immunol 2009;182:7501-8. 5. Kanasty R, Dorkin JR, Vegas A, Anderson D. Delivery materials for siRNA therapeutics. Nat Mater 2013;12:967-77. Available online July 18, 2014. http://dx.doi.org/10.1016/j.jaci.2014.06.009
Srijit Das, MS From the Faculty of Medicine, Department of Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. E-mail: [email protected]. Disclosure of potential conflict of interest: S. Das declares no relevant conflicts of interest. REFERENCES 1. Moreno-Macias H, Romieu I. Effects of antioxidant supplements and nutrients on patients with asthma and allergies. J Allergy Clin Immunol 2014;133: 1237-44. 2. Keat EC, Razak SS, Fadil NM, Yusof FM, Chan LH, Chyi FK, et al. The effect of Piper betel extract on the wound healing process in experimentally induced diabetic rats. Clin Ter 2010;161:117-20. 3. Teoh SL, Latiff AA, Das S. The effect of topical extract of Momordica charantia (bitter gourd) on wound healing in nondiabetic rats and in rats with diabetes induced by streptozotocin. Clin Exp Dermatol 2009;34:815-22. 4. Rashid Jusoh A, Das S, Kamsiah J, Qodriyah HM, Faizah O. Effect of curcumin on aortic changes in ovariectomized rats fed with repeatedly heated soy oil: a preliminary electron microscopic study. Clin Ter 2013;164:307-13. 5. Devereux G. Session 1: allergic disease: nutrition as a potential determinant of asthma. Proc Nutr Soc 2010;69:1-10. 6. Misso NL, Thompson PJ. Oxidative stress and antioxidant deficiencies in asthma: potential modification by diet. Redox Rep 2005;10:247-55. Available online July 25, 2014. http://dx.doi.org/10.1016/j.jaci.2014.06.011
Effect of antioxidants and nutrients in patients with allergy and asthma
Reply
To the Editor: I read with much interest the article by Moreno-Macias and Romieu.1 The authors discussed the importance of antioxidant supplements and nutrients. Over the last decade, my colleagues and I have performed experimental laboratory studies on various potential herbs and their extracts. Many of the oxidative stress disorders in experimental animals were shown to have fewer complications or even the damages were reverted once treated with herbal supplements. Notable to mention is the effect of Piper betel and Momordica charantia on experimentally induced type 2 diabetes and of Curcuma longa on experimentally induced rheumatoid arthritis.2-4 Many of our experiments ascertained the level of different antioxidants and inflammatory markers, which were observed to be decreased after treatment with plant extract rich in flavonoids and antioxidants. This may be due to flavonoids and phenolic compounds present in the extract that acted as antioxidants. Recently, there has been an increase in global awareness to consume more green leafy vegetables and fruits to increase the level of antioxidants in the body. It should not be forgotten that any oxidative disease involves the production of reactive oxygen species, which causes profound damage to the organs and tissues. Reducing the oxidative process may be the mainstay of the treatment. The authors highlighted the effect of vitamins C and E on oxidative stress in their Fig 1 but other exogenous vitamins such as vitamins A and D were left out. Even omega-3-fatty acids may have a protective effect in airway diseases. The n-6:n-3 polyunsaturated fatty acids may also play an important role in the diet. A diet rich in antioxidants and nutrients may prove to be more beneficial during pregnancy.5 In fact, it is the glutathione S-transferase enzyme that determines an individual’s response to any oxidative stress.6 Researchers highlighted the importance of oxidant/antioxidant equilibrium in patients with asthma who were exposed to low dietary intake of vitamins C and E.6 I congratulate the authors and specially thank the Editor for publishing an article with immense clinical importance.
To the Editor: We thank Dr Das1 for his insightful comments. Although we focused our revision on antioxidant intake, we agree that other nutrients may have protective effects in asthma and allergic diseases. Fatty acids do not have antioxidant properties; nevertheless, they have an active role in anti- and proinflammatory activities. Omega-3 polyunsaturated fatty acids (v-3 PUFAs) refer to a group of 3 fats known as a-linolenic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid. Metabolic competition between EPA and arachidonic acid results in decreased production of prostaglandins, and thromboxane. EPA and docosahexaenoic acid give rise to families of mediators that have anti-inflammatory actions. In addition to these effects, v-3 PUFAs affect cell signaling processes and gene expression in inflammatory cells, resulting in decreased expression of inflammatory cytokines.2 Omega-6 polyunsaturated fatty acids (v-6 PUFAs) are a family of acids that have in common a final carbon-carbon double bond in the n-6 position.3 The most abundant source of v-6 PUFAs is linoleic acid, which is converted to arachidonic acid, a progenitor of both prostaglandin E2 and leukotriene B4 via cyclooxygenase and 5-lipoxygenase enzymatic pathways, respectively. Both prostaglandin E2 and leukotriene B4 have proinflammatory biologic actions.4 Competitive interactions between v-3 PUFAs and v-6 PUFAs determine the cellular content of arachidonic acid (v-6) and EPA (v-3). v-3s are found in high quantity in fish oil and monounsaturated oils such as canola and flaxseed oils, whereas v-6s are found in polyunsaturated fats such as soybean, corn, safflower, and sunflower oils. Results of epidemiologic studies have not been conclusive. Almqvist et al5 found that plasma levels of fatty acids v-3 or v-6 were not associated with asthma-related phenotypes in children with a family history of asthma at age 5 years. Simopoulos6 reported that a v-3/v-6 ratio of 5:1 exerts beneficial effects on asthma, while a ratio of 10:1 has adverse effects. In a double-blind randomized controlled trial, D’Vaz et al7 found that after receiving a daily supplementation of fish oil from birth
J ALLERGY CLIN IMMUNOL VOLUME 134, NUMBER 3
Disclosure of potential conflict of interest: R. Agrawal is employed by the University of Virginia. J. A. Woodfolk has received research support from the National Institutes of Health/National Institute of Allergy and Infectious Diseases and the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases and from Danisco Dupont and is employed by the University of Virginia. The rest of the authors declare that they have no relevant conflicts of interest.
REFERENCES 1. Dreyfus DH. Gene silencing and related oligonucleotide therapies for TH2-promoting cytokines. J Allergy Clin Immunol 2014;134:762-3. 2. Romeo MJ, Agrawal R, Pomes A, Woodfolk JA. A molecular perspective on TH2-promoting cytokine receptors in patients with allergic disease. J Allergy Clin Immunol 2014;133:952-60. 3. Lively TN, Kossen K, Balhron A, Koya T, Zinnen S, Takeda K, et al. Effect of chemically modified IL-13 short interfering RNA on development of airway hyperresponsiveness in mice. J Allergy Clin Immunol 2008;121:88-94. 4. Darcan-Nicolaisen Y, Meinicke H, Fels G, Hegend O, Haberland A, Kuhl A, et al. Small interfering RNA against transcription factor STAT6 inhibits allergic airway inflammation and hyperreactivity in mice. J Immunol 2009;182:7501-8. 5. Kanasty R, Dorkin JR, Vegas A, Anderson D. Delivery materials for siRNA therapeutics. Nat Mater 2013;12:967-77. Available online July 18, 2014. http://dx.doi.org/10.1016/j.jaci.2014.06.009
Srijit Das, MS From the Faculty of Medicine, Department of Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia. E-mail: [email protected]. Disclosure of potential conflict of interest: S. Das declares no relevant conflicts of interest. REFERENCES 1. Moreno-Macias H, Romieu I. Effects of antioxidant supplements and nutrients on patients with asthma and allergies. J Allergy Clin Immunol 2014;133: 1237-44. 2. Keat EC, Razak SS, Fadil NM, Yusof FM, Chan LH, Chyi FK, et al. The effect of Piper betel extract on the wound healing process in experimentally induced diabetic rats. Clin Ter 2010;161:117-20. 3. Teoh SL, Latiff AA, Das S. The effect of topical extract of Momordica charantia (bitter gourd) on wound healing in nondiabetic rats and in rats with diabetes induced by streptozotocin. Clin Exp Dermatol 2009;34:815-22. 4. Rashid Jusoh A, Das S, Kamsiah J, Qodriyah HM, Faizah O. Effect of curcumin on aortic changes in ovariectomized rats fed with repeatedly heated soy oil: a preliminary electron microscopic study. Clin Ter 2013;164:307-13. 5. Devereux G. Session 1: allergic disease: nutrition as a potential determinant of asthma. Proc Nutr Soc 2010;69:1-10. 6. Misso NL, Thompson PJ. Oxidative stress and antioxidant deficiencies in asthma: potential modification by diet. Redox Rep 2005;10:247-55. Available online July 25, 2014. http://dx.doi.org/10.1016/j.jaci.2014.06.011
Effect of antioxidants and nutrients in patients with allergy and asthma
Reply
To the Editor: I read with much interest the article by Moreno-Macias and Romieu.1 The authors discussed the importance of antioxidant supplements and nutrients. Over the last decade, my colleagues and I have performed experimental laboratory studies on various potential herbs and their extracts. Many of the oxidative stress disorders in experimental animals were shown to have fewer complications or even the damages were reverted once treated with herbal supplements. Notable to mention is the effect of Piper betel and Momordica charantia on experimentally induced type 2 diabetes and of Curcuma longa on experimentally induced rheumatoid arthritis.2-4 Many of our experiments ascertained the level of different antioxidants and inflammatory markers, which were observed to be decreased after treatment with plant extract rich in flavonoids and antioxidants. This may be due to flavonoids and phenolic compounds present in the extract that acted as antioxidants. Recently, there has been an increase in global awareness to consume more green leafy vegetables and fruits to increase the level of antioxidants in the body. It should not be forgotten that any oxidative disease involves the production of reactive oxygen species, which causes profound damage to the organs and tissues. Reducing the oxidative process may be the mainstay of the treatment. The authors highlighted the effect of vitamins C and E on oxidative stress in their Fig 1 but other exogenous vitamins such as vitamins A and D were left out. Even omega-3-fatty acids may have a protective effect in airway diseases. The n-6:n-3 polyunsaturated fatty acids may also play an important role in the diet. A diet rich in antioxidants and nutrients may prove to be more beneficial during pregnancy.5 In fact, it is the glutathione S-transferase enzyme that determines an individual’s response to any oxidative stress.6 Researchers highlighted the importance of oxidant/antioxidant equilibrium in patients with asthma who were exposed to low dietary intake of vitamins C and E.6 I congratulate the authors and specially thank the Editor for publishing an article with immense clinical importance.
To the Editor: We thank Dr Das1 for his insightful comments. Although we focused our revision on antioxidant intake, we agree that other nutrients may have protective effects in asthma and allergic diseases. Fatty acids do not have antioxidant properties; nevertheless, they have an active role in anti- and proinflammatory activities. Omega-3 polyunsaturated fatty acids (v-3 PUFAs) refer to a group of 3 fats known as a-linolenic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid. Metabolic competition between EPA and arachidonic acid results in decreased production of prostaglandins, and thromboxane. EPA and docosahexaenoic acid give rise to families of mediators that have anti-inflammatory actions. In addition to these effects, v-3 PUFAs affect cell signaling processes and gene expression in inflammatory cells, resulting in decreased expression of inflammatory cytokines.2 Omega-6 polyunsaturated fatty acids (v-6 PUFAs) are a family of acids that have in common a final carbon-carbon double bond in the n-6 position.3 The most abundant source of v-6 PUFAs is linoleic acid, which is converted to arachidonic acid, a progenitor of both prostaglandin E2 and leukotriene B4 via cyclooxygenase and 5-lipoxygenase enzymatic pathways, respectively. Both prostaglandin E2 and leukotriene B4 have proinflammatory biologic actions.4 Competitive interactions between v-3 PUFAs and v-6 PUFAs determine the cellular content of arachidonic acid (v-6) and EPA (v-3). v-3s are found in high quantity in fish oil and monounsaturated oils such as canola and flaxseed oils, whereas v-6s are found in polyunsaturated fats such as soybean, corn, safflower, and sunflower oils. Results of epidemiologic studies have not been conclusive. Almqvist et al5 found that plasma levels of fatty acids v-3 or v-6 were not associated with asthma-related phenotypes in children with a family history of asthma at age 5 years. Simopoulos6 reported that a v-3/v-6 ratio of 5:1 exerts beneficial effects on asthma, while a ratio of 10:1 has adverse effects. In a double-blind randomized controlled trial, D’Vaz et al7 found that after receiving a daily supplementation of fish oil from birth