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This is an Editorial.

According to the WHO's recommendation for developing countries, Bacillus Calmette-Guerin (BCG) vaccination has been implemented in some countries as part of national vaccination programs at birth. Although it is generally considered safe, some complications may occur; including BCGitis (local) or BCGosis (systemic), ranging from mild like local abscesses to fatal impediments like osteomyelitis and disseminated BCG infection. This study aimed to determine the spectrum of inborn errors of immunity (IEI) in BCG-vaccinated neonates experiencing local or systemic complications. In this cross-sectional study, we investigated Iranian children referred to the Immunology, Asthma, and Allergy Research Institute (IAARI) between 2007-2023 for suspected immunodeficiency. Medical history was recorded, and primary screening tests for immunodeficiency were conducted for all cases. For suspected cases, more advanced immunologic investigations were performed to reach a definitive diagnosis. Furthermore, the study incorporated the documented genetic findings of the patients under investigation. All patients with inborn error of immunity who had a history of BCG vaccine complications within the first year of vaccination were enrolled in the study. We investigated 3,275 cases suspected of IEI, identifying197 patients with both IEI and BCG vaccine complications. Among these, 127 (64.5%) were male. Symptoms began at or before 3 months of age in 64.8% of the cases, and parental consanguinity was reported in 79.2%. Genetic diagnoses were confirmed in 108 patients. Of the 197 patients, 108 (54.8%) had BCGitis, while 89 (45.2%) experienced systemic complications (BCGosis). A family history of IEI, BCG-related complications, and unexplained deaths were observed in 20.3%, 12.2%, and 29.9% of cases, respectively. Furthermore, 46.2% had at least one of these three risk factors in their history. Early BCG vaccine complications may indicate an underlying immunodeficiency, particularly when there is a positive family history of BCG complications, immunodeficiency, or unexplained deaths. Nation-wide vaccination protocols should address this issue by delaying inoculation to allow for immunological screening of suspected immunodeficient patients, thereby preventing BCG vaccine-related morbidity and mortality.

Noise has been reported as one of the most important risk factors for asthma, but there are some disagreements. This study aimed to investigate the effect of road noise on asthma prevalence in adults. In the current study, 3172 adults were interviewed through the ECRHS standardized questionnaire in Tehran, the capital of Iran. Exposure to road noise was assessed considering distance of individual participants from the noise monitoring stations via the spatial analysis in GIS software. Logistic regression was used to assess the effect of noise on the symptoms of asthma. Findings showed a significant positive association between wheezing with dyspnea as the best marker for asthma and noise levels at daytime ( OR 1.03; 0.98–1.05) and nighttime ( OR 1.05; 0.84–1.09). Also, a significant positive association was obtained between daytime and nighttime noise levels and other asthma symptoms including wheezing, nocturnal chest tightness, nocturnal dyspnea, wheezing without cold, nocturnal cough, and asthma medication. Association between current asthma and noise level was not significant. There was a significant association between population age and current asthma prevalence ( P  = 0.001). Therefore, chronic exposure to road noise especially in the nighttime could increase asthma prevalence. So, control of noise sources can be suggested to diminish asthma in adults.

This article is an Editorial and does not include an Abstract.

Asthma is a complex, heterogeneous and chronic airway inflammatory disease with different clinical phenotypes caused by diverse triggers and pathophysiological mechanisms. Asthma heritability has been established in many genetic studies but it is evident that only genetic elements are not responsible for the development of asthma. Increasing rate of asthma incidence during past decades has implicated the role of epigenetics in development of asthma. Environmental factors perform as initiator signals through epigenetic mechanisms. Three epigenetic mechanisms have been identified, including DNA methylation, histone modifications, and small noncoding RNAs. These mechanisms regulate the immune responses and inflammatory genes expression in asthma and allergy. This review explains the role of epigenetic modifications in controlling Th2 response and IgE production in asthma and also briefly overviews the role of environmental factors such as pollutions, allergens, prenatal exposures and diet in developing asthma. Recognizing environmental risk factors and their effects on epigenetic mechanisms would be of great interest for prognostic and preventive aspect in treatment of asthma.

Air pollution is defined as the risk factors for asthma. This study aimed to investigate the effect of exposure to ambient air pollution and prevalence of asthma in adults. This cross-sectional study was done between November 2015 and February 2016. The asthma prevalence was surveyed in 3172 adults between 20 and 44 years old in Tehran, Iran. Face to face interview and standardized questionnaire (European Community Respiratory Health Survey (ECRHS)) were used for data gathering. Concentrations of air pollutants in the whole city of Tehran were obtained from Tehran Air Quality Control Company (AQCC). Air pollution exposure assessed by the spatial analysis based on GIS method. The effect of ambient air pollution on the asthma symptoms was assessed with the crude and adjusted logistic regression. Results were reported as odds ratios (OR) with 95% confidence interval (CI). Results showed that the asthma prevalence in adults in Tehran was 11.73%, higher than the average prevalence of asthma in the whole country equal to the 8.9%. The prevalence of asthma in males (6.43%, n=204) was significantly higher than females (5.26%, n=167), but this difference was not significant (P = 0.29). A significant positive association was observed between the asthma prevalence and the concentration of CO (OR 1.64; 1.26 to 1.85) and PM10 (1.04; 1.01 to 1.08) (P <0.05). Finally, we concluded that exposure to some air pollutants can affect the asthma prevalence in adults. Therefore, control of air pollution is recommended to reduce the asthma in Tehran metropolis.

In this study, we aimed to conduct a meta-analysis on the results of eligible studies to estimate the prevalence of asthma, COPD, and Chronic bronchitis in Iran. International and Iranian databases including PubMed, Scopus, Web of Science, Iranmedex, and scientific information database (SID) were searched for population-based studies that had reported the prevalence of asthma and COPD from 1990 to 2015. We conducted the meta-analysis using metaprop application of Stata statistical software. I-Squared was used for calculating heterogeneity among the studies. To determine causes of heterogeneity, subgroup analysis and meta-regression method were used. Based on the results of random effect method, the overall prevalence of asthma ever was 4.56% (3.76%-5.36%) among men while it was 4.17% (3.42%-4.91%) among women. Pooled prevalence of current asthma was 7.95% while confidence interval changed from 5.85% to 10.06% (men 5.83% (2.75%-8.92%), women 9.13% (3.35%-14.94%)). Also based on the results of random effect model pooled prevalence of chronic bronchitis of five studies was 5.57%. It seems that the total crude prevalence of current asthma in Iran is less than many other countries such as Kuwait, Lebanon, Thailand, Japan, Australia and Germany and is higher than some other countries such as Oman, Pakistan, South Korea, India, China, Taiwan, Indonesia, Spain, Russia, and Greece. On the other hand, Iran is in middle situation in terms of the prevalence current asthma. Our results can fill the information and knowledge gaps about the status of the prevalence of respiratory diseases in Iran.

Selective IgA deficiency (IgAD) is the most common primary immunodeficiency in Caucasians. Although it is often asymptomatic, selected patients show an increased frequency of infections, allergies and autoimmune manifestations. Common variable immunodeficiency (CVID) is a primary antibody deficiency disease that shares many clinical features with IgAD. A common genetic basis for IgAD and CVID has been suggested based on their occurrence in members of the same family and the similarity of the underlying B cell defects. Progression from IgAD to CVID has also been reported in several cases. Here we present 4 patients with IgAD and autoimmune features who subsequently developed CVID. All symptomatic IgAD patients, especially those with associated IgG subclass deficiency or autoimmune features, should be monitored for evolution to CVID. Early diagnosis of this conversion and institution of immunoglobulin therapy is effective in preventing severe bacterial infections and pulmonary insufficiency.

Exosomes are extracellular vesicles that are involved in intracellular communication and different biological processes. Recently, the importance of microRNAs (miRNAs) in exosomes has been considered as biomarkers in asthma diagnosis. This study aimed to determine the expression of selective miRNAs from plasma-derived exosomes in moderate and severe asthmatic patients compared with healthy controls. Forty-six subjects including 22 patients with severe and mild to moderate allergic asthma and 24 healthy controls have entered this study. MiRNAs were extracted from the plasma exosomes and selective miRNAs (miR-21, miR-16, miR-Let7, miR-148a, miR-155, miR-125, miR-150, miR146a, miR-223, miR-126) expressions levels were determined; using quantitative polymerase chain reaction (qPCR). In this study, we found a significant up-regulation of miR-223 and miR-21 in moderate asthmatic patients compared to the healthy controls (p=0.002, p=0.006). MiR-223 and miR-21 had the probability of 83% and 76% diagnosis estimation in moderate asthmatic patients respectively. Therefore, they could be used as biomarkers in these patients. No expression of miR-125, miR-126, and miR-155 was found in plasma exosomes by qPCR in this study. The other miRNAs had no significant expression between different groups. Based on our findings, miR-223 and miR-21 may be considered biomarkers or used for targeted immunotherapies in asthma.