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Nystad et al. [ 31] suggest that increases in exposure and adjuvant factors may be contributing to the asthmatic response without triggering atopic symptoms, such as hayfever and eczema.
For example, microbial compounds present in sputum may play a role as adjuvant factors and encourage a Th2-biased allergic response [ 22, 23].
It is known that efficiency of uptake of antigen by DC, as well as co-stimulatory signals derived from adjuvant factors, is an important determinant of generation of antigen-specific immunity.
One such hypothesis is that the increase in allergies is attributable to new adjuvant factors: exposure to environmental pollutants such as endocrine disruptors (e.g., phthalate esters) which may act as modulators of the immune system and induce an allergic response (Chalubinski and Kowalski 2006).
Although not mutually exclusive, other hypotheses are equally plausible (Platts-Mills et al. 2005): The increased prevalence of allergic disease could be attributable to new immune adjuvant factors, for example, exposure to environmental pollutants such as diesel fuel exhaust particles and EDCs (Chalubinski and Kowalski 2006).
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Some toxicologic studies have indicated that DEHP may act as an adjuvant factor (Chalubinski and Kowalski 2006; Nielsen et al. 2007).
An "adjuvant factor" of at least a reduction by 100 can be applied to the present calculation of the ADI if this is confirmed by other studies in vivo.
Our neoadjuvant approach is based on the use of IL-12, a potent immunostimulatory cytokine with strong antiangiogenic activity [ 32, 35, 43] in combination with LVR01, an attenuated auxotrophic mutant of S. Typhimurium [ 27, 42] as co-adjuvant factor.
In the multivariate Cox proportional hazards (PH) regression model for IBTR with adjuvant therapy factors, independent risk factors included age < 40 years (relative risk (RR) = 1.89, 95% confidence interval (CI) of 1.00 – 3.58), presence of intraductal disease (RR = 1.81, 95% CI = 1.15 2.85) and histological grade ('G2' or G3 versus G1: RR = 1.59, 95% CI = 0.87 2.94).
Patients in London live closer to teaching hospitals with high consultant caseloads and high usage of adjuvant therapy, factors known to influence survival (Sainsbury et al, 1995).
Increased exposures to allergens and/or adjuvants (enhancing factors) may each be partially responsible for the increase.
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