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Abstract
The school is a complex microenvironment of indoor allergens, pollutants, and other exposures. The school represents an occupational model for children and exposures in this environment have a significant health effect. Current research establishes an association between school exposure and asthma morbidity in children. This review will focus on common school environmental exposures (cockroach, rodents, cat, dog, classroom pets, dust mite, fungus, and pollution) and their impact on children with allergies and asthma. Understanding and evaluation of school-based environments is needed to help guide school-based interventions. School-based interventions have the potential for substantial benefit to the individual, school, community, and public health. However, there is a paucity data on school-based environmental interventions and health outcomes. The studies performed to date are small and cross-sectional with no control for home exposures. Randomized controlled school-based environmental intervention trials are needed to assess health outcomes and the cost-effectiveness of these interventions. The School Inner-City Asthma Intervention Study (SICAS 2), a NIH/NIAID randomized controlled clinical trial using environmental interventions modeled from successful home-based interventions, is currently underway with health outcome results pending. If efficacious, these interventions could potentially help further guide school-based interventions potentially with policy implications. In the meanwhile, the allergist/immunologist can continue to play a vital role in improving the quality of life in children with allergies and asthma at school through the use of the ADA policy and Section 504 of the Rehabilitation Act as well as encouraging adoption of toolkits to build successful school-based asthma programs and asthma-friendly schools.
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Permaul P, Gaffin JM, Petty CR, Baxi SN, Lai PS, Sheehan WJ, Camargo CA, Gold DR, Phipatanakul W. Obesity may enhance the adverse effects of NO 2 exposure in urban schools on asthma symptoms in children. J Allergy Clin Immunol 2020; 146:813-820.e2. [PMID: 32197971 DOI: 10.1016/j.jaci.2020.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/26/2020] [Accepted: 03/09/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sparse data address the effects of nitrogen dioxide (NO2) exposure in inner-city schools on obese students with asthma. OBJECTIVE We sought to evaluate relationships between classroom NO2 exposure and asthma symptoms and morbidity by body mass index (BMI) category. METHODS The School Inner-City Asthma Study enrolled students aged 4 to 13 years with asthma from 37 inner-city schools. Students had baseline determination of BMI percentile. Asthma symptoms, morbidity, pulmonary inflammation, and lung function were monitored throughout the subsequent academic year. Classroom NO2 data, linked to enrolled students, were collected twice per year. We determined the relationship between classroom NO2 levels and asthma outcomes by BMI stratification. RESULTS A total of 271 predominantly black (35%) or Hispanic students (35%) were included in analyses. Fifty percent were normal weight (5-84th BMI percentile), 15% overweight (≥85-94th BMI percentile), and 35% obese (≥95th BMI percentile). For each 10-parts per billion increase in NO2, obese students had a significant increase in the odds of having an asthma symptom day (odds ratio [OR], 1.86; 95% CI, 1.15-3.02) and in days caregiver changed plans (OR, 4.24; 95% CI, 2.33-7.70), which was significantly different than normal weight students who exhibited no relationship between NO2 exposure and symptom days (OR, 0.90; 95% CI, 0.57-1.42; pairwise interaction P = .03) and change in caregiver plans (OR, 1.37; 95% CI, 0.67-2.82; pairwise interaction P = .02). Relationships between NO2 levels and lung function and fractional exhaled nitric oxide did not differ by BMI category. If we applied a conservative Holm-Bonferroni correction for 16 comparisons (obese vs normal weight and overweight vs normal weight for 8 outcomes), these findings would not meet statistical significance (all P > .003). CONCLUSIONS Obese BMI status appears to increase susceptibility to classroom NO2 exposure effects on asthma symptoms in inner-city children. Environmental interventions targeting indoor school NO2 levels may improve asthma health for obese children. Although our findings would not remain statistically significant after adjustment for multiple comparisons, the large effect sizes warrant future study of the interaction of obesity and pollution in pediatric asthma.
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Affiliation(s)
- Perdita Permaul
- Division of Pediatric Pulmonology, Allergy and Immunology, New York-Presbyterian/Weill Cornell Medicine, New York, NY; Weill Cornell Medical College, New York, NY
| | - Jonathan M Gaffin
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Carter R Petty
- Clinical Research Center, Boston Children's Hospital, Boston, Mass
| | - Sachin N Baxi
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Peggy S Lai
- Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Mass
| | - William J Sheehan
- Division of Allergy and Immunology, Children's National Health System, Washington, DC; George Washington University School of Medicine, Washington, DC
| | - Carlos A Camargo
- Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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53
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Stern J, Pier J, Litonjua AA. Asthma epidemiology and risk factors. Semin Immunopathol 2020; 42:5-15. [PMID: 32020334 DOI: 10.1007/s00281-020-00785-1] [Citation(s) in RCA: 217] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/15/2020] [Indexed: 12/20/2022]
Abstract
Asthma is a clinical syndrome that affects all age groups. Asthma prevalence worldwide has seen a rapid increase in the latter part of the last century. Recent data has shown that asthma prevalence has plateaued and even decreased in some areas of the world, despite continuing to increase in other areas of the world. Many risk factors have been associated with asthma and the differences in distributions of these risk factors may explain the differences in prevalence. This article will review recent trends in the prevalence of asthma and recent studies that investigate risk factors of asthma.
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Affiliation(s)
- Jessica Stern
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Division of Allergy and Immunology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Jennifer Pier
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Division of Allergy and Immunology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, 601 Elmwood Avenue, Box 667, Rochester, NY, 14642, USA. .,Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
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54
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Olson C, Leu CS, Alper H, Millican M, Reznik M. A randomized trial of a one-time pest intervention: impact on childhood asthma outcomes. J Asthma 2020; 58:616-624. [PMID: 31920176 DOI: 10.1080/02770903.2019.1709870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: To evaluate the effects of a one-time, apartment-level Integrated Pest Management (IPM) intervention on healthcare utilization and asthma symptoms among children with persistent asthma living in households with a pest infestation.Study design: In a randomized controlled trial of 384 children aged 5-12 years with persistent asthma, we assigned 183 to receive IPM and 197 to usual care (UC). The primary outcome was healthcare utilization from hospital and Medicaid claims records. Secondary outcomes included caregiver-reported asthma symptoms, pest infestation levels, missed days of school due to asthma, and rescue medication use.Results: The entire cohort improved over the study period, with significant but equivalent declines in mean healthcare utilization in both groups. IPM group had fewer days with reduced activity due to asthma (p = 0.04) and larger declines that fell short of statistical significance in asthma symptom days (p = 0.22), severe symptoms (p = 0.16), missed school (p = 0.27) and rescue medication use (p = 0.27). Both roach (p = 0.001) and mice (p = 0.11) infestations decreased much more in the IPM group than the UC group.Conclusions: After a one-time, apartment-level IPM intervention, we found no difference in health care utilization, but fewer days of reduced activity and consistent suggestive evidence of clinically meaningful improvements relative to usual care across other secondary outcomes. Coupled with the established effectiveness of IPM in reducing allergens and scientific consensus on pest-related allergens as asthma triggers, these findings support adding home pest control to traditional medical management of children with severe asthma.
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Affiliation(s)
- Carolyn Olson
- Division of Environmental Health, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Cheng-Shiun Leu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Howard Alper
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Michael Millican
- Division of Environmental Health, New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Marina Reznik
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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Reduction in mouse allergen exposure is associated with greater lung function growth. J Allergy Clin Immunol 2019; 145:646-653.e1. [PMID: 31866099 DOI: 10.1016/j.jaci.2019.08.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 07/18/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Current childhood asthma therapies have little effect on lung function trajectory. OBJECTIVE We sought to determine whether mouse allergen exposure reduction is associated with lung function growth in mouse-sensitized/exposed asthmatic children. METHODS Three hundred fifty mouse-sensitized/exposed asthmatic children (5-17 years old) were enrolled in a 1-year randomized trial of integrated pest management plus education versus education alone. Prebronchodilator/postbronchodilator spirometry was performed at baseline and 6 and 12 months, and bedroom floor mouse allergen levels were measured every 3 months. Mouse allergen reduction was defined as a 75% or greater decrease in mouse allergen levels from baseline. Treatment groups were combined for analyses because there were no differences in outcomes between groups. Changes in lung function over time were modeled, adjusting for age, sex, race, atopy, group, and bronchodilator reversibility and including an interaction term (allergen reduction*time). RESULTS The study population was predominantly black (79.4%) and low income (66.3% [<$30,000]). At baseline, the median mouse allergen level was 5.7 μg/g (interquartile range, 1.5-22.8 μg/g), and the mean (SD) prebronchodilator FEV1/forced vital capacity ratio was 80.2% (9.0%). Ninety-two (26.3%) participants had 75% or greater reduction in mouse allergen levels. For a 10-year-old black boy, 75% or greater allergen reduction was associated with an increase in prebronchodilator FEV1 of 238 mL/y (95% CI, 177-299 mL/y), whereas less than 75% allergen reduction was associated with an increase in prebronchodilator FEV1 of 131 mL/y (95% CI, 97-166 mL/y). Estimated differences in prebronchodilator and postbronchodilator FEV1 growth were as follows: 107 mL/y (95% CI, 37-177 mL/y; Pint = .003) and 48 mL/y (95% CI, -17 to 113 mL/y; Pint = .15), respectively. Estimated differences in prebronchodilator and postbronchodilator forced expiratory flow at 25% to 75% of vital capacity growth were as follows: 182 mL/y (95% CI, 61-304 mL/y; Pint = .003) and 181 mL/y (95% CI, 48-314 mL/y; Pint = .008), respectively. CONCLUSION Mouse allergen reduction is associated with greater increases in prebronchodilator FEV1 and prebronchodilator/postbronchodilator forced expiratory flow at 25% to 75% of vital capacity over 1 year among sensitized/exposed asthmatic children.
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Louisias M, Ramadan A, Naja AS, Phipatanakul W. The Effects of the Environment on Asthma Disease Activity. Immunol Allergy Clin North Am 2019; 39:163-175. [PMID: 30954168 DOI: 10.1016/j.iac.2018.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is highly prevalent and causes significant morbidity in children. The development of asthma depends on complex relationships between genetic predisposition and environmental modifiers of immune function. The biological and physical environmental factors include aeroallergens, microbiome, endotoxin, genetics, and pollutants. The psychosocial environment encompasses stress, neighborhood safety, housing, and discrimination. They all have been speculated to influence asthma control and the risk of developing asthma. Control of the factors that contribute to or aggravate symptoms, interventions to eliminate allergen exposure, guidelines-based pharmacologic therapy, and education of children and their caregivers are of paramount importance.
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Affiliation(s)
- Margee Louisias
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 6th floor, Boston, MA 02115, USA; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Amira Ramadan
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Fegan Building, 6th Floor, Boston, MA 02115, USA; Beth Israel Deaconess Medical Center, Boston, MA
| | - Ahmad Salaheddine Naja
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Fegan Building, 6th Floor, Boston, MA 02115, USA; Lebanese American University, Beirut, Lebanon
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 6th floor, Boston, MA 02115, USA.
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Coleman AT, Teach SJ, Sheehan WJ. Inner-City Asthma in Childhood. Immunol Allergy Clin North Am 2019; 39:259-270. [PMID: 30954175 DOI: 10.1016/j.iac.2018.12.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The inner-city is a well-established and well-studied location that includes children at high risk for high asthma prevalence and morbidity. A number of intrinsic and extrinsic risk factors contribute to asthma in inner-city populations. This review seeks to explore these risk factors and evaluate how they contribute to increased asthma morbidity. Previous literature has identified risk factors such as race and ethnicity, prematurity, obesity, and exposure to aeroallergens and pollutants. Environmental and medical interventions aimed at individual risk factors and specific asthma phenotypes have contributed to improved outcomes in the inner-city children with asthma.
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Affiliation(s)
- Amaziah T Coleman
- Division of Allergy and Immunology, Department of Pediatrics, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
| | - Stephen J Teach
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA; Division of Emergency Medicine, Department of Pediatrics, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA
| | - William J Sheehan
- Division of Allergy and Immunology, Department of Pediatrics, Children's National Health System, 111 Michigan Avenue Northwest, Washington, DC 20010, USA; George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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58
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Kakumanu S, Lemanske RF. Asthma in Schools: How School-Based Partnerships Improve Pediatric Asthma Care. Immunol Allergy Clin North Am 2019; 39:271-281. [PMID: 30954176 DOI: 10.1016/j.iac.2018.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Children with asthma experience frequent exacerbations that require careful care coordination among families, clinicians, and schools. Prior studies have shown that children with asthma miss more school each year compared with their healthy peers due to uncontrolled asthma symptoms. Successful school-based asthma programs have built strong partnerships among patients, their families, and clinicians to improve communication and the dissemination of asthma action plans and medications to schools. The widely endorsed School-based Asthma Management Program, consisting of 4 components, provides a comprehensive and expert-supported framework to coordinate care with schools.
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Affiliation(s)
- Sujani Kakumanu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, William S. Middleton Veterans Memorial Hospital, 600 Highland Avenue CSC 9988, Madison, WI 53792, USA.
| | - Robert F Lemanske
- Department of Pediatrics, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA; Department of Medicine, Institute for Clinical and Translational Research, University of Wisconsin School of Medicine and Public Health, 4235 HSLC, 750 Highland Avenue, Madison, WI 53705, USA
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59
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Abstract
Childhood asthma affects many children placing them at significant risk for health care utilization and school absences. Several new developments relevant to the field of pediatric asthma have occurred over the last 5 years; yet, there is much more to learn. It is poorly understood how to prevent the disease, optimally address environmental challenges, or effectively manage poor adherence. Moreover, it is not clear how to customize therapy by asthma phenotype, age group, high risk groups, or severity of disease. Highlights of advances in pediatric asthma are reviewed and multiple essential areas for further exploration and research are discussed.
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60
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Abramson SL. Reducing Environmental Allergic Triggers: Policy Issues. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:32-35. [PMID: 29310764 DOI: 10.1016/j.jaip.2017.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 02/03/2023]
Abstract
The implementation of policies to reduce environmental allergic triggers can be an important adjunct to optimal patient care for allergic rhinitis and allergic asthma. Policies at the local level in schools and other public as well as private buildings can make an impact on disease morbidity. Occupational exposures for allergens have not yet been met with the same rigorous policy standards applied for exposures to toxicants by Occupational Safety and Health Administration. Further benefit may be obtained through policies by local, county, state, and national governments, and possibly through international cooperative agreements. The reduction of allergenic exposures can and should be affected by policies with strong scientific, evidence-based derivation. However, a judicious application of the precautionary principle may be needed in circumstances where the health effect of inaction could lead to more serious threats to vulnerable populations with allergic disease. This commentary covers the scientific basis, current implementation, knowledge gaps, and pro/con views on policy issues in reducing environmental allergic triggers.
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Indoor Environmental Interventions for Furry Pet Allergens, Pest Allergens, and Mold: Looking to the Future. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:9-19. [PMID: 29310769 DOI: 10.1016/j.jaip.2017.10.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 12/12/2022]
Abstract
Over the last 2 to 3 decades, significant advances have been made in understanding the role that indoor allergen exposures play with regard to respiratory health. Multiple studies have confirmed that sensitization and exposure to indoor allergens can be a risk factor for asthma morbidity. Environmental interventions targeting key indoor allergens have been evaluated with the aims of examining their causal effects on asthma-related outcomes and identifying clinically efficacious interventions to incorporate into treatment recommendations. Historically, it appeared that the most successful intervention, as performed in the Inner-City Asthma Study, was individually tailored, targeting multiple allergens in a predominantly low-income, minority, and urban pediatric population. Recent studies suggest that single-allergen interventions may be efficacious when targeting the most clinically relevant allergen for a population. In this article, we review recent literature on home environmental interventions and their effects on specific indoor allergen levels and asthma-related outcomes.
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Airborne Rodent Allergen Levels in Dutch Households: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193736. [PMID: 31590211 PMCID: PMC6801909 DOI: 10.3390/ijerph16193736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 09/18/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022]
Abstract
Little research has been conducted in Europe regarding indoor exposure to airborne rodent allergens. The aims of this study were to gain insight into the prevalence of rodent allergens in airborne dust in Dutch households, to assess whether there is a relationship between rodent sightings and detectable allergens, and to identify risk factors associated with the presence of rodent allergens. Airborne dust was collected from the living rooms of 80 households distributed around central Netherlands by passive sampling using electrostatic dust collectors (EDCs). Samples were analysed for mouse (Mus m 1) and rat (Rat n 1) allergens. Participants completed a questionnaire on household and building characteristics, household pets, cleaning habits and ventilation. Mouse allergen was more prevalent than rat allergen and mouse sightings within the past year more than doubled the odds of detectable mouse allergen. Proximity to green areas, ventilation through an open window and insulation under the living room floor were determinants for detectable mouse allergen. Conversely, proximity to surface water was protective. No significant association was found between asthma and detectable mouse allergen. The passive EDC sampling method was used successfully to detect mouse and rat allergens in homes. The presence of mouse allergen was associated with previous mouse sightings. Risk factors and protective factors associated with the presence and levels of mouse allergen were identified.
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63
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Ahmed A, Sadreameli SC, Curtin-Brosnan J, Grant T, Phipatanakul W, Perzanowski M, Balcer-Whaley S, Peng R, Newman M, Cunningham A, Divjan A, Bollinger ME, Wise RA, Miller R, Chew G, Matsui EC. Do Baseline Asthma and Allergic Sensitization Characteristics Predict Responsiveness to Mouse Allergen Reduction? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:596-602.e3. [PMID: 31520838 DOI: 10.1016/j.jaip.2019.08.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/08/2019] [Accepted: 08/19/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Mouse allergen reduction is associated with improvements in asthma among sensitized and exposed children, but whether clinical characteristics predict responsiveness to allergen reduction is unclear. OBJECTIVE To examine the effects of clinical characteristics on relationships between mouse allergen reduction and asthma outcomes. METHODS We performed a secondary analysis of data from a randomized clinical trial of a mouse allergen intervention, examining the effects of atopy, demographic characteristics, lung function, asthma control, and asthma severity on relationships between mouse allergen reduction and asthma outcomes. RESULTS Participants were predominantly low-income and minority (78% black, 22% Hispanic), and had persistent asthma. Among less atopic participants (<6 positive skin prick test results), each 50% reduction in mouse allergen was associated with fewer symptoms (incidence rate ratio [95% CI]: maximal symptoms: 0.94 [0.92-0.96]). There was little effect of mouse allergen reduction on symptoms among more atopic participants (P > .05). The interactions between atopic status and mouse allergen reduction were statistically significant for all symptom outcomes; however, there was no evidence that atopic status influenced the effect of mouse allergen reduction on exacerbation-related outcomes. Older children (≥9 years) tended to experience greater improvement in some asthma outcomes with reduction in mouse allergen exposure than younger children. There was no evidence that either mouse-specific IgE or lung function influenced the effect of mouse allergen reduction on any asthma outcomes. CONCLUSIONS Although there may be variability in the clinical response to mouse allergen reduction among low-income, minority children with asthma, there were no clinical characteristics that clearly identified a subgroup at which the intervention should be targeted.
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Affiliation(s)
- Ammara Ahmed
- Division of Pediatric Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - S Christy Sadreameli
- Division of Pediatric Pulmonology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Jean Curtin-Brosnan
- Division of Pediatric Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Torie Grant
- Division of Pediatric Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Wanda Phipatanakul
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard University Medical School, Boston, Mass
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Susan Balcer-Whaley
- Division of Pediatric Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Roger Peng
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md
| | - Michelle Newman
- Division of Pediatric Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Amparito Cunningham
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard University Medical School, Boston, Mass
| | - Adnan Divjan
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Mary E Bollinger
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Md
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Rachel Miller
- Division of Pulmonary, Allergy and Critical Care Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Ginger Chew
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Elizabeth C Matsui
- Department of Population Health and Pediatrics, Dell Medical School at the University of Texas, Austin, Tex.
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Wurth M, Papantonakis CM, Nevel RJ, Thomas CS, Sokolow AG, Moore PE, Rosas-Salazar C. Risk Factors Associated with Asthma Development and Control in Children. Mouse Infestation, Antipyretics, Respiratory Viruses, and Allergic Sensitization. Am J Respir Crit Care Med 2019; 196:1605-1607. [PMID: 29064272 DOI: 10.1164/rccm.201704-0696rr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mark Wurth
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Christina M Papantonakis
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Rebekah J Nevel
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Caroline S Thomas
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Andrew G Sokolow
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Paul E Moore
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Christian Rosas-Salazar
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
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Abrams EM, Szefler SJ, Becker AB. Time for Allergists to Consider the Role of Mouse Allergy in Non-Inner City Children with Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1778-1782. [PMID: 30962154 DOI: 10.1016/j.jaip.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 01/19/2023]
Abstract
Mouse allergen is endemic in the inner cities of the United States, with research predominantly in the Northeastern United States. A recent practice parameter notes the effect of mouse exposure in asthma in inner cities. However, studies are emerging that find a role of mouse allergen in non-inner cities as well. Mouse sensitization is associated with mouse allergen exposure and has been linked with adverse asthma outcomes including increased asthma symptoms, poorer lung function, and increased risk of exacerbations. There are commercially available extracts for testing for mouse sensitization although they are not standardized. Pest management studies have had varying results, but with decreased allergen exposure, there is a trend toward improved asthma outcomes. Physicians should be aware of the potential for rodent exposure and sensitization and consider screening for mouse allergy in asthmatic children, especially if they are located in the inner city, have poorly controlled asthma, or have a history of mouse infestation in their location. Evidence is emerging that this allergen should be considered in non-inner-city asthmatics as well. Finally, advocacy efforts are necessary to ensure that removal of this allergen is accomplished, when possible, in the environments of asthmatic children sensitized to mouse.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Stanley J Szefler
- Department of Pediatrics, Section of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
| | - Allan B Becker
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
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Baxi SN, Sheehan WJ, Sordillo JE, Muilenberg ML, Rogers CA, Gaffin JM, Permaul P, Lai PS, Louisias M, Petty CR, Fu C, Gold DR, Phipatanakul W. Association between fungal spore exposure in inner-city schools and asthma morbidity. Ann Allergy Asthma Immunol 2019; 122:610-615.e1. [PMID: 30904580 DOI: 10.1016/j.anai.2019.03.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/06/2019] [Accepted: 03/14/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Home fungus exposures may be associated with development or worsening of asthma. Little is known about the effects of school/classroom fungus exposures on asthma morbidity in students. OBJECTIVE To evaluate the association of school-based fungus exposures on asthma symptoms in both fungus-sensitized and nonsensitized students with asthma. METHODS In this prospective study, 280 children with asthma from 37 inner-city schools were phenotypically characterized at baseline and followed-up for 1 year. Fungal spores were collected by using a Burkard air sampler twice during the school year. Clinical outcomes were evaluated throughout the school year and linked to classroom-specific airborne spore sampling. The primary outcome was days with asthma symptoms per 2-week period. RESULTS Fungal spores were present in all classroom samples. The geometric mean of the total fungi was 316.9 spores/m3 and ranged from 15.0 to 59,345.7 spores/m3. There was variability in total fungus quantity between schools and classrooms within the same school. Mitospores were the most commonly detected fungal grouping. Investigation of the individual mitospores revealed that exposure to Alternaria was significantly associated with asthma symptom days in students sensitized to Alternaria (OR = 3.61, CI = 1.34-9.76, P = .01), but not in children not sensitized to Alternaria (OR = 1.04, CI = 0.72-1.49, P = .85). Students sensitized to Alternaria and exposed to high levels (≥75th percentile exposure) had 3.2 more symptom days per 2-week period as compared with students sensitized but exposed to lower levels. CONCLUSION Children with asthma who are sensitized to Alternaria and exposed to this fungus in their classroom may have significantly more days with asthma symptoms than those who were sensitized and not exposed. CLINICAL TRIAL REGISTRATION Clinicaltrials.govNCT01756391.
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Affiliation(s)
- Sachin N Baxi
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - William J Sheehan
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Joanne E Sordillo
- Channing Laboratory, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael L Muilenberg
- Division of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Christine A Rogers
- Division of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts
| | - Jonathan M Gaffin
- Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Division of Respiratory Diseases, Boston, Massachusetts
| | - Perdita Permaul
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Pediatric Allergy and Immunology, Boston, Massachusetts
| | - Peggy S Lai
- Harvard Medical School, Boston, Massachusetts; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, Massachusetts
| | | | - Carter R Petty
- Brigham and Women's Hospital, Boston, Massachusetts; Boston Children's Hospital, Clinical Research Center Boston, Massachusetts
| | - Chunxia Fu
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Diane R Gold
- Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts
| | - Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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67
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Butz AM, Bollinger ME, Ogborn J, Morphew T, Mudd SS, Kub JE, Bellin MH, Lewis-Land C, DePriest K, Tsoukleris M. Children with poorly controlled asthma: Randomized controlled trial of a home-based environmental control intervention. Pediatr Pulmonol 2019; 54:245-256. [PMID: 30614222 PMCID: PMC6408727 DOI: 10.1002/ppul.24239] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 12/08/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Few trials have tested targeted environmental control (EC) interventions based on biomarkers of second hand smoke (SHS) exposure and allergen sensitization in reducing asthma emergency department (ED) visits in children with poorly controlled asthma. METHODS Overall, 222 children with poorly controlled asthma were randomized into a home-based EC intervention (INT) or control (CON) group and followed for ED visits over 12 months. All children received allergen-specific IgE serologic testing and SHS exposure biomarker testing to inform the EC intervention. Pharmacy data was examined for asthma medication fills. Cox proportional hazards and multivariate regression models were performed to examine factors associated with repeat ED visits. RESULTS There was no difference in increased risk of >1 ED visit at 12 months between INT and CON groups. Most children (75%) had moderate/severe persistent asthma. Over half (56%) had SHS exposure and 83% tested positive for >1 allergen sensitization. Among children without SHS exposure, the median time to first recurrent ED visit differed by group (CON: 195; INT: >365 days) after adjusting for child age, allergic sensitization, medication fills prior to baseline, controller medication use, and the interaction between group status and SHS exposure. Children who had positive allergic sensitizations, younger, had increased controller medication use and randomized to the CON group and had no SHS exposure had increased risk for a repeat ED visit over 12 months. CONCLUSIONS In this study, a home-based EC intervention was not successful in reducing asthma ED revisits in children with poorly controlled asthma with SHS exposure. Allergic sensitization, young age, and increased controller medication use were important predictors of asthma ED visits.
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Affiliation(s)
- Arlene Manns Butz
- Division of General Pediatrics and Adolescent Medicine, Baltimore, Maryland.,The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
| | - Mary E Bollinger
- School of Medicine, Department of Pediatrics, Baltimore, Maryland
| | - Jean Ogborn
- Department of Pediatric Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Shawna S Mudd
- The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
| | - Joan E Kub
- Department of Nursing, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California.,University of Maryland, Baltimore, Maryland
| | - Melissa H Bellin
- School of Social Work, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Cassia Lewis-Land
- Division of General Pediatrics and Adolescent Medicine, Baltimore, Maryland
| | - Kelli DePriest
- The Johns Hopkins University School of Nursing, University of Maryland, Baltimore, Maryland
| | - Mona Tsoukleris
- The School of Pharmacy, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Grant T, Rule AM, Koehler K, Wood RA, Matsui EC. Sampling Devices for Indoor Allergen Exposure: Pros and Cons. Curr Allergy Asthma Rep 2019; 19:9. [PMID: 30747291 PMCID: PMC10371220 DOI: 10.1007/s11882-019-0833-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW To review current indoor allergen sampling devices, including devices to measure allergen in reservoir and airborne dust, and personal sampling devices, with attention to sampling rationale and major indoor allergen size and characteristics. RECENT FINDINGS While reservoir dust vacuuming samples and airborne dust volumetric air sampling remain popular techniques, recent literature describes sampling using furnace filters and ion-charging devices, both which help to eliminate the need for trained staff; however, variable correlation with reservoir dust and volumetric air sampling has been described. Personal sampling devices include intra-nasal samples and personal volumetric air samples. While these devices may offer better estimates of breathable allergens, they are worn for short periods of time and can be cumbersome. Reservoir dust sampling is inexpensive and is possible for families to perform. Airborne dust sampling can be more expensive and may better quantify cat, dog, and mouse allergen exposure. Personal sampling devices may offer a better representation of breathable air.
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Affiliation(s)
- Torie Grant
- Division of Pediatric Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Robert A Wood
- Division of Pediatric Allergy/Immunology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth C Matsui
- Departments of Population Health and Pediatrics, Dell Medical School, The University of Texas at Austin, 1701 Trinity St., Stop Z0500, Austin, TX, 78712, USA.
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69
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Kochis SR, Grant T, Phipatanakul W, Perzanowski M, Balcer-Whaley S, Curtin-Brosnan J, Newman M, Cunningham A, Bollinger ME, Matsui EC. Caregiver-Reported Asthma Control Predicts Future Visits, Independent of Guideline-Based Control Measures. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:1516-1521.e1. [PMID: 30703536 DOI: 10.1016/j.jaip.2018.12.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is unknown whether caregiver perception of a child's asthma control, independent of guideline-based asthma control assessment, is a predictor of future acute visits. OBJECTIVE To determine whether caregiver-reported asthma control is an indicator of future risk of acute visit. METHODS Two study populations of low-income, minority 5- to 17-year-old children with persistent asthma were included. Questionnaires administered at baseline and at 3, 6, 9, and 12 months captured symptoms, short-acting β-agonist use, acute visits in the previous 3 months, and caregiver-reported asthma control. Well-controlled, not well-controlled, and very poorly controlled asthma were defined using National Asthma Education and Prevention Program guideline-based assessment. Relationships between caregiver-reported control and acute visits in the subsequent 3 months were examined. RESULTS At baseline, both populations were predominantly black/African American (91% and 79%) with public insurance (85% and 88%) and very poorly controlled asthma (47% and 50%). In both populations, most caregivers reported that their child's asthma was well controlled (73% and 69%). In both populations, participants whose caregivers reported that their child had uncontrolled asthma had greater odds of having an acute visit in the following 3 months as compared with participants whose caregivers reported that their child's asthma was well controlled, independent of guideline-based control, age, sex, race, controller medication, insurance, and atopy (odds ratio [95% CI], 2.4 [1.4-4.2] and 1.6 [1.1-2.4]). CONCLUSIONS Among predominantly low-income minority children with asthma, caregiver-reported asthma control may provide information about the risk of future acute visit for asthma that is complementary to guideline-based control assessment.
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Affiliation(s)
- Suzanne R Kochis
- Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Torie Grant
- Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Wanda Phipatanakul
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Columbia University, New York, NY
| | - Susan Balcer-Whaley
- Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Jean Curtin-Brosnan
- Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Michelle Newman
- Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, Baltimore, Md
| | - Amparito Cunningham
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Mary E Bollinger
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Md
| | - Elizabeth C Matsui
- Department of Public Health, Dell Medical School, University of Texas, Austin, TX.
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Louisias M, Wright L, Phipatanakul W. Asthma in the melting pot. Ann Allergy Asthma Immunol 2018; 122:136-139. [PMID: 30465857 DOI: 10.1016/j.anai.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/03/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Affiliation(s)
- Margee Louisias
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Brigham and Women's Hospital Division of Rheumatology, Immunology and Allergy, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Lakiea Wright
- Brigham and Women's Hospital Division of Rheumatology, Immunology and Allergy, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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71
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Wu TD, Perzanowski M, Peng RD, Wise RA, Balcer-Whaley S, Newman M, Cunningham A, Phipatanakul W, Matsui EC, McCormack MC. Validation of the maximum symptom day among children with asthma. J Allergy Clin Immunol 2018; 143:803-805.e10. [PMID: 30342891 DOI: 10.1016/j.jaci.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/02/2018] [Accepted: 10/09/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tianshi David Wu
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Roger D Peng
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Robert A Wise
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Susan Balcer-Whaley
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Michelle Newman
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Amparito Cunningham
- Division of Pediatric Allergy and Immunology, Harvard Medical School, and Boston Children's Hospital, Boston, Mass
| | - Wanda Phipatanakul
- Division of Pediatric Allergy and Immunology, Harvard Medical School, and Boston Children's Hospital, Boston, Mass
| | - Elizabeth C Matsui
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, Tex
| | - Meredith C McCormack
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
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Grayson MH, Feldman S, Prince BT, Patel PJ, Matsui EC, Apter AJ. Advances in asthma in 2017: Mechanisms, biologics, and genetics. J Allergy Clin Immunol 2018; 142:1423-1436. [PMID: 30213625 DOI: 10.1016/j.jaci.2018.08.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 02/07/2023]
Abstract
This review summarizes some of the most significant advances in asthma research over the past year. We first focus on novel discoveries in the mechanism of asthma development and exacerbation. This is followed by a discussion of potential new biomarkers, including the use of radiographic markers of disease. Several new biologics have become available to the clinician in the past year, and we summarize these advances and how they can influence the clinical delivery of asthma care. After this, important findings in the genetics of asthma and heterogeneity in phenotypes of the disease are explored, as is the role the environment plays in shaping the development and exacerbation of asthma. Finally, we conclude with a discussion of advances in health literacy and how they will affect asthma care.
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Affiliation(s)
- Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio.
| | - Scott Feldman
- Section of Allergy and Immunology, Division of Pulmonary Allergy Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Benjamin T Prince
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Priya J Patel
- Section of Allergy and Immunology, Division of Pulmonary Allergy Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Elizabeth C Matsui
- Department of Population Health, Dell Medical School, University of Texas-Austin, Austin, Tex
| | - Andrea J Apter
- Section of Allergy and Immunology, Division of Pulmonary Allergy Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa
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Abstract
PURPOSE OF REVIEW The review provides insight into recent findings on bedroom allergen exposures, primarily focusing on pet, pest, and fungal exposures. RECENT FINDINGS Large-scale studies and improved exposure assessment technologies, including measurement of airborne allergens and of multiple allergens simultaneously, have extended our understanding of indoor allergen exposures and their impact on allergic disease. Practical, streamlined methods for exposure reduction have shown promise in some settings, and potential protective effects of early-life exposures have been further elucidated through the investigation of specific bacterial taxa. Advances in molecular allergology have yielded novel data on sensitization profiles and cross-reactivity. The role of indoor allergen exposures in allergic disease is complex and remains incompletely understood. Advancing our knowledge of various co-exposures, including the environmental and host microbiome, that interact with allergens in early life will be crucial for the development of efficacious interventions to reduce the substantial economic and social burden of allergic diseases including asthma.
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Gordon J, Detjen P, Nimmagadda S, Rogers L, Patel S, Thompson J, Reboulet R, Gandhi P. Bedroom exposure to airborne allergens in the Chicago area using a patient-operated sampling device. Ann Allergy Asthma Immunol 2018; 121:211-217.e3. [PMID: 29860049 DOI: 10.1016/j.anai.2018.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/24/2018] [Accepted: 05/23/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND In current practice, allergens in vacuum-collected dust are used as surrogates for inhalable allergens. We developed an air-sampling device that can be used by patients for direct measurement of airborne allergen concentrations in their own homes. OBJECTIVE To demonstrate the use of this device to establish allergen concentration reference ranges in a target population and to evaluate associations between patient-reported information and measured allergen concentrations. METHODS Patients from 5 allergist's practices in the Chicagoland region were provided with instructions, questionnaires, informed consent forms, and samplers to run for 5 days in their bedrooms. Samples were collected from cartridges and assayed by multiplex immunoassays for 12 common household allergens and enzyme-linked immunosorbent assay for ragweed. RESULTS Unique allergen profiles were obtained for 102 patient homes. Samples with allergen concentrations above the limit of detection were as follows: total dust mite, 28%; cat, 61%; dog, 64%; mouse, 12%; rat, 0%; cockroach, 4%; Alternaria, 6%; Aspergillus, 21%; birch pollen 1%; grass, 8%; and ragweed, 5%. Of those, 75 completed questionnaires, providing meta-data for further analysis. Pet allergens correlated significantly with number of pets owned. Humidity correlated with dust mite allergens, open windows with Alternaria and mouse allergens, and high-efficiency particulate air filter use with reduced levels of several allergens. Many other variables showed no significant correlations. CONCLUSION The combination of ease of use, high air-sampling rate, and sensitive immunoassays permitted the measurement of airborne allergen concentrations in homes and establishment of reference ranges. Patient-reported information permitted identification of factors that could relate to allergen concentrations and suggested remedial measures.
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Affiliation(s)
| | - Paul Detjen
- Kenilworth Medical Allergy & Immunology, Kenilworth, Illinois
| | - Sai Nimmagadda
- Associated Allergy and Asthma Specialists Ltd, Chicago, Illinois
| | | | | | - James Thompson
- Associated Allergy and Asthma Specialists Ltd, Chicago, Illinois
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Leas BF, D'Anci KE, Apter AJ, Bryant-Stephens T, Lynch MP, Kaczmarek JL, Umscheid CA. Effectiveness of indoor allergen reduction in asthma management: A systematic review. J Allergy Clin Immunol 2018; 141:1854-1869. [DOI: 10.1016/j.jaci.2018.02.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
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Naja AS, Permaul P, Phipatanakul W. Taming Asthma in School-Aged Children: A Comprehensive Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:726-735. [PMID: 29747980 PMCID: PMC5953205 DOI: 10.1016/j.jaip.2018.01.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 12/14/2022]
Abstract
Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity as measured by school absences, emergency department visits, and hospitalizations. Multiple factors play a role in the development, treatment and prevention of childhood asthma including racial/ethnic and socioeconomic disparities, both the home and school environments, and medication use. The goals of this review are to summarize these aspects of asthma in school-aged children and to present an updated review of medications as it relates to treatment strategies that will help in the care of these children. We conclude that phenotypic heterogeneity and appropriate environmental assessments and interventions are important considerations in the management of childhood asthma.
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Affiliation(s)
- Ahmad Salaheddine Naja
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Lebanese American University, Beirut, Lebanon
| | - Perdita Permaul
- Harvard Medical School, Boston, Mass; Division of Pediatric Allergy and Immunology, Massachusetts General Hospital for Children, Boston, Mass
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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Advances in environmental and occupational disorders in 2016. J Allergy Clin Immunol 2017; 140:1683-1692. [PMID: 29080787 DOI: 10.1016/j.jaci.2017.09.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/06/2017] [Accepted: 09/28/2017] [Indexed: 12/29/2022]
Abstract
In this review we highlight recent studies that advance the knowledge and understanding of the effects of various environmental factors and associated immune responses in patients with allergic diseases. This review will focus on new literature regarding allergic and immune responses to a variety of environmental factors, including aeroallergens, stinging insects, fungi, pollutants, viral respiratory tract infections, climate change, and microbial exposures.
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Davis MF, Rankin SC, Schurer JM, Cole S, Conti L, Rabinowitz P. Checklist for One Health Epidemiological Reporting of Evidence (COHERE). One Health 2017; 4:14-21. [PMID: 28825424 PMCID: PMC5536878 DOI: 10.1016/j.onehlt.2017.07.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 06/02/2017] [Accepted: 07/16/2017] [Indexed: 12/14/2022] Open
Abstract
One Health is defined as the intersection and integration of knowledge regarding humans, animals, and the environment, yet as the One Health scientific literature expands, there is considerable heterogeneity of approach and quality of reporting in One Health studies. In addition, many researchers who publish such studies do not include or integrate data from all three domains of human, animal, and environmental health. This points to a critical need to unify guidelines for One Health studies. This report details the Checklist for One Health Epidemiological Reporting of Evidence (COHERE) to guide the design and publication format of future One Health studies. COHERE was developed by a core writing team and international expert review group that represents multiple disciplines, including human medicine, veterinary medicine, public health, allied professionals, clinical laboratory science, epidemiology, the social sciences, ecohealth and environmental health. The twin aims of the COHERE standards are to 1) improve the quality of reporting of observational or interventional epidemiological studies that collect and integrate data from humans, animals and/or vectors, and their environments; and 2) promote the concept that One Health studies should integrate knowledge from these three domains. The 19 standards in the COHERE checklist address descriptions of human populations, animal populations, environmental assessment, spatial and temporal relationships of data from the three domains, integration of analyses and interpretation, and inclusion of expertise in the research team from disciplines related to human health, animal health, and environmental health.
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Affiliation(s)
- Meghan F. Davis
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Molecular and Comparative Pathobiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Shelley C. Rankin
- Department of Pathobiology, Clinical Microbiology Laboratory, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Janna M. Schurer
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Stephen Cole
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Conti
- Florida Department of Agriculture and Consumer Services, FL, USA
| | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences and Global Health, University of Washington School of Public Health, USA
- Department of Family Medicine (joint), University of Washington School of Medicine, Seattle, WA, USA
- Department of Medicine, Division of Allergy and Infectious Diseases (adjunct), University of Washington School of Medicine, Seattle, WA, USA
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Gold DR, Adamkiewicz G, Arshad SH, Celedón JC, Chapman MD, Chew GL, Cook DN, Custovic A, Gehring U, Gern JE, Johnson CC, Kennedy S, Koutrakis P, Leaderer B, Mitchell H, Litonjua AA, Mueller GA, O'Connor GT, Ownby D, Phipatanakul W, Persky V, Perzanowski MS, Ramsey CD, Salo PM, Schwaninger JM, Sordillo JE, Spira A, Suglia SF, Togias A, Zeldin DC, Matsui EC. NIAID, NIEHS, NHLBI, and MCAN Workshop Report: The indoor environment and childhood asthma-implications for home environmental intervention in asthma prevention and management. J Allergy Clin Immunol 2017; 140:933-949. [PMID: 28502823 PMCID: PMC5632590 DOI: 10.1016/j.jaci.2017.04.024] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 04/14/2017] [Indexed: 01/19/2023]
Abstract
Environmental exposures have been recognized as critical in the initiation and exacerbation of asthma, one of the most common chronic childhood diseases. The National Institute of Allergy and Infectious Diseases; National Institute of Environmental Health Sciences; National Heart, Lung, and Blood Institute; and Merck Childhood Asthma Network sponsored a joint workshop to discuss the current state of science with respect to the indoor environment and its effects on the development and morbidity of childhood asthma. The workshop included US and international experts with backgrounds in allergy/allergens, immunology, asthma, environmental health, environmental exposures and pollutants, epidemiology, public health, and bioinformatics. Workshop participants provided new insights into the biologic properties of indoor exposures, indoor exposure assessment, and exposure reduction techniques. This informed a primary focus of the workshop: to critically review trials and research relevant to the prevention or control of asthma through environmental intervention. The participants identified important limitations and gaps in scientific methodologies and knowledge and proposed and prioritized areas for future research. The group reviewed socioeconomic and structural challenges to changing environmental exposure and offered recommendations for creative study design to overcome these challenges in trials to improve asthma management. The recommendations of this workshop can serve as guidance for future research in the study of the indoor environment and on environmental interventions as they pertain to the prevention and management of asthma and airway allergies.
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Affiliation(s)
- Diane R Gold
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass.
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Syed Hasan Arshad
- David Hide Asthma and Allergy Research Centre, Isle of Wight, and Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Juan C Celedón
- Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pa
| | | | - Ginger L Chew
- Centers for Disease Control and Prevention (CDC), National Center for Environmental Health, Division of Environmental Hazards and Health Effects | Air Pollution and Respiratory Health Branch, Atlanta, Ga
| | - Donald N Cook
- Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Adnan Custovic
- Section of Paediatrics and MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - James E Gern
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Christine C Johnson
- Department of Public Health Sciences, Henry Ford Hospital & Health System, Detroit, Mich
| | - Suzanne Kennedy
- Department of Pediatrics, NC Children's Hospital, University of North Carolina, Chapel Hill, NC
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Brian Leaderer
- Yale School of Public Health, Yale School of Medicine, Yale School of Forestry and Environmental Studies, Center for Perinatal, Pediatric and Environmental Epidemiology (CPPEE), New Haven, Conn
| | | | - Augusto A Litonjua
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Geoffrey A Mueller
- Genome Integrity and Structural Biology Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - George T O'Connor
- Pulmonary Center, Boston University School of Medicine, Boston, Mass
| | - Dennis Ownby
- Division of Allergy-Immunology and Rheumatology, Department of Pediatrics, Augusta University, Augusta, Ga
| | - Wanda Phipatanakul
- Asthma, Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Victoria Persky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Ill
| | - Matthew S Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Clare D Ramsey
- Departments of Medicine and Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Päivi M Salo
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Julie M Schwaninger
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Md
| | - Joanne E Sordillo
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Avrum Spira
- Division of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, Md
| | - Darryl C Zeldin
- Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC
| | - Elizabeth C Matsui
- Division of Pediatric Allergy/Immunology, Johns Hopkins University, Baltimore, Md
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80
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Louisias M, Phipatanakul W. Managing Asthma in Low-Income, Underrepresented Minority, and Other Disadvantaged Pediatric Populations: Closing the Gap. Curr Allergy Asthma Rep 2017; 17:68. [PMID: 28914405 DOI: 10.1007/s11882-017-0734-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW In this article, we review current understanding of the epidemiology and etiology of disparities in asthma. We also highlight current and emerging literature on solutions to tackle disparities while underscoring gaps and pressing future directions. RECENT FINDINGS Tailored, multicomponent approaches including the home, school, and clinician-based interventions show great promise. Managing asthma in disadvantaged populations can be challenging as they tend to have disproportionately worse outcomes due to a multitude of factors. However, multifaceted, innovative interventions that are sustainable and scalable are key to improving outcomes.
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Affiliation(s)
- Margee Louisias
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA. .,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
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81
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Miller RL, Zhang H, Jezioro J, De Planell Saguer M, Lovinsky-Desir S, Liu X, Perzanowski M, Divjan A, Phipatanakul W, Matsui EC. Reduced mouse allergen is associated with epigenetic changes in regulatory genes, but not mouse sensitization, in asthmatic children. ENVIRONMENTAL RESEARCH 2017; 156:619-624. [PMID: 28454014 PMCID: PMC5503684 DOI: 10.1016/j.envres.2017.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/06/2017] [Accepted: 04/20/2017] [Indexed: 06/07/2023]
Abstract
Chronic exposure to mouse allergen may contribute greatly to the inner-city asthma burden. We hypothesized that reducing mouse allergen exposure may modulate the immunopathology underlying symptomatic pediatric allergic asthma, and that this occurs through epigenetic regulation. To test this hypothesis, we studied a cohort of mouse sensitized, persistent asthmatic inner-city children undergoing mouse allergen-targeted integrated pest management (IPM) vs education in a randomized controlled intervention trial. We found that decreasing mouse allergen exposure, but not cockroach, was associated with reduced FOXP3 buccal DNA promoter methylation, but this was unrelated to mouse specific IgE production. This finding suggests that the environmental epigenetic regulation of an immunomodulatory gene may occur following changing allergen exposures in some highly exposed cohorts. Given the clinical and public health importance of inner-city pediatric asthma and the potential impact of environmental interventions, further studies will be needed to corroborate changes in epigenetic regulation following changing exposures over time, and determine their impact on asthma morbidity in susceptible children.
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Affiliation(s)
- Rachel L Miller
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA; Department of Environmental Health Sciences, Columbia University, 722 W 168th St, 11th Floor, New York City, NY, 10032, USA.
| | - Hanjie Zhang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA
| | - Jacqueline Jezioro
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA
| | - Mariangels De Planell Saguer
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Columbia University Medical Center, PH8E-101B, 630 W. 168th St., New York City, NY 10032, USA
| | - Stephanie Lovinsky-Desir
- Division of Pulmonary, Department of Pediatrics, Columbia University Medical Center, 3959 Broadway, CHC 7-701, New York City, NY 10032, USA
| | - Xinhua Liu
- Department of Biostatistics, Columbia University Medical Center, 722 W 168 St, 6 Floor, New York City, NY, 10032, USA
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Columbia University, 722 W 168th St, 11th Floor, New York City, NY, 10032, USA
| | - Adnan Divjan
- Department of Environmental Health Sciences, Columbia University, 722 W 168th St, 11th Floor, New York City, NY, 10032, USA
| | - Wanda Phipatanakul
- Division of Pediatric Allergy/Immunology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
| | - Elizabeth C Matsui
- Division of Pediatric Allergy/Immunology, Johns Hopkins School of Medicine, CMSC 1102, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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82
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Phipatanakul W, Koutrakis P, Coull BA, Kang CM, Wolfson JM, Ferguson ST, Petty CR, Samnaliev M, Cunningham A, Sheehan WJ, Gaffin JM, Baxi SN, Lai PS, Permaul P, Liang L, Thorne PS, Adamkiewicz G, Brennan KJ, Baccarelli AA, Gold DR. The School Inner-City Asthma Intervention Study: Design, rationale, methods, and lessons learned. Contemp Clin Trials 2017; 60:14-23. [PMID: 28619649 DOI: 10.1016/j.cct.2017.06.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/31/2017] [Accepted: 06/10/2017] [Indexed: 02/08/2023]
Abstract
Asthma is the most common chronic disease of childhood in the United States, causes significant morbidity, particularly in the inner-city, and accounts for billions of dollars in health care utilization. Home environments are established sources of exposure that exacerbate symptoms and home-based interventions are effective. However, elementary school children spend 7 to 12h a day in school, primarily in one classroom. From the observational School Inner-City Asthma Study we learned that student classroom-specific exposures are associated with worsening asthma symptoms and decline in lung function. We now embark on a randomized, blinded, sham-controlled school environmental intervention trial, built on our extensively established school/community partnerships, to determine the efficacy of a school-based intervention to improve asthma control. This factorial school/classroom based environmental intervention will plan to enroll 300 students with asthma from multiple classrooms in 40 northeastern inner-city elementary schools. Schools will be randomized to receive either integrated pest management versus control and classrooms within these schools to receive either air purifiers or sham control. The primary outcome is asthma symptoms during the school year. This study is an unprecedented opportunity to test whether a community of children can benefit from school or classroom environmental interventions. If effective, this will have great impact as an efficient, cost-effective intervention for inner city children with asthma and may have broad public policy implications.
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Affiliation(s)
- Wanda Phipatanakul
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Petros Koutrakis
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Brent A Coull
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Choong-Min Kang
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Jack M Wolfson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Stephen T Ferguson
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Carter R Petty
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Mihail Samnaliev
- Boston Children's Hospital, Clinical Research Center, Boston, MA, United States
| | - Amparito Cunningham
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States
| | - William J Sheehan
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jonathan M Gaffin
- Boston Children's Hospital, Division of Respiratory Diseases, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Sachin N Baxi
- Boston Children's Hospital, Division of Allergy and Immunology, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Peggy S Lai
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Massachusetts General Hospital, Division of Pulmonary and Critical Care, Boston, MA, United States
| | - Perdita Permaul
- Massachusetts General Hospital, Division of Pediatric Allergy and Immunology, Boston, MA, United States
| | - Liming Liang
- Harvard T.H. Chan School of Public Health, Department of Biostatistics, Boston, MA, United States
| | - Peter S Thorne
- University of Iowa, Department of Occupational and Environmental Health, Iowa City, United States
| | - Gary Adamkiewicz
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States
| | - Kasey J Brennan
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Andrea A Baccarelli
- Columbia University School of Public Health, New York, Department of Environmental Health, New York, United States
| | - Diane R Gold
- Harvard Medical School, Boston, MA, United States; Harvard T.H. Chan School of Public Health, Department of Environmental Health, Boston, MA, United States; Channing Laboratory, Brigham and Women's Hospital, Boston, MA, United States
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83
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Eggleston PA. Cockroach allergy and urban asthma. J Allergy Clin Immunol 2017; 140:389-390. [PMID: 28528788 DOI: 10.1016/j.jaci.2017.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/18/2017] [Accepted: 04/26/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Peyton A Eggleston
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
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