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Evidence and Practicalities of Aqueous Sublingual Immunotherapy, Tablet Sublingual Immunotherapy, and Oral Mucosal Immunotherapy for Allergic Rhinitis and Allergic Asthma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Niespodziana K, Borochova K, Pazderova P, Schlederer T, Astafyeva N, Baranovskaya T, Barbouche MR, Beltyukov E, Berger A, Borzova E, Bousquet J, Bumbacea RS, Bychkovskaya S, Caraballo L, Chung KF, Custovic A, Docena G, Eiwegger T, Evsegneeva I, Emelyanov A, Errhalt P, Fassakhov R, Fayzullina R, Fedenko E, Fomina D, Gao Z, Giavina-Bianchi P, Gotua M, Greber-Platzer S, Hedlin G, Ilina N, Ispayeva Z, Idzko M, Johnston SL, Kalayci Ö, Karaulov A, Karsonova A, Khaitov M, Kovzel E, Kowalski ML, Kudlay D, Levin M, Makarova S, Matricardi PM, Nadeau KC, Namazova-Baranova L, Naumova O, Nazarenko O, O'Byrne PM, Osier F, Pampura AN, Panaitescu C, Papadopoulos NG, Park HS, Pawankar R, Pohl W, Renz H, Riabova K, Sampath V, Sekerel BE, Sibanda E, Siroux V, Sizyakina LP, Sun JL, Szepfalusi Z, Umanets T, Van Bever HPS, van Hage M, Vasileva M, von Mutius E, Wang JY, Wong GWK, Zaikov S, Zidarn M, Valenta R. Toward personalization of asthma treatment according to trigger factors. J Allergy Clin Immunol 2020; 145:1529-1534. [PMID: 32081759 PMCID: PMC7613502 DOI: 10.1016/j.jaci.2020.02.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/06/2020] [Accepted: 02/07/2020] [Indexed: 12/16/2022]
Abstract
Asthma is a severe and chronic disabling disease affecting more than 300 million people worldwide. Although in the past few drugs for the treatment of asthma were available, new treatment options are currently emerging, which appear to be highly effective in certain subgroups of patients. Accordingly, there is a need for biomarkers that allow selection of patients for refined and personalized treatment strategies. Recently, serological chip tests based on microarrayed allergen molecules and peptides derived from the most common rhinovirus strains have been developed, which may discriminate 2 of the most common forms of asthma, that is, allergen- and virus-triggered asthma. In this perspective, we argue that classification of patients with asthma according to these common trigger factors may open new possibilities for personalized management of asthma.
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Affiliation(s)
- Katarzyna Niespodziana
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Kristina Borochova
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Petra Pazderova
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Thomas Schlederer
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Natalia Astafyeva
- Department of Clinical Immunology and Allergology of Saratov State Medical University, Saratov, Russia
| | | | | | - Evgeny Beltyukov
- Department of Faculty Therapy, Endocrinology, Allergology and Immunology, Ural State Medical University, Ekaterinburg, Russia
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Elena Borzova
- Department of Clinical Allergology and Immunology, Russian Medical Academy of Continuous Professional Education, Moscow, Russia; Department of Clinical Genetics, Research and Clinical Institute for Pediatrics named after Yuri Veltischev at the Pirogov Russian National Research Medical University, Moscow, Russia; Department of Dermatology and Venereology, I.V. Sechenov First State Medical University, Moscow, Russia
| | - Jean Bousquet
- University Hospital, Montpellier, France; MACVIA-France, Montpellier, France; Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany
| | - Roxana S Bumbacea
- Department of Allergology and Clinical Immunology, University of Medicine and Pharmacy "Carol Davila," Bucharest, Romania
| | | | - Luis Caraballo
- Institute for Immunological Research, The University of Cartagena, Cartagena de Indias, Colombia
| | - Kian Fan Chung
- National Heart & Lung Institute, Imperial College London, London, United Kingdom; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Adnan Custovic
- National Heart & Lung Institute, Imperial College London, London, United Kingdom; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Guillermo Docena
- Facultad de Ciencias Exactas, Universidad Nacional de La Plata, La Plata, Argentina
| | - Thomas Eiwegger
- Translational Medicine Program, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Immunology, University of Toronto, Toronto, Ontario, Canada; Division of Immunology and Allergy, Food Allergy and Anaphylaxis Program, Hospital for Sick Children, Departments of Paedriatrics and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Irina Evsegneeva
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander Emelyanov
- Department of Respiratory Medicine and Allergy, North-Western Medical University, St Petersburg, Russia
| | - Peter Errhalt
- Department of Pneumology, University Hospital Krems and Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Rustem Fassakhov
- Institute of Fundamental Medicine and Biology of Kazan Federal University, Kazan, Russia
| | - Rezeda Fayzullina
- Faculty of Pediatrics, Bashkir State Medical University, Ufa, Russia
| | - Elena Fedenko
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Daria Fomina
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia; City Moscow Center of Allergy and Immunology, Clinical Hospital No. 52, Moscow, Russia
| | - Zhongshan Gao
- Allergy Research Center, Zhejiang University, Hangzhou, China
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, University of Sao Paulo, Sao Paulo, Brazil
| | - Maia Gotua
- Center of Allergy and Immunology, David Tvildiani Medical University, Tbilisi, Georgia
| | - Susanne Greber-Platzer
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Gunilla Hedlin
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Womenś and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Natalia Ilina
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Zhanat Ispayeva
- Allergology Department, Kazakh National Medical University, Almaty, Kazakhstan
| | - Marco Idzko
- Department of Pneumology, Medical University of Vienna, Vienna, Austria
| | - Sebastian L Johnston
- National Heart & Lung Institute, Imperial College London, London, United Kingdom; MRC and Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Ömer Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Antonina Karsonova
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Musa Khaitov
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Elena Kovzel
- Department of Clinical Immunology, Allergology, Pulmonology, Republic Diagnostic Center, Corporate Fund University Medical Center of Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Marek L Kowalski
- Department of Allergy and Immunology, Medical University Lodz, Lodz, Poland
| | - Dmitry Kudlay
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Michael Levin
- Division of Asthma and Allergy, University of Cape Town, Cape Town, South Africa
| | - Svetlana Makarova
- Department of Preventive Pediatrics, National Medical Research Center for Children's Health, Moscow, Russia
| | - Paolo Maria Matricardi
- Department of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité-University Medicine Berlin, Berlin, Germany
| | - Kari C Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif
| | - Leyla Namazova-Baranova
- Department of Pediatrics, Russian National Research Medical University of MoH RF, Moscow, Russia
| | - Olga Naumova
- Center of Allergic Diseases of Upper Respiratory Ways, National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | - Oleksandr Nazarenko
- Department of Clinical and Laboratory Allergology and Immunology, National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Paul M O'Byrne
- Firestone Institute of Respiratory Health, Department of Medicine, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Faith Osier
- KEMRI-Wellcome Trust Research Programme (KWTRP), Kilifi, Kenya
| | - Alexander N Pampura
- Department of Allergology and Clinical Immunology, Research and Clinical Institute for Pediatrics named after Yuri Veltischev at the Pirogov Russian National Research Medical University of the Russian Ministry of Health, Moscow, Russia
| | - Carmen Panaitescu
- OncoGen Center, County Clinical Emergency Hospital "Pius Branzeu," and University of Medicine and Pharmacy V Babes, Timisoara, Romania
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Wolfgang Pohl
- Pulmonary Department and Karl Landsteiner Institute for Clinical and Experimental Pulmology, Hietzing Hospital, Vienna, Austria
| | - Harald Renz
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL) Marburg, Marburg, Germany
| | - Ksenja Riabova
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, Calif
| | - Bülent E Sekerel
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - Elopy Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, Twin Palms Medical Centre, Harare, Zimbabwe; Department of Pathology, Medical School, National University of Science and Technology, Bulawayo, Zimbabwe
| | - Valérie Siroux
- Univ. Grenoble Alpes, Inserm, CNRS, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, IAB, Grenoble, France
| | - Ludmila P Sizyakina
- Department of Allergology and Immunology, Rostov Medical University, Rostov, Russia
| | - Jin-Lyu Sun
- Department of Allergy and Clinical Immunology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zsolt Szepfalusi
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Tetiana Umanets
- Department of Respiratory Diseases and Respiratory Allergy in Children, Institute of Pediatrics, Obstetrics and Gynecology, National Academy of Medical Sciences, Kyiv, Ukraine
| | - Hugo P S Van Bever
- Department of Paediatrics, National University of Singapore, Singapore, Singapore
| | - Marianne van Hage
- Division of Immunology and Allergy, Department of Medicine, Karolinska Institutet and University Hospital, Stockholm
| | - Margarita Vasileva
- Center of Allergology and Clinical Immunology, Regional Clinical Hospital, Khabarovsk, Russia
| | - Erika von Mutius
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University Munich, Munich, Germany; Institute of Asthma and Allergy Prevention, Helmholtz Centre Munich, Munich, Germany; German Centre for Lung Research, Germany
| | - Jiu-Yao Wang
- Center for Allergy and Clinical Immunology Research (ACIR), Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Gary W K Wong
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Sergii Zaikov
- Department of Phtihisiatry and Pulmonology, Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
| | - Mihaela Zidarn
- University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Rudolf Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria; Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia; NRC Institute of Immunology FMBA of Russia, Moscow, Russia; Division of Immunology and Allergy, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Karl Landsteiner University, Krems, Austria.
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Heymann PW, Platts-Mills TAE, Woodfolk JA, Borish L, Murphy DD, Carper HT, Conaway MR, Steinke JW, Muehling L, Gerald Teague W, Kennedy JL, Irani AM, McGraw MD, Early SV, Wheatley LM, Adams AP, Turner RB. Understanding the asthmatic response to an experimental rhinovirus infection: Exploring the effects of blocking IgE. J Allergy Clin Immunol 2020; 146:545-554. [PMID: 32018030 DOI: 10.1016/j.jaci.2020.01.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/20/2019] [Accepted: 01/15/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rhinovirus frequently causes asthma exacerbations among children and young adults who are allergic. The interaction between allergen and rhinovirus-induced symptoms and inflammation over time is unclear. OBJECTIVE Our aim was to compare the response to an experimental inoculation with rhinovirus-16 in allergic asthmatics with the response in healthy controls and to evaluate the effects of administrating omalizumab before and during the infection. METHODS Two clinical trials were run in parallel. In one of these trials, the response to an experimental inoculation with rhinovirus-16 among asthmatics with high levels of total IgE was compared to the response in healthy controls. The other trial compared the effects of administering omalizumab versus placebo to asthmatics in a randomized, double-blind placebo-controlled investigation. The primary outcome for both trials compared lower respiratory tract symptoms (LRTSs) between study groups over the first 4 days of infection. RESULTS Frequent comparisons of symptoms, lung function, and blood eosinophil counts revealed differences that were more pronounced among allergic asthmatics than among controls by days 2 and 3 after virus inoculation. Additionally, an augmentation of upper respiratory tract symptom scores and LRTS scores occurred among the atopic asthmatics versus the controls during the resolution of symptoms (P < .01 for upper respiratory symptom tract scores and P < .001 for LRTS scores). The beneficial effects of administering omalizumab on reducing LRTSs and improving lung function were strongest over the first 4 days. CONCLUSIONS LRTSs and blood eosinophil counts were augmented and lung function was reduced among allergic asthmatics early after rhinovirus inoculation but increased late in the infection during symptom resolution. The effect of administering omalizumab on the response to rhinovirus was most pronounced during the early/innate phase of the infection.
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Affiliation(s)
- Peter W Heymann
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va.
| | | | - Judith A Woodfolk
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - Larry Borish
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - Deborah D Murphy
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va
| | - Holliday T Carper
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va; Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va
| | - Mark R Conaway
- Department of Public Health Sciences, University of Virginia, Charlottsville, Va
| | - John W Steinke
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - Lyndsey Muehling
- Asthma and Allergic Diseases Center, University of Virginia, Charlottsville, Va
| | - W Gerald Teague
- Division of Pediatric Respiratory Medicine, University of Virginia, Charlottsville, Va
| | - Joshua L Kennedy
- Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, Ark
| | - Anne-Marie Irani
- Division of Pediatric Allergy and Immunology, Virginia Commonwealth University, Richmond, Va
| | - Matthew D McGraw
- Division of Pediatric Pulmonology, University of Rochester, Rochester, NY
| | - Stephen V Early
- Division of Pediatric Otolaryngology, University of Virginia, Charlottsville, Va
| | - Lisa M Wheatley
- Allergy, Asthma and Airways Biology Branch, Division of Allergy, Immunology, and Transplantation/National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Amy P Adams
- Department of Pharmacy, University of Virginia, Charlottsville, Va
| | - Ronald B Turner
- Department of Pediatric Infectious Diseases, University of Virginia, Charlottsville, Va
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Denlinger LC, Heymann P, Lutter R, Gern JE. Exacerbation-Prone Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:474-482. [PMID: 31765853 DOI: 10.1016/j.jaip.2019.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/28/2019] [Accepted: 11/12/2019] [Indexed: 02/07/2023]
Abstract
Patients who are prone to exacerbations of asthma experience significant costs in terms of missed work and school, acute care visits, and hospitalizations. Exacerbations are largely driven by environmental exposures including pollutants, stress, and viral and bacterial pathogens. These exposures are most likely to induce acute severe "asthma attacks" in high-risk patients. These personal risk factors for exacerbations can vary with the phenotype of asthma and age of the patient. In children, allergic sensitization is a strong risk factor, especially for those children who develop sensitization early in life. Airway inflammation is an important risk factor, and biomarkers are under evaluation for utility in detecting eosinophilic and type 2 inflammation and neutrophilic inflammation as indicators of risk for recurrent exacerbations. Insights into inflammatory mechanisms have led to new approaches to prevent exacerbations using mAb-based biologics that target specific type 2 pathways. Challenges remain in developing an evidence base to support precision interventions with these effective yet expensive therapies, and in determining whether these treatments will be safe and effective in young children. Unfortunately, there has been less progress in developing treatments for acute exacerbations. Hopefully, greater understanding of mechanisms relating airway viruses, bacteria, mucin production, and neutrophilic inflammatory responses will lead to additional treatment options for patients experiencing acute exacerbations.
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Affiliation(s)
- Loren C Denlinger
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis.
| | - Peter Heymann
- Department of Pediatrics, University of Virginia, Charlottesville, Va
| | - Rene Lutter
- Departments of Respiratory Medicine and Experimental Immunology, Amsterdam University Centers, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, The Netherlands
| | - James E Gern
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wis
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Ardura-Garcia C, Arias E, Hurtado P, Bonnett LJ, Sandoval C, Maldonado A, Workman LJ, Platts-Mills TAE, Cooper PJ, Blakey JD. Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study. Eur Respir J 2019; 54:1802419. [PMID: 31515399 PMCID: PMC6860994 DOI: 10.1183/13993003.02419-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/11/2019] [Indexed: 01/23/2023]
Abstract
Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC.We followed a cohort of 5-15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months' follow-up.We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79-0.96 per year), previous asthma diagnosis (2.2, 1.2-3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1-1.5), food triggers (2.0, 1.1-3.6) and eczema diagnosis (4.2, 1.02-17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50-0.95). Laboratory and lung function tests did not predict recurrence.Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused.
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Affiliation(s)
- Cristina Ardura-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Erick Arias
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Paola Hurtado
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Laura J Bonnett
- Dept of Biostatistics, University of Liverpool, Liverpool, UK
| | - Carlos Sandoval
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Augusto Maldonado
- Colegio de Ciencias de la Salud, Universidad San Francsico de Quito, Quito, Ecuador
| | - Lisa J Workman
- Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, VA, USA
| | | | - Philip J Cooper
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
- Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador
- Institute of Infection and Immunity, St George's University of London, London, UK
- Both authors contributed equally
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, Curtin University, Perth, Australia
- Both authors contributed equally
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Home Environmental Interventions for House Dust Mite. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1-7. [PMID: 29310755 DOI: 10.1016/j.jaip.2017.10.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/26/2017] [Accepted: 10/03/2017] [Indexed: 11/20/2022]
Abstract
It has been 50 years since the dust mite was first appreciated to be a major source of allergen in house dust, and by extension a key trigger of allergic respiratory disease. Since that time a number of protein allergens have been identified and characterized, mainly from mite feces, and standardized mite extracts and IgE assays have been developed. Insights into the lifecycle of dust mites and aspects of mite allergen biology have shed light on the mechanisms that lead to respiratory disease and to the development of interventions that can minimize dust mite allergen exposure. It is now clear that dust mite allergy is a key contributor to asthma in many parts of the world, and that long-term avoidance can be effective for preventing sensitization and minimizing the development and severity of respiratory disease. Here, we discuss the evidence linking dust mites with respiratory disease, outline studies that support the efficacy of home environmental interventions, and highlight practical methods that have been shown to be effective as part of a multifaceted approach to dust mite avoidance.
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Basnet S, Bochkov YA, Brockman-Schneider RA, Kuipers I, Aesif SW, Jackson DJ, Lemanske RF, Ober C, Palmenberg AC, Gern JE. CDHR3 Asthma-Risk Genotype Affects Susceptibility of Airway Epithelium to Rhinovirus C Infections. Am J Respir Cell Mol Biol 2019; 61:450-458. [PMID: 30916989 PMCID: PMC6775945 DOI: 10.1165/rcmb.2018-0220oc] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 03/25/2019] [Indexed: 12/15/2022] Open
Abstract
CDHR3 (cadherin-related family member 3) is a transmembrane protein that is highly expressed in airway epithelia and the only known receptor for rhinovirus C (RV-C). A CDHR3 SNP (rs6967330) with G to A base change has been linked to severe exacerbations of asthma and increased susceptibility to RV-C infections in young children. The goals of this study were to determine the subcellular localization of CDHR3 and to test the hypothesis that CDHR3 asthma-risk genotype affects epithelial cell function and susceptibility to RV-C infections of the airway epithelia. We used immunofluorescence imaging, Western blot analysis, and transmission electron microscopy to show CDHR3 subcellular localization in apical cells, including expression in the cilia of airway epithelia. Polymorphisms in CDHR3 rs6967330 locus (G→A) that were previously associated with childhood asthma were related to differences in CDHR3 expression and epithelial cell function. The rs6967330 A allele was associated with higher overall protein expression and RV-C binding and replication compared with the rs6967330 G allele. Furthermore, the rs6967330 A allele was associated with earlier ciliogenesis and higher FOXJ1 expression. Finally, CDHR3 genotype had no significant effects on membrane integrity or ciliary beat function. These findings provide information on the subcellular localization and possible functions of CDHR3 in the airways and link CDHR3 asthma-risk genotype to increased RV-C binding and replication.
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Affiliation(s)
| | | | | | | | | | | | | | - Carol Ober
- Department of Human Genetics, University of Chicago, Chicago, Illinois
| | - Ann C. Palmenberg
- Institute of Molecular Virology, University of Wisconsin–Madison, Madison, Wisconsin; and
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Mikhail I, Grayson MH. Asthma and viral infections: An intricate relationship. Ann Allergy Asthma Immunol 2019; 123:352-358. [PMID: 31276807 PMCID: PMC7111180 DOI: 10.1016/j.anai.2019.06.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/11/2019] [Accepted: 06/24/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To synthesize available data related to the complex associations among viral infections, atopy, and asthma. DATA SOURCES Key historical articles, articles highlighted in our recent review of most significant recent asthma advancements, and findings from several birth cohorts related to asthma and viral infections were reviewed. In addition, PubMed was searched for review articles and original research related to the associations between viral infection and asthma, using the search words asthma, viral infections, atopy, development of asthma, rhinovirus (RV), and respiratory syncytial virus (RSV). STUDY SELECTIONS Articles were selected based on novelty and relevance to our topic of interest, the role of asthma and viral infections, and possible mechanisms to explain the association. RESULTS There is a large body of evidence demonstrating a link between early viral infections (especially RV and RSV) and asthma inception and exacerbations. RV-induced wheezing is an important risk factor for asthma only when atopy is present, with much evidence supporting the idea that sensitization is a risk factor for early RV-induced wheezing, which in turn is a risk factor for asthma. RSV, on the other hand, is a more important risk factor for nonatopic asthma, with severe infections conferring greater risk. CONCLUSION There are important differences in the development of atopic and nonatopic asthma, with several proposed mechanisms explaining the association between viral infections and the development of asthma and asthma exacerbations. Understanding these complex associations is important for developing asthma prevention strategies and targeted asthma therapies.
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Affiliation(s)
- Irene Mikhail
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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59
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Adeli M, El-Shareif T, Hendaus MA. Asthma exacerbation related to viral infections: An up to date summary. J Family Med Prim Care 2019; 8:2753-2759. [PMID: 31681638 PMCID: PMC6820381 DOI: 10.4103/jfmpc.jfmpc_86_19] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/01/2019] [Accepted: 08/27/2019] [Indexed: 12/21/2022] Open
Abstract
Asthma exacerbation can be a major life threatening event. Viruses have been pinned as the cause behind the vast majority of these exacerbations. The purpose of this short review is to explore the mechanisms behind these exacerbations, focusing mostly on viral infections as triggers. We will also be discussing the phenotypes prone to asthma exacerbation, the pathophysiology of viral induced asthma and ventilation patterns of asthmatic lungs. This manuscript will assist primary care physicians in delineating the proper pathophysiology of the disease as well as the management.
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Affiliation(s)
- Mehdi Adeli
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Hamad General Corporation, Doha, Qatar.,Department of Clinical Pediatrics, Weill- Cornell Medicine, Doha, Qatar
| | | | - Mohamed A Hendaus
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar.,Department of Pediatrics, Hamad General Corporation, Doha, Qatar.,Department of Clinical Pediatrics, Weill- Cornell Medicine, Doha, Qatar
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60
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Custovic A, Murray CS, Simpson A. Dust-mite inducing asthma: what advice can be given to patients? Expert Rev Respir Med 2019; 13:929-936. [PMID: 31369320 DOI: 10.1080/17476348.2019.1651647] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: Amongst allergic asthmatics, high allergen exposure increases asthma severity. However, there is no consensus on the role of mite allergen avoidance in the management of asthma, and various guidelines differ in their recommendations. Areas covered: Several systematic reviews/meta-analyses on mite avoidance in the management of asthma have been published, and their findings have been used for a call to provide a recommendation in British guidelines that dust-mite control measures should not be recommended. However, there are several problems with such analysis (such as combining studies in adults and children), and we question whether these are appropriate tools to evaluate available evidence about mite allergen avoidance, and whether it is correct to rely disproportionately on the results of meta-analyses/systematic reviews to inform clinical practice in this area. Recent evidence in children suggests that mite-impermeable bed encasings reduce emergency hospital attendance with severe asthma exacerbations. Expert opinion: The practical questions include how to achieve a sufficient real-life reduction allergen exposure, and how to identify patients who will benefit from effective intervention. The intervention should start early in the natural history of asthma, and consideration for choosing patients should include using the titre of allergen-specific IgE antibodies or the size of skin test wheal as an indicator.
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Affiliation(s)
- Adnan Custovic
- National Heart and Lund Institute, Imperial College London , London , UK
| | - Clare S Murray
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre , Manchester , UK
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61
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Fischer GB, Sarria EE, Camargos P, Mocelin HT, Soto-Quiroz M, Cruz AA, Bousquet J, Zar HJ. Childhood asthma in low and middle-income countries: Where are we now? Paediatr Respir Rev 2019; 31:52-57. [PMID: 30987798 DOI: 10.1016/j.prrv.2018.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/04/2018] [Indexed: 01/08/2023]
Abstract
Pediatric asthma has been increasing in LMICs (Low Middle-Income Countries), leading to an important burden for both children and national health systems. Implementing measures to achieve control are influenced by the degree of organization health systems have, the availability and affordability of essential asthma medications, and the effective implementation of asthma programs and asthma guidelines. In this review authors give an updated view of the current situation of these components of asthma management in LMICs.
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Affiliation(s)
- Gilberto Bueno Fischer
- Department of Paediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil; Paediatric Pulmonology Section, Hospital da Crianças Santo Antônio (HCSA), Porto Alegre, Brazil.
| | - Edgar E Sarria
- Department of Biology and Pharmacy, School of Medicine, Universidade de Santa Cruz do Sul (UNISC), Brazil; Paediatric Pulmonology Section - HCSA, Brazil
| | - Paulo Camargos
- Department of Paediatrics, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Postgraduate Program on Health Sciences, Universidade Federal de São João del-Rei, Divinópolis, Brazil.
| | - Helena Teresinha Mocelin
- Department of Paediatrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Paediatric Pulmonology Section - HCSA, Porto Alegre, Brazil
| | - Manuel Soto-Quiroz
- Pediatric Pulmology, University of Costa Rica, Hospital CIMA, San Jose, Costa Rica
| | - Alvaro A Cruz
- ProAR - Federal University of Bahia, School of Medicine, Bahia, Brazil
| | - Jean Bousquet
- MACVIA, France; Contre les Maladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.
| | - Heather J Zar
- Dept Pediatrics & Child Health, Red Cross Children's Hospital and SA-MRC Unit on Child and Adolescent Health, University of Cape Town, South Africa.
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Abstract
There is an important link between the upper and lower respiratory tracts whereby inflammation in one environment can influence the other. In acute rhinosinusitis, pathogen exposures are the primary driver for inflammation in the nose, which can exacerbate asthma. In chronic rhinosinusitis, a disease clinically associated with asthma, the inflammation observed is likely from a combination of an impaired epithelial barrier, dysregulated immune response, and potentially infection (or colonization) by specific pathogens. This review explores the associations between rhinosinusitis and asthma, with particular emphasis placed on the role of infections and inflammation.
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Affiliation(s)
- Anna G Staudacher
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street Suite 1000, Chicago, IL 60611, USA
| | - Whitney W Stevens
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, 211 East Ontario Street Suite 1000, Chicago, IL 60611, USA.
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63
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Kennedy JL, Pham S, Borish L. Rhinovirus and Asthma Exacerbations. Immunol Allergy Clin North Am 2019; 39:335-344. [PMID: 31284924 DOI: 10.1016/j.iac.2019.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Rhinovirus (RV) is ubiquitous and typically causes only minor upper respiratory symptoms. However, especially in children and adolescent asthmatics, RV is responsible for most exacerbations. This ability of RV to drive exacerbations typically requires the concomitant presence of exposure to a bystander allergen. Susceptibility to RV-mediated exacerbations is also related to the genetic background of the host, which contributes to greater infectivity, more severe infections, altered immune responses, and to greater inflammation and loss of asthma control. Given these responses, there are several treatments available or being developed that should improve the control of exacerbations related to RV infection.
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Affiliation(s)
- Joshua L Kennedy
- Department of Pediatrics, University of Arkansas for Medical Sciences, 13 Children's Way, Slot 512-13, Little Rock, AR 72202, USA; Department of Internal Medicine, University of Arkansas for Medical Sciences, 13 Children's Way, Slot 512-13, Little Rock, AR 72202, USA; Arkansas Children's Research Institute, University of Arkansas for Medical Sciences, 13 Children's Way, Slot 512-13, Little Rock, AR 72202, USA.
| | - Sarah Pham
- Department of Pediatrics, University of Arkansas for Medical Sciences, 13 Children's Way, Slot 512-13, Little Rock, AR 72202, USA
| | - Larry Borish
- Department of Medicine, University of Virginia Health Systems, MR4 Building Room 5041, 409 Lane Road, Charlottesville, VA 22903, USA; Department of Microbiology, University of Virginia Health Systems, MR4 Building Room 5041, 409 Lane Road, Charlottesville, VA 22903, USA; Carter Immunology Center, University of Virginia Health Systems, MR4 Building Room 5041, 409 Lane Road, Charlottesville, VA 22903, USA
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64
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Agache I, Lau S, Akdis CA, Smolinska S, Bonini M, Cavkaytar O, Flood B, Gajdanowicz P, Izuhara K, Kalayci O, Mosges R, Palomares O, Papadopoulos NG, Sokolowska M, Angier E, Fernandez‐Rivas M, Pajno G, Pfaar O, Roberts G, Ryan D, Sturm GJ, Ree R, Varga EM, Wijk RG, Yepes‐Nuñez J, Jutel M. EAACI Guidelines on Allergen Immunotherapy: House dust mite-driven allergic asthma. Allergy 2019; 74:855-873. [PMID: 31095767 DOI: 10.1111/all.13749] [Citation(s) in RCA: 168] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/12/2019] [Indexed: 12/14/2022]
Abstract
Allergen immunotherapy (AIT) has been in use for the treatment of allergic disease for more than 100 years. Asthma treatment relies mainly on corticosteroids and other controllers recommended to achieve and maintain asthma control, prevent exacerbations, and improve quality of life. AIT is underused in asthma, both in children and in adults. Notably, patients with allergic asthma not adequately controlled on pharmacotherapy (including biologics) represent an unmet health need. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline providing evidence-based recommendations for the use of house dust mites (HDM) AIT as add-on treatment for HDM-driven allergic asthma. This guideline was developed by a multi-disciplinary working group using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. HDM AIT was separately evaluated by route of administration and children and adults: subcutaneous (SCIT) and sublingual AIT (SLIT), drops, and tablets. Recommendations were formulated for each. The important prerequisites for successful treatment with HDM AIT are (a) selection of patients most likely to respond to AIT and (b) use of allergen extracts and desensitization protocols of proven efficacy. To date, only AIT with HDM SLIT-tablet has demonstrated a robust effect in adults for critical end points (exacerbations, asthma control, and safety). Thus, it is recommended as an add-on to regular asthma therapy for adults with controlled or partially controlled HDM-driven allergic asthma (conditional recommendation, moderate-quality evidence). HDM SCIT is recommended for adults and children, and SLIT drops are recommended for children with controlled HDM-driven allergic asthma as the add-on to regular asthma therapy to decrease symptoms and medication needs (conditional recommendation, low-quality evidence).
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Department of Allergy and Clinical Immunology Transylvania University Brasov Brasov Romania
| | - Susanne Lau
- Department for Pediatric Pneumology, Immunology and Intensive Care Charité Universität Medizin Berlin Germany
| | - Cezmi A. Akdis
- University of Zürich Swiss Institute of Allergy and Asthma Research (SIAF) Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - Sylwia Smolinska
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- “ALL‐MED” Medical Research Institute Wroclaw Poland
| | - Matteo Bonini
- National Heart and Lung Institute (NHLI) Royal Brompton Hospital & Imperial College London UK
| | - Ozlem Cavkaytar
- Faculty of Medicine Department of Pediatric Allergy Istanbul Medeniyet University Goztepe Training and Research Hospital Istanbul Turkey
| | - Breda Flood
- European Federation of Allergy and Airways Diseases, Patients Association Brussels Belgium
| | - Pawe Gajdanowicz
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
| | | | - Omer Kalayci
- Hacettepe University School of Medicine Ankara Turkey
| | - Ralph Mosges
- Universität zu Koln Institute of Medical Statistics, Informatics and Epidemiology (IMSIE) Koln Germany
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Complutense University of Madrid Madrid Spain
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity and respiratory medicine University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
| | - Milena Sokolowska
- University of Zürich Swiss Institute of Allergy and Asthma Research (SIAF) Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | | | | | - Giovanni Pajno
- Allergy Unit Department of Pediatrics University of Messina Messina Italy
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Graham C. Roberts
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Newport Isle of Wight UK
- NIHR Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- Faculty of Medicine University of Southampton Southampton UK
| | - Dermot Ryan
- Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
- Asthma UK Centre for Applied Research The University of Edinburgh Edinburgh UK
| | - Gunter J. Sturm
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
- Outpatient Allergy Clinic Reumannplaz Vienna Austria
| | - Ronald Ree
- Department of Experimental Immunology Academic Medical Center University of Amsterdam Amsterdam The Netherlands
- Department of Otorhinolaryngology Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Eva M. Varga
- Department of Pediatric and Adolescent Medicine Respiratory and Allergic Disease Division Medical University of Graz Graz Austria
| | - Roy Gerth Wijk
- Section of Allergology Department of Internal Medicine Erasmus Medical Center Rotterdam The Netherlands
| | | | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- “ALL‐MED” Medical Research Institute Wroclaw Poland
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65
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Paul AGA, Muehling LM, Eccles JD, Woodfolk JA. T cells in severe childhood asthma. Clin Exp Allergy 2019; 49:564-581. [PMID: 30793397 DOI: 10.1111/cea.13374] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 12/17/2022]
Abstract
Severe asthma in children is a debilitating condition that accounts for a disproportionately large health and economic burden of asthma. Reasons for the lack of a response to standard anti-inflammatory therapies remain enigmatic. Work in the last decade has shed new light on the heterogeneous nature of asthma, and the varied immunopathologies of severe disease, which are leading to new treatment approaches for the individual patient. However, most studies to date that explored the immune landscape of the inflamed lower airways have focused on adults. T cells are pivotal to the inception and persistence of inflammatory processes in the diseased lungs, despite a contemporary shift in focus to immune events at the epithelial barrier. This article outlines current knowledge on the types of T cells and related cell types that are implicated in severe asthma. The potential for environmental exposures and other inflammatory cues to condition the immune environment of the lung in early life to favour pathogenic T cells and steroid resistance is discussed. The contributions of T cells and their cytokines to inflammatory processes and treatment resistance are also considered, with an emphasis on new observations in children that argue against conventional type 1 and type 2 T cell paradigms. Finally, the ability for new technologies to revolutionize our understanding of T cells in severe childhood asthma, and to guide future treatment strategies that could mitigate this disease, is highlighted.
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Affiliation(s)
- Alberta G A Paul
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Lyndsey M Muehling
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Jacob D Eccles
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Judith A Woodfolk
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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66
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Xepapadaki P, Kostoudi S, Tzeli K, Kitsioulis N, Papadopoulos NG. A pilot study to investigate the influence of upper respiratory infections on IgE reactivity to food allergens. Pediatr Allergy Immunol 2019; 30:127-130. [PMID: 30312514 DOI: 10.1111/pai.12988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, Athens, Greece
| | - Sophia Kostoudi
- Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, Athens, Greece
| | - Kassiani Tzeli
- Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kitsioulis
- Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National & Kapodistrian University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, The University of Manchester, Manchester, UK
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67
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Allergic asthma is associated with increased risk of infections requiring antibiotics. Ann Allergy Asthma Immunol 2019; 120:169-176.e1. [PMID: 29413341 DOI: 10.1016/j.anai.2017.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/07/2017] [Accepted: 11/20/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Viral infection and allergy have been identified as major risk factors for exacerbation in asthma, especially in the presence of both. However, whether patients with allergic asthma are more susceptible to respiratory infections requiring antibiotics remains unknown. OBJECTIVE To investigate allergy as a risk factor for respiratory infections requiring antibiotics based on register data from a nationwide population of patients with asthma. METHODS A register-based prospective follow-up study was performed using the Danish prescription database. In the inclusion period from 2010 through 2011, we identified patients with allergic asthma 18 to 44 years old. Patients were investigated during the follow-up period from 2012 through 2013, depending on their prescription drug use of antiallergic medication and antibiotics. Odds ratios were adjusted for age, sex, asthma severity, education, and urban vs rural residence. RESULTS In a nationwide population we identified 60,415 patients with asthma. Based on prescriptions fillings for antiallergic medication, patients were subdivided into (1) nonallergic asthma (n = 35,334, 51.5%) and (2) allergic asthma (n = 25,081, 48.5%). Allergic asthma was associated with an increased risk of filling at least 2 antibiotic prescriptions per year compared with nonallergic asthma (odds ratio 1.28, 95% confidence interval 1.24-1.33, P < .0001). Interestingly, a subgroup analysis showed a protective effect of immunotherapy against the risk of requiring antibiotics (odds ratio 0.76, 95% confidence interval 0.66-0.87, P = .0001). CONCLUSION Patients with allergic asthma have an increased risk of being prescribed antibiotics for respiratory infections compared with those with nonallergic asthma. Treatment with allergen immunotherapy appears to have a protective effect against this risk.
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68
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Arasi S, Porcaro F, Cutrera R, Fiocchi AG. Severe Asthma and Allergy: A Pediatric Perspective. Front Pediatr 2019; 7:28. [PMID: 30805326 PMCID: PMC6378301 DOI: 10.3389/fped.2019.00028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/23/2019] [Indexed: 12/17/2022] Open
Abstract
Severe asthma in children is associated with significant morbidity and lung function decline. It represents a highly heterogeneous disorder with multiple clinical phenotypes. As its management is demanding, the social and economic burden are impressive. Several co-morbidities may contribute to worsen asthma control and complicate diagnostic and therapeutic management of severe asthmatic patients. Allergen sensitization and/or allergy symptoms may predict asthma onset and severity. A better framing of "allergen sensitization" and understanding of mechanisms underlying progression of atopic march could improve the management and the long-term outcomes of pediatric severe asthma. This review focuses on the current knowledge about interactions between severe asthma and allergies.
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Affiliation(s)
- Stefania Arasi
- Pediatric Allergology Unit, Bambino Gesù Hospital (IRCCS), Rome, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
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Ross KR, Teague WG, Gaston BM. Life Cycle of Childhood Asthma: Prenatal, Infancy and Preschool, Childhood, and Adolescence. Clin Chest Med 2018; 40:125-147. [PMID: 30691707 DOI: 10.1016/j.ccm.2018.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Asthma is a heterogeneous developmental disorder influenced by complex interactions between genetic susceptibility and exposures. Wheezing in infancy and early childhood is highly prevalent, with a substantial minority of children progressing to established asthma by school age, most of whom are atopic. Adolescence is a time of remission of symptoms with persistent lung function deficits. The transition to asthma in adulthood is not well understood.
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Affiliation(s)
- Kristie R Ross
- Division of Pediatric Pulmonology, Allergy, Immunology and Sleep Medicine, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - W Gerald Teague
- Pediatric Asthma Center of Excellence, Department of Pediatrics, University of Virginia School of Medicine, 409 Lane Road, Building MR4, Room 2112, PO Box 801349, Charlottesville, VA 22908, USA
| | - Benjamin M Gaston
- Division of Pediatric Pulmonology, Allergy, Immunology and Sleep Medicine, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Children's Lung Foundation, 2109 Adelbert Road, BRB 827, Cleveland, OH 44106, USA
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70
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Platts-Mills TAE, Perzanowski M. The use of machine learning to understand the relationship between IgE to specific allergens and asthma. PLoS Med 2018; 15:e1002696. [PMID: 30457990 PMCID: PMC6245509 DOI: 10.1371/journal.pmed.1002696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Thomas Platts-Mills and Matthew Perzanowski provide their expert Perspective on a translational study from Custovic and colleagues that identifies pairings of IgE that show value in estimating risk of concurrent asthma.
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Affiliation(s)
| | - Matthew Perzanowski
- Columbia University Mailman School of Public Health, New York, New York, United States of America
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71
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Wong L, Van Bever HP. Primary Prevention of Asthma: Will It Be Possible in the Future? CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0192-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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72
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Lo D, Kennedy JL, Kurten RC, Panettieri RA, Koziol-White CJ. Modulation of airway hyperresponsiveness by rhinovirus exposure. Respir Res 2018; 19:208. [PMID: 30373568 PMCID: PMC6206673 DOI: 10.1186/s12931-018-0914-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/17/2018] [Indexed: 01/12/2023] Open
Abstract
Rhinovirus (RV) exposure has been implicated in childhood development of wheeze evoking asthma and exacerbations of underlying airways disease. Studies such as the Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) and Childhood Origins of ASThma (COAST) have identified RV as a pathogen inducing severe respiratory disease. RVs also modulate airway hyperresponsiveness (AHR), a key characteristic of such diseases. Although potential factors underlying mechanisms by which RV induces AHR have been postulated, the precise mechanisms of AHR following RV exposure remain elusive. A challenge to RV-related research stems from inadequate models for study. While human models raise ethical concerns and are relatively difficult in terms of subject recruitment, murine models are limited by susceptibility of infection to the relatively uncommon minor group (RV-B) serotypes, strains that are generally associated with infrequent clinical respiratory virus infections. Although a transgenic mouse strain that has been developed has enhanced susceptibility for infection with the common major group (RV-A) serotypes, few studies have focused on RV in the context of allergic airways disease rather than understanding RV-induced AHR. Recently, the receptor for the virulent RV-C CDHR3, was identified, but a dearth of studies have examined RV-C-induced effects in humans. Currently, the mechanisms by which RV infections modulate airway smooth muscle (ASM) shortening or excitation-contraction coupling remain elusive. Further, only one study has investigated the effects of RV on bronchodilatory mechanisms, with only speculation as to mechanisms underlying RV-mediated modulation of bronchoconstriction.
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Affiliation(s)
- Dennis Lo
- Department of Medicine, Rutgers Institute for Translational Medicine and Science, Rutgers University, New Brunswick, NJ, USA
| | - Joshua L Kennedy
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Richard C Kurten
- Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Reynold A Panettieri
- Department of Medicine, Rutgers Institute for Translational Medicine and Science, Rutgers University, New Brunswick, NJ, USA
| | - Cynthia J Koziol-White
- Department of Medicine, Rutgers Institute for Translational Medicine and Science, Rutgers University, New Brunswick, NJ, USA.
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73
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Ardura-Garcia C, Stolbrink M, Zaidi S, Cooper PJ, Blakey JD. Predictors of repeated acute hospital attendance for asthma in children: A systematic review and meta-analysis. Pediatr Pulmonol 2018; 53:1179-1192. [PMID: 29870146 PMCID: PMC6175073 DOI: 10.1002/ppul.24068] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/15/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Asthma attacks are common and have significant physical, psychological, and financial consequences. Improving the assessment of a child's risk of subsequent asthma attacks could support front-line clinicians' decisions on augmenting chronic treatment or specialist referral. We aimed to identify predictors for emergency department (ED) or hospital readmission for asthma from the published literature. METHODS We searched MEDLINE, EMBASE, AMED, PsycINFO, and CINAHL with no language, location, or time restrictions. We retrieved observational studies and randomized controlled trials (RCT) assessing factors (personal and family history, and biomarkers) associated with the risk of ED re-attendance or hospital readmission for acute childhood asthma. RESULTS Three RCTs and 33 observational studies were included, 31 from Anglophone countries and none from Asia or Africa. There was an unclear or high risk of bias in 14 of the studies, including 2 of the RCTs. Previous history of emergency or hospital admissions for asthma, younger age, African-American ethnicity, and low socioeconomic status increased risk of subsequent ED and hospital readmissions for acute asthma. Female sex and concomitant allergic diseases also predicted hospital readmission. CONCLUSION Despite the global importance of this issue, there are relatively few high quality studies or studies from outside North America. Factors other than symptoms are associated with the risk of emergency re-attendance for acute asthma among children. Further research is required to better quantify the risk of future attacks and to assess the role of commonly used biomarkers.
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Affiliation(s)
| | | | - Seher Zaidi
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Philip J Cooper
- Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK
| | - John D Blakey
- Respiratory Medicine, Royal Liverpool Hospital, Liverpool, UK.,Health Services Research, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
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74
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Pembrey L, Barreto ML, Douwes J, Cooper P, Henderson J, Mpairwe H, Ardura-Garcia C, Chico M, Brooks C, Cruz AA, Elliott AM, Figueiredo CA, Langan SM, Nassanga B, Ring S, Rodrigues L, Pearce N. Understanding asthma phenotypes: the World Asthma Phenotypes (WASP) international collaboration. ERJ Open Res 2018; 4:00013-2018. [PMID: 30151371 PMCID: PMC6104297 DOI: 10.1183/23120541.00013-2018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/28/2018] [Indexed: 12/12/2022] Open
Abstract
The World Asthma Phenotypes (WASP) study started in 2016 and has been conducted in five centres, in the UK, New Zealand, Brazil, Ecuador and Uganda. The objectives of this study are to combine detailed biomarker and clinical information in order to 1) better understand and characterise asthma phenotypes in high-income countries (HICs) and low and middle-income countries (LMICs), and in high and low prevalence centres; 2) compare phenotype characteristics, including clinical severity; 3) assess the risk factors for each phenotype; and 4) assess how the distribution of phenotypes differs between high prevalence and low prevalence centres. Here we present the rationale and protocol for the WASP study to enable other centres around the world to carry out similar analyses using a standardised protocol. Large collaborative and integrative studies like this are essential to further our understanding of asthma phenotypes. The findings of this study will help elucidate the aetiological mechanisms of asthma and might potentially identify new causes and guide the development of new treatments, thereby enabling better management and prevention of asthma in both HICs and LMICs.
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Affiliation(s)
- Lucy Pembrey
- London School of Hygiene and Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil.,Center for Data and Knowledge Integration for Health (CIDACS), Fiocruz, Salvador, Brazil
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Philip Cooper
- St George's University of London, London, UK.,Universidad Internacional del Ecuador, Quito, Ecuador.,Fundacion Ecuatoriana Para Investigacion en Salud, Quito, Ecuador
| | - John Henderson
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Harriet Mpairwe
- Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | - Martha Chico
- Fundacion Ecuatoriana Para Investigacion en Salud, Quito, Ecuador
| | - Collin Brooks
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Alvaro A Cruz
- The Programme for Control of Asthma and Allergic Rhinitis (ProAR), Federal University of Bahia, Salvador, Brazil.,Institute for Health Sciences, Federal University of Bahia, Salvador, Brazil
| | - Alison M Elliott
- Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Camila A Figueiredo
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | | | - Beatrice Nassanga
- Medical Research Council (MRC)/Uganda Virus Research Institute (UVRI) Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Susan Ring
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Neil Pearce
- London School of Hygiene and Tropical Medicine, London, UK.,Centre for Public Health Research, Massey University, Wellington, New Zealand
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75
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Platts-Mills TAE. The continuing effect of the discovery of IgE by Kimishige Ishizaka. J Allergy Clin Immunol 2018; 142:788-789. [PMID: 30075153 DOI: 10.1016/j.jaci.2018.07.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 07/27/2018] [Indexed: 11/15/2022]
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76
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Pascal M, Perez-Gordo M, Caballero T, Escribese MM, Lopez Longo MN, Luengo O, Manso L, Matheu V, Seoane E, Zamorano M, Labrador M, Mayorga C. Microbiome and Allergic Diseases. Front Immunol 2018; 9:1584. [PMID: 30065721 PMCID: PMC6056614 DOI: 10.3389/fimmu.2018.01584] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/26/2018] [Indexed: 12/17/2022] Open
Abstract
Allergic diseases, such as respiratory, cutaneous, and food allergy, have dramatically increased in prevalence over the last few decades. Recent research points to a central role of the microbiome, which is highly influenced by multiple environmental and dietary factors. It is well established that the microbiome can modulate the immune response, from cellular development to organ and tissue formation exerting its effects through multiple interactions with both the innate and acquired branches of the immune system. It has been described at some extent changes in environment and nutrition produce dysbiosis in the gut but also in the skin, and lung microbiome, inducing qualitative and quantitative changes in composition and metabolic activity. Here, we review the potential role of the skin, respiratory, and gastrointestinal tract (GIT) microbiomes in allergic diseases. In the GIT, the microbiome has been proven to be important in developing either effector or tolerant responses to different antigens by balancing the activities of Th1 and Th2 cells. In the lung, the microbiome may play a role in driving asthma endotype polarization, by adjusting the balance between Th2 and Th17 patterns. Bacterial dysbiosis is associated with chronic inflammatory disorders of the skin, such as atopic dermatitis and psoriasis. Thus, the microbiome can be considered a therapeutical target for treating inflammatory diseases, such as allergy. Despite some limitations, interventions with probiotics, prebiotics, and/or synbiotics seem promising for the development of a preventive therapy by restoring altered microbiome functionality, or as an adjuvant in specific immunotherapy.
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Affiliation(s)
- Mariona Pascal
- Immunology Department, Centro de Diagnóstico Biomédico, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, ARADyAL, Barcelona, Spain
| | - Marina Perez-Gordo
- Basic Medical Science Department, Faculty of Medicine, CEU San Pablo University, ARADyAL, Madrid, Spain.,Institute of Applied and Molecular Medicine (IMMA), Faculty of Medicine, CEU San Pablo University, Madrid, Spain
| | | | - Maria M Escribese
- Basic Medical Science Department, Faculty of Medicine, CEU San Pablo University, ARADyAL, Madrid, Spain
| | | | | | - Luis Manso
- Hospital Universitario del Sureste, Madrid, Spain
| | - Victor Matheu
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Elena Seoane
- Hospital Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Cristobalina Mayorga
- Research Laboratory and Allergy Unit, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario, Universidad de Málaga, ARADyAL, Malaga, Spain
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77
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Akbarshahi H, Menzel M, Ramu S, Mahmutovic Persson I, Bjermer L, Uller L. House dust mite impairs antiviral response in asthma exacerbation models through its effects on TLR3. Allergy 2018; 73:1053-1063. [PMID: 29319193 DOI: 10.1111/all.13378] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Impaired antiviral interferon expression may be involved in asthma exacerbations commonly caused by rhinovirus infections. Allergy is a known risk factor for viral-induced asthma exacerbation, but little is known whether allergens may affect interferon responses. OBJECTIVE Our hypothesis is that house dust mite (HDM) impairs viral stimulus-induced antiviral signalling. METHODS Experimental asthma exacerbations were produced in vitro in human bronchial epithelial cells (HBECs) and in mice using sequential challenges with HDM and a viral infection mimic, Poly(I:C). We examined rhinovirus pattern recognition receptors (PRRs) signalling pathways and potential mechanisms of impaired interferon response. RESULTS HBECs and mice exposed to HDM prior to Poly(I:C) exhibited a reduced antiviral response compared to Poly(I:C) alone, including reduced IFN-β, IFN-λ, TLR3, RIG-I, MDA5, IRF-3 and IRF-7. Heat inactivation of HDM partially restored the TLR3-induced interferon response in vitro and in vivo. Our HBEC-data further showed that HDM directly affects TLR3 signalling by targeting the receptor glycosylation level. CONCLUSIONS Direct effects of allergens such as HDM on PRRs can present as potential mechanism for defective antiviral airway responses. Accordingly, therapeutic measures targeting inhibitory effects of allergens on antiviral PRRs may find use as a strategy to boost antiviral response and ameliorate exacerbations in asthmatic patients.
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Affiliation(s)
- H. Akbarshahi
- Unit of Respiratory Immunopharmacology; Department of Experimental Medical Science; Lund University; Lund Sweden
- Lung Medicine and Allergology; Department of Clinical Sciences; Lund University; Lund Sweden
| | - M. Menzel
- Unit of Respiratory Immunopharmacology; Department of Experimental Medical Science; Lund University; Lund Sweden
| | - S. Ramu
- Unit of Respiratory Immunopharmacology; Department of Experimental Medical Science; Lund University; Lund Sweden
| | - I. Mahmutovic Persson
- Unit of Respiratory Immunopharmacology; Department of Experimental Medical Science; Lund University; Lund Sweden
| | - L. Bjermer
- Lung Medicine and Allergology; Department of Clinical Sciences; Lund University; Lund Sweden
| | - L. Uller
- Unit of Respiratory Immunopharmacology; Department of Experimental Medical Science; Lund University; Lund Sweden
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78
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Kennedy JL, Koziol-White CJ, Jeffus S, Rettiganti MR, Fisher P, Kurten M, Eze A, House S, Sikes JD, Askew E, Putt C, Panettieri RA, Jones SM, Kurten RC. Effects of rhinovirus 39 infection on airway hyperresponsiveness to carbachol in human airways precision cut lung slices. J Allergy Clin Immunol 2018; 141:1887-1890.e1. [PMID: 29317243 PMCID: PMC5938135 DOI: 10.1016/j.jaci.2017.11.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/16/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Joshua L Kennedy
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, Ark; Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark; Translational Research Institute, University of Arkansas for Medical Sciences, Little Rock, Ark.
| | | | - Susanne Jeffus
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mallikarjuna R Rettiganti
- Arkansas Children’s Research Institute, Little Rock, AR,Department of Pediatrics, Biostatistics Program, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Paige Fisher
- Department of Pediatrics, Biostatistics Program, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Megan Kurten
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Anthony Eze
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Suzanne House
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - James D Sikes
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Emily Askew
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Claire Putt
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Reynold A Panettieri
- Department of Medicine, Rutgers, the State University of New Jersey, New Brunswick, NJ
| | - Stacie M Jones
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR,Arkansas Children’s Research Institute, Little Rock, AR,Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Richard C Kurten
- Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, AR,Arkansas Children’s Research Institute, Little Rock, AR,Department of Physiology and Biophysics, University of Arkansas for Medical Sciences, Little Rock, AR
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79
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Valenta R, Karaulov A, Niederberger V, Gattinger P, van Hage M, Flicker S, Linhart B, Campana R, Focke-Tejkl M, Curin M, Eckl-Dorna J, Lupinek C, Resch-Marat Y, Vrtala S, Mittermann I, Garib V, Khaitov M, Valent P, Pickl WF. Molecular Aspects of Allergens and Allergy. Adv Immunol 2018; 138:195-256. [PMID: 29731005 DOI: 10.1016/bs.ai.2018.03.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Immunoglobulin E (IgE)-associated allergy is the most common immune disorder. More than 30% of the population suffer from symptoms of allergy which are often severe, disabling, and life threatening such as asthma and anaphylaxis. Population-based birth cohort studies show that up to 60% of the world population exhibit IgE sensitization to allergens, of which most are protein antigens. Thirty years ago the first allergen-encoding cDNAs have been isolated. In the meantime, the structures of most of the allergens relevant for disease in humans have been solved. Here we provide an update regarding what has been learned through the use of defined allergen molecules (i.e., molecular allergology) and about mechanisms of allergic disease in humans. We focus on new insights gained regarding the process of sensitization to allergens, allergen-specific secondary immune responses, and mechanisms underlying allergic inflammation and discuss open questions. We then show how molecular forms of diagnosis and specific immunotherapy are currently revolutionizing diagnosis and treatment of allergic patients and how allergen-specific approaches may be used for the preventive eradication of allergy.
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Affiliation(s)
- Rudolf Valenta
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria; NRC Institute of Immunology FMBA of Russia, Moscow, Russia.
| | - Alexander Karaulov
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Verena Niederberger
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Pia Gattinger
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Marianne van Hage
- Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Sabine Flicker
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Birgit Linhart
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Raffaela Campana
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Margarete Focke-Tejkl
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Mirela Curin
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Julia Eckl-Dorna
- Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria
| | - Christian Lupinek
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Yvonne Resch-Marat
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Susanne Vrtala
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Irene Mittermann
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Victoria Garib
- Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria; International Network of Universities for Molecular Allergology and Immunology, Vienna, Austria
| | - Musa Khaitov
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
| | - Peter Valent
- Department of Internal Medicine I, Division of Hematology & Hemostaseology, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - Winfried F Pickl
- Institute of Immunology, Medical University of Vienna, Vienna, Austria
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80
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Guibas GV, Tsolia M, Christodoulou I, Stripeli F, Sakkou Z, Papadopoulos NG. Distinction between rhinovirus-induced acute asthma and asthma-augmented influenza infection. Clin Exp Allergy 2018; 48:536-543. [PMID: 29473978 DOI: 10.1111/cea.13124] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/24/2018] [Accepted: 01/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Rhinovirus (RV) is an established trigger of asthma attacks, whereas such a link is less consistent for influenza virus (IFV). OBJECTIVE In the context of precision medicine, we hypothesized that IFV infection may cause a condition essentially different from RV, and we investigated this by evaluating clinical characteristics of RV/IFV-positive and -negative children with respiratory symptoms and/or fever. METHODS One thousand two hundred and seven children, 6 months to 13 years old, hospitalized for flu-like illness were recruited in this cross-sectional study. Collected information included demographics, medical history, symptoms/physical findings/diagnosis at presentation and treatment. Nasal secretions were PCR-tested for IFV/RV. Associations were evaluated with adjusted logistic regression models. RESULTS Rhinovirus positivity was associated with an asthma-like presentation, including increased wheeze/effort of breathing/diagnosis of acute asthma, and decreased fever/vomiting. Conversely, IFV+ children presented with less wheeze/effort of breathing/diagnosis of acute asthma, while they were more frequently febrile. In those with previous asthma history, both viruses induced wheeze; however, IFV was uniquely associated with a more generalised and severe presentation including fever, rales, intercostal muscle retractions and lymphadenopathy. These symptoms were not seen in RV+ asthmatics, who had fewer systemic signs and more cough. CONCLUSIONS AND CLINICAL RELEVANCE In children with respiratory symptoms and/or fever, RV but not IFV is associated with wheeze and an asthma-like presentation. In those with an asthma history, IFV causes more generalised and severe disease that may be better described as "asthma-augmented influenza" rather than an "asthma attack." Differences in the acute conditions caused by these viruses should be considered in the design of epidemiological studies.
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Affiliation(s)
- G V Guibas
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.,Paediatric Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - M Tsolia
- 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | | | - F Stripeli
- 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | - Z Sakkou
- 2nd Paediatric Clinic, University of Athens, Athens, Greece
| | - N G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.,Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.,Paediatric Allergy Department, Manchester University NHS Foundation Trust, Manchester, UK.,2nd Paediatric Clinic, University of Athens, Athens, Greece
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81
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Ardura-Garcia C, Garner P, Cooper PJ. Is childhood wheeze and asthma in Latin America associated with poor hygiene and infection? A systematic review. BMJ Open Respir Res 2018. [PMID: 29531744 PMCID: PMC5844372 DOI: 10.1136/bmjresp-2017-000249] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction High asthma prevalence in Latin-American cities is thought to be caused by poor hygiene and infections. This contradicts the widely accepted 'hygiene hypothesis' for asthma aetiology. Methods Systematic review of observational studies evaluating the association between poor hygiene exposures or infections and asthma/wheeze among Latin-American children aged 4-16 years. MEDLINE, EMBASE, LILACS and CINAHL electronic databases were searched following a predefined strategy to 18 December 2017. We quantified outcomes measured and reported, assessed risk of bias and tabulated the results. Results Forty-five studies included: 6 cohort, 30 cross-sectional and 9 case-control studies. 26 cross-sectional studies were school-based surveys (14 of over 3000 children), whereas 5 case-control studies were hospital/health centre-based. Exposures measured and reported varied substantially between studies, and current wheeze was the most common outcome reported. Data showed selective reporting based on statistical significance (P value <0.05): 17/45 studies did not clearly describe the number of exposures measured and 15/45 studies reported on less than 50% of the exposures measured. Most exposures studied did not show an association with wheeze or asthma, except for a generally increased risk associated with acute respiratory infections in early life. Contradictory associations were observed frequently between different studies. Conclusion Selective reporting is common in observational studies exploring the association between environmental exposures and risk of wheeze/asthma. This, together with the use of different study outcomes (wheeze/asthma) associated with possibly distinct causal mechanisms, complicates inferences about the role of poor hygiene exposures and childhood infections in explaining asthma prevalence in Latin-American children.
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Affiliation(s)
| | - Paul Garner
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Philip J Cooper
- Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,Institute of Infection and Immunity, St George's, University of London, London, UK
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82
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Silveyra P, Zeldin DC. It All Begins In Utero: Cord Blood Bacterial DNA and T Cell Immunity. Am J Respir Cell Mol Biol 2018; 57:379-380. [PMID: 28960102 DOI: 10.1165/rcmb.2017-0185ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Patricia Silveyra
- 1 Department of Pediatrics Pennsylvania State University College of Medicine Hershey, Pennsylvania and
| | - Darryl C Zeldin
- 2 Division of Intramural Research National Institute of Environmental Health Sciences National Institutes of Health Research Triangle Park, North Carolina
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83
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Castillo JR, Peters SP, Busse WW. Asthma Exacerbations: Pathogenesis, Prevention, and Treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:918-927. [PMID: 28689842 PMCID: PMC5950727 DOI: 10.1016/j.jaip.2017.05.001] [Citation(s) in RCA: 260] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/27/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022]
Abstract
Guideline-based management of asthma focuses on disease severity and choosing the appropriate medical therapy to control symptoms and reduce the risk of exacerbations. However, irrespective of asthma severity and often despite optimal medical therapy, patients may experience acute exacerbations of symptoms and a loss of disease control. Asthma exacerbations are most commonly triggered by viral respiratory infections, particularly with human rhinovirus. Given the importance of these events to asthma morbidity and health care costs, we will review common inciting factors for asthma exacerbations and approaches to prevent and treat these events.
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Affiliation(s)
- Jamee R Castillo
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Stephen P Peters
- Wake Forest School of Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Winston-Salem, NC
| | - William W Busse
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
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84
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Muehling LM, Turner RB, Brown KB, Wright PW, Patrie JT, Lahtinen SJ, Lehtinen MJ, Kwok WW, Woodfolk JA. Single-Cell Tracking Reveals a Role for Pre-Existing CCR5+ Memory Th1 Cells in the Control of Rhinovirus-A39 After Experimental Challenge in Humans. J Infect Dis 2018; 217:381-392. [PMID: 29309618 PMCID: PMC5853408 DOI: 10.1093/infdis/jix514] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/05/2017] [Indexed: 01/01/2023] Open
Abstract
Background Little is known about T cells that respond to human rhinovirus in vivo, due to timing of infection, viral diversity, and complex T-cell specificities. We tracked circulating CD4+ T cells with identical epitope specificities that responded to intranasal challenge with rhinovirus (RV)-A39, and we assessed T-cell signatures in the nose. Methods Cells were monitored using a mixture of 2 capsid-specific major histocompatibility complex II tetramers over a 7-week period, before and after RV-A39 challenge, in 16 human leukocyte antigen-DR4+ subjects who participated in a trial of Bifidobacterium lactis (Bl-04) supplementation. Results Pre-existing tetramer+ T cells were linked to delayed viral shedding, enriched for activated CCR5+ Th1 effectors, and included a minor interleukin-21+ T follicular helper cell subset. After RV challenge, expansion and activation of virus-specific CCR5+ Th1 effectors was restricted to subjects who had a rise in neutralizing antibodies, and tetramer-negative CCR5+ effector memory types were comodulated. In the nose, CXCR3-CCR5+ T cells present during acute infection were activated effector memory type, whereas CXCR3+ cells were central memory type, and cognate chemokine ligands were elevated over baseline. Probiotic had no T-cell effects. Conclusions We conclude that virus-specific CCR5+ effector memory CD4+ T cells primed by previous exposure to related viruses contribute to the control of rhinovirus.
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Affiliation(s)
- Lyndsey M Muehling
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Ronald B Turner
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
| | - Kenneth B Brown
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - Paul W Wright
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville
| | | | | | - William W Kwok
- Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Judith A Woodfolk
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville
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85
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Kim CK, Callaway Z, Gern JE. Viral Infections and Associated Factors That Promote Acute Exacerbations of Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:12-17. [PMID: 29178673 PMCID: PMC5705478 DOI: 10.4168/aair.2018.10.1.12] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/08/2017] [Accepted: 08/20/2017] [Indexed: 01/08/2023]
Abstract
Despite asthma being the most common chronic childhood ailment, there is still much to learn about the disease. Early childhood infections with well-known or emerging viruses can lay the pathophysiologic framework for asthma development and exacerbation later in life, which may be due partly to alteration of the airway microbiome. Once asthma is established, acute exacerbations are usually associated with infections with respiratory viruses, such as rhinoviruses (RVs). Once again, there are bidirectional interactions between viruses and airway bacteria that appear to influence the severity of illness and the likelihood of exacerbation. Studies employing recent advances in viral and bacterial identification analytic techniques will clarify these new concepts and may provide the basis for new treatments or prevention or respiratory infection-associated exacerbation. This paper is a review of the associations among respiratory viruses, bacteria, inflammatory mechanisms, and asthma exacerbation.
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Affiliation(s)
- Chang Keun Kim
- Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Zak Callaway
- School of Biological Sciences, University of Ulsan, Ulsan, Korea
| | - James E Gern
- Departments of Pediatrics and Medicine, University of Wisconsin-Madison, Madison, WI, USA.
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86
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Puranik S, Forno E, Bush A, Celedón JC. Predicting Severe Asthma Exacerbations in Children. Am J Respir Crit Care Med 2017; 195:854-859. [PMID: 27710010 DOI: 10.1164/rccm.201606-1213pp] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Sandeep Puranik
- 1 Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Erick Forno
- 1 Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Andrew Bush
- 2 Royal Brompton Hospital, Imperial College London, London, United Kingdom
| | - Juan C Celedón
- 1 Division of Pediatric Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania; and
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87
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Platts-Mills TAE, Woodfolk JA. Mite Avoidance as a Logical Treatment for Severe Asthma in Childhood. Why Not? Am J Respir Crit Care Med 2017; 196:119-121. [PMID: 28707970 DOI: 10.1164/rccm.201703-0450ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Thomas A E Platts-Mills
- 1 Department of Medicine University of Virginia School of Medicine Charlottesville, Virginia
| | - Judith A Woodfolk
- 1 Department of Medicine University of Virginia School of Medicine Charlottesville, Virginia
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88
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Muehling LM, Lawrence MG, Woodfolk JA. Pathogenic CD4 + T cells in patients with asthma. J Allergy Clin Immunol 2017; 140:1523-1540. [PMID: 28442213 PMCID: PMC5651193 DOI: 10.1016/j.jaci.2017.02.025] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 02/07/2017] [Accepted: 02/20/2017] [Indexed: 02/08/2023]
Abstract
Asthma encompasses a variety of clinical phenotypes that involve distinct T cell-driven inflammatory processes. Improved understanding of human T-cell biology and the influence of innate cytokines on T-cell responses at the epithelial barrier has led to new asthma paradigms. This review captures recent knowledge on pathogenic CD4+ T cells in asthmatic patients by drawing on observations in mouse models and human disease. In patients with allergic asthma, TH2 cells promote IgE-mediated sensitization, airway hyperreactivity, and eosinophilia. Here we discuss recent discoveries in the myriad molecular pathways that govern the induction of TH2 differentiation and the critical role of GATA-3 in this process. We elaborate on how cross-talk between epithelial cells, dendritic cells, and innate lymphoid cells translates to T-cell outcomes, with an emphasis on the actions of thymic stromal lymphopoietin, IL-25, and IL-33 at the epithelial barrier. New concepts on how T-cell skewing and epitope specificity are shaped by multiple environmental cues integrated by dendritic cell "hubs" are discussed. We also describe advances in understanding the origins of atypical TH2 cells in asthmatic patients, the role of TH1 cells and other non-TH2 types in asthmatic patients, and the features of T-cell pathogenicity at the single-cell level. Progress in technologies that enable highly multiplexed profiling of markers within a single cell promise to overcome barriers to T-cell discovery in human asthmatic patients that could transform our understanding of disease. These developments, along with novel T cell-based therapies, position us to expand the assortment of molecular targets that could facilitate personalized treatments.
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Affiliation(s)
- Lyndsey M Muehling
- Allergy Division, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Monica G Lawrence
- Allergy Division, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va
| | - Judith A Woodfolk
- Allergy Division, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Va.
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89
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Esquivel A, Busse WW, Calatroni A, Togias AG, Grindle KG, Bochkov YA, Gruchalla RS, Kattan M, Kercsmar CM, Khurana Hershey G, Kim H, Lebeau P, Liu AH, Szefler SJ, Teach SJ, West JB, Wildfire J, Pongracic JA, Gern JE. Effects of Omalizumab on Rhinovirus Infections, Illnesses, and Exacerbations of Asthma. Am J Respir Crit Care Med 2017; 196:985-992. [PMID: 28608756 DOI: 10.1164/rccm.201701-0120oc] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
RATIONALE Allergic inflammation has been linked to increased susceptibility to viral illnesses, but it is unclear whether this association is causal. OBJECTIVES To test whether omalizumab treatment to reduce IgE would shorten the frequency and duration of rhinovirus (RV) illnesses in children with allergic asthma. METHODS In the PROSE (Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations) study, we examined children with allergic asthma (aged 6-17 yr; n = 478) from low-income census tracts in eight U.S. cities, and we analyzed virology for the groups randomized to treatment with guidelines-based asthma care (n = 89) or add-on omalizumab (n = 259). Weekly nasal mucus samples were analyzed for RVs, and respiratory symptoms and asthma exacerbations were recorded over a 90-day period during the fall seasons of 2012 or 2013. Adjusted illness rates (illnesses per sample) by treatment arm were calculated using Poisson regression. MEASUREMENTS AND MAIN RESULTS RVs were detected in 97 (57%) of 171 exacerbation samples and 2,150 (36%) of 5,959 nonexacerbation samples (OR, 2.32; P < 0.001). Exacerbations were significantly associated with detection of rhinovirus C (OR, 2.85; P < 0.001) and rhinovirus A (OR, 2.92; P < 0.001), as well as, to a lesser extent, rhinovirus B (OR, 1.98; P = 0.019). Omalizumab decreased the duration of RV infection (11.2 d vs. 12.4 d; P = 0.03) and reduced peak RV shedding by 0.4 log units (95% confidence interval, -0.77 to -0.02; P = 0.04). Finally, omalizumab decreased the frequency of RV illnesses (risk ratio, 0.64; 95% confidence interval, 0.49-0.84). CONCLUSIONS In children with allergic asthma, treatment with omalizumab decreased the duration of RV infections, viral shedding, and the risk of RV illnesses. These findings provide direct evidence that blocking IgE decreases susceptibility to RV infections and illness. Clinical trial registered with www.clinicaltrials.gov (NCT01430403).
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Affiliation(s)
- Ann Esquivel
- 1 University of Wisconsin, Madison, Madison, Wisconsin
| | | | | | - Alkis G Togias
- 3 National Institute of Allergy and Infectious Diseases, Rockville, Maryland
| | | | | | | | - Meyer Kattan
- 5 Columbia University Medical Center, New York, New York
| | | | | | - Haejin Kim
- 7 Henry Ford Health System, Detroit, Michigan
| | - Petra Lebeau
- 2 Rho Inc. Federal Systems Division, Chapel Hill, North Carolina
| | - Andrew H Liu
- 8 National Jewish Health, Denver, Colorado.,9 Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | - Stanley J Szefler
- 9 Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado
| | | | - Joseph B West
- 11 Boston University School of Medicine, Boston, Massachussetts; and
| | - Jeremy Wildfire
- 2 Rho Inc. Federal Systems Division, Chapel Hill, North Carolina
| | | | - James E Gern
- 1 University of Wisconsin, Madison, Madison, Wisconsin
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90
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Jartti T, Gern JE. Role of viral infections in the development and exacerbation of asthma in children. J Allergy Clin Immunol 2017; 140:895-906. [PMID: 28987219 PMCID: PMC7172811 DOI: 10.1016/j.jaci.2017.08.003] [Citation(s) in RCA: 277] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/03/2017] [Accepted: 08/22/2017] [Indexed: 12/31/2022]
Abstract
Viral infections are closely linked to wheezing illnesses in children of all ages. Respiratory syncytial virus (RSV) is the main causative agent of bronchiolitis, whereas rhinovirus (RV) is most commonly detected in wheezing children thereafter. Severe respiratory illness induced by either of these viruses is associated with subsequent development of asthma, and the risk is greatest for young children who wheeze with RV infections. Whether viral illnesses actually cause asthma is the subject of intense debate. RSV-induced wheezing illnesses during infancy influence respiratory health for years. There is definitive evidence that RSV-induced bronchiolitis can damage the airways to promote airway obstruction and recurrent wheezing. RV likely causes less structural damage and yet is a significant contributor to wheezing illnesses in young children and in the context of asthma. For both viruses, interactions between viral virulence factors, personal risk factors (eg, genetics), and environmental exposures (eg, airway microbiome) promote more severe wheezing illnesses and the risk for progression to asthma. In addition, allergy and asthma are major risk factors for more frequent and severe RV-related illnesses. Treatments that inhibit inflammation have efficacy for RV-induced wheezing, whereas the anti-RSV mAb palivizumab decreases the risk of severe RSV-induced illness and subsequent recurrent wheeze. Developing a greater understanding of personal and environmental factors that promote more severe viral illnesses might lead to new strategies for the prevention of viral wheezing illnesses and perhaps reduce the subsequent risk for asthma.
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Affiliation(s)
- Tuomas Jartti
- Department of Paediatrics, Turku University Hospital and University of Turku, Turku, Finland.
| | - James E Gern
- Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
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91
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Lambert KA, Prendergast LA, Dharmage SC, Tang M, O'Sullivan M, Tran T, Druce J, Bardin P, Abramson MJ, Erbas B. The role of human rhinovirus (HRV) species on asthma exacerbation severity in children and adolescents. J Asthma 2017; 55:596-602. [PMID: 29020463 DOI: 10.1080/02770903.2017.1362425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE It is recognized that human rhinovirus (HRV) infection is an important factor in asthma exacerbations requiring hospitalization in children. However, previous studies have disagreed on the differential impact of various HRV species. We sought to assess the impact of HRV species on the severity of asthma exacerbations in children and adolescents. We also examined whether the effect of HRV species on severity was modified by age and gender. METHODS Virus strain was determined for 113 children with HRV detectable at the time of admission for asthma exacerbation. Patient characteristics were collected on admission and exacerbation severity was scored using several validated scales. RESULTS HRV species by itself was not associated with moderate/severe vs. mild exacerbations. Boys with HRV-C infections were more likely (OR: 3.7, 95% CI: 1.2-13.4) to have a moderate/severe exacerbation than girls with HRV-C (p = 0.04 for interaction term). Higher odds were observed in younger boys (3 years old: OR: 9.1, 95% CI: 1.8-47.1 vs 5 years old: OR: 3.3, 95% CI: 0.9-11.8 vs 7 years old: OR: 1.2, 95% CI: 0.2-6.6). In contrast, children with HRV-C infection and sensitized to pollen during the pollen season were less likely to have moderate/severe exacerbations (p = 0.01 for the interaction term). CONCLUSION Acute asthma exacerbations are more likely to be moderate/severe in boys under 5 years of age who had HRV-C infection on admission. The opposite was found in children with sensitization to pollen during pollen season.
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Affiliation(s)
- Katrina A Lambert
- a School of Psychology and Public Health , La Trobe University , Victoria , Melbourne , Australia
| | - Luke A Prendergast
- b Department of Mathematics and Statistics , La Trobe University , Victoria , Melbourne , Australia
| | - Shyamali C Dharmage
- c Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health , The University of Melbourne , Victoria , Melbourne , Australia
| | - Mimi Tang
- d Department of Paediatrics , The University of Melbourne , Victoria , Melbourne , Australia.,e Murdoch Children's Research Institute , The Royal Children's Hospital , Victoria , Melbourne , Australia
| | - Molly O'Sullivan
- e Murdoch Children's Research Institute , The Royal Children's Hospital , Victoria , Melbourne , Australia
| | - Thomas Tran
- f Victorian Infectious Diseases Reference Laboratory, The Doherty Institute , Victoria , Melbourne , Australia
| | - Julian Druce
- f Victorian Infectious Diseases Reference Laboratory, The Doherty Institute , Victoria , Melbourne , Australia
| | - Philip Bardin
- g Faculty of Medicine, Nursing and Health Sciences , Monash University and Hospital , Victoria , Melbourne , Australia
| | - Michael J Abramson
- h School of Public Health and Preventive Medicine , Monash University , Victoria , Melbourne , Australia
| | - Bircan Erbas
- a School of Psychology and Public Health , La Trobe University , Victoria , Melbourne , Australia
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92
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Turturice BA, Ranjan R, Nguyen B, Hughes LM, Andropolis KE, Gold DR, Litonjua AA, Oken E, Perkins DL, Finn PW. Perinatal Bacterial Exposure Contributes to IL-13 Aeroallergen Response. Am J Respir Cell Mol Biol 2017; 57:419-427. [PMID: 28443674 PMCID: PMC5650087 DOI: 10.1165/rcmb.2017-0027oc] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/25/2017] [Indexed: 12/22/2022] Open
Abstract
There is a high prevalence of aeroallergen sensitivity in asthmatic populations, and seroreactivity to aeroallergens early in infancy is associated with increased risk of developing asthma later in life. In addition to allergen sensitivity, asthma development has been associated with differential microbial exposure and infection in early life. We have previously shown that cord blood mononuclear cells respond to common aeroallergens (i.e., house dust mite [Der f1] and cockroach [Bla g2]) as assayed by lymphoproliferation and cytokine (IL-13 and IFN-γ) production. We hypothesized that there is a relationship between perinatal microbial exposure and response to specific aeroallergens. To test this hypothesis, we isolated DNA from cord blood serum samples with known lymphoproliferative and cytokine responses to Bla g2 and Der f1. Bacterial 16S ribosomal DNA amplicon libraries were generated and analyzed using high throughput sequencing of cord blood serum samples. In our analysis, we identified major compositional differences, including diversity and abundance of specific taxa, between groups whose IL-13 response to Der f1 and Bla g2 differed. We demonstrate a strong association between the ratio of Acinetobacter to Proteobacteria and IL-13 production and the probability of IL-13 production after allergen exposure. IL-13 concentrations in serum were also significantly correlated with the diversity of bacterial DNA. Together, these results underscore the relationship between immune responses to allergens and bacterial exposure during perinatal development.
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Affiliation(s)
- Benjamin A. Turturice
- Department of Microbiology and Immunology
- Division of Pulmonary, Critical Care, Sleep, and Allergy, and
| | - Ravi Ranjan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, and
| | - Brian Nguyen
- Division of Pulmonary, Critical Care, Sleep, and Allergy, and
| | | | | | - Diane R. Gold
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and
| | - Augusto A. Litonjua
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Oken
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - David L. Perkins
- Division of Nephrology, Department of Medicine, and
- Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Patricia W. Finn
- Department of Microbiology and Immunology
- Division of Pulmonary, Critical Care, Sleep, and Allergy, and
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93
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Franklin JM, Grunwell JR, Bruce AC, Smith RC, Fitzpatrick AM. Predictors of emergency department use in children with persistent asthma in metropolitan Atlanta, Georgia. Ann Allergy Asthma Immunol 2017; 119:129-136. [PMID: 28479192 PMCID: PMC5604877 DOI: 10.1016/j.anai.2017.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/07/2017] [Accepted: 04/11/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Racial disparities are evident among children with asthma in the United States, with non-Hispanic black children at particularly high risk for poor asthma outcomes, including frequent emergency department (ED) use for asthma exacerbations. OBJECTIVE To compare asthma features in non-Hispanic black vs white children in Atlanta, Georgia, and determine what clinical features predict future ED use for asthma. METHODS Self-reported black and white children 6 to 17 years of age with persistent asthma treated with controller medications completed medical history questionnaires, lung function testing, aeroallergen sensitization testing, and venipuncture. Medical records were reviewed for asthma-related ED visits for 12 months after the initial study visit. RESULTS A total of 276 children were enrolled. Black children, compared with white children, resided in more disadvantaged zip code areas and were more likely to have public insurance. Black children also had more features of asthma severity and more ED visits during the study period. Predictors of ED use, aside from a previous ED visit, differed by race. After adjustment for socioeconomic status, predictors of ED use in white children included an ED visit in the previous year and sensitization to pets and dust; in black children, predictors included ED use in the previous year, the number of asthma controller medications, forced expiratory volume in 1 second less than 80% predicted, blood eosinophil count greater than 4%, and mold sensitization. CONCLUSION Asthma features and ED use differ between black and white children in metropolitan Atlanta. Strategies to eliminate allergen exposure in the home and improve asthma control in these children may require tailoring for different racial groups.
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Affiliation(s)
| | | | - Alice C Bruce
- Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Robin C Smith
- Department of Pediatrics, Emory University, Atlanta, Georgia
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94
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Steinke JW, Borish L. Immune Responses in Rhinovirus-Induced Asthma Exacerbations. Curr Allergy Asthma Rep 2017; 16:78. [PMID: 27796793 DOI: 10.1007/s11882-016-0661-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute asthma exacerbations are responsible for urgent care visits and hospitalizations; they interfere with school and work productivity, thereby driving much of the morbidity and mortality associated with asthma. Approximately 80 to 85 % of asthma exacerbations in children, adolescents, and less frequently adults are associated with viral upper respiratory tract viral infections, and rhinovirus (RV) accounts for ∼60-70 % of these virus-associated exacerbations. Evidence suggests that it is not the virus itself but the nature of the immune response to RV that drives this untoward response. In particular, evidence supports the concept that RV acts to exacerbate an ongoing allergic inflammatory response to environmental allergens present at the time of the infection. The interaction of the ongoing IgE- and T cell-mediated response to allergen superimposed on the innate and adaptive immune responses to the virus and how this leads to triggering of an asthma exacerbation is discussed.
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Affiliation(s)
- John W Steinke
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA.,Carter Immunology Center, University of Virginia Health System, Charlottesville, VA, USA.,Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, VA, 22908-1355, USA
| | - Larry Borish
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA. .,Department of Microbiology, University of Virginia Health System, Charlottesville, VA, USA. .,Carter Immunology Center, University of Virginia Health System, Charlottesville, VA, USA. .,Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, VA, 22908-1355, USA.
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95
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Murray CS, Foden P, Sumner H, Shepley E, Custovic A, Simpson A. Preventing Severe Asthma Exacerbations in Children. A Randomized Trial of Mite-Impermeable Bedcovers. Am J Respir Crit Care Med 2017; 196:150-158. [DOI: 10.1164/rccm.201609-1966oc] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Clare S. Murray
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- University Hospital of South Manchester, Manchester, United Kingdom
- Royal Manchester Children’s Hospital, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester, United Kingdom
| | - Philip Foden
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- University Hospital of South Manchester, Manchester, United Kingdom
| | - Helen Sumner
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Elizabeth Shepley
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- University Hospital of South Manchester, Manchester, United Kingdom
- National Institute for Health Research South Manchester Respiratory and Allergy Clinical Research Facility, University Hospital of South Manchester, United Kingdom; and
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
- University Hospital of South Manchester, Manchester, United Kingdom
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96
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Pomés A, Mueller GA, Randall TA, Chapman MD, Arruda LK. New Insights into Cockroach Allergens. Curr Allergy Asthma Rep 2017; 17:25. [PMID: 28421512 DOI: 10.1007/s11882-017-0694-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This review addresses the most recent developments on cockroach allergen research in relation to allergic diseases, especially asthma. RECENT FINDINGS The number of allergens relevant to cockroach allergy has recently expanded considerably up to 12 groups. New X-ray crystal structures of allergens from groups 1, 2, and 5 revealed interesting features with implications for allergen standardization, sensitization, diagnosis, and therapy. Cockroach allergy is strongly associated with asthma particularly among children and young adults living in inner-city environments, posing challenges for disease control. Environmental interventions targeted at reducing cockroach allergen exposure have provided conflicting results. Immunotherapy may be a way to modify the natural history of cockroach allergy and decrease symptoms and asthma severity among sensitized and exposed individuals. The new information on cockroach allergens is important for the assessment of allergen markers of exposure and disease, and for the design of immunotherapy trials.
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Affiliation(s)
- Anna Pomés
- Indoor Biotechnologies, Inc., 700 Harris Street, Charlottesville, VA, 22903, USA.
| | - Geoffrey A Mueller
- Genome Integrity and Structural Biology Laboratory, Intramural Program, National Institute of Environmental Health Sciences, National Institutes of Health, 111 T.W. Alexander Drive, MD-MR01, Research Triangle Park, NC, 27709, USA
| | - Thomas A Randall
- Integrative Bioinformatics, National Institute of Environmental Health Sciences, National Institutes of Health, 111 T.W. Alexander Drive, MD-MR01, Research Triangle Park, NC, 27709, USA
| | - Martin D Chapman
- Indoor Biotechnologies, Inc., 700 Harris Street, Charlottesville, VA, 22903, USA
| | - L Karla Arruda
- Department of Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Av. Bandeirantes 3900, Ribeirao Preto, SP, 14049-900, Brazil
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97
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Heymann PW, Nguyen HT, Steinke JW, Turner RB, Woodfolk JA, Platts-Mills TAE, Martin L, He H, Biagini Myers J, Lindsey M, Sivaprasad U, Medvedovic M, Mahi N, Carper H, Murphy DD, Patrie J, Khurana Hershey GK. Rhinovirus infection results in stronger and more persistent genomic dysregulation: Evidence for altered innate immune response in asthmatics at baseline, early in infection, and during convalescence. PLoS One 2017; 12:e0178096. [PMID: 28552993 PMCID: PMC5446117 DOI: 10.1371/journal.pone.0178096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/07/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Rhinovirus (HRV) is associated with the large majority of virus-induced asthma exacerbations in children and young adults, but the mechanisms remain poorly defined. METHODS Asthmatics and non-asthmatic controls were inoculated with HRV-A16, and nasal epithelial samples were obtained 7 days before, 36 hours after, and 7 days after viral inoculation. RNA was extracted and subjected to RNA-seq analysis. RESULTS At baseline, 57 genes were differentially expressed between asthmatics and controls, and the asthmatics had decreased expression of viral replication inhibitors and increased expression of genes involved in inflammation. At 36 hours (before the emergence of peak symptoms), 1329 genes were significantly altered from baseline in the asthmatics compared to 62 genes in the controls. At this time point, asthmatics lacked an increase in IL-10 signaling observed in the controls. At 7 days following HRV inoculation, 222 genes were significantly dysregulated in the asthmatics, whereas only 4 genes were dysregulated among controls. At this time point, the controls but not asthmatics demonstrated upregulation of SPINK5. CONCLUSIONS As judged by the magnitude and persistence of dysregulated genes, asthmatics have a substantially different host response to HRV-A16 infection compared with non-asthmatic controls. Gene expression differences illuminate biologically plausible mechanisms that contribute to a better understanding of the pathogenesis of HRV-induced asthma exacerbations.
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Affiliation(s)
- Peter W. Heymann
- Division of Allergy, Immunology and Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
- Department of Internal Medicine, Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Huyen-Tran Nguyen
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - John W. Steinke
- Department of Internal Medicine, Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Ronald B. Turner
- Division of Infectious Diseases, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
| | - Judith A. Woodfolk
- Department of Internal Medicine, Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Thomas A. E. Platts-Mills
- Department of Internal Medicine, Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, Virginia, United States of America
| | - Lisa Martin
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Hua He
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Jocelyn Biagini Myers
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Mark Lindsey
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Umasundari Sivaprasad
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Mario Medvedovic
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Naim Mahi
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Holliday Carper
- Division of Allergy, Immunology and Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
| | - Deborah D. Murphy
- Division of Allergy, Immunology and Respiratory Medicine, Department of Pediatrics, University of Virginia, Charlottesville, Virginia, United States of America
| | - James Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, United States of America
| | - Gurjit K. Khurana Hershey
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, United States of America
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98
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Yan Y, Huang L, Wang M, Wang Y, Ji W, Zhu C, Chen Z. Clinical and epidemiological profiles including meteorological factors of low respiratory tract infection due to human rhinovirus in hospitalized children. Ital J Pediatr 2017; 43:23. [PMID: 28270165 PMCID: PMC5341482 DOI: 10.1186/s13052-017-0346-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/28/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lower respiratory tract infection (LRTI) is a major cause of morbidity and mortality in children. Human rhinovirus (HRV) is confirmed to be associated with pediatric lower respiratory tract infection. Seasonal and meteorological factors may play a key role in the epidemiology of HRV. The purposes of this study were to investigate the frequency, seasonal distribution, and clinical characteristics of hospitalized children with LRTI caused by HRVs. In addition, associations between incidence of HRVs and meteorological factors in a subtropical region of China were discussed. METHODS Hospitalized children <14 years old admitted to the Respiratory Department of the Children's Hospital, which is affiliated to Soochow University, between January 1, 2013 and December 31, 2015, were enrolled in this study. Multi-pathogens were detected in nasopharyngeal aspirate samples. Meanwhile, meteorological factors were recorded. RESULTS The average incidence of HRVs infection was 11.4% (707/6194) and 240 cases of which were co-infection cases with other pathogens. Children with co-infection presented more frequent fever and tachypnea compared to children infected with HRVs only (both P < 0.05). Among 707 HRV positive children, the mean age was 23.2 months (range 1 to 140 months). Among all respiratory infections, the highest incidence of HRVs cases occurred in children age 13-36 months old (15.1%, 203/1341). Of all 228 HRV cases in 2014, 85 cases (37.3%) were HRV-C positive. HRVs and HRV-C infection occurred throughout the year during the study period, although a higher incidence was observed in summer and autumn seasons. HRVs or HRV-C incidence in hospitalized children with LRTI was associated with the monthly mean temperature (both P < 0.05). CONCLUSION HRV was one of the most common viral pathogen detected in hospitalized children with LRTI at the Children's Hospital of Suzhou, China, and had its own seasonal distribution including HRV-C, which was partly caused by temperature.
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Affiliation(s)
- Yongdong Yan
- Department of Respiratory Disease, Children's Hospital of Soochow University, NO.303, Jingde Road, Suzhou, Jiangsu Province, 215003, People's Republic of China
| | - Li Huang
- Department of Respiratory Disease, Children's Hospital of Soochow University, NO.303, Jingde Road, Suzhou, Jiangsu Province, 215003, People's Republic of China
| | - Meijuan Wang
- Department of Respiratory Disease, Children's Hospital of Soochow University, NO.303, Jingde Road, Suzhou, Jiangsu Province, 215003, People's Republic of China
| | - Yuqing Wang
- Department of Respiratory Disease, Children's Hospital of Soochow University, NO.303, Jingde Road, Suzhou, Jiangsu Province, 215003, People's Republic of China
| | - Wei Ji
- Department of Respiratory Disease, Children's Hospital of Soochow University, NO.303, Jingde Road, Suzhou, Jiangsu Province, 215003, People's Republic of China
| | - Canhong Zhu
- Department of Respiratory Disease, Children's Hospital of Soochow University, NO.303, Jingde Road, Suzhou, Jiangsu Province, 215003, People's Republic of China.
| | - Zhengrong Chen
- Department of Respiratory Disease, Children's Hospital of Soochow University, NO.303, Jingde Road, Suzhou, Jiangsu Province, 215003, People's Republic of China.
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99
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Comberiati P, Di Cicco ME, D'Elios S, Peroni DG. How Much Asthma Is Atopic in Children? Front Pediatr 2017; 5:122. [PMID: 28603709 PMCID: PMC5445121 DOI: 10.3389/fped.2017.00122] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 05/08/2017] [Indexed: 12/17/2022] Open
Affiliation(s)
- Pasquale Comberiati
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Maria Elisa Di Cicco
- Department of Clinical and Experimental Medicine, Section of Pediatric, University of Pisa, Pisa, Italy
| | - Sofia D'Elios
- Department of Clinical and Experimental Medicine, Section of Pediatric, University of Pisa, Pisa, Italy
| | - Diego G Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatric, University of Pisa, Pisa, Italy
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100
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Odajima H, Ebisawa M, Nagakura T, Fujisawa T, Akasawa A, Ito K, Doi S, Yamaguchi K, Katsunuma T, Kurihara K, Teramoto T, Sugai K, Nambu M, Hoshioka A, Yoshihara S, Sato N, Seko N, Nishima S. Long-term safety, efficacy, pharmacokinetics and pharmacodynamics of omalizumab in children with severe uncontrolled asthma. Allergol Int 2017; 66:106-115. [PMID: 27507228 DOI: 10.1016/j.alit.2016.06.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/23/2016] [Accepted: 06/01/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Omalizumab is effective and well-tolerated in children with moderate to severe allergic asthma. However, the effects of long-term treatment with omalizumab in this population haven't been well investigated. The objective of this study is to evaluate the long-term safety, efficacy, pharmacokinetics and pharmacodynamics of omalizumab in children with uncontrolled severe asthma. METHODS Thirty-eight Japanese children (aged 7-16 years) who completed the 24-week treatment core study were included in an uncontrolled extension study, in which treatment with omalizumab continued until the pediatric indication was approved in Japan (ClinicalTrials.gov number: NCT01328886). RESULTS Thirty-five patients (92.1%) completed the extension study. The median exposure throughout the core and extension studies was 116.6 weeks (range, 46.9-151.1 weeks). The most common adverse events were nasopharyngitis, influenza, upper respiratory tract infection, and asthma. Serious adverse events developed in 10 patients (26.3%), but resolved completely with additional treatments. Incidence of adverse events didn't increase with extended exposure with omalizumab. Twenty-nine patients (76.3%) achieved completely- or well-controlled asthma compared with 9 patients (23.7%) at the start of the extension study. QOL scores, the rates (per year) of hospitalizations and ER visits were significantly improved compared with the baseline of the core study [39.0 vs 48.0 (median), p < 0.001 for QOL, 1.33 vs 0.16, p < 0.001 for hospitalization, 0.68 vs 0.15, p = 0.002 for ER visits]. Remarkably, the mean total IgE level showed a decreasing trend while exposure to omalizumab remained at steady-state. CONCLUSIONS Long-term treatment with omalizumab is well-tolerated and effective in children with uncontrolled severe allergic asthma. No new safety findings were identified.
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