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Juhn YJ. Risks for infection in patients with asthma (or other atopic conditions): is asthma more than a chronic airway disease? J Allergy Clin Immunol 2014; 134:247-57; quiz 258-9. [PMID: 25087224 PMCID: PMC4122981 DOI: 10.1016/j.jaci.2014.04.024] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 04/22/2014] [Accepted: 04/22/2014] [Indexed: 12/16/2022]
Abstract
Most of the research effort regarding asthma has been devoted to its causes, therapy, and prognosis. There is also evidence that the presence of asthma can influence patients' susceptibility to infections, yet research in this aspect of asthma has been limited. There is additional debate in this field, with current literature tending to view the increased risk of infection among atopic patients as caused by opportunistic infections secondary to airway inflammation, especially in patients with severe atopic diseases. However, other evidence suggests that such risk and its underlying immune dysfunction might be a phenotypic or clinical feature of atopic conditions. This review argues (1) that improved understanding of the effects of asthma or other atopic conditions on the risk of microbial infections will bring important and new perspectives to clinical practice, research, and public health concerning atopic conditions and (2) that research efforts into the causes and effects of asthma must be juxtaposed because they are likely to guide each other.
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MESH Headings
- Asthma/complications
- Asthma/immunology
- Asthma/pathology
- Bacterial Infections/complications
- Bacterial Infections/immunology
- Bacterial Infections/pathology
- Chronic Disease
- Dermatitis, Atopic/complications
- Dermatitis, Atopic/immunology
- Dermatitis, Atopic/pathology
- Disease Susceptibility
- Humans
- Immunity, Innate
- Mycoses/complications
- Mycoses/immunology
- Mycoses/pathology
- Rhinitis, Allergic, Perennial/complications
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Perennial/pathology
- Rhinitis, Allergic, Seasonal/complications
- Rhinitis, Allergic, Seasonal/immunology
- Rhinitis, Allergic, Seasonal/pathology
- Risk Factors
- Virus Diseases/complications
- Virus Diseases/immunology
- Virus Diseases/pathology
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Affiliation(s)
- Young J Juhn
- Department of Pediatric and Adolescent Medicine/Internal Medicine/Health Sciences Research, Mayo Clinic, Rochester, Minn.
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52
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Greenhawt MJ. Influenza vaccination in asthmatic patients. J Allergy Clin Immunol 2014; 133:1233-4. [PMID: 24679474 DOI: 10.1016/j.jaci.2014.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 02/03/2014] [Accepted: 02/11/2014] [Indexed: 11/20/2022]
Affiliation(s)
- Matthew J Greenhawt
- University of Michigan Food Allergy Center, Division of Allergy and Clinical Immunology, University of Michigan Health System, Ann Arbor, Mich.
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53
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Łuczyńska A, Logan C, Nieters A, Elgizouli M, Schöttker B, Brenner H, Rothenbacher D. Cord blood 25(OH)D levels and the subsequent risk of lower respiratory tract infections in early childhood: the Ulm birth cohort. Eur J Epidemiol 2014; 29:585-94. [DOI: 10.1007/s10654-014-9918-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/16/2014] [Indexed: 01/31/2023]
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Grunwald T, Tenbusch M, Schulte R, Raue K, Wolf H, Hannaman D, de Swart RL, Überla K, Stahl-Hennig C. Novel vaccine regimen elicits strong airway immune responses and control of respiratory syncytial virus in nonhuman primates. J Virol 2014; 88:3997-4007. [PMID: 24453366 PMCID: PMC3993754 DOI: 10.1128/jvi.02736-13] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 01/11/2014] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED Induction of long-lasting immunity against viral respiratory tract infections remains an elusive goal. Using a nonhuman primate model of human respiratory syncytial virus (hRSV) infection, we compared mucosal and systemic immune responses induced by different DNA delivery approaches to a novel parenteral DNA prime-tonsillar adenoviral vector booster immunization regimen. Intramuscular (i.m.) electroporation (EP) of a DNA vaccine encoding the fusion protein of hRSV induced stronger systemic immune responses than intradermal EP, tattoo immunization, and conventional i.m. DNA injection. A single EP i.m., followed by two atraumatic tonsillar immunizations with the adenoviral vector, elicited strong systemic immune responses, an unique persistent CD4(+) and CD8(+) T cell response in the lower respiratory tract and protection from intranasal hRSV challenge. Thus, parenteral DNA priming followed by booster immunization targeted to a mucosal inductive site constitutes an effective vaccine regimen for eliciting protective immune responses at mucosal effector sites. IMPORTANCE The human respiratory syncytial virus (hRSV) is the most common cause of severe respiratory tract disease in infancy and leads to substantial morbidity and morality in the elderly. In this study, we compared the immunogenicity and efficacy of several gene-based immunization protocols in rhesus macaques. Thereby, we found that the combination of an initially parenterally delivered DNA vaccine with a subsequent atraumatic tonsillar adenoviral vector immunization results in a strong systemic immune response accompanied by an exceptional high T-cell response in the mucosa. Strikingly, these animals were protected against a RSV challenge infection controlling the viral replication indicated by a 1,000-fold-lower viral load in the lower respiratory tract. Since mucosal cellular responses of this strength had not been described in earlier RSV vaccine studies, this heterologous DNA prime-tonsillar boost vaccine strategy is very promising and should be pursued for further preclinical and clinical testing.
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Affiliation(s)
- Thomas Grunwald
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Germany
| | - Matthias Tenbusch
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Germany
| | - Reiner Schulte
- Unit of Infection Models, German Primate Center, Göttingen, Germany
| | - Katharina Raue
- Unit of Infection Models, German Primate Center, Göttingen, Germany
| | - Hans Wolf
- Institute for Medical Microbiology and Hygiene, Regensburg, Germany
| | - Drew Hannaman
- Ichor Medical Systems, Inc., San Diego, California, USA
| | - Rik L. de Swart
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Klaus Überla
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Germany
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55
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Richter D, Anca I, André FE, Bakir M, Chlibek R, Čižman M, Mangarov A, Mészner Z, Pokorn M, Prymula R, Salman N, Šimurka P, Tamm E, Tešović G, Urbančíková I, Usonis V, Wysocki J, Zavadska D. Immunization of high-risk paediatric populations: Central European Vaccination Awareness Group recommendations. Expert Rev Vaccines 2014; 13:801-15. [DOI: 10.1586/14760584.2014.897615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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56
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Abstract
The pathogenetic mechanisms leading to asthma are likely to be diverse, influenced by multiple genetic polymorphisms as well as elements of the environment. Recent data on the microbiome of the airway have revealed intriguing differences between the number and diversity of microbial populations in healthy persons and asthmatics. There is convincing evidence that early viral infections, particularly with human rhinovirus and respiratory syncytial virus, are often associated with the development of chronic asthma and with exacerbations. Recent studies suggest that two unrelated types of atypical bacteria, Mycoplasma pneumoniae (Mpn) and Chlamydia pneumoniae, are present in the airways of a substantial proportion of the population, bringing up the possibility that the persistent presence of the organism may contribute to the asthmatic phenotype in a subset of patients. This review will examine the current data regarding a possible role for infection in chronic asthma with a particular focus on atypical bacterial infections.
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Affiliation(s)
- T Prescott Atkinson
- Children's of Alabama CPP M220, 1601 4th Ave South, Birmingham, AL, 35233, USA,
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57
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Murphy VE, Powell H, Wark PAB, Gibson PG. A prospective study of respiratory viral infection in pregnant women with and without asthma. Chest 2014; 144:420-427. [PMID: 23493968 PMCID: PMC7107276 DOI: 10.1378/chest.12-1956] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Respiratory viral infections are common in pregnancy, but their health impact, especially in asthma, is unknown. The objective of this study was to assess the frequency, severity, and consequences of respiratory viral infection during pregnancy in women with and without asthma. METHODS In this prospective cohort study, common cold symptoms were assessed during pregnancy in 168 women with asthma and 117 women without asthma using the common cold questionnaire and by self-report. Nasal and throat swabs were collected for suspected infections and tested by polymerase chain reaction for respiratory viruses. Pregnancy and asthma outcomes were recorded. RESULTS Pregnant women with asthma had more prospective self-reported and questionnaire-detected common colds than pregnant women without asthma (incidence rate ratio, 1.77; 95% CI, 1.30-2.42; P < .0001). Retrospectively reported common colds in early pregnancy and post partum were increased in women with asthma compared with women without asthma. The severity of cold symptoms was also increased in women with asthma (total cold score median, 8; interquartile range [5, 10] in women with asthma vs 6 [5, 8] in control subjects; P = .031). Among women with asthma, having a laboratory-confirmed viral infection was associated with poorer maternal health, with 60% of infections associated with uncontrolled asthma and a higher likelihood of preeclampsia. CONCLUSIONS Pregnant women with asthma have more common colds during pregnancy than pregnant women without asthma. Colds during pregnancy were associated with adverse maternal and pregnancy outcomes. Prevention of viral infection in pregnancy may improve the health of mothers with asthma.
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Affiliation(s)
- Vanessa E Murphy
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Heather Powell
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia; John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter A B Wark
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia; John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter G Gibson
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia; John Hunter Hospital, Newcastle, NSW, Australia
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Asthma and Microbes: A New Paradigm. THE ROLE OF MICROBES IN COMMON NON-INFECTIOUS DISEASES 2014. [PMCID: PMC7120979 DOI: 10.1007/978-1-4939-1670-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Asthma is worldwide at pandemic levels for the past 30 years but is increasing at a greater rate in more affluent societies. It is a heterogeneous disorder caused by interaction between genetic predisposition, atopy, and environmental factors, including allergens, air pollution, and respiratory infections. The pathological aspects and pathophysiological mechanisms are reviewed in this chapter. Allergens or infectious agents may stimulate Th-2 inflammation which causes activation of IL-13, eosinophils, and increase IgE levels, subsequently leading to bronchial smooth muscle hypercontraction. Respiratory viral infections are well-known causes of precipitation of acute asthma exacerbations in 50–60 % of attacks. There is also increasing evidence that bacterial infections, Chlamydia pneumoniae, and Mycoplasma pneumoniae, may contribute to the onset and course of asthma. The two main hypothesis of microbial genesis of asthma that has arisen in the past 20–30 years appears to be incongruous, but are not, are the hygiene hypothesis of asthma, and the virus-related asthma, early onset of viral bronchiolitis in the susceptible hosts being responsible for later development of asthma. The clinical and experimental evidences to support these contentions are reviewed and critiqued.
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59
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Clinical profile of recurrent community-acquired pneumonia in children. BMC Pulm Med 2013; 13:60. [PMID: 24106756 PMCID: PMC3852007 DOI: 10.1186/1471-2466-13-60] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 09/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this case-control study was to analyse the clinical characteristics of children with recurrent community-acquired pneumonia (rCAP) affecting different lung areas (DLAs) and compare them with those of children who have never experienced CAP in order to contribute to identifying the best approach to such patients. METHODS The study involved 146 children with ≥2 episodes of radiographically confirmed CAP in DLA in a single year (or ≥3 episodes in any time frame) with radiographic clearing of densities between occurrences, and 145 age- and gender-matched controls enrolled in Milan, Italy, between January 2009 and December 2012. The demographic and clinical characteristics of the cases and controls were compared, and a comparison was also made between the cases with rCAP (i.e. ≤3 episodes) and those with highly recurrent CAP (hrCAP: i.e. >3 episodes). RESULTS Gestational age at birth (p = 0.003), birth weight (p = 0.006), respiratory distress at birth (p < 0.001), and age when starting day care attendance (p < 0.001) were significantly different between the cases and controls, and recurrent infectious wheezing (p < 0.001), chronic rhinosinusitis with post-nasal drip (p < 0.001), recurrent upper respiratory tract infections (p < 0.001), atopy/allergy (p < 0.001) and asthma (p < 0.001) were significantly more frequent. Significant risk factors for hrCAP were gastroesophageal reflux disease (GERD; p = 0.04), a history of atopy and/or allergy (p = 0.005), and a diagnosis of asthma (p = 0.0001) or middle lobe syndrome (p = 0.001). Multivariate logistic regression analysis, adjusted for age and gender, showed that all of the risk factors other than GERD and wheezing were associated with hrCAP. CONCLUSIONS The diagnostic approach to children with rCAP in DLAs is relatively easy in the developed world, where the severe chronic underlying diseases favouring rCAP are usually identified early, and patients with chronic underlying disease are diagnosed before the occurrence of rCAP in DLAs. When rCAP in DLAs does occur, an evaluation of the patients' history and clinical findings make it possible to limit diagnostic investigations.
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Proklou A, Soulitzis N, Neofytou E, Rovina N, Zervas E, Gaga M, Siafakas NM, Tzortzaki EG. Granule Cytotoxic Activity and Oxidative DNA Damage in Smoking and Nonsmoking Patients With Asthma. Chest 2013; 144:1230-1237. [DOI: 10.1378/chest.13-0367] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Fuchs O, von Mutius E. Prenatal and childhood infections: implications for the development and treatment of childhood asthma. THE LANCET RESPIRATORY MEDICINE 2013; 1:743-54. [PMID: 24429277 PMCID: PMC7104105 DOI: 10.1016/s2213-2600(13)70145-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Bacterial and viral infections occur early and recurrently in life and thereby impose a substantial disease burden. Besides causing clinical symptoms, a potential role of infection in the development of the asthma syndrome later in life has also been suggested. However, whether bacterial and viral infections unmask host factors in children at risk of asthma or whether they directly cause asthma remains unclear; both viewpoints could be justified, but the underlying mechanisms are complex and poorly understood. Recently, the role of the bacterial microbiome has been emphasised. But data are still sparse and future studies are needed for definitive conclusions to be made. In this Review, we discuss present knowledge of viruses and bacteria that infect and colonise the respiratory tract and mucosal surfaces, including their timepoint of action, host factors related to infection, and their effect on childhood asthma. Childhood asthma could be the result of a combination of altered host susceptibility and infectious agents.
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Affiliation(s)
- Oliver Fuchs
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Pneumology Centre Munich (CPC-M), Munich, Germany.
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Pneumology Centre Munich (CPC-M), Munich, Germany
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Moncayo AL, Vaca M, Oviedo G, Workman LJ, Chico ME, Platts-Mills TAE, Rodrigues LC, Barreto ML, Cooper PJ. Effects of geohelminth infection and age on the associations between allergen-specific IgE, skin test reactivity and wheeze: a case-control study. Clin Exp Allergy 2013; 43:60-72. [PMID: 23278881 PMCID: PMC3563216 DOI: 10.1111/cea.12040] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 08/19/2012] [Accepted: 09/24/2012] [Indexed: 01/15/2023]
Abstract
Background Most childhood asthma in poor populations in Latin America is not associated with aeroallergen sensitization, an observation that could be explained by the attenuation of atopy by chronic helminth infections or effects of age. Objective To explore the effects of geohelminth infections and age on atopy, wheeze, and the association between atopy and wheeze. Methods A case-control study was done in 376 subjects (149 cases and 227 controls) aged 7–19 years living in rural communities in Ecuador. Wheeze cases, identified from a large cross-sectional survey, had recent wheeze and controls were a random sample of those without wheeze. Atopy was measured by the presence of allergen-specific IgE (asIgE) and skin prick test (SPT) responses to house dust mite and cockroach. Geohelminth infections were measured in stools and anti-Ascaris IgE in plasma. Results The fraction of recent wheeze attributable to anti-Ascaris IgE was 45.9%, while those for SPT and asIgE were 10.0% and 10.5% respectively. The association between atopy and wheeze was greater in adolescents than children. Although Anti-Ascaris IgE was strongly associated with wheeze (adj. OR 2.24 (95% CI 1.33–3.78, P = 0.003) and with asIgE (adj. OR 5.34, 95% CI 2.49–11.45, P < 0.001), the association with wheeze was independent of asIgE. There was some evidence that the association between atopy and wheeze was greater in uninfected subjects compared with those with active geohelminth infections. Conclusions and clinical relevance Atopy to house dust mite and cockroach explained few wheeze cases in our study population, while the presence of anti-Ascaris IgE was an important risk factor. Our data provided only limited evidence that active geohelminth infections attenuated the association between atopy and wheeze in endemic areas or that age modified this association. The role of allergic sensitization to Ascaris in the development of wheeze, independent of atopy, requires further investigation.
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Affiliation(s)
- A-L Moncayo
- Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Lemke M, Hartert TV, Gebretsadik T, Carroll KN. Relationship of secondhand smoke and infant lower respiratory tract infection severity by familial atopy status. Ann Allergy Asthma Immunol 2013; 110:433-7. [PMID: 23706712 DOI: 10.1016/j.anai.2013.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 03/13/2013] [Accepted: 04/12/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Individuals with atopy have more severe complications of infectious diseases. We hypothesized that the importance of secondhand smoke (SHS) on lower respiratory tract infection (LRTI) severity would be greater in infants with a familial atopic predisposition. OBJECTIVE To determine whether infants with a familial atopic predisposition are more susceptible to adverse effects of SHS, resulting in more severe LRTI. METHODS We conducted cross-sectional analyses of mother-infant dyads enrolled during 2004 to 2008 during an infant LRTI. Predictor variables were SHS and 2 measures of a familial atopic predisposition (maternal atopic disease with allergen sensitization or familial atopy). LRTI severity was determined by bronchiolitis severity score (BSS) and hospital length of stay (LOS). We conducted multivariable regression analysis to test for a differential relationship between SHS and LRTI severity by measures of familial atopic predisposition. RESULTS In 451 dyads, 57% of infants had SHS exposure, 36% had a mother with atopic disease, and 68% had familial atopy. We did not detect differences in BSS or LOS by SHS exposure stratified by history of maternal atopic disease. In bivariate analysis, there was a significant difference in LOS by SHS in those with familial atopy (P = .006) but not in those without (P = .66). In multivariable analysis, among infants with familial atopy, there was a 23% increased LOS in infants with SHS exposure (P = .03), whereas no statistical significance was detected in those without familial atopy (P = .07). CONCLUSION In infants with familial atopy, SHS was associated with longer hospital LOS for LRTI but not BSS. Because the effect was seen only among hospitalized infants, confirmation is required.
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Affiliation(s)
- Meghan Lemke
- Departments of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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Tan BK, Chandra RK, Pollak J, Kato A, Conley DB, Peters AT, Grammer LC, Avila PC, Kern RC, Stewart WF, Schleimer RP, Schwartz BS. Incidence and associated premorbid diagnoses of patients with chronic rhinosinusitis. J Allergy Clin Immunol 2013; 131:1350-60. [PMID: 23541327 PMCID: PMC3788631 DOI: 10.1016/j.jaci.2013.02.002] [Citation(s) in RCA: 160] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 02/02/2013] [Accepted: 02/07/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a prevalent condition with underexplored risk factors. OBJECTIVES We sought to determine CRS incidence and evaluate associations with a range of premorbid medical conditions for chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) using real-world clinical practice data. METHODS Electronic health records data from 446,480 Geisinger Clinic primary care patients were used for a retrospective longitudinal cohort study for data from 2001-2010. By using logistic regression, newly diagnosed CRS cases between 2007 and 2009 were compared with frequency-matched control subjects on premorbid factors in the immediate (0-6 months), intermediate (7-24 months), and entire observed timeframes before diagnosis. RESULTS The average incidence of CRS was 83 ± 13 CRSwNP cases per 100,000 person-years and 1048 ± 78 CRSsNP cases per 100,000 person-years. Between 2007 and 2009, 595 patients with incident CRSwNP and 7523 patients with incident CRSsNP were identified and compared with 8118 control subjects. Compared with control subjects and patients with CRSsNP, patients with CRSwNP were older and more likely to be male. Before diagnosis, patients with CRS had a higher prevalence of acute rhinosinusitis, allergic rhinitis, chronic rhinitis, asthma, gastroesophageal reflux disease, adenotonsillitis, sleep apnea, anxiety, and headaches (all P < .001). Patients with CRSsNP had a higher premorbid prevalence of infections of the upper and lower airway, skin/soft tissue, and urinary tract (all P < .001). In the immediate and intermediate timeframes analyzed, patients with CRS had more outpatient encounters and antibiotic prescriptions (P < .001), but guideline-recommended diagnostic testing was performed in a minority of cases. CONCLUSIONS Patients who are given a diagnosis of CRS have a higher premorbid prevalence of anxiety, headaches, gastroesophageal reflux disease, sleep apnea, and infections of the respiratory system and some nonrespiratory sites, which results in higher antibiotic, corticosteroid, and health care use. The use of guideline-recommended diagnostic testing for confirmation of CRS remains poor.
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Affiliation(s)
- Bruce K Tan
- Department of Otolaryngology Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Dreyfus DH. Herpesviruses and the microbiome. J Allergy Clin Immunol 2013; 132:1278-86. [PMID: 23611298 DOI: 10.1016/j.jaci.2013.02.039] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 02/07/2013] [Accepted: 02/25/2013] [Indexed: 12/15/2022]
Abstract
The focus of this article will be to examine the role of common herpesviruses as a component of the microbiome of atopic patients and to review clinical observations suggesting that atopic patients might be predisposed to more severe and atypical herpes-related illness because their immune response is biased toward a TH2 cytokine profile. Human populations are infected with 8 herpesviruses, including herpes simplex virus HSV1 and HSV2 (also termed HHV1 and HHV2), varicella zoster virus (VZV or HHV3), EBV (HHV4), cytomegalovirus (HHV5), HHV6, HHV7, and Kaposi sarcoma-associated herpesvirus (termed KSV or HHV8). Herpesviruses are highly adapted to lifelong infection of their human hosts and thus can be considered a component of the human "microbiome" in addition to their role in illness triggered by primary infection. HSV1 and HSV2 infection and reactivation can present with more severe cutaneous symptoms termed eczema herpeticum in the atopic population, similar to the more severe eczema vaccinatum, and drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) is associated with reactivation of HSV6 and possibly other herpesviruses in both atopic and nonatopic patients. In this review evidence is reviewed that primary infection with herpesviruses may have an atypical presentation in the atopic patient and conversely that childhood infection might alter the atopic phenotype. Reactivation of latent herpesviruses can directly alter host cytokine profiles through viral expression of cytokine-like proteins, such as IL-10 (EBV) or IL-6 (cytomegalovirus and HHV8), viral encoded and secreted siRNA and microRNAs, and modulation of expression of host transcription pathways, such as nuclear factor κB. Physicians caring for allergic and atopic populations should be aware of common and uncommon presentations of herpes-related disease in atopic patients to provide accurate diagnosis and avoid unnecessary laboratory testing or incorrect diagnosis of other conditions, such as drug allergy or autoimmune disease. Antiviral therapy and vaccines should be administered promptly when indicated clinically.
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Affiliation(s)
- David H Dreyfus
- Department of Pediatrics, Clinical Faculty, Yale School of Medicine, New Haven, and the Center for Allergy, Asthma, and Immunology, Waterbury, Conn.
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Lay MK, González PA, León MA, Céspedes PF, Bueno SM, Riedel CA, Kalergis AM. Advances in understanding respiratory syncytial virus infection in airway epithelial cells and consequential effects on the immune response. Microbes Infect 2012; 15:230-42. [PMID: 23246463 DOI: 10.1016/j.micinf.2012.11.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 11/29/2012] [Accepted: 11/29/2012] [Indexed: 01/06/2023]
Abstract
This article reviews aspects of respiratory syncytial virus (RSV) infection in airway epithelial cells (AECs), including cytopathogenesis, entry, replication and the induction of immune response to the virus, including a new role for thymic stromal lymphopoietin in RSV immunopathology.
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Affiliation(s)
- Margarita K Lay
- Millennium Institute on Immunology and Immunotherapy, Departamento de Genética Molecular y Microbiología, Facultad de Ciencias Biológicas, Pontificia Universidad Católica de Chile, Alameda 340, Santiago E-8331010, Chile
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Abstract
Last year's "Advances in pediatric asthma: moving forward" concluded the following: "Now is also the time to utilize information recorded in electronic medical records to develop innovative disease management plans that will track asthma over time and enable timely decisions on interventions in order to maintain control that can lead to disease remission and prevention." This year's summary will focus on recent advances in pediatric asthma on modifying disease activity, preventing asthma exacerbations, managing severe asthma, and risk factors for predicting and managing early asthma, as indicated in Journal of Allergy and Clinical Immunology publications in 2012. Recent reports continue to shed light on methods to improve asthma management through steps to assess disease activity, tools to standardize outcome measures in asthma, genetic markers that predict risk for asthma and appropriate treatment, and interventions that alter the early presentation of asthma to prevent progression. We are well on our way to creating a pathway around wellness in asthma care and also to use new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.
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Affiliation(s)
- Stanley J Szefler
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, National Jewish Health, Denver, CO 80206, USA.
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Early asthma: stepping closer to primary prevention. J Allergy Clin Immunol 2012; 130:308-10. [PMID: 22846745 DOI: 10.1016/j.jaci.2012.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 02/07/2023]
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