51
|
Blöndal V, Sundbom F, Borres MP, Högman M, Alving K, Malinovschi A, Janson C. Study of atopic multimorbidity in subjects with rhinitis using multiplex allergen component analysis. Clin Transl Allergy 2020; 10:6. [PMID: 32110380 PMCID: PMC7033937 DOI: 10.1186/s13601-020-0311-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/06/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Rhinitis is a common problem within the population. Many subjects with rhinitis also have atopic multimorbidity, such as asthma and eczema. The purpose of this investigation was to compare subjects with only rhinitis to those that have rhinitis, asthma and/or eczema in relation to immunoglobulin E (IgE) sensitization, inflammatory markers, family history, lung function and body mass index (BMI). METHODS A total of 216 adult subjects with rhinitis from the European Community Respiratory Health Survey II were investigated with multiplex component allergen analysis (103 allergen components), total IgE, C-reactive protein, eosinophilic cationic protein, fractional exhaled nitric oxide and spirometry. Rhinitis, eczema, asthma and parental allergy were questionnaire-assessed. RESULTS Of the 216 participants with rhinitis, 89 also had asthma and/or eczema. Participants with rhinitis that also had asthma or eczema were more likely to be IgE-sensitized (3.44, odds ratio, OR: 95% CI 1.62-7.30, adjusted for sex, age, mother's allergy, total IgE and forced expiratory volume (FEV1)). The number of IgE-positive components was independently associated with atopic multimorbidity (1.11, OR: 95% Cl 1.01-1.21) adjusted for sex, age, mother's allergy, total IgE and FEV1. When analysing different types of sensitization, the strongest association with atopic multimorbidity was found in participants that were IgE-sensitized both to perennial and seasonal allergens (4.50, OR: 95% CI 1.61-12.5). Maternal allergy (2.75, OR: 95% CI 1.15-4.46), high total IgE (2.38, OR: 95% CI 1.21-4.67) and lower FEV1 (0.73, OR: 95% CI 0.58-0.93) were also independently associated with atopic multimorbidity, while no association was found with any of the other inflammatory markers. CONCLUSION IgE polysensitization, to perennial and seasonal allergens, and levels of total IgE seem to be the main determinants of atopic multimorbidity in subjects with rhinitis. This indicates that disease-modifying treatment that targets IgE sensitization may be of value when decreasing the risk of developing atopic multimorbidity.
Collapse
Affiliation(s)
- Viiu Blöndal
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
- Department of Medical Sciences, Lung Allergy and Sleep Research, Uppsala University Hospital, Uppsala University, 751 85 Uppsala, Sweden
| | - Fredrik Sundbom
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Magnus P. Borres
- Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Thermo Fischer Scientific, Uppsala, Sweden
| | - Marieann Högman
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Kjell Alving
- Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Andrei Malinovschi
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Christer Janson
- Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| |
Collapse
|
52
|
Arakawa H, Shimojo N, Katoh N, Hiraba K, Kawada Y, Yamanaka K, Igawa K, Murota H, Okafuji I, Fukuie T, Nakahara T, Noguchi T, Kanakubo A, Katayama I. Consensus statements on pediatric atopic dermatitis from dermatology and pediatrics practitioners in Japan: Goals of treatment and topical therapy. Allergol Int 2020; 69:84-90. [PMID: 31558354 DOI: 10.1016/j.alit.2019.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Pediatric atopic dermatitis (PAD) is a pluricausal disease and is frequently seen in dermatological and pediatric practice. Therefore, it is important to find common views in clinical practice and to promote consensus among practitioners. Aiming to obtain common views among dermatologists and pediatricians and to disseminate them widely in clinical practice, we held the PAD Consensus Forums described herein. METHODS Questionnaire surveys of treatment goals and drug therapy were conducted to prepare topics for discussion at the PAD Consensus Forums. Reaching consensus was defined as agreement among at least 70% of the participants. RESULTS As a result of discussion among 24 dermatologists and 25 pediatricians, consensus was obtained on 7 topics. These topics configure 3 consensus of treatment goals (Attainment targets were divided into the short/medium term and the long term. Attainment targets were associated with the primary evaluation domains of the Harmonising Outcome Measures for Eczema (HOME) roadmap, etc.) and 4 consensus of drug therapy (The number of applications of topical anti-inflammatory drugs in the acute phase and selection and ideal intervals between applications of topical anti-inflammatory drugs in proactive therapy, etc.). CONCLUSIONS The consensus is expected to help practitioners set appropriate treatment goals in clinical practice and facilitate the choice of drugs for treatment.
Collapse
Affiliation(s)
- Hirokazu Arakawa
- Department of Pediatrics, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Naoki Shimojo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | | | | | - Keiichi Yamanaka
- Department of Dermatology, Mie University, Graduate School of Medicine, Tsu, Japan
| | - Ken Igawa
- Department of Dermatology, Dokkyo Medical University, School of Medicine, Tochigi, Japan
| | - Hiroyuki Murota
- Department of Dermatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ikuo Okafuji
- Department of Pediatrics, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuki Fukuie
- Division of General Allergy, Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Takeshi Nakahara
- Division of Skin Surface Sensing, Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taro Noguchi
- Medical Affairs Department, Maruho Co., Ltd., Osaka, Japan
| | - Akira Kanakubo
- Medical Affairs Department, Maruho Co., Ltd., Osaka, Japan.
| | - Ichiro Katayama
- Department of Dermatology, Course of Integrated Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| |
Collapse
|
53
|
Nibbering B, Ubags NDJ. Microbial interactions in the atopic march. Clin Exp Immunol 2019; 199:12-23. [PMID: 31777060 DOI: 10.1111/cei.13398] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 12/13/2022] Open
Abstract
The human body is populated by a large number of microorganisms and exist in symbiosis with these immensely diverse communities, which are suggested to influence health and disease. The microbiota plays an essential role in the maturation and function of the immune system. The prevalence of atopic diseases has increased drastically over the past decades, and the co-occurrence of multiple allergic diseases and allergic sensitization starting in early life has gained a great deal of attention. Immune responses in different organs affected by allergic diseases (e.g. skin, intestine and lung) may be linked to microbial changes in peripheral tissues. In the current review, we provide an overview of the current understanding of microbial interactions in allergic diseases and their potential role in the atopic march.
Collapse
Affiliation(s)
- B Nibbering
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Lausanne, Switzerland
| | - N D J Ubags
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Lausanne, Switzerland
| |
Collapse
|
54
|
Hong CH, Joseph M, Kim VHD, Lansang P, Lara-Corrales I. Approach to the Assessment and Management of Pediatric Patients with Atopic Dermatitis: A Consensus Document. Section II: Comorbid Disease in Pediatric Atopic Dermatitis. J Cutan Med Surg 2019; 23:12S-18S. [DOI: 10.1177/1203475419882655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pediatric atopic dermatitis (AD) is one of the most common skin conditions encountered by health-care providers caring for infants, children, and adolescents. Pediatric patients with AD may present with other allergic and nonallergic comorbidities that require appropriate treatment and referral. They may also experience a trajectory of allergic diseases known as the atopic march, which depends on a complex interaction between genetic and environmental factors and likely involves early epidermal barrier dysfunction. Here we provide a review and clinical recommendations on the assessment and referral of comorbidities in pediatric AD.
Collapse
Affiliation(s)
- Chih-ho Hong
- Dr. Chih-ho Hong Medical Inc., Surrey, BC, Canada
- Probity Medical Research, Waterloo, ON, Canada
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Marissa Joseph
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Vy HD Kim
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Immunology & Allergy, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Perla Lansang
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
- Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Irene Lara-Corrales
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| |
Collapse
|
55
|
Irvine A, Mina‐Osorio P. Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide. Br J Dermatol 2019; 181:895-906. [PMID: 30758843 PMCID: PMC6899789 DOI: 10.1111/bjd.17766] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a heterogeneous disease with a multifactorial aetiology and complex pathophysiology. This heterogeneity translates into different trajectories of disease progression with respect to severity, persistence and risk of development of atopic comorbidities. Determining which possible disease trajectories or comorbidities any individual child might develop is challenging in clinical practice. Tools that help identify paediatric patients at higher risk of disease progression would greatly aid clinicians. METHODS We reviewed recent cohort studies to synthesize and simplify the epidemiological data to try to identify shared clinically relevant characteristics that may help physicians estimate the risk of disease progression in paediatric patients with AD. RESULTS Despite the variability in data collection and methods of analysis and their limitations, there are common patterns of early-childhood AD that may aid in the estimation of risk for disease progression. Factors associated with risk of AD progression include younger age of onset, family history of atopy, greater AD severity, filaggrin mutations, urban environment and polysensitization and/or allergic multimorbidity. Based on these factors, we provide a practitioner's guide for identifying, counselling and/or referring infants and children with AD at potentially higher risk of developing persistent AD and atopic comorbidities. We also present clinical scenarios to illustrate how these data relate to real-life situations. CONCLUSIONS Useful insights are provided for physicians and patients to inform them better about the risk of AD progression and to help guide care pathways for the paediatric population with AD. What's already known about this topic? The complex pathophysiology of atopic dermatitis (AD) translates into a heterogeneous clinical presentation and trajectories of disease progression. Although the consensus is that most paediatric patients with AD will eventually 'outgrow' the disease or follow the longitudinal trajectory known as the 'atopic march', a significant proportion will develop persistent AD and/or other atopic conditions. No known factors conclusively predict the risk of progression or development of comorbidities. What does this study add? Recent analyses of data from large cohorts of paediatric patients with AD have suggested the existence of potentially discrete clusters of patients who present with relatively common AD phenotypes. These studies have shed some light onto the factors associated with risk of progression, which we review in this article. A practitioner's guide with clinical scenarios is provided to help identify patients at high risk of progression to determine whether a patient should be monitored and/or would require specialist referral.
Collapse
Affiliation(s)
- A.D. Irvine
- Paediatric DermatologyOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- National Children's Research CentreOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- Clinical MedicineTrinity College DublinDublinIreland
| | | |
Collapse
|
56
|
Abstract
Atopic dermatitis (AD) is one of the most frequent chronic inflammatory skin diseases, characterized by pruritic eczematous lesions. Due to the fact that AD is accompanied by signs of systemic inflammation and that an increased number of novel systemic treatment options are currently emerging, research into general medical comorbidities in moderately to severely affected AD patients has received great impetus in recent years. These studies have confirmed an increased risk of atopic diseases such as allergic asthma in AD patients. Furthermore, an association between AD and dermatological diseases with autoimmune pathophysiology such as vitiligo and alopecia areata has been demonstrated. Moreover, several studies have revealed an increased risk for internal autoimmune diseases in AD patients, e.g. inflammatory bowel disease and rheumatoid arthritis. A differentiated view of the data on AD as a possible risk factor for cardiovascular disease is needed. Large cross-sectional studies in the US revealed a correlation between AD and cardiovascular comorbidities. This has not been confirmed as yet in large German, Danish and Canadian investigations. Whether diverse "coping" strategies in different countries can explain these variances remains to be discussed. In terms of microbial comorbidities, AD patients display a particular susceptibility to viral infections.
Collapse
Affiliation(s)
- S Traidl
- Klinik für Dermatologie, Allergologie und Venerologie, Abteilung für Immundermatologie und experimentelle Allergologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
| | - T Werfel
- Klinik für Dermatologie, Allergologie und Venerologie, Abteilung für Immundermatologie und experimentelle Allergologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
| |
Collapse
|
57
|
Drislane C, Irvine AD. The role of filaggrin in atopic dermatitis and allergic disease. Ann Allergy Asthma Immunol 2019; 124:36-43. [PMID: 31622670 DOI: 10.1016/j.anai.2019.10.008] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/07/2019] [Accepted: 10/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To provide an overview of filaggrin biology and the role of filaggrin variants in atopic dermatitis (AD) and allergic disease. DATA SOURCES We performed a PubMed literature review consisting mainly of studies relating to filaggrin in the last 5 years. STUDY SELECTIONS We selected articles that were found in PubMed using the search terms filaggrin, atopic dermatitis, skin barrier, and atopy. RESULTS Filaggrin plays an important role in the development of AD and allergic disease. Novel methods in measuring filaggrin expression and identifying filaggrin mutations aid in stratifying this patient cohort. We review new insights into understanding the role of filaggrin in AD and allergic disease. CONCLUSION Filaggrin remains a very important player in the pathogenesis of atopic dermatitis and allergic disease. This review looks at recent studies that aid our understanding of this crucial epidermal protein.
Collapse
Affiliation(s)
| | - Alan D Irvine
- Department of Paediatric Dermatology, Our Lady's Children's Hospital Crumlin, Dublin, National Children's Research Centre, Crumlin and Clinical Medicine, Trinity College Dublin, Ireland.
| |
Collapse
|
58
|
Aw M, Penn J, Gauvreau GM, Lima H, Sehmi R. Atopic March: Collegium Internationale Allergologicum Update 2020. Int Arch Allergy Immunol 2019; 181:1-10. [PMID: 31593946 DOI: 10.1159/000502958] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/27/2019] [Indexed: 11/19/2022] Open
Abstract
In recent decades, the worldwide prevalence of allergic disease has increased considerably. The atopic march is a model aimed at explaining the apparent progression of allergic diseases from atopic dermatitis (AD) to allergic asthma (AA) and to allergic rhinitis (AR). It hypothesizes that allergic disease begins, typically in children, with the development of AD, then AA, and finally progresses to AR. This theory has been widely studied in cross-sectional and long-term longitudinal studies and it has been found that as prevalence of AD declines, prevalence of AA increases. A similar relationship is reported between AA and AR. The legitimacy of the atopic march model is, however, currently debated. Epidemiological evidence and criticism of longitudinal studies point to an overstatement of the atopic march's prevalence and incorrect mechanisms, opening a discussion for alternative models to better explain the pathophysiological and epidemiological processes that promote this progression of allergic diseases. Albeit, risk factors for the development and progression of allergic disease, particularly AD, are critical in identifying disease progression. Investigating the role of age, severity, family history, phenotype, and genetic traits may give a better indication into the progression of allergic diseases. In addition, studies following patients from infancy into adulthood and a general increase in longitudinal studies would help broaden the knowledge of allergic disease progression and the atopic march.
Collapse
Affiliation(s)
- Michael Aw
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Jeremy Penn
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gail M Gauvreau
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Hermenio Lima
- Division of Dermatology, McMaster University, Hamilton, Ontario, Canada
| | - Roma Sehmi
- Division of Respirology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada,
| |
Collapse
|
59
|
Wen HJ, Wang SL, Chuang YC, Chen PC, Guo YL. Prenatal perfluorooctanoic acid exposure is associated with early onset atopic dermatitis in 5-year-old children. CHEMOSPHERE 2019; 231:25-31. [PMID: 31128349 DOI: 10.1016/j.chemosphere.2019.05.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
Atopic dermatitis (AD) is the most common childhood skin disease and the first step of atopic march. Perfluoroalkyl substance (PFAS) exposure is associated with atopic diseases, including AD. However, whether PFAS exposure is related to earlier AD onset remains unclear. We aimed to investigate the association between prenatal PFAS exposure and earlier onset of AD in children in a 5-year follow-up study. From 2001 to 2005, 1264 mother-infant pairs were recruited from eight Taiwanese maternity hospitals. PFAS levels were analyzed from cord blood. Information on children's health status, including AD occurrence, was obtained via phone interviews at multiple time points. Perfluorooctanoic acid (PFOA) and perfluorooctane sulfonate (PFOS) concentrations were measured by ultra-high performance liquid chromatography/tandem mass spectrometry. Cox proportional hazards models assessed associations between prenatal PFAS exposure and early onset AD. Overall, 863 mother-infant pairs with complete measurements were recruited. The prevalence of physician-diagnosed AD before 5 years of age was 7.1%. PFOA and PFOS concentrations were grouped based on whether they were above the 75th percentile. PFOA exposure was positively associated with earlier onset of AD (Kaplan-Meier estimate, p = 0.014). In the Cox model, after adjusting for sex, family income, parental atopy, breast feeding, and maternal age at childbirth, significance was observed in children above the upper quartile (≥75th) of the PFOA group (hazard ratio: 1.89; 95% confidence interval, 1.10-3.16). Our findings suggested that children with higher prenatal PFOA exposure have a higher risk of earlier AD development. Minimizing early life PFAS exposure may help inhibit AD development.
Collapse
Affiliation(s)
- Hui-Ju Wen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Shu-Li Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Public Health, National Defense Medical Centre, Taipei, Taiwan; Department of Safety, Health, and Environmental Engineering, National United University, Miaoli, Taiwan
| | - Yu-Chen Chuang
- Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan.
| | - Pau-Chung Chen
- Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan; Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Yue Leon Guo
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| |
Collapse
|
60
|
Krabbendam L, Bal SM, Spits H, Golebski K. New insights into the function, development, and plasticity of type 2 innate lymphoid cells. Immunol Rev 2019; 286:74-85. [PMID: 30294969 DOI: 10.1111/imr.12708] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/16/2018] [Indexed: 12/27/2022]
Abstract
Group 2 innate lymphoid cells (ILC2s) are the most well defined group of ILCs. ILC2 development is controlled by the GATA-3 transcription factor and these cells produce archetypal type 2 cytokines, such as IL-5 and IL-13. These cytokines mediate parasite expulsion and tissue repair, but also contribute to type 2 inflammatory diseases, including allergy, asthma and chronic rhinosinusitis with nasal polyps. In response to tightly regulated local environmental cues ILCs can generate characteristics of other subtypes, a process known as plasticity. Recent advances in the ILC2 field has led to the discovery that ILC2s can promptly shift to functional IFN-γ-producing ILC1s or IL-17-producing ILC3s, depending on the cytokines and chemokines produced by antigen presenting cells or epithelial cells. Due to yet unknown triggers, this complex network of signals may become dysregulated. In this review, we will discuss general ILC characteristic, ILC2 development, plasticity, memory function, and implications in disease.
Collapse
Affiliation(s)
- Lisette Krabbendam
- Department of Experimental Immunology, Amsterdam-UMC, Amsterdam, the Netherlands
| | - Suzanne M Bal
- Department of Experimental Immunology, Amsterdam-UMC, Amsterdam, the Netherlands
| | - Hergen Spits
- Department of Experimental Immunology, Amsterdam-UMC, Amsterdam, the Netherlands
| | - Korneliusz Golebski
- Department of Experimental Immunology, Amsterdam-UMC, Amsterdam, the Netherlands
| |
Collapse
|
61
|
Chiu CY, Yang CH, Su KW, Tsai MH, Hua MC, Liao SL, Lai SH, Chen LC, Yeh KW, Huang JL. Early-onset eczema is associated with increased milk sensitization and risk of rhinitis and asthma in early childhood. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 53:1008-1013. [PMID: 31129013 DOI: 10.1016/j.jmii.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/16/2019] [Accepted: 04/19/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Atopic eczema and food allergy most commonly occur in the early childhood. However, the relationships between eczema onset and their relevance to the occurrence of atopic diseases relating to allergen sensitization remain unclear. METHODS We investigated 186 children who were followed up regularly at the clinic for 4 years in a birth cohort study. The children were classified into three groups: early-onset eczema (<2 years old, n = 55), late-onset eczema (≥2 years old, n = 40), and never eczema groups (n = 91). The associations between the different onsets of eczema and total immunoglobulin E levels, absolute eosinophil count, sensitization to food and inhalant allergens, and allergic outcomes were assessed. RESULTS A significantly higher prevalence of sensitization to food, especially milk was observed in children with early-onset eczema compared with those without eczema at age 1, 1.5, 2, 3, and 4 years. Furthermore, a significantly higher number of eosinophils was detected in children with early or late-onset eczema at the age of 1.5 years. Both the early- and late-onset eczema were significantly associated with a higher prevalence of allergic rhinitis at age 2, 3, and 4 years, and asthma at age 2. Moreover, the early-onset eczema group showed a significantly increased risk of allergic rhinitis (P = 0.010) and asthma (P = 0.032) at age 4. CONCLUSION The children with early-onset eczema (<2 years old) appear to be associated with an increased prevalence of milk sensitization and risk of rhinitis and asthma in early childhood.
Collapse
Affiliation(s)
- Chih-Yung Chiu
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan; Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsuan Yang
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan; Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuan-Wen Su
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan; Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Han Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan; Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Man-Chin Hua
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan; Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Sui-Ling Liao
- Department of Pediatrics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan; Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shen-Hao Lai
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Pediatric Pulmonology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Chen Chen
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Jing-Long Huang
- Community Medicine Research Centre, Chang Gung Memorial Hospital, Keelung, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, and Chang Gung University College of Medicine, Taoyuan, Taiwan.
| |
Collapse
|
62
|
Hypoallergenic diet may control refractory epilepsy in allergic children: A quasi experimental study. Sci Rep 2019; 9:6875. [PMID: 31053764 PMCID: PMC6499767 DOI: 10.1038/s41598-019-43252-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 04/18/2019] [Indexed: 11/12/2022] Open
Abstract
Recent data has suggested a definitive role for inflammatory processes in the pathophysiology of epilepsy. In this study we hypothesized that food allergies, as chronic inflammatory processes, underlie the pathophysiology of refractory idiopathic epilepsy and investigated whether food elimination diets may assist in managing refractory epilepsy. The study was conducted on 34 patients up to 16 years of age with refractory convulsions who attended the Allergy Outpatient Clinic, Mofid Children Hospital between 2015 and 2016 with youngest and oldest participants at ages of 3 months and 16 years old, respectively. The participants were categorized into three groups according to the results of skin prick test and serum specific IgE measurements. Elimination diets were instituted for the patients with non IgE-mediated and mixed food allergies. The study was conducted for a period of 12 weeks. The participants were assessed for at least 50% reduction in number of seizures following the intervention. There was a significant reduction in number of seizures (p < 0.001) following the intervention. Seventeen patients (50%) did not experience any seizures after 8 weeks of treatment and 12 patients (35%) had a significant (51–99%) decrease in the number of their seizures. Five patients did not show any changes in their daily seizure frequency. The obtained data suggest that food allergy may play a role in triggering refractory epilepsies and their adequate response to treatment. A trial of elimination diet showed more than 50% seizure reduction in more than 85% of the children studied. However, we believe these results are preliminary and they motivate a fully controlled study in the future.
Collapse
|
63
|
Meyer R, Fox AT, Chebar Lozinsky A, Michaelis LJ, Shah N. Non-IgE-mediated gastrointestinal allergies-Do they have a place in a new model of the Allergic March. Pediatr Allergy Immunol 2019; 30:149-158. [PMID: 30403301 DOI: 10.1111/pai.13000] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 10/08/2018] [Accepted: 10/23/2018] [Indexed: 12/18/2022]
Abstract
The rise in food allergy has been described as the "second wave" of the allergy epidemic, with some developed countries reporting a prevalence of 10% of challenge-proven food allergies. Recognition of the Allergic March has played a crucial role in identifying causality in allergic conditions, linking atopic dermatitis to food allergy and food allergy to other atopic disorders, thereby highlighting opportunities in prevention and the importance of early intervention. This publication will establish the value of weaving the less well-understood, non-IgE-mediated food allergy into the Allergic March and mapping its progression through childhood and its associated co-morbidities. The proposed non-IgE-mediated Allergic March highlights the concomitant presentation of gastrointestinal symptoms and atopic dermatitis as early presenting symptoms in confirmed non-IgE-mediated allergies and the later development of atopic co-morbidities, including asthma and allergic rhinitis, similar to the IgE-mediated Allergic March. This publication highlights recent observations of a link between non-IgE-mediated food allergy in early childhood and functional gastrointestinal disorders in later life and also the reported occurrence of extra-intestinal manifestations at later ages. Although significant limitations exist in regard to the proposed evolution of the Allergic March model, the authors hope that this publication will influence the management of non-IgE-mediated gastrointestinal allergies and inform future research and interventions.
Collapse
Affiliation(s)
- Rosan Meyer
- Department Paediatrics, Imperial College, London, UK
| | - Adam T Fox
- Department of Paediatric Allergy, Evelina London Children's Hospital, London, UK
| | | | - Louise J Michaelis
- Department of Allergy and Immunology, Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Neil Shah
- Department Gastroenterology, Great Ormond Street Hospital, London, UK
| |
Collapse
|
64
|
Obbagy JE, English LK, Wong YP, Butte NF, Dewey KG, Fleischer DM, Fox MK, Greer FR, Krebs NF, Scanlon KS, Stoody EE. Complementary feeding and food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis: a systematic review. Am J Clin Nutr 2019; 109:890S-934S. [PMID: 30982864 DOI: 10.1093/ajcn/nqy220] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/11/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo. OBJECTIVES The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis? METHODS The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded. RESULTS Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed. CONCLUSIONS Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality.
Collapse
Affiliation(s)
| | | | | | - Nancy F Butte
- USDA-Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kathryn G Dewey
- Department of Nutrition, University of California, Davis, Davis, CA
| | - David M Fleischer
- Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | | | - Frank R Greer
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nancy F Krebs
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO
| | | | - Eve E Stoody
- USDA, Food and Nutrition Service, Alexandria, VA
| |
Collapse
|
65
|
Matta SA, Blanchet-Rethore S, Sio YY, Suri BK, Andiappan AK, Anantharaman R, Piketty C, Bourdes V, Chew FT. Different phenotypes and factors associated with atopic dermatitis in the young adult Singaporean Chinese population: A cross-sectional study. World Allergy Organ J 2019; 12:100008. [PMID: 30937133 PMCID: PMC6439406 DOI: 10.1016/j.waojou.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 11/07/2018] [Accepted: 11/28/2018] [Indexed: 10/28/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic allergic disease typically accompanied by atopy and thus, a tendency to develop allergic diseases such as allergic rhinitis, asthma or food allergies. Currently, individuals with AD are classified into those presenting with AD alone and those presenting with AD along with other allergic diseases (AD+). It is important to identify the various endophenotypes of AD using anthropometric, environmental, socio-economic, and disease history data in order to improve disease management. To characterize the phenotypic differences among Singaporean Chinese individuals with AD alone and AD+, and identify the socioeconomic, lifestyle, and environmental factors associated with these different presentations. Methods Based on data collected via a standardized/validated questionnaire, 4604 participants (mean age: 22.1 years) were classified into three groups: 1) AD alone group; 2) AD with other allergic diseases group (AD+); and 3) Control group. Results Participants were less sensitized to common inhalant allergens in the AD alone group versus the Control group (67% vs. 72%, respectively; p < 0.05).High Body Mass Index (i.e., BMI > 23) was associated with the disease and the difference was more pronounced in the AD alone group compared to the AD+ group (Odds Ratio: 1.38; 95% Confidence Interval: 1.4-1.67; p < 0.001). No major differences in habits were observed between the AD alone and AD+ groups. Conclusions The two presentations of AD may have different underlying pathogenesis and associated risk factors.
Collapse
Affiliation(s)
- Sri Anusha Matta
- Department of Biological Science, National University of Singapore, Singapore
| | | | - Yang Yie Sio
- Department of Biological Science, National University of Singapore, Singapore
| | - Bani Kaur Suri
- Department of Biological Science, National University of Singapore, Singapore
| | - Anand Kumar Andiappan
- Singapore Immunology Network (SIgN), Agency for Science Technology and Research (ASTAR), Singapore
| | - Ramani Anantharaman
- Department of Biological Science, National University of Singapore, Singapore
| | | | - Valerie Bourdes
- Nestlé Skin Health-Galderma R&D, Sophia Antipolis, Biot, France
| | - Fook Tim Chew
- Department of Biological Science, National University of Singapore, Singapore
| |
Collapse
|
66
|
Hill DA, Spergel JM. The atopic march: Critical evidence and clinical relevance. Ann Allergy Asthma Immunol 2019; 120:131-137. [PMID: 29413336 DOI: 10.1016/j.anai.2017.10.037] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/16/2017] [Accepted: 10/31/2017] [Indexed: 01/18/2023]
Affiliation(s)
- David A Hill
- Department of Pediatrics, Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan M Spergel
- Department of Pediatrics, Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
67
|
Tham EH, Leung DY. Mechanisms by Which Atopic Dermatitis Predisposes to Food Allergy and the Atopic March. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:4-15. [PMID: 30479073 PMCID: PMC6267189 DOI: 10.4168/aair.2019.11.1.4] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/13/2018] [Indexed: 12/23/2022]
Abstract
The Atopic march denotes the progression from atopic dermatitis (AD) to the development of other allergic disorders such as immunoglobulin (Ig) E-mediated food allergy, allergic rhinitis and asthma in later childhood. There is increasing evidence from prospective birth cohort studies that early-onset AD is a risk factor for other allergic diseases or is found in strong association with them. Animal studies now provide mechanistic insights into the pathways that may be responsible for triggering the progression from the skin barrier dysfunction seen in AD to epicutaneous sensitization, food allergy and allergic airway disorders. Recent large randomized controlled trials have demonstrated the efficacy of early interventions targeted at AD and food allergy prevention. These show great promise for research into future strategies aimed at prevention of the atopic march.
Collapse
Affiliation(s)
- Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore.,Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Donald Ym Leung
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.,Department of Pediatrics, University of Colorado at Denver Health Sciences Center, Aurora, CO, USA.
| |
Collapse
|
68
|
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.
Collapse
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
| | | |
Collapse
|
69
|
Jin M, Yoon J. From Bench to Clinic: the Potential of Therapeutic Targeting of the IL-22 Signaling Pathway in Atopic Dermatitis. Immune Netw 2018; 18:e42. [PMID: 30619628 PMCID: PMC6312894 DOI: 10.4110/in.2018.18.e42] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 12/11/2022] Open
Abstract
Atopic dermatitis (AD) is the most common pruritic inflammatory skin disease characterized by thickening of epidermis and dermis as well as by the infiltration of multiple pathogenic polarized T lymphocytes, including Th2, Th17, and Th22 cells. Significant progress has been made to develop targeted therapeutics for treating AD, e.g., Food and Drug Administration-approved dupilumab, an antibody for dual targeting of IL-4 and IL-13 signaling pathways. Additionally, a growing body of published evidence and a promising result from the early stage of the clinical trial with ILV-094, an anti-IL-22 antibody, strongly support the notion that IL-22 is a potential therapeutic target for treating AD. Moreover, we also experimentally proved that IL-22 contributes to the pathophysiology of AD by employing a murine model of AD induced by epicutaneous sensitization. Here, we review recent preclinical and clinical findings that have advanced our understanding of the roles of IL-22 and Th22 cells in skin inflammation. We conclude that blockade of IL-22 signaling may be a promising therapeutic approach for the treatment of AD.
Collapse
Affiliation(s)
- Mirim Jin
- Department of Microbiology, College of Medicine, Gachon University, Incheon 21999, Korea.,Department of Health Science and Technology, Gachon Advanced Institute for Health Sciences & Technology (GAIHST), Gachon University, Incheon 21999, Korea
| | - Juhan Yoon
- Department of Pharmacology, C&C Research Laboratories, Suwon 16419, Korea
| |
Collapse
|
70
|
Tang HH, Teo SM, Belgrave DC, Evans MD, Jackson DJ, Brozynska M, Kusel MM, Johnston SL, Gern JE, Lemanske RF, Simpson A, Custovic A, Sly PD, Holt PG, Holt KE, Inouye M. Trajectories of childhood immune development and respiratory health relevant to asthma and allergy. eLife 2018; 7:35856. [PMID: 30320550 PMCID: PMC6221547 DOI: 10.7554/elife.35856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/05/2018] [Indexed: 12/28/2022] Open
Abstract
Events in early life contribute to subsequent risk of asthma; however, the causes and trajectories of childhood wheeze are heterogeneous and do not always result in asthma. Similarly, not all atopic individuals develop wheeze, and vice versa. The reasons for these differences are unclear. Using unsupervised model-based cluster analysis, we identified latent clusters within a prospective birth cohort with deep immunological and respiratory phenotyping. We characterised each cluster in terms of immunological profile and disease risk, and replicated our results in external cohorts from the UK and USA. We discovered three distinct trajectories, one of which is a high-risk ‘atopic’ cluster with increased propensity for allergic diseases throughout childhood. Atopy contributes varyingly to later wheeze depending on cluster membership. Our findings demonstrate the utility of unsupervised analysis in elucidating heterogeneity in asthma pathogenesis and provide a foundation for improving management and prevention of childhood asthma. Asthma causes wheezy and troubled breathing, and can be life-threatening. Scientists and doctors understand that asthma begins in early childhood. Chest infections, exposure to bacteria, viruses, and allergies may cause or trigger asthma. One person with asthma may not have the same origins as another. But it is not yet clear how various triggers may interact to trigger or exacerbate asthma. To disentangle how these factors contribute to asthma, experts have tried to group people with asthma into subgroups. Unfortunately, the groups often vary from expert to expert. Now, some scientists are using computers to sort patients with asthma. The scientists let the computers decide the best criteria for sorting patients. This way the machines may identify patterns that are not obvious to humans. Using this computer-based approach, Tang et al. sorted Australian children with asthma into 3 groups based on their early life allergies and respiratory health. One group has high-risk asthma with frequent chest infections and strong allergic responses. The other two groups are low-risk, but they respond differently to allergy and infection. Common tests used by doctors to diagnose patients with allergy or asthma may not work the same with all three groups. The bacteria found in the nose influence the risk of asthma, even in patients who are well, and the way this occurs varies by group. Similar groups were also found among children with asthma in the United States and the United Kingdom. Learning more about subgroups of patients with asthma may help other scientists and doctors design better ways to diagnose, treat, or prevent asthma. Working together with scientists around the world to determine how to best describe subgroups of people according to asthma type and risk is a critical step in the process. Tang et al. hope other scientist will test whether these three groups are also found in people from other parts of the world.
Collapse
Affiliation(s)
- Howard Hf Tang
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Victoria, Australia.,School of BioSciences, The University of Melbourne, Victoria, Australia
| | - Shu Mei Teo
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Victoria, Australia.,Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Michael D Evans
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Marta Brozynska
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Victoria, Australia.,Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Merci Mh Kusel
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Sebastian L Johnston
- Airway Disease Infection Section, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Robert F Lemanske
- University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, United Kingdom
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Peter D Sly
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Patrick G Holt
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Kathryn E Holt
- Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Victoria, Australia.,The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Victoria, Australia.,Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,The Alan Turing Institute, London, United Kingdom
| |
Collapse
|
71
|
Scherzer R, Grayson MH. Heterogeneity and the origins of asthma. Ann Allergy Asthma Immunol 2018; 121:400-405. [PMID: 29928982 PMCID: PMC6237278 DOI: 10.1016/j.anai.2018.06.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 06/01/2018] [Accepted: 06/10/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the roots of asthma across different ages, including atopy, the role of the microbiome and viral infections, and comorbidities and confounders, such as obesity, aspirin-exacerbated respiratory disease, neutrophilic asthma, cigarette smoking, and the possibility of an asthma-chronic obstructive pulmonary disease overlap syndrome. DATA SOURCES Data were taken from various scientific search engines, including PubMed and Science Direct databases. STUDY SELECTIONS Articles that reviewed information on the origins of asthma in persons of all ages, including different phenotypes and genotypes of asthma, were used. RESULTS Asthma is a common and complex disease whose origins are likely a combination of both genetic predisposition and environmental exposures. Factors such as the microbiome, other atopic disease, viral infections in young children, and other diagnoses, such as obesity or aspirin-exacerbated respiratory disease, are important to consider when creating a treatment plan for patients. CONCLUSION Asthma is a disease that is often diagnosed in childhood but can present at any age. There is debate in the field as to whether asthma is one disease or several different diseases that include airway inflammation as a key finding. There are risk factors for disease in the environment and through comorbidities that likely play significant roles in the origins of asthma, the development of symptoms, and the response to treatment. These factors are even more important as we look toward the future with the goal of personalized medicine.
Collapse
Affiliation(s)
- Rebecca Scherzer
- 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
| |
Collapse
|
72
|
Abo-Zaid G, Sharpe RA, Fleming LE, Depledge M, Osborne NJ. Association of Infant Eczema with Childhood and Adult Asthma: Analysis of Data from the 1958 Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071415. [PMID: 29976870 PMCID: PMC6069479 DOI: 10.3390/ijerph15071415] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 07/02/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022]
Abstract
The influence of early life exposures on later life disease has for some time provided clues to modifiable risk factors of disease. The “atopic march” is thought to play a role in the progression of allergic diseases and may offer an opportunity to lower asthma’s health and socioeconomic burden, although evidence remains controversial. We aimed to examine the relationship between early life eczema and asthma later in life. Using the National Child Development Study, we examined infant eczema and childhood and adult asthma. Data related to asthma or wheezing bronchitis were available for 13,503 (73%; 95% CI 72–74), 11,503 (61%; 95% CI 60–61), 12,524 (68%; 95% CI 67–69), 11,194 (60%; 95% CI 60–60), 9377 (51%; 95% CI 51–51), and 9760 (53%; 95% CI 52–53) subjects at ages 11, 16, 23, 33, 44, and 50 years, respectively. Logistic regression models were fitted to examine each wave separately before and after adjusting for a range of potential confounders. Generalised estimating equation (GEE) methods were undertaken to examine the associations after pooling all data from questionnaires. The prevalence of self-reported asthma in those that had previously reported infant eczema ranged from 1.0%; 95% CI 0.9–1.4 (age 44 years) to 2.2%; 95% CI 2.1–2.3 (age 33 years). Participants with infant eczema had a 2–3-fold increased risk of reporting asthma in childhood and adulthood; this was 1.6 times at age 44 years when using spirometry measures. Similar effect sizes were observed in the GEE models when considering all participants (OR 2.9; 95% CI 2.6–3.2). Childhood and adult asthma were consistently associated with infant eczema both by using the self-reported data and lung measures.
Collapse
Affiliation(s)
- Ghada Abo-Zaid
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
- Department of Mathematics and Statistics, Ain Shams University, Khalifa El-Maamon St, Abbasiya Sq., Cairo 11566, Egypt.
| | - Richard A Sharpe
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
- Public Health, Cornwall Council, New County Hall, Truro, Cornwall, TR1 3AY, UK.
| | - Lora E Fleming
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Michael Depledge
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
| | - Nicholas J Osborne
- European Centre for Environment and Human Health, University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall TR1 3HD, UK.
- School of Public Health and Community Medicine, University of New South Wales, Kensington, Sydney 2052, Australia.
| |
Collapse
|
73
|
Hill DA, Grundmeier RW, Ramos M, Spergel JM. Eosinophilic Esophagitis Is a Late Manifestation of the Allergic March. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1528-1533. [PMID: 29954692 DOI: 10.1016/j.jaip.2018.05.010] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND The allergic march describes the natural history of allergic conditions as they develop during childhood. Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease that can be triggered by specific foods. Despite its allergic pathophysiology, the epidemiologic relationship between EoE and established members of the allergic march is unknown. OBJECTIVE We sought to determine whether EoE meets epidemiologic criteria for being considered a member of the allergic march. METHODS Using a primary care birth cohort of 130,435 children, we determined the natural histories of atopic dermatitis (AD), IgE-mediated food allergy (IgE-FA), asthma, EoE, and allergic rhinitis (AR) in individual patients. We then performed case-control analyses to establish the extent that existing allergic conditions influence the rate of subsequent EoE diagnosis. RESULTS A total of 139 children developed EoE during the observation period (prevalence of 0.11%). The peak age of EoE diagnosis was 2.6 years, as compared with 0.3 years, 1 year, 1.1 years, and 2.1 years for AD, IgE-FA, asthma, and AR, respectively. The presence of AD (hazard ratio [HR] 3.2, 95% confidence interval [CI] 2.2-4.6), IgE-FA (HR 9.1, 95% CI 6.5-12.6), and asthma (HR 1.9, 95% CI 1.3-2.7) was independently and cumulatively associated with subsequent EoE diagnosis. The presence of AR was associated with subsequent EoE diagnosis (HR 2.8, 95% CI 2.0-3.9), and the presence of EoE was associated with subsequent AR diagnosis (HR 2.5, 95% CI 1.7-3.5). CONCLUSIONS Allergic comorbidities are positively associated with EoE diagnosis. Together, our findings suggest that EoE is a late manifestation of the allergic march.
Collapse
Affiliation(s)
- David A Hill
- Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa.
| | - Robert W Grundmeier
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Mark Ramos
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Jonathan M Spergel
- Institute for Immunology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa; Department of Pediatrics, Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa
| |
Collapse
|
74
|
Best KP, Sullivan TR, Palmer DJ, Gold M, Martin J, Kennedy D, Makrides M. Prenatal omega-3 LCPUFA and symptoms of allergic disease and sensitization throughout early childhood - a longitudinal analysis of long-term follow-up of a randomized controlled trial. World Allergy Organ J 2018; 11:10. [PMID: 29977437 PMCID: PMC6003086 DOI: 10.1186/s40413-018-0190-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/18/2018] [Indexed: 11/10/2022] Open
Abstract
Background Randomized controlled trials of prenatal omega (ω-3) long chain polyunsaturated fatty acid (LCPUFA) supplementation are suggestive of some protective effects on allergic sensitization and symptoms of allergic disease in childhood. Due to the nature of the atopic march, investigation of any effects of this prenatal intervention may be most informative when consistently assessed longitudinally during childhood. Methods Follow-up of children (n = 706) with familial risk of allergy from the Docosahexaenoic Acid to Optimize Mother Infant Outcome (DOMInO) trial. The intervention group received fish oil capsules (900 mg of ω-3 LCPUFA) daily from <21 weeks' gestation until birth; the control group received vegetable oil capsules without ω-3 LCPUFA. This new longitudinal analysis reports previously unpublished data collected at 1 and 3 years of age. The allergic disease symptom data at 1, 3 and 6 years of age were consistently reported by parents using the "International Study of Asthma and Allergies in Childhood" (ISAAC) questionnaire. Sensitization was determined by skin prick test to age specific, common allergen extracts. Results Changes over time in symptoms of allergic disease with sensitization (IgE-mediated) and sensitization did not differ between the groups; interaction p = 0.49, p = 0.10, respectively. Averaged across the 1, 3 and 6-year assessments, there were no significant effects of prenatal ω-3 LCPUFA supplementation on IgE-mediated allergic disease symptoms (adjusted relative risk 0.88 (95% CI 0.69, 1.12), p = 0.29) or sensitization (adjusted relative risk 0.97 (95% CI 0.82, 1.15), p = 0.76). Sensitization patterns to common allergens were consistent with the atopic march, with egg sensitization at 1 year strongly associated with house dust mite sensitization at 6 years, (p < 0.0001). Discussion Although there is some evidence to suggest that maternal supplementation with 900mg ω-3 LCPUFA has a protective effect on early symptoms of allergic disease and sensitization in the offspring, we did not observe any differences in the progression of disease over time in this longitudinal analysis. Further investigation into the dose and timing of ω-3 LCPUFA supplementation, including long-term follow up of children using consistent outcome reporting, is essential to determine whether this intervention may be of benefit as a primary prevention strategy for allergic disease. Conclusion Maternal supplementation with 900 mg of ω-3 LCPUFA did not change the progression of IgE-mediated allergic disease symptoms or sensitization throughout childhood from 1 to 6 years. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN); DOMInO trial ACTRN12605000569606, early childhood allergy follow up ACTRN12610000735055 and 6-year allergy follow up ACTRN12615000498594.
Collapse
Affiliation(s)
- K P Best
- 1Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia Australia.,2School of Medicine, University of Adelaide, Adelaide, South Australia Australia.,7South Australian Health and Medical Research Institute, 72 King William Road, North Adelaide, South Australia 5006 Australia
| | - T R Sullivan
- 3School of Public Health, University of Adelaide, Adelaide, South Australia Australia
| | - D J Palmer
- 4School of Medicine, University of Western Australia, Nedlands, Western Australia 6009 Australia.,Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia 6008 Australia
| | - M Gold
- 2School of Medicine, University of Adelaide, Adelaide, South Australia Australia
| | - J Martin
- 6Department of Respiratory and Sleep Medicine, Women's & Children's Hospital, North Adelaide, South Australia Australia
| | - D Kennedy
- 2School of Medicine, University of Adelaide, Adelaide, South Australia Australia.,6Department of Respiratory and Sleep Medicine, Women's & Children's Hospital, North Adelaide, South Australia Australia
| | - M Makrides
- 1Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia Australia.,2School of Medicine, University of Adelaide, Adelaide, South Australia Australia
| |
Collapse
|
75
|
Amat F, Soria A, Tallon P, Bourgoin-Heck M, Lambert N, Deschildre A, Just J. New insights into the phenotypes of atopic dermatitis linked with allergies and asthma in children: An overview. Clin Exp Allergy 2018; 48:919-934. [PMID: 29676818 DOI: 10.1111/cea.13156] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/05/2018] [Accepted: 04/01/2018] [Indexed: 01/09/2023]
Abstract
Atopic dermatitis (AD) is a complex disease with multiple causes and complex mechanistic pathways according to age of onset, severity of the illness, ethnic modifiers, response to therapy and triggers. A group of difficult-to-manage patients characterized by early-onset AD and severe lifelong disease associated with allergic asthma and/or food allergy (FA) has been identified. In this study, we focus on these severe phenotypes, analysing their links with other atopic comorbidities, and taking into account the results from recent cohort studies and meta-analyses. The main hypothesis that is currently proposed to explain the onset of allergic diseases is an epithelial barrier defect. Thus, the atopic march could correspond to an epithelial dysfunction, self-sustained by a secondary allergenic sensitization, explaining the transition from AD to allergic asthma. Furthermore, AD severity seems to be a risk factor for associated FA. Results from population-based, birth and patient cohorts show that early-onset and severe AD, male gender, parental history of asthma, and early and multiple sensitizations are risk factors leading to the atopic march and the development of asthma. The importance of environmental factors should be recognized in these high-risk children and prevention programs adapted accordingly. Effective targeted therapies to restore both barrier function and to control inflammation are necessary; early emollient therapy is an important approach to prevent AD in high-risk children. Clinicians should also keep in mind the specific risk of atopic comorbidities in case of filaggrin loss-of-function mutations and the rare phenotypes of orphan syndromes due to heritable mutations in skin barrier components.
Collapse
Affiliation(s)
- F Amat
- Department of Allergology, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| | - A Soria
- UPMC Univ Paris 06, Sorbonne Universités, Paris, France.,Department of Dermatology and Allergology, Hôpital Tenon, APHP Paris, Paris, France.,Inserm, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), UMR 1135, Paris, France
| | - P Tallon
- Department of Allergology, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - M Bourgoin-Heck
- Department of Allergology, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - N Lambert
- Department of Allergology, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| | - A Deschildre
- Pediatric Pulmonology and Allergy Department, Hôpital Jeanne de Flandre, CHRU Lille, Lille, France
| | - J Just
- Department of Allergology, Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France.,UPMC Univ Paris 06, Sorbonne Universités, Paris, France.,Equipe EPAR, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
| |
Collapse
|
76
|
Abstract
PURPOSE OF REVIEW The progression of atopic disorders from atopic dermatitis in infants to allergic rhinitis and asthma in children, adolescents, and adults defines the allergy march. Allergen immunotherapy is the only causal treatment altering the immunological mechanism underlying the allergic diseases. The sublingual administration route is more acceptable than the subcutaneous one in pediatric age. RECENT FINDINGS Several studies show the efficacy and safety profile of sublingual immunotherapy (SLIT) for the treatment of respiratory allergy diseases, but few data are available on its effect of primary and secondary prevention of allergic disease. The purpose of this manuscript is to review the latest studies addressing the effect of SLIT on the development of new sensitizations in not sensitized or already sensitized patients and progression of the allergy march.
Collapse
Affiliation(s)
- Federica Porcaro
- Respiratory Unit, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, A.O.U.P. "P. Giaccone", Department of Sciences for Health Promotion and Mother and Child Care "G. D'Alessandro", University of Palermo, Via Alfonso Giordano n. 3, 90127, Palermo, Italy
| | | |
Collapse
|
77
|
Atopic Dermatitis: Disease Background and Risk Factors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1027:11-19. [PMID: 29063427 DOI: 10.1007/978-3-319-64804-0_2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multiple risk factors have been associated with the development of atopic dermatitis (AD). Recent advances in understanding the role of genetics in this disease have been made, with discovery of the filaggrin (FLG) gene as the most notable so far. In addition to FLG gene mutations as a risk factor for AD, a positive family history of atopic or allergic disease in either parent, has been shown to confer a greater risk of developing AD. Atopic dermatitis usually presents early in life and is thought to represent the initial-step in the "atopic march" which is characterized by the development of other atopic diseases later in life such as asthma, allergic rhinitis and/or rhinoconjunctivitis, food allergies and hay fever. Other comorbid diseases that have been associated with AD include increase risk of viral and bacterial skin infections, neuropsychiatric diseases such as attention-deficit hyperactivity disorders (ADHD) and autistic spectrum disorder (ASD). Patients with AD, have also been found to have worse sleep quality overall compared to patients without AD. In this chapter, we will discuss the risk factors associated with development of atopic dermatitis as well as the most commonly reported comorbidities in patients with this disease.
Collapse
|
78
|
Li MM, Lu CY, Wang XM. [Predictive value of cord blood 25(OH)D3 for early infantile atopic dermatitis]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:303-307. [PMID: 29658456 PMCID: PMC7390034 DOI: 10.7499/j.issn.1008-8830.2018.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To explore the predictive value of cord blood 25(OH)D3 [25(OH)D3] for infantile atopic dermatitis (AD), and to provide a reference for primary prevention of early infantile AD. METHODS The neonates born from July to September, 2015 were enrolled. The cord blood samples were collected at birth to measure the level of 25(OH)D3. Outpatient follow-up was conducted for all the infants at 6 weeks, 3 months, and 6 months after birth. A survey was performed to investigate the incidence of AD. RESULTS A total of 67 neonates completed a 6-month follow-up. The incidence of AD was 34% (23/67), and 91% (21/23) of these cases occurred in the first month after birth. The 23 AD children had a significantly lower cord 25(OH)D3 level than those without AD (P<0.05). The children with a cord 25(OH)D3 level <30 nmol/L showed a significantly higher incidence of AD than those with a cord 25(OH)D3 level ≥30 nmol/L (P<0.05). The receiver operating characteristic (ROC) analysis showed that the area under the ROC curve of cord 25(OH)D3 in predicting AD was 0.648 (standard error: 0.075; 95%CI: 0.502-0.795). Its sensitivity, specificity, positive predictive value, and negative predictive value were 52.2%, 79.5%, 57.1%, and 76.1%, respectively. Logistic regression analysis showed that low cord 25(OH)D3 level, preference for seafood during pregnancy, atopic family history, and mixed feeding were risk factors for infantile AD (P<0.05). CONCLUSIONS Cord 25(OH)D3 level is inversely associated with the risk of infantile AD, but it has a low diagnostic value for this disease.
Collapse
Affiliation(s)
- Min-Min Li
- Department of Pediatrics, Shanghai Fifth People′s Hospital Affiliated to Fudan University, Shanghai 200240, China.
| | | | | |
Collapse
|
79
|
Han H, Roan F, Ziegler SF. The atopic march: current insights into skin barrier dysfunction and epithelial cell-derived cytokines. Immunol Rev 2018; 278:116-130. [PMID: 28658558 DOI: 10.1111/imr.12546] [Citation(s) in RCA: 179] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Atopic dermatitis often precedes the development of other atopic diseases. The atopic march describes this temporal relationship in the natural history of atopic diseases. Although the pathophysiological mechanisms that underlie this relationship are poorly understood, epidemiological and genetic data have suggested that the skin might be an important route of sensitization to allergens. Animal models have begun to elucidate how skin barrier defects can lead to systemic allergen sensitization. Emerging data now suggest that epithelial cell-derived cytokines such as thymic stromal lymphopoietin (TSLP), IL-33, and IL-25 may drive the progression from atopic dermatitis to asthma and food allergy. This review focuses on current concepts of the role of skin barrier defects and epithelial cell-derived cytokines in the initiation and maintenance of allergic inflammation and the atopic march.
Collapse
Affiliation(s)
- Hongwei Han
- Immunology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Florence Roan
- Immunology Program, Benaroya Research Institute, Seattle, WA, USA
| | - Steven F Ziegler
- Immunology Program, Benaroya Research Institute, Seattle, WA, USA.,Department of Immunology, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
80
|
Huang CC, Chiang TL, Chen PC, Lin SJ, Wen HJ, Guo YL. Risk factors for asthma occurrence in children with early-onset atopic dermatitis: An 8-year follow-up study. Pediatr Allergy Immunol 2018; 29:159-165. [PMID: 29168282 DOI: 10.1111/pai.12835] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Children with early-onset atopic dermatitis (AD) are at substantial risk of developing asthma later in life, and identifying the critical window of detrimental exposure is advantageous for implementing preventive actions. The aim of this study was to evaluate the role of exposure to environmental modifiers during pregnancy and early childhood in asthma occurrence in an infantile AD cohort. METHODS Eligible study participants were selected from the Taiwan Birth Cohort Study, which enrolled 24 200 newborns in 2005. We enrolled those cases who had been diagnosed as having AD before 3 years of age and followed them up till age 8. We excluded those ever diagnosed with asthma before AD onset. The dependent variable was defined in terms of whether the participant was diagnosed as having asthma before 8 years of age. We applied logistic regression models to evaluate the risks of exposure to different determinants in asthma occurrence. RESULTS A total of 1549 children with AD had completed the 8-year follow-up, and 334 (21.6%) of them had asthma. The results revealed that male sex, lower birth order, maternal asthma history, maternal obesity before pregnancy, and environmental tobacco smoke exposure before 3 years of age were significant risk factors for further development of asthma. Furthermore, food allergy during early life, lower respiratory tract infection, and longer durations of symptomatic AD influenced asthma development later in life. CONCLUSIONS The findings confirmed the critical determinants for asthma occurrence in infantile AD, which may enable a more personalized approach to the prevention of asthma.
Collapse
Affiliation(s)
- Ching-Chun Huang
- Environmental and Occupational Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan
| | - Tung-Liang Chiang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Pau-Chung Chen
- Environmental and Occupational Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan
| | - Shio-Jean Lin
- Department of Pediatrics, Chi Mei Hospital, Tainan, Taiwan
| | - Hui-Ju Wen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Yue Leon Guo
- Environmental and Occupational Medicine, National Taiwan University and National Taiwan University Hospital, Taipei, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan.,National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| |
Collapse
|
81
|
JAK/STAT inhibitors and other small molecule cytokine antagonists for the treatment of allergic disease. Ann Allergy Asthma Immunol 2018; 120:367-375. [PMID: 29454096 DOI: 10.1016/j.anai.2018.02.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/08/2018] [Accepted: 02/12/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To provide an overview of janus kinase (JAK), chemoattractant receptor homologous molecule expressed on TH2 cells (CRTH2), and phosphodiesterase 4 (PDE4) inhibitors in allergic disorders. DATA SOURCES PubMed literature review. STUDY SELECTIONS Articles included in this review discuss the emerging mechanism of action of small molecule inhibitors and their use in the treatment of atopic dermatitis (AD), asthma, and allergic rhinitis (AR). RESULTS Allergic diseases represent a spectrum of diseases, including AD, asthma, and AR. For decades, these diseases have been primarily characterized by increased TH2 signaling and downstream inflammation. In recent years, additional research has identified disease phenotypes and subsets of patients with non-Th2 mediated inflammation. The increasing heterogeneity of disease has prompted investigators to move away from wide-ranging treatment approaches with immunosuppressive agents, such as corticosteroids, to consider more targeted immunomodulatory approaches focused on specific pathways. In the past decade, inhibitors that target JAK signaling, PDE4, and CRTH2 have been explored for their potential activity in models of allergic disease and therapeutic benefit in clinical trials. Interestingly, although JAK inhibitors provide an opportunity to interfere with cytokine signaling and could be beneficial in a broad range of allergic diseases, current clinical trials are focused on the treatment of AD. Conversely, both PDE4 and CRTH2 inhibitors have been evaluated in a spectrum of allergic diseases. This review summarizes the varying degrees of success that these small molecules have demonstrated across allergic diseases. CONCLUSION Emerging therapies currently in development may provide more consistent benefit to patients with allergic diseases by specifically targeting inflammatory pathways important for disease pathogenesis.
Collapse
|
82
|
Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, Ciprandi G, Corey J, Cox LS, Creticos PS, Custovic A, Damask C, DeConde A, DelGaudio JM, Ebert CS, Eloy JA, Flanagan CE, Fokkens WJ, Franzese C, Gosepath J, Halderman A, Hamilton RG, Hoffman HJ, Hohlfeld JM, Houser SM, Hwang PH, Incorvaia C, Jarvis D, Khalid AN, Kilpeläinen M, Kingdom TT, Krouse H, Larenas-Linnemann D, Laury AM, Lee SE, Levy JM, Luong AU, Marple BF, McCoul ED, McMains KC, Melén E, Mims JW, Moscato G, Mullol J, Nelson HS, Patadia M, Pawankar R, Pfaar O, Platt MP, Reisacher W, Rondón C, Rudmik L, Ryan M, Sastre J, Schlosser RJ, Settipane RA, Sharma HP, Sheikh A, Smith TL, Tantilipikorn P, Tversky JR, Veling MC, Wang DY, Westman M, Wickman M, Zacharek M. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8:108-352. [PMID: 29438602 PMCID: PMC7286723 DOI: 10.1002/alr.22073] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR). METHODS Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus. RESULTS The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR. CONCLUSION This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.
Collapse
Affiliation(s)
| | | | | | | | - Cezmi A. Akdis
- Allergy/Asthma, Swiss Institute of Allergy and Asthma Research, Switzerland
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, USA
| | | | | | | | | | - Cemal Cingi
- Otolaryngology, Eskisehir Osmangazi University, Turkey
| | | | | | | | | | | | | | - Adam DeConde
- Otolaryngology, University of California San Diego, USA
| | | | | | | | | | | | | | - Jan Gosepath
- Otorhinolaryngology, Helios Kliniken Wiesbaden, Germany
| | | | | | | | - Jens M. Hohlfeld
- Respiratory Medicine, Hannover Medical School, Airway Research Fraunhofer Institute for Toxicology and Experimental Medicine, German Center for Lung Research, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Amber U. Luong
- Otolaryngology, McGovern Medical School at the University of Texas Health Science Center Houston, USA
| | | | | | | | - Erik Melén
- Pediatric Allergy, Karolinska Institutet, Sweden
| | | | | | - Joaquim Mullol
- Otolaryngology, Universitat de Barcelona, Hospital Clinic, IDIBAPS, Spain
| | | | | | | | - Oliver Pfaar
- Rhinology/Allergy, Medical Faculty Mannheim, Heidelberg University, Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | | | - Carmen Rondón
- Allergy, Regional University Hospital of Málaga, Spain
| | - Luke Rudmik
- Otolaryngology, University of Calgary, Canada
| | - Matthew Ryan
- Otolaryngology, University of Texas Southwestern, USA
| | - Joaquin Sastre
- Allergology, Hospital Universitario Fundacion Jiminez Diaz, Spain
| | | | | | - Hemant P. Sharma
- Allergy/Immunology, Children's National Health System, George Washington University School of Medicine, USA
| | | | | | | | | | | | - De Yun Wang
- Otolaryngology, National University of Singapore, Singapore
| | | | | | | |
Collapse
|
83
|
Khan SJ, Dharmage SC, Matheson MC, Gurrin LC. Is the atopic march related to confounding by genetics and early-life environment? A systematic review of sibship and twin data. Allergy 2018; 73:17-28. [PMID: 28618023 DOI: 10.1111/all.13228] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 01/14/2023]
Abstract
A popular hypothesis known as the atopic march proposes a set of sequential allergy and respiratory disorders in early childhood contributes enormously to the burden of disease in developed countries. Although the concept of the atopic march has been refined and strengthened by many cross-sectional and longitudinal studies linking eczema as the initial manifestation with progression to hay fever and then asthma, there is yet no definitive proof that the atopic march is the primary causal factor in childhood allergic disease. This debate is mainly related to the controversy around potential confounding of these associations by genetic and environmental factors. Family studies are ideally suited to unravelling the role of these factors. While multiple reviews have synthesized evidence from studies investigating this question, no review to date has explored specific evidence generated by twin and sibling studies to understand the aetiology of atopic march diseases. Our aim was to conduct a systematic review of twin and sibling studies that examine the allergic phenotypes that form the atopic march, to determine whether such analyses of data from these studies attempt to control for the effect confounding by shared factors, and to report estimates of the magnitude of associations between multiple phenotypes. Our review suggests that (1) genetics play a bigger role predisposing eczema to hay fever and eczema to asthma than environmental factors, and (2) the link between eczema and asthma and hay fever is independent of shared early-life environmental factors.
Collapse
Affiliation(s)
- S. J. Khan
- Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Melbourne Vic Australia
| | - S. C. Dharmage
- Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Melbourne Vic Australia
- Murdoch Childrens Research Institute Melbourne Vic Australia
| | - M. C. Matheson
- Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Melbourne Vic Australia
- Murdoch Childrens Research Institute Melbourne Vic Australia
| | - L. C. Gurrin
- Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Melbourne Vic Australia
- Murdoch Childrens Research Institute Melbourne Vic Australia
| |
Collapse
|
84
|
Kim DH, Han K, Kim SW. Effects of Antibiotics on the Development of Asthma and Other Allergic Diseases in Children and Adolescents. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:457-465. [PMID: 30088366 PMCID: PMC6082825 DOI: 10.4168/aair.2018.10.5.457] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/17/2018] [Accepted: 05/03/2018] [Indexed: 01/15/2023]
Abstract
Purpose Our aim was to explore whether antibiotic exposure in children and adolescents is associated with the later development of allergic diseases, using nationwide population-based claims data. Methods We collected information from the National Health Insurance Service (2006–2015) database. A total of 5,626,328 children and adolescents were eligible for the study. We explored whether exposure to antibiotics over the prior 7 years affects the later development of allergic diseases. We ran 3 analytical models after adjusting for confounding factors including age, sex, the number of visits to healthcare providers, income, and the place of residence (urban/rural). Results Allergic diseases were most common in male children and those aged < 10 years (atopic dermatitis, asthma and allergic rhinitis; all P < 0.01). Also, urban residents with higher incomes were more likely to develop allergic diseases (all P < 0.01). The annual number of days on which antibiotics were prescribed differed significantly between subjects with each allergic disease studied and a comparison group (all P < 0.01). Multiple logistic regression showed that as the duration of antibiotic exposure increased, the incidences of atopic dermatitis, asthma, and allergic rhinitis trended upward, even after adjusting for confounding factors (P for trend < 0.01). Conclusions Antibiotic use early in life is associated with an increased risk of allergic disease, especially in young children; the risk increases as the duration of antibiotic therapy rises. Moreover, urban residence was more strongly associated with a longer duration of antibiotic use than was rural residence.
Collapse
Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea
| | - Soo Whan Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
85
|
Czarnowicki T, Krueger JG, Guttman-Yassky E. Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march. J Allergy Clin Immunol 2017; 139:1723-1734. [PMID: 28583445 DOI: 10.1016/j.jaci.2017.04.004] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/07/2017] [Accepted: 04/13/2017] [Indexed: 12/16/2022]
Abstract
Skin barrier abnormalities have been suggested to play an essential role in initiation of early atopic dermatitis (AD). Antigen penetration through a compromised barrier likely leads to increased innate immune responses, antigen-presenting cell stimulation, and priming of overt cutaneous disease. In a TH2-promoting environment, T-cell/B-cell interactions occurring in regional lymph nodes lead to excessive IgE switch. Concurrent redistribution of memory T cells into the circulation not only leads to exacerbation of AD through T-cell skin infiltration but also spreads beyond the skin to initiate the atopic march, which includes food allergy, asthma, and allergic rhinitis. Possible primary interventions to prevent AD are focusing on improving skin barrier integrity, including supplementing barrier function with moisturizers. As for secondary prophylaxis in children with established AD, this can be stratified into prevention of disease exacerbations by using proactive approaches (with either topical corticosteroids or topical calcineurin inhibitors) in mild AD cases or the prevention of other atopic disorders that will probably mandate systemic immunosuppression in severe AD cases.
Collapse
Affiliation(s)
- Tali Czarnowicki
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - James G Krueger
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY.
| |
Collapse
|
86
|
Huang A, Cho C, Leung DYM, Brar K. Atopic Dermatitis: Early Treatment in Children. CURRENT TREATMENT OPTIONS IN ALLERGY 2017; 4:355-369. [PMID: 29868331 DOI: 10.1007/s40521-017-0140-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Therapeutic regimens for the treatment and long-term management of AD traditionally had a two-fold objective of decreasing skin inflammation and repairing the defective skin barrier. Essential treatments for AD in children should include topical moisturizers for skin hydration and prevention of flares, topical anti-inflammatory medications (e.g. corticosteroids, calcineurin inhibitors, PDE4 inhibitor), allergen/irritant avoidance, and treatment of skin infections. Treatment regimens should be severity-based, and implemented in a stepwise approach tailored to the individual patient. This stepwise approach includes initial use of emollients, gentle skin care, and escalating to more potent anti-inflammatory treatments as the disease severity increases. Currently available systemic medications should be reserved for the presence of recalcitrance to topical therapies due to associated toxicities. We believe that early treatment of AD is not only essential in treating the skin disease, but also in preventing the development of additional atopic diseases, such as food allergy, asthma and allergic rhinitis. The defective skin barrier of AD permits a route of entry for food and environmental allergens, and upon exposure, keratinocytes secrete TSLP, which activates the TH2 pathway. This TH2 differentiation sets off the atopic march and the subsequent diseases that are seen. This review highlights treatment options and strategies in pediatric AD therapy with an emphasis on early therapy. Supporting evidence on the efficacy and safety of each intervention will be discussed.
Collapse
Affiliation(s)
- Amy Huang
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, NY
| | - Christine Cho
- Department of Pediatrics, National Jewish Health, Denver, CO
| | | | - Kanwaljit Brar
- Department of Pediatrics, National Jewish Health, Denver, CO
| |
Collapse
|
87
|
Roduit C, Frei R, Depner M, Karvonen AM, Renz H, Braun-Fahrländer C, Schmausser-Hechfellner E, Pekkanen J, Riedler J, Dalphin JC, von Mutius E, Lauener RP, Hyvärinen A, Kirjavainen P, Remes S, Roponen M, Dalphin ML, Kaulek V, Ege M, Genuneit J, Illi S, Kabesch M, Schaub B, Pfefferle PI, Doekes G. Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood. JAMA Pediatr 2017; 171:655-662. [PMID: 28531273 PMCID: PMC5710337 DOI: 10.1001/jamapediatrics.2017.0556] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Atopic dermatitis is an inflammatory, pruritic skin disease that often occurs in early infancy with a chronic course. However, a specific description of subtypes of atopic dermatitis depending on the timing of onset and progression of the disease in childhood is lacking. OBJECTIVE To identify different phenotypes of atopic dermatitis using a definition based on symptoms before age 6 years and to determine whether some subtypes are more at risk for developing other allergic diseases. DESIGN, SETTING, AND PARTICIPANTS The Protection Against Allergy Study in Rural Environments (PASTURE) is a European birth cohort where pregnant women were recruited between August 2002 and March 2005 and divided in 2 groups dependent on whether they lived on a farm. Children from this cohort with data on atopic dermatitis from birth to 6 years of age were included. EXPOSURES Atopic dermatitis, defined as an itchy rash on typical locations from birth to 6 years. MAIN OUTCOMES AND MEASURES The latent class analysis was used to identify subtypes of atopic dermatitis in childhood based on the course of symptoms. Multivariable logistic regressions were used to analyze the association between atopic dermatitis phenotypes and other allergic diseases. RESULTS We included 1038 children; of these, 506 were girls. The latent class analysis model with the best fit to PASTURE data separated 4 phenotypes of atopic dermatitis in childhood: 2 early phenotypes with onset before age 2 years (early transient [n = 96; 9.2%] and early persistent [n = 67; 6.5%]), the late phenotype with onset at age 2 years or older (n = 50; 4.8%), and the never/infrequent phenotype (n = 825; 79.5%), defined as children with no atopic dermatitis. Children with both parents with history of allergies were 5 times more at risk to develop atopic dermatitis with an early-persistent phenotype compared with children with parents with no history of allergies. Both early phenotypes were strongly associated with food allergy. The risk of developing asthma was significantly increased among the early-persistent phenotype (adjusted odds ratio, 2.87; 95% CI, 1.31-6.31). The late phenotype was only positively associated with allergic rhinitis. CONCLUSIONS AND RELEVANCE Using latent class analysis, 4 phenotypes of atopic dermatitis were identified depending on the onset and course of the disease. The prevalence of asthma and food allergy by 6 years of age was strongly increased among children with early phenotypes (within age 2 years), especially with persistent symptoms. These findings are important for the development of strategies in allergy prevention.
Collapse
Affiliation(s)
- Caroline Roduit
- University Children’s Hospital, Zurich, Switzerland,Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - Remo Frei
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland,Swiss Institute of Allergy and Asthma Research, University of Zurich, Zurich, Switzerland
| | - Martin Depner
- Dr von Hauner Children’s Hospital, Ludwig Maximilian University, Munich, Germany
| | - Anne M. Karvonen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Harald Renz
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany
| | | | | | - Juha Pekkanen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Josef Riedler
- Children’s Hospital Schwarzach, Teaching Hospital Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Jean-Charles Dalphin
- University of Besançon, Department of Respiratory Disease, Unités Mixtes de Recherche/Le Centre National de la Recherche Scientifique 6249 Chrono-environment, University Hospital, Besançon, France
| | - Erika von Mutius
- Dr von Hauner Children’s Hospital, Ludwig Maximilian University, Munich, Germany,Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | - Roger Pascal Lauener
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland,Children’s Hospital of Eastern Switzerland, St Gallen, Switzerland
| | | | - Anne Hyvärinen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | | | | | | | | | - Vincent Kaulek
- University of Besançon, Department of Respiratory Disease, Unités Mixtes de Recherche/Le Centre National de la Recherche Scientifique 6249 Chrono-environment, University Hospital, Besançon, France
| | - Markus Ege
- Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Sabina Illi
- Asthma and Allergy Research Group, University of Munich, Munich, Germany
| | - Micahel Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, Regensburg, Germany
| | - Bianca Schaub
- Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Gert Doekes
- Utrecht University, Institue for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht, Germany
| |
Collapse
|
88
|
Qiao M, Xiao D, Qian L, Qiao J. The Natural Course of Atopic Dermatitis and the Association with Asthma. Inflammation 2017; 40:546-554. [PMID: 28063089 DOI: 10.1007/s10753-016-0501-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this paper, we aimed to explore the potential mechanism underlying atopic dermatitis (AD) and its association with asthma. The BALB/c mice were randomly assigned to three groups, including the vehicle control (VD) group, the AD group, and the treatment (TR) group. The AD mice model was successfully constructed in the AD and TR group. The dermatitis severity scores and skin lesions were significantly increased in AD mice after DNCB application. Airway responsiveness in the AD group was significantly higher than in the TR group. The number of inflammatory cells was increased in skin lesions and bronchoalveolar lavage fluid (BALF) of AD mice. The levels of IL-4, IL-5, IFN-γ, and OVA-IgE in BALF supernatants of mice in the AD group were higher than those in the VC group. All the changes in AD mice were decreased by tacrolimus. These results indicate that AD may be a significant risk factor for atopic asthma development.
Collapse
Affiliation(s)
- Min Qiao
- Department of Internal Medicine, Kingsbrook Jewish Medical Center, 585 Schenectady Ave, Brooklyn, NY, USA
| | - Deqi Xiao
- Department of Dermatology, Shanghai Sixth People's Hospital Affiliated of Shanghai Jiaotong University, Shanghai, China
| | - Li Qian
- Department of Emergency, Shanghai Ninth People's Hospital Affiliated of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian'ou Qiao
- Department of Emergency, Shanghai Ninth People's Hospital Affiliated of Shanghai Jiaotong University School of Medicine, Shanghai, China.
- Department of Respiratory Medicine, Shanghai Ninth People's Hospital Affiliated of Shanghai Jiaotong University School of Medicine, No. 639, Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
| |
Collapse
|
89
|
Choi H, Song WM, Zhang B. Linking childhood allergic asthma phenotypes with endotype through integrated systems biology: current evidence and research needs. REVIEWS ON ENVIRONMENTAL HEALTH 2017; 32:55-63. [PMID: 28170342 DOI: 10.1515/reveh-2016-0054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/11/2016] [Indexed: 06/06/2023]
Abstract
Asthma and other complex diseases results from a complex web of interactions involving inflammation, immunity, cell cycle, apoptosis, and metabolic perturbations across multiple organ systems. The extent to which various degrees of the age at onset, symptom severity, and the natural progression of the disease reflect multiple disease subtypes, influenced by unique process of development remains unknown. One of the most critical challenges to our understanding stems from incomplete understanding of the mechanisms. Within this review, we focus on the phenotypes of childhood allergic asthma as the basis to better understand the endotype for quantitative define subtypes of asthma. We highlight some of the known mechanistic pathways associated with the key hallmark events before the asthma onset. In particular, we examine how the recent advent of multiaxial -omics technologies and systems biology could help to clarify our current understanding of the pathway. We review how a large volume of molecular, genomic data generated by multiaxial technologies could be digested to identify cogent pathophysiologic molecular networks. We highlight some recent successes in application of these technologies within the context of other disease conditions for therapeutic interventions. We conclude by summarizing the research needs for the predictive value of preclinical biomarkers.
Collapse
|
90
|
Broeks SA, Brand PLP. Atopic dermatitis is associated with a fivefold increased risk of polysensitisation in children. Acta Paediatr 2017; 106:485-488. [PMID: 28027409 DOI: 10.1111/apa.13729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 12/12/2016] [Accepted: 12/21/2016] [Indexed: 01/21/2023]
Abstract
AIM It has been hypothesised that in atopic dermatitis, the dysfunctional skin barrier facilitates the transcutaneous presentation of allergens to the immune system. This study examined whether atopic dermatitis increased the likelihood of polysensitisation, namely sensitisation to five or more allergens. METHODS We examined the electronic hospital charts of 1743 children aged 0-17 years who had visited primary or secondary care physicians with allergic symptoms, whose blood was examined for the presence of specific immunoglobulin E (IgE) to the 10 most common inhaled and food allergens and whose files contained documentation of the presence of atopic dermatitis and other skin disorders. Sensitisation was defined as a specific IgE level of ≥0.35 kU/L. RESULTS Polysensitisation was more common in children with atopic dermatitis (268/1197, 22.4%) than those without (30/546, 5.5%, p < 0.001). This remained significant after adjustment for gender and age in a multiple logistic regression model (odds ratio: 5.63, 95% confidence interval 3.77-8.40). Other skin disorders did not show an increased risk of polysensitisation (5/97, 5.2%). CONCLUSION Polysensitisation was considerably more common in children with atopic dermatitis than those without. This supports the hypothesis that sensitisation occurs through a defective skin barrier and appears to be specific for atopic dermatitis.
Collapse
Affiliation(s)
- Suzanne A. Broeks
- Department of Internal Medicine; ZGT Hospital; Almelo The Netherlands
| | - Paul L. P. Brand
- Princess Amalia Children's Centre; Isala Hospital; Zwolle The Netherlands
- UMCG Postgraduate School of Medicine; University Medical Centre and University of Groningen; Groningen The Netherlands
| |
Collapse
|
91
|
Kim SY, Kim MS, Park B, Kim JH, Choi HG. Allergic rhinitis, atopic dermatitis, and asthma are associated with differences in school performance among Korean adolescents. PLoS One 2017; 12:e0171394. [PMID: 28207843 PMCID: PMC5312966 DOI: 10.1371/journal.pone.0171394] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 01/19/2017] [Indexed: 12/20/2022] Open
Abstract
Several studies have reported negative relations between allergic diseases and school performance but have not simultaneously considered various allergic diseases, including allergic rhinitis, asthma, and atopic dermatitis, and only examined a limited number of participants. The present study investigated the associations of allergic rhinitis, asthma, and atopic dermatitis with school performance in a large, representative Korean adolescent population. A total of 299,695 7th through 12th grade students participated in the Korea Youth Risk Behaviour Web-based Survey (KYRBWS) from 2009 to 2013. The subjects' history of allergic rhinitis, asthma, and atopic dermatitis and number of school absences due to these diseases in the previous 12 months were examined and compared. School performance was classified into 5 levels. The relations between allergic disorders and school performance were analyzed using multiple logistic regressions with complex sampling and adjusted for the subjects' durations of sleep, days of physical activity, body mass indexes (BMIs), regions of residence, economic levels, parents' education levels, stress levels, smoking status, and alcohol use. A subgroup analysis of the economic groups was performed. Allergic rhinitis was positively correlated with better school performance in a dose-dependent manner (adjusted odds ratios, AOR, [95% confidence interval, CI] = 1.50 [1.43-1.56 > 1.33 [1.28-1.38] > 1.17 [1.13-1.22] > 1.09 [1.05-1.14] for grades A > B > C > D; P < 0.001). Asthma was negatively correlated with better school performance (AOR [95% CI] = 0.74 [0.66-0.83], 0.87 [0.79-0.96], 0.83 [0.75-0.91], 0.93 [0.85-1.02] for performance A, B, C, and D, respectively; P < 0.001). Atopic dermatitis was not significantly correlated with school performance. The subgroup analysis of the students' economic levels revealed associations between allergic diseases and school performance. Compared to other allergic disorders, the asthma group had more school absences due to their symptoms (P < 0.001). School performance was positively correlated with allergic rhinitis and negatively correlated with asthma in Korean adolescents, even after adjusting for other variables. The asthma group had an increased number of school absence days, which presumably contributes to these students' poor school performance.
Collapse
Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Min-Su Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea University Ansan Hospital, Ansan, Korea
| | - Bumjung Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
| | - Jin-Hwan Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Korea
- * E-mail:
| |
Collapse
|
92
|
Ha EK, Baek JH, Lee SY, Park YM, Kim WK, Sheen YH, Lee SJ, Bae Y, Kim J, Lee KJ, Ahn K, Kwon HJ, Han MY. Association of Polysensitization, Allergic Multimorbidity, and Allergy Severity: A Cross-Sectional Study of School Children. Int Arch Allergy Immunol 2017; 171:251-260. [PMID: 28049188 DOI: 10.1159/000453034] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/02/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Aeroallergen sensitization is related to the coexistence of allergic diseases, but the nature of this relationship is poorly understood. The aim of this study was to clarify the relationship of polysensitization with allergic multimorbidities and the severity of allergic diseases. METHODS This study is a cross-sectional analysis of 3,368 Korean children aged 6-7 years-old. We defined IgE-mediated allergic diseases based on structured questionnaires, and classified the sensitivity to 18 aeroallergens by logistic regression and the Ward hierarchical clustering method. The relationship of polysensitization (positive IgE responses against 2 or more aeroallergens classes) with allergic multimorbidities (coexistence of 2 or more of the following allergic diseases: asthma, rhinitis, eczema, and conjunctivitis) and severity of allergic diseases was determined by ordinal logistic regression analysis. RESULTS The rate of polysensitization was 13.6% (n = 458, 95% CI 12.4-14.8) and that of allergic multimorbidity was 23.5% (n = 790, 95% CI 22.0-24.9). Children sensitized to more aeroallergens tended to have more allergic diseases (rho = 0.248, p < 0.001), although the agreement between polysensitization and multimorbidity was poor (kappa = 0.11, p < 0.001). The number allergen classes to which a child was sensitized increased the risk of wheezing attacks (1 allergen: adjusted odds ratio [aOR] 2.22, 4 or more allergens: aOR 9.39), absence from school (1 allergen: aOR 1.96, 3 allergens: aOR 2.08), and severity of nasal symptoms (1 allergen: aOR 1.61, 4 or more allergens: aOR 4.38). CONCLUSION Polysensitization was weakly related to multimorbidity. However, the number of allergens to which a child is sensitized is related to the severity of IgE-mediated symptoms.
Collapse
Affiliation(s)
- Eun Kyo Ha
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
93
|
Na MS, Kim GR, Ha EK, Lee SJ, Sheen YH, Choi SH, Jung YH, Lee KS, Jee HM, Han MY. Allergen sensitization and clinical characteristics in young children with atopic dermatitis. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.3.128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Min Sun Na
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Ga Ram Kim
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seung Jin Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Sun Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Yong Ho Jung
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Kyung Suk Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| |
Collapse
|
94
|
Serezani APM, Bozdogan G, Sehra S, Walsh D, Krishnamurthy P, Potchanant EAS, Nalepa G, Goenka S, Turner MJ, Spandau DF, Kaplan MH. IL-4 impairs wound healing potential in the skin by repressing fibronectin expression. J Allergy Clin Immunol 2017; 139:142-151.e5. [PMID: 27554818 PMCID: PMC5222746 DOI: 10.1016/j.jaci.2016.07.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 05/27/2016] [Accepted: 07/05/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is characterized by intense pruritis and is a common childhood inflammatory disease. Many factors are known to affect AD development, including the pleiotropic cytokine IL-4. Yet little is known regarding the direct effects of IL-4 on keratinocyte function. OBJECTIVE AND METHODS In this report RNA sequencing and functional assays were used to define the effect of the allergic environment on primary keratinocyte function and wound repair in mice. RESULTS Acute or chronic stimulation by IL-4 modified expression of more than 1000 genes expressed in human keratinocytes that are involved in a broad spectrum of nonoverlapping functions. Among the IL-4-induced changes, repression of fibronectin critically impaired the human keratinocyte wound response. Moreover, in mouse models of spontaneous and induced AD-like lesions, there was delayed re-epithelialization. Importantly, topical treatment with fibronectin restored the epidermal repair response. CONCLUSION Keratinocyte gene expression is critically shaped by IL-4, altering cell fate decisions, which are likely important for the clinical manifestations and pathology of allergic skin disease.
Collapse
Affiliation(s)
- Ana PM Serezani
- Department of Pediatrics, H.B. Wells Center for Pediatric Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gunseli Bozdogan
- Department of Pediatrics, H.B. Wells Center for Pediatric Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sarita Sehra
- Department of Pediatrics, H.B. Wells Center for Pediatric Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel Walsh
- Department of Pediatrics, H.B. Wells Center for Pediatric Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Purna Krishnamurthy
- Department of Pediatrics, H.B. Wells Center for Pediatric Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elizabeth A Sierra Potchanant
- Department of Pediatrics, H.B. Wells Center for Pediatric Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Division of Pediatric Hematology-Oncology Bone Marrow Failure Program, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Grzegorz Nalepa
- Department of Pediatrics, H.B. Wells Center for Pediatric Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Division of Pediatric Hematology-Oncology Bone Marrow Failure Program, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shreevrat Goenka
- Department of Pediatrics, H.B. Wells Center for Pediatric Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Matthew J Turner
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dan F Spandau
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Mark H Kaplan
- Department of Pediatrics, H.B. Wells Center for Pediatric Research and Department of Microbiology and Immunology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
95
|
Goksör E, Loid P, Alm B, Åberg N, Wennergren G. The allergic march comprises the coexistence of related patterns of allergic disease not just the progressive development of one disease. Acta Paediatr 2016; 105:1472-1479. [PMID: 27381249 PMCID: PMC5129460 DOI: 10.1111/apa.13515] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 05/22/2016] [Accepted: 07/04/2016] [Indexed: 01/12/2023]
Abstract
Aim This study explored the development and comorbidity of allergic diseases by analysing the relationship between allergic manifestations in infancy and at the age of 8. Methods We included 5654 children born in Sweden in 2003 in a longitudinal study. Parents answered postal questionnaires when the children were six months and one, four‐and‐a‐half and eight years of age. Results The response rate at eight years was 4051 (71.6%), and we analysed 3382 children with complete data. The number of manifestations in infancy increased the risk of allergic disease at eight years of age: 72% of children with one early manifestation were symptom free at 8, compared to 45% with two or more manifestations. Similar manifestations occurred in infancy and at the age of 8, for example recurrent wheeze increased the risk of doctor‐diagnosed asthma by an adjusted odds ratio of 6.5. Eczema and food allergy independently increased the risk of all four allergic manifestations at eight years. Conclusion Allergic disease at the age of 8 was related to the number of allergic manifestations in infancy. Manifestations were similar at both ages, suggesting an allergic march with the coexistence of disease patterns rather than the progressive development of one disease.
Collapse
Affiliation(s)
- Emma Goksör
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Petra Loid
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Bernt Alm
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Nils Åberg
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| | - Göran Wennergren
- Department of Paediatrics University of Gothenburg Queen Silvia Children's Hospital Gothenburg Sweden
| |
Collapse
|
96
|
Tenn MW, Ellis AK. The clinical relevance of filaggrin mutations: Effect on allergic disease. Ann Allergy Asthma Immunol 2016; 117:483-489. [PMID: 27788876 DOI: 10.1016/j.anai.2016.03.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Mark W Tenn
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Anne K Ellis
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada; Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada; Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| |
Collapse
|
97
|
Sasaki M, Yoshida K, Adachi Y, Furukawa M, Itazawa T, Odajima H, Saito H, Hide M, Akasawa A. Environmental factors associated with childhood eczema: Findings from a national web-based survey. Allergol Int 2016; 65:420-424. [PMID: 27134054 DOI: 10.1016/j.alit.2016.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 03/16/2016] [Accepted: 03/21/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Genetic and environmental factors are known to be related to the development of childhood eczema. Our aim was to assess the environmental factors associated with the prevalence of eczema among children using a web-based survey. METHODS In June 2012, we conducted a nation-wide web-based survey to identify the prevalence and characteristics of allergic diseases among Japanese children. The prevalence of allergic diseases including eczema was assessed using the International Study of Asthma and Allergies in Childhood core questionnaire. The associations between eczema prevalence and environmental factors, as well as those between background characteristics and comorbid allergic diseases among 6-12 year old children were assessed. RESULTS A total of 28,348 children were included in the analysis. The prevalence of current eczema was 13.0%. Current eczema was significantly associated with a higher prevalence of wheeze, rhinitis, and food allergy. In multiple logistic regression models, birth during autumn (aOR: 1.18 95%CI: 1.06-1.31) or winter (aOR: 1.21 95%CI: 1.08-1.34), duration of exclusive breastfeeding for at least 6 months (aOR: 1.14 95%CI: 1.06-1.23), and ownership of a pet from infancy (aOR: 2.61 95%CI: 1.68-4.07) were also associated with a higher prevalence of eczema. The prevalence was lower in those with a high annual household income (aOR: 0.90 95%CI: 0.81-0.99) and 2 or more siblings (aOR: 0.86 95%CI: 0.76-0.97). CONCLUSIONS Duration of breastfeeding, season of birth, pet ownership, household income, and the number of siblings were associated with the prevalence of childhood eczema in a nationwide web survey.
Collapse
Affiliation(s)
- Mari Sasaki
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan.
| | - Koichi Yoshida
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Yuichi Adachi
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | - Mayumi Furukawa
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Toshiko Itazawa
- Department of Pediatrics, University of Toyama, Toyama, Japan
| | - Hiroshi Odajima
- Department of Pediatrics, Fukuoka National Hospital, Fukuoka, Japan
| | - Hirohisa Saito
- Department of Allergy and Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Michihiro Hide
- Department of Dermatology, Integrated Health Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akira Akasawa
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| |
Collapse
|
98
|
Wei HT, Lan WH, Hsu JW, Huang KL, Su TP, Li CT, Lin WC, Chen TJ, Bai YM, Chen MH. Risk of developing major depression and bipolar disorder among adolescents with atopic diseases: A nationwide longitudinal study in Taiwan. J Affect Disord 2016; 203:221-226. [PMID: 27310101 DOI: 10.1016/j.jad.2016.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 06/02/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUNDS Previous studies have found an increased prevalence of atopic diseases among patients with major depression and bipolar disorder. But the temporal association between atopic diseases in adolescence and the subsequent risk of developing mood disorders has been rarely investigated. METHODS Using the Taiwan National Health Insurance Research Databases, 5075 adolescents with atopic diseases (atopic cohort) and 44,729 without (non-atopic cohort) aged between 10 and 17 in 2000 were enrolled into our study and followed to the end of 2010. Subjects who developed major depression or bipolar disorder during the follow-up were identified. RESULTS The atopic cohort had an increased risk of developing major depression (HR: 2.45, 95% CI: 1.93~3.11) and bipolar disorder (HR: 2.51, 95% CI: 1.71~3.67) compared to the non-atopic cohort, with a dose-dependent relationship between having a greater number of atopic comorbidities and a greater likelihood of major depression (1 atopic disease: HR: 1.80, 95% CI: 1.29~2.50; 2 atopic comorbidities: HR: 2.42, 95% CI: 1.93~3.04;≥3 atopic comorbidities: HR: 3.79, 95% CI: 3.05~4.72) and bipolar disorder (HR: 1.40, 95% CI: 0.57~3.44; HR: 2.81, 95% CI: 1.68~4.68; HR: 3.02, 95% CI: 1.69~5.38). DISCUSSION Having atopic diseases in adolescence increased the risk of developing major depression and bipolar disorder in later life. Further studies may be required to clarify the underlying mechanism between atopy and mood disorders, and to investigate whether prompt intervention may decrease the risk of subsequent mood disorders.
Collapse
Affiliation(s)
- Han-Ting Wei
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Psychiatry, Kunming Branch, Taipei City Hospital, Taiwan
| | - Wen-Hsuan Lan
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Psychiatry, Taipei Municipal Gan-Dau Hospital, Taiwan
| | - Ju-Wei Hsu
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kai-Lin Huang
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tung-Ping Su
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Ta Li
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Chen Lin
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Bai
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Mu-Hong Chen
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
| |
Collapse
|
99
|
Segura N, Fraj J, Cubero J, Sobrevía M, Lezaun A, Ferrer L, Sebastián A, Colás C. Mould and grass pollen allergy as risk factors for childhood asthma in Zaragoza, Spain. Allergol Immunopathol (Madr) 2016; 44:455-60. [PMID: 27255475 DOI: 10.1016/j.aller.2016.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/03/2016] [Accepted: 02/08/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Examine the prevalence of asthma and associated predictive factors in a group of 468 students. PATIENTS AND METHODS A descriptive, cross-sectional observational study in a randomly selected population of 468 children aged 10-12, in the city of Zaragoza. We used the ISAAC questionnaire on asthma completed by children under supervision of the investigators. We assessed the genetic risk (family history of asthma) and environmental risks. The risk for atopy was assessed by the presence of positive skin prick tests. RESULTS 25.3% of the children had symptoms consistent with asthma in the city of Zaragoza. Among them 33.1% reported a history of asthma in close relatives (OR=1.78, p<0.001). The history of hospitalisations for lower respiratory tract illness was strongly associated with the presence of asthma (OR=6.72, p<0.0001). Positive skin tests to Alternaria (OR=2.00, p<0.0001) and grass pollen (OR=1.76, p<0.001) were predictors of asthma. 63.6% of asthmatic children had presented clinical rhinitis in the previous 12 months, compared with 32% of non-asthmatics, and this difference was statistically significant (OR=3.89, p<0.0001). 47% of asthmatics presented with or previously had eczema, whereas only 26.9% of non-asthmatics presented with or previously had these types of lesions (p<0.0001). CONCLUSION The following are predictors of asthma: History of hospital admissions for lower respiratory tract illness, presence of rhinitis and/or eczema, positive prick test for certain aeroallergens, especially Alternaria and grass pollen, and family history of asthma.
Collapse
|
100
|
Foong RX, Roberts G, Fox AT, du Toit G. Pilot study: assessing the clinical diagnosis of allergy in atopic children using a microarray assay in addition to skin prick testing and serum specific IgE. Clin Mol Allergy 2016; 14:8. [PMID: 27547124 PMCID: PMC4991090 DOI: 10.1186/s12948-016-0046-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 08/08/2016] [Indexed: 11/10/2022] Open
Abstract
Background Children with atopic dermatitis (AD) are at risk of developing allergy. Alongside clinical history, testing modalities include skin prick tests (SPT), specific immunoglobulin-E (sp-IgE) and recently, microarray assays. The aim of this pilot study was to assess current tests and the ISAC sIgE-112 system in the diagnosis of food and aeroallergen allergy. Methods Children aged 0–11 years with moderate to severe AD were included. An initial allergy assessment including clinical history, SPT and sp-IgE was performed to determine food and aeroallergen sensitization. A second independent clinical assessment using the same information given to the first assessor and ISAC test results for food and aeroallergen sensitization was also made for each participant. The results from both were compared. Results 30 children [mean age 3.91 years (SD 3.3)] were included; 53.3 and 46.7 % had moderate and severe AD, respectively. Sp-IgE tests had a higher percentage of positive results compared to SPT and ISAC tests for common allergens. There was a significant difference between the three tests in detecting aeroallergen sensitization (p = 0.038), especially between sp-IgE and ISAC tests, but no significant difference between the tests for food allergen sensitization. There was good agreement between the two assessors; 70 % of the children had a change in diagnosis, with 60 % having at least one diagnosis added and 40 % having at least one diagnosis removed. Conclusions There is a role for the use of ISAC testing in diagnosing sensitization and allergy in children with AD as it leads to a change in diagnosis for many patients. Further work is required to assess its clinical and cost effectiveness. Electronic supplementary material The online version of this article (doi:10.1186/s12948-016-0046-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ru-Xin Foong
- Division of Asthma, Allergy and Lung Biology, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 7EH UK ; Institute of Child Health, University College of London, London, UK
| | - Graham Roberts
- University of Southampton and National Institute for Health Research Respiratory Biomedical Research Unit, Southampton and David Hide Centre, Southampton, UK
| | - Adam Tobias Fox
- Division of Asthma, Allergy and Lung Biology, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 7EH UK
| | - George du Toit
- Division of Asthma, Allergy and Lung Biology, Guy's and St. Thomas' NHS Foundation Trust, London, SE1 7EH UK
| |
Collapse
|