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Siegfried EC, Jaworski JC, Eichenfield LF, Paller A, Hebert AA, Simpson EL, Altman E, Arena C, Blauvelt A, Block J, Boguniewicz M, Chen S, Cordoro K, Hanna D, Horii K, Hultsch T, Lee J, Leung DY, Lio P, Milner J, Omachi T, Schneider C, Schneider L, Sidbury R, Smith T, Sugarman J, Taha S, Tofte S, Tollefson M, Tom WL, West DP, Whitney L, Zane L. Developing drugs for treatment of atopic dermatitis in children (≥3 months to <18 years of age): Draft guidance for industry. Pediatr Dermatol 2018; 35:303-322. [PMID: 29600515 DOI: 10.1111/pde.13452] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Atopic dermatitis is the most common chronic skin disease, and it primarily affects children. Although atopic dermatitis (AD) has the highest effect on burden of skin disease, no high-level studies have defined optimal therapy for severe disease. Corticosteroids have been used to treat AD since the 1950s and remain the only systemic medication with Food and Drug Administration approval for this indication in children, despite published guidelines of care that recommend against this option. Several clinical trials with level 1 evidence have supported the use of topical treatments for mild to moderate atopic dermatitis in adults and children, but these trials have had little consistency in protocol design. Consensus recommendations will help standardize clinical development and trial design for children. The Food and Drug Administration issues guidance documents for industry as a source for "the Agency's current thinking on a particular subject." Although they are nonbinding, industry considers these documents to be the standard for clinical development and trial design. Our consensus group is the first to specifically address clinical trial design in this population. We developed a draft guidance document for industry, Developing Drugs for Treatment of Atopic Dermatitis in Children (≥3 months to <18 years of age). This draft guidance has been submitted to the Food and Drug Administration based on a provision in the Federal Register (Good Guidance Practices).
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Affiliation(s)
- Elaine C Siegfried
- Department of Pediatrics, Saint Louis University and Cardinal Glennon Children's Hospital, St. Louis, MO, USA
| | | | - Lawrence F Eichenfield
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Amy Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Division of Dermatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Adelaide A Hebert
- Department of Dermatology, UTHealth McGovern Medical School at Houston, Houston, TX, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Charles Arena
- Clinical Development & Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | | | - Julie Block
- National Eczema Association, San Rafael, CA, USA
| | - Mark Boguniewicz
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Suephy Chen
- Department of Dermatology, Emory University, and Division of Dermatology, Atlanta Veterans Affairs Medical Center, Atlanta, GA, USA
| | - Kelly Cordoro
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Diane Hanna
- Medical Affairs, Regeneron Pharmaceuticals, Tarrytown, NY, USA
| | - Kimberly Horii
- Division of Dermatology, Children's Mercy and University of Missouri, Kansas City, MO, USA
| | - Thomas Hultsch
- Translational Medicine, Sanofi-Genzyme, Cambridge, MA, USA
| | - James Lee
- Dermavant Sciences, Raleigh-Durham, NC, USA
| | - Donald Y Leung
- Department of Pediatrics, National Jewish Health and Division of Pediatric Allergy-Immunology, University of Colorado School of Medicine, Denver, CO, USA
| | - Peter Lio
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joshua Milner
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Theodore Omachi
- Immunology/Respiratory, Genentech, Inc., San Francisco, CA, USA
| | | | - Lynda Schneider
- Department of Pediatrics, Harvard Medical School and Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Robert Sidbury
- Division of Dermatology, Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Jeffrey Sugarman
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - Sharif Taha
- National Eczema Association, San Rafael, CA, USA
| | - Susan Tofte
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | | | - Wynnis L Tom
- Department of Dermatology, School of Medicine, University of California, and Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital-San Diego, San Diego, CA, USA
| | - Dennis P West
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lucinda Whitney
- School of Nursing, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lee Zane
- Anacor Pharmaceuticals, Palo Alto, CA, USA
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Abstract
PURPOSE OF REVIEW Airway inflammation is considered to be a cardinal feature of asthma. However, the type of airway inflammation is heterogeneous and airway inflammation may even be absent. Biomarkers may help to identify the inflammatory phenotype or endotype, especially now the time has come that targeted therapies enter daily practice. RECENT FINDINGS Sputum biomarkers have increased our insights into the different inflammatory asthma phenotypes, their response to treatment and their association with progression of disease. New endotypes of type 2 driven inflammation were identified using a multidimensional approach. A specific mast cell subtype has been linked with type 2 driven inflammation and response to inhaled corticosteroids. Advances have been made with regard to sputum cytokine analysis and might also help to guide future treatment of severe asthma. SUMMARY Identifying the target population for biological therapies will not be possible without the use of biomarkers. Optimized, easy-to-apply, automated methods for sputum analysis (cellular content or soluble markers) need to be developed for implementation of sputum biomarkers in daily clinical practice.
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153
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Simpson EL, Villarreal M, Jepson B, Rafaels N, David G, Hanifin J, Taylor P, Boguniewicz M, Yoshida T, De Benedetto A, Barnes KC, Leung DYM, Beck LA. Patients with Atopic Dermatitis Colonized with Staphylococcus aureus Have a Distinct Phenotype and Endotype. J Invest Dermatol 2018; 138:2224-2233. [PMID: 29604251 DOI: 10.1016/j.jid.2018.03.1517] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 02/26/2018] [Accepted: 03/09/2018] [Indexed: 12/31/2022]
Abstract
Patients with atopic dermatitis (AD) are commonly colonized with Staphylococcus aureus (AD S. aureus+), but what differentiates this group from noncolonized AD patients (AD S. aureus-) has not been well studied. To evaluate whether these two groups have unique phenotypic or endotypic features, we performed a multicenter, cross-sectional study enrolling AD S. aureus+ (n = 51) and AD S. aureus- (n = 45) participants defined by the presence or absence of S. aureus by routine culture techniques and nonatopic, noncolonized control individuals (NA S. aureus-) (n = 46). Filaggrin (FLG) genotypes were determined, and disease severity (Eczema Area and Severity Index, Rajka-Langeland Severity Score, Investigator's Global Assessment score, Numerical Rating Scale, and Dermatology Life Quality Index) was captured. Skin physiology was assessed (transepidermal water loss [TEWL], stratum corneum integrity, hydration, and pH), and serum biomarkers were also measured. We found that AD S. aureus+ patients had more severe disease based on all scoring systems except itch (Numerical Rating Scale), and they had higher levels of type 2 biomarkers (eosinophil count, tIgE, CCL17, and periostin). Additionally, AD S. aureus+ patients had significantly greater allergen sensitization (Phadiatop and tIgE), barrier dysfunction (TEWL and stratum corneum integrity), and serum lactate dehydrogenase (LDH) than both the AD S. aureus- and NA S. aureus- groups. FLG mutations did not associate with S. aureus+ colonization. In conclusion, adult patients with AD who are colonized on their skin with S. aureus have more severe disease, greater type 2 immune deviation, allergen sensitization, barrier disruption, and LDH level elevation than noncolonized patients with AD.
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Affiliation(s)
- Eric L Simpson
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | | | | | - Jon Hanifin
- Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Takeshi Yoshida
- University of Rochester Medical Center, Rochester, New York, USA
| | | | | | | | - Lisa A Beck
- University of Rochester Medical Center, Rochester, New York, USA.
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154
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Muñoz X, Álvarez-Puebla MJ, Arismendi E, Arochena L, Ausín MDP, Barranco P, Bobolea I, Cañas JA, Cardaba B, Crespo A, Del Pozo V, Domínguez-Ortega J, Fernandez-Nieto MDM, Giner J, González-Barcala FJ, Luna JA, Mullol J, Ojanguren I, Olaguibel JM, Picado C, Plaza V, Quirce S, Ramos D, Rial M, Romero-Mesones C, Salgado FJ, San-José ME, Sánchez-Diez S, Sastre B, Sastre J, Soto L, Torrejón M, Urnadoz M, Valdes L, Valero A, Cruz MJ. The MEGA Project: A Study of the Mechanisms Involved in the Genesis and Disease Course of Asthma. Asthma Cohort Creation and Long-Term Follow-Up. Arch Bronconeumol 2018; 54:S0300-2896(18)30009-7. [PMID: 29566971 DOI: 10.1016/j.arbres.2017.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 12/27/2022]
Abstract
The general aim of this study is to create a cohort of asthma patients with varying grades of severity in order to gain greater insight into the mechanisms underlying the genesis and course of this disease. The specific objectives focus on various studies, including imaging, lung function, inflammation, and bronchial hyperresponsiveness, to determine the relevant events that characterize the asthma population, the long-term parameters that can determine changes in the severity of patients, and the treatments that influence disease progression. The study will also seek to identify the causes of exacerbations and how this affects the course of the disease. Patients will be contacted via the outpatient clinics of the 8 participating institutions under the auspices of the Spanish Respiratory Diseases Networking System (CIBER). In the inclusion visit, a standardized clinical history will be obtained, a clinical examination, including blood pressure, body mass index, complete respiratory function tests, and FENO will be performed, and the Asthma Control Test (ACT), Morisky-Green test, Asthma Quality of Life Questionnaire (Mini AQLQ), the Sino-Nasal Outcome Test 22 (SNOT-22), and the Hospital Anxiety and Depression scale (HADS) will be administered. A specific electronic database has been designed for data collection. Exhaled breath condensate, urine and blood samples will also be collected. Non-specific bronchial hyperresponsiveness testing with methacholine will be performed and an induced sputum sample will be collected at the beginning of the study and every 24 months. A skin prick test for airborne allergens and a chest CT will be performed at the beginning of the study and repeated every 5 years.
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Affiliation(s)
- Xavier Muñoz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de Biología Celular, Fisiología e Inmunología, Universitat Autònoma de Barcelona, Barcelona, España.
| | | | - Ebymar Arismendi
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Lourdes Arochena
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - María Del Pilar Ausín
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital del Mar-IMIM, Barcelona, España
| | - Pilar Barranco
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Alergia, Instituto de Investigación, Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Irina Bobolea
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Jose Antonio Cañas
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Blanca Cardaba
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Astrid Crespo
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Victora Del Pozo
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Javier Domínguez-Ortega
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Alergia, Instituto de Investigación, Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - María Del Mar Fernandez-Nieto
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Jordi Giner
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | | | - Juan Alberto Luna
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Alergia, Instituto de Investigación, Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - Joaquim Mullol
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Iñigo Ojanguren
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - José María Olaguibel
- Servicio de Alergología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - César Picado
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - Vicente Plaza
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Santiago Quirce
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Alergia, Instituto de Investigación, Hospital Universitario La Paz (IdiPAZ), Madrid, España
| | - David Ramos
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Manuel Rial
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Christian Romero-Mesones
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Francisco Javier Salgado
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - María Esther San-José
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Silvia Sánchez-Diez
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
| | - Beatriz Sastre
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Joaquin Sastre
- CIBER de Enfermedades Respiratorias (CIBERES), España; Departamento de inmunología, Servicio de Neumología, IIS-Fundación Jiménez Díaz, Madrid, España
| | - Lorena Soto
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Montserrat Torrejón
- Departamento de Medicina Respiratoria, Hospital de la Santa Creu i Sant Pau, Instituto de investigación biomédica Sant Pau (IIB Snat Pau), Universidad Autonoma de Barcelona. Departamento de Medicina, Barcelona, España
| | - Marisa Urnadoz
- Servicio de Alergología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | - Luis Valdes
- Servicio de Neumología, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
| | - Antonio Valero
- CIBER de Enfermedades Respiratorias (CIBERES), España; Servicio de Neumología, Hospital Clínic, Universitat de Barcelona, IDIBAPS, Barcelona, España
| | - María Jesús Cruz
- Servicio de Neumología, Hospital Vall d'Hebron, Barcelona, España; CIBER de Enfermedades Respiratorias (CIBERES), España
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Nomura T, Honda T, Kabashima K. Multipolarity of cytokine axes in the pathogenesis of atopic dermatitis in terms of age, race, species, disease stage and biomarkers. Int Immunol 2018. [DOI: 10.1093/intimm/dxy015] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Takashi Nomura
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8326, Japan
| | - Tetsuya Honda
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8326, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Sakyo-ku, Kyoto 606-8326, Japan
- Singapore Immunology Network (SIgN) and Institute of Medical Biology (IMB), Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore
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156
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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.
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157
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Wilson JL, Altman RB. Biomarkers: Delivering on the expectation of molecularly driven, quantitative health. Exp Biol Med (Maywood) 2018; 243:313-322. [PMID: 29199461 PMCID: PMC5813871 DOI: 10.1177/1535370217744775] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Biomarkers are the pillars of precision medicine and are delivering on expectations of molecular, quantitative health. These features have made clinical decisions more precise and personalized, but require a high bar for validation. Biomarkers have improved health outcomes in a few areas such as cancer, pharmacogenetics, and safety. Burgeoning big data research infrastructure, the internet of things, and increased patient participation will accelerate discovery in the many areas that have not yet realized the full potential of biomarkers for precision health. Here we review themes of biomarker discovery, current implementations of biomarkers for precision health, and future opportunities and challenges for biomarker discovery. Impact statement Precision medicine evolved because of the understanding that human disease is molecularly driven and is highly variable across patients. This understanding has made biomarkers, a diverse class of biological measurements, more relevant for disease diagnosis, monitoring, and selection of treatment strategy. Biomarkers' impact on precision medicine can be seen in cancer, pharmacogenomics, and safety. The successes in these cases suggest many more applications for biomarkers and a greater impact for precision medicine across the spectrum of human disease. The authors assess the status of biomarker-guided medical practice by analyzing themes for biomarker discovery, reviewing the impact of these markers in the clinic, and highlight future and ongoing challenges for biomarker discovery. This work is timely and relevant, as the molecular, quantitative approach of precision medicine is spreading to many disease indications.
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Affiliation(s)
- Jennifer L Wilson
- Bioengineering Department, Stanford University, Stanford, CA 94305, USA
| | - Russ B Altman
- Bioengineering Department, Stanford University, Stanford, CA 94305, USA
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
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158
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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.
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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
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Almela RM, Rubio CP, Cerón JJ, Ansón A, Tichy A, Mayer U. Selected serum oxidative stress biomarkers in dogs with non-food-induced and food-induced atopic dermatitis. Vet Dermatol 2018; 29:229-e82. [PMID: 29392808 DOI: 10.1111/vde.12525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Oxidative stress (OS) has been shown to be involved in the pathogenesis of human and canine atopic dermatitis (AD) through several distinct mechanisms. Selected serum biomarkers of OS (sbOS) have been validated in normal dogs and studied in several canine diseases. To the best of the authors' knowledge, the sbOS evaluated in this study have not previously been described in canine AD. HYPOTHESIS/OBJECTIVES The aims of the study were to evaluate a panel of sbOS in dogs with food-induced (FIAD) and non-food-induced (NFIAD) AD: cupric reducing antioxidant capacity (CUPRAC), ferrous oxidation-xylenol orange (FOX), ferric reducing ability of the plasma (FRAP), paraoxonase-1 (PON1), trolox equivalent antioxidant capacity (TEAC) and serum total thiol (THIOL). The aim was to compare these metabolites with those in healthy control dogs, and to correlate sbOS with validated pruritus and CADESI-04 severity scales in dogs with AD. ANIMALS Forty six healthy, nine NFIAD and three FIAD client-owned dogs were included. METHODS The study was designed as a cohort study. RESULTS There were significant differences in atopic dogs when compared to healthy dogs for all of the sbOS analysed. CONCLUSIONS AND CLINICAL RELEVANCE These findings suggest that OS could play a role in the pathogenesis of canine NFIAD and FIAD. In addition, the evaluation of sbOS could be useful for precision medicine to help to detect atopic dogs that might benefit from antioxidant-targeted therapies.
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Affiliation(s)
- Ramón M Almela
- Kleintierspezialisten Augsburg Überweisungszentrum, Max-Josef-Metzger Straße 9, 86157, Augsburg, Germany
| | - Camila P Rubio
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, 30100, Espinardo, Murcia, Spain
| | - José J Cerón
- Department of Animal Medicine and Surgery, Faculty of Veterinary Medicine, Regional Campus of International Excellence "Campus Mare Nostrum", University of Murcia, 30100, Espinardo, Murcia, Spain
| | - Agustina Ansón
- Veterinärmedizinische Universität Wien, Veterinärplatz 1, 1210, Vienna, Austria
| | - Alexander Tichy
- Veterinärmedizinische Universität Wien, Veterinärplatz 1, 1210, Vienna, Austria
| | - Ursula Mayer
- Kleintierspezialisten Augsburg Überweisungszentrum, Max-Josef-Metzger Straße 9, 86157, Augsburg, Germany
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160
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Pepper AN, Renz H, Casale TB, Garn H. Biologic Therapy and Novel Molecular Targets of Severe Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 5:909-916. [PMID: 28689841 DOI: 10.1016/j.jaip.2017.04.038] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 01/02/2023]
Abstract
Treatment options for severe or uncontrolled asthma are increasing, especially pertaining to novel biologic therapies. The 2 primary asthma endotypes, T2 high and T2 low, are defined by the level of type 2 T helper and innate lymphoid cell activity and mediators. Most therapies for severe asthma target T2 high asthma, including the 3 biologics approved for use in the United States and Europe: omalizumb, mepolizumb, and reslizumab. Other biologics, with various molecular targets, are under investigation. Unfortunately, treatment options for T2 low asthma are limited. Although these therapies may improve asthma symptoms, exacerbation rates, and lung function parameters, they have not been shown to modify the disease process or provide lasting benefits after discontinuation. Biomarkers identified thus far to help guide individualized therapy in severe asthma are helpful, but imperfect discriminators for picking the best option for individual patients. This review will discuss the mechanisms of action, indications, and therapeutic effects of currently available and emerging biologics for the treatment of severe or uncontrolled asthma.
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Affiliation(s)
- Amber N Pepper
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine and James A. Haley Veterans' Affairs Hospital, Tampa, Fla
| | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Medical Faculty, Philipps University of Marburg, Marburg, Germany
| | - Thomas B Casale
- Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine and James A. Haley Veterans' Affairs Hospital, Tampa, Fla.
| | - Holger Garn
- Institute of Laboratory Medicine and Pathobiochemistry, Medical Faculty, Philipps University of Marburg, Marburg, Germany
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161
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Kang SY, Song WJ, Cho SH, Chang YS. Time trends of the prevalence of allergic diseases in Korea: A systematic literature review. Asia Pac Allergy 2018; 8:e8. [PMID: 29423375 PMCID: PMC5796968 DOI: 10.5415/apallergy.2018.8.e8] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/27/2018] [Indexed: 11/30/2022] Open
Abstract
The prevalence of allergic diseases has increased dramatically in recent decades, and are now considered major chronic diseases at the global level. The increasing burden of allergic diseases has led to numerous worldwide and local researchers to investigate the time trends in its prevalence and identify its driving factors. Environmental changes such as urbanization and industrialization have been suggested to explain the increasing prevalence, but recent reports from Western countries suggest that this prevalence has reached a plateau or even possibly, started to decrease. However, such environmental changes are still occurring in many Asia-Pacific countries, including Korea, and it is speculated that the peak in allergy epidemics has yet to come. The present systematic literature review aimed to explore the time trends in the prevalence of allergic diseases in Korea and to identify the unmet needs for facilitating further studies.
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Affiliation(s)
- Sung-Yoon Kang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Woo-Jung Song
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Sang-Heon Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul 03080, Korea.,Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul 03080, Korea.,Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Korea
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162
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Eosinophils from Physiology to Disease: A Comprehensive Review. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9095275. [PMID: 29619379 PMCID: PMC5829361 DOI: 10.1155/2018/9095275] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/27/2017] [Indexed: 12/26/2022]
Abstract
Despite being the second least represented granulocyte subpopulation in the circulating blood, eosinophils are receiving a growing interest from the scientific community, due to their complex pathophysiological role in a broad range of local and systemic inflammatory diseases as well as in cancer and thrombosis. Eosinophils are crucial for the control of parasitic infections, but increasing evidence suggests that they are also involved in vital defensive tasks against bacterial and viral pathogens including HIV. On the other side of the coin, eosinophil potential to provide a strong defensive response against invading microbes through the release of a large array of compounds can prove toxic to the host tissues and dysregulate haemostasis. Increasing knowledge of eosinophil biological behaviour is leading to major changes in established paradigms for the classification and diagnosis of several allergic and autoimmune diseases and has paved the way to a "golden age" of eosinophil-targeted agents. In this review, we provide a comprehensive update on the pathophysiological role of eosinophils in host defence, inflammation, and cancer and discuss potential clinical implications in light of recent therapeutic advances.
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163
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Pfaar O, Bonini S, Cardona V, Demoly P, Jakob T, Jutel M, Kleine-Tebbe J, Klimek L, Klysner S, Kopp MV, Kuna P, Larché M, Muraro A, Schmidt-Weber CB, Shamji MH, Simonsen K, Somoza C, Valovirta E, Zieglmayer P, Zuberbier T, Wahn U. Perspectives in allergen immunotherapy: 2017 and beyond. Allergy 2018; 73 Suppl 104:5-23. [PMID: 29171712 DOI: 10.1111/all.13355] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 01/01/2023]
Abstract
The Future of the Allergists and Specific Immunotherapy (FASIT) workshop provides a regular platform for global experts from academia, allergy clinics, regulatory authorities and industry to review developments in the field of allergen immunotherapy (AIT). The most recent meeting, held in February 2017, had two main themes: advances in AIT and hot topics in AIT from the regulatory point of view. The first theme covered opportunities for personalized AIT, advances in adjuvants and delivery systems, and the development of new molecules and future vaccines for AIT. Key topics in the second part of the meeting were the effects of the enactment of European Directive 2001/83 on the availability of allergens for therapy and diagnosis across the EU, the challenges of conducting Phase 3 studies in the field, the future role of allergen exposure chambers in AIT studies and specific considerations in performing AIT studies in the paediatric population. Finally, the group highlighted the forthcoming EAACI guidelines and their particular importance for the standardization of practice in the treatment of allergies. This review presents a comprehensive insight into those panel discussions and highlights unmet needs and also possible solutions to them for the future.
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Affiliation(s)
- O. Pfaar
- Department of Otorhinolaryngology; Head and Neck Surgery; Universitätsmedizin Mannheim; Medical Faculty Mannheim; Heidelberg University; Mannheim Germany
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - S. Bonini
- Italian National Research Council; Institute of Translational Pharmacology; Rome, and University of Campania ‘Luigi Vanvitelli’; Naples Italy
- Expert-on Secondment at the European Medicines Agency; London UK
| | - V. Cardona
- Hospital Vall D'Hebron, S. Allergologia, S. Medicina Interna; Barcelona Spain
| | - P. Demoly
- Departement de Pneumologie et Addictologie; Hopital Arnaud de Villeneuve; University Hospital of Montpellier; Montpellier France
| | - T. Jakob
- Department of Dermatology and Allergology; University Medical Center Giessen (UKGM); Justus-Liebig-University Giessen; Giessen Germany
- Allergy Research Group; Department of Dermatology; Medical Center - University Freiburg; Freiburg Germany
| | - M. Jutel
- Department of Clinical Immunology; Wroclaw Medical University; Wroclaw Poland
- All-Med Medical Research Institute; Wroclaw Poland
| | - J. Kleine-Tebbe
- Allergy & Asthma Center Westend; Outpatient Clinic and Clinical Research Center; Berlin Germany
| | - L. Klimek
- Center for Rhinology and Allergology; Wiesbaden Germany
| | - S. Klysner
- Expres ion Biotechnologies Aps; Hørsholm Denmark
| | - M. V. Kopp
- Department of Pediatric Allergy and Pulmonology; University of Luebeck; Luebeck Germany
- Airway Research Center North (ARCN); Member of the Deutsches Zentrum für Lungenforschung (DZL); Luebeck Germany
| | - P. Kuna
- Department of Internal Medicine, Asthma and Allergy; Barlicki University Hospital; Medical University of Lodz; Lodz Poland
| | - M. Larché
- Divisions of Clinical Immunology & Allergy, and Respirology; Department of Medicine and Firestone Institute for Respiratory Health; McMaster University; Hamilton ON Canada
| | - A. Muraro
- Food Allergy Referral Centre; Padua University Hospital; Padua Italy
| | - C. B. Schmidt-Weber
- Center of Allergy and Environment (ZAUM); Member of the German Center for Lung Research (DZL); Technical University of Munich and Helmholtz Center Munich; Munich Germany
| | - M. H. Shamji
- Immunomodulation and Tolerance Group; Allergy and Clinical Immunology; Inflammation Repair and Development; National Heart and Lung Institute; Imperial College; London UK
- MRC & Asthma UK Centre in Allergic Mechanisms of Asthma; London UK
| | | | - C. Somoza
- Biological Products and Biotechnology Division; Medicines for Human Use Department; Agencia Española de Medicamentos y Productos Sanitarios (AEMPS); Madrid Spain
| | - E. Valovirta
- Department of Lung Disease and Clinical Allergology; University of Turku and Terveystalo Allergy Clinic; Turku Finland
| | - P. Zieglmayer
- Allergy Center Vienna West; Vienna Challenge Chamber; Vienna Austria
| | - T. Zuberbier
- Comprehensive Allergy-Centre-Charité; Department of Dermatology and Allergy; Charité - Universitätsmedizin Berlin; Berlin Germany
- Member of Global Allergy and Asthma European Network (GA LEN); GA LEN coordinating Office; Charité - Universitätsmedizin Berlin; Germany
| | - U. Wahn
- Department for Pediatric Pneumology and Immunology; Charité - Universitätsmedizin Berlin; Berlin Germany
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164
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Economic Impact of Atopic Dermatitis in Adults: A Population-Based Study (IDEA Study). ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.adengl.2017.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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165
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Hellings PW, Borrelli D, Pietikainen S, Agache I, Akdis C, Bachert C, Bewick M, Botjes E, Constantinidis J, Fokkens W, Haahtela T, Hopkins C, Illario M, Joos G, Lund V, Muraro A, Pugin B, Seys S, Somekh D, Stjärne P, Valiulis A, Valovirta E, Bousquet J. European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases: report of the European Union Parliament Summit (29 March 2017). Clin Transl Allergy 2017; 7:49. [PMID: 29299230 PMCID: PMC5745781 DOI: 10.1186/s13601-017-0186-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 12/15/2017] [Indexed: 01/19/2023] Open
Abstract
On March 29, 2017, a European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases (CRD) was organized by the European Forum for Research and Education in Allergy and Airway Diseases. The event took place in the European Parliament of Brussels and was hosted by MEP David Borrelli and MEP Sirpa Pietikainen. The aim of the Summit was to correspond to the needs of the European Commission and of patients suffering from CRD to join forces in Europe for the prevention and self-management. Delegates of the European Rhinologic Society, European Respiratory Society, European Academy of Allergy and Clinical Immunology, European Academy of Paediatrics, and European Patients Organization EFA all lectured on their vision and action plan to join forces in achieving adequate prevention and self-management of CRD in the context of Precision Medicine. Recent data highlight the preventive capacity of education on optimal care pathways for CRD. Self-management and patient empowerment can be achieved by novel educational on-line materials and by novel mobile health tools enabling patients and doctors to monitor and optimally treat CRDs based on the level of control. This report summarizes the contributions of the representatives of different European academic stakeholders in the field of CRD.
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Affiliation(s)
- Peter W. Hellings
- Department of Otorhinolaryngology, University Hospitals Leuven, KU Leuven, Louvain, Belgium
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - David Borrelli
- Italian Member of the European Parliament, EFDD Group, Brussels, Belgium
| | | | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Cezmi Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
| | | | - Erna Botjes
- EFA - European Federation of Allergy and Airways Diseases Patients’ Associations, Brussels, Belgium
| | - Jannis Constantinidis
- 1st Department of ORL, Head and Neck Surgery, Aristotle University, Thessaloníki, Greece
| | - Wytske Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Claire Hopkins
- ENT Department, Guy’s and St Thomas’ Hospitals, London, UK
| | - Maddalena Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | - Guy Joos
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Valerie Lund
- Royal National Throat, Nose and Ear Hospital, University College London Hospitals, London, UK
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Benoit Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - Sven Seys
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
- Lab of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Brussels, Belgium
| | - David Somekh
- European Health Futures Forum (EHFF), Isle of Wright, UK
| | - Pär Stjärne
- Rhinology Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Arunas Valiulis
- Vilnius University Clinic of Children’s Diseases and Public Health Institute, Vilnius, Lithuania
- European Academy of Paediatrics (EAP/UEMS-SP), Brussels, Belgium
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Allergology, Univ. of Turku, and Allergy Clinic, Terveystalo, Turku, Finland
| | - Jean Bousquet
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France
- INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Villejuif, Montigny le Bretonneux, France
- EUFOREA aisbl, 132, Ave. Brand Whitlock, 1200 Brussels, Belgium
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166
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Tabatabaian F, Ledford DK, Casale TB. Biologic and New Therapies in Asthma. Immunol Allergy Clin North Am 2017; 37:329-343. [PMID: 28366480 DOI: 10.1016/j.iac.2017.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Several biologics are currently FDA approved for asthma that target Th2 high patients. Unfortunately, 50% of patients with severe asthma do not fit this phenotype of disease and have fewer effective therapeutic options. In the clinical setting, total IgE, FeNO and peripheral blood eosinophils are important tools in defining Th2 high patients with asthma. However, precise biomarkers to predict better response to one specific Th2 high asthma therapy versus another is lacking. It is important to recognize that none of the current medications targeting the Th2 pathway induces persistent immunomodulation or remission.
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Affiliation(s)
- Farnaz Tabatabaian
- Division of Allergy and Immunology, Department of Internal medicine, Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr. 5th Floor, MDC 80, Tampa, FL 33612-4799, USA
| | - Dennis K Ledford
- Division of Allergy and Immunology, Department of Internal medicine, Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr. 5th Floor, MDC 80, Tampa, FL 33612-4799, USA; Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, James A. Haley VA Hospital, University of South Florida, 13000 Bruce B, Downs Boulevard, Tampa, FL 33612, USA
| | - Thomas B Casale
- Division of Allergy and Immunology, Department of Internal medicine, Morsani College of Medicine, University of South Florida, 13330 USF Laurel Dr. 5th Floor, MDC 80, Tampa, FL 33612-4799, USA; Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, 12901 Bruce B Downs Boulevard, MDC 19, Tampa, FL 33612 USA.
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167
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Kumar S, Ward BR, Irani AM. Future Prospects of Biologic Therapies for Immunologic Diseases. Immunol Allergy Clin North Am 2017; 37:431-448. [PMID: 28366486 DOI: 10.1016/j.iac.2017.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This article presents an overview of future uses for biologic therapies in the treatment of immunologic and allergic conditions. Discussion is centered on the use of existing therapies outside of their current indication or on new therapies that are close to approval. This information may help familiarize practicing allergists and immunologists with therapies they may soon encounter in their practice as well as help identify conditions and treatments that will require further study in the near future.
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Affiliation(s)
- Santhosh Kumar
- Division of Allergy and Immunology, Children's Hospital of Richmond, Virginia Commonwealth University, CHoR Pavilion, 5th Floor, 1000 East Broad Street, Richmond, VA 23298-0225, USA.
| | - Brant R Ward
- Division of Allergy and Immunology, Children's Hospital of Richmond, Virginia Commonwealth University, CHoR Pavilion, 5th Floor, 1000 East Broad Street, Richmond, VA 23298-0225, USA; Division of Rheumatology, Allergy, and Immunology, Virginia Commonwealth University, McGuire Hall, Room 4-115A, 1112 East Clay Street, Richmond, VA 23298-0263, USA; Department of Microbiology and Immunology, Virginia Commonwealth University, 1101 East Marshall Street, P.O. Box 980678, Richmond, VA 23298, USA
| | - Anne-Marie Irani
- Division of Allergy and Immunology, Children's Hospital of Richmond, Virginia Commonwealth University, CHoR Pavilion, 5th Floor, 1000 East Broad Street, Richmond, VA 23298-0225, USA
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168
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Martinez FD, Kraft M. AJRCCM: 100-Year Anniversary. Focus on Asthma in Children and Adults. Am J Respir Crit Care Med 2017; 195:1085-1088. [PMID: 28459319 DOI: 10.1164/rccm.201702-0301ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Fernando D Martinez
- 1 Asthma and Airway Disease Research Center University of Arizona Health Sciences Tucson, Arizona
| | - Monica Kraft
- 1 Asthma and Airway Disease Research Center University of Arizona Health Sciences Tucson, Arizona
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169
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Abstract
PURPOSE OF REVIEW In this review, we will integrate recent knowledge on endoplasmic reticulum (ER) stress and allergy, thereby highlighting the therapeutic potential of ER stress in the context of precision medicine for allergic diseases. RECENT FINDINGS Emerging evidence suggests that allergic diseases are very heterogeneous having numerous endotypes. This leads to the new era of modern medicine, which assumes that a particular endotype-driven therapy, called precision medicine, would be more efficacious in a specific group of patients rather than in all patients. Currently, a dichotomy involving type 2/non-type 2 immune response underlies most of the studies on inflammatory and immunologic mechanisms of allergic disorders. Whereas there are several approved or investigational endotype-driven therapeutic agents targeting type 2 immune responses, investigation of mechanisms and endotype-driven interventions regarding non-type 2 immune response lags far behind. Considering that non-type 2 immune response may represent a significant proportion of allergic disease, particularly corticosteroid-resistant severe disease, defining a novel concept of endotype-driven approach may be essential. Recently, stress responses originate from the endoplasmic reticulum (ER) and the associated inflammatory molecular platform has been suggested as a crucial player of immune and inflammatory responses. This implies that ER stress-related pathways may represent a new endotype-driven therapeutic strategy in the treatment of allergic diseases.
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Affiliation(s)
- Jae Seok Jeong
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, san 2-20, Geumam-dong, Deokjin-gu, Jeonju, 561-180, South Korea
| | - So Ri Kim
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, san 2-20, Geumam-dong, Deokjin-gu, Jeonju, 561-180, South Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, 561-180, South Korea
| | - Seong Ho Cho
- Division of Allergy and Immunology, Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, USA
| | - Yong Chul Lee
- Department of Internal Medicine, Research Center for Pulmonary Disorders, Chonbuk National University Medical School, san 2-20, Geumam-dong, Deokjin-gu, Jeonju, 561-180, South Korea.
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, San 2-20 Geumam-dong, Deokjin-gu, Jeonju, 561-180, South Korea.
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170
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Sicras-Mainar A, Navarro-Artieda R, Carrascosa Carrillo JM. Economic Impact of Atopic Dermatitis in Adults: A Population-Based Study (IDEA Study). ACTAS DERMO-SIFILIOGRAFICAS 2017; 109:35-46. [PMID: 29126499 DOI: 10.1016/j.ad.2017.09.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 09/01/2017] [Accepted: 09/10/2017] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To determine resource usage and costs associated with atopic dermatitis in adults according to severity and comorbid conditions in daily clinical practice. PATIENTS AND METHODS We performed an observational, retrospective study based on a review of registries of patients aged ≥18 years who sought health care in 2013 and 2014 in an area of Catalonia, Spain, with a population of 215,634 persons. We established 3 classes of severity depending on the treatment prescribed. The variables evaluated were total comorbid conditions, concomitant/specific medication, and direct/indirect health care costs. The statistical analysis was based on multiple regression models. Statistical significance was set at P<.05. RESULTS We included 6,186 patients with a diagnosis of atopic dermatitis (mean age, 47.1 years; women, 61.6%). We established 3 groups based on severity, as follows: mild (n=3,445 [55.7%]); moderate (n=2,361 [38.2%]); and severe (n=380 [6.1%]). Severe atopic dermatitis was associated with risk of presenting comorbid conditions (β=0.192), namely, asthma (β=0.138), depression (β=0.099), cardiovascular events (β=0.087), obesity (β=0.085), and smoking (β=0.025); P<.001. Costs reached €9.3 million (health care costs, 75.5%; loss of productivity, 24.5%), with an average unit cost of €1,504 per year. The corrected average unit cost (ANCOVA) was greater in severe atopic dermatitis compared with moderate and mild disease (€3,397 vs. €2,111 vs. €885; P<.001), respectively. CONCLUSIONS Severe atopic dermatitis generates considerable usage of health care resources and high costs for the National Health System. These are in proportion with the severity of the disease. General comorbid conditions and asthma were the factors with the greatest impact on health care costs.
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Affiliation(s)
- A Sicras-Mainar
- Red de Investigación en Servicios Sanitarios (Fundación REDISS), Barcelona, España
| | - R Navarro-Artieda
- Documentación Médica, Hospital Germans Trias i Pujol, Badalona, Barcelona, España
| | - J M Carrascosa Carrillo
- Servicio de Dermatología, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Barcelona, España.
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Sakano E, Sarinho ESC, Cruz AA, Pastorino AC, Tamashiro E, Kuschnir F, Castro FFM, Romano FR, Wandalsen GF, Chong-Neto HJ, Mello JFD, Silva LR, Rizzo MC, Miyake MAM, Rosário Filho NA, Rubini NDPM, Mion O, Camargos PA, Roithmann R, Godinho RN, Pignatari SSN, Sih T, Anselmo-Lima WT, Solé D. IV Brazilian Consensus on Rhinitis - an update on allergic rhinitis. Braz J Otorhinolaryngol 2017; 84:S1808-8694(17)30187-8. [PMID: 29254864 PMCID: PMC9442845 DOI: 10.1016/j.bjorl.2017.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/16/2017] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The guidelines on allergic rhinitis aim to update knowledge about the disease and care for affected patients. The initiative called "Allergic Rhinitis and its Impact on Asthma", initially published in 2001 and updated in 2008 and 2010, has been very successful in disseminating information and evidence, as well as providing a classification of severity and proposing a systemized treatment protocol. In order to include the participation of other medical professionals in the treatment of allergic rhinitis, it is important to develop algorithms that accurately indicate what should and can be done regionally. OBJECTIVE To update the III Brazilian Consensus on Rhinitis - 2012, with the creation of an algorithm for allergic rhinitis management. METHODS We invited 24 experts nominated by the Brazilian Association of Allergy and Immunology, Brazilian Association of Otorhinolaryngology and Head and Neck Surgery and Brazilian Society of Pediatrics to update the 2012 document. RESULTS The update of the last Brazilian Consensus on Rhinitis incorporated and adapted the relevant information published in all "Allergic Rhinitis and its Impact on Asthma" Initiative documents to the Brazilian scenario, bringing new concepts such as local allergic rhinitis, new drugs and treatment evaluation methods. CONCLUSION A flowchart for allergic rhinitis treatment has been proposed.
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Affiliation(s)
- Eulalia Sakano
- Universidade Estadual de Campinas (Unicamp), Faculdade de Ciências Médicas, Departamento de Oftalmologia e Otorrinolaringologia, Campinas, SP, Brazil; Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil.
| | - Emanuel S C Sarinho
- Universidade Federal de Pernambuco (UFPE), Faculdade de Medicina, Departamento de Pediatria, Recife, PE, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Alvaro A Cruz
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria - Instituto da Criança, Salvador, BA, Brazil; Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil
| | - Antonio C Pastorino
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Department of Pediatrics - Instituto da Criança, São Paulo, SP, Brazil
| | - Edwin Tamashiro
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Fábio Kuschnir
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Faculdade de Medicina, Departamento de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Fábio F M Castro
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Medicina - Divisão de Imunologia Clínica e Alergia, São Paulo, SP, Brazil
| | - Fabrizio R Romano
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Gustavo F Wandalsen
- Universidade Federal de Pernambuco (UFPE), Faculdade de Medicina, Departamento de Pediatria, Recife, PE, Brazil; Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil
| | - Herberto J Chong-Neto
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal do Paraná (UFPR), Departamento de Pediatria, Curitiba, PR, Brazil
| | - João F de Mello
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Luciana R Silva
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Pediatria, Salvador, BA, Brazil
| | - Maria Cândida Rizzo
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Cidade de São Paulo (UNICID), Faculdade de Medicina, São Paulo, SP, Brazil
| | - Mônica A M Miyake
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Hospital Sirio-Libanês, Núcleo de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Nelson A Rosário Filho
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Paraná (UFPR), Departamento de Pediatria, Curitiba, PR, Brazil
| | - Norma de Paula M Rubini
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Departamento de Medicina, Divisão de Alergia e Imunologia, Rio de Janeiro, RJ, Brazil
| | - Olavo Mion
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Paulo A Camargos
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade Federal de Minas Gerais (UFMG), Departamento de Pediatria, Divisão de Pneumologia, Belo Horizonte, MG, Brazil
| | - Renato Roithmann
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade Luterana do Brasil (ULBRA), Departamento de Otorrinolaringologia, Canoas, RS, Brazil
| | - Ricardo N Godinho
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Pontifícia Universidade Católica de Minas Gerais (PUC-MG), Instituto de Ciências Biológicas e da Saúde, Belo Horizonte, MG, Brazil
| | - Shirley Shizue N Pignatari
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil
| | - Tania Sih
- Sociedade Brasileira de Pediatria, Rio de Janeiro, RJ, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, São Paulo, SP, Brazil
| | - Wilma T Anselmo-Lima
- Associação Brasileira de Otorrinolaringologia e Cirurgia Crânio-Facial, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina de Ribeirão Preto (FMRP), Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Ribeirão Preto, SP, Brazil
| | - Dirceu Solé
- Associação Brasileira de Alergia e Imunologia, São Paulo, SP, Brazil; Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Pediatria - Divisão de Alergia, Imunologia Clínica e Reumatologia, São Paulo, SP, Brazil
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172
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Rodriguez‐Perez N, Schiavi E, Frei R, Ferstl R, Wawrzyniak P, Smolinska S, Sokolowska M, Sievi N, Kohler M, Schmid‐Grendelmeier P, Michalovich D, Simpson K, Hessel E, Jutel M, Martin‐Fontecha M, Palomares O, Akdis C, O'Mahony L. Altered fatty acid metabolism and reduced stearoyl-coenzyme a desaturase activity in asthma. Allergy 2017; 72:1744-1752. [PMID: 28397284 DOI: 10.1111/all.13180] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Fatty acids and lipid mediator signaling play an important role in the pathogenesis of asthma, yet this area remains largely underexplored. The aims of this study were (i) to examine fatty acid levels and their metabolism in obese and nonobese asthma patients and (ii) to determine the functional effects of altered fatty acid metabolism in experimental models. METHODS Medium- and long-chain fatty acid levels were quantified in serum from 161 human volunteers by LC/MS. Changes in stearoyl-coenzyme A desaturase (SCD) expression and activity were evaluated in the ovalbumin (OVA) and house dust mite (HDM) murine models. Primary human bronchial epithelial cells from asthma patients and controls were evaluated for SCD expression and activity. RESULTS The serum desaturation index (an indirect measure of SCD) was significantly reduced in nonobese asthma patients and in the OVA murine model. SCD1 gene expression was significantly reduced within the lungs following OVA or HDM challenge. Inhibition of SCD in mice promoted airway hyper-responsiveness. SCD1 expression was suppressed in bronchial epithelial cells from asthma patients. IL-4 and IL-13 reduced epithelial cell SCD1 expression. Inhibition of SCD reduced surfactant protein C expression and suppressed rhinovirus-induced IP-10 secretion, which was associated with increased viral titers. CONCLUSIONS This is the first study to demonstrate decreased fatty acid desaturase activity in humans with asthma. Experimental models in mice and human epithelial cells suggest that inhibition of desaturase activity leads to airway hyper-responsiveness and reduced antiviral defense. SCD may represent a new target for therapeutic intervention in asthma patients.
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Affiliation(s)
- N. Rodriguez‐Perez
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - E. Schiavi
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - R. Frei
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - R. Ferstl
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - P. Wawrzyniak
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - S. Smolinska
- Department of Clinical ImmunologyWroclaw Medical University Wroclaw Poland
- ”ALL‐MED” Medical Research Institute Wroclaw Poland
| | - M. Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - N.A. Sievi
- Pulmonary Division University Hospital of Zürich Zürich Switzerland
| | - M. Kohler
- Pulmonary Division University Hospital of Zürich Zürich Switzerland
| | - P. Schmid‐Grendelmeier
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Allergy Unit Department of Dermatology University Hospital of Zürich Zürich Switzerland
| | - D. Michalovich
- Refractory Respiratory Inflammation Discovery Performance Unit GlaxoSmithKlineStevenage UK
| | - K.D. Simpson
- Refractory Respiratory Inflammation Discovery Performance Unit GlaxoSmithKlineStevenage UK
| | - E.M. Hessel
- Refractory Respiratory Inflammation Discovery Performance Unit GlaxoSmithKlineStevenage UK
| | - M. Jutel
- Department of Clinical ImmunologyWroclaw Medical University Wroclaw Poland
- ”ALL‐MED” Medical Research Institute Wroclaw Poland
| | - M. Martin‐Fontecha
- Departamento de Química Orgánica I Facultad de Ciencias Químicas Universidad Complutense de Madrid Madrid Spain
| | - O. Palomares
- Department of Biochemistry and Molecular Biology School of Chemistry Complutense University Madrid Spain
| | - C.A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - L. O'Mahony
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
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173
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Bachert C, Akdis CA. Phenotypes and Emerging Endotypes of Chronic Rhinosinusitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 4:621-8. [PMID: 27393777 DOI: 10.1016/j.jaip.2016.05.004] [Citation(s) in RCA: 161] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 02/05/2023]
Abstract
Chronic rhinosinusitis can be differentiated into several phenotypes based on clinical criteria; however, these phenotypes do not teach us much about the underlying inflammatory mechanisms. Thus, the use of nasal endoscopy and CT scanning, and eventually taking a swab or a biopsy, may not be sufficient to fully appreciate the individual patient's pathology. Endotyping of chronic rhinosinusitis on the basis of pathomechanisms, functionally and pathologically different from others by the involvement of specific molecules or cells, may in contrast provide us with information on the risk of disease progression or recurrence and on the best available treatment, and also helps us identifying innovative therapeutic targets for treatment. Endotyping may best be structured around T helper cells and their downstream events, such as tissue eosinophilia or neutrophilia; this approach involves the cytokines and chemokines related to specific T helper cell populations, and related markers such as IgE. Endotyping is of specific interest at the time of the arrival of new biologicals, confronting us with the challenge of the selection of eligible patients for treatment and predicting their therapeutic response; defining suitable biomarkers is therefore an urgent task. Failure to appreciate the underlying mechanisms and endotypes of chronic rhinosinusitis may limit progress in the management of the disease at present.
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Affiliation(s)
- Claus Bachert
- Upper Airways Research Laboratory, Ghent University, Ghent, Belgium; Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
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174
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Evanescence wave-based technology for the rapid and sensitive quantification of biological analytes. J Allergy Clin Immunol 2017; 141:817-820.e5. [PMID: 29074455 DOI: 10.1016/j.jaci.2017.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 08/25/2017] [Accepted: 08/29/2017] [Indexed: 11/23/2022]
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175
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Matera MG, Rinaldi B, Calzetta L, Cazzola M. Pharmacogenetic and pharmacogenomic considerations of asthma treatment. Expert Opin Drug Metab Toxicol 2017; 13:1159-1167. [PMID: 28992739 DOI: 10.1080/17425255.2017.1391215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pharmacogenetic and pharmacogenomic approaches are already utilized in some areas, such as oncology and cardiovascular disease, for selecting appropriate patients and/or establishing treatment and dosing guidelines. This is not true in asthma although many patients have different responses to drug treatment due to genetic factors. Areas covered: Several genetic factors that affect the pharmacotherapeutic responses to asthma medications, such as β2-AR agonists, corticosteroids, and leukotriene modifiers and could contribute to significant between-person variability in response are described. Expert opinion: An expanding number of genetic loci have been associated with therapeutic responses to asthma drugs but the individual effect of one single-nucleotide polymorphism is partial. In fact, epigenetic changes can modify genetic effects in time-, environment-, and tissue-specific manners, genes interact together in networks, and nongenetic components such as environmental exposures, gender, nutrients, and lifestyle can significantly interact with genetics to determine the response to therapy. Therefore, well-designed randomized controlled trials or observational studies are now mandatory to define if response to asthma medications in individual patients can be improved by using pharmacogenetic predictors of treatment response. Meanwhile, routine implementation of pharmacogenetics and pharmacogenomics into clinical practice remains a futuristic, far-off challenge for many clinical practices.
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Affiliation(s)
- Maria Gabriella Matera
- a Department of Experimental Medicine , University of Campania Luigi Vanvitelli , Naples , Italy
| | - Barbara Rinaldi
- a Department of Experimental Medicine , University of Campania Luigi Vanvitelli , Naples , Italy
| | - Luigino Calzetta
- b Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
| | - Mario Cazzola
- b Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy
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176
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Agache I, Strasser DS, Pierlot GM, Farine H, Izuhara K, Akdis CA. Monitoring inflammatory heterogeneity with multiple biomarkers for multidimensional endotyping of asthma. J Allergy Clin Immunol 2017; 141:442-445. [PMID: 28987809 DOI: 10.1016/j.jaci.2017.08.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 08/29/2017] [Accepted: 08/31/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania.
| | - Daniel S Strasser
- Department of Translational Science, Idorsia Pharmaceuticals Ltd, Basel, Switzerland
| | - Gabin M Pierlot
- Department of Translational Science, Idorsia Pharmaceuticals Ltd, Basel, Switzerland
| | - Hervé Farine
- Department of Translational Science, Idorsia Pharmaceuticals Ltd, Basel, Switzerland
| | - Kenji Izuhara
- Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - Cezmi A Akdis
- Swiss Institute for Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
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177
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Nwaru BI, Friedman C, Halamka J, Sheikh A. Can learning health systems help organisations deliver personalised care? BMC Med 2017; 15:177. [PMID: 28965492 PMCID: PMC5623976 DOI: 10.1186/s12916-017-0935-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/22/2017] [Indexed: 02/06/2023] Open
Abstract
There is increasing international policy and clinical interest in developing learning health systems and delivering precision medicine, which it is hoped will help reduce variation in the quality and safety of care, improve efficiency, and lead to increasing the personalisation of healthcare. Although reliant on similar policies, informatics tools, and data science and implementation research capabilities, these two major initiatives have thus far largely progressed in parallel. In this opinion piece, we argue that they should be considered as complementary, synergistic initiatives whereby the creation of learning health systems infrastructure can support and catalyse the delivery of precision medicine that maximises the benefits and minimises the risks associated with treatments for individual patients. We illustrate this synergy by considering the example of treatments for asthma, which is now recognised as an umbrella term for a heterogeneous group of related conditions.
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Affiliation(s)
- Bright I Nwaru
- Krefting Research Centre, Department of Internal Medicine, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Charles Friedman
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - John Halamka
- Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Aziz Sheikh
- Krefting Research Centre, Department of Internal Medicine, University of Gothenburg, Gothenburg, Sweden.
- Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA.
- Asthma UK Centre for Applied Research, Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK.
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178
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Yilmaz I, Terl M. Asthma management: A new phenotype-based approach using presence of eosinophilia and allergy. Allergy 2017; 72:1587-1589. [PMID: 28905457 DOI: 10.1111/all.13188] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- I. Yilmaz
- Department of Chest Diseases, Division of Immunology and Allergy; Erciyes University School of Medicine; Kayseri Turkey
| | - M. Terl
- Department of Pulmonary Medicine, University Hospital and Faculty of Medicine in Pilsen; Charles University; Prague Czech Republic
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179
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van de Veen W, Wirz OF, Globinska A, Akdis M. Novel mechanisms in immune tolerance to allergens during natural allergen exposure and allergen-specific immunotherapy. Curr Opin Immunol 2017; 48:74-81. [DOI: 10.1016/j.coi.2017.08.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 01/22/2023]
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180
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Advances and highlights in allergen immunotherapy: On the way to sustained clinical and immunologic tolerance. J Allergy Clin Immunol 2017; 140:1250-1267. [PMID: 28941667 DOI: 10.1016/j.jaci.2017.08.025] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/17/2017] [Accepted: 08/21/2017] [Indexed: 12/11/2022]
Abstract
Allergen immunotherapy (AIT) is an effective treatment strategy for allergic diseases and has been used for more than 100 years. In recent years, however, the expectations on concepts, conduct, statistical evaluation, and reporting have developed significantly. Products have undergone dose-response and confirmative studies in adults and children to provide evidence for the optimal dosage, safety, and efficacy of AIT vaccines using subcutaneous and sublingual delivery pathways in large patient cohorts, ensuring solid conclusions to be drawn from them for the advantage of patients and societies alike. Those standards should be followed today, and products answering to them should be preferred over others lacking optimization and proof of efficacy and safety. Molecular and cellular mechanisms of AIT include early mast cell and basophil desensitization effects, regulation of T- and B-cell responses, regulation of IgE and IgG4 production, and inhibition of responses from eosinophils, mast cells, and basophils in the affected tissues. There were many developments to improve vaccination strategies, demonstration of new molecules involved in molecular mechanisms, and demonstration of new biomarkers for AIT during the last few years. The combination of probiotics, vitamins, and biological agents with AIT is highlighting current advances. Development of allergoids and recombinant and hypoallergenic vaccines to skew the immune response from IgE to IgG4 and regulation of dendritic cell, mast cell, basophil, innate lymphoid cell, T-cell, and B-cell responses to allergens are also discussed in detail.
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181
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Kabashima K, Nomura T. Revisiting murine models for atopic dermatitis and psoriasis with multipolar cytokine axes. Curr Opin Immunol 2017; 48:99-107. [PMID: 28915378 DOI: 10.1016/j.coi.2017.08.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 07/18/2017] [Accepted: 08/16/2017] [Indexed: 12/18/2022]
Abstract
Atopic dermatitis (AD) and psoriasis are one of the common skin diseases. Animal models are a powerful tool to analyze these diseases, which are complicated by multiple cytokine pathways. However, many discrepancies between the human diseases and murine models have been noticed. Therefore, investigators should be aware of the differences between the murine AD models and human AD when translating murine data to human skin diseases. This review highlights the differences between the inflammatory profiles between murine models and human diseases focusing on AD and psoriasis.
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Affiliation(s)
- Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara, Sakyoku, Kyoto 606-8507, Japan; Singapore Immunology Network (SIgN) and Institute of Medical Biology, Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore.
| | - Takashi Nomura
- Department of Dermatology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara, Sakyoku, Kyoto 606-8507, Japan
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182
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Immune monitoring for precision medicine in allergy and asthma. Curr Opin Immunol 2017; 48:82-91. [PMID: 28889067 DOI: 10.1016/j.coi.2017.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/01/2017] [Accepted: 08/16/2017] [Indexed: 11/22/2022]
Abstract
'Precision Medicine' embodies the analyses of extensive data collected from patients and their environments to identify and apply patient-specific prophylactic strategies and medical treatments to improve clinical outcomes and healthcare cost-effectiveness. Many new methods have been developed for evaluating the activity of the human immune system. Such 'immune monitoring' approaches are now being used in studies of allergy and asthma in the hope of identifying better correlates of disease status, predictors of therapeutic outcomes, and potential side-effects of treatment. Together with analyses of family histories, genetic and other biometric data, and measurements of exposures to environmental and other risk factors for developing or exacerbating disease, immune monitoring approaches promise to enable 'Precision Medicine' for allergic diseases and asthma.
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Hellings PW, Fokkens WJ, Bachert C, Akdis CA, Bieber T, Agache I, Bernal-Sprekelsen M, Canonica GW, Gevaert P, Joos G, Lund V, Muraro A, Onerci M, Zuberbier T, Pugin B, Seys SF, Bousquet J. Positioning the principles of precision medicine in care pathways for allergic rhinitis and chronic rhinosinusitis - A EUFOREA-ARIA-EPOS-AIRWAYS ICP statement. Allergy 2017; 72:1297-1305. [PMID: 28306159 DOI: 10.1111/all.13162] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2017] [Indexed: 12/20/2022]
Abstract
Precision medicine (PM) is increasingly recognized as the way forward for optimizing patient care. Introduced in the field of oncology, it is now considered of major interest in other medical domains like allergy and chronic airway diseases, which face an urgent need to improve the level of disease control, enhance patient satisfaction and increase effectiveness of preventive interventions. The combination of personalized care, prediction of treatment success, prevention of disease and patient participation in the elaboration of the treatment plan is expected to substantially improve the therapeutic approach for individuals suffering from chronic disabling conditions. Given the emerging data on the impact of patient stratification on treatment outcomes, European and American regulatory bodies support the principles of PM and its potential advantage over current treatment strategies. The aim of the current document was to propose a consensus on the position and gradual implementation of the principles of PM within existing adult treatment algorithms for allergic rhinitis (AR) and chronic rhinosinusitis (CRS). At the time of diagnosis, prediction of success of the initiated treatment and patient participation in the decision of the treatment plan can be implemented. The second-level approach ideally involves strategies to prevent progression of disease, in addition to prediction of success of therapy, and patient participation in the long-term therapeutic strategy. Endotype-driven treatment is part of a personalized approach and should be positioned at the tertiary level of care, given the efforts needed for its implementation and the high cost of molecular diagnosis and biological treatment.
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Affiliation(s)
- P. W. Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery; UZ Leuven; Leuven Belgium
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
- Department of Otorhinolaryngology-Head and Neck Surgery; Upper Airways Research Laboratory; Ghent University; Ghent Belgium
| | - W. J. Fokkens
- Department of Otorhinolaryngology; Academic Medical Center; Amsterdam The Netherlands
| | - C. Bachert
- Department of Otorhinolaryngology-Head and Neck Surgery; Upper Airways Research Laboratory; Ghent University; Ghent Belgium
- Department of Otorhinolaryngology; Karolinska Institute; Stockholm Sweden
| | - C. A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); Christine-Kühne Center for Allergy Research and Education; University of Zurich; Davos Switzerland
| | - T. Bieber
- Department of Dermatology and Allergy; Christine Kühne-Center for Allergy Research and Education; Friedrich-Wilhelms-University; Bonn Germany
| | - I. Agache
- Faculty of Medicine; Transylvania University; Brasov Romania
| | - M. Bernal-Sprekelsen
- Department of Otorhinolaryngology; Hospital Clínic Universitari; Barcelona Spain
| | - G. W. Canonica
- Department of Biomedical Science; Personalized Medicine Clinic Asthma & Allergy; Humanitas Clinical and Research Center; Humanitas University - Rozzano (Milano); Rozzano Italy
| | - P. Gevaert
- Department of Otorhinolaryngology-Head and Neck Surgery; Upper Airways Research Laboratory; Ghent University; Ghent Belgium
| | - G. Joos
- Department of Respiratory Medicine; Ghent University; Ghent Belgium
| | - V. Lund
- Royal National Throat, Nose and Ear Hospital; University College London Hospitals; London UK
| | - A. Muraro
- Department of Women and Child Health; Food Allergy Referral Centre Veneto Region; Padua General University Hospital; Padua Italy
| | - M. Onerci
- Department of Otorhinolaryngology Head and Neck Surgery; Hacettepe University Faculty of Medicine; Ankara Turkey
| | - T. Zuberbier
- Department of Dermatology and Allergy; Comprehensive Allergy-Centre-Charité; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - B. Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA); Brussels Belgium
| | - S. F. Seys
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA); Brussels Belgium
- Department of Immunology and Microbiology; Laboratory of Clinical Immunology; KU Leuven; Leuven Belgium
| | - J. Bousquet
- Department of Respiratory Disease; University Hospital Arnaud de Villeneuve; Montpellier France
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184
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Loxham M, Davies DE. Phenotypic and genetic aspects of epithelial barrier function in asthmatic patients. J Allergy Clin Immunol 2017; 139:1736-1751. [PMID: 28583446 PMCID: PMC5457128 DOI: 10.1016/j.jaci.2017.04.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 12/22/2022]
Abstract
The bronchial epithelium is continuously exposed to a multitude of noxious challenges in inhaled air. Cellular contact with most damaging agents is reduced by the action of the mucociliary apparatus and by formation of a physical barrier that controls passage of ions and macromolecules. In conjunction with these defensive barrier functions, immunomodulatory cross-talk between the bronchial epithelium and tissue-resident immune cells controls the tissue microenvironment and barrier homeostasis. This is achieved by expression of an array of sensors that detect a wide variety of viral, bacterial, and nonmicrobial (toxins and irritants) agents, resulting in production of many different soluble and cell-surface molecules that signal to cells of the immune system. The ability of the bronchial epithelium to control the balance of inhibitory and activating signals is essential for orchestrating appropriate inflammatory and immune responses and for temporally modulating these responses to limit tissue injury and control the resolution of inflammation during tissue repair. In asthmatic patients abnormalities in many aspects of epithelial barrier function have been identified. We postulate that such abnormalities play a causal role in immune dysregulation in the airways by translating gene-environment interactions that underpin disease pathogenesis and exacerbation.
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Affiliation(s)
- Matthew Loxham
- Clinical and Experimental Sciences and the Southampton NIHR Respiratory Biomedical Research Unit, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, University Hospital Southampton, Southampton, United Kingdom
| | - Donna E Davies
- Clinical and Experimental Sciences and the Southampton NIHR Respiratory Biomedical Research Unit, University of Southampton Faculty of Medicine, Sir Henry Wellcome Laboratories, University Hospital Southampton, Southampton, United Kingdom.
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185
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Hossny E, Caraballo L, Casale T, El-Gamal Y, Rosenwasser L. Severe asthma and quality of life. World Allergy Organ J 2017; 10:28. [PMID: 28855973 PMCID: PMC5563897 DOI: 10.1186/s40413-017-0159-y] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 06/25/2017] [Indexed: 02/03/2023] Open
Abstract
Severe asthma has a great impact on the quality of life (QOL) of patients and their families. The magnitude of this morbidity is affected by several personal factors including age. Appropriate asthma control and modifications of social roles and activities are expected to improve QOL. Biologics, primarily monoclonal antibodies, have been developed to target specific pathways and molecules important in the pathogenesis of asthma. The use of biologics has shown some promising effects on the QOL of patients with severe recalcitrant asthma. Other potential measures involve targeting risk factors and comorbidities and improving the levels of adherence to therapy. This article briefly reviews the impact of severe asthma on QOL and the potential methods to combat this morbidity including the available therapeutic biologics.
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Affiliation(s)
- Elham Hossny
- Pediatric Allergy and Immunology Unit, Children's Hospital Ain Shams University, 40A Baghdad Street, Cairo, 11341 Egypt
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena, Colombia
| | - Thomas Casale
- Department of Internal Medicine, Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, FL USA
| | - Yehia El-Gamal
- Pediatric Allergy and Immunology Unit, Children's Hospital Ain Shams University, 40A Baghdad Street, Cairo, 11341 Egypt
| | - Lanny Rosenwasser
- University of Missouri - Kansas City, School of Medicine, Kansas City, MO USA
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186
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Casale TB. Biologics and biomarkers for asthma, urticaria, and nasal polyposis. J Allergy Clin Immunol 2017; 139:1411-1421. [PMID: 28477720 DOI: 10.1016/j.jaci.2017.03.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/21/2017] [Accepted: 03/21/2017] [Indexed: 01/22/2023]
Abstract
Many patients with allergic disorders continue to have uncontrolled symptoms despite new and better pharmacologic options. Novel biologic agents that target specific and critical pathophysiologic pathways have been developed to better manage these patients. The utility of biologic agents for the management of allergic diseases has been facilitated by recent advances in better characterizing patients, including identification of relevant biomarkers that predict clinical responsiveness. This has led to the ability to phenotype and endotype patients, allowing for a more rational approach to picking a specific biologic agent for a specific patient. In this review I focus on point-of-care biomarkers that enhance the usefulness of biologics to manage uncontrolled asthma, urticaria, and nasal polyposis. I discuss biologic agents already approved for the management of allergic and respiratory disorders and biologics currently in development or recently abandoned because of a lack of efficacy or intolerable side effects. The successes and failures of biologics in clinical trials have facilitated our ability to better understand which molecules and pathways are most important in the pathogenesis of allergic diseases and in the development of symptoms and impairment in individual patients.
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Affiliation(s)
- Thomas B Casale
- Department of Internal Medicine, Division of Allergy and Immunology, Morsani College of Medicine, University of South Florida, Tampa, Fla.
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187
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Aranda CS, Pereira KCHM, Velasco HF, Mallozi MC, Andrade RS, Rodrigues WDR, Pesquero JB, Martins AM, Solé D. Isoleucine and atopic dermatitis. Pediatr Allergy Immunol 2017; 28:495-497. [PMID: 28474841 DOI: 10.1111/pai.12731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Carolina S Aranda
- Division of Allergy and Clinical Immunology, Department of Pediatrics. Federal, University of São Paulo, São Paulo, Brazil.,Department of Pediatrics, Referral Center of Inborn Errors of Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Kelly C H M Pereira
- Division of Allergy and Clinical Immunology, Department of Pediatrics. Federal, University of São Paulo, São Paulo, Brazil
| | - Helena F Velasco
- Division of Allergy and Clinical Immunology, Department of Pediatrics. Federal, University of São Paulo, São Paulo, Brazil
| | - Márcia C Mallozi
- Division of Allergy and Clinical Immunology, Department of Pediatrics. Federal, University of São Paulo, São Paulo, Brazil
| | - Roseani S Andrade
- Division of Allergy and Clinical Immunology, Department of Pediatrics. Federal, University of São Paulo, São Paulo, Brazil
| | - Wellington D R Rodrigues
- Division of Allergy and Clinical Immunology, Department of Pediatrics. Federal, University of São Paulo, São Paulo, Brazil
| | - João B Pesquero
- Department of Biophysics, Federal University of São Paulo, São Paulo, Brazil
| | - Ana Maria Martins
- Department of Pediatrics, Referral Center of Inborn Errors of Metabolism, Federal University of São Paulo, São Paulo, Brazil
| | - Dirceu Solé
- Division of Allergy and Clinical Immunology, Department of Pediatrics. Federal, University of São Paulo, São Paulo, Brazil
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188
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Tan HTT, Sugita K, Akdis CA. Novel Biologicals for the Treatment of Allergic Diseases and Asthma. Curr Allergy Asthma Rep 2017; 16:70. [PMID: 27613653 DOI: 10.1007/s11882-016-0650-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW The development of biological therapies has rapidly progressed during the last few years, and major advances were reported for the treatment of allergic diseases, such as atopic dermatitis, allergic rhinitis, urticaria, food allergy, and asthma. Here, we review biologicals targeting the type 2 immune response involving Th2 cells, type 2 innate lymphoid cells, natural killer T cells, mast cells, basophils, and epithelial cells, such as IL-4, IL-5, IL-13, IL-31, tumor necrosis factor alpha (TNF-α), and thymic stromal lymphopoietin (TSLP). RECENT FINDINGS The biologicals that have been currently approved for asthma are omalizumab targeting IgE and reslizumab and mepolizumab targeting interleukin (IL)-5. Many other monoclonal antibodies are currently in various phases of clinical development. The new biological therapies for allergic diseases will eventually be tailored to the endotypes of these diseases and the identification of novel biomarkers. Further development of novel biologicals for the treatment of allergic diseases and asthma will be possible upon improved understanding of mechanisms of allergic diseases. Accordingly, further refinement of endotypes of allergen-specific and non-specific type 2 immune response and related inflammatory mediators is needed for optimal treatment of allergic diseases.
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Affiliation(s)
- Hern-Tze Tina Tan
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos Platz, Switzerland.,Department of Immunology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Kazunari Sugita
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos Platz, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.,Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Tottori University Faculty of Medicine, Yonago, Japan
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos Platz, Switzerland. .,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.
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189
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Anderson WC, Apter AJ, Dutmer CM, Searing DA, Szefler SJ. Advances in asthma in 2016: Designing individualized approaches to management. J Allergy Clin Immunol 2017; 140:671-680. [PMID: 28709967 DOI: 10.1016/j.jaci.2017.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022]
Abstract
In this year's Advances in Asthma review, we discuss viral infections in asthmatic patients and potential therapeutic agents, the microbiome, novel genetic associations with asthma, air quality and climate effects on asthma, exposures during development and long-term sequelae of childhood asthma, patient-centered outcomes research, and precision medicine. In addition, we discuss application of biomarkers to precision medicine and new information on asthma medications. New evidence indicates that rhinovirus-triggered asthma exacerbations become more severe as the degree of sensitization to dust mite and mouse increase. The 2 biggest drivers of asthma severity are an allergy pathway starting with allergic sensitization and an environmental tobacco smoke pathway. In addition, allergic sensitization and blood eosinophils can be used to select medications for management of early asthma in young children. These current findings, among others covered in this review, represent significant steps toward addressing rapidly advancing areas of knowledge that have implications for asthma management.
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Affiliation(s)
- William C Anderson
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Andrea J Apter
- Section of Allergy & Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Cullen M Dutmer
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Daniel A Searing
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Stanley J Szefler
- Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
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190
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De Greve G, Hellings PW, Fokkens WJ, Pugin B, Steelant B, Seys SF. Endotype-driven treatment in chronic upper airway diseases. Clin Transl Allergy 2017; 7:22. [PMID: 28706720 PMCID: PMC5506670 DOI: 10.1186/s13601-017-0157-8] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/05/2017] [Indexed: 12/31/2022] Open
Abstract
Rhinitis and rhinosinusitis are the two major clinical entities of chronic upper airway disease. Chronic rhinosinusitis (CRS) and allergic rhinitis (AR) affect respectively up to 10 and 30% of the total population, hence being associated with an important socio-economic burden. Different phenotypes of rhinitis and CRS have been described based on symptom severity and duration, atopy status, level of control, comorbidities and presence or absence of nasal polyps in CRS. The underlying pathophysiological mechanisms are diverse, with different, and sometimes overlapping, endotypes being recognized. Type 2 inflammation is well characterized in both AR and CRS with nasal polyps (CRSwNP), whereas type 1 inflammation is found in infectious rhinitis and CRS without nasal polyps (CRSsNP). The neurogenic endotype has been demonstrated in some forms of non-allergic rhinitis. Epithelial barrier dysfunction is shown in AR and CRSwNP. Emerging therapies are targeting one specific pathophysiological pathway or endotype. This endotype-driven treatment approach requires careful selection of the patient population who might benefit from a specific treatment. Personalized medicine is addressing the issue of providing targeted treatment for the right patient and should be seen as one aspect of the promising trend towards precision medicine. This review provides a comprehensive overview of the current state of endotypes, biomarkers and targeted treatments in chronic inflammatory conditions of the nose and paranasal sinuses.
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Affiliation(s)
- Glynnis De Greve
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Louvain, Belgium
| | - Peter W Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery, UZ Leuven, Louvain, Belgium
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
- Upper Airways Research Laboratory, Department of Otorhinolaryngology-Head and Neck Surgery, Ghent University, Ghent, Belgium
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, The Netherlands
| | - Benoit Pugin
- Laboratory of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Herestraat 49/PB811, 3000 Louvain, Belgium
| | - Brecht Steelant
- Laboratory of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Herestraat 49/PB811, 3000 Louvain, Belgium
| | - Sven F Seys
- Laboratory of Clinical Immunology, Department of Immunology and Microbiology, KU Leuven, Herestraat 49/PB811, 3000 Louvain, Belgium
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191
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Bieber T, D'Erme AM, Akdis CA, Traidl-Hoffmann C, Lauener R, Schäppi G, Schmid-Grendelmeier P. Clinical phenotypes and endophenotypes of atopic dermatitis: Where are we, and where should we go? J Allergy Clin Immunol 2017; 139:S58-S64. [PMID: 28390478 DOI: 10.1016/j.jaci.2017.01.008] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/13/2017] [Accepted: 01/24/2017] [Indexed: 12/15/2022]
Abstract
Atopic dermatitis (AD) is a paradigmatic chronic inflammatory skin disease characterized by a complex pathophysiology and a wide spectrum of the clinical phenotype. Despite this high degree of heterogeneity, AD is still considered a single disease and usually treated according to the "one-size-fits-all" approach. Thus more tailored prevention and therapeutic strategies are still lacking. As for other disciplines, such as oncology or rheumatology, we have to approach AD in a more differentiated way (ie, to dissect and stratify the complex clinical phenotype into more homogeneous subgroups based on the endophenotype [panel of biomarkers]) with the aim to refine the management of this condition. Because we are now entering the era of personalized medicine, a systems biology approach merging the numerous clinical phenotypes with robust (ie, relevant and validated) biomarkers will be needed to best exploit their potential significance for the future molecular taxonomy of AD. This approach will not only allow an optimized prevention and treatment with the available drugs but also hopefully help assign newly developed medicinal products to those patients who will have the best benefit/risk ratio.
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Affiliation(s)
- Thomas Bieber
- Department of Dermatology and Allergy, University of Bonn, Bonn, Germany; Christine Kühne-Center for Allergy Research and Education (CK-CARE) Davos-Augsburg-Bonn-St Gallen-Zürich, St Gallen, Switzerland.
| | - Angelo M D'Erme
- Unit of Dermatology, Livorno Hospital, Livomo, Italy; Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Cezmi A Akdis
- Christine Kühne-Center for Allergy Research and Education (CK-CARE) Davos-Augsburg-Bonn-St Gallen-Zürich, St Gallen, Switzerland; Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland
| | - Claudia Traidl-Hoffmann
- Christine Kühne-Center for Allergy Research and Education (CK-CARE) Davos-Augsburg-Bonn-St Gallen-Zürich, St Gallen, Switzerland; Institute for Environmental Medicine, Technische Universität München and Helmholtzzentrum München, Munich, Germany
| | - Roger Lauener
- Christine Kühne-Center for Allergy Research and Education (CK-CARE) Davos-Augsburg-Bonn-St Gallen-Zürich, St Gallen, Switzerland; Children's Hospital of Eastern Switzerland, St Gallen, and the University of Zurich, Zurich, Switzerland
| | - Georg Schäppi
- Christine Kühne-Center for Allergy Research and Education (CK-CARE) Davos-Augsburg-Bonn-St Gallen-Zürich, St Gallen, Switzerland
| | - Peter Schmid-Grendelmeier
- Christine Kühne-Center for Allergy Research and Education (CK-CARE) Davos-Augsburg-Bonn-St Gallen-Zürich, St Gallen, Switzerland; Allergy Unit, Department of Dermatology, University Hospital, Zurich, Switzerland
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192
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Muraro A, Lemanske RF, Castells M, Torres MJ, Khan D, Simon HU, Bindslev-Jensen C, Burks W, Poulsen LK, Sampson HA, Worm M, Nadeau KC. Precision medicine in allergic disease-food allergy, drug allergy, and anaphylaxis-PRACTALL document of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology. Allergy 2017; 72:1006-1021. [PMID: 28122115 DOI: 10.1111/all.13132] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2017] [Indexed: 12/30/2022]
Abstract
This consensus document summarizes the current knowledge on the potential for precision medicine in food allergy, drug allergy, and anaphylaxis under the auspices of the PRACTALL collaboration platform. PRACTALL is a joint effort of the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology, which aims to synchronize the European and American approaches to allergy care. Precision medicine is an emerging approach for disease treatment based on disease endotypes, which are phenotypic subclasses associated with specific mechanisms underlying the disease. Although significant progress has been made in defining endotypes for asthma, definitions of endotypes for food and drug allergy or for anaphylaxis lag behind. Progress has been made in discovery of biomarkers to guide a precision medicine approach to treatment of food and drug allergy, but further validation and quantification of these biomarkers are needed to allow their translation into practice in the clinical management of allergic disease.
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Affiliation(s)
- A. Muraro
- Food Allergy Referral Centre Veneto Region; Department of Women and Child Health; Padua General University Hospital; Padua Italy
| | - R. F. Lemanske
- Department of Pediatrics; University of Wisconsin School of Medicine and Public Health; Madison WI USA
| | - M. Castells
- Drug Hypersensitivity and Desensitization Center; Brigham & Women's Hospital; Harvard Medical School; Boston MA USA
| | - M. J. Torres
- Allergy Unit; Regional University Hospital of Malaga-IBIMA; UMA; Malaga Spain
| | - D. Khan
- Division of Allergy & Immunology; Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas TX USA
| | - H.-U. Simon
- Institute of Pharmacology; University of Bern; Bern Switzerland
| | - C. Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense Research Center for Anaphylaxis (ORCA); Odense University Hospital; Odense Denmark
| | - W. Burks
- Department of Pediatrics; University of North Carolina; Chapel Hill NC USA
| | - L. K. Poulsen
- Allergy Clinic; Copenhagen University Hospital at Gentofte Hospital; Copenhagen Denmark
| | - H. A. Sampson
- Icahn School of Medicine at Mount Sinai; New York NY USA
| | - M. Worm
- Klinik für Dermatologie; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - K. C. Nadeau
- Department of Medicine; Stanford University School of Medicine; Stanford CA USA
- Sean N. Parker Center for Allergy and Asthma Research; Stanford University School of Medicine; Stanford CA USA
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193
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Werfel T, Allam JP, Biedermann T, Eyerich K, Gilles S, Guttman-Yassky E, Hoetzenecker W, Knol E, Simon HU, Wollenberg A, Bieber T, Lauener R, Schmid-Grendelmeier P, Traidl-Hoffmann C, Akdis CA. Cellular and molecular immunologic mechanisms in patients with atopic dermatitis. J Allergy Clin Immunol 2017; 138:336-49. [PMID: 27497276 DOI: 10.1016/j.jaci.2016.06.010] [Citation(s) in RCA: 403] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 12/18/2022]
Abstract
Atopic dermatitis (AD) is a complex skin disease frequently associated with other diseases of the atopic diathesis. Recent evidence supports the concept that AD can also recognize other comorbidities, such as chronic inflammatory bowel or cardiovascular diseases. These comorbidities might result from chronic cutaneous inflammation or from a common, yet-to-be-defined immunologic background leading to immune deviations. The activation of immune cells and their migration to the skin play an essential role in the pathogenesis of AD. In patients with AD, an underlying immune deviation might result in higher susceptibility of the skin to environmental factors. There is a high unmet medical need to define immunologic endotypes of AD because it has significant implications on upcoming stratification of the phenotype of AD and the resulting targeted therapies in the development of precision medicine. This review article emphasizes studies on environmental factors affecting AD development and novel biological agents used in the treatment of AD. Best evidence of the clinical efficacy of novel immunologic approaches using biological agents in patients with AD is available for the anti-IL-4 receptor α-chain antibody dupilumab, but a number of studies are currently ongoing with other specific antagonists to immune system players. These targeted molecules can be expressed on or drive the cellular players infiltrating the skin (eg, T lymphocytes, dendritic cells, or eosinophils). Such approaches can have immunomodulatory and thereby beneficial clinical effects on the overall skin condition, as well as on the underlying immune deviation that might play a role in comorbidities. An effect of these immunologic treatments on pruritus and the disturbed microbiome in patients with AD has other potential consequences for treatment.
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Affiliation(s)
- Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
| | - Jean-Pierre Allam
- Department of Dermatology and Allergy, Rheinische Friedrich Wilhelm University, Bonn, Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Kilian Eyerich
- Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - Stefanie Gilles
- Institute of Environmental Medicine, UNIKA-T, Technical University Munich and Helmholtz Zentrum München, Augsburg, Germany
| | - Emma Guttman-Yassky
- Laboratory for Investigative Dermatology, Rockefeller University, and the Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wolfram Hoetzenecker
- Department of Dermatology/Allergology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Edward Knol
- Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thomas Bieber
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Department of Dermatology and Allergy, University of Bonn, Bonn, Germany
| | - Roger Lauener
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Peter Schmid-Grendelmeier
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Allergy Unit, University of Zurich, Zurich, Switzerland
| | - Claudia Traidl-Hoffmann
- Institute of Environmental Medicine, UNIKA-T, Technical University Munich and Helmholtz Zentrum München, Augsburg, Germany; Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Cezmi A Akdis
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland; Swiss Institute for Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
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194
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize recent research regarding the diagnosis of allergic rashes and to suggest future directions for the promotion of accurate diagnosis and endotype specification. RECENT FINDINGS Multiple cohort studies demonstrate that with appropriate clinical evaluation, drug allergy labels can be removed in up to 90% of cases. Genetic tests can predict severe adverse cutaneous drug reactions in some cases and in vitro tests are being sought to identify causative drugs in others. Biomarkers to define endotypes of atopic dermatitis are needed to predict which patients will benefit from evolving targeted therapies. Hyperspectral imaging is a rapidly evolving technology in medical diagnostics; additional research is needed to demonstrate whether this promising technology can be used to distinguish allergic rashes and/or endotypes in atopic dermatitis. SUMMARY Diagnostic tools for the assessment of allergic rashes are primitive in that they frequently rely on challenges to ascertain whether suspected allergens were causative. Validated in vitro tests with high sensitivity and specificity for drug allergies would benefit the field, particularly in delayed type reactions, as would identification of any hyperspectral signatures that could identify endotypes in atopic dermatitis.
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Kortekaas Krohn I, Bobic S, Dooley J, Lan F, Zhang N, Bachert C, Steelant B, Bullens DM, Liston A, Ceuppens JL, Seys SF, Hellings PW. Programmed cell death-1 expression correlates with disease severity and IL-5 in chronic rhinosinusitis with nasal polyps. Allergy 2017; 72:985-993. [PMID: 28122135 DOI: 10.1111/all.13136] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Programmed cell death-1 (PD-1) is a negative regulator of T-cell responses. Expression of PD-1 and its ligands PD-L1 and PD-L2 in chronic rhinosinusitis with nasal polyps (CRSwNP) is poorly studied. METHODS Expression of PD-1, PD-L1, PD-L2, TGF-β, IL-5, and IL-10 mRNA was measured by real-time quantitative PCR on tissue homogenates of patients with CRSwNP (n = 21) and healthy controls (n = 21) and on primary epithelial cells. Disease severity was scored using the Lund-Mackay scores of maxillofacial computed tomography (CT) scans. Expression of PD-1 and PD-L1/L2 was evaluated at the cellular and tissue levels (n = 6) by flow cytometry and immunohistochemistry. RESULTS Programmed cell death-1 mRNA expression was increased in tissue homogenates from patients with CRSwNP compared with controls, irrespective of the atopy status. Importantly, expression of PD-1 correlated with the total CT scan scores (r = 0.5, P = 0.02). Additionally, a significant association was found between PD-1 mRNA and expression of IL-5 mRNA in control nasal tissue (r = 0.95, P < 0.0001) and in CRSwNP (r = 0.63, P = 0.002). PD-1 was expressed on different subsets of T cells and CD11b- dendritic cells. Both PD-1 and its ligands were expressed on primary epithelial cells from control nasal tissue and nasal polyp tissue. CONCLUSIONS Higher PD-1 expression was found in CRSwNP than in nasal tissue from controls. This was associated with disease severity and tissue IL-5 expression but unrelated to the patients' atopy status.
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Affiliation(s)
- I. Kortekaas Krohn
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - S. Bobic
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - J. Dooley
- Translational Immunology Laboratory; VIB; University of Leuven; Leuven Belgium
| | - F. Lan
- Upper Airway Research Laboratory; Department of Otorhinolaryngology; University Hospital Ghent; Ghent Belgium
| | - N. Zhang
- Upper Airway Research Laboratory; Department of Otorhinolaryngology; University Hospital Ghent; Ghent Belgium
| | - C. Bachert
- Upper Airway Research Laboratory; Department of Otorhinolaryngology; University Hospital Ghent; Ghent Belgium
| | - B. Steelant
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - D. M. Bullens
- Pediatric Immunology; Department of Microbiology and Immunology; University of Leuven; Leuven Belgium
- Clinical Department of Pediatrics; University Hospitals Leuven; Leuven Belgium
| | - A. Liston
- Translational Immunology Laboratory; VIB; University of Leuven; Leuven Belgium
| | - J. L. Ceuppens
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - S. F. Seys
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
| | - P. W. Hellings
- Laboratory of Clinical Immunology; Department of Microbiology & Immunology; University of Leuven; Leuven Belgium
- Clinical Division of Otorhinolaryngology; University Hospitals Leuven; Leuven Belgium
- Clinical Division of Otorhinolaryngology; Academic Medical Centre; Amsterdam The Netherlands
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196
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Cancer subtypes in aetiological research. Eur J Epidemiol 2017; 32:353-361. [PMID: 28497292 DOI: 10.1007/s10654-017-0253-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/03/2017] [Indexed: 01/12/2023]
Abstract
Researchers often attempt to categorize tumors into more homogeneous subtypes to better predict prognosis or understand pathogenic mechanisms. In clinical research, typically the focus is on prognosis: the tumor subtypes are intended to be associated with specific responses to treatment and/or different clinical outcomes. In aetiological research, the focus is on identifying distinct pathogenic mechanisms, which may involve different risk factors. We used directed acyclic graphs to present a framework for considering potential biases arising in aetiological research of tumor subtypes, when there is incomplete correspondence between the identified subtypes and the underlying pathogenic mechanisms. We identified two main scenarios: (1) weak effect, when the tumor subtypes are identified through combinations of characteristics and some of these characteristics are affected by factors that are unrelated with the underlying pathogenic mechanisms; and (2) lack of causality, when the set of characteristics corresponds with a mechanism that is actually not a cause of the tumor of interest. Examples of the magnitude of bias that can be introduced in these situations are provided. Although categorization of tumors into homogenous subtypes may have important implications for aetiological research and identification of risk factors, the characteristics used to classify tumors into subtypes should be as close as possible to the actual pathogenic mechanisms to avoid interpretative biases. Whenever our knowledge of these mechanisms is limited, research into risk factors for tumor subtypes should first aim to causally link the characteristics to the pathogenic mechanisms.
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Abstract
OBJECTIVE Studies show high comorbidity of mood disorders in asthma. As asthma is a highly heterogeneous disease with different phenotypes it can be expected that there is a difference in this association with different asthma phenotypes. The aim of our cross-sectional study was to assess the association of specific asthma phenotypes with anxiety and/or depression and their impact on asthma control. METHODS A cross-sectional study in 201 consecutive adult outpatients with asthma (≥18 years of age) was conducted. Each patient underwent physical examination, detailed medical history, Hospital Anxiety and Depression Scale, Asthma Control Questionnaire, Asthma Control Test, together with measurements of lung function and fraction of exhaled nitric oxide. Phenotypes were assessed using cluster analysis, and a multivariate analysis was used to identify associations of mood disorders with different phenotypes. RESULTS Five asthma phenotypes were identified: allergic (AA, 43.8%), aspirin-exacerbated respiratory disease (AERD, 21.9%), late-onset (LOA, 18.9%), obesity-associated (OAA, 10.0%), and respiratory infections associated asthma (RIAA, 5.5%). A multivariate analysis showed a significant association of anxiety with LOA and comorbid hypertension (LOA, odds ratio (OR) = 2.12; hypertension, OR = 2.37, p = 0.012), and depression with AA, RIAA, hypertension, and ACQ score (AA, OR = 6.07; RIAA, OR = 4.73; hypertension, OR = 5.67; ACQ, OR = 1.87; p < 0.001). Comorbid anxiety/depression was associated with AA, LOA, RIAA, hypertension, and ACQ score (AA, OR = 10.15; LOA, OR = 2.98; RIAA, OR = 6.29; hypertension, OR = 5.15; ACQ, OR = 1.90; p < 0.001. CONCLUSION Mood disorders were significantly associated with AA, LOA, and infection-associated asthma, together with comorbid hypertension and the level of asthma control.
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Affiliation(s)
- Marina Labor
- a Department of Pulmonology , University Hospital Center Osijek , Osijek , Croatia.,b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia
| | - Slavica Labor
- a Department of Pulmonology , University Hospital Center Osijek , Osijek , Croatia.,b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia
| | - Iva Jurić
- c Department of Medicine , University Hospital Center Osijek , Osijek , Croatia
| | - Vladimir Fijačko
- a Department of Pulmonology , University Hospital Center Osijek , Osijek , Croatia.,b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia
| | - Sanja Popović Grle
- d Department of Pulmonology , University Hospital Center Zagreb , Zagreb , Croatia
| | - Davor Plavec
- b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia.,e Research Department , Children's Hospital Srebrnjak , Zagreb , Croatia
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199
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Stemeseder T, Klinglmayr E, Moser S, Lueftenegger L, Lang R, Himly M, Oostingh GJ, Zumbach J, Bathke AC, Hawranek T, Gadermaier G. Cross-sectional study on allergic sensitization of Austrian adolescents using molecule-based IgE profiling. Allergy 2017; 72:754-763. [PMID: 27753449 DOI: 10.1111/all.13071] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Allergen-specific IgE antibodies are a hallmark of type I allergy. The aim of this cross-sectional study was to analyze the sensitization profiles of an Austrian adolescent population utilizing molecule-based IgE diagnosis. METHODS Serum samples of 501 nonselected pupils from Salzburg, Austria, were tested in ImmunoCAP ISAC® for IgE reactivity to 112 single allergens. Sensitization profiles were assessed and statistically coordinated with reported allergies. RESULTS In the population aged 12-21 years, 53.5% showed IgE reactivity to at least one allergen tested. The highest prevalence was found for Phl p 1 from grass pollen (26.5%), group 2 mite allergens (18.2%), Bet v 1 from birch pollen (16.3%) and Fel d 1 from cat (14.4%). The majority of participants showed a complex sensitization profile and reacted on average to 9 allergens. Pollen sensitization was highly prevalent (41.7%) and mainly driven by group I grass and PR-10 allergens of the Betulaceae family, while Pla l 1 represented the most relevant weed. Diagnosed and self-reported allergies were noted in 21.9% and 45.5% of participants, respectively, and correlated well with in vitro results. Among atopic individuals, 71.4% reported to suffer from at least one allergy; concordance was found for grass and cat sensitization, while venom- and weed pollen-positive individuals were frequently asymptomatic. CONCLUSIONS More than half of the tested adolescent population had already established an atopic status presenting a complex IgE reactivity profile dominated by pollen sensitization. Detailed molecule-based analysis allows determining relevant biomarkers and monitoring of the atopic status in populations.
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Affiliation(s)
- T. Stemeseder
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
| | - E. Klinglmayr
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
| | - S. Moser
- School of Education; University of Salzburg; Salzburg Austria
- TUM School of Education; Technical University of Munich; Munich Germany
| | - L. Lueftenegger
- Department of Dermatology; Paracelsus Medical University Salzburg; Salzburg Austria
- Biomedical Sciences; Salzburg University of Applied Sciences; Puch Salzburg Austria
| | - R. Lang
- Department of Dermatology; Paracelsus Medical University Salzburg; Salzburg Austria
| | - M. Himly
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
| | - G. J. Oostingh
- Biomedical Sciences; Salzburg University of Applied Sciences; Puch Salzburg Austria
| | - J. Zumbach
- School of Education; University of Salzburg; Salzburg Austria
| | - A. C. Bathke
- Department of Mathematics; University of Salzburg; Salzburg Austria
| | - T. Hawranek
- Department of Dermatology; Paracelsus Medical University Salzburg; Salzburg Austria
| | - G. Gadermaier
- Department of Molecular Biology; University of Salzburg; Salzburg Austria
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Rø ADB, Simpson MR, Rø TB, Storrø O, Johnsen R, Videm V, Øien T. Reduced Th22 cell proportion and prevention of atopic dermatitis in infants following maternal probiotic supplementation. Clin Exp Allergy 2017; 47:1014-1021. [PMID: 28346719 DOI: 10.1111/cea.12930] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/19/2017] [Accepted: 03/16/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND In the randomized, controlled study Probiotics in the Prevention of Allergy among Children in Trondheim (ProPACT), maternal probiotic supplementation reduced the incidence of atopic dermatitis (AD) in the offspring. In the current study, we hypothesized that the effect was mediated by a shift in the T helper (Th) cells in the children. OBJECTIVE To examine whether Th cell proportions were affected by maternal probiotic supplementation and thus could mediate the preventive effect of probiotics on AD. METHODS A total of 415 pregnant women were randomized to ingest a combination of Lactobacillus rhamnosus GG (LGG), Bifidobacterium animalis subsp. lactis Bb-12 (Bb-12) and Lactobacillus acidophilus La-5 (La-5) or placebo, and their offspring were assessed for AD during the first 2 years of life. Peripheral blood collected at 3 months of age was analysed for regulatory T cells (n=140) and Th subsets (n=77) including Th1, Th2, Th9, Th17 and Th22. RESULTS The proportion of Th22 cells was reduced in children in the probiotic group compared to the placebo group (median 0.038% vs 0.064%, P=.009). The difference between the probiotic and placebo groups was also observed in the children who did not develop AD during the 2-year follow-up. The proportion of Th22 cells was increased in children who developed AD compared to the children who did not develop AD (0.090% vs 0.044%, P<.001). Mediation analysis indicated that the preventive effect of probiotics was partially mediated through the reduction in Th22 cells. CONCLUSION Perinatal maternal probiotic supplementation with a combination of LGG, Bb-12 and La-5 reduced the proportion of Th22 cells in 3-month-old children. This may partially explain the preventive effect of probiotics on AD.
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Affiliation(s)
- A D B Rø
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Immunology and Transfusion Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - M R Simpson
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - T B Rø
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - O Storrø
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - R Johnsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - V Videm
- Department of Immunology and Transfusion Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - T Øien
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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