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Celik E, Kocacik Uygun D, Kaya MA, Gungoren MS, Keven A, Bingol A. Aspergillus-sensitized asthma in children. Pediatr Allergy Immunol 2024; 35:e14212. [PMID: 39099328 DOI: 10.1111/pai.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Asthma is the most common chronic respiratory disease in childhood. Aspergillus fumigatus sensitivity may be involved in the pathogenesis of asthma by leading to different clinical presentations. OBJECTIVE To investigate the demographic, clinical, laboratory, and radiological characteristics of A. fumigatus sensitivity in childhood asthma and identify associated risk factors and diagnostic parameters. METHODS A total of 259 children with asthma were included in the study, 7 (2.7%) with allergic bronchopulmonary aspergillosis (ABPA), 84 (32.4%) with A. fumigatus-sensitized asthma (Af-SA), and 168 (64.9%) with A. fumigatus-unsensitized asthma (Af-UA). RESULTS Aspergillus sensitivity was associated with early asthma onset and longer asthma duration. Total IgE level and asthma severity are highest in ABPA and higher in Af-SA. Absolute eosinophil count was higher, and FEV1 was lower in Af-SA and ABPA. Aspergillus fumigatus was associated with greater odds of being male (odds ratio [OR], 2.45), having atopic dermatitis (OR, 3.159), Alternaria sensitivity (OR, 10.37), and longer asthma duration (OR, 1.266). The best cut-off values for detecting A. fumigatus positivity were 363.5 IU/mL for total IgE and 455 cells/μL for absolute eosinophil count. In Af-SA compared to Af-UA, centrilobular nodules and peribronchial thickening were more common, and the bronchoarterial ratio was higher. CONCLUSIONS Aspergillus sensitivity is a strong allergic stimulus in asthma, leading to laboratory, structural, clinical, and functional consequences. Af-SA is a distinct asthma endotype independent of ABPA that is characterized by increased risk of severe clinical presentations and impaired lung function.
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Affiliation(s)
- Enes Celik
- Department of Pediatric Allergy-Immunology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Dilara Kocacik Uygun
- Department of Pediatric Allergy-Immunology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Mehmet Akif Kaya
- Department of Pediatric Allergy-Immunology, Akdeniz University School of Medicine, Antalya, Turkey
| | | | - Ayse Keven
- Department of Radiology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Aysen Bingol
- Department of Pediatric Allergy-Immunology, Akdeniz University School of Medicine, Antalya, Turkey
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Hossny E, Adachi Y, Anastasiou E, Badellino H, Custovic A, El-Owaidy R, El-Sayed ZA, Filipovic I, Gomez RM, Kalayci Ö, Le Souëf P, Miligkos M, Morais-Almeida M, Nieto A, Phipatanakul W, Shousha G, Teijeiro A, Wang JY, Wong GW, Xepapadaki P, Yong SB, Papadopoulos NG. Pediatric asthma comorbidities: Global impact and unmet needs. World Allergy Organ J 2024; 17:100909. [PMID: 38827329 PMCID: PMC11141278 DOI: 10.1016/j.waojou.2024.100909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/14/2024] [Accepted: 04/18/2024] [Indexed: 06/04/2024] Open
Abstract
Real-world data on the range and impact of comorbid health conditions that affect pediatric asthma are scant, especially from developing countries. Lack of data hinders effective diagnosis, treatment, and overall management of these complex cases. We, hereby, describe the common pediatric asthma comorbid conditions in terms of evidence for association, potential mechanisms of impact on asthma control, and treatment benefit. Obesity, upper airway allergies, dysfunctional breathing, multiple sensitizations, depressive disorders, food allergy, and gastro-esophageal reflux are common associations with difficult-to-treat asthma. On the other hand, asthma symptoms and/or management may negatively impact the well-being of children through drug adverse effects, worsening of anaphylaxis symptoms, and disturbing mental health. Awareness of these ailments may be crucial for designing the optimum care for each asthmatic child individually and may ultimately improve the quality of life of patients and their families. A multidisciplinary team of physicians is required to identify and manage such comorbidities aiming to mitigate the over-use of asthma pharmacotherapy. Asthma research should target relevant real-world difficulties encountered at clinical practice and focus on interventions that would mitigate the impact of such comorbidities. Finally, policymakers and global healthcare organizations are urged to recognize pediatric asthma control as a healthcare priority and allocate resources for research and clinical interventions. In other words, global asthma control needs support by compassionate scientific partnership.
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Affiliation(s)
- Elham Hossny
- Pediatric Allergy, Immunology, and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Yuichi Adachi
- Pediatric Allergy Center, Toyama Red Cross Hospital, Japan
| | - Eleni Anastasiou
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Héctor Badellino
- Faculty of Psychology, UCES University, San Francisco, Argentina
| | - Adnan Custovic
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Rasha El-Owaidy
- Pediatric Allergy, Immunology, and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology, and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | | | - Ömer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Peter Le Souëf
- School of Medicine, University of Western Australia, Perth, WA, Australia
| | - Michael Miligkos
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Antonio Nieto
- Pediatric Pulmonology and Allergy Unit, Hospital Universitari i Politècnic La Fe, Health Research Institute La Fe, Valencia, Spain
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ghada Shousha
- Pediatric Allergy, Immunology, and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Alvaro Teijeiro
- Respiratory Department, Pediatric Hospital, Córdoba, Argentina
| | - Jiu-Yao Wang
- Allergy, Immunology and Microbiome Research Center, China Medical University Children's Hospital, Taichung, Taiwan
| | - Gary W.K. Wong
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Su Boon Yong
- Department of Allergy and Immunology, China Medical University Children's Hospital, Taichung, Taiwan
| | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
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3
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Olsen Y, Arildskov E, Hansen SN, Pedersen M, Dharmage SC, Kloster M, Sigsgaard T. Outdoor Alternaria and Cladosporium spores and acute asthma. Clin Exp Allergy 2023; 53:1256-1267. [PMID: 37748858 DOI: 10.1111/cea.14397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Outdoor Alternaria and Cladosporium spores are ubiquitous. Few studies have assessed their impact on asthma hospitalizations providing conflicting results, mainly focused on vulnerable paediatric populations. We aimed to study the impact of outdoor Alternaria and Cladosporium concentrations on acute hospitalizations in the Capital Region of Denmark. METHODS This is a bi-directional case-crossover study with 26 years of national registry data at individual level on acute asthma hospitalizations and daily average data on Alternaria and Cladosporium, pollen (Artemisia, Poaceae), maximal temperature, and air pollution. Conditional logistic regression models were applied to assess the associations. Concentration quartiles at lag 0 were used for categorizing the exposure. RESULTS For lags 0-2, the odds of hospitalization were significantly higher for both Alternaria and Cladosporium at concentration quartile 2-4 compared with quartile 1. When stratified for age and sex, odds of hospitalization at Alternaria quartiles 2-4 were significantly higher in males below 40 years at lag 0-2, and at lag 0 in females (18-30 years), while quartiles 2-4 of Cladosporium concentrations were associated with significantly higher odds in boys (0-17 years) at lag 1-3, males (18-39 years) at lag 0-1, females (18-39 years) at lag 1-2, males (40-64 years) at lag 0-2, females (40-64 years) at lag 0 and 2, in seniors (65+ years) male at lag 1-2 and female at lag 0-1. The effect of Alternaria varied significantly depending on the level of Cladosporium (p < .0001). CONCLUSION Ambient Alternaria and Cladosporium spores can induce asthma hospitalizations. Males are more susceptible to both genera. Males and females under age 40 years are more susceptible to Alternaria.
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Affiliation(s)
- Yulia Olsen
- Institute of Public Health & Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Elias Arildskov
- Department of Public Health - Section of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Stefan Nygaard Hansen
- Department of Public Health - Section of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Marianne Pedersen
- Department of Public Health - Section of Environment, Occupation & Health, Aarhus University, Aarhus, Denmark
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | | | - Torben Sigsgaard
- Institute of Public Health & Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
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Denning DW, Pfavayi LT. Poorly controlled asthma - Easy wins and future prospects for addressing fungal allergy. Allergol Int 2023; 72:493-506. [PMID: 37544851 DOI: 10.1016/j.alit.2023.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 08/08/2023] Open
Abstract
Poorly controlled asthma is especially common in low resource countries. Aside from lack of access to, or poor technique with, inhaled beta-2 agonists and corticosteroids, the most problematic forms of asthma are frequently associated with both fungal allergy and exposure, especially in adults leading to more asthma exacerbations and worse asthma. The umbrella term 'fungal asthma' describes many disorders linked to fungal exposure and/or allergy to fungi. One fungal asthma endotype, ABPA, is usually marked by a very high IgE and its differential diagnosis is reviewed. Both ABPA and fungal bronchitis in bronchiectasis are marked by thick excess airway mucus production. Dermatophyte skin infection can worsen asthma and eradication of the skin infection improves asthma. Exposure to fungi in the workplace, home and schools, often in damp or water-damaged buildings worsens asthma, and remediation improves symptom control and reduces exacerbations. Antifungal therapy is beneficial for fungal asthma as demonstrated in nine of 13 randomised controlled studies, reducing symptoms, corticosteroid need and exacerbations while improving lung function. Other useful therapies include azithromycin and some biologics approved for the treatment of severe asthma. If all individuals with poorly controlled and severe asthma could be 'relieved' of their fungal allergy and infection through antifungal therapy without systemic corticosteroids, the health benefits would be enormous and relatively inexpensive, improving the long term health of over 20 million adults and many children. Antifungal therapy carries some toxicity, drug interactions and triazole resistance risks, and data are incomplete. Here we summarise what is known and what remains uncertain about this complex topic.
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Affiliation(s)
- David W Denning
- Manchester Fungal Infection Group, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK.
| | - Lorraine T Pfavayi
- Institute of Immunology & Infection Research, Ashworth Laboratories, School of Biological Sciences, University of Edinburgh, Edinburgh, UK
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5
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Aspergillus Sensitization and Allergic Bronchopulmonary Aspergillosis in Asthmatic Children: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13050922. [PMID: 36900068 PMCID: PMC10001349 DOI: 10.3390/diagnostics13050922] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/16/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Background: The prevalence of aspergillus sensitization (AS) and allergic bronchopulmonary aspergillosis (ABPA) in asthmatic children remains unclear. Objective: To systematically review the literature to estimate the prevalence of AS and ABPA in children with bronchial asthma. Methods: We searched the PubMed and Embase databases for studies reporting the prevalence of AS or ABPA in pediatric asthma. The primary outcome was to assess the prevalence of AS, while the secondary outcome was to evaluate the prevalence of ABPA. We pooled the prevalence estimates using a random effects model. We also calculated the heterogeneity and publication bias. Results: Of the 11,695 records retrieved, 16 studies with 2468 asthmatic children met the inclusion criteria. Most studies were published from tertiary centers. The pooled prevalence of AS in asthma (15 studies; 2361 subjects) was 16.1% (95% confidence intervals [CI], 9.3-24.3). The prevalence of AS was significantly higher in prospective studies, studies from India, and those from developing countries. The pooled prevalence of ABPA in asthma (5 studies; 505 children) was 9.9% (95% CI, 0.81-27.6). There was significant heterogeneity and publication bias for both outcomes. Conclusions: We found a high prevalence of AS and ABPA in asthmatic children. There is a need for community-based studies from different ethnicities using a standard methodology to ascertain the true prevalence of AS and ABPA in pediatric asthma.
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6
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Moss RB. Severe Fungal Asthma: A Role for Biologics and Inhaled Antifungals. J Fungi (Basel) 2023; 9:jof9010085. [PMID: 36675906 PMCID: PMC9861760 DOI: 10.3390/jof9010085] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Allergic asthma has traditionally been treated with inhaled and systemic glucocorticosteroids. A continuum of allergic fungal airways disease associated with Aspergillus fumigatus colonization and/or atopic immune responses that encompasses fungal asthma, severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis is now recognized along a phenotypic severity spectrum of T2-high immune deviation lung disease. Oral triazoles have shown clinical, anti-inflammatory and microbiologic efficacy in this setting; in the future inhaled antifungals may improve the therapeutic index. Humanized monoclonal antibody biologic agents targeting T2-high disease also show efficacy and promise of improved control in difficult cases. Developments in these areas are highlighted in this overview.
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Affiliation(s)
- Richard B Moss
- Center of Excellence in Pulmonary Biology, Division of Pulmonary, Asthma and Sleep Medicine, Department of Pediatrics, Stanford University School of Medicine, 770 Welch Road, Suite 350, Palo Alto, CA 94304, USA
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7
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Lo YL, Lin HC, Lo CY, Huang HY, Lin TY, Lin CH, Hsieh MH, Fang YF, Lin SM, Huang YT, Liao TW, Wang CH, Lin CY. Clinical manifestations and outcomes of fungus-associated asthma: A multi-institution database study in Taiwan. Microbiol Res 2023; 266:127234. [DOI: 10.1016/j.micres.2022.127234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/20/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
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8
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Licari A, Andrenacci B, Di Cicco ME, Leone M, Marseglia GL, Tosca M. Respiratory comorbidities in severe asthma: focus on the pediatric age. Expert Rev Respir Med 2023; 17:1-13. [PMID: 36631726 DOI: 10.1080/17476348.2023.2168261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Asthma comorbidities are a frequent cause of adverse outcomes, such as poor asthma control, frequent asthma attacks, reduced quality of life, and higher healthcare costs. Comorbidities are well-known treatable traits whose proper management can help achieve optimal asthma control. Although multimorbidity is frequent among asthmatics, comorbidities are still a potential cause of misdiagnosis and under or over treatments, and little is known about their impact on severe pediatric asthma. AREAS COVERED We provided a comprehensive, 5-year updated review focusing on the main respiratory comorbidities in severe asthma, particularly in epidemiology, pathogenesis, and current and future therapies. EXPERT OPINION Respiratory comorbidities have unique characteristics in childhood. Their management must be multidisciplinary, age-specific, and integrated. Further longitudinal studies are needed to understand better the mutual interrelation and synergistic effect between asthma and its respiratory comorbidities, the identification of common, treatable risk factors leading to potential asthma prevention, the effectiveness of actual and future target-therapies, and the correlation between long-lasting respiratory comorbidities and poor lung function trajectories.
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Affiliation(s)
- Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Beatrice Andrenacci
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Maria Elisa Di Cicco
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pavia, Italy
| | | | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mariangela Tosca
- Allergy Centre, IRCCS G. Gaslini Pediatric Hospital, Genova, Italy
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9
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Gaffin JM, Castro M, Bacharier LB, Fuhlbrigge AL. The Role of Comorbidities in Difficult-to-Control Asthma in Adults and Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:397-408. [PMID: 34863928 PMCID: PMC8837696 DOI: 10.1016/j.jaip.2021.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023]
Abstract
Assessment of asthma comorbidities, conditions that adversely affect the pathobiology of asthma or impair its response to therapies, is a fundamental step in the evaluation and management of patients with difficult-to-treat asthma. Identifying and effectively treating asthma comorbidities, such as obesity, obstructive sleep apnea, and chronic sinusitis with nasal polyps, may improve asthma control and reduce exacerbations. In addition, identifying comorbid T2 inflammatory conditions may help guide optimal selection of biologic therapies. Here, we describe common comorbid conditions found in adult and pediatric difficult-to-control asthma, discuss evidence for the association with asthma morbidity and treatment benefit, and provide information on how and when to assess comorbidities.
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Affiliation(s)
- Jonathan M. Gaffin
- Division of Pulmonary Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston MA, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care Medicine, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Leonard B. Bacharier
- Division of Pediatric Allergy, Immunology and Pulmonary Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
| | - Anne L. Fuhlbrigge
- Pulmonary Sciences and Critical Care, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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Deschildre A, Abou-Taam R, Drummond D, Giovannini-Chami L, Labouret G, Lejeune S, Lezmi G, Lecam MT, Marguet C, Petat H, Taillé C, Wanin S, Corvol H, Epaud R. [Update of the 2021 Recommendations for the management of and follow-up of adolescent asthmatic patients (over 12 years) under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version]. Rev Mal Respir 2022; 39:e1-e31. [PMID: 35148929 DOI: 10.1016/j.rmr.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- A Deschildre
- Université Lille, CHU Lille, service de pneumologie et allergologie pédiatriques, hôpital Jeanne de Flandre, 59000 Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019, CNRS UMR9017, équipe OpinFIELD: Infections opportunistes, Immunité, Environnement et Maladies Pulmonaires, Institut Pasteur de Lille, 59019 Lille cedex, France.
| | - R Abou-Taam
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - D Drummond
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - L Giovannini-Chami
- Service de Pneumo-Allergologie pédiatrique, Hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - G Labouret
- Service de Pneumo-allergologie pédiatrique, Hôpital des Enfants, CHU Toulouse, 31000 Toulouse, France
| | - S Lejeune
- Université Lille, CHU Lille, service de pneumologie et allergologie pédiatriques, hôpital Jeanne de Flandre, 59000 Lille, France; Centre d'infection et d'immunité de Lille, Inserm U1019, CNRS UMR9017, équipe OpinFIELD: Infections opportunistes, Immunité, Environnement et Maladies Pulmonaires, Institut Pasteur de Lille, 59019 Lille cedex, France
| | - G Lezmi
- Service de pneumologie et allergologie pédiatriques, hôpital Necker-enfants malades, APHP, université de Paris, Paris, France
| | - M T Lecam
- Service de pathologies professionnelles et de l'environnement. Centre Hospitalier Inter Communal de Créteil, 94000 Créteil, France
| | - C Marguet
- Université de Normandie, UNIROUEN, EA 2456, CHU Rouen, maladies respiratoires et allergiques, CRCM, département de Pédiatrie, et de Médecine de l'adolescent, 76000 Rouen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN,UNIROUEN, EA2656, 14033 Caen, France
| | - H Petat
- Université de Normandie, UNIROUEN, EA 2456, CHU Rouen, maladies respiratoires et allergiques, CRCM, département de Pédiatrie, et de Médecine de l'adolescent, 76000 Rouen, France; Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie Université, UNICAEN,UNIROUEN, EA2656, 14033 Caen, France
| | - C Taillé
- Groupe Hospitalier Universitaire AP-HP Nord-Université de Paris, hôpital Bichat, Service de Pneumologie et Centre de Référence constitutif des maladies pulmonaires rares ; Inserm UMR1152, Paris, France
| | - S Wanin
- Service d'allergologie pédiatrique, hôpital universitaire Armand Trousseau, 75012 Paris, France; Unité Transversale d'éducation thérapeutique Sorbonne Université, Paris, France
| | - H Corvol
- Service de pneumologie pédiatrique, Sorbonne Université, Centre de Recherche Saint-Antoine, Inserm UMRS938, Assistance Publique-Hôpitaux de Paris (APHP), Hôpital Trousseau, Paris, France
| | - R Epaud
- Centre hospitalier intercommunal de Créteil, service de pédiatrie générale, 94000 Créteil, France; Université Paris Est Créteil, Inserm, IMRB, 94010 Créteil, France; FHU SENEC, Créteil, France
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11
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Pashley CH, Wardlaw AJ. Allergic fungal airways disease (AFAD): an under-recognised asthma endotype. Mycopathologia 2021; 186:609-622. [PMID: 34043134 PMCID: PMC8536613 DOI: 10.1007/s11046-021-00562-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
The term allergic fungal airways disease has a liberal definition based on IgE sensitisation to thermotolerant fungi and evidence of fungal-related lung damage. It arose from a body of work looking into the role of fungi in asthma. Historically fungi were considered a rare complication of asthma, exemplified by allergic bronchopulmonary aspergillosis; however, there is a significant proportion of individuals with Aspergillus fumigatus sensitisation who do not meet these criteria, who are at high risk for the development of lung damage. The fungi that play a role in asthma can be divided into two groups; those that can grow at body temperature referred to as thermotolerant, which are capable of both infection and allergy, and those that cannot but can still act as allergens in IgE sensitised individuals. Sensitisation to thermotolerant filamentous fungi (Aspergillus and Penicillium), and not non-thermotolerant fungi (Alternaria and Cladosporium) is associated with lower lung function and radiological abnormalities (bronchiectasis, tree-in-bud, fleeting shadows, collapse/consolidation and fibrosis). For antifungals to play a role in treatment, the focus should be on fungi capable of growing in the airways thereby causing a persistent chronic allergenic stimulus and releasing tissue damaging proteases and other enzymes which may disrupt the airway epithelial barrier and cause mucosal damage and airway remodelling. All patients with IgE sensitisation to thermotolerant fungi in the context of asthma and other airway disease are at risk of progressive lung damage, and as such should be monitored closely.
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Affiliation(s)
- Catherine H Pashley
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Andrew J Wardlaw
- Department of Respiratory Sciences, Institute for Lung Health, University of Leicester, University Road, Leicester, LE1 7RH, UK
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12
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Goussard P, Pohunek P, Eber E, Midulla F, Di Mattia G, Merven M, Janson JT. Pediatric bronchoscopy: recent advances and clinical challenges. Expert Rev Respir Med 2021; 15:453-475. [PMID: 33512252 DOI: 10.1080/17476348.2021.1882854] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and interventional options.Areas covered: We provide a review of recent advances and clinical challenges in pediatric bronchoscopy. This includes single-use bronchoscopes, endobronchial ultrasound, and cryoprobe. Bronchoscopy in persistent preschool wheezing and asthma is included. The indications for interventional bronchoscopy have amplified and included balloon dilatation, endoscopic intubation, the use of airway stents, whole lung lavage, closing of fistulas and air leak, as well as an update on removal of foreign bodies. Others include the use of laser and microdebrider in airway surgery. Experience with bronchoscope during the COVID-19 pandemic has been included in this review. PubMed was searched for articles on pediatric bronchoscopy, including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years.Expert opinion: As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed. There is a scarcity of published evidence in this field. Courses for pediatric interventional bronchoscopy need to be developed. The COVID-19 experience resulted in safer bronchoscopy practice for all involved.
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Affiliation(s)
- P Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - P Pohunek
- Division of Pediatric Respiratory Diseases, Pediatric Department, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - E Eber
- Department of Paediatrics and Adolescent Medicine, Head, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - F Midulla
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - G Di Mattia
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - M Merven
- Department Otorhinolaryngology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - J T Janson
- Department of Surgical Sciences, Division of Cardio-Thoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
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13
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Welsh KG, Holden KA, Wardlaw AJ, Satchwell J, Monteiro W, Pashley CH, Gaillard EA. Fungal sensitization and positive fungal culture from sputum in children with asthma are associated with reduced lung function and acute asthma attacks respectively. Clin Exp Allergy 2020; 51:790-800. [PMID: 33274520 DOI: 10.1111/cea.13799] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/02/2020] [Accepted: 11/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sensitization to thermotolerant fungi, including filamentous fungi and Candida albicans, is associated with poor lung function in adults with severe asthma. Data in children are lacking. Environmental exposure to fungi is linked with acute severe asthma attacks, but there are few studies reporting the presence of fungi in the airways during asthma attacks. METHODS We investigated the association between fungal sensitization and/or positive fungal sputum culture and markers of asthma severity in children with chronic and acute asthma. Sensitization was determined using serum-specific IgE and skin prick testing against a panel of five fungi. Fungal culture was focused towards detection of filamentous fungi from sputum samples. RESULTS We obtained sensitization data and/or sputum from 175 children: 99 with chronic asthma, 39 with acute asthma and 37 controls. 34.1% of children with chronic asthma were sensitized to thermotolerant fungi compared with no children without asthma (p =< 0.001). These children had worse pre-bronchodilator lung function compared with asthmatics without sensitization including a lower FEV1 /FVC ratio (p < .05). The isolation rate of filamentous fungi from sputum was higher in children with acute compared with chronic asthma. CONCLUSIONS Fungal sensitization is a feature of children with chronic asthma. Children sensitized to thermotolerant fungi have worse lung function, require more courses of systemic corticosteroids and have greater limitation of activities due to asthma. Asthma attacks in children were associated with the presence of filamentous fungi positive sputum culture. Mechanistic studies are required to establish whether fungi contribute directly to the development of acute asthma.
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Affiliation(s)
- Kathryn G Welsh
- Department of Respiratory Sciences. Institute for Lung Health, Leicester NIHR Biomedical Research Centre - Respiratory theme. University of Leicester, Leicester, UK.,Department of Paediatric Respiratory Medicine, Leicester Children's Hospital. Leicester Royal Infirmary, Leicester, UK
| | - Karl A Holden
- Department of Respiratory Sciences. Institute for Lung Health, Leicester NIHR Biomedical Research Centre - Respiratory theme. University of Leicester, Leicester, UK.,Department of Paediatric Respiratory Medicine, Leicester Children's Hospital. Leicester Royal Infirmary, Leicester, UK
| | - Andrew J Wardlaw
- Department of Respiratory Sciences. Institute for Lung Health, Leicester NIHR Biomedical Research Centre - Respiratory theme. University of Leicester, Leicester, UK.,Institute for Lung Health, Leicester NIHR Biomedical Research Centre-Respiratory and Department of Respiratory Sciences, University Hospitals Leicester, Glenfield Hospital, Leicester, UK
| | - Jack Satchwell
- Department of Respiratory Sciences. Institute for Lung Health, Leicester NIHR Biomedical Research Centre - Respiratory theme. University of Leicester, Leicester, UK
| | - William Monteiro
- Institute for Lung Health, Leicester NIHR Biomedical Research Centre-Respiratory and Department of Respiratory Sciences, University Hospitals Leicester, Glenfield Hospital, Leicester, UK
| | - Catherine H Pashley
- Department of Respiratory Sciences. Institute for Lung Health, Leicester NIHR Biomedical Research Centre - Respiratory theme. University of Leicester, Leicester, UK
| | - Erol A Gaillard
- Department of Respiratory Sciences. Institute for Lung Health, Leicester NIHR Biomedical Research Centre - Respiratory theme. University of Leicester, Leicester, UK.,Department of Paediatric Respiratory Medicine, Leicester Children's Hospital. Leicester Royal Infirmary, Leicester, UK
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14
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Kids, Difficult Asthma and Fungus. J Fungi (Basel) 2020; 6:jof6020055. [PMID: 32349347 PMCID: PMC7345103 DOI: 10.3390/jof6020055] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 12/28/2022] Open
Abstract
Fungi have many potential roles in paediatric asthma, predominantly by being a source of allergens (severe asthma with fungal sensitization, SAFS), and also directly damaging the epithelial barrier and underlying tissue by releasing proteolytic enzymes (fungal bronchitis). The umbrella term ‘fungal asthma’ is proposed for these manifestations. Allergic bronchopulmonary aspergillosis (ABPA) is not a feature of childhood asthma, for unclear reasons. Diagnostic criteria for SAFS are based on sensitivity to fungal allergen(s) demonstrated either by skin prick test or specific IgE. In children, there are no exclusion criteria on total IgE levels or IgG precipitins because of the rarity of ABPA. Diagnostic criteria for fungal bronchitis are much less well established. Data in adults and children suggest SAFS is associated with worse asthma control and greater susceptibility to asthma attacks than non-sensitized patients. The data on whether anti-fungal therapy is beneficial are conflicting. The pathophysiology of SAFS is unclear, but the epithelial alarmin interleukin-33 is implicated. However, whether individual fungi have different pathobiologies is unclear. There are many unanswered questions needing further research, including how fungi interact with other allergens, bacteria, and viruses, and what optimal therapy should be, including whether anti-neutrophilic strategies, such as macrolides, should be used. Considerable further research is needed to unravel the complex roles of different fungi in severe asthma.
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15
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Januska MN, Goldman DL, Webley W, Teague WG, Cohen RT, Bunyavanich S, Vicencio AG. Bronchoscopy in severe childhood asthma: Irresponsible or irreplaceable? Pediatr Pulmonol 2020; 55:795-802. [PMID: 31730298 PMCID: PMC7385726 DOI: 10.1002/ppul.24569] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/14/2019] [Indexed: 12/13/2022]
Abstract
For children with severe asthma, guideline-based management focuses on the escalation of anti-inflammatory and bronchodilatory medications while addressing comorbid conditions. Bronchoscopy, in this context, has been relegated to ruling out asthma mimickers. More recently, however, there have been questions surrounding the clinical utility of bronchoscopy in severe childhood asthma. In this solicited lecture summary, we discuss the past, present, and potential future applications of bronchoscopy in severe childhood asthma.
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Affiliation(s)
- Megan N. Januska
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY
| | | | | | | | | | - Supinda Bunyavanich
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY
- Ichan School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences, New York, NY
| | - Alfin G. Vicencio
- Icahn School of Medicine at Mount Sinai, Department of Pediatrics, New York, NY
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16
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Neisi A, Borsi SH, Dastoorpoor M, Kiasat N, Goudarzi G, AlizadehAttar G, Angali KA, AlizadehAttar S. Relationship between environmental Fungi and changes in lung function indices of new referral allergic patients in Ahvaz city under normal and dust conditions. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2019; 17:961-967. [PMID: 32030166 PMCID: PMC6985357 DOI: 10.1007/s40201-019-00411-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Aim of this study was to determine whether any specific fungal spores could be responsible for changes observed in lung function indices. MATERIALS AND METHODS 1042 new allergic patients were selected from July 2017 to May 2018 in Ahvaz City, Iran. Fungal samples were collected in normal and dusty condition within 5 and 2 min, respectively. Sampling was repeated once every 6 days and also in the dusty days. RESULTS Average numbers of fungi colony were 639.86 and 836.44 CFU m-3 under normal and dusty conditions, respectively. Most common fungi in Ahwaz City air were Cladosporium sp., Penicillium sp., Aspergillus Niger, Aspergillus Flavus and Alternaria sp.. Highest fungal mean concentrations, 392 and 480 CFU m-3, were related to Cladosporium sp. under normal and dust conditions, respectively. Average total numbers of colony fungal were 614, 483, 1082, 424 CFU m-3 and 856, 701, 1418, 418 CFU m-3 during the spring, summer, autumn, and winter under normal and dusty conditions, respectively. Patients were evaluated by measured lung function parameters of FEV1 (L), FEV1 (%pred), FVC (L), FVC (%pred), and FEV1/FVC ratio with mean values of 1.85, 58.32, 2.63, 68.18, and 69.43, respectively. CONCLUSION Increases in mean total spores of fungi in spring were accompanied by decreases in FEV1/FVC ratio. Enhanced spores of Cladosporium sp. in spring led to reduced FEV1/FVC ratio. Increase the spores of Curvularia sp. in summer decreased by FEF25-75%. The augmented spores of Drechslera sp. in summer were associated with declined FEV1 and FEV1/FVC ratio. Enhanced fungal spores of Rhizopus sp. in spring resulted in lowered FEV1, FEV1/FVC ratio, and FEF25-75%.
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Affiliation(s)
- Abdolkazem Neisi
- Environmental Health Department, Public Health Faculty, Air Pollution and Respiratory Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Seyed-Hamid Borsi
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Dastoorpoor
- Biostatistics and Epidemiology Department, Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Neda Kiasat
- Department of Medical Mycology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholamreza Goudarzi
- Environmental Health Department, Public Health Faculty, Air Pollution and Respiratory Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Gholamreza AlizadehAttar
- Air Pollution and Respiratory Diseases Research Center, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Somayeh AlizadehAttar
- Environmental Health Department, Public Health Faculty, Air Pollution and Respiratory Diseases Research Centre, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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17
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Tham R, Erbas B, Dharmage SC, Tang ML, Aldakheel F, Lodge CJ, Thomas PS, Taylor PE, Abramson MJ, Lowe AJ. Outdoor fungal spores and acute respiratory effects in vulnerable individuals. ENVIRONMENTAL RESEARCH 2019; 178:108675. [PMID: 31450143 DOI: 10.1016/j.envres.2019.108675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/01/2019] [Accepted: 08/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Many outdoor fungal spores are ubiquitous, respirable and possibly allergenic. They may contribute to asthma symptoms; however, little is known about their effects on respiratory function. OBJECTIVE To investigate if outdoor fungal spore levels were associated with lung function or airway inflammation, and whether fungal sensitization or current asthma modified any associations. METHODS Cross-sectional associations between same day (Lag0) and cumulative 3-day lagged (Lag0-3) counts of 12 outdoor fungal spore taxa and pre-bronchodilator spirometry (FEV1, FVC, FEF25%-75%), bronchodilator response (BDR) and airway inflammation (fractional exhaled nitric oxide (FeNO) and exhaled breath condensate (EBC) nitrogen oxides (NOx) and pH were investigated in 936 Melbourne Atopy Cohort Study participants during September 2009 to December 2011. Generalized linear models were used to quantify associations with lung function, FeNO and EBC pH; generalized estimating equations for BDR; and ordinal logistic regression for EBC NOx. Models were adjusted for age, sex, height, temperature, relative humidity, grass pollen and sample storage time. Potential effect modification by fungal sensitization and current asthma were examined using interaction terms. RESULTS Mixed associations were found. Higher levels of Ustilago/smuts were associated with lower lung function at Lag0 (FEV1: 21ml [95%CI -36, -7]; FEF25%-75%: 39ml [-65, -13]) and Lag0-3 (FEV1: 9ml [-14, -4]; FEF25%-75% -18ml [-27, -9]). Positive BDR was associated with Ustilago/smuts (Lag0 OR = 1.1 [1.04, 1.2]; Lag0-3 OR = 1.04 [1.02, 1.07]), Alternaria (Lag0 OR = 1.3 [1.0, 1.6]) and Drechslera (Lag0 OR = 1.1 [1.03, 1.2]). Higher EBC NOx was associated with Cladosporium (Lag0-3 OR = 1.1 [1.0, 1.2]), Alternaria (Lag0-3 OR = 1.1 [1.0, 1.3]). No associations were found with higher FeNO. In those with fungal sensitization, Ustilago/smuts and Drechslera were associated with lower FEV1 and FVC; Cladosporium was associated with increased FEV1, FVC and FEF25%-75% but also with higher FeNO and lower EBC pH. In those with current asthma, Alternaria, Ustilago/smuts and Drechslera were associated with lower FEV1, FVC, FEF25-75% and EBC pH. CONCLUSION Exposure to outdoor fungal spores may be associated with lower lung function and increased airway inflammation, particularly in those with fungal sensitization and/or current asthma.
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Affiliation(s)
- Rachel Tham
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Bircan Erbas
- School of Psychology and Public Health, La Trobe University, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Mimi Lk Tang
- Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Australia
| | - Fahad Aldakheel
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Caroline J Lodge
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Paul S Thomas
- Department of Respiratory Medicine and Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, Australia
| | - Philip E Taylor
- School of Life and Environmental Sciences, Deakin University, Geelong, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Adrian J Lowe
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
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18
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Almeida MC, Antunes D, Silva BMA, Rodrigues L, Mota M, Borges O, Fernandes C, Gonçalves T. Early Interaction of Alternaria infectoria Conidia with Macrophages. Mycopathologia 2019; 184:383-392. [PMID: 31183740 DOI: 10.1007/s11046-019-00339-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 05/08/2019] [Indexed: 12/21/2022]
Abstract
Fungi of the genus Alternaria are ubiquitous indoor and outdoor airborne agents, and individuals are daily exposed to their spores. Although its importance in human infections and, particularly in respiratory allergies, there are no studies of how Alternaria spp. spores interact with host cells. Our aim was to study the early interaction of Alternaria infectoria spores with macrophages, the first line of immune defense. RAW 264.7 macrophages were infected with A. infectoria conidia, and the internalization and viability of conidia once inside the macrophages were quantified during the first 6 h of interaction. Live cell imaging was used to study the dynamics of this interaction. TNF-α production was quantified by relative gene expression, and the concentration of other cytokines (IL-1α, IL-1β, IL-6, IL-4, IL-10, IL-17, GM-CSF and INF-γ) and a chemokine, MIP-1α, was quantified by ELISA. Conidia were rapidly internalized by macrophages, with approximately half internalized after 30 min of interaction. During the first 6 h of interaction, macrophages retained the ability to mitotically divide while containing internalized conidia. The classical macrophage-activated morphology was absent in macrophages infected with conidia, and TNF-α and other cytokines and chemokines failed to be produced. Thus, macrophages are able to efficiently phagocyte A. infectoria conidia, but, during the first 6 h, no effective antifungal response is triggered, therefore promoting the residence of these fungal conidia inside the macrophages.
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Affiliation(s)
- M C Almeida
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.
| | - D Antunes
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | - B M A Silva
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | - L Rodrigues
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - M Mota
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - O Borges
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,FFUC - Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
| | - C Fernandes
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal
| | - T Gonçalves
- CNC - Center for Neuroscience and Cell Biology of Coimbra, University of Coimbra, Rua Larga, 3004-504, Coimbra, Portugal.,FMUC - Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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19
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Louisias M, Ramadan A, Naja AS, Phipatanakul W. The Effects of the Environment on Asthma Disease Activity. Immunol Allergy Clin North Am 2019; 39:163-175. [PMID: 30954168 PMCID: PMC6452888 DOI: 10.1016/j.iac.2018.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is highly prevalent and causes significant morbidity in children. The development of asthma depends on complex relationships between genetic predisposition and environmental modifiers of immune function. The biological and physical environmental factors include aeroallergens, microbiome, endotoxin, genetics, and pollutants. The psychosocial environment encompasses stress, neighborhood safety, housing, and discrimination. They all have been speculated to influence asthma control and the risk of developing asthma. Control of the factors that contribute to or aggravate symptoms, interventions to eliminate allergen exposure, guidelines-based pharmacologic therapy, and education of children and their caregivers are of paramount importance.
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Affiliation(s)
- Margee Louisias
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 6th floor, Boston, MA 02115, USA; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA
| | - Amira Ramadan
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Fegan Building, 6th Floor, Boston, MA 02115, USA; Beth Israel Deaconess Medical Center, Boston, MA
| | - Ahmad Salaheddine Naja
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Fegan Building, 6th Floor, Boston, MA 02115, USA; Lebanese American University, Beirut, Lebanon
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Fegan Building, 6th floor, Boston, MA 02115, USA.
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20
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Mouse models of severe asthma for evaluation of therapeutic cytokine targeting. Immunol Lett 2019; 207:73-83. [PMID: 30659868 DOI: 10.1016/j.imlet.2018.11.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/19/2018] [Accepted: 11/25/2018] [Indexed: 12/13/2022]
Abstract
Severe asthma is a heterogeneous inflammatory disease of the airways, which requires treatment with high-dose inhaled corticosteroids or their systemic administration, yet often remains uncontrolled despite this therapy. Over the past decades, research efforts into phenotyping of severe asthma and defining the pathological mechanisms of this disease were successful largely due to the development of appropriate animal models. Recent identification of distinct inflammatory patterns of severe asthma endotypes led to novel treatment approaches, including targeting specific cytokines or their receptors with neutralizing antibodies. Here we discuss how different experimental mouse models contributed to generation of clinically relevant findings concerning pathogenesis of severe asthma and to identification of potential targets for biologic therapy.
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21
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Arasi S, Porcaro F, Cutrera R, Fiocchi AG. Severe Asthma and Allergy: A Pediatric Perspective. Front Pediatr 2019; 7:28. [PMID: 30805326 PMCID: PMC6378301 DOI: 10.3389/fped.2019.00028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/23/2019] [Indexed: 12/17/2022] Open
Abstract
Severe asthma in children is associated with significant morbidity and lung function decline. It represents a highly heterogeneous disorder with multiple clinical phenotypes. As its management is demanding, the social and economic burden are impressive. Several co-morbidities may contribute to worsen asthma control and complicate diagnostic and therapeutic management of severe asthmatic patients. Allergen sensitization and/or allergy symptoms may predict asthma onset and severity. A better framing of "allergen sensitization" and understanding of mechanisms underlying progression of atopic march could improve the management and the long-term outcomes of pediatric severe asthma. This review focuses on the current knowledge about interactions between severe asthma and allergies.
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Affiliation(s)
- Stefania Arasi
- Pediatric Allergology Unit, Bambino Gesù Hospital (IRCCS), Rome, Italy
| | - Federica Porcaro
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
| | - Renato Cutrera
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children's Hospital, Rome, Italy
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22
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Bonner K, Roberts G. Does allergy explain why some children have severe asthma? Clin Exp Allergy 2018; 48:1594-1605. [PMID: 30019503 DOI: 10.1111/cea.13234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/30/2018] [Accepted: 07/15/2018] [Indexed: 12/13/2022]
Abstract
Asthma is a common disease in childhood with a minority of affected children having severe therapy-resistant asthma (STRA). Children with STRA can be differentiated from those with mild-moderate disease by greater allergic sensitization, increased eosinophilic airway inflammation, increased airway remodelling and reduced corticosteroid responsiveness. The aetiology of STRA in children is multifactorial but allergy seems to play a key role. Many children with asthma have coexisting allergic disease, and severe rhinitis seems to be an important driver of STRA in children. Allergies to foods, moulds, pollen and pets have also been associated with severe asthma exacerbations. Identifying allergens that are driving asthma symptoms in children with STRA may provide additional strategies for improving their disease control. Avoidance strategies may be possible. Additional monoclonal antibody therapy with Omalizumab or Mepolizumab may be helpful in children with clinically important polysensitization.
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Affiliation(s)
- Katie Bonner
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK.,Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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23
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Abstract
Fungal diseases became a major medical problem in the second half of the 20th century when advances in modern medicine together with the HIV epidemic resulted in large numbers of individuals with impaired immunity. Fungal diseases are difficult to manage because they tend to be chronic, hard to diagnose, and difficult to eradicate with antifungal drugs. This essay considers the future of medical mycology in the 21st century, extrapolating from current trends. In the near horizon, the prevalence of fungal diseases is likely to increase, as there will be more hosts with impaired immunity and drug resistance will inevitably increase after selection by antifungal drug use. We can expect progress in the development of new drugs, diagnostics, vaccines, and immunotherapies. In the far horizon, humanity may face new fungal diseases in association with climate change. Some current associations between chronic diseases and fungal infections could lead to the establishment of fungi as causative agents, which will greatly enhance their medical importance. All trends suggest that the importance of fungal diseases will increase in the 21st century, and enhanced human preparedness for this scourge will require more research investment in this group of infectious diseases.
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Affiliation(s)
- Arturo Casadevall
- Department of Molecular Microbiology and Immunology, The Johns Hopkins School of Public Health, Baltimore, Maryland
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24
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Tesse R, Borrelli G, Mongelli G, Mastrorilli V, Cardinale F. Treating Pediatric Asthma According Guidelines. Front Pediatr 2018; 6:234. [PMID: 30191146 PMCID: PMC6115494 DOI: 10.3389/fped.2018.00234] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/01/2018] [Indexed: 12/27/2022] Open
Abstract
Asthma is a common chronic inflammatory disorder of the lower respiratory airways in childhood. The management of asthma exacerbations and the disease control are major concerns for clinical practice. The Global Strategy for Asthma Management and Prevention, published by GINA, updated in 2017, the British Thoracic Society/Scottish Intercollegiate Guideline Network, revised in 2016, the National Institute for Health and Care Excellence asthma guideline consultation, available in 2017, are widely accepted documents, frequently implemented, with conflicting advices, and different conclusion on asthma definition and treatment. An International Consensus on Pediatric Asthma was carried out in 2012 by a Committee with expertise in the field, to critically review differences on current guidelines. In addition, the specific issue of treating severe and difficult asthma has been recently highlighted throughout the International European Respiratory Society/American Thoracic Society guidelines on severe asthma. The aim of this paper is to describe conventional treatments and some new therapeutic approaches to pediatric asthma according to guidelines, highlighting key aspects, and differences on proposed clinical recommendations for asthma management. Age specific therapy are proposed in steps, according to clinical severity and the level of disease control. If control is not achieved within 3 months, stepping-up should be considered; otherwise, if control is achieved after 3 months, stepping down may be considered. The most used drug classes of asthma medications are beta-2 adrenergic agonists, corticosteroids, and leukotriene modifiers. Intramuscolar triamcinolone has been used for severe asthma treatment. Chromones and xanthines have been extensively used in the past, but they have shown limits related to their efficacy and safety profile. Omalizumab, a monoclonal antibody against IgE, is an immunomodulatory biological agent, used as new drug in patients with confirmed IgE-mediated allergic asthma, only for patient's specific range of total IgE level. There are low evidences in the efficacy of metotrexate, as well as macrolide antibiotics in children with asthma. Antifungal agents are also not recommended in asthmatic patients. Non-pharmacological measures that may improve patient's quality of life should also be attempted. We conclude that treatment decisions on childhood asthma management should be critically made, pondering the differences suggested by agreed international consensus documents.
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Affiliation(s)
- Riccardina Tesse
- Allergy, Immunology and Pediatric Pulmonology Unit, Ospedale Pediatrico Papa Giovanni XXIII, Bari, Italy
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25
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Edwards MR, Walton RP, Jackson DJ, Feleszko W, Skevaki C, Jartti T, Makrinoti H, Nikonova A, Shilovskiy IP, Schwarze J, Johnston SL, Khaitov MR. The potential of anti-infectives and immunomodulators as therapies for asthma and asthma exacerbations. Allergy 2018; 73:50-63. [PMID: 28722755 PMCID: PMC7159495 DOI: 10.1111/all.13257] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2017] [Indexed: 12/30/2022]
Abstract
Asthma is responsible for approximately 25,000 deaths annually in Europe despite available medicines that maintain asthma control and reduce asthma exacerbations. Better treatments are urgently needed for the control of chronic asthma and reduction in asthma exacerbations, the major cause of asthma mortality. Much research spanning >20 years shows a strong association between microorganisms including pathogens in asthma onset, severity and exacerbation, yet with the exception of antibiotics, few treatments are available that specifically target the offending pathogens. Recent insights into the microbiome suggest that modulating commensal organisms within the gut or lung may also be a possible way to treat/prevent asthma. The European Academy of Allergy & Clinical Immunology Task Force on Anti-infectives in Asthma was initiated to investigate the potential of anti-infectives and immunomodulators in asthma. This review provides a concise summary of the current literature and aimed to identify and address key questions that concern the use of anti-infectives and both microbe- and host-based immunomodulators and their feasibility for use in asthma.
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Affiliation(s)
- M. R. Edwards
- Airway Disease Infection Section National Heart Lung Institute Imperial College London London UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma London UK
| | - R. P. Walton
- Airway Disease Infection Section National Heart Lung Institute Imperial College London London UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma London UK
| | - D. J. Jackson
- Airway Disease Infection Section National Heart Lung Institute Imperial College London London UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma London UK
- Division of Asthma, Allergy & Lung Biology King's College London & Guy's and St Thomas' NHS Trust London UK
| | - W. Feleszko
- Department of Pediatric Respiratory Diseases and Allergy The Medical University of Warsaw Warsaw Poland
| | - C. Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics Philipps University Marburg & University Hospital Giessen Marburg Germany
| | - T. Jartti
- The Department of Pediatrics Turku University Hospital Turku Finland
| | - H. Makrinoti
- Airway Disease Infection Section National Heart Lung Institute Imperial College London London UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma London UK
| | - A. Nikonova
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
- Mechnikov Research Institute of Vaccines and Sera Moscow Russia
| | - I. P. Shilovskiy
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
| | - J. Schwarze
- Centre for Inflammation Research University of Edinburgh The Queens Medical Research Institute Edinburgh Edinburgh UK
| | - S. L. Johnston
- Airway Disease Infection Section National Heart Lung Institute Imperial College London London UK
- MRC and Asthma UK Centre for Allergic Mechanisms of Asthma London UK
| | - M. R. Khaitov
- National Research Center Institute of Immunology of Federal Medicobiological Agency Moscow Russia
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26
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Gupta A, Singh M, Chakrabarti A, Mathew JL, Rawat A. Correlation between fungal sensitisation in childhood persistent asthma and disease severity. Mycoses 2017; 61:195-200. [PMID: 29110335 DOI: 10.1111/myc.12726] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 11/27/2022]
Abstract
Fungal sensitisation in adults is associated with severe asthma but prevalence and clinical significance of fungal sensitisation remains unclear in paediatric population. The aim of this study was to study the association of fungal sensitisation with disease severity in children with persistent asthma. One hundred children with persistent asthma in age group 7-15 years, symptom duration >2 years and forced expiratory volume in first second >50% of expected were enrolled. Skin prick test (SPT) to 8 fungal antigens and total serum immunoglobulin E (IgE) were done. Fungal sensitisation was described as positive SPT (wheel diameter more than 3 mm larger than the negative control) to any of the fungal antigens and total serum IgE >200 ng/mL. Seventeen patients showed evidence of fungal sensitisation, of which, 6 demonstrated sensitisation to multiple fungi. 17.6% patients with fungal sensitisation had severe asthma as compared to 2.4% patients without fungal sensitisation (P value .032). Significant increase in family history of allergic comorbidities was noted among patients with fungal sensitisation (47.1% vs 21.7%, P value .03). The most common implicated organism in fungal sensitised patients was Aspergillus flavus (47.1%). The results of this study, a first among Indian children with asthma, suggest that children with fungal sensitisation have more severe asthma as compared to children without fungal sensitisation.
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Affiliation(s)
- Aman Gupta
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenu Singh
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joseph L Mathew
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Rawat
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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27
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Iturra PA, Rojas DA, Pérez FJ, Méndez A, Ponce CA, Bonilla P, Bustamante R, Rodríguez H, Beltrán CJ, Vargas SL. Progression of Type 2 Helper T Cell-Type Inflammation and Airway Remodeling in a Rodent Model of Naturally Acquired Subclinical Primary Pneumocystis Infection. THE AMERICAN JOURNAL OF PATHOLOGY 2017; 188:417-431. [PMID: 29169991 DOI: 10.1016/j.ajpath.2017.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/03/2017] [Accepted: 10/19/2017] [Indexed: 12/25/2022]
Abstract
Subclinical primary Pneumocystis infection is the most common pulmonary infection in early infancy, making it important to determine whether it damages the lung. Pneumocystis peaks at 2 to 5 months of age, when respiratory morbidity coincidently increases. We have documented that Pneumocystis increases mucus production in infant lungs, and animal models reveal lung lesions that warrant characterization. Herein, immunocompetent rats infected at birth with Pneumocystis by cohabitation, to resemble community-acquired infection, underwent lung assessments at 45, 60, and 75 days of age. Lungs fixed by vascular perfusion to prevent collapse during necropsy were used for morphometry evaluations of mucus production, airway epithelial thickening, perivascular and peribronchiolar inflammation, and structural airway remodeling. Changes in these histologic features indicate lung disease. Selected immune markers were assessed in parallel using fresh-frozen lung tissue from sibling rats of the same cages. Sequential activation of NF-κB and an increased Gata3/T-bet mRNA level ratio, consistent with a type 2 helper T-cell-type inflammatory response, and subacute fibrosis were recognized. Therefore, documenting subclinical Pneumocystis infection induces lung disease in the immunocompetent host. Taken together with the peak age of primary Pneumocystis infection, results warrant investigating the clinical impact of this often subclinical infection on the severity of respiratory diseases in early infancy. This model can also be used to assess the effects of airway insults, including coinfections by recognized respiratory pathogens.
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Affiliation(s)
- Pablo A Iturra
- Microbiology and Mycology Program, Biomedical Sciences Institute, University of Chile School of Medicine, Santiago, Chile
| | - Diego A Rojas
- Microbiology and Mycology Program, Biomedical Sciences Institute, University of Chile School of Medicine, Santiago, Chile
| | - Francisco J Pérez
- Microbiology and Mycology Program, Biomedical Sciences Institute, University of Chile School of Medicine, Santiago, Chile
| | - Andrea Méndez
- Microbiology and Mycology Program, Biomedical Sciences Institute, University of Chile School of Medicine, Santiago, Chile
| | - Carolina A Ponce
- Microbiology and Mycology Program, Biomedical Sciences Institute, University of Chile School of Medicine, Santiago, Chile
| | - Paula Bonilla
- Microbiology and Mycology Program, Biomedical Sciences Institute, University of Chile School of Medicine, Santiago, Chile
| | - Rebeca Bustamante
- Microbiology and Mycology Program, Biomedical Sciences Institute, University of Chile School of Medicine, Santiago, Chile
| | - Héctor Rodríguez
- Anatomy and Developmental Biology Program, Biomedical Sciences Institute, University of Chile School of Medicine, Santiago, Chile
| | - Caroll J Beltrán
- Gastroenterology Division, University Hospital, University of Chile School of Medicine, Santiago, Chile
| | - Sergio L Vargas
- Microbiology and Mycology Program, Biomedical Sciences Institute, University of Chile School of Medicine, Santiago, Chile.
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28
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Jones JT, Tassew DD, Herrera LK, Walton-Filipczak SR, Montera MA, Chand HS, Delgado M, Mebratu YA, Tesfaigzi Y. Extent of allergic inflammation depends on intermittent versus continuous sensitization to house dust mite. Inhal Toxicol 2017; 29:106-112. [PMID: 28413916 DOI: 10.1080/08958378.2017.1311389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE House dust mite (HDM) exposure is used to model experimental asthma in mice. However, a direct comparison of inflammatory responses following continuous versus intermittent HDM exposure has not been reported. Therefore, we investigated whether the HDM dose at sensitization or challenge affects extent of inflammation in mice that were either continuously or intermittently sensitized with HDM. MATERIALS AND METHODS C57BL/6 mice received either 10 continuous exposures with 10 μg HDM per exposure or two intermittent HDM exposures over a period of two weeks and were subsequently challenged by three instillations with HDM during the third week. For the intermittent model, mice were sensitized with 1 or 10 μg HDM and challenged on three consecutive days with 1 or 10 μg HDM. Inflammatory cells in the bronchoalveolar lavage fluid and epithelial cell hyperplasia and mucous cell metaplasia were quantified. RESULTS Significantly higher levels of inflammation and mucous cell metaplasia were observed when mice were sensitized intermittently compared with continuously. Intermittent sensitization and challenge with 10 μg HDM caused maximum inflammation, mucous cell metaplasia, and epithelial cell hyperplasia. However, sensitization with 1 μg HDM only also showed increased inflammation when challenged with 10 μg HDM. DISCUSSION These findings suggest major differences in adaptive immunity, depending on the sensitization protocol. CONCLUSIONS Because of significant differences, the HDM sensitization protocol should be carefully considered when designing studies to investigate the underlying mechanisms of immunity in mouse models of asthma.
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Affiliation(s)
- Jane Tully Jones
- a COPD Program, Lovelace Respiratory Research Institute , Albuquerque , NM , USA
| | - Dereje D Tassew
- a COPD Program, Lovelace Respiratory Research Institute , Albuquerque , NM , USA
| | - Lois K Herrera
- a COPD Program, Lovelace Respiratory Research Institute , Albuquerque , NM , USA
| | | | - Marena A Montera
- a COPD Program, Lovelace Respiratory Research Institute , Albuquerque , NM , USA
| | - Hitendra S Chand
- a COPD Program, Lovelace Respiratory Research Institute , Albuquerque , NM , USA
| | - Monica Delgado
- a COPD Program, Lovelace Respiratory Research Institute , Albuquerque , NM , USA
| | - Yohannes A Mebratu
- a COPD Program, Lovelace Respiratory Research Institute , Albuquerque , NM , USA
| | - Yohannes Tesfaigzi
- a COPD Program, Lovelace Respiratory Research Institute , Albuquerque , NM , USA
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29
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Del Giacco SR, Bakirtas A, Bel E, Custovic A, Diamant Z, Hamelmann E, Heffler E, Kalayci Ö, Saglani S, Sergejeva S, Seys S, Simpson A, Bjermer L. Allergy in severe asthma. Allergy 2017; 72:207-220. [PMID: 27775836 DOI: 10.1111/all.13072] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/20/2022]
Abstract
It is well recognized that atopic sensitization is an important risk factor for asthma, both in adults and in children. However, the role of allergy in severe asthma is still under debate. The term 'Severe Asthma' encompasses a highly heterogeneous group of patients who require treatment on steps 4-5 of GINA guidelines to prevent their asthma from becoming 'uncontrolled', or whose disease remains 'uncontrolled' despite this therapy. Epidemiological studies on emergency room visits and hospital admissions for asthma suggest the important role of allergy in asthma exacerbations. In addition, allergic asthma in childhood is often associated with severe asthma in adulthood. A strong association exists between asthma exacerbations and respiratory viral infections, and interaction between viruses and allergy further increases the risk of asthma exacerbations. Furthermore, fungal allergy has been shown to play an important role in severe asthma. Other contributing factors include smoking, pollution and work-related exposures. The 'Allergy and Asthma Severity' EAACI Task Force examined the current evidence and produced this position document on the role of allergy in severe asthma.
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Affiliation(s)
- S. R. Del Giacco
- Department of Medical Sciences and Public Health; University of Cagliari; Cagliari Italy
| | - A. Bakirtas
- Department of Pediatric Allergy and Asthma; School of Medicine; Gazi University; Ankara Turkey
| | - E. Bel
- Department of Respiratory Medicine; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - A. Custovic
- Department of Paediatrics; Imperial College London; London UK
| | - Z. Diamant
- Department of General Practice and Department of Clinical Pharmacy & Pharmacology; University Medical Centre Groningen; University of Groningen; Groningen The Netherlands
- Department of Respiratory Medicine and Allergology; Lund University; Lund Sweden
| | - E. Hamelmann
- Klinik für Kinder and Jugendmedizin Kinderzentrum; Bethel Evangelisches Krankenhaus; Allergy Center; Ruhr University Bochum; Bielefeld Germany
| | - E. Heffler
- Respiratory Medicine and Allergology - Department of Experimental and Clinical Medicine; University of Catania; Catania Italy
| | - Ö. Kalayci
- School of Medicine; Hacettepe University; Ankara Turkey
| | - S. Saglani
- National Heart & Lung Institute; Imperial College London; London UK
| | - S. Sergejeva
- Institute of Technology; University of Tartu; Tartu Estonia
| | - S. Seys
- Department of Microbiology and Immunology; Laboratory of Clinical Immunology; KU Leuven Belgium
| | - A. Simpson
- Centre Lead for Respiratory Medicine and Allergy; University Hospital of South Manchester; Education and Research Centre; University of Manchester; Manchester UK
| | - L. Bjermer
- Department of Respiratory Medicine and Allergology; Lund University; Lund Sweden
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30
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Byeon JH, Ri S, Amarsaikhan O, Kim E, Ahn SH, Choi IS, Kim HJ, Seo S, Yoon W, Yoo Y. Association Between Sensitization to Mold and Impaired Pulmonary Function in Children With Asthma. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2017; 9:509-516. [PMID: 28913990 PMCID: PMC5603479 DOI: 10.4168/aair.2017.9.6.509] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/16/2017] [Accepted: 03/31/2017] [Indexed: 12/27/2022]
Abstract
Purpose Recent data indicate that sensitization to mold contributes to the severity and persistence of asthma. In this study, we investigated the relationships between sensitization to mold and lung function parameters in children with asthma. Methods We retrospectively reviewed clinical data from 551 asthmatic subjects. We selected subjects who met clinical diagnostic criteria of asthma. Their spirometry, methacholine challenge tests, and measurements of blood eosinophils, serum IgE, eosinophil cationic protein (ECP) and fractional exhaled nitric oxide (FeNO) results were included. Skin prick testing (SPT) results with 13 common aeroallergens in Korea including house dust mites, animal dander, pollen, cockroach and mold were reviewed. Subjects were divided into 3 groups according to their SPT results. Subjects who showed no positive result to any aeroallergen were designated as group 1 (non-sensitized). Group 2 represented subjects who were sensitized to aeroallergens other than mold (other allergen-sensitized) and group 3 included subjects who were sensitized to mold allergens (mold-sensitized). Results Among the 551 asthmatic subjects, 67 (12.2%) were sensitized to mold and 366 (66.4%) were sensitized to other aeroallergens. The log mean IgE levels were higher in groups 2 (5.96±1.14 IU/mL) and 3 (5.81±0.97 IU/mL) compared to group 1 (3.88±1.68 IU/mL). Blood eosinophils, ECP and FeNO concentrations were significantly higher in groups 2 and 3, but no significant difference was found between the 2 groups. The mean FEV1 value was significantly lower in group 3 (86.9±12.1%pred) than in groups 2 (92.0±14.8%pred) and 1 (93.4±15.4%pred). The log mean methacholine PC20 was significantly lower in group 3 (0.08±1.91 mg/mL) than in groups 2 (1.31±1.69 mg/mL) and 1 (2.29±1.66 mg/mL). Conclusions We observed a differential association between mold and other aeroallergen sensitization, and severity of asthma. Sensitization to mold is associated with lower lung function and increased airway hyper-responsiveness in children with asthma. Mold sensitization could be an important factor determining asthma severity particularly airflow limitation in children.
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Affiliation(s)
- Jung Hye Byeon
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Soohyun Ri
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Oyuntulga Amarsaikhan
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Eunji Kim
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - So Hyun Ahn
- Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Ic Sun Choi
- Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Hyung Jin Kim
- Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - SungChul Seo
- Environmental Health Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Wonsuck Yoon
- Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea.
| | - Young Yoo
- Department of Pediatrics, Korea University College of Medicine, Anam Hospital, Seoul, Korea.,Allergy Immunology Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea.,Environmental Health Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea.
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31
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Lehmann S, Sprünken A, Wagner N, Tenbrock K, Ott H. Clinical relevance of IgE-mediated sensitization against the mould Alternaria alternata in children with asthma. Ther Adv Respir Dis 2016; 11:30-39. [PMID: 28043213 PMCID: PMC5941980 DOI: 10.1177/1753465816680786] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Asthma in childhood has a prevalence of 5–10% in Germany and severe asthma
accounts for about 5% in this patient group. Positive predictive values for
severe asthma are atopy, a positive family history and sensitizations
against inhalative allergens. Alternaria is an important
inhalative allergen and sensitization is suspected to correlate with severe
and lethal asthma. We investigated the prevalence and impact of
Alternaria sensitization in paediatric asthma. Methods: We reviewed paediatric patients with a diagnosis of low-grade, moderate and
severe asthma. Data collection included concomitant atopic diseases,
sensitization profiles, family history and prior hospitalization for asthma
exacerbation. Results: A total of 207 paediatric patients (aged 1–17 years) were included in the
study. Overall, 25% had low-grade asthma, 31% moderate and 44% severe asthma
and 26% were formerly hospitalized. Alternaria
sensitization was the most common in moulds, although without significant
correlation with hospitalization and severe asthma.
Alternaria sensitization increased with age and was
significantly associated with co-sensitization against other moulds, grass
pollen and cat epithelia. Allergic rhinitis was significantly correlated
with hospitalization, independent of Alternaria
sensitization. Conclusions: Alternaria sensitization was common and increased with age.
No significant correlation was found between asthma degree, hospitalization
rates and sensitization profiles. Alternaria sensitization
demonstrated no isolated risk factor for severe asthma and
hospitalization.
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Affiliation(s)
- Sylvia Lehmann
- Department of Pediatric Pulmonology and Allergology, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | | | | | | | - Hagen Ott
- Children's Hospital Auf der Bult, Hannover, Germany
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32
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Eddens T, Campfield BT, Serody K, Manni ML, Horne W, Elsegeiny W, McHugh KJ, Pociask D, Chen K, Zheng M, Alcorn JF, Wenzel S, Kolls JK. A Novel CD4 + T Cell-Dependent Murine Model of Pneumocystis-driven Asthma-like Pathology. Am J Respir Crit Care Med 2016; 194:807-820. [PMID: 27007260 DOI: 10.1164/rccm.201511-2205oc] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Infection with Pneumocystis, an opportunistic fungal pathogen, can result in fulminant pneumonia in the clinical setting of patients with immunosuppression. In murine models, Pneumocystis has previously been shown to induce a CD4+ T cell-dependent eosinophilic response in the lung capable of providing protection. OBJECTIVES We sought to explore the role of Pneumocystis in generating asthma-like lung pathology, given the natural eosinophilic response to infection. METHODS Pneumocystis infection or antigen treatment was used to induce asthma-like pathology in wild-type mice. The roles of CD4+ T cells and eosinophils were examined using antibody depletion and knockout mice, respectively. The presence of anti-Pneumocystis antibodies in human serum samples was detected by ELISA and Western blotting. MEASUREMENTS AND MAIN RESULTS Pneumocystis infection generates a strong type II response in the lung that requires CD4+ T cells. Pneumocystis infection was capable of priming a Th2 response similar to that of a commonly studied airway allergen, the house dust mite. Pneumocystis antigen treatment was also capable of inducing allergic inflammation in the lung, resulting in anti-Pneumocystis IgE production, goblet cell hyperplasia, and increased airway resistance. In the human population, patients with severe asthma had increased levels of anti-Pneumocystis IgG and IgE compared with healthy control subjects. Patients with severe asthma with elevated anti-Pneumocystis IgG levels had worsened symptom scores and lung parameters such as decreased forced expiratory volume and increased residual volume compared with patients with severe asthma who had low anti-Pneumocystis IgG. CONCLUSIONS The present study demonstrates for the first time, to our knowledge, that Pneumocystis is an airway allergen capable of inducing asthma-like lung pathology.
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Affiliation(s)
- Taylor Eddens
- 1 Richard King Mellon Foundation Institute for Pediatric Research and.,2 Department of Immunology
| | - Brian T Campfield
- 1 Richard King Mellon Foundation Institute for Pediatric Research and.,3 Division of Pediatric Infectious Diseases, Department of Pediatrics, and
| | - Katelin Serody
- 1 Richard King Mellon Foundation Institute for Pediatric Research and
| | - Michelle L Manni
- 4 Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - William Horne
- 1 Richard King Mellon Foundation Institute for Pediatric Research and
| | - Waleed Elsegeiny
- 1 Richard King Mellon Foundation Institute for Pediatric Research and.,2 Department of Immunology
| | - Kevin J McHugh
- 4 Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Derek Pociask
- 5 Department of Pulmonary Diseases, Critical Care, and Environmental Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Kong Chen
- 1 Richard King Mellon Foundation Institute for Pediatric Research and
| | - Mingquan Zheng
- 1 Richard King Mellon Foundation Institute for Pediatric Research and
| | - John F Alcorn
- 4 Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Sally Wenzel
- 6 Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; and
| | - Jay K Kolls
- 1 Richard King Mellon Foundation Institute for Pediatric Research and
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Severe asthma in school-age children: evaluation and phenotypic advances. Curr Allergy Asthma Rep 2015; 15:20. [PMID: 26134431 DOI: 10.1007/s11882-015-0521-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Although the majority of children with asthma have a favorable clinical response to treatment with low to moderate doses of inhaled corticosteroids (ICS), a small subset of children have "severe" asthma characterized by ongoing symptoms and airway inflammation despite treatment with high doses of ICS and even oral corticosteroids. Although there is symptom heterogeneity in the affected children, children with severe asthma share the risk for adverse outcomes, including recurrent and potentially life-threatening exacerbations, which contribute to substantial economic burden. This article reviews current knowledge of severe asthma in school-age children (age 6-17 years) with a focus on recent literature published after January 2012. Clinical management approaches for children with severe asthma are discussed as well as current phenotyping efforts and emerging phenotypic-directed therapies that may be of benefit for subpopulations of children with severe asthma in the future.
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Abstract
PURPOSE OF REVIEW Fungal spores are ubiquitously present in indoor and outdoor air. A number can act as aeroallergens in Immunoglobulin E (IgE)-sensitized individuals and some thermotolerant fungi germinate in the lung where they can cause a combined allergic and infective stimulus leading to a number of clinical presentations characterized by evidence of lung damage. We discuss which biomarkers are useful in helping to guide diagnosis, prognosis and treatment of allergic fungal airway disease (AFAD). RECENT FINDINGS Diagnostic biomarkers, such as specific IgEs and fungal culture, for AFAD are limited by sensitivity, although this may be improved with novel agents such as specific IgEs to fungal components and quantitative PCR. Total IgE and hypereosinophilia are nonspecific and do not clearly relate to disease activity. High attenuation mucus and proximal bronchiectasis are specific, albeit insensitive markers of AFAD. Biomarkers that predict prognosis and treatment response are yet to be defined. SUMMARY This review summarizes the fungi involved and the current debate regarding the diagnostic criteria to define fungal-associated lung disease. We advocate the phasing out of the term allergic bronchopulmonary aspergillosis and the use of a more inclusive term such as AFAD, together with a more liberal set of criteria based largely on IgE sensitization to thermotolerant fungi, which identifies those patients at risk of developing lung damage.
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35
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Fainardi V, Saglani S. The need to differentiate between adults and children when treating severe asthma. Expert Rev Respir Med 2015; 9:419-28. [PMID: 26175269 DOI: 10.1586/17476348.2015.1068693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Severe asthma at all ages is heterogeneous incorporating several phenotypes that are distinct in children and adults, however, there are also numerous similar features including the limitation that they may not remain stable longitudinally. Severe asthma in both children and adults is characterized by eosinophilic airway inflammation and evidence of airway remodeling. In adults, targeting eosinophilia with anti-IL-5 antibody therapy is very successful, resulting in the recommendation that sputum eosinophils should be used to guide treatment. In contrast, data for the efficacy of blocking IL-5 remain unavailable in children. However, its effectiveness is uncertain since many children with severe asthma have normal blood eosinophils and the dominance of Th2-mediated inflammation is controversial. Approaches that have revealed gene signatures and biomarkers such as periostin that are specific to adult disease now need to be adopted in children to identify effective pediatric specific therapeutics and minimize the extrapolation of adult therapeutics to children.
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Affiliation(s)
- Valentina Fainardi
- Leukocyte Biology and Respiratory Paediatrics, National Heart and Lung Institute, Imperial College London, London, UK
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36
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Noah TL, Yilmaz O, Nicolai T, Birnkrant D, Praud JP. Pediatric Pulmonology year in review 2014: Part 1. Pediatr Pulmonol 2015; 50:621-9. [PMID: 25891206 DOI: 10.1002/ppul.23202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/29/2015] [Indexed: 11/08/2022]
Abstract
Our discipline and our journal cover an extremely broad range of research and scholarly topics related to children's respiratory disorders. To better meet the needs of our readership for updated perspectives on the rapidly expanding knowledge in our field, we here summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages.
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Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | | | - David Birnkrant
- MetroHealth Medical Center Department of Pediatrics, Cleveland, Ohio
| | - Jean-Paul Praud
- University Sherbrooke Pediatrics, Sherbrooke, Quebec, Canada
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de Andrade WCC, Lasmar LMDLBF, Ricci CDAT, Camargos PAM, Cruz ÁA. Phenotypes of severe asthma among children and adolescents in Brazil: a prospective study. BMC Pulm Med 2015; 15:36. [PMID: 25912047 PMCID: PMC4412043 DOI: 10.1186/s12890-015-0029-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/31/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The morbidity associated with severe uncontrolled asthma is disproportionately higher in low- and middle-income countries than in high-income countries. The aim of this study was to describe the phenotypic characteristics of difficult-to-treat severe asthma and treatment-resistant severe asthma in a sample of children and adolescents in Brazil. METHODS This was a prospective study, conducted between 2010 and 2014, following 61 patients (6-18 years of age) who had been diagnosed with severe uncontrolled asthma. The patients were classified and managed in accordance with the World Health Organization asthma follow-up protocol, which calls for re-evaluations of the diagnosis, level of control (functional and clinical), comorbidities, inhaler technique, and environmental factors, together with adjustment of the treatment to achieve a target level of control. We assessed pulmonary function, measured fractional exhaled nitric oxide, and performed sputum cytology. After the target rate of ≥ 80% adherence to inhaled corticosteroid treatment had been reached and all of the re-evaluations had been performed, the patients incorrectly diagnosed with severe uncontrolled asthma were excluded and the remaining patients were classified as having treatment-resistant or difficult-to-treat severe asthma. RESULTS We found that, of the 61 patients evaluated, 10 had been misdiagnosed (i.e., they did not have asthma), 15 had moderate asthma, and 36 had severe uncontrolled asthma. Among those 36 patients, the asthma was classified as treatment-resistant in 20 (55.6%) and as difficult-to-treat in 16 (44.4%). In comparison with the patients with difficult-to-treat severe asthma, those with treatment-resistant severe asthma showed a higher median level of fractional exhaled nitric oxide (40 ppb vs. 12 ppb; P < 0.037) and a lower median forced expiratory volume in one second (61% vs. 87%; P < 0.001). CONCLUSIONS Although patients with treatment-resistant severe asthma cannot always be distinguished from those with difficult-to-treat severe asthma on the basis of baseline clinical characteristics, reduced airflow and elevated fractional exhaled nitric oxide are factors that could distinguish the two groups. Patients diagnosed with severe uncontrolled asthma should be re-evaluated on a regular basis, in order to exclude other diagnoses, to reduce exacerbations, and to identify patients with persistent airflow limitation.
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Affiliation(s)
| | | | - Cristiane de Abreu Tonelli Ricci
- Pediatric Pulmonology Unit, University Hospital, Federal University of Minas Gerais, Avenida Alfredo Balena, 190, sala 267, Belo Horizonte, MG, Brazil.
| | - Paulo Augusto Moreira Camargos
- Pediatric Pulmonology Unit, University Hospital, Federal University of Minas Gerais, Avenida Alfredo Balena, 190, sala 267, Belo Horizonte, MG, Brazil.
| | - Álvaro A Cruz
- ProAR-Center of Excellence in Asthma, Federal University of Bahia School of Medicine, Salvador, Brazil.
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Abstract
BACKGROUND Glucan is a component of the fungal cell wall that is used as a marker of fungal exposure. Little is known about indoor glucan, atopy, and asthma exacerbations among children living in tropical environments such as Puerto Rico. Our objective was to examine whether glucan exposure is associated with degree of atopy or visits to the emergency department (ED)/urgent care for asthma in Puerto Rican children. METHODS This was a cross-sectional study of 317 children aged 6 to 14 years with (cases, n = 160) and without (control subjects, n = 157) asthma in San Juan, Puerto Rico. Our primary outcomes were the number of positive skin tests to allergens (range, 0-15) and (in cases only) having had at least one visit to the ED/urgent care for asthma in the prior year. Levels of glucan, endotoxin, peptidoglycan, and five allergens (Der p 1, Bla g 2, Fel d 1, Can f 1, and Mus m 1) were measured in samples of house dust. Linear or logistic regression was used for the multivariate analysis. MEASUREMENTS AND MAIN RESULTS In a multivariate analysis adjusting for case-control status, mouse allergen, and other covariates, children exposed to glucan levels in the second and third quartiles had approximately two more positive skin tests than those in the lowest quartile (P < 0.01 in both instances). Among children with asthma, exposure to the highest quartile of glucan was associated with nearly ninefold greater odds of one or more visits to the ED/urgent care for asthma (95% confidence interval for adjusted odds ratio, 2.7-28.4; P < 0.001). CONCLUSIONS Our results suggest that indoor fungal exposure leads to an increased degree of atopy and visits to the ED/urgent care for asthma in Puerto Rican children.
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Castanhinha S, Sherburn R, Walker S, Gupta A, Bossley CJ, Buckley J, Ullmann N, Grychtol R, Campbell G, Maglione M, Koo S, Fleming L, Gregory L, Snelgrove RJ, Bush A, Lloyd CM, Saglani S. Pediatric severe asthma with fungal sensitization is mediated by steroid-resistant IL-33. J Allergy Clin Immunol 2015; 136:312-22.e7. [PMID: 25746970 PMCID: PMC4534777 DOI: 10.1016/j.jaci.2015.01.016] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/24/2014] [Accepted: 01/05/2015] [Indexed: 11/16/2022]
Abstract
Background The mechanism underlying severe asthma with fungal sensitization (SAFS) is unknown. IL-33 is important in fungus-induced asthma exacerbations, but its role in fungal sensitization is unexplored. Objective We sought to determine whether fungal sensitization in children with severe therapy-resistant asthma is mediated by IL-33. Methods Eighty-two children (median age, 11.7 years; 63% male) with severe therapy-resistant asthma were included. SAFS (n = 38) was defined as specific IgE or skin prick test response positivity to Aspergillus fumigatus, Alternaria alternata, or Cladosporium herbarum. Clinical features and airway immunopathology were assessed. Chronic exposure to house dust mite and A alternata were compared in a neonatal mouse model. Results Children with SAFS had earlier symptom onset (0.5 vs 1.5 years, P = .006), higher total IgE levels (637 vs 177 IU/mL, P = .002), and nonfungal inhalant allergen-specific IgE. Significantly more children with SAFS were prescribed maintenance oral steroids (42% vs 14%, P = .02). SAFS was associated with higher airway IL-33 levels. In neonatal mice A alternata exposure induced higher serum IgE levels, pulmonary IL-33 levels, and IL-13+ innate lymphoid cell (ILC) and TH2 cell numbers but similar airway hyperresponsiveness (AHR) compared with those after house dust mite exposure. Lung IL-33 levels, IL-13+ ILC numbers, TH2 cell numbers, IL-13 levels, and AHR remained increased with inhaled budesonide during A alternata exposure, but all features were significantly reduced in ST2−/− mice lacking a functional receptor for IL-33. Conclusion Pediatric SAFS was associated with more oral steroid therapy and higher IL-33 levels. A alternata exposure resulted in increased IL-33–mediated ILC2 numbers, TH2 cell numbers, and steroid-resistant AHR. IL-33 might be a novel therapeutic target for SAFS.
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Affiliation(s)
- Susana Castanhinha
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Rebekah Sherburn
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Simone Walker
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Atul Gupta
- Department of Respiratory Paediatrics, Kings College Hospital, London, United Kingdom
| | - Cara J Bossley
- Department of Respiratory Paediatrics, Kings College Hospital, London, United Kingdom
| | - James Buckley
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Nicola Ullmann
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Ruth Grychtol
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Gaynor Campbell
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Marco Maglione
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Sergio Koo
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom
| | - Louise Fleming
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Airways Disease, NHLI, Imperial College London, London, United Kingdom
| | - Lisa Gregory
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Robert J Snelgrove
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Andrew Bush
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Airways Disease, NHLI, Imperial College London, London, United Kingdom
| | - Clare M Lloyd
- Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom
| | - Sejal Saglani
- Department of Respiratory Paediatrics, Royal Brompton Hospital, London, United Kingdom; Leukocyte Biology, NHLI, Imperial College London, London, United Kingdom.
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Cook RC, Blinman TA. Alleviation of Retching and Feeding Intolerance After Fundoplication. Nutr Clin Pract 2014; 29:386-96. [DOI: 10.1177/0884533614525211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Robin C. Cook
- Division of Pediatric General, Thoracic, and Fetal Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Clinical Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thane A. Blinman
- Division of Pediatric General, Thoracic, and Fetal Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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