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Larson PS, Steiner AL, Bennion E, Baptist AP, O'Neill MS, Gronlund CJ. Pollen effects in a changing climate: Ragweed pollen exposure and sleepiness in immunotherapy patients of a Southeastern Michigan allergy clinic. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024:10.1007/s00484-024-02737-y. [PMID: 39141134 DOI: 10.1007/s00484-024-02737-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/27/2024] [Accepted: 07/10/2024] [Indexed: 08/15/2024]
Abstract
Allergic rhino-conjunctivitis (AR) is a globally relevant health disorder characterized by sneezing, rhinorrhea and sleep disturbance. Ragweed (Ambrosia artemisiifolia) is a plant common to North America and an important allergen. Coarse methods of measuring airborne pollen counts are used to predict seasonal allergy symptoms. This research used a longitudinal study design with a novel, model-based raster of predicted pollen counts to test associations with self-reported symptoms of AR collected from patients receiving immunotherapy for pollen allergies at an allergy clinic. Researchers visited a clinic six times over three weeks. Immunotherapy patients were asked to fill out a brief intake survey on allergic and symptomatic profiles, daytime sleepiness, housing quality, and demographics. Participants responded to a daily, emailed survey on sleepiness and asthma symptoms for 21 days. Using the date and location of responses, ragweed pollen counts were extracted from a prognostic, model based raster (25km pixels). Lag associations of pollen counts with sleepiness were tested using a logistic regression model , adjusted for housing and demographic characteristics, in a distributed lag non-linear model (DLNM) framework. 49 people participated in the study. 26 (52%) were female. The mean age was 37.9 years. Asthma/allergy symptoms were not associated with ragweed pollen but sleepiness was highest two days after exposure (Estimate: 0.33 [0.04,0.62]). Subjects traveled widely during the study period. Intense exposures to ragweed pollen may be associated with daytime sleepiness within small exposure windows. Model-based predicted pollen counts could be used to study health impacts of pollen in people with disease severe enough to receive immunotherapy. Daytime sleepiness can affect productivity and injury risk, and pollen season length and allergenicity may be increasing with climate change. Thus our results may have important implications for population health.
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Affiliation(s)
- Peter S Larson
- Institute for Social Research, Survey Research Center, University of Michigan, 426 Thompson St., Ann Arbor, 48104, MI, USA.
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, 48109, MI, USA.
| | - Allison L Steiner
- Department of Climate and Space Sciences and Engineering, School of Engineering, University of Michigan, 2455 Hayward Street, Ann Arbor, 48109-2143, MI, USA
| | - Erica Bennion
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, 48109, MI, USA
| | - Alan P Baptist
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, 48109, MI, USA
- Department of Internal Medicine, Henry Ford Health and Michigan State University, One Ford Place, Detroit, 48202, MI, USA
| | - Marie S O'Neill
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, 48109, MI, USA
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, 48109, MI, USA
| | - Carina J Gronlund
- Institute for Social Research, Survey Research Center, University of Michigan, 426 Thompson St., Ann Arbor, 48104, MI, USA
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, 48109, MI, USA
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Paolino G, Carugno A, Frontera A, Rongioletti F, Malagoli P, Foti A, Brianti P, Guida S, Germiniasi F, Bianchi VG, Raponi F, Sena P, Narcisi A, Costanzo A, Mercuri SR, Valenti M. Arrhythmias and other cardiovascular diseases in young patients (<40 years) with moderate/severe atopic dermatitis: A multicentric study in northern Italy. J Eur Acad Dermatol Venereol 2024. [PMID: 38940515 DOI: 10.1111/jdv.20184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/27/2024] [Indexed: 06/29/2024]
Affiliation(s)
- G Paolino
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute, San Raffaele, Milan, Italy
| | - A Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
- PhD Program in Molecular and Translational Medicine (DIMET), University of Milano-Bicocca, Milan, Italy
| | - A Frontera
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - F Rongioletti
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute, San Raffaele, Milan, Italy
| | - P Malagoli
- Dermatology Unit, Azienda Ospedaliera San Donato Milanese, Milan, Italy
| | - A Foti
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - P Brianti
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - S Guida
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute, San Raffaele, Milan, Italy
| | - F Germiniasi
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute, San Raffaele, Milan, Italy
| | - V G Bianchi
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Raponi
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - P Sena
- Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - A Narcisi
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - A Costanzo
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - S R Mercuri
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
- Università Vita-Salute, San Raffaele, Milan, Italy
| | - M Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Kumaran T, Damodaran S, Singh AP, Kanchi M. Intraoperative cardiac arrest due to allergic acute coronary syndrome (Kounis syndrome) triggered by cephalosporin. Ann Card Anaesth 2023; 26:219-222. [PMID: 37706392 PMCID: PMC10284483 DOI: 10.4103/aca.aca_302_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 07/25/2021] [Indexed: 04/03/2023] Open
Abstract
An acute coronary syndrome due to mast-cell activation in the presence of an allergen is known as Kounis Syndrome (KS). This relatively new entity of KS is being increasingly recognized among allergists, cardiologists, and emergency physicians; however, it is not well-known among anesthesiologists. We report here, a case of type 2 KS due to antibiotic administration causing sudden perioperative cardiac arrest.
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Affiliation(s)
- Thiruthani Kumaran
- Department of Cardio-Thoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
| | - Srinath Damodaran
- Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
| | - Akshaya Pratap Singh
- Department of Cardio-Thoracic Surgery, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
| | - Muralidhar Kanchi
- Anaesthesia and Intensive Care, Narayana Institute of Cardiac Sciences, Narayana Health City, Bangalore, Karnataka, India
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Pollen Exposure and Cardiopulmonary Health Impacts in Adelaide, South Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159093. [PMID: 35897462 PMCID: PMC9331296 DOI: 10.3390/ijerph19159093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/22/2022] [Accepted: 07/23/2022] [Indexed: 11/22/2022]
Abstract
(1) Background: Limited research has suggested that cardiopulmonary health outcomes should be considered in relation to pollen exposure. This study sets out to test the relationship between pollen types (grasses, trees, weeds) and cardiovascular, lower respiratory and COPD health outcomes using 15 years (2003–2017) of data gathered in Adelaide, South Australia; (2) Methods: A time-series analysis by months was conducted using cardiopulmonary data from hospital admissions, emergency presentations and ambulance callouts in relation to daily pollen concentrations in children (0–17) for lower respiratory outcomes and for adults (18+). Incidence rate ratios (IRR) were calculated over lags from 0 to 7 days; (3) Results: IRR increases in cardiovascular outcomes in March, May, and October were related to grass pollen, while increases in July, November, and December were related to tree pollen. IRRs ranged from IRR 1.05 (95% confidence interval (CI) 1.00–1.10) to 1.25 (95% CI 1.12–1.40). COPD increases related to grass pollen occurred only in May. Pollen-related increases were observed for lower respiratory outcomes in adults and in children; (4) Conclusion: Notable increases in pollen-related associations with cardiopulmonary outcomes were not restricted to any one season. Prevention measures for pollen-related health effects should be widened to consider cardiopulmonary outcomes.
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Increased Risk of Atrial Fibrillation in Patients with Atopic Triad: A Nationwide Population-Based Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3422-3430.e5. [PMID: 33965590 DOI: 10.1016/j.jaip.2021.04.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite a sharp increase in the global prevalence of allergy over the past decade, the relation between multiple atopic conditions and atrial fibrillation (AF) has not been fully elucidated. OBJECTIVE To determine whether there is an association between atopic diseases and AF and to examine the effect of multiple atopic diseases on the incidence of AF. METHODS This retrospective population-based study used the database from the 2009 National Health Insurance Services-Health Screening Cohort in Korea. A total of 6,748,564 subjects without a previous history of AF were included in the final analysis and observed until 2017. The atopic triad included asthma, allergic rhinitis, and atopic dermatitis. A total of 1,168,196 subjects (17.3%) with at least one atopic disease were classified as the atopic group. The primary outcome was new-onset AF. RESULTS During a median 7.2 ± 1.0 years of follow-up, 136,253 subjects were given the new diagnosis of AF (30,300 in the atopic group and 105,953 in the nonatopic group). The incidence of AF was 3.63/1000 person-years in the atopic group and 2.64/1000 person-years in the nonatopic group. The risk for AF showed a positive correlation with the number of diseases in the atopic triad (adjusted hazard ratio [aHR], 95% confidence interval [CI]: one disease: aHR = 1.15, CI, 1.14-1.17; two diseases: aHR = 1.34, CI, 1.31-1.38; and three diseases: aHR = 1.35, CI, 1.11-1.66; P for trend < .001). CONCLUSIONS The atopic triad of asthma, allergic rhinitis, and atopic dermatitis was associated with an increased risk for AF. Moreover, multiple atopic conditions have a higher risk for AF.
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Gurgone D, McShane L, McSharry C, Guzik TJ, Maffia P. Cytokines at the Interplay Between Asthma and Atherosclerosis? Front Pharmacol 2020; 11:166. [PMID: 32194407 PMCID: PMC7064545 DOI: 10.3389/fphar.2020.00166] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/07/2020] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease (CVD) is an important comorbidity in a number of chronic inflammatory diseases. However, evidence in highly prevalent respiratory disease such as asthma are still limited. Epidemiological and clinical data are not univocal in supporting the hypothesis that asthma and CVD are linked and the mechanisms of this relationship remain poorly defined. In this review, we explore the relationship between asthma and cardiovascular disease, with a specific focus on cytokine contribution to vascular dysfunction and atherosclerosis. This is important in the context of recent evidence linking broad inflammatory signaling to cardiovascular events. However inflammatory regulation in asthma is different to the one typically observed in atherosclerosis. We focus on the contribution of cytokine networks encompassing IL-4, IL-6, IL-9, IL-17A, IL-33 but also IFN-γ and TNF-α to vascular dysfunction in atherosclerosis. In doing so we highlight areas of unmet need and possible therapeutic implications.
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Affiliation(s)
- Danila Gurgone
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | - Lucy McShane
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Charles McSharry
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Department of Internal and Agricultural Medicine, Jagiellonian University College of Medicine, Kraków, Poland
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.,Department of Pharmacy, University of Naples Federico II, Naples, Italy.,Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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7
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Ingebrigtsen TS, Marott JL, Vestbo J, Nordestgaard BG, Lange P. Coronary heart disease and heart failure in asthma, COPD and asthma-COPD overlap. BMJ Open Respir Res 2020; 7:7/1/e000470. [PMID: 33371008 PMCID: PMC7011896 DOI: 10.1136/bmjresp-2019-000470] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/22/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION We investigated risk of coronary heart disease and heart failure in phenotypes of obstructive airway disease. METHODS Among 91 692 participants in the Copenhagen General Population Study, 42 058 individuals were classified with no respiratory disease, and 11 988 individuals had different phenotypes of obstructive airways disease: asthma with early onset or late-onset, chronic obstructive pulmonary disease (COPD) with forced expiratory volume in one second (FEV1) above or below 50% of predicted value (%p) or asthma-COPD overlap (ACO). RESULTS During a mean follow-up of 5.7 years we registered 3584 admissions for coronary heart disease and 1590 admissions for heart failure. Multivariable Cox regression analyses of time to first admission were used with a two-sided p value of 0.05 as significance level. Compared with no respiratory disease the highest risks of coronary heart disease and heart failure were observed in ACO with late-onset asthma and FEV1 <50% p, HR=2.2 (95% CI 1.6 to 3.0), and HR=2.9 (95% CI 2.0 to 4.3), respectively. In COPD with FEV1 above 50% p the HRs were 1.3 (95% CI 1.2 to 1.5) for coronary heart disease and 1.9 (95% CI 1.6 to 2.3) for heart failure. Asthma associated with increased risks of coronary heart disease and heart failure, however, in asthma without allergy the HR was 1.1 (95% CI 0.7 to 1.6) for coronary heart disease while individuals with allergy had an HR of 1.4 (95% CI 1.1 to 1.6). CONCLUSIONS Risks of coronary heart disease and heart failure were increased in asthma, COPD and ACO. In asthma, the risk of coronary heart disease depended on presence of allergy. We suggest that cardiovascular risk factors should be assessed systematically in individuals with obstructive airway disease with the potential to facilitate targeted treatments.
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Affiliation(s)
- Truls Sylvan Ingebrigtsen
- Respiratory Section, Department of Internal Medicine, Herlev and Gentofte Hospital, Copenhagen University Hospital, Hellerup, Denmark.,The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, Denmark
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Børge Grønne Nordestgaard
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, Denmark.,Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Lange
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark .,The Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, Frederiksberg, Denmark.,Medical department O, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark.,Section of Epidemiology, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Mast Cells in Cardiovascular Disease: From Bench to Bedside. Int J Mol Sci 2019; 20:ijms20143395. [PMID: 31295950 PMCID: PMC6678575 DOI: 10.3390/ijms20143395] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023] Open
Abstract
Mast cells are pluripotent leukocytes that reside in the mucosa and connective tissue. Recent studies show an increased prevalence of cardiovascular disease among patients with mastocytosis, which is a hematological disease that is characterized by the accumulation of mast cells due to clonal proliferation. This association suggests an important role for mast cells in cardiovascular disease. Indeed, the evidence establishing the contribution of mast cells to the development and progression of atherosclerosis is continually increasing. Mast cells may contribute to plaque formation by stimulating the formation of foam cells and causing a pro-inflammatory micro-environment. In addition, these cells are able to promote plaque instability by neo-vessel formation and also by inducing intraplaque hemorrhage. Furthermore, mast cells appear to stimulate the formation of fibrosis after a cardiac infarction. In this review, the available data on the role of mast cells in cardiovascular disease are summarized, containing both in vitro research and animal studies, followed by a discussion of human data on the association between cardiovascular morbidity and diseases in which mast cells are important: Kounis syndrome, mastocytosis and allergy.
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Li J, Zheng J, Zhou Y, Liu X, Peng W. Acute coronary syndrome secondary to allergic coronary vasospasm (Kounis Syndrome): a case series, follow-up and literature review. BMC Cardiovasc Disord 2018; 18:42. [PMID: 29486712 PMCID: PMC6389040 DOI: 10.1186/s12872-018-0781-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/23/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Kounis syndrome (KS) is the concurrence of acute coronary syndrome associated with mast-cell and platelet activation in the setting of hypersensitivity and allergic or anaphylactic insults. Many drugs and environmental exposures had been reported as inducers, but various inducers and the mechanism of KS remained unknown till now. The widely used traditional Chinese medicine (TCM) as a potential sensitizer were scarcely reported to induce allergic vasospasm due to the ignorance of the linkage between traditional medicine allergy and vasospasm. CASE PRESENTATION We described 5 rare cases of KS including unreported triggers of TCM and abortion, reported the treatment strategy and 1~4 years' follow-up results, and tried to probe into the etiology of KS. Case 1 and case 2 for the first time reported acute ST-segment elevation myocardial infarction (STEMI) caused by Chinese herbs related allergic coronary vasospasm. Case 3 reported recurrent angina following allergen contact and wheezing, indicating the internal linkage of coronary vasospasm and allergic asthma. Case 4 described a childbearing-age woman suffered refractory ischemic chest pain due to coronary vasospasm in a special period of post-abortion, the attacks suddenly disappeared when her menopause recovered. Case 5 described an isolated episode of allergic coronary vasospasm under exposure of smoking and stress, which was successfully prevented by avoiding the exposures. CONCLUSION Kounis syndrome is not rare but rarely recognized and under-diagnosed. It is necessary to recognize KS and various inducers, especially for the patients suffering refractory vasospastic cardiac attacks concentrating in special periods. Blood test of eosinophil might contribute to diagnose KS and anti-allergic agents might be helpful for controlling KS attacks.
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Affiliation(s)
- Jing Li
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, Yinghua Road, Beijing, 100029, China.
| | - Jingang Zheng
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, Yinghua Road, Beijing, 100029, China
| | - Yifeng Zhou
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, Yinghua Road, Beijing, 100029, China
| | - Xiaofei Liu
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, Yinghua Road, Beijing, 100029, China
| | - Wenhua Peng
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, Yinghua Road, Beijing, 100029, China
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Crans Yoon AM, Chiu V, Rana JS, Sheikh J. Association of allergic rhinitis, coronary heart disease, cerebrovascular disease, and all-cause mortality. Ann Allergy Asthma Immunol 2017; 117:359-364.e1. [PMID: 27742084 DOI: 10.1016/j.anai.2016.08.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/03/2016] [Accepted: 08/18/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Inflammation is implicated in atherosclerotic cardiovascular disease. Allergic diseases also involve a systemic inflammatory state, which may potentiate cardiovascular disease. OBJECTIVE To examine the association of allergic rhinitis, coronary heart disease (CHD), cerebrovascular disease (CVD), and all-cause mortality. METHODS We conducted a retrospective, population-based, matched cohort study comparing the incidence of CHD, CVD, and all-cause mortality from January 1, 1999, through December 31, 2012, in patients with International Classification of Disease, Ninth Revision, documented allergic rhinitis matched 1:1 by age, sex, and ethnicity to a reference cohort without allergic rhinitis within Kaiser Permanente Southern California. Fully adjusted hazard ratios (HRs) were calculated. Further analyses for those with positive environmental allergen specific IgE (sIgE) test results within the allergic rhinitis cohort were also performed. RESULTS Patients with physician-diagnosed allergic rhinitis (N = 110, 207 in matched cohort) had significantly lower risk for myocardial infarction (HR, 0.63; 95% confidence interval [CI], 0.59-0.67; P < .001), all CHD (HR, 0.81; 95% CI, 0.78-0.84; P < .001), CVD (HR, 0.67; 95% CI, 0.64-0.70; P < .001), and all-cause mortality (HR, 0.42; 95% CI, 0.40-0.43; P < .001). The results were similar after excluding patients with asthma. Patients with positive sIgE test result also had a decreased risk of all CHD (relative risk [RR], 0.87; 95% CI, 0.79-0.95; P = .003) but no association with cerebrovascular events (RR, 0.89; 95% CI, 0.77-1.02; P = .10) and all-cause mortality (RR, 1.16; 95% CI, 1.00-1.34; P = .06). CONCLUSION We found that the presence of allergic rhinitis was associated with decreased CHD, CVD, and all-cause mortality. This decreased risk was more pronounced after excluding patients with asthma. Patients with positive sIgE test results also had decreased risk of CHD.
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Affiliation(s)
- Angelina M Crans Yoon
- Department of Allergy and Clinical Immunology, Kaiser Permanente Los Angeles, Los Angeles, California
| | - Vicki Chiu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Jamal S Rana
- Department of Cardiology and Division of Research, Kaiser Permanente Northern California, Oakland, California; Department of Medicine, University of California San Francisco, San Francisco, California
| | - Javed Sheikh
- Department of Allergy and Clinical Immunology, Kaiser Permanente Los Angeles, Los Angeles, California.
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11
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Kounis NG. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. ACTA ACUST UNITED AC 2016; 54:1545-59. [DOI: 10.1515/cclm-2016-0010] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 02/03/2016] [Indexed: 12/14/2022]
Abstract
AbstractKounis syndrome has been established as a hypersensitivity coronary disorder induced by various conditions, drugs, environmental exposures, foods and coronary stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute are the three reported, so far, variants of this syndrome. Apart from coronary arteries, it affects the cerebral and mesenteric arteries. Its manifestations are broadening and its etiology is continuously increasing. Kounis syndrome is a ubiquitous disease which represents a magnificent natural paradigm and nature’s own experiment in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture. Kounis syndrome seems to be not a rare disease but an infrequently diagnosed clinical entity which has revealed that the same mediators released from the same inflammatory cells are also present and in acute coronary events of non allergic etiology. These cells are not only present in the culprit region before plaque erosion or rupture but they release their contents just before an actual coronary event. Therefore, awareness of etiology, epidemiology, pathogenesis and clinical manifestations seems to be important for its prognosis, diagnosis, treatment, prevention.
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12
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Davies JM, Beggs PJ, Medek DE, Newnham RM, Erbas B, Thibaudon M, Katelaris CH, Haberle SG, Newbigin EJ, Huete AR. Trans-disciplinary research in synthesis of grass pollen aerobiology and its importance for respiratory health in Australasia. THE SCIENCE OF THE TOTAL ENVIRONMENT 2015; 534:85-96. [PMID: 25891684 DOI: 10.1016/j.scitotenv.2015.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/31/2015] [Accepted: 04/01/2015] [Indexed: 05/25/2023]
Abstract
Grass pollen is a major trigger for allergic rhinitis and asthma, yet little is known about the timing and levels of human exposure to airborne grass pollen across Australasian urban environments. The relationships between environmental aeroallergen exposure and allergic respiratory disease bridge the fields of ecology, aerobiology, geospatial science and public health. The Australian Aerobiology Working Group comprised of experts in botany, palynology, biogeography, climate change science, plant genetics, biostatistics, ecology, pollen allergy, public and environmental health, and medicine, was established to systematically source, collate and analyse atmospheric pollen concentration data from 11 Australian and six New Zealand sites. Following two week-long workshops, post-workshop evaluations were conducted to reflect upon the utility of this analysis and synthesis approach to address complex multidisciplinary questions. This Working Group described i) a biogeographically dependent variation in airborne pollen diversity, ii) a latitudinal gradient in the timing, duration and number of peaks of the grass pollen season, and iii) the emergence of new methodologies based on trans-disciplinary synthesis of aerobiology and remote sensing data. Challenges included resolving methodological variations between pollen monitoring sites and temporal variations in pollen datasets. Other challenges included "marrying" ecosystem and health sciences and reconciling divergent expert opinion. The Australian Aerobiology Working Group facilitated knowledge transfer between diverse scientific disciplines, mentored students and early career scientists, and provided an uninterrupted collaborative opportunity to focus on a unifying problem globally. The Working Group provided a platform to optimise the value of large existing ecological datasets that have importance for human respiratory health and ecosystems research. Compilation of current knowledge of Australasian pollen aerobiology is a critical first step towards the management of exposure to pollen in patients with allergic disease and provides a basis from which the future impacts of climate change on pollen distribution can be assessed and monitored.
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Affiliation(s)
- Janet M Davies
- School of Medicine, The University of Queensland, Woolloongabba, QLD 4102, Australia.
| | - Paul J Beggs
- Department of Environmental Sciences, Faculty of Science and Engineering, Macquarie University, NSW 2109, Australia.
| | - Danielle E Medek
- Harvard School of Public Health, Harvard University, Boston, MA 02115, USA.
| | - Rewi M Newnham
- School of Geography, Environment and Earth Sciences, Victoria University of Wellington, Wellington, New Zealand.
| | - Bircan Erbas
- School of Public Health and Human Biosciences, La Trobe University, VIC 3086, Australia.
| | - Michel Thibaudon
- European Aerobiology Society, Réseau National de Surveillance Aérobiologique, 11 chemin de la Creuzille, 69690 Brussieu, France.
| | - Connstance H Katelaris
- Campbelltown Hospital, The School of Medicine, University of Western Sydney, Macarthur, NSW, Australia.
| | - Simon G Haberle
- Department of Archaeology and Natural History, College of Asia and the Pacific, The Australian National University, Canberra, Australia.
| | - Edward J Newbigin
- School of BioSciences, The University of Melbourne, VIC 3010, Australia.
| | - Alfredo R Huete
- Plant Functional Biology and Climate Change, University of Technology Sydney, NSW 2007, Australia.
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Xu Z, Li Y, Liu ZQ. Allergy: a risk factor for cardiovascular diseases? Br J Hosp Med (Lond) 2014; 75:223-6. [PMID: 24727962 DOI: 10.12968/hmed.2014.75.4.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Zhanwen Xu
- Physician in the Department of Cardiology, Affiliated Hospital of Hebei University, Baoding City, Hebei Province, 071000, China
| | - Yaqin Li
- Associate Professor in the Department of Cardiology, Affiliated Hospital of Hebei University, Baoding City, Hebei Province, 071000, China
| | - Zhi-Qiang Liu
- Associate Professor in the Shenzhen Otorhinolaryngologic Institute, Longgang District Central Hospital, Shenzhen City, Guangdong Province, China
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Song WJ, Kim MY, Jo EJ, Kim MH, Kim TH, Kim SH, Kim KW, Cho SH, Min KU, Chang YS. Rhinitis in a community elderly population: relationships with age, atopy, and asthma. Ann Allergy Asthma Immunol 2013; 111:347-51. [PMID: 24125139 DOI: 10.1016/j.anai.2013.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 07/23/2013] [Accepted: 08/18/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND Rhinitis is one of the most frequent medical conditions. However, there is sparse epidemiologic evidence for rhinitis in the elderly population. OBJECTIVE To investigate the prevalence of rhinitis in elderly adults and its relations to asthma and other comorbidities. METHODS A cross-sectional analysis was performed using the baseline dataset of the Korean Longitudinal Study on Health and Aging, a community-based elderly population cohort in Korea (≥65 years old). Structured questionnaires were used to define rhinitis, asthma, and comorbidity, and allergen skin prick tests were used to define atopy. Health-related quality of life was assessed by short-form 36 questionnaires. RESULTS In total, 982 elderly adults (98.2%) were included in the present study. The prevalence of rhinitis was 25.6% and did not decrease until 90 years of age. The prevalence of atopy was 17.2% (18.8% in participants with rhinitis), and atopy did not show a significant association with rhinitis. In multivariate logistic regression analyses, relations between asthma and rhinitis were significant. Among comorbid conditions, none were significantly associated with rhinitis. In the short-form 36 questionnaire analyses, rhinitis was independently related to a decrease in the physical aspects of quality of life. CONCLUSION The present study found a high prevalence of nonallergic rhinitis in elderly participants, which was significantly related to asthma and quality of life.
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Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
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15
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Kounis NG. Coronary hypersensitivity disorder: the Kounis syndrome. Clin Ther 2013; 35:563-71. [PMID: 23490289 DOI: 10.1016/j.clinthera.2013.02.022] [Citation(s) in RCA: 201] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 02/21/2013] [Accepted: 02/25/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND When allergy or hypersensitivity and anaphylactic or anaphylactoid insults lead to cardiovascular symptoms and signs, including acute coronary events, the result might be the recently defined nosologic entity Kounis syndrome. Vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells are the 3 reported variants of this syndrome. OBJECTIVE The purpose of this review was to highlight and consolidate the recent literature on allergic angina and allergic myocardial infarction and to propose new therapeutic modalities for stabilizing mast cells. METHODS A search for current literature on the pathophysiology, causality, clinical appearance, variance, prevention, and treatment of Kounis syndrome was conducted. RESULTS Kounis syndrome is caused by inflammatory mediators such as histamine; neutral proteases, including tryptase, chymase, and cathepsin-D; arachidonic acid products; platelet-activating factor; and a variety of cytokines and chemokines released during the mast-cell activation. Platelets with Fc γ receptor (FcγR) Ι, FcγRII, FcεRI, and FcεRII also have a role in the activation cascade. The same mediators released from the similar inflammatory cells are involved in acute coronary events of nonallergic etiology. These cells are not only present in the involved region before plaque erosion or rupture but also release their contents just before an acute coronary event. Pro-inflammatory mediators similar to those found in Kounis syndrome are found in some cases with nonallergic etiology, suggesting that this is a more general problem. The acute coronary and cerebrovascular events in Kounis syndrome may be prevented by the inhibition of mast-cell degranulation. Substances and natural molecules that protect the mast-cell surface and stabilize the mast-cell membrane are emerging as novel agents in the prevention of acute coronary and other arterial events. CONCLUSIONS The 3 reported variants of Kounis syndrome-vasospastic allergic angina, allergic myocardial infarction, and stent thrombosis with occluding thrombus-are caused by inflammatory mediators. Agents that inhibit mast-cell degranulation may be efficacious in preventing the acute coronary and cerebrovascular events of Kounis syndrome.
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Affiliation(s)
- Nicholas G Kounis
- Department of Medical Sciences, Patras Highest Institute of Education and Technology, Patras, Greece.
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Brunetti N, De Gennaro L, Cuculo A, Gaglione A, Di Biase M. History of allergy is a predictor of adverse events in unstable angina treated with coronary angioplasty. Allergol Immunopathol (Madr) 2013; 41:25-9. [PMID: 22417939 DOI: 10.1016/j.aller.2011.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 11/20/2011] [Accepted: 12/03/2011] [Indexed: 12/25/2022]
Abstract
BACKGROUND The aim was to investigate prognostic relevance of history of allergy in subjects with unstable angina treated with coronary angioplasty. METHODS Fifty-seven consecutive patients with unstable angina who underwent coronary angioplasty were enrolled in the study and were divided into two groups: those with a history of allergy (Group A, N = 15); and controls (Group C, N =42). Major adverse cardiac events were recorded over a six-month follow-up period. Patients with primary or unsuccessful angioplasty and patients treated with drug eluting stent were excluded from the study. RESULTS Group A patients (history of allergy) showed a 46.67% incidence of major adverse cardiac events at six-month follow-up (vs. 9.52% Group C, p < 0.01): results remained significant even in a multiple Cox regression analysis (hazard ratio 7.17, 95% CI 1.71-29.98, p < 0.01). CONCLUSION History of allergy is an independent predictor of major adverse cardiac events after coronary angioplasty in a six-month follow-up period in unstable angina.
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Iribarren C, Tolstykh IV, Miller MK, Sobel E, Eisner MD. Adult asthma and risk of coronary heart disease, cerebrovascular disease, and heart failure: a prospective study of 2 matched cohorts. Am J Epidemiol 2012; 176:1014-24. [PMID: 23139248 DOI: 10.1093/aje/kws181] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Asthma has been associated with increased cardiovascular disease (CVD) risk. The authors ascertained the association of asthma with CVD and the roles that sex, concurrent allergy, and asthma medications may play in this association. They assembled a cohort of 203,595 Northern California adults with asthma and a parallel asthma-free referent cohort (matched 1:1 on age, sex, and race/ethnicity); both cohorts were followed for incident nonfatal or fatal CVD and all-cause mortality from January 1, 1996, through December 31, 2008. Each cohort was 66% female and 47% white. After adjustment for age, sex, race/ethnicity, cardiac risk factors, and comorbid allergy, asthma was associated with a 1.40-fold (95% confidence interval (CI): 1.35, 1.45) increased hazard of coronary heart disease, a 1.20-fold (95% CI: 1.15, 1.25) hazard of cerebrovascular disease, a 2.14-fold (95% CI: 2.06, 2.22) hazard of heart failure, and a 3.28-fold (95% CI: 3.15, 3.41) hazard of all-cause mortality. Stronger associations were noted among women. Comorbid allergy predicted CVD but did not synergistically increase the CVD risk associated with asthma. Only asthma patients using asthma medications (particularly those on oral corticosteroids alone or in combination) were at enhanced risk of CVD. In conclusion, asthma was prospectively associated with increased risk of major CVD. Modifying effects were noted for sex and asthma medication use but not for comorbid allergy.
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Affiliation(s)
- Carlos Iribarren
- Division of Research, Kaiser Permanente Medical Care Program, Oakland, California 94612, USA.
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Fidan V, Alp H, Karaca F, Ozcan A, Ozcan K. Effect of endoscopic sinus surgery on plasma asymmetric dimethylarginine levels in patients with extensive nasal polyposis. J Int Med Res 2012; 40:565-71. [PMID: 22613417 DOI: 10.1177/147323001204000218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study examined the effect of endoscopic sinus surgery (ESS) on plasma levels of asymmetric dimethylarginine (ADMA) and mean pulmonary arterial pressure (mPAP) in patients with extensive nasal polyposis (ENP). METHODS Preoperative and 3 month post-ESS plasma levels of ADMA and mPAP were measured in patients with ENP and in age-and gender-matched controls. RESULTS The study included 45 patients with ENP and 31 controls (mean ± SD age 39.4 ± 8.8 and 38.1 ± 9.6 years, respectively). The mean preoperative ADMA level in ENP patients (0.69 ± 0.27 μmol/l) was statistically significantly lower than in the control group (1.08 ± 0.37 μmol/l). The postoperative ADMA level increased significantly in ENP patients (0.97 ± 0.36 μmol/l) versus the preoperative level. Mean preoperative mPAP in ENP patients (25.7 ± 5.4 mmHg) was statistically significantly higher than in the control group (20.8 ± 2.1 mmHg), and ENP patients showed significant decreases in mPAP after (21.9 ± 3.5 mmHg) versus before ESS. CONCLUSION Patients with ENP had lower plasma ADMA levels compared with healthy controls, however ADMA levels and mPAP improved in ENP patients after ESS.
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Affiliation(s)
- V Fidan
- Ear, Nose and Throat Department, Erzurum Education and Research Hospital, Erzurum, Turkey.
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Jaramillo R, Cohn RD, Crockett PW, Gowdy KM, Zeldin DC, Fessler MB. Relation between objective measures of atopy and myocardial infarction in the United States. J Allergy Clin Immunol 2012; 131:405-11.e1-11. [PMID: 22921873 DOI: 10.1016/j.jaci.2012.06.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 05/29/2012] [Accepted: 06/29/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although rodent studies indicate that atherosclerosis is a T(H)1-mediated disease and that atopic T(H)2 immunity is atheroprotective, findings in humans are conflicting. Total IgE (tIgE) is associated with atherosclerotic disease but has limited specificity for atopy. OBJECTIVE Our aim was to determine the relation between atopy, as indicated by a broad panel of serum allergen-specific IgE (sIgE), and past myocardial infarction (MI) in a sample representative of the US population. METHODS Data were analyzed from 4002 participants aged ≥ 20 years from the 2005-2006 National Health and Nutrition Examination Survey. RESULTS Subjects reporting a history of MI had lower summed sIgE (5.51 vs 7.71 kU/L; P < .001) and were less likely to have ≥ 1 positive sIgE test (29.9% vs 44.6%; P = .02) or current hay fever (3.3% vs 7.6%; P = .002). After adjustment for age, sex, race/ethnicity, diabetes mellitus, hypertension, family history of MI, smoking, total/high-density lipoprotein cholesterol, body mass index, and C-reactive protein, the odds ratio (OR) for MI was 0.91 (95% CI, 0.85-0.97) per positive sIgE; 0.70 (95% CI, 0.57-0.85) per 2-fold increase in sum[sIgE]; and 0.82 (95% CI, 0.69-0.98) per 10% increase in the ratio of sum[sIgE] to tIgE. Analysis with 7 data-driven, prespecified allergen clusters found that house dust mite is the only allergen cluster for which sIgE is associated with reduced odds for MI (fully adjusted OR, 0.36; 95% CI, 0.20-0.64). CONCLUSION Serum sIgE is inversely related to MI in the US population in a manner independent of multiple coronary risk factors.
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Kounis NG, Mazarakis A, Tsigkas G, Giannopoulos S, Goudevenos J. Kounis syndrome: a new twist on an old disease. Future Cardiol 2012; 7:805-24. [PMID: 22050066 DOI: 10.2217/fca.11.63] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Kounis syndrome is the concurrence of acute coronary syndromes with conditions associated with mast cell activation, such as allergies or hypersensitivity and anaphylactic or anaphylactoid insults that can involve other interrelated and interacting inflammatory cells behaving as a 'ball of thread'. It is caused by inflammatory mediators such as neutral proteases including tryptase and chymase, arachidonic acid products, histamine, platelet activating factor and a variety of cytokines and chemokines released during the activation process. Platelets with FCεRI and FCεRII receptors also participate in the above cascade. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute the three reported variants of this syndrome. Kounis syndrome is a ubiquitus disease that represents a magnificent natural paradigm and nature's own experiment, in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture. Kounis syndrome can complicate anesthesia, vaccination, medical therapy and stent implantation and it seems to be associated with coronary allograft vasculopathy and takotsubo syndrome, it can often be confused with hypersensitivity myocarditis and can be the cause of unexplained sudden death. Kounis syndrome has revealed that the same mediators released from the same inflammatory cells are present in acute coronary events of nonallergic etiology. These cells are not only present in the culprit region before plaque erosion or rupture but they release their contents just before an actual coronary event. Therefore, does Kounis syndrome represent a magnificent natural paradigm and nature's own experiment in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture showing a novel way towards our effort to prevent acute coronary syndromes? Drugs, substances targeting the stem cell factor that is essential for mast cell development, proliferation, survival, adhesion and homing as well as monoclonal antibodies and natural molecules that protect mast cell surface and stabilize mast cell membrane could emerge as novel therapeutic ways capable to prevent acute coronary and acute cerebrovascular events.
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Affiliation(s)
- Nicholas G Kounis
- Department of Cardiology, Agios Andreas State General Hospital, Patras, Greece.
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