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McDonald VM, Hamada Y, Agusti A, Gibson PG. Treatable Traits in Asthma: The Importance of Extrapulmonary Traits-GERD, CRSwNP, Atopic Dermatitis, and Depression/Anxiety. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:824-837. [PMID: 38278324 DOI: 10.1016/j.jaip.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/14/2023] [Accepted: 01/02/2024] [Indexed: 01/28/2024]
Abstract
Treatable traits is a personalized medicine approach to the management of airway disease. Assessing traits within the 3 domains of pulmonary, extrapulmonary, and behavioral/lifestyle/risk factor traits, and applying targeted treatments to effectively manage these traits, enables a holistic and personalized approach to care. Asthma is a heterogeneous and complex airway disease that is frequently complicated by several extrapulmonary traits that impact asthma outcomes and predict future outcomes. We propose that the identification of extrapulmonary and behavioral risk factor traits and the implementation of targeted therapy will lead to improved management of people with asthma. Furthermore, many extrapulmonary traits present as "connected comorbidities"; that is, they coexist with asthma, have an impact on asthma, and effective treatment improves both asthma and the comorbidity or the comorbidities may share a similar mechanism. In this review, we explore this concept and look at atopic dermatitis, chronic rhinosinusitis with nasal polyps, gastroesophageal reflux disease, anxiety, and depression as treatable traits of asthma and how these can be managed using this approach.
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Affiliation(s)
- Vanessa M McDonald
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia.
| | - Yuto Hamada
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia; Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Peter G Gibson
- Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, New Lambton Heights, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
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Huang H, Zhang KP, Sun KK, Yu G. Association between type 2 inflammatory diseases and neurodevelopmental disorders in low-birth-weight children and adolescents. Front Psychol 2024; 15:1292071. [PMID: 38455122 PMCID: PMC10918750 DOI: 10.3389/fpsyg.2024.1292071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Background Evidence of the association of certain neurodevelopmental disorder with specific type 2 inflammatory (T2) disease has been found. However, the association of various neurodevelopmental disorders with T2 diseases as a whole remains unclear in low-birth-weight (LBW) infants. Objective To evaluate the association of type 2 inflammatory (T2) diseases with intellectual disability (ID), autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and learning disability (LD) in LBW children and adolescents. Methods The study sample was derived from 2005 to 2018 National Health Interview Survey sample child files. LBW children and adolescents aged 3-17 were included. History of T2 diseases (including asthma and atopic dermatitis) and four neurodevelopmental disorders were reported by adults in families. The relationship between T2 diseases and the risk of four neurodevelopmental disorders was investigated through multiple-weighted logistic regression. Age, sex, race/ethnicity, region, highest education in family and ratio of family income to the poverty threshold were adjusted as covariates for model estimation. Subgroup analyses were conducted by age stratification (3-11 and 12-17 years), sex (male and female), and race (white and non-white). Results 11,260 LBW children aged 3-17 years [mean age (SE), 9.73 (0.05) years] were included, in which 3,191 children had T2 diseases. History of T2 diseases was associated with an increased risk of neurodevelopmental disorders, with an OR of 1.35 (95% CI, 0.99-1.84) for ID, 1.47 (95% CI, 1.05-2.05) for ASD, 1.81 (95% CI, 1.51-2.16) for ADHD, and 1.74 (95% CI, 1.49-2.04) for LD following the adjustment of all the covariates. The correlations between T2 disorders and each of the four neurodevelopmental disorders were significantly different by sex and race (all P for interaction < 0.001), and no differences were found in age stratification (all P for interaction > 0.05). Conclusion In a nationally representative sample of children, we found a significant association of T2 diseases with ASD, ADHD, and LD, even after adjusting for demographic baseline. We also found that the association of T2 disease with neurodevelopmental disorders differed between sex and race. Further investigation is needed to evaluate causal relationships and elucidate their potential mechanisms.
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Affiliation(s)
- Hengye Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kelvin Pengyuan Zhang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Karol Kexin Sun
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Biomedical Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Guangjun Yu
- Shanghai Engineering Research Center for Big Data in Pediatric Precision Medicine, Center for Biomedical Informatics, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Adamiec A, Cieślik M, Mączka K, Tarnoruda J, Jensen S, Chawes B, Bønnelykke K, Konradsen JR, Söderhäll C, Makrinioti H, Camargo CA, Hasegawa K, Ambrożej D, Jartti T, Ruszczyński M, Feleszko W. A systematic review and meta-analysis on absolute eosinophil counts and the risk of asthma in preschool children with wheezing: An EAACI Task Force Report. Pediatr Allergy Immunol 2024; 35:e14078. [PMID: 38339981 DOI: 10.1111/pai.14078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
Preschool children with wheezing disorders pose diagnostic and therapeutic challenges and consume substantial healthcare resources. Peripheral eosinophil blood count (EBC) has been proposed as a potential indicator for future asthma development. This review by the European Academy of Allergy and Clinical Immunology (EAACI) Preschool Wheeze Task Force aimed to provide systematic evidence for the association between increased EBC and the risk of future asthma, as well as to identify potential cutoff values. In February 2023, a search of PubMed, EMBASE, and Cochrane Library databases was conducted to identify studies comparing EBCs in preschool children with wheezing who continued to wheeze later in life and those who did not. Included observational studies focused on children aged <6 years with a wheezing disorder, assessment of their EBCs, and subsequent asthma status. No language or publication date restrictions were applied. Among the initial 3394 studies screened, 10 were included in the final analysis, involving 1225 patients. The data from these studies demonstrated that high EBC in preschool children with wheezing is associated with future asthma development, with odds ratios of 1.90 (95% CI: 0.45-7.98, p = .38), 2.87 (95% CI: 1.38-5.95, p < .05), and 3.38 (95% CI: 1.72-6.64, p < .05) for cutoff values in the <300, 300-449, and ≥450 cells/μL ranges, respectively. Defining a specific cutoff point for an elevated EBC lacks consistency, but children with EBC >300 cells/μL are at increased risk of asthma. However, further research is needed due to the limitations of the included studies. Future investigations are necessary to fully elucidate the discussed association.
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Affiliation(s)
- Aleksander Adamiec
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Maja Cieślik
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
| | - Katarzyna Mączka
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Tarnoruda
- Department of Paediatrics, Medical University of Warsaw Children's Hospital, Warsaw, Poland
| | - Signe Jensen
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo Chawes
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jon R Konradsen
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Cilla Söderhäll
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Heidi Makrinioti
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Dominika Ambrożej
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
- Doctoral School, Medical University of Warsaw, Warsaw, Poland
| | - Tuomas Jartti
- Department of Paediatrics, Turku University Hospital and Turku University, Turku, Finland
- PEDEGO Research Unit, Medical Research Centre, University of Oulu, Turku, Finland
- Department of Pediatrics, Oulu University Hospital, Turku, Finland
| | - Marek Ruszczyński
- Department of Paediatrics, Medical University of Warsaw Children's Hospital, Warsaw, Poland
| | - Wojciech Feleszko
- Department of Paediatric Pneumonology and Allergy, Medical University of Warsaw Children's Hospital, Warsaw, Poland
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Scadding GK, McDonald M, Backer V, Scadding G, Bernal-Sprekelsen M, Conti DM, De Corso E, Diamant Z, Gray C, Hopkins C, Jesenak M, Johansen P, Kappen J, Mullol J, Price D, Quirce S, Reitsma S, Salmi S, Senior B, Thyssen JP, Wahn U, Hellings PW. Pre-asthma: a useful concept for prevention and disease-modification? A EUFOREA paper. Part 1-allergic asthma. FRONTIERS IN ALLERGY 2024; 4:1291185. [PMID: 38352244 PMCID: PMC10863454 DOI: 10.3389/falgy.2023.1291185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/26/2023] [Indexed: 02/16/2024] Open
Abstract
Asthma, which affects some 300 million people worldwide and caused 455,000 deaths in 2019, is a significant burden to suffers and to society. It is the most common chronic disease in children and represents one of the major causes for years lived with disability. Significant efforts are made by organizations such as WHO in improving the diagnosis, treatment and monitoring of asthma. However asthma prevention has been less studied. Currently there is a concept of pre- diabetes which allows a reduction in full blown diabetes if diet and exercise are undertaken. Similar predictive states are found in Alzheimer's and Parkinson's diseases. In this paper we explore the possibilities for asthma prevention, both at population level and also investigate the possibility of defining a state of pre-asthma, in which intensive treatment could reduce progression to asthma. Since asthma is a heterogeneous condition, this paper is concerned with allergic asthma. A subsequent one will deal with late onset eosinophilic asthma.
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Affiliation(s)
- G. K. Scadding
- Department of Allergy & Rhinology, Royal National ENT Hospital, London, United Kingdom
- Division of Immunity and Infection, University College, London, United Kingdom
| | - M. McDonald
- The Allergy Clinic, Blairgowrie, Randburg, South Africa
| | - V. Backer
- Department of Otorhinolaryngology, Head & Neck Surgery, and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - G. Scadding
- Allergy, Royal Brompton Hospital, London, United Kingdom
| | - M. Bernal-Sprekelsen
- Head of ORL-Deptartment, Clinic Barcelona, Barcelona, Spain
- Chair of ORL, University of Barcelona, Barcelona, Spain
| | - D. M. Conti
- The European Forum for Research and Education in Allergy and Airway Diseases Scientific Expert Team Members, Brussels, Belgium
| | - E. De Corso
- Otolaryngology Head and Neck Surgery, A. Gemelli University Hospital Foundation IRCCS, Rome, Italy
| | - Z. Diamant
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
- Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Deptarment of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
| | - C. Gray
- Paediatric Allergist, Red Cross Children’s Hospital and University of Cape Town, Cape Town, South Africa
- Kidsallergy Centre, Cape Town, South Africa
| | - C. Hopkins
- Department of Rhinology and Skull Base Surgery, Guy’s and St Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
| | - M. Jesenak
- Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovakia
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia
| | - P. Johansen
- Department of Dermatology, University of Zurich, Zurich, Switzerland
- Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
| | - J. Kappen
- Department of Pulmonology, STZ Centre of Excellence for Asthma, COPD and Respiratory Allergy, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - J. Mullol
- Rhinology Unit and Smell Clinic, ENT Department, Hospital Clínic, FRCB-IDIBAPS, Universitat de Barcelona, CIBERES, Barcelona, Spain
| | - D. Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom
| | - S. Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, Madrid, Spain
| | - S. Reitsma
- Department of Otorhinolarynogology and Head/Neck Surgery, Amsterdam University Medical Centres, Location AMC, University of Amsterdam, Amsterdam, Netherlands
| | - S. Salmi
- Department of Otorhinolaryngology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
- Department of Allergy, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - B. Senior
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - J. P. Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - U. Wahn
- Former Head of the Department for Pediatric Pneumology and Immunology, Charite University Medicine, Berlin, Germany
| | - P. W. Hellings
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospitals, Leuven, Belgium
- Laboratory of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
- Upper Airways Research Laboratory, Department of Head and Skin, Ghent University, Ghent, Belgium
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Kim JH, Lee E, Ha EK, Shin J, Lee GC, Rha YH, Han MY. Cascade of atopic dermatitis comorbidities in children after birth for 15 years. Allergy 2024; 79:153-163. [PMID: 37843069 DOI: 10.1111/all.15917] [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: 06/28/2023] [Revised: 09/07/2023] [Accepted: 09/16/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Individuals with atopic dermatitis often develop other conditions. OBJECTIVE This study aimed to determine how atopic dermatitis comorbidities develop in children over time. METHODS This population-based administrative cohort study used national health insurance data. We traced individuals born in Korea between 2002 and 2003 to 2018. The date of initial atopic dermatitis diagnosis was set as the index date. Fifty-three childhood comorbidities of atopic dermatitis were identified as outcomes of interest by performing a comprehensive literature search and comparing the prevalence of diagnostic codes in children with and without atopic dermatitis. Four control children per individual in the atopic dermatitis group were randomly matched based on sex and index date. The association between atopic dermatitis and the development of each specified disease was assessed using proportional hazard assumption, followed by mapping of the temporal sequences of interconnected comorbidities. RESULTS The atopic dermatitis and control groups contained 67,632 and 270,528 individuals, respectively. The median age at the index date was 10 months, whereas the median follow-up period was 15 years. Twenty diseases that were associated with a higher risk of atopic dermatitis were identified and a chain of interconnected conditions created. The progression began in childhood with febrile seizures, constipation, and asthma, and was later associated with the emergence of food allergy, allergic rhinitis, psychiatric disorders, and autoimmune diseases. CONCLUSION Our study highlights the temporal nature of atopic dermatitis comorbidities in children, and indicates that an understanding of the comorbidities may inform its clinical management and treatment.
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Affiliation(s)
- Ju Hee Kim
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, Kangnam Sacred Heart Hospital, Seoul, Korea
| | - Jeewon Shin
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Gi Chun Lee
- Department of Computer Science and Engineering, Konkuk University, Seoul, Korea
| | - Yeong Ho Rha
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea
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Kaczmarska A, Kwiatkowska D, Skrzypek KK, Kowalewski ZT, Jaworecka K, Reich A. Pathomechanism of Pruritus in Psoriasis and Atopic Dermatitis: Novel Approaches, Similarities and Differences. Int J Mol Sci 2023; 24:14734. [PMID: 37834183 PMCID: PMC10573181 DOI: 10.3390/ijms241914734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Pruritus is defined as an unpleasant sensation that elicits a desire to scratch. Nearly a third of the world's population may suffer from pruritus during their lifetime. This symptom is widely observed in numerous inflammatory skin diseases-e.g., approximately 70-90% of patients with psoriasis and almost every patient with atopic dermatitis suffer from pruritus. Although the pathogenesis of atopic dermatitis and psoriasis is different, the complex intricacies between several biochemical mediators, enzymes, and pathways seem to play a crucial role in both conditions. Despite the high prevalence of pruritus in the general population, the pathogenesis of this symptom in various conditions remains elusive. This review aims to summarize current knowledge about the pathogenesis of pruritus in psoriasis and atopic dermatitis. Each molecule involved in the pruritic pathway would merit a separate chapter or even an entire book, however, in the current review we have concentrated on some reports which we found crucial in the understanding of pruritus. However, the pathomechanism of pruritus is an extremely complex and intricate process. Moreover, many of these signaling pathways are currently undergoing detailed analysis or are still unexplained. As a result, it is currently difficult to take an objective view of how far we have come in elucidating the pathogenesis of pruritus in the described diseases. Nevertheless, considerable progress has been made in recent years.
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Affiliation(s)
- Agnieszka Kaczmarska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
| | - Dominika Kwiatkowska
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
| | | | | | - Kamila Jaworecka
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
| | - Adam Reich
- Department of Dermatology, Institute of Medical Sciences, Medical College of Rzeszow University, 35-055 Rzeszów, Poland; (A.K.); (D.K.); (K.J.)
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Dubini M, Benzecry V, Rivolta F, Sangalli A, Marzano AV, Pravettoni V, Tavecchio S, Ferrucci SM. Asthma improvement in patients treated with dupilumab for severe atopic dermatitis. FRONTIERS IN ALLERGY 2023; 4:1223657. [PMID: 37753208 PMCID: PMC10518613 DOI: 10.3389/falgy.2023.1223657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Introduction Atopic dermatitis (AD) is considered a systemic type 2 immune driven disease, and it is associated to many atopic comorbidities including asthma. The aim of our study was to prospectively evaluate the respiratory outcomes in patients with persistent allergic asthma treated with dupilumab due to severe AD (sAD). Methods We enrolled eligible patients with sAD for dupilumab treatment from September 2018 to December 2020. We then selected the subgroup of patients sensitized to perennial allergens. Dupilumab's efficacy and safety on AD and comorbid asthma were assessed at baseline, one month, four months, and then every 4 months up to one year. Results A total of 437 patients with sAD were enrolled for dupilumab treatment due to sAD, and 273 reached 48 weeks of therapy. Respiratory outcomes were evaluated in the 85 asthmatic patients with positivity only to perennial allergens. Our patients showed statistically and clinically significant improvement in asthma control (Asthma Control Test and Asthma Control Questionnaire) and airway obstruction parameters (FEV1), in addition to the expected AD-related skin outcomes. Specifically, a significant improvement was achieved at the fourth month of dupilumab therapy, and this trend was maintained up to twelve months, regardless of asthma severity. Conclusions Our results showed the overall improvement of the clinical picture that dupilumab offers for patients with severe AD and persistent allergic asthma of any severity, highlighting the importance of a global multidisciplinary approach of type 2 driven disease.
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Affiliation(s)
- Marco Dubini
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Valentina Benzecry
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Federica Rivolta
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Sangalli
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angelo Valerio Marzano
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Valerio Pravettoni
- Department of Internal Medicine, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simona Tavecchio
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Silvia Mariel Ferrucci
- Dermatology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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O'Connor C, Livingstone V, O’B Hourihane J, Irvine AD, Boylan G, Murray D. Early emollient bathing is associated with subsequent atopic dermatitis in an unselected birth cohort study. Pediatr Allergy Immunol 2023; 34:e13998. [PMID: 37492907 PMCID: PMC10947084 DOI: 10.1111/pai.13998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Skin barrier dysfunction is a key component of the pathogenesis of atopic dermatitis (AD). Recent research on barrier optimization to prevent AD has shown mixed results. The aim of this study was to assess the relationship between emollient bathing at 2 months and the trajectory of AD in the first 2 years of life in a large unselected observational birth cohort study. METHODS The Babies After SCOPE: Evaluating the Longitudinal Impact Using Neurological and Nutritional Endpoints Birth Cohort study enrolled 2183 infants. Variables extracted from the database related to early skincare, skin barrier function, parental history of atopy, and AD outcomes. Statistical analysis was performed to adjust for potential confounding variables. RESULTS One thousand five hundred five children had data on AD status available at 6, 12, and 24 months. Prevalence of AD was 18.6% at 6 months, 15.2% at 12 months, and 16.5% at 24 months. Adjusted for potential confounding variables, the odds of AD at any point were higher among infants who had emollient baths at 2 months (OR (95% CI): 2.41 (1.56 to 3.72), p < .001). Following multivariable analysis, the odds of AD were higher among infants who had both emollient baths and frequent emollient application at 2 months, compared with infants who had neither (OR (95% CI) at 6 months 1.74 (1.18-2.58), p = .038), (OR (95% CI) at 12 months 2.59 (1.69-3.94), p < .001), (OR (95% CI) at 24 months 1.87 (1.21-2.90), p = .009). CONCLUSION Early emollient bathing was associated with greater development of AD by 2 years of age in this population-based birth cohort study.
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Affiliation(s)
- Cathal O'Connor
- Paediatrics and Child HealthCork University HospitalCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Vicki Livingstone
- Paediatrics and Child HealthCork University HospitalCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Jonathan O’B Hourihane
- Paediatrics and Child HealthCork University HospitalCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
- Paediatrics and Child Health, Royal College of Physicians of IrelandDublinIreland
| | - Alan D. Irvine
- INFANT Research CentreUniversity College CorkCorkIreland
- Department of DermatologyChildren's Health Ireland at CrumlinDublinIreland
| | - Geraldine Boylan
- Paediatrics and Child HealthCork University HospitalCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
| | - Deirdre Murray
- Paediatrics and Child HealthCork University HospitalCorkIreland
- INFANT Research CentreUniversity College CorkCorkIreland
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9
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Wang A, Zhou Y, Luo Y, Gao Y, Chen J, Li W, Luo X, Yao X. High loading-dose of dupilumab resulted in rapid disease control in pediatric patients with atopic dermatitis. Front Immunol 2023; 14:1160710. [PMID: 37153599 PMCID: PMC10157040 DOI: 10.3389/fimmu.2023.1160710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Background The real-world experience of dupilumab in Chinese is limited, and the initial loading dose has not yet been deeply explored in patients aged <6 years. Objective To explore the efficacy and safety of dupilumab in Chinese patients with moderate-to-severe atopic dermatitis and investigate the effect of higher loading dose for disease control in patients aged <6 years. Methods A total of 155 patients were divided into three groups according to age: <6 years, 6-11 years, and >11 years. Among patients aged <6 years, 37 patients received a high loading dose of 300 mg for body weight <15kg or 600 mg for body weight ≥15kg, and another 37 patients received a standard loading dose of 200 mg for body weight <15kg or 300 mg for body weight ≥15kg. Multiple physicians and patient-reported outcome measures were evaluated at baseline and 2, 4, 6, 8, 12, and 16 weeks after dupilumab treatment. Results The proportion of patients showing an improvement of ≥75% in the Eczema Area and Severity Index was 68.0% (17/25), 76.9% (10/13), and 62.5% (25/40) in the aged <6, 6-11, and >11 years groups, respectively, at week 16. After increasing the loading dose, 69.6% (16/23) of patients aged <6 years achieved 4-point improvement in Pruritus Numerical Rating Scale at week 2, compared with 23.5% (8/34) of patients receiving standard loading dose (P < 0.001). Obesity (odds ratio=0.12, 95% confidence interval: 0.02-0.70) was predictive of a poor response to dupilumab treatment, while female (odds ratio=3.94, 95% confidence interval: 1.26-12.31) predicted good response at week 16. The change of serum C-C motif ligand 17(CCL17/TARC) could reflect the response to dupilumab (r = 0.53, P = 0.002 in EASI) among patients aged <18 years. No major adverse events were reported during the treatment. Conclusions Dupilumab was effective and well-tolerated in Chinese patients with atopic dermatitis. The increased loading dose helped achieve rapid pruritus control in patients aged <6 years.
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Affiliation(s)
- Ao Wang
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yuan Zhou
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yang Luo
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Yingxia Gao
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
| | - Jingsi Chen
- Department of Dermatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key laboratory of Child Development and Disorders, Chongqing, China
| | - Wei Li
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoyan Luo
- Department of Dermatology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Ministry of Education Key laboratory of Child Development and Disorders, Chongqing, China
| | - Xu Yao
- Department of Allergy and Rheumatology, Jiangsu Key Laboratory of Molecular Biology for Skin Diseases and STIs, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, China
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10
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Thyssen JP, Halling AS, Schmid-Grendelmeier P, Guttman-Yassky E, Silverberg JI. Comorbidities of atopic dermatitis-what does the evidence say? J Allergy Clin Immunol 2023; 151:1155-1162. [PMID: 36621338 DOI: 10.1016/j.jaci.2022.12.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023]
Abstract
Atopic dermatitis (AD) is a common disease that is associated with atopic and nonatopic comorbidities. There has been a growing interest in this area of AD, because presence or risk of comorbidities can in many ways impact the management of patients with AD. Thus, some treatments for AD may improve its comorbidities as well, whereas others may increase their risk. In this review article, we discuss various comorbidities of AD mostly on the basis of the results of recent multiple systematic reviews and meta-analyses to update readers about this rapidly developing area of dermatology. We emphasize the important information provided by studies presenting both relative risk and absolute risk, and show that AD is associated with, among others, atopic comorbidities such as asthma, rhinitis, and food allergy, nonatopic comorbidities such as ocular, psychiatric, infectious, endocrine, autoimmune, and cardiovascular diseases, and certain cancers. Clinicians need to be aware of these and be cognizant about positive and negative effects of existing and new treatments for AD.
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Affiliation(s)
- Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Anne-Sofie Halling
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
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11
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Han JH, Lee HJ, Yook HJ, Han K, Lee JH, Park YM. Atopic Disorders and Their Risks of Migraine: A Nationwide Population-Based Cohort Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 15:55-66. [PMID: 36693358 PMCID: PMC9880296 DOI: 10.4168/aair.2023.15.1.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 07/21/2022] [Accepted: 09/06/2022] [Indexed: 01/20/2023]
Abstract
PURPOSE Migraine is a relatively common neurologic disorder. A possible link between atopic disorders and migraine has been suggested. This study investigated atopic disorders and their risks of migraine in the Korean population. METHODS From the Korean National Health Insurance Service database, patients aged ≥ 20 years who underwent health screening between January and December of 2009 were enrolled. To evaluate the risk of migraine, Cox proportional hazards regression analyses were performed. RESULTS In multivariable analysis, the atopic dermatitis group (adjusted hazard ratio [aHR], 1.28; 95% confidence interval [CI], 1.23-1.33), asthma group (aHR, 1.32; 95% CI, 1.30-1.34) and allergic rhinitis group (aHR, 1.45; 95% CI, 1.44-1.46) had significantly increased risks of migraine compared to their respective control groups (P < 0.001). The patients with 1 (aHR, 1.43; 95% CI, 1.42-1.44), 2 (aHR, 1.50; 95% CI, 1.47-1.53), and 3 (aHR, 1.64; 95% CI, 1.43-1.88) atopic disorders had significantly increased risks of migraine compared to the control group (P < 0.001). CONCLUSIONS Our results demonstrate that patients with atopic disorders may have increased risk of migraine and that the larger the number of concomitant atopic disorders, the higher the risk of migraine.
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Affiliation(s)
- Ju Hee Han
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Ji Lee
- Department of Dermatology, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwa Jung Yook
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Ji Hyun Lee
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Min Park
- Department of Dermatology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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12
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Vetrano S, Bouma G, Benschop RJ, Birngruber T, Costanzo A, D’Haens GRAM, Frasca L, Hillenbrand R, Iversen L, Johansen C, Kaser A, Koenen HJPM, Noehammer C, Peyrin-Biroulet L, Raes J, Ricotti L, Rosenstiel P, Satagopam VP, Schreiber S, Vermeire S, Wollenberg A, Weidinger S, Ziemek D, Danese S. ImmUniverse Consortium: Multi-omics integrative approach in personalized medicine for immune-mediated inflammatory diseases. Front Immunol 2022; 13:1002629. [PMID: 36439150 PMCID: PMC9682955 DOI: 10.3389/fimmu.2022.1002629] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/26/2022] [Indexed: 09/22/2023] Open
Abstract
Immune mediated inflammatory diseases (IMIDs) are a heterogeneous group of debilitating, multifactorial and unrelated conditions featured by a dysregulated immune response leading to destructive chronic inflammation. The immune dysregulation can affect various organ systems: gut (e.g., inflammatory bowel disease), joints (e.g., rheumatoid arthritis), skin (e.g., psoriasis, atopic dermatitis), resulting in significant morbidity, reduced quality of life, increased risk for comorbidities, and premature death. As there are no reliable disease progression and therapy response biomarkers currently available, it is very hard to predict how the disease will develop and which treatments will be effective in a given patient. In addition, a considerable proportion of patients do not respond sufficiently to the treatment. ImmUniverse is a large collaborative consortium of 27 partners funded by the Innovative Medicine Initiative (IMI), which is sponsored by the European Union (Horizon 2020) and in-kind contributions of participating pharmaceutical companies within the European Federation of Pharmaceutical Industries and Associations (EFPIA). ImmUniverse aims to advance our understanding of the molecular mechanisms underlying two immune-mediated diseases, ulcerative colitis (UC) and atopic dermatitis (AD), by pursuing an integrative multi-omics approach. As a consequence of the heterogeneity among IMIDs patients, a comprehensive, evidence-based identification of novel biomarkers is necessary to enable appropriate patient stratification that would account for the inter-individual differences in disease severity, drug efficacy, side effects or prognosis. This would guide clinicians in the management of patients and represent a major step towards personalized medicine. ImmUniverse will combine the existing and novel advanced technologies, including multi-omics, to characterize both the tissue microenvironment and blood. This comprehensive, systems biology-oriented approach will allow for identification and validation of tissue and circulating biomarker signatures as well as mechanistic principles, which will provide information about disease severity and future disease progression. This truly makes the ImmUniverse Consortium an unparalleled approach.
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Affiliation(s)
- Stefania Vetrano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- IBD Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Gerben Bouma
- Clinical Pharmacology and Experimental Medicine, GlaxoSmithKline R&D, United Kingdom
| | - Robert J. Benschop
- Immunology and Translation, Eli Lilly and Company, Indianapolis, IN, United States
| | - Thomas Birngruber
- Joanneum Research GmbH, HEALTH - Institute for Biomedicine and Health Sciences, Graz, Austria
| | - Antonio Costanzo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - G. R. A. M. D’Haens
- Department of Gastroenterology and Hepatology, Academisch Medisch Centrum Bij De Universiteit Van Amsterdam, Amsterdam, Netherlands
| | - Loredana Frasca
- Pharmacological Research and Experimental Therapy Unit, Istituto Superiore Di Sanità, Roma, Italy
| | | | - Lars Iversen
- Department of Dermatology, Aarhus Universitetshospital, Aarhus, Denmark
| | | | - Arthur Kaser
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Hans J. P. M. Koenen
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Stichting Radboud Universitair Medisch Centrum, Nijmegen, Netherlands
| | - Christa Noehammer
- Department of Health and Environment, AIT Austrian Institute of Technology GmbH, Vienna, Austria
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Centre Hospitalier Regional Universitaire Nancy, Nancy, France
| | - Jeroen Raes
- Department of Microbiology and Immunology, Vib Vzw, Gent, Belgium
| | - Leonardo Ricotti
- The BioRobotics Institute, Scuola Superiore Sant’Anna, Pisa, Italy
- Department of Excellence in Robotics & AI, Scuola Superiore Sant’Anna, Pisa, Italy
| | - Philip Rosenstiel
- Institute of Clinical Molecular Biology, Christian Albrechts University and University Hospital, Kiel, Germany
| | - Venkata P. Satagopam
- Luxembourg Centre for Systems Biomedicine, House of Biomedicine II, University of Luxembourg, Belvaux, Luxembourg
| | - Stefan Schreiber
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Severine Vermeire
- Department of Gastroenterology and Hepatology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Andreas Wollenberg
- Department of Dermatology, Ludwig-Maximilian-University Munich, Munich, Germany
- Department of Dermatology, Free University Brussels, University Hospital Brussels, Brussels, Belgium
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Daniel Ziemek
- Worldwide Research and Development, Pfizer Pharma, Berlin, Germany
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Department of Gastroenterology and Endoscopy IRCCS Ospedale San Raffaele, Milan, Italy
- University Vita-Salute San Raffaele, Milan, Italy
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13
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Zhang Q, Wang Q, Zhang LX. Granzyme B: A novel therapeutic target for treatment of atopic dermatitis. Indian J Dermatol Venereol Leprol 2022; 89:166-169. [PMID: 36331826 DOI: 10.25259/ijdvl_260_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/01/2022] [Indexed: 11/04/2022]
Abstract
Granzyme B is a serine protease that can play multiple roles in intracellular and extracellular perforin-dependent or non-perforin-dependent mechanisms. Granzyme B has been found to be an important factor involved in the pathogenesis of atopic dermatitis and is increased in both skin lesions and peripheral blood of atopic dermatitis patients. In this article, we review the correlation between granzyme B and atopic dermatitis to provide a novel therapeutic targeting option for clinical treatment of the latter.
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Affiliation(s)
| | | | - Li-Xia Zhang
- Department of Dermatology & Venerology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
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14
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Ali Z, Egeberg A, Thyssen JP, Ulrik CS, Thomsen SF. Adults with concomitant atopic dermatitis and asthma have more frequent urgent health care utilization and less frequent scheduled follow-up visits than adults with atopic dermatitis or asthma only: A nationwide cohort study. J Eur Acad Dermatol Venereol 2022; 36:2406-2413. [PMID: 35796157 DOI: 10.1111/jdv.18415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) and asthma often co-occur in the same patient, and health care utilization is related to disease severity of these diseases. OBJECTIVE To investigate differences in healthcare utilization in adults with concomitant AD and asthma compared to patients with asthma or AD only. METHODS All Danish adults with a hospital-diagnosis of AD, asthma or concomitant AD and asthma recorded in national registries were included. Health care utilization data were obtained in 3-month intervals from two year prior to index date (the date of the first hospital diagnosis), and to five years after. RESULTS A total of 12,409 patients with AD were included (11,590 with AD only and 819 with concomitant AD and asthma), and 65,539 with asthma only. Adults with concomitant AD and asthma had higher risk of hospitalization for AD (OR 1.38, 95% CI (1.15-1.67), p=0.001) and asthma (OR 1.16, 95% CI (1.00-1.35), p=0.047) compared to patients with only AD and asthma, respectively. These patients also had fewer visits in outpatient clinics for AD (OR 0.10, 95% CI (0.08-0.12), p<0.001) and asthma (OR 0.34, 95% CI (0.29-0.39), P<0.001) compared to patients with only AD or asthma. Outpatient clinic visits for rhinitis were more frequent among patients with concomitant AD and asthma compared to patients with only AD or asthma. CONCLUSION Adults with concomitant AD and asthma had different patterns of healthcare utilization compared to adults with AD or asthma alone, suggesting that improvements in management and monitoring may reduce unscheduled health care visits, and lower healthcare costs.
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Affiliation(s)
- Z Ali
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - A Egeberg
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - J P Thyssen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark
| | - C S Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - S F Thomsen
- Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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15
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Shima K, Inoue T, Uehara Y, Iwamura M, Fukagawa S, Kuwano T, Tanida K, Takada N, Saito‐Abe M, Yamamoto‐Hanada K, Ohya Y, Murase T. Non‐invasive transcriptomic analysis using
mRNAs
in skin surface lipids obtained from children with mild‐to‐moderate atopic dermatitis. J Eur Acad Dermatol Venereol 2022; 36:1477-1485. [PMID: 35462437 PMCID: PMC9545805 DOI: 10.1111/jdv.18173] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
Background Specimens for analysing the molecular pathology of skin disease are generally obtained through invasive methods, such as biopsy. However, less burdensome methods are desirable for paediatric patients. We recently established a method that comprehensively analyses RNA present in sebum (skin surface lipid–RNAs: SSL‐RNAs) using a next‐generation sequencer. Using this method, biological information can be obtained from the skin in a completely non‐invasive manner. Objectives To verify the applicability of the SSL‐RNA method for analysis of paediatric skin and analyse the molecular pathology of mild‐to‐moderate atopic dermatitis (AD) in children. Methods We collected sebum specimens from the whole faces of 23 healthy children and 16 children with mild‐to‐moderate AD (eczema area and severity index (EASI) score: 5.9 ± 2.6) ranging in age from 6 months to 5 years, using an oil‐blotting film. We then extracted SSL‐RNAs from the samples and performed an AmpliSeq transcriptomic analysis. Results The expressions of genes related to keratinization (LCE, PSORS1C2, IVL and KRT17), triglyceride synthesis and storage (PLIN2, DGAT2 and CIDEA), wax synthesis (FAR2), ceramide synthesis (GBA2, SMPD3 and SPTLC3), antimicrobial peptides (DEFB1) and intercellular adhesion (CDSN), all of which are related to the skin barrier, are lower in children with AD than in healthy children. The children with AD also have higher expression of CCL17, a Th2‐cytokine and an increased Th2‐immune response as demonstrated by a gene set variation analysis. Moreover, KRT17 and CCL17 expression levels are significantly correlated with the EASI score. Conclusions Molecular changes associated with abnormal immune responses and the epidermal barrier in children with mild‐to‐moderate AD can be determined using the SSL‐RNA method. This non‐invasive method could therefore be a useful means for understanding the molecular pathology of paediatric AD.
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Affiliation(s)
- K. Shima
- Biological Science Research, Kao Corporation Tochigi Japan
| | - T. Inoue
- Biological Science Research, Kao Corporation Tochigi Japan
| | - Y. Uehara
- Biological Science Research, Kao Corporation Tochigi Japan
| | - M. Iwamura
- Biological Science Research, Kao Corporation Tochigi Japan
| | - S. Fukagawa
- Biological Science Research, Kao Corporation Tochigi Japan
| | - T. Kuwano
- Biological Science Research, Kao Corporation Tochigi Japan
| | - K. Tanida
- Biological Science Research, Kao Corporation Tochigi Japan
| | - N. Takada
- Biological Science Research, Kao Corporation Tochigi Japan
| | - M. Saito‐Abe
- Allergy Center, National Center for Child Health and Development Tokyo Japan
| | - K. Yamamoto‐Hanada
- Allergy Center, National Center for Child Health and Development Tokyo Japan
| | - Y. Ohya
- Allergy Center, National Center for Child Health and Development Tokyo Japan
| | - T. Murase
- Biological Science Research, Kao Corporation Tochigi Japan
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16
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Ortíz de Frutos J, Carretero G, de Lucas R, Puig S, Serra E, Gómez Castro S, Rebollo Laserna F, Loza E, Silvestre-Salvador JF. Comorbidity Identification and Referral in Atopic Dermatitis: a Consensus Document. J DERMATOL TREAT 2022; 33:2643-2653. [PMID: 35435103 DOI: 10.1080/09546634.2022.2067815] [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: 10/18/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is associated with different comorbidities. OBJECTIVE To develop evidence-based and practical recommendations for comorbidity detection in patients with AD in daily practice. METHODS We employed a modified RAND/UCLA methodology, including a systematic literature review (SLR). A group of six experts on AD was established. We conducted a comprehensive search strategy on Medline, Embase, and Cochrane Library up to June 2020. The selection criteria included studies with AD patients with any comorbidity reporting data on comorbidity prevalence, burden, and management. The included studies quality was assessed. The SLR results were discussed in a nominal group meeting, and several recommendations were generated. The recommendation agreement grade was tested on additional experts through a Delphi process. RESULTS The recommendations cover the following issues: 1) Which comorbidities should be investigated at the first and subsequent visits; 2) How and when should comorbidities be investigated (screening); 3) How should patients with specific comorbidities be referred to confirm their diagnosis and initiate management; 4) Specific recommendations to ensure an integral care approach for AD patients with any comorbidity. CONCLUSIONS These recommendations seek to guide dermatologists, patients, and other stakeholders in regard to early comorbidity identification and AD patient referral to improve decision-making.
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Affiliation(s)
| | - Gregorio Carretero
- Department of Dermatology, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Raul de Lucas
- Department of Dermatology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Susana Puig
- Department of Dermatology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Biomedical Research Networking Center on Rare Diseases (CIBERER), ISCIII, Barcelona, Spain
| | - Esther Serra
- Dermatology Service, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | - Juan Francisco Silvestre-Salvador
- Department of Dermatology, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL-FISABIO Foundation), Alicante, Spain
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17
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Maiello N, Comberiati P, Giannetti A, Ricci G, Carello R, Galli E. New Directions in Understanding Atopic March Starting from Atopic Dermatitis. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040450. [PMID: 35455494 PMCID: PMC9029734 DOI: 10.3390/children9040450] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 01/12/2023]
Abstract
Recent evidence showed that the postulated linear progression of the atopic march, from atopic dermatitis to food and respiratory allergies, does not capture the heterogeneity of allergic phenotypes, which are influenced by complex interactions between environmental, genetic, and psychosocial factors. Indeed, multiple atopic trajectories are possible in addition to the classic atopic march. Nevertheless, atopic dermatitis is often the first manifestation of an atopic march. Improved understanding of atopic dermatitis pathogenesis is warranted as this could represent a turning point in the prevention of atopic march. In this review, we outline the recent findings on the pathogenetic mechanisms leading to atopic dermatitis that could be targeted by intervention strategies for the prevention of atopic march.
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Affiliation(s)
- Nunzia Maiello
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy
- Correspondence:
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy;
- Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Arianna Giannetti
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Giampaolo Ricci
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy;
| | - Rossella Carello
- Pediatric Allergic Unit, S.Pietro Hospital FbF Roma, 00189 Rome, Italy; (R.C.); (E.G.)
| | - Elena Galli
- Pediatric Allergic Unit, S.Pietro Hospital FbF Roma, 00189 Rome, Italy; (R.C.); (E.G.)
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18
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Jiang Z, Li J, Kong N, Kim JH, Kim BS, Lee MJ, Park YM, Lee SY, Hong SJ, Sul JH. Accurate diagnosis of atopic dermatitis by combining transcriptome and microbiota data with supervised machine learning. Sci Rep 2022; 12:290. [PMID: 34997172 PMCID: PMC8741793 DOI: 10.1038/s41598-021-04373-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
Atopic dermatitis (AD) is a common skin disease in childhood whose diagnosis requires expertise in dermatology. Recent studies have indicated that host genes–microbial interactions in the gut contribute to human diseases including AD. We sought to develop an accurate and automated pipeline for AD diagnosis based on transcriptome and microbiota data. Using these data of 161 subjects including AD patients and healthy controls, we trained a machine learning classifier to predict the risk of AD. We found that the classifier could accurately differentiate subjects with AD and healthy individuals based on the omics data with an average F1-score of 0.84. With this classifier, we also identified a set of 35 genes and 50 microbiota features that are predictive for AD. Among the selected features, we discovered at least three genes and three microorganisms directly or indirectly associated with AD. Although further replications in other cohorts are needed, our findings suggest that these genes and microbiota features may provide novel biological insights and may be developed into useful biomarkers of AD prediction.
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Affiliation(s)
- Ziyuan Jiang
- Department of Automation, Tsinghua University, Beijing, 100084, China
| | - Jiajin Li
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Nahyun Kong
- Department of Biological Sciences, Korea Advanced Institute of Science and Technology, Daejeon, Daejeon, 34141, Republic of Korea
| | - Jeong-Hyun Kim
- Department of Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Bong-Soo Kim
- Department of Life Science, Multidisciplinary Genome Institute, Hallym University, Chuncheon, 24252, Republic of Korea
| | - Min-Jung Lee
- Department of Life Science, Multidisciplinary Genome Institute, Hallym University, Chuncheon, 24252, Republic of Korea
| | - Yoon Mee Park
- Department of Medicine, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - So-Yeon Lee
- Department of Pediatrics, Asan Medical Center, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Asan Medical Center, Childhood Asthma Atopy Center, Humidifier Disinfectant Health Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
| | - Jae Hoon Sul
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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19
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Arasu A, Sharma N, Yazdabadi A, Sladden M. Dual biologic therapy with Omalizumab and Dupilumab for refractory atopic disease. Australas J Dermatol 2021; 63:110-111. [PMID: 34755893 DOI: 10.1111/ajd.13743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/08/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Niyati Sharma
- Department of Dermatology, Monash Health, Clayton, Victoria, Australia
| | - Anousha Yazdabadi
- Department of Dermatology, Eastern Health, Box Hill, Victoria, Australia.,Department of Medical Education, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Sladden
- Department of Medicine, University of Tasmania, Launceston, Tasmania, Australia
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20
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Liu X, Zhang Y, Ren Y, Li J. Melatonin prevents allergic airway inflammation in epicutaneously sensitized mice. Biosci Rep 2021; 41:BSR20210398. [PMID: 34522948 PMCID: PMC8458693 DOI: 10.1042/bsr20210398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The pathological process of atopic dermatitis (AD) progressing into other types of allergic diseases such as asthma and allergic rhinitis during the first several years of life is often referred to as the atopic march. Although the phenomenon of atopic march has been recognized for decades, how asthma stems from AD is still not fully understood, confounding a universal strategy to effectively protect people from the atopic march. METHODS We established experimental atopic march mice by first inducing allergic dermatitis with 0.5% fluorescein isothiocyante (FITC) applied to the skin, followed by an ovalbumin (OVA) airway challenge. In addition, by examining serum immunoglobulin (Ig) concentrations, airway cytokines, the levels of oxidative stress markers, histopathological changes in lung tissue and airway hyperresponsiveness (AHR), we were able to validate the successful establishment of the model. Furthermore, by detecting the attenuating effects of melatonin (MT) and the levels of oxidative stress in the atopic march mice, we explored the potential molecular mechanisms involved in the development of atopic march. RESULTS By successfully establishing an experimental atopic march mouse model, we were able to demonstrate that overproduction of oxidative stress in the lung significantly up-regulated the activation of nuclear factor-κB (NF-κB) signaling pathways causing thymic stromal lymphopoietin (TSLP) release, which further promotes the development of atopic march. CONCLUSIONS To mitigate the development of the atopic march, antioxidants such as MT may be imperative to inhibit NF-κB activation in the lung, especially after the onset of AD.
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Affiliation(s)
- Xudong Liu
- Department of Food Science and Engineering, Moutai Institute, Renhuai 564507, China
| | - Yuchao Zhang
- Department of Food Science and Engineering, Moutai Institute, Renhuai 564507, China
| | - Yaolin Ren
- School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Jinquan Li
- School of Medicine, Wuhan University of Science and Technology, Wuhan 430065, China
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21
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Jackson-Cowan L, Cole EF, Arbiser JL, Silverberg JI, Lawley LP. TH2 sensitization in the skin-gut-brain axis: How early-life Th2-mediated inflammation may negatively perpetuate developmental and psychologic abnormalities. Pediatr Dermatol 2021; 38:1032-1039. [PMID: 34338364 DOI: 10.1111/pde.14657] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We recently reported children with comorbid atopic dermatitis (AD), asthma, allergic rhinitis, and food allergies displaying a 2.7-fold increase in developmental delays.2 To this end, we hypothesize unregulated increases in T helper-2 (Th2)-driven inflammation, such as those seen in atopic diseases, can exert deleterious effects on the developing brain. Recognizing that available information is incomplete and that many potential associations are not firmly established, we speculate these effects underlie the association between Th2 sensitization and cognitive dysfunction in children. In this review, we explore the role of Th2 sensitization in the skin-gut-brain axis and explain how it can lead to reduced connectivity and transmission in the developing brain. With a focus on AD, we explore the association between Th2 sensitization and developmental abnormalities such as developmental delays, memory impairment, autism spectrum disorder (ASD), and epilepsy/seizures. As such, we review the available literature to examine the impact of increased IL-4 exposure in early life on the brain. We explore the possible association between Th2 sensitization and psychologic dysfunction such as attention-deficit/hyperactivity disorder (ADHD), depression, anxiety, and suicidal ideation. We also examine the impact that increased exposure to glucocorticoids and neurotrophins in early life exerts on the developing brain. Last, we discuss future directions for the advancement of our knowledge as a scientific community including possible interventions to reduce developmental and psychologic aberrations in children.
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Affiliation(s)
- LaDonya Jackson-Cowan
- AU/UGA Medical Partnership, The Medical College of Georgia at Augusta University, University of Georgia College of Pharmacy, Athens, GA, USA
| | - Emily F Cole
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jack L Arbiser
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Jonathan I Silverberg
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
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22
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Ricciardolo FLM, Bertolini F, Carriero V. The Role of Dupilumab in Severe Asthma. Biomedicines 2021; 9:biomedicines9091096. [PMID: 34572281 PMCID: PMC8468984 DOI: 10.3390/biomedicines9091096] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 12/16/2022] Open
Abstract
Dupilumab is a fully humanized monoclonal antibody, capable of inhibiting intracellular signaling of both interleukin (IL)-4 and IL-13. These are two molecules that, together with other proinflammatory cytokines such as IL-5 and eotaxins, play a pivotal role in orchestrating the airway inflammatory response defined as Type 2 (T2) inflammation, driven by Th2 or Type 2 innate lymphoid cells, which is the major feature of the T2 high asthma phenotype. The dual inhibition of IL-4 and IL-13 activities is due to the blockade of type II IL-4 receptor through the binding of dupilumab with the subunit IL-4Rα. This results in the repression of STAT6 and in the suppression of subsequent de novo formation of several molecules involved in the T2 inflammatory signature. Several clinical trials tested the efficacy and safety of dupilumab in large populations of uncontrolled severe asthmatics, revealing significant improvements in lung function, asthma control, and exacerbation rate. Similar results were reported when dupilumab was employed in patients harboring pathogenetic processes related to T2 immune response, such as atopic dermatitis and chronic rhinosinusitis. In this review, we provide an overview of the recent research in the field of respiratory medicine about dupilumab mechanism of action and its effects.
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23
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Alenius H, Sinkko H, Moitinho-Silva L, Rodriguez E, Broderick C, Alexander H, Reiger M, Hjort Hjelmsø M, Fyhrquist N, Olah P, Bryce P, Smith C, Koning F, Eyerich K, Greco D, van den Bogaard EH, Neumann AU, Traidl-Hoffmann C, Homey B, Flohr C, Bønnelykke K, Stokholm J, Weidinger S. The power and potential of BIOMAP to elucidate host-microbiome interplay in skin inflammatory diseases. Exp Dermatol 2021; 30:1517-1531. [PMID: 34387406 DOI: 10.1111/exd.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/02/2021] [Accepted: 08/02/2021] [Indexed: 11/27/2022]
Abstract
The two most common chronic inflammatory skin diseases are atopic dermatitis (AD) and psoriasis. The underpinnings of the remarkable degree of clinical heterogeneity of AD and psoriasis are poorly understood and, as a consequence, disease onset and progression are unpredictable and the optimal type and time-point for intervention are as yet unknown. The BIOMAP project is the first IMI (Innovative Medicines Initiative) project dedicated to investigating the causes and mechanisms of AD and psoriasis and to identify potential biomarkers responsible for the variation in disease outcome. The consortium includes 7 large pharmaceutical companies and 25 non-industry partners including academia. Since there is mounting evidence supporting an important role for microbial exposures and our microbiota as factors mediating immune polarization and AD and psoriasis pathogenesis, an entire work package is dedicated to the investigation of skin and gut microbiome linked to AD or psoriasis. The large collaborative BIOMAP project will enable the integration of patient cohorts, data and knowledge in unprecedented proportions. The project has a unique opportunity with a potential to bridge and fill the gaps between current problems and solutions. This review highlights the power and potential of BIOMAP project in the investigation of microbe-host interplay in AD and psoriasis.
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Affiliation(s)
- Harri Alenius
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden.,Human Microbiome Research Program (HUMI), Faculty of Medicine, University of Helsinki, Finland
| | - Hanna Sinkko
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden.,Human Microbiome Research Program (HUMI), Faculty of Medicine, University of Helsinki, Finland
| | - Lucas Moitinho-Silva
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.,Institute of Clinical Molecular Biology, Kiel University, Kiel, Germany
| | - Elke Rodriguez
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Conor Broderick
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Helen Alexander
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Matthias Reiger
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany.,Chair of Environmental Medicine, Technical University Munich, Munich, Germany
| | - Mathis Hjort Hjelmsø
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nanna Fyhrquist
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden
| | - Peter Olah
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Department of Dermatology, Venereology and Oncodermatology, Medical Faculty, University of Pécs, Hungary
| | - Paul Bryce
- Type 2 Inflammation & Fibrosis Cluster, Immunology & Inflammation Therapeutic Area, Sanofi US, Cambridge, MA, United States of America
| | - Catherine Smith
- St John's Institute of Dermatology, Kings College London, and Guys and St Thomas' NHS Foundation Trust, 9th Floor, Tower Wing, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK
| | - Frits Koning
- Department of Immunology, Leiden University Medical Centre (LUMC), Leiden, the Netherlands
| | - Kilian Eyerich
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Dario Greco
- Institute of Biotechnology, Helsinki Institute of Life Science, University of Helsinki, Helsinki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Ellen H van den Bogaard
- Department of Dermatology, Radboud university medical center, Radboud Institute for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Avidan U Neumann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany
| | - Claudia Traidl-Hoffmann
- Department of Environmental Medicine, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute of Environmental Medicine, Helmholtz Zentrum München, Augsburg, Germany.,Chair of Environmental Medicine, Technical University Munich, Munich, Germany.,CK CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,ZIEL - Institute for Food & Health, Technical University of Munich, Freising-Weihenstephan, Germany
| | - Bernhard Homey
- Department of Dermatology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, School of Basic and Medical Biosciences, King's College London, London, United Kingdom
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Stokholm
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Food Science, University of Copenhagen, Frederiksberg, Denmark
| | - Stephan Weidinger
- Department of Dermatology and Allergy, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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24
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Yousaf M, Ayasse M, Ahmed A, Gwillim E, Janmohamed SR, Yousaf A, Patel KR, Thyssen JP, Silverberg JI. Association between Atopic Dermatitis and Hypertension: A Systematic Review and Meta-Analysis. Br J Dermatol 2021; 186:227-235. [PMID: 34319589 DOI: 10.1111/bjd.20661] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies found conflicting results about the association of atopic dermatitis (AD) with hypertension. OBJECTIVES Determine whether AD and AD severity are associated with hypertension. METHODS A systematic review was performed of published studies in MEDLINE, EMBASE, Scopus, Web of Science, and GREAT databases. At least 2 reviewers conducted title/abstract, full-text review, and data extraction. Quality of evidence was assessed using the Newcastle-Ottawa Scale. RESULTS Fifty-one studies met inclusion criteria; 19 had sufficient data for meta-analysis. AD was associated with higher odds of hypertension compared to healthy controls (increased in 9 of 16 studies; pooled prevalence: 16.4% vs 13.8%; random-effects regression, pooled unadjusted odds ratio [OR][95% confidence interval <CI95>]: 1.16 [1.04-1.30]), but lower odds of hypertension compared to psoriasis (decreased in 5 of 8 studies; 15.4% vs 24.8%; 0.53 [0.37-0.76]). In particular, moderate-severe AD were associated with hypertension compared to healthy controls (increased in 4 of 6 studies; 24.9% vs 14.7%; 2.33 [1.10-4.94]). Hypertension was commonly reported as an adverse-event secondary to AD treatments, particularly systemic cyclosporine A. Limitations include lack of longitudinal studies or individual-level data and potential confounding. CONCLUSIONS AD, particularly moderate-to-severe disease, was associated with increased hypertension compared to healthy controls, but lower odds than psoriasis.
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Affiliation(s)
- M Yousaf
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Ayasse
- Department of Dermatology, George Washington University School of Medicine, Washington, DC, USA
| | - A Ahmed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - E Gwillim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S R Janmohamed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Dermatology, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - A Yousaf
- Department of Dermatology, West Virginia University School of Medicine, Morgantown
| | - K R Patel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J P Thyssen
- Department of Dermatology and Allergy, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
| | - J I Silverberg
- The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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25
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Ali Z, Ulrik CS, Egeberg A, Thyssen JP, Francis Thomsen S. Increased all-cause mortality in concomitant atopic dermatitis and asthma: A nationwide registry-based study. Clin Exp Allergy 2021; 51:1207-1217. [PMID: 34191378 DOI: 10.1111/cea.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Excess mortality has been reported for adults with atopic dermatitis (AD) and asthma. OBJECTIVE To assess the mortality rate in adults with concomitant AD and asthma. METHODS Adults with hospital-diagnosed AD were matched (1:4) with non-AD individuals from the background population. RESULTS The study cohort comprised 8,095 adults with AD (of which 1,201 (14.8%) had concomitant asthma) and 32,380 reference individuals without AD from the background population (of which 878 (2.7%) had asthma). A total of 1,057, 330, 55 and 99 deaths were observed among subjects with neither AD nor asthma, AD only, asthma only, and subjects with concomitant AD and asthma, respectively. The mortality rate per 1,000 person-years was 4.75 (95% CI 4.47-5.05) for subjects with neither AD nor asthma, 7.17 (95% CI 5.92-10.05) for asthma only, 7.09 (95% CI 6.37-7.90) for AD only and 10.87 (95% CI 8.92-13.23) for concomitant AD and asthma. Risk for all-cause mortality was increased in subjects with concomitant AD and asthma compared to asthma only (HR 1.52, 95% CI 1.07-2.15) and neither AD nor asthma (HR 2.27, 95% CI 1.83-2.81) but not compared to subjects with AD only (HR 1.10, 95% CI 0.87-1.39). However, compared to AD only subjects with AD and asthma had increased risk of death due to pulmonary disease (HR 1.81, 95% CI 1.04-3.15). CONCLUSION Adults with AD, asthma or both conditions have increased risk of death, and further concomitant AD and asthma have increased risk of death compared with asthma alone.
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Affiliation(s)
- Zarqa Ali
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Pulmonary Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Simon Francis Thomsen
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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26
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Serum IgE Predicts Difference of Population and Allergens in Allergic Diseases: Data from Weifang City, China. Mediators Inflamm 2021; 2021:6627087. [PMID: 34257517 PMCID: PMC8257378 DOI: 10.1155/2021/6627087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 04/08/2021] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Immunoglobulin E (IgE) is the most important promoter of allergic inflammation. However, there are few systematic studies on IgE in age range, genders, disease spectrum, and time regularity. Aim To screen the common allergens, allergen spectrum, and IgE difference between type 2 inflammatory allergic diseases and other allergic diseases in Weifang, China. Methods A retrospective study was performed by estimating patients' clinical data suffering from allergic diseases (urticaria, pollinosis, allergic rhinitis, atopic dermatitis, and bronchial asthma) between May 2019 and April 2020 using an allergen detection kit of Macro-Union Pharmaceutical. Results 732 of the 1367 patients showed different antigen positive, and the positive rate was 53.5%. The most common allergens were dust mites, mixed fungi, Artemisia pollen, cat/dog dander, and cockroaches. There were 27.0% (369/1367) of the patients with single positive allergen-specific IgE (sIgE), 26.5% (363/1367) with multiple-positive IgE. The total immunoglobulin E (tIgE) levels varied with gender, age, and type of disease. There was a difference in the distribution of allergens between children and adults. A positive correlation between the serum-specific IgE and the corresponding local inhaled allergen density was observed. Conclusions In this study, we found that type 2 inflammatory allergic diseases have higher serum IgE and a higher probability of inhaled sIgE positive. According to age, gender, and condition, serological IgE detection of allergens provides new insight into the early diagnosis and prevention of allergic diseases.
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27
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Knudgaard MH, Andreasen TH, Ravnborg N, Bieber T, Silverberg JI, Egeberg A, Halling AS, Thyssen JP. Rhinitis prevalence and association with atopic dermatitis: A systematic review and meta-analysis. Ann Allergy Asthma Immunol 2021; 127:49-56.e1. [PMID: 33684526 DOI: 10.1016/j.anai.2021.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) and rhinitis are common atopic diseases that may co-occur owing to an overlap in pathophysiology. Although most cases of both diseases are mild and managed with topical anti-inflammatory medicaments, the advent of new systemic and biologic treatments targeting type 2 inflammation in both diseases warrants further insight in the exact overlap of AD and rhinitis. OBJECTIVE To determine the association between AD and rhinitis. METHODS A systematic review and meta-analysis of the databases PubMed, Embase, and CNKI were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled prevalence and pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. RESULTS The search resulted in 10,422 citations, and 341 and 302 articles were included in the qualitative and quantitative analyses, respectively. The pooled prevalence of rhinitis was 40.5% (95% CI 39.0-42.0) in patients with AD and 18.0% (95% CI 16.7-19.2) in the reference individuals without AD. The pooled prevalence of having both rhinitis and asthma was 14.2% (95% CI 13.0-15.5) in patients with AD. There was an association between AD and rhinitis (OR 3.00, 95% CI 2.83-3.18), allergic rhinitis (OR 3.25, 95% CI 2.26-4.66), and nonallergic rhinitis (OR 1.99, 95% CI 1.39-2.86), respectively. CONCLUSION Rhinitis, both allergic and nonallergic forms, is very common in patients with AD. Future investigations should clarify how medications targeting both diseases should be indicated in these patients.
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Affiliation(s)
- Mette Hjorslev Knudgaard
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Thomas Holger Andreasen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Nanna Ravnborg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Thomas Bieber
- Department of Dermatology and Allergy, University Hospital Bonn, Bonn, Germany; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Anne-Sofie Halling
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark
| | - Jacob P Thyssen
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Dermatology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; LEO Foundation Skin Immunology Research Center, University of Copenhagen, Copenhagen, Denmark.
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28
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Bilbao A, Pérez-Garay R, Rius I, Irurzun A, Terrén I, Orrantia A, Astarloa-Pando G, Borrego F, Zenarruzabeitia O. Increased Frequency of CTLA-4 and PD-1 Expressing Regulatory T Cells and Basophils With an Activating Profile in Infants With Moderate-to-Severe Atopic Dermatitis Hypersensitized to Food Allergens. Front Pediatr 2021; 9:734645. [PMID: 34912758 PMCID: PMC8667617 DOI: 10.3389/fped.2021.734645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/08/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Infants with severe atopic dermatitis (AD) may be sensitized to foods that have not been introduced into their diet, posing a risk for developing an immediate hypersensitivity reaction on the first exposure to the food to which they are sensitized. The aim of this work was to perform an analysis of the sensitization profile in infants with moderate-to-severe AD and to identify cellular and molecular markers for food allergy (FA). Methods: Blood samples from healthy donors and children with moderate-to-severe AD were studied. Specific IgE to several allergens were determined using ImmunoCAP FEIA system and ISAC technology. Furthermore, using flow cytometry-based studies, basophils and regulatory T (Treg) cells were phenotypically characterized. Results: 90% of children with AD were sensitized to food antigens before introducing them into the diet, and 100% developed FA. Phenotypic analysis showed a significantly higher percentage of CTLA-4 and PD-1 expressing Treg cells in AD patients than in healthy controls. Basophils from patients exhibited a marked reduction in the expression of CD300a, higher expression of FcεRI and CXCR4, and to some extent higher expression of CD63 and CD300c. Conclusions: Infants with moderate-to-severe AD are at high risk of being sensitized to food allergens. Therefore, to avoid allergic reactions, broad-spectrum sensitization studies are necessary before introducing complementary diet. Increased expression of CTLA-4 and PD-1 suggests greater suppressive potential of Treg cells in infants with AD than healthy controls. Furthermore, our results suggest a role for CD300 molecules on circulating basophils as possible biomarkers for FA susceptibility.
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Affiliation(s)
- Agurtzane Bilbao
- Immunopathology Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Pediatrics Service, Cruces University Hospital, Barakaldo, Spain
| | - Raquel Pérez-Garay
- Immunopathology Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Clinical Analysis Service, Cruces University Hospital, Barakaldo, Spain
| | - Idoia Rius
- Pediatrics Service, Cruces University Hospital, Barakaldo, Spain
| | - Alex Irurzun
- Pediatrics Service, Cruces University Hospital, Barakaldo, Spain
| | - Iñigo Terrén
- Immunopathology Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ane Orrantia
- Immunopathology Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | | | - Francisco Borrego
- Immunopathology Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.,Ikerbasque, Basque Foundation for Science, Bilbao, Spain
| | - Olatz Zenarruzabeitia
- Immunopathology Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
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