1
|
Appanna R, Gargano D, Caputo A, De Bartolomeis F, Ricciardi L, Santonicola A, Stefanelli B, Caiazza L, Guarciariello M, D'Antonio A, D'Auria R, Conti V, Casolaro V, Iovino P. Changes in mucosal IgG4 +- and IL-10 +-cell frequencies in adults with eosinophilic esophagitis on a two-food elimination diet. Clin Immunol 2023; 257:109853. [PMID: 38013163 DOI: 10.1016/j.clim.2023.109853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
Eosinophilic esophagitis (EoE) is increasingly diagnosed in patients with dysphagia. Type-2 immunity can induce EoE histopathology via non-IgE-dependent mechanisms, possibly involving IgG4 and IL-10. To elucidate the contribution of this response to EoE pathogenesis, we examined its association with clinical and histologic endpoints in adult EoE patients given a two-food elimination diet. IgG4- and IL-10-expressing cells were counted in esophageal biopsies and serum food-specific IgG4 measured at baseline and follow-up. Variables were correlated with histologic measures of disease activity. Patients exhibited significant reduction in esophageal eosinophilia and overall histology. A significant decrease in IL-10+-cell frequencies correlated with histologic changes. In contrast, a decline in serum and esophageal IgG4, while substantial, did not correlate with IL-10+-cell frequencies or histologic parameters. These results suggest a critical role of IL-10 in EoE pathogenesis. Conversely, IgG4 expression, while reflecting exposure to food antigens, is not obviously related to EoE histopathology or IL-10 expression.
Collapse
Affiliation(s)
- Ramapraba Appanna
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | | | - Alessandro Caputo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy; San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | | | - Luca Ricciardi
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Antonella Santonicola
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy; San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Berenice Stefanelli
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Laura Caiazza
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | | | - Antonio D'Antonio
- San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Raffaella D'Auria
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Valeria Conti
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy; San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy
| | - Vincenzo Casolaro
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy; San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy.
| | - Paola Iovino
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy; San Giovanni di Dio e Ruggi d'Aragona University Hospital, Salerno, Italy.
| |
Collapse
|
2
|
Nørgaard SK, Følsgaard N, Vissing NH, Kyvsgaard JN, Chawes B, Stokholm J, Smilde AK, Bønnelykke K, Bisgaard H, Rasmussen MA. Novel Connections of Common Childhood Illnesses Based on More Than 5 Million Diary Registrations From Birth Until Age 3 Years. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2162-2171.e6. [PMID: 37146879 DOI: 10.1016/j.jaip.2023.04.030] [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: 03/18/2022] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND All children experience numerous episodes of illness during the first 3 years of life. Most episodes are mild and handled without medical attention but nevertheless burden the families and society. There is a large, and still unexplained, variation in the burden of illness between children. OBJECTIVE To describe and provide a better understanding of the disease burden of common childhood diseases through a data-driven approach investigating the communalities between symptom patterns and predefined variables on predispositions, pregnancy, birth, environment, and child development. METHODS The study is based on the prospectively followed clinical mother-child cohort COpenhagen Prospective Studies on Asthma in Childhood, which includes 700 children with daily symptom registration in the first 3 years of life, including symptoms of cough, breathlessness, wheeze, cold, pneumonia, sore throat, ear infections, gastrointestinal infections, fever, and eczema. First, we described the number of episodes of symptoms. Next, factor analysis models were used to describe the variation in symptom load in the second year of life (both based on n = 556, with >90% complete diary). Then we characterized patterns of similarity between symptoms using a graphical network model (based on n = 403, with a 3-year monthly compliance of >50%). Finally, predispositions and pregnancy, birth, environmental, and developmental factors were added to the network model. RESULTS The children experienced a median of 17 (interquartile range, 12-23) episodes of symptoms during the first 3 years of life, of which most were respiratory tract infections (median, 13; interquartile range, 9-18). The frequency of symptoms was the highest during the second year of life. Eczema symptoms were unrelated to the other symptoms. The strongest association to respiratory symptoms was found for maternal asthma, maternal smoking during the third trimester, prematurity, and CDHR3 genotype. This was in contrast to the lack of associations for the well-established asthma locus at 17q21. CONCLUSIONS Healthy young children are burdened by multiple episodes of symptoms during the first 3 years of life. Prematurity, maternal asthma, and CDHR3 genotype were among the strongest drivers of symptom burden.
Collapse
Affiliation(s)
- Sarah Kristine Nørgaard
- COPSAC (COpenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nilo Følsgaard
- COPSAC (COpenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nadja Hawwa Vissing
- COPSAC (COpenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics and Adolescence Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie Nyholm Kyvsgaard
- COPSAC (COpenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo Chawes
- 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 Pediatrics, Slagelse Hospital, Slagelse, Denmark; Department of Food Science, University of Copenhagen, Copenhagen, Denmark
| | - Age K Smilde
- Department of Food Science, University of Copenhagen, Copenhagen, Denmark; Biosystems Data Analysis, Swammerdam Institute for Life Sciences, Amsterdam, The Netherlands
| | - Klaus Bønnelykke
- COPSAC (COpenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Hans Bisgaard
- COPSAC (COpenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Arendt Rasmussen
- COPSAC (COpenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Food Science, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
3
|
Farraia M, Mendes FC, Sokhatska O, Severo M, Rufo JC, Barros H, Moreira A. Sensitization trajectories to multiple allergen components in a population-based birth-cohort. Pediatr Allergy Immunol 2023; 34:e13963. [PMID: 37366209 DOI: 10.1111/pai.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/18/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND The characteristics of allergic sensitization profiles can differ between populations and geographic regions, contributing differently to the association with allergic diseases. Consequently, the sensitization trajectories found in previous studies conducted in Northern Europe may not apply in Southern European countries. OBJECTIVE To identify trajectories of allergic sensitization profiles during childhood and evaluate the association with allergic outcomes, using data from a Portuguese birth cohort. METHODS A random sample from Generation XXI was screened for allergic sensitization at 10 years of age. Among 452 allergic sensitized children, 186 were tested with ImmunoCAP™ ISAC multiplex array that detects 112 molecular components, at three follow-ups (4, 7, and 10 years old). Information on allergic outcomes (asthma, rhinitis, atopic dermatitis) was obtained at the 13-year-old follow-up. Latent class analysis (LCA) was used to identify clusters of participants with similar sensitization profiles. Then, sensitization trajectories were defined based on the most prevalent transitions between clusters over time. Logistic regression was applied to estimate the association between sensitization trajectories and allergic diseases. RESULTS Five trajectories were proposed: "no/few sensitizations," "early persistent house dust mites (HDM)," "early HDM and persistent/late grass pollen," "late grass pollen," and "late HDM." The "early HDM and persistent/late grass pollen" trajectory was associated with rhinitis and "early persistent HDM" with asthma and rhinitis. CONCLUSION Distinct sensitization trajectories pose different risks in the development of allergic diseases. These trajectories present some differences from those in Northern European countries and are important for planning adequate prevention health plans.
Collapse
Affiliation(s)
- Mariana Farraia
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisca Castro Mendes
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Oksana Sokhatska
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Milton Severo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Cavaleiro Rufo
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - André Moreira
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto, Portugal
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, Porto, Portugal
| |
Collapse
|
4
|
Kitahara A, Yamamoto Y, Fukutomi Y, Shiraishi Y, Tanaka J, Oguma T, Taniguchi M, Nagai T, Asano K. Sensitization pattern to environmental allergens in a Japanese population. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:30-35. [PMID: 37780114 PMCID: PMC10509945 DOI: 10.1016/j.jacig.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 10/14/2022] [Accepted: 10/27/2022] [Indexed: 10/03/2023]
Abstract
Background We previously described the prevalence of allergen-specific IgE in a general population of Japanese adults. Objective We sought to elucidate allergen sensitization patterns in this population. Methods Serum samples had been obtained from 800 blood donors aged 20 to 59 years and living in Tokyo, Japan, in 2005 and stored in the Japanese Red Cross Society. These samples were examined for IgE levels, total and specific for 23 allergens or allergen sources correlated with allergic airway diseases using the ImmunoCAP method. Exploratory and confirmatory factor analyses were performed to uncover the relationship among allergen-specific IgE based on their titers. Hierarchical cluster analysis was executed using Ward's method based on standardized factor scores identified through factor analysis. Results Exploratory factor analysis revealed 6 categories of allergen-specific IgE: specific to 2 types of animals (insects and Dermatophagoides pteronyssinus/animal dander), 2 types of pollens (group 1 [Japanese cedar and cypress] and group 2 [alder, grass, and weeds]), and 2 types of microorganisms (fungi and commensal microorganisms on the skin). The Japanese population was categorized into 3 clusters: (A) nonatopic type, (B) house dust mite-dominant sensitization type, and (C) panatopic type. The panatopic group could be further classified into 2 subclusters positive and negative for fungal sensitization. Conclusions This study demonstrated that a Japanese population could be divided into 3 clusters according to the sensitization pattern to 6 types of allergens.
Collapse
Affiliation(s)
- Asako Kitahara
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Yoshiro Yamamoto
- Department of Mathematics, School of Science, Tokai University, Kanagawa, Japan
| | - Yuma Fukutomi
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
| | - Yoshiki Shiraishi
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Jun Tanaka
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Tsuyoshi Oguma
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Masami Taniguchi
- Clinical Research Center, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
- Shonan Kamakura General Hospital Center for Immunology and Allergology, Kanagawa, Japan
| | - Tadashi Nagai
- Central Blood Institute, Japanese Red Cross Society, Tokyo, Japan
| | - Koichiro Asano
- Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan
| |
Collapse
|
5
|
Vukičević Lazarević V, Marković I, Šola AM. Adolescent and young adult allergic asthma treatment challenges. BMJ Case Rep 2022; 15:e251244. [PMID: 36316051 PMCID: PMC9628657 DOI: 10.1136/bcr-2022-251244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
The transition from paediatric care to adult care is often difficult, especially in children with chronic diseases like asthma. A significant number of children reach remission throughout puberty; consequently, they are not tracked down for subsequent follow-ups and are not included in transition programmes to adult care. This case report focuses on a young adult with asthma that began in childhood and went into remission during adolescence, only to experience a recurrence when the patient was a young adult. Due to failing to complete the transition process into adult care services, she had poor adherence to therapy and asthma control.Adherence and asthma control significantly improved after a multidisciplinary approach in an adult care setting. In conclusion, appropriate transition and a multidisciplinary approach are critical for the effective management of asthma in young adults.
Collapse
Affiliation(s)
- Vesna Vukičević Lazarević
- MSc Allergy, Faculty of Medicine, Imperial College London, London, UK
- Special Hospital for Pulmonary Diseases, Zagreb, Croatia
| | - Ivan Marković
- Special Hospital for Pulmonary Diseases, Zagreb, Croatia
| | | |
Collapse
|
6
|
Classification of atopic dermatitis phenotypes according to allergic sensitization by cluster analysis. World Allergy Organ J 2022; 15:100671. [PMID: 35983566 PMCID: PMC9357948 DOI: 10.1016/j.waojou.2022.100671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/18/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
A cluster study to classify atopic dermatitis (AD) phenotypes into subgroups is required to better understand and manage the disease owing to the heterogeneity of its clinical features. This study aimed to identify the phenotypic subgroups of childhood AD according to allergic sensitization. In 258 children with AD, hierarchical cluster analysis based on specific immunoglobulin (Ig) E sensitization revealed four distinct clusters. Cluster A (n = 71) revealed no IgE sensitization, whereas cluster B (n = 28) showed sensitization to egg white only. Cluster B was highly associated with early-onset AD (<3 months) and a family history of atopic diseases. Cluster C (n = 68) and D (n = 91), sensitized to multiple foods and inhalants, respectively, showed a higher prevalence of skin infection within the last 1 year than others. Cluster D was related to late-onset AD (>12 months) and had more atopic comorbidities. In addition, cluster D showed the most severely impaired health-related quality of life and more frequent use of immunosuppressants. Therefore, childhood AD can be classified into 4 clusters based on the allergic sensitization status, and clinical phenotypes and treatment strategy may be different according to clusters.
Collapse
|
7
|
Asthma and Allergy: Unravelling a Tangled Relationship with a Focus on New Biomarkers and Treatment. Int J Mol Sci 2022; 23:ijms23073881. [PMID: 35409241 PMCID: PMC8999577 DOI: 10.3390/ijms23073881] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 12/19/2022] Open
Abstract
Asthma is a major driver of health care costs across ages. Despite widely disseminated asthma-treatment guidelines and a growing variety of effective therapeutic options, most patients still experience symptoms and/or refractoriness to standard of care treatments. As a result, most patients undergo a further intensification of therapy to optimize symptom control with a subsequent increased risk of side effects. Raising awareness about the relevance of evaluating aeroallergen sensitizations in asthmatic patients is a key step in better informing clinical practice while new molecular tools, such as the component resolved diagnosis, may be of help in refining the relationship between sensitization and therapeutic recommendations. In addition, patient care should benefit from reliable, easy-to-measure and clinically accessible biomarkers that are able to predict outcome and disease monitoring. To attain a personalized asthma management and to guide adequate treatment decisions, it is of paramount importance to expand clinicians' knowledge about the tangled relationship between asthma and allergy from a molecular perspective. Our review explores the relevance of allergen testing along the asthma patient's journey, with a special focus on recurrent wheezing children. Here, we also discuss the unresolved issues regarding currently available biomarkers and summarize the evidence supporting the eosinophil-derived neurotoxin as promising biomarker.
Collapse
|
8
|
Pijnenburg MW, Frey U, De Jongste JC, Saglani S. Childhood asthma- pathogenesis and phenotypes. Eur Respir J 2021; 59:13993003.00731-2021. [PMID: 34711541 DOI: 10.1183/13993003.00731-2021] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 10/15/2021] [Indexed: 11/05/2022]
Abstract
In the pathogenesis of asthma in children there is a pivotal role for a type 2 inflammatory response to early life exposures or events. Interactions between infections, atopy, genetic susceptibility, and environmental exposures (such as farmyard environment, air pollution, tobacco smoke exposure) influence the development of wheezing illness and the risk for progression to asthma. The immune system, lung function and the microbiome in gut and airways develop in parallel and dysbiosis of the microbiome may be a critical factor in asthma development. Increased infant weight gain and preterm birth are other risk factors for development of asthma and reduced lung function. The complex interplay between these factors explains the heterogeneity of asthma in children. Subgroups of patients can be identified as phenotypes based on clinical parameters, or endotypes, based on a specific pathophysiological mechanism. Paediatric asthma phenotypes and endotypes may ultimately help to improve diagnosis of asthma, prediction of asthma development and treatment of individual children, based on clinical, temporal, developmental or inflammatory characteristics. Unbiased, data-driven clustering, using a multidimensional or systems biology approach may be needed to better define phenotypes. The present knowledge on inflammatory phenotypes of childhood asthma has now been successfully applied in the treatment with biologicals of children with severe therapy resistant asthma, and it is to be expected that more personalized treatment options may become available.
Collapse
Affiliation(s)
- Mariëlle W Pijnenburg
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Urs Frey
- University Children's Hospital Basel (UKBB), Basel, Switzerland
| | - Johan C De Jongste
- Department of Paediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sejal Saglani
- National Heart and Lung Institute, Imperial College, London, UK
| |
Collapse
|
9
|
Schoos AMM, Nwaru BI, Borres MP. Component-resolved diagnostics in pet allergy: Current perspectives and future directions. J Allergy Clin Immunol 2021; 147:1164-1173. [PMID: 33444632 DOI: 10.1016/j.jaci.2020.12.640] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/30/2020] [Accepted: 12/23/2020] [Indexed: 12/14/2022]
Abstract
Furry mammals kept as pets are important allergen sources. The prevalence of sensitization to dander from various animals appears to be increasing worldwide. Several mammalian allergens from diverse species and distinct protein families have been characterized, and some are available for component-resolved diagnostics (CRD). This review presents an overview of mammalian aeroallergens, with a focus on cat, dog, and horse allergens. The potential of CRD in fine-tuning the diagnostic workup following traditional methods based on whole- allergen extracts and allergen immunotherapy is discussed. The review highlights the clinical utility of CRD, particularly as a marker/predictor of increased asthma risk and disease severity. Finally, several perspectives of the future implications of CRD are offered in the context of furry animal allergens.
Collapse
Affiliation(s)
- Ann-Marie M Schoos
- COpenhagen Prospective Studies on Asthma in Childhood (COPSAC), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Pediatrics, Slagelse Sygehus, Slagelse, Denmark.
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Magnus P Borres
- Thermo Fisher Scientific, Uppsala, Sweden; Department of Maternal and Child Health, Uppsala University, Uppsala, Sweden
| |
Collapse
|
10
|
Glaumann S, Lilja G, Nopp A, Nilsson C. Positive Phadiatop Infant (Phinf) can predict allergic disease during childhood. Pediatr Allergy Immunol 2020; 31:994-996. [PMID: 32340076 DOI: 10.1111/pai.13266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/27/2020] [Accepted: 04/09/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Susanne Glaumann
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Solna, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Gunnar Lilja
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Solna, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Anna Nopp
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Solna, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Caroline Nilsson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Solna, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
11
|
Schoos AMM, Jelding-Dannemand E, Stokholm J, Bønnelykke K, Bisgaard H, Chawes BL. Single and multiple time-point allergic sensitization during childhood and risk of asthma by age 13. Pediatr Allergy Immunol 2019; 30:716-723. [PMID: 31299117 DOI: 10.1111/pai.13109] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/29/2019] [Accepted: 07/05/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND The relationship between allergic sensitization during childhood and risk of developing asthma remains unclear. OBJECTIVE To analyze single time-point and temporal patterns of sensitization in childhood in relation to asthma at age 13. METHODS Specific IgE (sIgE) level and skin prick test (SPT) toward 22 food allergens and aeroallergens were assessed at 6, 18 months, 4, 6, and 13 years in children from the high-risk Copenhagen Prospective Studies on Asthma in Childhood2000 (COPSAC2000 ) mother-child cohort. We analyzed the association between single time-point monosensitization, polysensitization, and quantitative assessment of sensitization, that is, sum of all sIgE levels and SPT wheal sizes, against asthma at age 13. In addition, we analyzed the association between three temporal patterns of sensitization: (a) early-transient, (b) late-onset, and (c) persistent sensitization and asthma. RESULTS Polysensitization status measured by SPT or sIgE was at all single time-points associated with increased risk of asthma at age 13: OR range, SPT = 3.0-15.7, and sIgE = 2.6-15.7, respectively, whereas monosensitization status was inconsistently associated with asthma. Quantitative assessment of both sIgE and SPT results was associated with asthma at all single time-points: OR range, SPT = 1.3-3.6, and sIgE = 1.1-1.7. Persistent sensitization, but not early-transient or late-onset sensitization was associated with asthma by age 13: OR [95% CI], SPT = 8.9 [2.8-28.23], and sIgE = 2.9 [1.1-7.6], respectively. CONCLUSION Sensitization to multiple allergens at single time-points, increasing sIgE levels and SPT wheal sizes, and persistent sensitization during childhood were associated with increased risk of asthma at age 13, suggesting the use of quantitative and repetitive sensitization measurements when assessing risk of developing asthma.
Collapse
Affiliation(s)
- Ann-Marie Malby Schoos
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ea Jelding-Dannemand
- 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
| | - Klaus Bønnelykke
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Bo Lund Chawes
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
12
|
Irvine A, Mina‐Osorio P. Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide. Br J Dermatol 2019; 181:895-906. [PMID: 30758843 PMCID: PMC6899789 DOI: 10.1111/bjd.17766] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a heterogeneous disease with a multifactorial aetiology and complex pathophysiology. This heterogeneity translates into different trajectories of disease progression with respect to severity, persistence and risk of development of atopic comorbidities. Determining which possible disease trajectories or comorbidities any individual child might develop is challenging in clinical practice. Tools that help identify paediatric patients at higher risk of disease progression would greatly aid clinicians. METHODS We reviewed recent cohort studies to synthesize and simplify the epidemiological data to try to identify shared clinically relevant characteristics that may help physicians estimate the risk of disease progression in paediatric patients with AD. RESULTS Despite the variability in data collection and methods of analysis and their limitations, there are common patterns of early-childhood AD that may aid in the estimation of risk for disease progression. Factors associated with risk of AD progression include younger age of onset, family history of atopy, greater AD severity, filaggrin mutations, urban environment and polysensitization and/or allergic multimorbidity. Based on these factors, we provide a practitioner's guide for identifying, counselling and/or referring infants and children with AD at potentially higher risk of developing persistent AD and atopic comorbidities. We also present clinical scenarios to illustrate how these data relate to real-life situations. CONCLUSIONS Useful insights are provided for physicians and patients to inform them better about the risk of AD progression and to help guide care pathways for the paediatric population with AD. What's already known about this topic? The complex pathophysiology of atopic dermatitis (AD) translates into a heterogeneous clinical presentation and trajectories of disease progression. Although the consensus is that most paediatric patients with AD will eventually 'outgrow' the disease or follow the longitudinal trajectory known as the 'atopic march', a significant proportion will develop persistent AD and/or other atopic conditions. No known factors conclusively predict the risk of progression or development of comorbidities. What does this study add? Recent analyses of data from large cohorts of paediatric patients with AD have suggested the existence of potentially discrete clusters of patients who present with relatively common AD phenotypes. These studies have shed some light onto the factors associated with risk of progression, which we review in this article. A practitioner's guide with clinical scenarios is provided to help identify patients at high risk of progression to determine whether a patient should be monitored and/or would require specialist referral.
Collapse
Affiliation(s)
- A.D. Irvine
- Paediatric DermatologyOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- National Children's Research CentreOur Lady's Children's HospitalCrumlin, Dublin12Ireland
- Clinical MedicineTrinity College DublinDublinIreland
| | | |
Collapse
|
13
|
Gabet S, Rancière F, Just J, de Blic J, Lezmi G, Amat F, Seta N, Momas I. Asthma and allergic rhinitis risk depends on house dust mite specific IgE levels in PARIS birth cohort children. World Allergy Organ J 2019; 12:100057. [PMID: 31641405 PMCID: PMC6796773 DOI: 10.1016/j.waojou.2019.100057] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/28/2019] [Accepted: 07/23/2019] [Indexed: 11/06/2022] Open
Abstract
Background The natural history of allergic sensitization in childhood, and its impact on allergic disease development, needs to be clarified. This study aims to identify allergic sensitization and morbidity patterns during the first 8 years of life. Methods The study was conducted in the on-going population-based prospective Pollution and Asthma Risk: an Infant Study (PARIS) birth cohort. Sensitization profiles were identified by k-means clustering based upon allergen-specific IgE levels measured at 18 months and 8/9 years. Allergic morbidity profiles were identified by latent class analysis based on symptoms, symptom severity, treatments, and lifetime doctor-diagnoses of asthma, allergic rhinitis, and atopic dermatitis and on lower respiratory infections before 2 years. Results Five sensitization and 5 allergic morbidity patterns were established in 714 children. Children not sensitized or with isolated and low allergen-specific sensitization were grouped together (76.8%). A profile of early and transient sensitization to foods that increased the risk of asthma later in childhood was identified (4.9%). Children strongly sensitized (≥3.5 kUA/L) to house dust mite at 8/9 years (9.0%) had the highest risk of asthma and allergic rhinitis. Finally, timothy grass pollen at 8/9 years sensitization profile (5.3%) was related to respiratory allergic diseases, as was early onset and persistent sensitization profile (4.1%), this latter being also strongly associated with atopic dermatitis. Conclusions & Clinical Relevance We show that accurate assessment of the risk of allergic disease should rely on earliness and multiplicity of sensitization, involved allergens, and allergen-specific IgE levels, and not considering solely allergic sensitization as a dichotomous variable (allergen-specific IgE ≥0.35 kUA/L), as usually done. This is particularly striking for house dust mite. We are hopeful that, pending further confirmation in other populations, our findings will improve clinical practice as part of an approach to allergic disease prevention.
Collapse
Key Words
- AIC, Akaike Information Criteria
- Allergic morbidity
- BAMSE, Stockholm Children Allergy and Environmental Prospective Birth Cohort
- BIC, Bayesian Information Criteria
- BMI, body mass index
- Birth cohort
- COPSAC2000, Copenhagen Prospective Study on Asthma in Childhood 2000
- Cluster analysis
- ISAAC, International Study of Asthma and Allergies in Childhood
- IgE, Immunoglobulin E
- LCA, latent class analysis
- LRI, lower respiratory infections
- Latent class analysis
- MAS, Multicenter Allergy Study
- MeDALL, Mechanisms of the Development of ALLergy
- OR(a), (adjusted) odds ratio
- PARIS, Pollution and Asthma Risk: an Infant Study
- PASTURE, Protection Against Allergy: Study in Rural Environments
- SES, socio-economic status
- Specific IgE levels
Collapse
Affiliation(s)
- Stephan Gabet
- Université de Paris, Faculté de Pharmacie de Paris, Inserm UMR 1153, Centre of Research in Epidemiology and Statistics (CRESS), HERA team, Paris, France
| | - Fanny Rancière
- Université de Paris, Faculté de Pharmacie de Paris, Inserm UMR 1153, Centre of Research in Epidemiology and Statistics (CRESS), HERA team, Paris, France
| | - Jocelyne Just
- AP-HP, Hôpital d'Enfants Armand-Trousseau, Service d'Allergologie Pédiatrique, Paris, France
| | - Jacques de Blic
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France
| | - Guillaume Lezmi
- AP-HP, Hôpital Necker-Enfants Malades, Service de Pneumologie et d'Allergologie Pédiatriques, Paris, France
| | - Flore Amat
- AP-HP, Hôpital d'Enfants Armand-Trousseau, Service d'Allergologie Pédiatrique, Paris, France.,UPMC, Sorbonne Universités, Inserm UMR S1136, Paris, France
| | - Nathalie Seta
- Université de Paris, Faculté de Pharmacie de Paris, Inserm UMR 1153, Centre of Research in Epidemiology and Statistics (CRESS), HERA team, Paris, France
| | - Isabelle Momas
- Université de Paris, Faculté de Pharmacie de Paris, Inserm UMR 1153, Centre of Research in Epidemiology and Statistics (CRESS), HERA team, Paris, France.,Mairie de Paris, Direction de l'Action Sociale, de l'Enfance et de la Santé (DASES), Cellule Cohorte, Paris, France
| |
Collapse
|
14
|
Lee E, Hong SJ. Phenotypes of allergic diseases in children and their application in clinical situations. KOREAN JOURNAL OF PEDIATRICS 2019; 62:325-333. [PMID: 31096745 PMCID: PMC6753312 DOI: 10.3345/kjp.2018.07395] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/18/2019] [Indexed: 12/25/2022]
Abstract
Allergic diseases, including allergic rhinitis, asthma, and atopic dermatitis, are common heterogeneous diseases that encompass diverse phenotypes and different pathogeneses. Phenotype studies of allergic diseases can facilitate the identification of risk factors and their underlying pathophysiology, resulting in the application of more effective treatment, selection of better treatment responses, and prediction of prognosis for each phenotype. In the early phase of phenotype studies in allergic diseases, artificial classifications were usually performed based on clinical features, such as triggering factors or the presence of atopy, which can result in the biased classification of phenotypes and limit the characterization of heterogeneous allergic diseases. Subsequent phenotype studies have suggested more diverse phenotypes for each allergic disease using relatively unbiased statistical methods, such as cluster analysis or latent class analysis. The classifications of phenotypes in allergic diseases may overlap or be unstable over time due to their complex interactions with genetic and encountered environmental factors during the illness, which may affect the disease course and pathophysiology. In this review, diverse phenotype classifications of allergic diseases, including atopic dermatitis, asthma, and wheezing in children, allergic rhinitis, and atopy, are described. The review also discusses the applications of the results obtained from phenotype studies performed in other countries to Korean children. Consideration of changes in the characteristics of each phenotype over time in an individual’s lifespan is needed in future studies.
Collapse
Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
15
|
Development of allergic sensitization and its relevance to paediatric asthma. Curr Opin Allergy Clin Immunol 2019; 18:109-116. [PMID: 29389732 DOI: 10.1097/aci.0000000000000430] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the recent evidence on the distinct atopic phenotypes and their relationship with childhood asthma. We start by considering definitions and phenotypic classification of atopy and then review evidence on its association with asthma in children. RECENT FINDINGS It is now well recognized that both asthma and atopy are complex entities encompassing various different sub-groups that also differ in the way they interconnect. The lack of gold standards for diagnostic markers of atopy and asthma further adds to the existing complexity over diagnostic accuracy and definitions. Although recent statistical phenotyping studies contributed significantly to our understanding of these heterogeneous disorders, translating these findings into meaningful information and effective therapies requires further work on understanding underpinning biological mechanisms. SUMMARY The disaggregation of allergic sensitization may help predict how the allergic disease is likely to progress. One of the important questions is how best to incorporate tests for the assessment of allergic sensitization into diagnostic algorithms for asthma, both in terms of confirming asthma diagnosis, and the assessment of future risk.
Collapse
|
16
|
Lee S, Koh HY, Yon DK, Lee SW, Ha EK, Sung M, Lee KS, Jee HM, Sheen YH, Han MY. Association of Sensitization to Different Aeroallergens With Airway Function and Nasal Patency in Urban Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:572-582. [PMID: 31172725 PMCID: PMC6557775 DOI: 10.4168/aair.2019.11.4.572] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE Children with sensitization to aeroallergens have decreased lung function and nasal patency. Our purpose was to determine the association of sensitization to different aeroallergens with airway function and nasal patency. METHODS Four hundred and eighty-six randomly selected 11 year-old children who lived in Seongnam City were examined. Serum specific immunoglobulin E (IgE) levels against 6 common allergens (Dermatophagoidesfarinae, birch, cat, dog, Japanese hop and Alternaria), impulse oscillometry (IOS) results for the evaluation of airway dysfunction, and acoustic rhinometry for the determination of nasal airway patency were obtained. RESULTS IOS indicated that children sensitized to Alternaria (n = 38, 7.8%) and dog dander (n = 69, 14.2%) had decreased lung function, based on resistance at 10 Hz (Rrs10; aβ = 0.0072; 95% CI, 0.017, 0.127; P = 0.010) and 1 Hz (Rrs1; aβ = 0.038; 95% CI, 0.001, 0.074; P = 0.042). Children sensitized to D. farinae (n = 281, 57.8%) had decreased post-decongestant nasal volume at 0 to 5 cm (aβ = -0.605; 95% CI, -1.005, -0.205; P = 0.003), but normal IOS results at all measured frequencies (P > 0.05). Increased serum eosinophil level was associated with Rrs1 (P = 0.007) and Rrs2 (P = 0.018) and post-decongestant nasal volume at 0 to 5 cm (aβ = -0.885; 95% CI, -1.331, -0.439; P < 0.001). CONCLUSIONS Sensitivity to specific aeroallergens, serum eosinophil count and total IgE level had different associations with upper and lower airway dysfunction in urban children.
Collapse
Affiliation(s)
- Shinhae Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyun Yong Koh
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Korea
| | - Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.,Medical Service Corps, Republic of Korea Army, Seongnam, Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea
| | - Eun Kyo Ha
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Myongsoon Sung
- Department of Pediatrics, Soon Chun Hyang University Gumi Hospital, Gumi, Korea
| | - Kyung Suk Lee
- Department of Pediatrics, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hye Mi Jee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Youn Ho Sheen
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Man Yong Han
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
| |
Collapse
|
17
|
Keet CA, Allen KJ. Advances in food allergy in 2017. J Allergy Clin Immunol 2018; 142:1719-1729. [DOI: 10.1016/j.jaci.2018.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/01/2018] [Accepted: 10/19/2018] [Indexed: 12/31/2022]
|
18
|
Tang HH, Teo SM, Belgrave DC, Evans MD, Jackson DJ, Brozynska M, Kusel MM, Johnston SL, Gern JE, Lemanske RF, Simpson A, Custovic A, Sly PD, Holt PG, Holt KE, Inouye M. Trajectories of childhood immune development and respiratory health relevant to asthma and allergy. eLife 2018; 7:35856. [PMID: 30320550 PMCID: PMC6221547 DOI: 10.7554/elife.35856] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/05/2018] [Indexed: 12/28/2022] Open
Abstract
Events in early life contribute to subsequent risk of asthma; however, the causes and trajectories of childhood wheeze are heterogeneous and do not always result in asthma. Similarly, not all atopic individuals develop wheeze, and vice versa. The reasons for these differences are unclear. Using unsupervised model-based cluster analysis, we identified latent clusters within a prospective birth cohort with deep immunological and respiratory phenotyping. We characterised each cluster in terms of immunological profile and disease risk, and replicated our results in external cohorts from the UK and USA. We discovered three distinct trajectories, one of which is a high-risk ‘atopic’ cluster with increased propensity for allergic diseases throughout childhood. Atopy contributes varyingly to later wheeze depending on cluster membership. Our findings demonstrate the utility of unsupervised analysis in elucidating heterogeneity in asthma pathogenesis and provide a foundation for improving management and prevention of childhood asthma. Asthma causes wheezy and troubled breathing, and can be life-threatening. Scientists and doctors understand that asthma begins in early childhood. Chest infections, exposure to bacteria, viruses, and allergies may cause or trigger asthma. One person with asthma may not have the same origins as another. But it is not yet clear how various triggers may interact to trigger or exacerbate asthma. To disentangle how these factors contribute to asthma, experts have tried to group people with asthma into subgroups. Unfortunately, the groups often vary from expert to expert. Now, some scientists are using computers to sort patients with asthma. The scientists let the computers decide the best criteria for sorting patients. This way the machines may identify patterns that are not obvious to humans. Using this computer-based approach, Tang et al. sorted Australian children with asthma into 3 groups based on their early life allergies and respiratory health. One group has high-risk asthma with frequent chest infections and strong allergic responses. The other two groups are low-risk, but they respond differently to allergy and infection. Common tests used by doctors to diagnose patients with allergy or asthma may not work the same with all three groups. The bacteria found in the nose influence the risk of asthma, even in patients who are well, and the way this occurs varies by group. Similar groups were also found among children with asthma in the United States and the United Kingdom. Learning more about subgroups of patients with asthma may help other scientists and doctors design better ways to diagnose, treat, or prevent asthma. Working together with scientists around the world to determine how to best describe subgroups of people according to asthma type and risk is a critical step in the process. Tang et al. hope other scientist will test whether these three groups are also found in people from other parts of the world.
Collapse
Affiliation(s)
- Howard Hf Tang
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Victoria, Australia.,School of BioSciences, The University of Melbourne, Victoria, Australia
| | - Shu Mei Teo
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Victoria, Australia.,Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | | | - Michael D Evans
- Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Marta Brozynska
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Victoria, Australia.,Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Merci Mh Kusel
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Sebastian L Johnston
- Airway Disease Infection Section, MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Robert F Lemanske
- University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, United Kingdom
| | - Adnan Custovic
- Department of Paediatrics, Imperial College London, London, United Kingdom
| | - Peter D Sly
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Patrick G Holt
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Kathryn E Holt
- Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Victoria, Australia.,The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Victoria, Australia.,Cambridge Baker Systems Genomics Initiative, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom.,The Alan Turing Institute, London, United Kingdom
| |
Collapse
|
19
|
Grayson MH, Feldman S, Prince BT, Patel PJ, Matsui EC, Apter AJ. Advances in asthma in 2017: Mechanisms, biologics, and genetics. J Allergy Clin Immunol 2018; 142:1423-1436. [PMID: 30213625 DOI: 10.1016/j.jaci.2018.08.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/22/2018] [Accepted: 08/31/2018] [Indexed: 02/07/2023]
Abstract
This review summarizes some of the most significant advances in asthma research over the past year. We first focus on novel discoveries in the mechanism of asthma development and exacerbation. This is followed by a discussion of potential new biomarkers, including the use of radiographic markers of disease. Several new biologics have become available to the clinician in the past year, and we summarize these advances and how they can influence the clinical delivery of asthma care. After this, important findings in the genetics of asthma and heterogeneity in phenotypes of the disease are explored, as is the role the environment plays in shaping the development and exacerbation of asthma. Finally, we conclude with a discussion of advances in health literacy and how they will affect asthma care.
Collapse
Affiliation(s)
- Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio.
| | - Scott Feldman
- Section of Allergy and Immunology, Division of Pulmonary Allergy Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Benjamin T Prince
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Priya J Patel
- Section of Allergy and Immunology, Division of Pulmonary Allergy Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa
| | - Elizabeth C Matsui
- Department of Population Health, Dell Medical School, University of Texas-Austin, Austin, Tex
| | - Andrea J Apter
- Section of Allergy and Immunology, Division of Pulmonary Allergy Critical Care Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pa
| |
Collapse
|
20
|
Abstract
PURPOSE OF REVIEW The review provides insight into recent findings on bedroom allergen exposures, primarily focusing on pet, pest, and fungal exposures. RECENT FINDINGS Large-scale studies and improved exposure assessment technologies, including measurement of airborne allergens and of multiple allergens simultaneously, have extended our understanding of indoor allergen exposures and their impact on allergic disease. Practical, streamlined methods for exposure reduction have shown promise in some settings, and potential protective effects of early-life exposures have been further elucidated through the investigation of specific bacterial taxa. Advances in molecular allergology have yielded novel data on sensitization profiles and cross-reactivity. The role of indoor allergen exposures in allergic disease is complex and remains incompletely understood. Advancing our knowledge of various co-exposures, including the environmental and host microbiome, that interact with allergens in early life will be crucial for the development of efficacious interventions to reduce the substantial economic and social burden of allergic diseases including asthma.
Collapse
|
21
|
Belugina IN, Yagovdik NZ, Belugina OS, Belugin SN. Outdoor environment, ozone, radionuclide-associated aerosols and incidences of infantile eczema in Minsk, Belarus. J Eur Acad Dermatol Venereol 2018; 32:1977-1985. [PMID: 29730889 DOI: 10.1111/jdv.15063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 04/27/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The early occurrence of atopic dermatitis in infants may be influenced by urban air pollution. OBJECTIVE The aim of this study was to determine the relationship between incidences of infantile eczema in children under 2 years of age and urban outdoor environmental factors. METHODS A 11-year population-based study was conducted in retrospective design. The age/gender-adjusted incidence rates of infantile eczema were determined using the data of outpatient visits. We analysed 1965 cases with atopic dermatitis including infantile eczema in relation to the annual means of outdoor monitoring data from 2005 through 2015 in Minsk. Logistic regression and principal component analysis were performed to determine association between the annual means of air pollutants, meteorological variables and incidences of infantile eczema. RESULTS Higher mean annual carbon monoxide, ammonia, formaldehyde, lead, particulate matter and ground-level ozone were associated with high incidence rates of infantile eczema both in boys and girls. Higher nitrogen dioxide was associated with high incidence rates of infantile eczema in girls 1-2 years of age and boys 0-2 years of age. There were identified by principal component analysis five combinations of pollutants and meteorological factors. High incidence rates of infantile eczema were associated with the combinations contained higher levels of air pollutants and ultraviolet index, or lower β-activity of the radionuclide-associated aerosols. The higher phenol and formaldehyde levels the higher incidence rates of infantile eczema were observed among boys 0-1 years of age and girls 1-2 years of age. The higher total column ozone with lower lead level was associated with low incidence rates of infantile eczema among boys and girls 1-2 years of age. CONCLUSION Urban outdoor air pollutants and their combination with meteorological conditions may impact onset of infantile eczema in both genders.
Collapse
Affiliation(s)
- I N Belugina
- Department of Venereology and Dermatology, Belarusian State Medical University, Minsk, Belarus
| | - N Z Yagovdik
- Department of Venereology and Dermatology, Belarusian State Medical University, Minsk, Belarus
| | - O S Belugina
- Department of Psychiatry, Belarusian State Medical University, Minsk, Belarus
| | - S N Belugin
- Department of Radiation and Environmental Medicine, Belarusian State Medical University, Minsk, Belarus
| |
Collapse
|
22
|
Dharma C, Lefebvre DL, Tran MM, Lou WYW, Subbarao P, Becker AB, Mandhane PJ, Turvey SE, Sears MR. Patterns of allergic sensitization and atopic dermatitis from 1 to 3 years: Effects on allergic diseases. Clin Exp Allergy 2017; 48:48-59. [DOI: 10.1111/cea.13063] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 02/05/2023]
Affiliation(s)
- C. Dharma
- Department of Medicine; McMaster University; Hamilton Canada
| | - D. L. Lefebvre
- Department of Medicine; McMaster University; Hamilton Canada
| | - M. M. Tran
- Department of Medicine; McMaster University; Hamilton Canada
| | - W. Y. W. Lou
- Dalla Lana School of Public Health; University of Toronto; Toronto Canada
| | - P. Subbarao
- Department of Pediatrics; University of Toronto & Hospital for Sick Children; Toronto Canada
| | - A. B. Becker
- Department of Pediatrics & Child Health; University of Manitoba; Winnipeg Canada
| | - P. J. Mandhane
- Department of Pediatrics; University of Alberta; Edmonton Canada
| | - S. E. Turvey
- Department of Pediatrics; University of British Columbia; Vancouver Canada
| | - M. R. Sears
- Department of Medicine; McMaster University; Hamilton Canada
| | | |
Collapse
|
23
|
Westman M, Asarnoj A, Hamsten C, Wickman M, van Hage M. Windows of opportunity for tolerance induction for allergy by studying the evolution of allergic sensitization in birth cohorts. Semin Immunol 2017; 30:61-66. [PMID: 28789818 DOI: 10.1016/j.smim.2017.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 07/18/2017] [Indexed: 12/25/2022]
Abstract
Allergic sensitization is a risk factor for developing IgE-mediated allergic diseases, which are a major cause of chronic illness world-wide. The introduction of allergen molecules to the field of allergy diagnostics has allowed dissecting the IgE response on a molecular level to pinpoint the specific disease-causing allergens. Studying birth cohorts is an essential tool for understanding the development and life course of allergy, enabling the possibility to design preventive strategies. Here we review the evolution of sensitization using data from some of the large European birth cohort studies. Differences and similarities between sensitization to food and various sources of inhalant allergens are discussed and allergen molecules of importance in early childhood predicting disease in adolescence are highlighted. Finally, we discuss windows of opportunity where intervention could be considered and address possible preventive strategies.
Collapse
Affiliation(s)
- Marit Westman
- Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden; Department of Ear, Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden.
| | - Anna Asarnoj
- Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden; Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Carl Hamsten
- Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - Magnus Wickman
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Marianne van Hage
- Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden
| |
Collapse
|