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Rosada T, Lis K, Bartuzi Z, Grześk-Kaczyńska M, Ukleja-Sokołowska N. Diagnostics of Allergy to Furry Animals-Possibilities in 2024. J Clin Med 2024; 13:3239. [PMID: 38892951 PMCID: PMC11172995 DOI: 10.3390/jcm13113239] [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: 04/20/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
Diagnosing allergies is not always easy. Sometimes the symptoms reported by the patient do not match the results of diagnostic tests. Diagnostics of IgE-dependent allergy, including allergy to furry animals, can be based on two basic strategies, "BOTTOM-UP" and "TOP-DOWN", and almost all available allergy tests can be used ranging from skin tests, through specific IgE, to molecular panels and challenge tests. Currently, most information regarding the diagnosis and incidence of allergies to furry animals focuses almost exclusively on the two most common pets-dogs and cats. This is certainly due to the fact that allergy to cats and/or dogs is a common phenomenon, has a huge impact on quality of life, and is a challenge for doctors of many specialties. However, the growing number of owners of other pet species means that diagnostic methods must keep up with the changing needs of patients. Further research in these groups will certainly provide new facts and facilitate clinical decision-making when working with allergic patients.
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Affiliation(s)
- Tomasz Rosada
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland; (K.L.); (Z.B.); (N.U.-S.)
| | - Kinga Lis
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland; (K.L.); (Z.B.); (N.U.-S.)
| | - Zbigniew Bartuzi
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland; (K.L.); (Z.B.); (N.U.-S.)
| | - Magdalena Grześk-Kaczyńska
- Clinic of Allergology, Clinical Immunology and Internal Diseases, Jan Biziel University Hospital No. 2 in Bydgoszcz, 75 Ujejskiego St., 85-168 Bydgoszcz, Poland;
| | - Natalia Ukleja-Sokołowska
- Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 87-100 Toruń, Poland; (K.L.); (Z.B.); (N.U.-S.)
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Neff C, Price M, Cioffi G, Liu Z, Walsh R, Barnholtz-Sloan JS, Walsh KM, Salama AKS, Anders CK, Fecci PE, Ostrom QT. Atopy improves survival and decreases risk of brain metastasis in cutaneous melanoma. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.15.24307061. [PMID: 38798534 PMCID: PMC11118623 DOI: 10.1101/2024.05.15.24307061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Importance Development of new therapies in melanoma has increased survival, and as a result more patients are living to develop brain metastasis (BrM). Identifying patients at increased risk of BrM is therefore of significant public health importance. Objective To determine whether history of atopy is associated with improved survival or reduced incidence of BrM in cutaneous melanoma. Design A retrospective cohort study conducted from June 2022 to March 2024. Setting Population-based in states with Surveillance, Epidemiology and End Results (SEER) supported cancer registries. Participants Individuals (≥65 years) diagnosed with cutaneous melanoma between January 1, 2008 and December 31, 2017 that are participants in traditional Medicare. Exposures Individuals were compared that had history of atopy (allergic rhinitis, atopic dermatitis, asthma, and/or allergic/atopic conjunctivitis) diagnosed prior to melanoma diagnosis, ascertained using ICD-9 or ICD-10 codes in Medicare claims. Main Outcomes and Measures Primary endpoints were diagnosis with a BrM or death during the follow-up period. Associations between atopy and endpoints were assessed using cox proportional hazards models to estimate hazard ratios (HR) and p-values. Results A total of 29,956 cutaneous melanoma cases were identified (median age 76, 60% male and 97% non-Hispanic White). Overall, 7.1% developed BrM during follow up. Among the 35% that had history of atopy, the most common condition was atopic dermatitis (19%). After adjustment for demographic and prognostic factors, atopy was associated with a 16% decrease in death (HR=0.84 [95%CI:0.80-0.87], pFDR<0.001). Among those with non-metastatic disease at time of diagnosis, atopy conferred a 15% decrease in cumulative incidence BrM (HR=0.85 [95%CI: 0.76-0.94], pFDR=0.006), with a 25% decrease associated with atopic dermatitis (HR=0.75 [95%CI:0.65-0.86], pFDR<0.001). Among those with metastatic disease at diagnosis (any metastatic site), only those who received immune checkpoint inhibitors had a survival benefit associated with atopy (HR=0.31, [95%CI:0.15-0.64], p=0.001 vs HR=1.41, [95%CI:0.87-2.27], p=0.165). Conclusions and Relevance Atopy, particularly atopic dermatitis, was significantly associated with improved survival and decreased incidence of BrM. The improved survival associated with these conditions in the context of immunotherapy suggests that these conditions in the elderly may identify those with more robust immune function that may be more responsive to treatment.
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Affiliation(s)
- Corey Neff
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Mackenzie Price
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Gino Cioffi
- Trans Divisional Research Program (TDRP) Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, MD, USA
| | - Zhen Liu
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
| | - Rabina Walsh
- Department of Dermatology, Duke University School of Medicine, Durham, NC, USA
| | - Jill S. Barnholtz-Sloan
- Department of Biostatistics, Duke University School of Medicine, Durham, NC, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, MD, USA
| | - Kyle M. Walsh
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - April K. S. Salama
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Carey K. Anders
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Peter E. Fecci
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Quinn T. Ostrom
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
- The Preston Robert Tisch Brain Tumor Center, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
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Napolitano M, Potestio L, Nocerino M, Patruno C. Considerations for managing elderly patients with atopic dermatitis. Expert Rev Clin Immunol 2024; 20:501-511. [PMID: 38193289 DOI: 10.1080/1744666x.2024.2301967] [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: 10/21/2023] [Accepted: 12/22/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Atopic dermatitis (AD) diagnosis in elderly is challenging, due to its clinical polymorphism and the lack of diagnostic biomarkers. Moreover, the chronicity of the disease and the complex pathogenetic mechanism, make elderly AD management challenging. AREAS COVERED A narrative review of the current literature was performed using the PubMed, Medline, Embase, and Cochrane Skin databases, by researching the following terms: 'atopic dermatitis,' 'clinical phenotypes,' 'eczema,' 'elderly patients,' 'elderly type atopic dermatitis,' 'eczema clinical presentation.' The aim was to report the current knowledge on pathogenesis, clinical presentation, and treatment options of elderly AD. EXPERT OPINION Elderly type AD has recently been identified as a separate entity, with an increasing prevalence. With aging, both immunosenescence and barrier alterations can cause or modify AD presentation. Moreover, a chronic proinflammatory state (so-called 'inflammaging') is often present in elderly subjects. Older patients with AD may present with peculiar immunophenotypic profile, making AD diagnosis challenging. Similarly, the chronicity of the disease and the complex pathogenetic mechanism, make AD management a challenge. Indeed, systemic therapies for AD are often contraindicated or not tolerated and the management of elderly type AD is often burdened with numerous difficulties, leading to undertreated disease. Even if dupilumab and tralokinumab represent a valuable therapeutic weapon, more data on safety of JAK inhibitors are required.
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Affiliation(s)
- Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Mariateresa Nocerino
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Pawłowicz R, Bożek A, Dor-Wojnarowska A, Rosiek-Biegus M, Kopeć A, Gillert-Smutnicka M, Sobieszczańska M, Nittner-Marszalska M. Elderly Patients and Insect Venom Allergy: Are the Clinical Pictures and Immunological Parameters of Venom Allergy Age-Dependent? Vaccines (Basel) 2024; 12:394. [PMID: 38675776 PMCID: PMC11053896 DOI: 10.3390/vaccines12040394] [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: 02/14/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Insect venom is one of the most common triggers of anaphylaxis in the elderly population. Venom immunotherapy (VIT) remains the only treatment for Hymenoptera venom allergy (HVA). However, little is known about the differences in indication for VIT in the group of patients aged 60 years and older. The objective of this study was to assess the clinical and diagnostic differences of HVA in elderly patients. The study compared data from patients aged ≥ 60 (N = 132) to data from patients aged from 11 to 60 years (N = 750) in terms of HVA severity, comorbidities, and immunological parameters, namely, intradermal testing (IDT), specific IgE (sIgE) levels against extracts and major allergenic molecules, and serum tryptase level (sBT). The severity of systemic HVA (I-IV Müller scale) did not differ between adults and seniors. However, the severity of cardiovascular reactions (IV) increased with age, while the frequency of respiratory reactions (III) decreased. No differences were found in the immunological parameters of sensitization IDT, venom-specific IgE concentrations, or sIgE against Api m 1, 2, 4, 5, and 10 between patients below and above 60 or 65 years of age. Differences were noted for sIgE against Ves v1 and Ves v5; they were higher and lower, respectively, in seniors. In the seniors group, sBT levels were higher. Elevated tryptase levels, along with the aging process, can represent a risk factor within this age category. Nevertheless, advanced age does not influence the immunological parameters of immediate HVA reactions, nor does it impact the diagnosis of HVA.
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Affiliation(s)
- Robert Pawłowicz
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Chałbińskiego 1a, 50-368 Wrocław, Poland; (A.D.-W.); (M.R.-B.); (A.K.); (M.N.-M.)
| | - Andrzej Bożek
- Clinical Department of Internal Diseases, Dermatology and Allergology, Medical University of Silesia, Sklodowskiej 10, 41-800 Zabrze, Poland;
| | - Anna Dor-Wojnarowska
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Chałbińskiego 1a, 50-368 Wrocław, Poland; (A.D.-W.); (M.R.-B.); (A.K.); (M.N.-M.)
| | - Marta Rosiek-Biegus
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Chałbińskiego 1a, 50-368 Wrocław, Poland; (A.D.-W.); (M.R.-B.); (A.K.); (M.N.-M.)
| | - Agnieszka Kopeć
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Chałbińskiego 1a, 50-368 Wrocław, Poland; (A.D.-W.); (M.R.-B.); (A.K.); (M.N.-M.)
| | | | - Małgorzata Sobieszczańska
- Clinical Department of Geriatrics, Wroclaw Medical University, Chałbińskiego 1a, 50-368 Wrocław, Poland;
| | - Marita Nittner-Marszalska
- Clinical Department of Internal Medicine, Pneumology and Allergology, Wroclaw Medical University, Chałbińskiego 1a, 50-368 Wrocław, Poland; (A.D.-W.); (M.R.-B.); (A.K.); (M.N.-M.)
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Grammatikos A, Moghaddas F, White P, Fox C, Johnston S, Tsiougkos N, Gompels M. The incidence of physician-diagnosed food allergy declines with age: A specialist UK centre experience. Clin Exp Allergy 2024; 54:143-144. [PMID: 37771188 DOI: 10.1111/cea.14405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/05/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023]
Affiliation(s)
- Alexandros Grammatikos
- Bristol Immunology and Allergy Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Fiona Moghaddas
- Bristol Immunology and Allergy Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Paul White
- Department of Mathematics and Statistics, University of the West of England Bristol, Bristol, UK
| | - Catherine Fox
- Bristol Immunology and Allergy Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Sarah Johnston
- Bristol Immunology and Allergy Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Nikolaos Tsiougkos
- Bristol Immunology and Allergy Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Mark Gompels
- Bristol Immunology and Allergy Centre, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Papa V, Li Pomi F, Borgia F, Vaccaro M, Pioggia G, Gangemi S. Immunosenescence and Skin: A State of Art of Its Etiopathogenetic Role and Crucial Watershed for Systemic Implications. Int J Mol Sci 2023; 24:ijms24097956. [PMID: 37175661 PMCID: PMC10178319 DOI: 10.3390/ijms24097956] [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: 03/30/2023] [Revised: 04/23/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Immunosenescence is a complex multifactorial phenomenon consisting of wide-ranging remodeling of the immune system during the life span, resulting in an age-related qualitative-quantitative decline of immune cells and cytokines. A growing body of evidence in the international literature is highlighting the etiopathogenetic role of skin immunosenescence in the onset of various dermatologic conditions. Skin immunosenescence also serves as an interesting watershed for the onset of system-wide conditions in the context of allergic inflammation. Moreover, in recent years, an increasingly emerging and fascinating etiopathogenetic parallelism has been observed between some mechanisms of immunosenescence, both at cutaneous and systemic sites. This would help to explain the occurrence of apparently unconnected comorbidities. Throughout our review, we aim to shed light on emerging immunosenescent mechanisms shared between dermatologic disorders and other organ-specific diseases in the context of a more extensive discussion on the etiopathogenetic role of skin immunosenescence. A promising future perspective would be to focus on better understanding the mutual influence between skin and host immunity, as well as the influence of high inter-individual variability on immunosenescence/inflammaging. This can lead to a more comprehensive "immunobiographic" definition of each individual.
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Affiliation(s)
- Vincenzo Papa
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
| | - Federica Li Pomi
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Francesco Borgia
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Mario Vaccaro
- Section of Dermatology, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy
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Role of cellular senescence in inflammatory lung diseases. Cytokine Growth Factor Rev 2023; 70:26-40. [PMID: 36797117 DOI: 10.1016/j.cytogfr.2023.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
Cellular senescence, a characteristic sign of aging, classically refers to permanent cell proliferation arrest and is a vital contributor to the pathogenesis of cancer and age-related illnesses. A lot of imperative scientific research has shown that senescent cell aggregation and the release of senescence-associated secretory phenotype (SASP) components can cause lung inflammatory diseases as well. In this study, the most recent scientific progress on cellular senescence and phenotypes was reviewed, including their impact on lung inflammation and the contributions of these findings to understanding the underlying mechanisms and clinical relevance of cell and developmental biology. Within a dozen pro-senescent stimuli, the irreparable DNA damage, oxidative stress, and telomere erosion are all crucial in the long-term accumulation of senescent cells, resulting in sustained inflammatory stress activation in the respiratory system. An emerging role for cellular senescence in inflammatory lung diseases was proposed in this review, followed by the identification of the main ambiguities, thus further understanding this event and the potential to control cellular senescence and pro-inflammatory response activation. In addition, novel therapeutic strategies for the modulation of cellular senescence that might help to attenuate inflammatory lung conditions and improve disease outcomes were also presented in this research.
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Benfante A, Tomasello A, Gianquinto E, Cicero MN, Scichilone N. Diagnostic and therapeutic approaches for elderly asthma patients: the importance of multidisciplinary and multidimensional management. Expert Rev Respir Med 2023; 17:459-468. [PMID: 37194689 DOI: 10.1080/17476348.2023.2215432] [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: 11/19/2022] [Accepted: 05/15/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Asthma is commonly considered a disease of younger ages; however, it is not infrequent to pose a diagnosis of the disease in older individuals. Although current recommendations do not distinguish between young and old asthmatics in terms of diagnostic and therapeutic approaches, asthma in the elderly may present with peculiar features that contribute to complicate its management. AREAS COVERED The current review focuses on the challenges that arise when approaching an older individual with suspected asthma. Age-associated changes of the lung may complicate the diagnostic approach. Measurement of the forced expiratory volume in the first 6 s (FEV6) in an easier and faster alternative to FVC estimation, and residual volume should always be assessed. Older individuals are often affected by concomitant diseases, both age- and drug-related, that need to be considered when approaching elderly asthmatics, since they can affect the efficacy of the treatment as well as the control of the disease. EXPERT OPINION The potential drug to drug interaction should be routinely investigated, and documented in medical records. The effect of aging on the response to pharmacological therapy in older asthmatics should be explored. Therefore, the need of a multidisciplinary and multidimensional approach to the elderly asthmatics is strongly encouraged.
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Affiliation(s)
- Alida Benfante
- PROMISE Department, University of Palermo, Palermo, Italy
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Kumar R, Gaur S, Agarwal M, Menon B, Goel N, Mrigpuri P, Spalgais S, Priya A, Kumar K, Meena R, Sankararaman N, Verma A, Gupta V, Sonal, Prakash A, Safwan MA, Behera D, Singh A, Arora N, Prasad R, Padukudru M, Kant S, Janmeja A, Mohan A, Jain V, Nagendra Prasad K, Nagaraju K, Goyal M. Indian Guidelines for diagnosis of respiratory allergy. INDIAN JOURNAL OF ALLERGY, ASTHMA AND IMMUNOLOGY 2023. [DOI: 10.4103/0972-6691.367373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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A Proposal to Differentiate ACO, Asthma and COPD in Vietnam. J Pers Med 2022; 13:jpm13010078. [PMID: 36675738 PMCID: PMC9863084 DOI: 10.3390/jpm13010078] [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: 11/15/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In low- and middle-income countries, such as Vietnam, the population is exposed to multiple risks, leading to frequent allergic asthma, COPD and their overlap (ACO). We aimed to differentiate asthma and COPD, so that recommended treatments can be applied. METHODS We hypothesized that during life, the cumulative exposure to noxious particles increases the relative prevalence of COPD, while due to immuno-senescence, the prevalence of allergic asthma decreases with age. Among 568 patients with chronic respiratory symptoms, five phenotypes were defined, based on responsiveness to a bronchodilator (BD), diffusion capacity and cumulative smoking. Then the relative prevalence of each phenotype was related with age. RESULTS the smoker BD irreversible patients were considered "COPD", while the full BD responders and non-smoking BD incomplete responders were "asthmatics". The other patients were ACO, distributed as "like-COPD" or "like-asthma", based on decreased or normal diffusion capacity. The relative prevalence of asthma, COPD and ACO were 26, 42 and 32% (18% "like-asthma", 14% "like-COPD"). CONCLUSION Vietnamese patients with chronic respiratory symptoms were considered as falling into asthma or COPD groups, based on cumulative smoking, spirometry with reversibility and diffusion capacity. The relative prevalence of asthma and COPD were 44 and 56%, respectively, most of which did not require corticosteroids.
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Tsolakis N, Jacinto T, Janson C, Borres M, Malinovschi A, Alving K. Relationship between longitudinal changes in type-2 inflammation, immunoglobulin E sensitization, and clinical outcomes in young asthmatics. Clin Transl Allergy 2021; 11:e12066. [PMID: 34582101 PMCID: PMC9083004 DOI: 10.1002/clt2.12066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 09/16/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Asthma is a heterogeneous condition where biomarkers may be of considerable advantage in diagnosis and therapy monitoring. However, the changes in asthma biomarkers and immunoglobulin E (IgE) over the course of life has not been extensively investigated. OBJECTIVE To study longitudinal changes in type-2 inflammatory biomarkers, IgE, and clinical outcomes, and the association between these changes, in young asthmatics. METHODS Asthmatics (age 10-35 years, n = 253) were examined at baseline and at a follow-up visit, 43 [23-65] (median [range]) months later. Subjects were analyzed using the multi-allergen tests Phadiatop and fx5 (ImmunoCAP) and grouped based on the baseline allergen-specific IgE antibody (sIgE) concentration: <0.10, 0.10-0.34, and ≥0.35 kUA /L. The relationship between changes (Δ values) in type-2 biomarkers (individualized fraction of exhaled nitric oxide [FeNO%], blood eosinophil [B-Eos] count, total IgE [tIgE] and sIgE, lung function [% predicted forced expiratory volume in 1 second (FEV1 ) and FEV1 /forced vital capacity (FVC)], and Asthma Control Test [ACT]) score were determined. RESULTS At follow up, FEV1 and FEV1 /FVC had decreased (93.6% vs. 95.8%, and 93.4% vs. 94.7% of predicted, respectively [p < 0.001 both]), whereas ACT score had increased (21.6 vs. 20.6, p = 0.001). A significant decline in lung function was seen in subjects with sIgE ≥ 0.10 kUA/L, but not in those with undetectable sIgE (<0.10 kUA /L). Furthermore, tIgE and sIgE declined over time (p < 0.001 all) whereas FeNO% and B-Eos count were not significantly changed. In univariate analysis, significant negative correlations between ∆B-Eos count and ∆FeNO%, on one hand, and changes in lung function, on the other hand, were seen, and multivariate analysis showed an independent relationship between ΔFeNO%, and ΔFEV1 (p < 0.05) and ΔFEV1 /FVC% (p < 0.01). Sex-specific analysis showed that the independent association between ΔFeNO%, and ΔFEV1 remained only in females (p = 0.005), and there was a significant interaction with sex (p = 0.02). CONCLUSION In young asthmatics, IgE levels declined over 43 months, whereas FeNO and B-Eos remained unchanged. In spite of improved asthma control, an accelerated lung function decline was seen in patients with detectable sIgE at baseline, and the decline correlated with changes in type-2 biomarkers. Particularly, the increase in individualized FeNO associated independently with decline in FEV1 in females.
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Affiliation(s)
- Nikolaos Tsolakis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | | | - Magnus Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,ImmunoDiagnostics, Thermo Fisher Scientific, Uppsala, Sweden
| | | | - Kjell Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Kjaer HF, Mortz CG, Bindslev‐Jensen C. Does treatment with antidepressants, antipsychotics, or benzodiazepines hamper allergy skin testing? Clin Transl Allergy 2021; 11:e12060. [PMID: 34504681 PMCID: PMC8420966 DOI: 10.1002/clt2.12060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/18/2021] [Accepted: 08/24/2021] [Indexed: 11/15/2022] Open
Abstract
Background Treatment with commonly used drugs such as antidepressants (ADs), antipsychotics (APs), and benzodiazepines (BDs) may hamper the use of allergy skin testing due to possible antihistaminic effects. Objective To examine the antihistaminic effect of AD, AP, and BD as measured by the ability of these drugs to suppress the normal wheal reaction caused by skin prick test (SPT). Methods Skin prick test was performed in patients receiving treatment with AD, AP, and/or BD. Double SPT was performed with histamine solutions of 10, 30, and 100 mg/ml and mean wheal diameter calculated. Results A total of 313 patients were included. 236 (75%) patients were treated with one of the examined drugs and 77 (25%) patients with more than one of these drugs. Drugs most frequently used was sertraline (n = 65), citalopram (n = 63), mirtazapine (n = 36), venlafaxine (n = 33), and quetiapine (n = 32). Treatment with mirtazapine and/or quetiapine was associated with negative SPTs in 30/36 (83%) and 22/32 (69%), and the antihistaminic effect of these drugs was dose‐dependent. For patients treated with selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), serotonin norepinephrine reuptake inhibitors (SNRIs), or BD alone, almost all SPTs were positive (94%, 95%, 100%, and 100%, respectively). Negative SPTs in patients treated with SSRI, TCA, SNRI, or BD and ≥1 other of the examined drugs were associated with simultaneous treatment with mirtazapine or quetiapine in 39/44 (89%) patients. Conclusion Skin testing has little meaning in patients treated with mirtazapine or quetiapine. Treatment with SSRI, SNRI, and BD does not seem to affect the results of SPTs, whereas skin tests in patients treated with TCA should be interpreted with caution.
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Affiliation(s)
- Henrik Fomsgaard Kjaer
- Department of Dermatology and Allergy CentreOdense Research Center for Anaphylaxis (ORCA)Odense University HospitalOdenseDenmark
| | - Charlotte Gotthard Mortz
- Department of Dermatology and Allergy CentreOdense Research Center for Anaphylaxis (ORCA)Odense University HospitalOdenseDenmark
| | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy CentreOdense Research Center for Anaphylaxis (ORCA)Odense University HospitalOdenseDenmark
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13
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Janson C, Lisspers K, Ställberg B, Johansson G, Gutzwiller FS, Mezzi K, Mindeholm L, Bjerregaard BK, Jorgensen L, Larsson K. Osteoporosis and fracture risk associated with inhaled corticosteroid use among Swedish COPD patients: the ARCTIC study. Eur Respir J 2021; 57:13993003.00515-2020. [PMID: 32972982 DOI: 10.1183/13993003.00515-2020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023]
Abstract
The effect of inhaled corticosteroids (ICS) on the risk of osteoporosis and fracture in patients with chronic obstructive pulmonary disease (COPD) remains uncertain. The aim of this study was to assess this risk in patients with COPD.Electronic medical record data linked to National Health Registries were collected from COPD patients and matched reference controls at 52 Swedish primary care centres from 2000 to 2014. The outcomes analysed were the effect of ICS on all fractures, fractures typically related to osteoporosis, recorded osteoporosis diagnosis, prescriptions of drugs for osteoporosis and a combined measure of any osteoporosis-related event. The COPD patients were stratified by the level of ICS exposure.A total of 9651 patients with COPD and 59 454 matched reference controls were analysed. During the follow-up, 19.9% of COPD patients had at least one osteoporosis-related event compared with 12.9% of reference controls (p<0.0001). Multivariate analysis in the COPD population demonstrated a dose-effect relationship, with high-dose ICS being significantly associated with any osteoporosis-related event (risk ratio 1.52 (95% CI 1.24-1.62)), while the corresponding estimate for low-dose ICS was 1.27 (95% CI 1.13-1.56) compared with COPD patients not using ICS. A similar dose-related adverse effect was found for all four of the specific osteoporosis-related events: all fractures, fractures typically related to osteoporosis, prescriptions of drugs for osteoporosis and diagnosis of osteoporosis.We conclude that patients with COPD have a greater risk of bone fractures and osteoporosis, and high-dose ICS use increased this risk further.
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Affiliation(s)
- Christer Janson
- Respiratory, Allergy and Sleep Research, Dept of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Karin Lisspers
- Family Medicine and Preventive Medicine, Dept of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Björn Ställberg
- Family Medicine and Preventive Medicine, Dept of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Johansson
- Family Medicine and Preventive Medicine, Dept of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | | | - Linda Mindeholm
- Novartis Institutes for Biomedical Research (NIBR), Cambridge, MA, USA.,Novartis Institutes for Biomedical Research (NIBR), Basel, Switzerland
| | | | | | - Kjell Larsson
- Intergrative Toxicology, National Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
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14
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Sabit M, Wong C, Andaya A, Ramos JD. Pollen allergen skin test and specific IgE reactivity among Filipinos: a community-based study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2020; 16:74. [PMID: 32922458 PMCID: PMC7477877 DOI: 10.1186/s13223-020-00471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/05/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Despite the clinical importance of pollen allergens among Filipinos, few studies delve into the sensitization profiles of Filipinos against pollen allergens. This study determined the sensitization profile of Filipinos to pollen using skin prick test (SPT) and pollen-specific ELISA. METHODS Pollen from fifteen selected plant sources was collected and extracted for use in sensitization tests. Volunteers were interviewed for their clinical history prior to blood sampling and SPT. The blood samples collected were assessed using Enzyme-Linked Immunosorbent Assay (ELISA). RESULTS The best panel of pollen allergens for the skin prick test was Mangifera indica (64%), Acacia auriculiformis (28%), Mimosa spp. (25%) Amaranthus spinosus (22%), Lantana camara (20%), Pilea microphylla (16%) and Dichanthium aristatum (15%). Young adults had more sensitizations to pollen than among early childhood and elderly. There were more allergic subjects that have rhinitis (61%) than asthma (42%) and atopic dermatitis (35%). Pollen-specific IgE levels show low percent reactivity as compared to the skin test with Cocos nucifera obtaining the highest IgE reactivity (21%). CONCLUSIONS Pollen allergens from both arboreal and herbaceous plants used in this study yielded positive reactivities for both skin tests and specific IgE tests.
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Affiliation(s)
- Maureen Sabit
- The Graduate School, University of Santo Tomas, 1008 Manila, Philippines
- Research Center for the Natural and Applied Sciences, Thomas Aquinas Research Complex, University of Santo Tomas, 1008 Manila, Philippines
- Department of Biological Sciences, College of Science, University of Santo Tomas, 1008 Manila, Philippines
| | - Cecil Wong
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Santo Tomas Hospital, 1008 Manila, Philippines
| | - Agnes Andaya
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Santo Tomas Hospital, 1008 Manila, Philippines
| | - John Donnie Ramos
- The Graduate School, University of Santo Tomas, 1008 Manila, Philippines
- Research Center for the Natural and Applied Sciences, Thomas Aquinas Research Complex, University of Santo Tomas, 1008 Manila, Philippines
- Department of Biological Sciences, College of Science, University of Santo Tomas, 1008 Manila, Philippines
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15
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Tommola M, Won HK, Ilmarinen P, Jung H, Tuomisto LE, Lehtimäki L, Niemelä O, Kim TB, Kankaanranta H. Relationship between age and bronchodilator response at diagnosis in adult-onset asthma. Respir Res 2020; 21:179. [PMID: 32660470 PMCID: PMC7359254 DOI: 10.1186/s12931-020-01441-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 07/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Possible variation in bronchodilator response (BDR) according to age at the diagnosis of adult-onset asthma is unknown. Our aim was to assess if BDR in FEV1 is related to age at diagnosis of adult-onset asthma and how many subjects fulfill the 400 mL criterion of BDR, the suggested cut-off for asthma-like reversibility in asthma-COPD overlap (ACO). METHODS A total of 1030 patients with adult-onset asthma were included; 245 from SAAS (Seinäjoki Adult Asthma Study, Finland) and 785 from COREA (Cohort for Reality and Evolution of Adult Asthma in Korea) cohorts. BDR in FEV1 at the diagnosis of asthma was assessed. Patients were divided into groups based on age at asthma diagnosis: < 40, 40-59.9, and ≥ 60 years. The cohorts were analyzed separately. RESULTS BDR % in FEV1 did not differ between the groups of different age at asthma diagnosis and no correlation between BDR and age was found. Of patients aged ≥40 years, only 18% (SAAS-cohort) and 5% (COREA-cohort) reached the 400 mL BDR in FEV1. After exclusion of possible ACO patients, the results remained similar. CONCLUSION By using two large cohorts of steroid-naive patients with asthma, we have shown that BDR at diagnosis of asthma is constant over large age span range, and the limit of 400 mL in BDR in FEV1 is rarely reached. TRIAL REGISTRATION Seinäjoki Adult Asthma Study is registered at ClinicalTrials.gov with identifier number NCT02733016 .
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Affiliation(s)
- Minna Tommola
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Ha-Kyeong Won
- Department of Internal Medicine, VHS Medical Center, Seoul, South Korea
| | - Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Heewon Jung
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Onni Niemelä
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Laboratory Medicine and Medical Research Unit, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, FIN-60220, Seinäjoki, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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16
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Napolitano M, Fabbrocini G, Scalvenzi M, Blasio C, Stingeni L, Patruno C. Efficacy and safety of dupilumab in atopic dermatitis in elderly patients: a retrospective study. Clin Exp Dermatol 2020; 45:888-890. [DOI: 10.1111/ced.14260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 12/22/2022]
Affiliation(s)
- M. Napolitano
- Department of Health Sciences Vincenzo Tiberio University of Molise Campobasso Italy
| | - G. Fabbrocini
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - M. Scalvenzi
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - C. Blasio
- Section of Dermatology Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - L. Stingeni
- Dermatology Section Department of Medicine University of Perugia Perugia Italy
| | - C. Patruno
- Department of Health Sciences University Magna Graecia of Catanzaro Catanzaro Italy
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17
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Differences in the Clinical Characteristics of Early- and Late-Onset Asthma in Elderly Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2940296. [PMID: 32090072 PMCID: PMC7014554 DOI: 10.1155/2020/2940296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/17/2019] [Accepted: 06/24/2019] [Indexed: 11/24/2022]
Abstract
Differences between early-onset and late-onset asthma in elderly subjects have not been comprehensively described in China. We conducted a cross-sectional study to determine the phenotypic differences between early-onset asthma (EOA) and late-onset asthma (LOA) in elderly patients. We collected clinical and physiological data from 176 elderly patients with asthma. Participants were divided into two groups: EOA group and LOA group. Demographics, comorbidities, inflammatory parameters, lung function, severity, asthma control, and medication use among EOA and LOA elderly patients were compared. Elderly subjects with EOA had more atopic disease, a stronger positive family history of asthma, higher IgE, and exhaled nitric oxide levels as compared to those with LOA. In contrast, elderly subjects with LOA had lower lung function and more marked fixed airflow obstruction (FAO). Elderly subjects with LOA had a higher incidence of chronic obstructive pulmonary disease (COPD). No differences were observed in age, gender, BMI, history of smoking, severity, and asthma control between the two groups. Both similarities and differences exist between elderly subjects with EOA and those with LOA in China. Further work is required to determine the pathophysiological, clinical, and therapeutic implications for different asthma phenotypes in elderly subjects.
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18
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Jimenez-Rodriguez TW, Blanca-Lopez N, Ruano-Zaragoza M, Soriano-Gomis V, Esteban-Rodriguez A, Riera-Sendra G, Palazon-Bru A, Blanca M, Ramos-Rincon JM, Fernandez-Sanchez J. Allergological Study of 565 Elderly Patients Previously Labeled as Allergic to Penicillins. J Asthma Allergy 2019; 12:421-435. [PMID: 31853189 PMCID: PMC6916685 DOI: 10.2147/jaa.s232787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 11/21/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose Elderly people thought to have an allergy to beta-lactams (BLs) may tolerate the drugs in subsequent exposures due to initial false labeling of allergies, the spontaneous loss of sensitivity to BLs over time or age-related decline in sensitization. As a result, they may be treated with less appropriate antibiotics, causing more side effects and entailing increased costs for health systems. The aim of this investigation was to assess whether patients in the third and fourth age with previously confirmed allergies to BLs had lost sensitization and could tolerate these antibiotics. Patients and methods Patients allergic to BLs were divided into group A (aged 60-79 years) and B (aged ≥80 years). Clinical history, skin testing, drug challenge tests (DCT) and evaluation of resensitization were used to classify participants as showing immediate reactions, non-immediate reactions, or tolerance. We compared clinical entities, drugs involved, and final outcome by age group. Results Of 1362 cases evaluated, 565 underwent an allergological study. The skin was the most common organ involved. Anaphylaxis and side chain reactions were more frequent in group A (p<0.01), as were positive DCT. Classical benzylpenicillin determinants (benzylpenicilloyl and/or minor determinant mixture) were more frequent triggers in group B (p< 0.01). Resensitization after challenge occurred in very few participants. Conclusion The risk for allergy to BLs decreases with age and a history of anaphylaxis by BLs is a predictor of positive results in skin tests (ST). Both immunoglobin E (IgE) and T-cell-mediated responses can disappear in elderly people, who can develop tolerance to these antibiotics. These results are of clinical relevance to patients who need to be treated with antibiotics from this family.
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Affiliation(s)
- Teodorikez Wilfox Jimenez-Rodriguez
- Allergy Section, Alicante General University Hospital-ISABIAL, Alicante, Spain.,ARADyAL Spanish Network, Madrid, Spain.,PhD Program in Public Health, Medical and Surgical Sciences, Miguel Hernandez University, Alicante, Spain
| | - Natalia Blanca-Lopez
- ARADyAL Spanish Network, Madrid, Spain.,Allergy Section, Infanta Leonor University Hospital, Madrid, Spain
| | - Maria Ruano-Zaragoza
- Allergy Section, Alicante General University Hospital-ISABIAL, Alicante, Spain.,ARADyAL Spanish Network, Madrid, Spain.,PhD Program in Public Health, Medical and Surgical Sciences, Miguel Hernandez University, Alicante, Spain
| | - Victor Soriano-Gomis
- Allergy Section, Alicante General University Hospital-ISABIAL, Alicante, Spain.,ARADyAL Spanish Network, Madrid, Spain.,Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain
| | | | | | | | - Miguel Blanca
- ARADyAL Spanish Network, Madrid, Spain.,Allergy Section, Infanta Leonor University Hospital, Madrid, Spain
| | - Jose Manuel Ramos-Rincon
- Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain.,Internal Medicine Department, Alicante General University Hospital, Alicante, Spain
| | - Javier Fernandez-Sanchez
- Allergy Section, Alicante General University Hospital-ISABIAL, Alicante, Spain.,ARADyAL Spanish Network, Madrid, Spain.,Clinical Medicine Department, Miguel Hernandez University, Alicante, Spain
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19
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De Martinis M, Sirufo MM, Viscido A, Ginaldi L. Food Allergies and Ageing. Int J Mol Sci 2019; 20:E5580. [PMID: 31717303 PMCID: PMC6888073 DOI: 10.3390/ijms20225580] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023] Open
Abstract
All over the world, there is an increase in the overall survival of the population and the number of elderly people. The incidence of allergic reactions is also rising worldwide. Until recently, allergies, and in particular food allergies (FAs), was regarded as a pediatric problem, since some of them start in early childhood and may spontaneously disappear in adulthood. It is being discovered that, on the contrary, these problems are increasingly affecting even the elderly. Along with other diseases that are considered characteristics of advanced age, such as cardiovascular, dysmetabolic, autoimmune, neurodegenerative, and oncological diseases, even FAs are increasingly frequent in the elderly. An FA is a pleiomorphic and multifactorial disease, characterized by an abnormal immune response and an impaired gut barrier function. The elderly exhibit distinct FA phenotypes, and diagnosis is difficult due to frequent co-morbidities and uncertainty in the interpretation of in vitro and in vivo tests. Several factors render the elderly susceptible to FAs, including the physiological changes of aging, a decline in gut barrier function, the skewing of adaptive immunity to a Th2 response, dysregulation of innate immune cells, and age-related changes of gut microbiota. Aging is accompanied by a progressive remodeling of immune system functions, leading to an increased pro-inflammatory status where type 1 cytokines are quantitatively dominant. However, serum Immunoglobulin E (IgE) levels and T helper type 2 (Th2 cytokine production have also been found to be increased in the elderly, suggesting that the type 2 cytokine pattern is not necessarily defective in older age. Dysfunctional dendritic cells in the gut, defects in secretory IgA, and decreased T regulatory function in the elderly also play important roles in FA development. We address herein the main immunologic aspects of aging according to the presence of FAs.
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Affiliation(s)
- Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.M.S.); (L.G.)
- Allergy and Clinical Immunology Unit, AUSL 04 Teramo, Italy
| | - Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.M.S.); (L.G.)
- Allergy and Clinical Immunology Unit, AUSL 04 Teramo, Italy
| | - Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.M.S.); (L.G.)
- Allergy and Clinical Immunology Unit, AUSL 04 Teramo, Italy
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20
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Asthma and Chronic Obstructive Pulmonary Disease in the Elderly: What is New Under the Sun? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:872-873. [PMID: 29747990 DOI: 10.1016/j.jaip.2017.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/20/2022]
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21
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Benfante A, Principe S, Battaglia S, Scichilone N. Are biological drugs effective and safe in older severe asthmatics? Expert Opin Drug Saf 2019; 18:369-380. [PMID: 30983432 DOI: 10.1080/14740338.2019.1607838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The treatment of asthma in older ages follows the recommendations of international guidelines for the management of asthma in younger ages, although older age has always represented an exclusion criterion for eligibility to pharmacological trials. This poses a clinical challenge when deciding whether elderly severe asthmatics are candidates for biological drugs. AREAS COVERED The current article has a narrative structure to review the current literature on efficacy and safety of novel pharmacological drugs against immunoglobulins and interleukins that mediate and orchestrate the main inflammatory pathways in severe asthma, in order to explore whether older subjects (i.e. > 65 years of age) are included. EXPERT OPINION Asthma in older ages is not a rare entity, and loss of symptom control is common in most advanced ages. Current evidence from randomized clinical trials (RCTs) on the safety of biological drugs in elderly asthmatics is scarce and does not allow drawing definitive conclusions. An urgent call for studies specifically designed for elderly populations is needed, with the purpose to assess the efficacy and safety of target biological therapies in advanced ages. We envision the design of large multi-center clinical trials to decide whether and when geriatric population could benefit from biological therapies.
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Affiliation(s)
- Alida Benfante
- a Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS) , University of Palermo , Palermo , Italy
| | - Stefania Principe
- a Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS) , University of Palermo , Palermo , Italy
| | - Salvatore Battaglia
- a Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS) , University of Palermo , Palermo , Italy
| | - Nicola Scichilone
- a Biomedical Department of Internal Medicine and Medical Specialties (DIBIMIS) , University of Palermo , Palermo , Italy
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22
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Mothes-Luksch N, Jordakieva G, Hinterhölzl L, Jensen AN, Hallmann PK, Kundi M, Jensen-Jarolim E. Allergy diagnosis from symptoms to molecules, or from molecules to symptoms: a comparative clinical study. World Allergy Organ J 2018; 11:22. [PMID: 30214659 PMCID: PMC6131881 DOI: 10.1186/s40413-018-0199-y] [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: 03/06/2018] [Accepted: 07/24/2018] [Indexed: 01/04/2023] Open
Abstract
Background Classical allergy diagnostic workup “from symptoms to molecules” comprises 1) clinical investigation, 2) skin prick- and IgE- testing, and recently, 3) molecular allergy testing. We aimed to examine the diagnostic fidelity of the alternative approach “from molecules to symptoms”, which was recently suggested in the EAACI Molecular Allergology User’s Guide, in a retrospective clinical study. Methods Records from 202 patients with clinically suspected allergic sensitizations were extracted from files at two sites applying either the “ISAC-first” workup with IgE-testing by immuno-solid phase allergen chip ISAC112 followed by selected skin prick tests (SPT) or the “SPT-first” starting with SPT followed by the microarray test. Results In the ISAC-first procedure significantly less SPTs were performed during allergy diagnosis (median 4 vs. 14). By SPT in 19% of patients in the ISAC-first group and in 34% in the SPT-first group additional respiratory allergens (p = 0.014) were detected not positive in ISAC microarray. By ISAC microarray test 18% additional sensitizations were found in the ISAC-first, and 32% in SPT-first cohort (p = 0.016). For food allergens 13 and 12% additional sensitizations were detected by the microarray not detected by SPT in the two groups (p = 0.800). No additional food allergen was found by SPT in the ISAC-first group, while in 6% of the cases in the SPT-first group detected sensitizations were negative in the microarray. Discussion The ISAC-first approach followed by (fewer) SPTs meets the demands for a patient’s tailored diagnostic work-up and therefore can be considered equivalent to the conventional way using the skin prick test as first screening tool, followed by IgE diagnosis. Conclusions For the diagnostic verification of clinically suspected allergy, the novel concept “from molecules to clinic” offers a reliable diagnostic workup in shorter time. Due to lower skin test numbers it is especially applicable for young children and seniors, in atopic patients, and whenever skin tests get difficult or unreliable. Electronic supplementary material The online version of this article (10.1186/s40413-018-0199-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Mothes-Luksch
- 1Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Währinger G. 18-20, 1090 Vienna, Austria.,AllergyCare, Allergy Diagnosis and Study Center, Vienna, Austria.,3Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University Vienna, Vienna, Austria
| | - G Jordakieva
- 4Institute of Occupational Medicine, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - L Hinterhölzl
- 1Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Währinger G. 18-20, 1090 Vienna, Austria
| | - A N Jensen
- AllergyCare, Allergy Diagnosis and Study Center, Vienna, Austria
| | - P K Hallmann
- AllergyCare, Allergy Diagnosis and Study Center, Vienna, Austria
| | - M Kundi
- 5Center for Public Health, Medical University Vienna, Vienna, Austria
| | - E Jensen-Jarolim
- 1Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Währinger G. 18-20, 1090 Vienna, Austria.,AllergyCare, Allergy Diagnosis and Study Center, Vienna, Austria.,The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, Vienna, Austria
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23
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Yáñez A, Soria M, De Barayazarra S, Recuero N, Rovira F, Jares E, Stok AM, Nemirovsky S, Bueno C. Clinical characteristics and comorbidities of elderly asthmatics who attend allergy clinics. Asthma Res Pract 2018; 4:5. [PMID: 29713490 PMCID: PMC5911961 DOI: 10.1186/s40733-018-0041-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background To date, few studies have focused on the clinical and allergic characteristics of asthma in the elderly, defined as asthma in people aged 60 or over. Thus, we propose to identify and study the clinical and allergic characteristics and comorbidities of patients with asthma among the elderly. Methods A retrospective, observational, descriptive study was developed in five clinics and hospitals in Argentina. Allergy Physicians analyzed their patients' medical records in 2014 and included those adults over the age of 60, who had been diagnosed with asthma according to the GINA guidelines. Clinical and allergic characteristics were analyzed. Results A total of 152 patients diagnosed with asthma, of whom 73% were women and 11% ex-smokers, were included in this study, with a mean age of 66 years. Only 10.5% of the participants had onset asthma past the age of 60. Regarding asthma severity, 74.3% were diagnosed with moderate persistent asthma, and 7.2% with severe persistent asthma. Eighty-four percent of the patients were treated with an inhaled corticosteroid (ICS) along with a long-acting β 2-adrenergic agent (LABA). More than half of the patients had two or more comorbidities simultaneously. Allergic comorbidities were the most frequent comorbidities, followed by arterial hypertension. Among allergic comorbidities, most patients presented allergies at the nasal level. There were no significant differences between the subpopulations of patients with late-onset asthma (LOA) and asthma with onset before the age of 60, i.e. early onset asthma (EOA) in most of their clinical characteristics. However, it was observed that EOA accounted for a higher percentage of patients with nasal allergies as compared to LOA (71% vs 46%, p < 0.05).It is worth mentioning that almost half of the patients with LOA had allergies at the nasal level. Conclusion These results may provide a better understanding of the clinical characteristics of asthma in the elderly in Argentina, thus, enabling the development of future therapeutic strategies and a better quality of life for our elderly asthma patients.
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Affiliation(s)
- Anahí Yáñez
- Investigaciones en Alergia y Enfermedades Respiratorias (INAER), Buenos Aires, Argentina
| | - Marcela Soria
- Hospital Zona General de Agudos Dr. Ricardo Gutiérrez, La Plata, Argentina
| | | | - Nancy Recuero
- Allergy and Immunology Service, Hospital San Roque, Córdoba, Argentina
| | - Francisco Rovira
- Argentine Respiratory Medicine Association, Buenos Aires, Argentina
| | - Edgardo Jares
- Private Medical Centers SA, Ramos Mejía, Buenos Aires Argentina
| | - Ana María Stok
- Instituto de Investigaciones en Patologías Respiratorias, San Miguel de Tucumán, Tucumán Argentina
| | - Sergio Nemirovsky
- 7CONICET - Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina
| | - Carlos Bueno
- 7CONICET - Universidad de Buenos Aires. Instituto de Química Biológica de la Facultad de Ciencias Exactas y Naturales (IQUIBICEN), Buenos Aires, Argentina.,8Facultad de Ciencias Exactas y Naturales, Departamento de Química Biológica, Universidad de Buenos Aires, Laboratorio de Virología, Buenos Aires, Argentina
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Berson SR, Klimczak J, Prezio EA, Hu S, Abraham M. Clinical associations between allergies and rapid eye movement sleep disturbances. Int Forum Allergy Rhinol 2018; 8:817-824. [PMID: 29461689 PMCID: PMC6055599 DOI: 10.1002/alr.22099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/14/2018] [Accepted: 01/18/2018] [Indexed: 12/17/2022]
Abstract
Background Allergic rhinitis, an immunoglobulin E inflammatory condition including nasal congestion, obstruction, sneezing, pruritus, and fatigue symptoms, has significant impact on quality of life and impairs sleep. Sleep‐disordered breathing (SDB) patients often have normal all‐night apnea‐hypopnea (AHI) or respiratory‐disturbance (RDI) indices on polysomnography (PSG). We hypothesized that the rapid eye motion–respiratory disturbance index (REM‐RDI) may be a novel predictor of allergic status. Methods A retrospective analysis of 100 patients compared REM‐RDI results in 67 allergen‐positive patients with 33 nonallergic patients who presented with nasal blockage. Subjects completed STOP‐Bang©, 22‐item Sino‐Nasal Outcome Test (SNOT‐22)©, and Epworth Sleepiness Scale© questionnaires and underwent skin‐prick testing (SPT) and PSGs including REM‐RDI values. Using multivariate logistic regression models, we evaluated relationships between allergic status and sleep parameters while controlling for possible confounders including body mass index (BMI). Results Using REM‐RDI as the outcome of interest, allergen‐positive patients were 3.92 times more likely to have REM‐RDI values in a moderate/severe range (≥15 events/hour); and patients with moderate/severe REM‐RDI values were more likely to be allergen positive (p < 0.05). Allergic status was not significantly related to all‐night AHI, RDI, or REM‐AHI. BMI was not significantly related to REM‐RDI. STOP‐Bang© was related to allergy status (p = 0.02) and REM‐RDI (p < 0.01). Allergic patients had increased REM latency and less total amount of REM. Conclusion We revealed significant bidirectional associations between allergen positivity and increased REM‐RDI values independent of BMI, AHI, RDI, and REM‐AHI. Allergic inflammation and REM‐RDI data may play important roles in diagnosing and treating fatigued SDB patients and as objective perioperative safety and outcomes measures.
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Affiliation(s)
- Shelley R Berson
- Department of Otolaryngology, School of Medicine, New York Medical College, Valhalla, NY
| | - Jaclyn Klimczak
- Department of Ear, Nose and Throat (Otolaryngology)-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY
| | | | - Shirley Hu
- Department of Ear, Nose and Throat (Otolaryngology)-Head and Neck Surgery, Mount Sinai School of Medicine, New York, NY
| | - Manoj Abraham
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mt. Sinai, New York, NY
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Park CS, Kim BY, Kim SW, Lee JH, Koo SK, Kim KS, Kim ST, Kim YD, Kim JH, Kim JK, Kim CH, Kim HJ, Kim HY, Rha KS, Roh HJ, Park DJ, Shin SH, Lim SC, Lee JH, Lee HM, Lee HG, Kim YH, Cho JH. The Relationship between the Causative Allergens of Allergic Diseases and Environments in Korea Over a 8-Year-Period: Based on Skin Prick Test from 2006 to 2015. JOURNAL OF RHINOLOGY 2018. [DOI: 10.18787/jr.2018.25.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Chan-Soon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Vincent's Hospital, Seoul, Korea
| | - Boo-Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Uijeongbu St. Mary's Hospital, Uijeongbu, Korea
| | - Soo Whan Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, Seoul, Korea
| | - Joo Hyung Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Daejeon St. Mary's Hospital, The Catholic University of Korea, School of Medicine, Daejeon, Korea
| | - Soo Kweon Koo
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan St. Mary's Hospital, Pusan, Korea
| | - Kyung-Su Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seon Tae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University, Gil Medical Center, Incheon, Korea
| | - Yong-Dae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jeong Hong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeju Hospital, Jeju University, College of Medicine, Jeju, Korea
| | - Jin Kook Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kun Kook University, School of Medicine, Seoul, Korea
| | - Chang Hoon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Shinchon Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Jun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki-Sang Rha
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Hwan-Jung Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Dong-Joon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Heon Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Daegu, School of Medicine, Daegu, Korea
| | - Sang-Chul Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Hoon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Heung Man Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Guro Hospital, Korea University, School of Medicine, Seoul, Korea
| | - Heung Gu Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Vincent's Hospital, Seoul, Korea
| | - Young Ha Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, Seoul, Korea
| | - Jin Hee Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary's Hospital, Seoul, Korea
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Agondi RC, Andrade MC, Takejima P, Aun MV, Kalil J, Giavina-Bianchi P. Atopy Is Associated with Age at Asthma Onset in Elderly Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:865-871. [PMID: 29175370 DOI: 10.1016/j.jaip.2017.10.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 10/08/2017] [Accepted: 10/25/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Asthma in the elderly population (60 years of age and older) is frequently underdiagnosed, as well as atopy. Atopy, although more prevalent in younger patients, can be a major cause of asthma in the elderly. Chronic obstructive pulmonary disease (COPD) and cardiovascular disease are common differential diagnoses, especially in elderly smokers. OBJECTIVE The objective of this study was to assess atopy and comorbidities in elderly patients with asthma. METHODS This was an observational and retrospective study involving elderly asthmatic patients followed up at a tertiary center. Patients were assessed for severity of asthma, frequency of atopy, and frequency of comorbidities concomitant with asthma. Then, they were classified according to their age at asthma onset and the groups compared with each other for atopy, spirometric parameters, and comorbidities. RESULTS This study included 243 elderly asthmatic patients, 71.8% of them presenting severe disease and 82.3% forced expiratory volume in 1 second (FEV1) < 80%. Gastroesophageal reflux disease, obesity, and asthma-COPD overlap syndrome were observed, respectively, in 64%, 37%, and 13% of these patients. Atopy was observed in 63%, mainly in those with early onset disease, and its frequency decreased as the age of asthma onset increased (P < .05). Total serum IgE was higher for allergic patients and FEV1 values were lower for patients with long-term asthma. Aspirin-exacerbated respiratory disease was more frequent in patients with nonallergic asthma. CONCLUSIONS Most elderly asthmatic patients followed up in our tertiary center were atopic and higher values of total serum IgE suggest atopy. Atopy was inversely correlated with age of asthma onset. The diagnosis of allergic asthma in the elderly population is essential to treat patients more properly, improving their quality of life and decreasing asthma morbidity and mortality.
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Affiliation(s)
- Rosana Câmara Agondi
- Laboratory of Immunology (LIM19), Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Mayra Coutinho Andrade
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Priscila Takejima
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcelo Vivolo Aun
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Jorge Kalil
- Laboratory of Immunology (LIM19), Heart Institute (InCor), School of Medicine, University of São Paulo, São Paulo, Brazil; Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Pedro Giavina-Bianchi
- Clinical Immunology and Allergy Division, School of Medicine, University of São Paulo, São Paulo, Brazil
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Routine Use of Budesonide/Formoterol Fixed Dose Combination in Elderly Asthmatic Patients: Practical Considerations. Drugs Aging 2017; 34:321-330. [PMID: 28258535 DOI: 10.1007/s40266-017-0449-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Asthma has been demonstrated to be as common in the elderly as in younger age groups. Although no specific recommendations exist to manage the disease differently in older individuals, functional features and clinical presentations may be affected by age per se, and by age-related conditions, such as comorbidities and polypharmacy. In this review article, we aimed to explore the efficacy and safety in elderly asthmatic patients of one of the most currently used inhaled treatments for asthma, that is, the fixed-dose combination of budesonide/formoterol. We attempted to address some practical questions that are relevant to the daily practice of clinicians. We focused on the efficacy and real-world effectiveness of inhaled corticosteroids and long-acting β-adrenergic bronchodilators (ICS/LABA) as treatment in the elderly population, since data are extrapolated from younger populations. We investigated whether a maintenance and reliever therapy approach is more effective in the elderly as opposed to maintenance regimens, from both the general practitioner's and the pulmonologist's perspective. To address these questions, we scanned electronic databases (PubMed, MEDLINE, Embase, Scopus and Google Scholar) from the date of inception up to October 2016 with a cross-search using the following keywords: 'asthma', 'elderly', 'SMART therapy', 'MART therapy', 'Turbuhaler', and 'budesonide/formoterol'. The available literature on the topic confirms that when the age-associated changes are properly managed in clinical practice, asthma in older populations can be optimally controlled with inhaled treatment including ICS/LABA. This also applies for the budesonide/formoterol fixed combination, thus allowing for the maintenance and reliever therapy approach.
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Baseline Features of the Severe Asthma Research Program (SARP III) Cohort: Differences with Age. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:545-554.e4. [PMID: 28866107 DOI: 10.1016/j.jaip.2017.05.032] [Citation(s) in RCA: 186] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/18/2017] [Accepted: 05/19/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effect of age on asthma severity is poorly understood. OBJECTIVES The objective of this study was to compare the baseline features of severe and nonsevere asthma in the Severe Asthma Research Program (SARP) III cohort, and examine in cross section the effects of age on those features. METHODS SARP III is a National Institutes of Health/National Heart Lung Blood Institute multisite 3-year cohort study conducted to investigate mechanisms of severe asthma. The sample included 188 children (111 severe, 77 nonsevere) and 526 adults (313 severe, 213 nonsevere) characterized for demographic features, symptoms, health care utilization, lung function, and inflammatory markers compared by age and severity. RESULTS Compared with children with nonsevere asthma, children with severe asthma had more symptoms and more historical exacerbations, but no difference in body weight, post-bronchodilator lung function, or inflammatory markers. After childhood, and increasing with age, the cohort had a higher proportion of women, less allergen sensitization, and overall fewer blood eosinophils. Enrollment of participants with severe asthma was highest in middle-aged adults, who were older, more obese, with greater airflow limitation and higher blood eosinophils, but less allergen sensitization than adults with nonsevere asthma. CONCLUSIONS The phenotypic features of asthma differ by severity and with advancing age. With advancing age, patients with severe asthma are more obese, have greater airflow limitation, less allergen sensitization, and variable type 2 inflammation. Novel mechanisms besides type 2 inflammatory pathways may inform the severe asthma phenotype with advancing age.
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de Roos EW, In 't Veen JCCM, Braunstahl GJ, Lahousse L, Brusselle GGO. Targeted Therapy for Older Patients with Uncontrolled Severe Asthma: Current and Future Prospects. Drugs Aging 2017; 33:619-28. [PMID: 27638817 DOI: 10.1007/s40266-016-0397-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Severe asthma in the elderly places a high burden on affected individuals and society. Emerging therapies target specific phenotypes of the asthma disease spectrum, and can be beneficial for older asthmatics, albeit their response might be altered due to age-related characteristics. Paradoxically, these characteristics are often ground for exclusion from clinical trials. The question thus arises how the senior asthmatic population can successfully enter the era of targeted therapy. Therefore, we highlight characteristics of this population relevant to effective treatment, and review the evidence for targeted therapy in elderly patients. For targeted therapy it is important to account for aging, as this affects the distribution of phenotypes (e.g. late-onset asthma, non-eosinophilic asthma) and may alter biomarkers and drug metabolism. Elderly asthmatics suffer from age-related comorbidities and subsequent polypharmacy. A systematic search into targeted asthma therapy yielded no randomized clinical trials dedicated to older asthmatics. Post hoc analyses of the anti-immunoglobulin E agent omalizumab indicate similar efficacy in both younger and older adults. Conference abstracts on anti-interleukin-5 and anti-interleukin-13 therapy suggest even more pronounced effects of targeted treatments in late-onset disease and in asthmatic patients 65 years or older, but full reports are lacking. For non-eosinophilic asthma in the elderly, there is not yet high-level evidence for targeted therapy, but macrolides may offer a viable option. In conclusion, there is a gap in knowledge regarding the effect of older age on the safety and efficacy of targeted asthma therapy. Further investigations in the elderly are needed, with special emphasis on both late-onset asthma and therapeutics for non-eosinophilic asthma.
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Affiliation(s)
- E W de Roos
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - J C C M In 't Veen
- Department of Respiratory Medicine, Franciscus Gasthuis, 3045 PM, Rotterdam, The Netherlands
| | - G-J Braunstahl
- Department of Respiratory Medicine, Franciscus Gasthuis, 3045 PM, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - L Lahousse
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - G G O Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Respiratory Medicine, Erasmus MC - University Medical Center Rotterdam, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Liang JB, Liu LJ, Fang QH. Clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma. Ann Allergy Asthma Immunol 2017; 118:564-569. [PMID: 28477787 DOI: 10.1016/j.anai.2017.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/18/2017] [Accepted: 02/20/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The clinical characteristics of patients with chronic obstructive pulmonary disease overlapped with bronchial asthma (COPD-BA) have not been discussed thoroughly. OBJECTIVE To reveal the clinical features of patients with COPD-BA, to evaluate the risk factors of COPD-BA, and to provide suggestions for COPD individualized therapy. METHODS A retrospective observational study was performed. A total of 182 patients with COPD (90 with COPD-BA and 92 with pure COPD) were recruited in the study. Information on the following items was collected: demographics, clinical manifestations, complications, laboratory findings, other histories, and inpatient treatments during exacerbation. RESULTS A total of 182 patients were diagnosed with COPD, with 90 (49.45%) being classified as having COPD-BA. Patients with COPD-BA were more likely to be female (P = .004) and experienced more severe respiratory exacerbations (P = .04) despite being younger (P = .008). Those patients at onset of recurrent cough and sputum production were younger (P = .001). Significantly, a positive asthmatic family history (P = .03) was observed. Patients with COPD-BA usually had higher level of total serum IgE (although no differences were observed), had higher positive rates of the serum specific IgE (P = .004), and were more like to have an allergic history (P = .003). Allergic factor was the risk factor of COPD-BA (odds ratio, 4.477). During hospitalization, patients with COPD-BA tended to be treated with systemic corticosteroids (P = .008). CONCLUSION Patients with COPD-BA were characterized by persistent airflow limitation with unique clinical features. Allergic factor was associated with the presence of asthmatic characteristics in patients with COPD. When hospitalized for exacerbation, the individualized therapy for COPD-BA might include the use of corticosteroids systemically.
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Affiliation(s)
- Jing-Bo Liang
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Li-Jin Liu
- Medical Experimental Center, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Qiu-Hong Fang
- Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Abstract
The older population has seen the greatest increase in the prevalence of current asthma in recent years. Asthma may begin at any age and when it occurs at an advanced as opposed to a young age, it is often nonatopic, severe, and unremitting. Unfortunately, geriatric-specific guidelines are not available for the diagnosis and treatment of asthma. However, with objective monitoring, avoidance of asthma triggers, appropriate pharmacotherapy, and patient education, the disease can be managed successfully.
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Affiliation(s)
- Sidney S Braman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box #1232, New York, NY 10029, USA.
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Ponte EV, Lima A, Almeida PCA, de Jesus JPV, Lima VB, Scichilone N, Souza-Machado A, Cruz ÁA. Age is associated with asthma phenotypes. Respirology 2017; 22:1558-1563. [PMID: 28654167 DOI: 10.1111/resp.13102] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/01/2017] [Accepted: 05/01/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVE The relationship between age and asthma phenotypes is important as population is ageing, asthma is becoming common in older ages and recently developed treatments for asthma are guided by phenotypes. The aim of this study is to evaluate whether age is associated with specific asthma phenotypes. METHODS This is a cross-sectional study. We included subjects with asthma of varied degrees of severity. Subjects underwent spirometry, skin prick test to aeroallergens, answered the Asthma Control Questionnaire and had blood samples collected. We performed binary logistic regression analysis to evaluate whether age is associated with asthma phenotypes. RESULTS We enrolled 868 subjects. In comparison with subjects ≤ 40 years, older subjects had high odds of irreversible airway obstruction (from 41 to 64 years, OR: 1.83 (95% CI: 1.32-2.54); ≥65 years, OR: 3.45 (2.12-5.60)) and severe asthma phenotypes (from 41 to 64 years, OR: 3.23 (2.26-4.62); ≥65 years, OR: 4.55 (2.39-8.67)). Older subjects had low odds of atopic (from 41 to 64 years, OR: 0.56 (0.39-0.79); ≥65 years, OR: 0.47 (0.27-0.84)) and eosinophilic phenotypes (from 41 to 64 years, OR: 0.63 (0.46-0.84); ≥65 years, OR: 0.39 (0.24-0.64)). CONCLUSION Older subjects with asthma have low odds of atopic and eosinophilic phenotypes, whereas they present high odds of irreversible airway obstruction and severe asthma.
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Affiliation(s)
- Eduardo V Ponte
- Internal Medicine, Jundiaí Medical School, São Paulo, Brazil
| | - Aline Lima
- Center of Excellence in Asthma, Universidade Federal da Bahia, Salvador, Brazil
| | - Paula C A Almeida
- Center of Excellence in Asthma, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Valmar B Lima
- Center of Excellence in Asthma, Universidade Federal da Bahia, Salvador, Brazil
| | | | - Adelmir Souza-Machado
- Center of Excellence in Asthma, Health Institute, Federal University of Bahia, Salvador, Brazil
| | - Álvaro A Cruz
- Center of Excellence in Asthma, Health Institute, Federal University of Bahia, Salvador, Brazil
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Tosca MA, Silvestri M, Olcese R, Pistorio A, Rossi GA, Ciprandi G. The impact of age on serum allergen-specific IgE to inhaled molecular components. Allergol Immunopathol (Madr) 2017; 45:265-271. [PMID: 28153352 DOI: 10.1016/j.aller.2016.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 10/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Respiratory allergy is characterised by an IgE-mediated reaction. The immune system functions, including IgE production, progressively decline over time, such as growing up and ageing. Molecular-based allergy diagnostic defines sensitisation profile. This study aimed to evaluate the impact of age on serum allergen-specific IgE to molecular component levels in a large sample of subjects. METHODS Serum IgE to: Phl p1, Bet v1, Ole e1, Cup a1, Par j2, Can f1, Der p2, and Fel d1 were assessed by ISAC method. Sera from 2788 patients, 1230 males (44.1%) and 1558 females (55.9%), median age 23 years (1st and 3rd quartiles: 9.7-49.7 years; age range: 1 month-103 years) were analysed. RESULTS The number of positive tests (i.e. sensitisation) tended to increase between birth and school-age till young adulthood and then decreased (p<0.0001) with the exception of Fel d 1 (p=0.14). A similar age-dependent trend was observed considering the levels of each allergen components: the levels of each allergen component, with the exception of Fel d 1, tended to increase till early adulthood and then to decrease reaching the lowest levels in the elderly. CONCLUSIONS Allergen-specific IgE production to inhaled molecular components trend to reduce with ageing, but with differences between allergens. This phenomenon should be adequately evaluated managing allergic patients.
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Affiliation(s)
- M A Tosca
- Pediatric Pneumology and Allergy, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Silvestri
- Pediatric Pneumology and Allergy, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - R Olcese
- Pediatric Pneumology and Allergy, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A Pistorio
- Epidemiology and Biostatistics Service, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G A Rossi
- Pediatric Pneumology and Allergy, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Ciprandi
- Internal Medicine Department, IRCCS-AOU San Martino, Genoa, Italy.
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Ventura MT, Scichilone N, Paganelli R, Minciullo PL, Patella V, Bonini M, Passalacqua G, Lombardi C, Simioni L, Ridolo E, Del Giacco SR, Gangemi S, Canonica GW. Allergic diseases in the elderly: biological characteristics and main immunological and non-immunological mechanisms. Clin Mol Allergy 2017; 15:2. [PMID: 28174512 PMCID: PMC5290673 DOI: 10.1186/s12948-017-0059-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 01/06/2017] [Indexed: 02/08/2023] Open
Abstract
Life expectancy and the number of elderly people are progressively increasing around the world. Together with other pathologies, allergic diseases also show an increasing incidence in geriatric age. This is partly due to the growing emphasis on a more accurate and careful diagnosis of the molecular mechanisms that do not allow to ignore the real pathogenesis of many symptoms until now unknown, and partly to the fact that the allergic people from 20 years ago represent the elderly population now. Moreover, environmental pollution predisposes to the onset of allergic asthma and dermatitis which are the result of internal pathologies more than the expression of allergic manifestations. At the same time the food contamination permits the onset of allergic diseases related to food allergy. In this review we provide the state of the art on the physiological changes in the elderly responsible for allergic diseases, their biological characteristics and the major immunological and extra immunological mechanisms. Much emphasis is given to the management of several diseases in the elderly, including anaphylactic reactions. Moreover, some new features are discussed, such as management of asthma with the support of physical activity and the use of the AIT as prevention of respiratory diseases and for the purpose of a real and long lasting benefit. The mechanisms of adverse reactions to drugs are also discussed, due to their frequency in this age, especially in polytherapy regimens. Study of the modifications of the immune system is also of great importance, as regards to the distribution of the lymphocytes and also the presence of a chronic inflammatory disease related to the production of cytokines, especially in prevision of all the possible therapies to be adopted to allow an active and healthy aging.
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Affiliation(s)
- Maria Teresa Ventura
- Interdisciplinary Department of Medicine, Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | | | - Roberto Paganelli
- Laboratory of Immunology and Allergy, Department of Medicine and Sciences of Aging, University of G. d’Annunzio, Chieti, Italy
| | - Paola Lucia Minciullo
- Division and School of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, Battipaglia Hospital, Battipaglia, Salerno, Italy
- School of Allergy and Clinical Immunology, University of Naples Federico II, Naples, Italy
| | - Matteo Bonini
- National Heart and Lung Institute (NHLI), Imperial College London & Royal Brompton Hospital, London, UK
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS San Martino-IST-University of Genoa, Genoa, Italy
| | - Carlo Lombardi
- Departmental Unit of AllergologyClinical Immunology & Pneumology, Fondazione Poliambulanza Hospital, Brescia, Italy
| | - Livio Simioni
- Department of Medicine, Allergy Service, ULSS 2 Feltre, Belluno, Italy
| | - Erminia Ridolo
- Experimental and Clinical Medicine, University of Parma, Parma, Italy
| | | | - Sebastiano Gangemi
- Division and School of Allergy and Clinical Immunology, Department of Clinical and Experimental Medicine, University Hospital of Messina, Messina, Italy
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Tosca M, Silvestri M, Olcese R, Sacco O, Pistorio A, Rossi G, Ciprandi G. Allergen-specific IgE to food molecular components and age: From early childhood to adulthood. Allergol Immunopathol (Madr) 2017; 45:87-92. [PMID: 27720248 DOI: 10.1016/j.aller.2016.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/30/2016] [Accepted: 06/13/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Respiratory allergy is characterised by an IgE-mediated reaction. The immune system functions, including IgE production, progressively decline over time with growing up and ageing. Molecular-based allergy diagnostic defines sensitisation profile. This study aimed to evaluate the impact of age on serum allergen-specific IgE to molecular component levels in a large sample of subjects. METHODS Serum IgE to: rCor a11, rPru p3, nJug r3, rAra h8, rGly m4, rCor a8, nPen m1, nAct d8, Bos d 8, and nGal d2 were assessed by ISAC method. Sera from 2795 patients, 1234 males (44.1%) and 1561 females (55.9%), median age 23 years (1st and 3rd quartiles: 9.7-43.7 years; age range: 1 month-103 years) were analysed. RESULTS The number of positive tests (i.e. sensitisation) tended to increase between birth and school-age until young adulthood and then decreased. A similar age-dependent trend was observed considering the levels of each allergen components: the levels of each allergen component tended to increase until early adulthood, but Gal d 2 and Bos d 8 (rapidly diminishing), and then to decrease over time. However, the pattern is significantly dependent on each single tested food. CONCLUSIONS Allergen-specific IgE production to food molecular components tend to reduce with ageing, but with differences between allergens. This phenomenon should be adequately evaluated managing allergic patients.
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Jensen-Jarolim E, Jensen SAF. Food allergies in the elderly: Collecting the evidence. Ann Allergy Asthma Immunol 2016; 117:472-475. [PMID: 27788873 DOI: 10.1016/j.anai.2016.08.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 01/31/2023]
Affiliation(s)
- Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria; The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna, University of Vienna, Vienna, Austria.
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Kawamatawong T, Siripongpun S, Rerkpattanapipat T. Role of eosinophilic inflammation and atopy in elderly asthmatic patients. Asia Pac Allergy 2016; 6:181-6. [PMID: 27489791 PMCID: PMC4967619 DOI: 10.5415/apallergy.2016.6.3.181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background Asthma in the elderly is severe and associated with poor treatment outcome. Although atopy has an important role in pathogenesis, its role in the elderly is unclear, partly due to immune senescence. Objective We aimed to examine the associations of Th2-mediated inflammation with asthma severity in the elderly. Methods Consecutive asthmatics older than 60 years without severe exacerbation within 8 weeks were enrolled. Atopic status was determined by positive serum specific IgE or skin prick test to common aeroallergens. Serum total IgE was measured simultaneously to exhaled fractional concentration of nitric oxide (FeNO). Asthma control level was assessed by using Thai Asthma Control Test (ACT) score. Results Total of 44 elderly asthmatic patients were enrolled. The mean age was 68.9 years and mean age of asthma diagnosis was 46.6 years. Seventy-seven percent of patients were female. Atopic status was found in 45.5% of patients. Uncontrolled asthma classified as ACT score < 20 was noted in 25% of elderly asthma, but its association with either high serum total IgE (≥120 IU/mL), high FeNO (≥50 ppb) or atopic status was not detected. Conclusion One-fourth of elderly asthmatics were clinically uncontrolled, while atopy was confirmed in 45.5%. Neither high total IgE, high FeNO nor atopic status was associated with uncontrolled asthma in the elderly. Other factors might play role in asthma severity in the elderly, and has to be further investigated.
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Affiliation(s)
- Theerasuk Kawamatawong
- Division of Pulmonary and Critical Care Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Sitthisak Siripongpun
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - Ticha Rerkpattanapipat
- Division of Allergy, Immunology and Rheumatology, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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Role of atopy in chronic rhinosinusitis with nasal polyps: does an atopic condition affect the severity and recurrence of disease? The Journal of Laryngology & Otology 2016; 130:640-4. [PMID: 27268094 DOI: 10.1017/s0022215116008112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of atopy in chronic rhinosinusitis is unclear: it is particularly controversial in chronic rhinosinusitis with nasal polyps. METHODS A prospective study of 210 patients with chronic rhinosinusitis with nasal polyps was performed. Patient demographics, visual analogue scale scores, Lund-Kennedy endoscopy scores, Lund-Mackay computed tomography scores, serum total immunoglobulin E levels, serum eosinophil cationic protein (ECP) levels and Phadiatop test findings were analysed. RESULTS There were no significant differences in age, sex, visual analogue scale score, Lund-Mackay computed tomography score, total serum immunoglobulin E level, serum ECP level or Phadiatop test results between patients with primary and recurrent chronic rhinosinusitis with nasal polyps. A total of 99 patients (47 per cent) had positive atopy tests. No significant differences in sex, visual analogue scale score, Lund-Kennedy endoscopy score, Lund-Mackay computed tomography score or recurrence rates were found between atopic and non-atopic patients; however, atopic patients were significantly younger than non-atopic patients. Atopy status did not correlate with disease severity. CONCLUSION There was no association between atopy status and either disease severity or recurrence in patients with chronic rhinosinusitis with nasal polyps, although atopic patients were younger than non-atopic patients.
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Rok T, Rokita E, Tatoń G, Guzik T, Śliwa T. Thermographic assessment of skin prick tests in comparison with the routine evaluation methods. Postepy Dermatol Alergol 2016; 33:193-8. [PMID: 27512354 PMCID: PMC4969414 DOI: 10.5114/ada.2016.60611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 04/30/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The skin prick test is still the first and basic procedure in the diagnosis of allergic diseases. The possibility of using a sensitive thermographic method supported by the mathematical model for the assessment of skin test results will be highlighted in the studies. AIM To compare the proposed approach with routine planimetric and thermographic methods. MATERIAL AND METHODS A mathematical model of allergic reaction was developed. Simplifying assumptions of the IgE-mediated skin reaction is the essence of the model. Investigations were performed in a group of 40 patients. RESULTS Using the spatio-temporal evolution of temperature distributions, the ratios of the histamine released from mast cells to the control histamine were determined. The obtained values very well correlate with the standard evaluation of skin prick tests (correlation coefficient = 0.98). CONCLUSIONS The proposed method of skin test evaluation presents several advantages. The continuous acquisition of data provides the monitoring of time course of the allergic response. The transport of mediator and its concentration were distinctly discriminated, which may be diagnostically useful, especially for abnormal cases. The high sensitivity of the method enables studying patients regardless of age and skin sensitivity.
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Affiliation(s)
- Tomasz Rok
- Department of Biophysics, Chair of Physiology, Jagiellonian University, Medical College, Krakow, Poland
| | - Eugeniusz Rokita
- Department of Biophysics, Chair of Physiology, Jagiellonian University, Medical College, Krakow, Poland
| | - Grzegorz Tatoń
- Department of Biophysics, Chair of Physiology, Jagiellonian University, Medical College, Krakow, Poland
| | - Tomasz Guzik
- Department of Internal and Rural Medicine, Jagiellonian University, Medical College, Krakow, Poland
| | - Tomasz Śliwa
- Department of Internal and Rural Medicine, Jagiellonian University, Medical College, Krakow, Poland
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Zuo L, Pannell BK, Liu Z. Characterization and redox mechanism of asthma in the elderly. Oncotarget 2016; 7:25010-21. [PMID: 26843624 PMCID: PMC5041886 DOI: 10.18632/oncotarget.7075] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/17/2016] [Indexed: 12/15/2022] Open
Abstract
Asthma is a chronic disease characterized by reversible airflow limitation, coughing, bronchial constriction, and an inflammatory immune response. While asthma has frequently been categorized as emerging in childhood, evidence has begun to reveal that the elderly population is certainly susceptible to late-onset, or even long-standing asthma. Non-atopic asthma, most commonly found in elderly patients is associated with elevated levels of serum and sputum neutrophils and may be more detrimental than atopic asthma. The mortality of asthma is high in the elderly since these patients often possess more severe symptoms than younger populations. The redox mechanisms that mediate inflammatory reactions during asthma have not been thoroughly interpreted in the context of aging. Thus, we review the asthmatic symptoms related to reactive oxygen species (ROS) and reactive nitrogen species (RNS) in seniors. Moreover, immune status in the elderly is weakened in part by immunosenescence, which is broadly defined as the decline in functionality of the immune system that corresponds with increasing age. The effects of immunosenescence on the expression of biomarkers potentially utilized in the clinical diagnosis of asthma remain unclear. It has also been shown that existing asthma treatments are less effective in the elderly. Thus, it is necessary that clinicians approach the diagnosis and treatment of asthmatic senior patients using innovative methods. Asthma in the elderly demands more intentional diagnostic and therapeutic research since it is potentially one of the few causes of mortality and morbidity in the elderly that is largely reversible.
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Affiliation(s)
- Li Zuo
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
- The Interdisciplinary Biophysics Graduate Program, The Ohio State University, Columbus, OH, USA
| | - Benjamin K. Pannell
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Zewen Liu
- Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Anesthesiology, Affiliated Ezhou Central Hospital, Renmin Hospital of Wuhan University Medical School, Hubei, China
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Benfante A, Scichilone N. The geriatric asthma: pitfalls and challenges. Asthma Res Pract 2016; 2:2. [PMID: 27965770 PMCID: PMC5142431 DOI: 10.1186/s40733-015-0018-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 12/19/2015] [Indexed: 11/10/2022] Open
Abstract
Historically, asthma has been envisioned as a disease of younger ages. This has led to the assumption that respiratory symptoms suggestive of asthma occurring in older ages are to be attributed to conditions other than asthma, mainly COPD. Old observational reports and new epidemiological studies confirm that asthma is as frequent in older as it is in younger populations. Nevertheless, under-recognition, misdiagnosis and under-treatment are still relevant issues. The characterization of asthma in the aged suffers from the fact that there has been very little original research in this field. Indeed, geriatric asthma is often excluded from clinical trials because of age and comorbidities. The current review paper revises the areas that need to be elucidated, and highlights the gaps in the management of this condition. It follows that a multidimensional management is advocated for elderly asthmatics to evaluate the severity and establish the complexity of the disease. We suggest that the term “geriatric” asthma should be preferred to “senile” asthma, which is confined to the age-related changes in the lung, or the more generic “asthma in the elderly”, which is only descriptive of the prevalence in specific age groups.
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Affiliation(s)
- Alida Benfante
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Istituto Euro-Mediterraneo di Scienza e Tecnologia, via Trabucco 180, 90146 Palermo, Italy
| | - Nicola Scichilone
- Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Istituto Euro-Mediterraneo di Scienza e Tecnologia, via Trabucco 180, 90146 Palermo, Italy.,Euro-Mediterranean Institute of Science and Technology, Palermo, Italy
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Konishi S, Ng CFS, Stickley A, Watanabe C. Pollinosis and all-cause mortality among middle-aged and elderly Japanese: a population-based cohort study. Clin Exp Allergy 2015; 46:1083-9. [PMID: 26366720 DOI: 10.1111/cea.12638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/11/2015] [Accepted: 09/09/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Having an allergic disease may have health implications beyond those more commonly associated with allergy given that previous epidemiological studies have suggested that both atopy and allergy are linked to mortality. More viable immune functioning among the elderly, as indicated by the presence of an allergic disease, might therefore be associated with differences in all-cause mortality. OBJECTIVE Using data from a Japanese cohort, this study examined whether having pollinosis (a form of allergic rhinitis) in a follow-up survey could predict all-cause and cause-specific mortality. METHODS Data came from the Komo-Ise cohort, which at its 1993 baseline recruited residents aged 40-69 years from two areas in Gunma prefecture, Japan. The current study used information on pollinosis that was obtained from the follow-up survey in 2000. Mortality and migration data were obtained throughout the follow-up period up to December 2008. Proportional hazard models were used to examine the relation between pollinosis and mortality. RESULTS At the 2000 follow-up survey, 12% (1088 of 8796) of respondents reported that they had pollinosis symptoms in the past 12 months. During the 76 186 person-years of follow-up, 748 died from all causes. Among these, there were 37 external, 208 cardiovascular, 74 respiratory, and 329 neoplasm deaths. After adjusting for potential confounders, pollinosis was associated with significantly lower all-cause [hazard ratio 0.57 (95% confidence interval = 0.38-0.87)] and neoplasms mortality [hazard ratio 0.48 (95% confidence interval = 0.26-0.92)]. CONCLUSIONS AND CLINICAL RELEVANCE Having an allergic disease (pollinosis) at an older age may be indicative of more viable immune functioning and be protective against certain causes of death. Further research is needed to determine the possible mechanisms underlying the association between pollinosis and mortality.
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Affiliation(s)
- S Konishi
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Anthropology, University of Washington, Seattle, WA, USA
| | - C F S Ng
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - A Stickley
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
| | - C Watanabe
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Battaglia S, Benfante A, Scichilone N. Asthma in the older adult: presentation, considerations and clinical management. Expert Rev Clin Immunol 2015; 11:1297-308. [PMID: 26358013 DOI: 10.1586/1744666x.2015.1087850] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Asthma affects older adults to the same extent as children and adolescents. However, one is led to imagine that asthma prevalence decreases with aging and becomes a rare entity in the elderly. From a clinical perspective, this misconception has nontrivial consequences in that the recognition of the disease is delayed and the treatment postponed. The overall management of asthma in the elderly population is also complicated by specific features that the disease develops in the most advanced ages, and by the difficulties that the physician encounters when approaching the older asthmatic subjects. The current review article aims at describing the specific clinical presentations of asthma in the elderly and highlights the gaps and pitfalls in the diagnostic and therapeutic approaches. Relevant issues with regard to the clinical management of asthma in the elderly are also discussed.
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Affiliation(s)
- Salvatore Battaglia
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo Palermo, Italy
| | - Alida Benfante
- a Dipartimento Biomedico di Medicina Interna e Specialistica (Di.Bi.MIS), University of Palermo Palermo, Italy
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Ventura MT, Scichilone N, Gelardi M, Patella V, Ridolo E. Management of allergic disease in the elderly: key considerations, recommendations and emerging therapies. Expert Rev Clin Immunol 2015; 11:1219-28. [PMID: 26483075 DOI: 10.1586/1744666x.2015.1081564] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The number of people over 65 is increasing around the world. At present, between 5 and 10% of allergic diseases affect the elderly. In particular, rhinitis is increasing worldwide; the presence of high comorbidity makes the therapy of asthma even more complicated. With reference to dermatological allergies, the dryness of the skin favors the onset of allergic contact and atopic dermatitis, while the senescence of mucous membranes and the impaired secretion of polymeric IgA could be linked to food allergy. Overcoming the problem of adverse drug reaction is limited by the diagnostic difficulty in patients taking multiple drugs. In addition, some drugs, such as β-blockers, angiotensin-converting enzyme (ACE)-inhibitors and NSAIDs, are relevant factors of urticaria and anaphylaxis. The aim of this review is to provide updated diagnostic and therapeutic guidelines through a better understanding of the pathophysiologic mechanisms, preventive measures and adherence to therapy.
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Affiliation(s)
- Maria Teresa Ventura
- a 1 Interdisciplinary Department of Medicine, University of Bari Medical School, Unit of Geriatric Immunoallergology , Policlinico, piazza G. Cesare n 11, 70124, Bari, Italy
| | - Nicola Scichilone
- b 2 Department of Medicine, University of Palermo , via Trabucco 180, 90146 Palermo, Italy
| | - Matteo Gelardi
- c 3 Otolaryngology Unit, Department of Basic Medical Science, Neuroscience and Sensory Organ, University of Bari , Piazza G. Cesare n. 11, 70124 Bari, Italy
| | - Vincenzo Patella
- d 4 Post Doctoral Program in Allergy and Clinical Immunology, Federico II University via s Pansini , m.5,80131 Napoli, Italy
| | - Erminia Ridolo
- e 5 Department of Clinical and Experimental Medicine, University of Parma , via Gramsci 14, 43120 Parma, Italy
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Romand P, Kelkel E, Saint-Raymond C, Glas N, Caillaud D, Devouassoux G. [Severe uncontrolled asthma in patients over 75 years old: Treatment with omalizumab]. Rev Mal Respir 2015; 33:397-400. [PMID: 26346416 DOI: 10.1016/j.rmr.2015.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION With an aging population and an increase in the prevalence of asthma, this disease is becoming more common in the elderly. Nevertheless, the management of severe asthma can be complex, due to an increased risk of uncontrolled disease in patients over 65 years old and partly to the inherent characteristics of old age: comorbidities, underestimation of the role of allergies, poor adherence, difficulties with inhalation devices, etc. CASE REPORTS We report two cases of women over 75 with severe persistent allergic asthma not controlled by high doses of inhaled corticosteroids and long-acting beta-2-agonists in whom treatment with omalizumab was initiated. Following treatment with omalizumab a decrease in the number and severity of exacerbations, improved asthma control and dose reduction or discontinuation of systemic corticosteroids were observed. The tolerance of omalizumab was good in both cases. CONCLUSIONS Omalizumab is to be considered an effective and well-tolerated therapeutic option for elderly patients with inadequately controlled severe allergic asthma.
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Affiliation(s)
- P Romand
- Service de pneumologie, hôpital Alpes-Léman, 558, route de Findrol, 74130 Contamine-sur-Arve, France.
| | - E Kelkel
- Service de pneumologie, centre hospitalier, 73000 Chambéry, France
| | - C Saint-Raymond
- Service de pneumologie, hôpital universitaire, 38700 Grenoble, France
| | - N Glas
- Service de pneumologie et d'oncologie thoracique, hôpital Nord, 42055 Saint-Étienne, France
| | - D Caillaud
- Service de pneumologie-allergologie, hôpital G. Montpied, université d'Auvergne, 63000 Clermont-Ferrand, France
| | - G Devouassoux
- Service de pneumologie, hôpital universitaire de la Croix-Rousse, 69004 Lyon, France
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Murray MA, Chotirmall SH. The Impact of Immunosenescence on Pulmonary Disease. Mediators Inflamm 2015; 2015:692546. [PMID: 26199462 PMCID: PMC4495178 DOI: 10.1155/2015/692546] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/09/2015] [Indexed: 01/09/2023] Open
Abstract
The global population is aging with significant gains in life expectancy particularly in the developed world. Consequently, greater focus on understanding the processes that underlie physiological aging has occurred. Key facets of advancing age include genomic instability, telomere shortening, epigenetic changes, and declines in immune function termed immunosenescence. Immunosenescence and its associated chronic low grade systemic "inflamm-aging" contribute to the development and progression of pulmonary disease in older individuals. These physiological processes predispose to pulmonary infection and confer specific and unique clinical phenotypes observed in chronic respiratory disease including late-onset asthma, chronic obstructive pulmonary disease, and pulmonary fibrosis. Emerging concepts of the gut and airway microbiome further complicate the interrelationship between host and microorganism particularly from an immunological perspective and especially so in the setting of immunosenescence. This review focuses on our current understanding of the aging process, immunosenescence, and how it can potentially impact on various pulmonary diseases and the human microbiome.
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Affiliation(s)
- Michelle A. Murray
- Department of Respiratory Medicine, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland
| | - Sanjay H. Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232
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Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, Dawson DE, Dykewicz MS, Hackell JM, Han JK, Ishman SL, Krouse HJ, Malekzadeh S, Mims JWW, Omole FS, Reddy WD, Wallace DV, Walsh SA, Warren BE, Wilson MN, Nnacheta LC. Clinical practice guideline: Allergic rhinitis. Otolaryngol Head Neck Surg 2015; 152:S1-43. [PMID: 25644617 DOI: 10.1177/0194599814561600] [Citation(s) in RCA: 372] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Allergic rhinitis (AR) is one of the most common diseases affecting adults. It is the most common chronic disease in children in the United States today and the fifth most common chronic disease in the United States overall. AR is estimated to affect nearly 1 in every 6 Americans and generates $2 to $5 billion in direct health expenditures annually. It can impair quality of life and, through loss of work and school attendance, is responsible for as much as $2 to $4 billion in lost productivity annually. Not surprisingly, myriad diagnostic tests and treatments are used in managing this disorder, yet there is considerable variation in their use. This clinical practice guideline was undertaken to optimize the care of patients with AR by addressing quality improvement opportunities through an evaluation of the available evidence and an assessment of the harm-benefit balance of various diagnostic and management options. PURPOSE The primary purpose of this guideline is to address quality improvement opportunities for all clinicians, in any setting, who are likely to manage patients with AR as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The guideline is intended to be applicable for both pediatric and adult patients with AR. Children under the age of 2 years were excluded from the clinical practice guideline because rhinitis in this population may be different than in older patients and is not informed by the same evidence base. The guideline is intended to focus on a limited number of quality improvement opportunities deemed most important by the working group and is not intended to be a comprehensive reference for diagnosing and managing AR. The recommendations outlined in the guideline are not intended to represent the standard of care for patient management, nor are the recommendations intended to limit treatment or care provided to individual patients. ACTION STATEMENTS The development group made a strong recommendation that clinicians recommend intranasal steroids for patients with a clinical diagnosis of AR whose symptoms affect their quality of life. The development group also made a strong recommendation that clinicians recommend oral second-generation/less sedating antihistamines for patients with AR and primary complaints of sneezing and itching. The panel made the following recommendations: (1) Clinicians should make the clinical diagnosis of AR when patients present with a history and physical examination consistent with an allergic cause and 1 or more of the following symptoms: nasal congestion, runny nose, itchy nose, or sneezing. Findings of AR consistent with an allergic cause include, but are not limited to, clear rhinorrhea, nasal congestion, pale discoloration of the nasal mucosa, and red and watery eyes. (2) Clinicians should perform and interpret, or refer to a clinician who can perform and interpret, specific IgE (skin or blood) allergy testing for patients with a clinical diagnosis of AR who do not respond to empiric treatment, or when the diagnosis is uncertain, or when knowledge of the specific causative allergen is needed to target therapy. (3) Clinicians should assess patients with a clinical diagnosis of AR for, and document in the medical record, the presence of associated conditions such as asthma, atopic dermatitis, sleep-disordered breathing, conjunctivitis, rhinosinusitis, and otitis media. (4) Clinicians should offer, or refer to a clinician who can offer, immunotherapy (sublingual or subcutaneous) for patients with AR who have inadequate response to symptoms with pharmacologic therapy with or without environmental controls. The panel recommended against (1) clinicians routinely performing sinonasal imaging in patients presenting with symptoms consistent with a diagnosis of AR and (2) clinicians offering oral leukotriene receptor antagonists as primary therapy for patients with AR. The panel group made the following options: (1) Clinicians may advise avoidance of known allergens or may advise environmental controls (ie, removal of pets; the use of air filtration systems, bed covers, and acaricides [chemical agents formulated to kill dust mites]) in patients with AR who have identified allergens that correlate with clinical symptoms. (2) Clinicians may offer intranasal antihistamines for patients with seasonal, perennial, or episodic AR. (3) Clinicians may offer combination pharmacologic therapy in patients with AR who have inadequate response to pharmacologic monotherapy. (4) Clinicians may offer, or refer to a surgeon who can offer, inferior turbinate reduction in patients with AR with nasal airway obstruction and enlarged inferior turbinates who have failed medical management. (5) Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in nonpharmacologic therapy. The development group provided no recommendation regarding the use of herbal therapy for patients with AR.
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Affiliation(s)
- Michael D Seidman
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford West Bloomfield Hospital West Bloomfield, Michigan, USA
| | - Richard K Gurgel
- Department of Surgery Otolaryngology-Head and Neck Surgery University of Utah, Salt Lake City, Utah, USA
| | - Sandra Y Lin
- Johns Hopkins School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, Maryland, USA
| | | | - Fuad M Baroody
- University of Chicago Medical Center, Department of Otolaryngology, Chicago, Illinois, USA
| | | | | | - Mark S Dykewicz
- Department of Internal Medicine, St Louis University School of Medicine, St Louis, Missouri, USA
| | | | - Joseph K Han
- Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | | | - William D Reddy
- Acupuncture and Oriental Medicine (AAAOM), Annandale, Virginia, USA
| | - Dana V Wallace
- Florida Atlantic University, Boca Raton, Florida and Nova Southeastern University, Davie, Florida, USA
| | - Sandra A Walsh
- Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Barbara E Warren
- Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada
| | - Meghan N Wilson
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Lorraine C Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Park SS, Heo EY, Kim DK, Chung HS, Lee CH. The Association of BCG Vaccination with Atopy and Asthma in Adults. Int J Med Sci 2015; 12:668-73. [PMID: 26283887 PMCID: PMC4532975 DOI: 10.7150/ijms.12233] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/18/2015] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION There are few studies investigating the association between BCG vaccination and atopy or asthma in adults. OBJECTIVE We investigated the association between BCG scar and the occurrence of atopy and asthma in Korean adults. METHODS We carried out a retrospective study of Korean adults who underwent skin prick testing, and, in some cases, spirometry and bronchial provocation tests in a secondary care hospital from April 2010 to February 2011. Atopy status was classified according to allergen/histamine (A/H) ratio of wheal (A/H ratio ≥ 1, atopy; 0 < A/H ratio < 1, intermediate; A/H ratio = 0, non-atopy). A patient with asthma was defined as one who has symptoms compatible with asthma and showed either a positive provocation testing or bronchodilator reversibility. RESULTS Among 200 participants, neither the presence (intermediate vs. non-atopy: adjusted odds ratio (aOR) 0.83; 95% CI 0.26, 2.60; p = 0.75, atopy vs. non-atopy: aOR 0.89; 95% CI 0.33, 2.37; p = 0.81, respectively). nor the size of BCG scar was significantly associated with atopy status. However, among those patients who underwent either bronchodilator response testing or bronchial provocation testing, the presence of BCG scar (aOR 0.33; CI 0.14, 0.77; p = 0.01) and the size of BCG scar were inversely associated with asthma. (p = 0.01) CONCLUSIONS: We found a significant association between BCG scar and asthmatic status in Korean adults, although there was no significant association between either the presence or size of BCG scar and atopy.
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Affiliation(s)
- Sung Soo Park
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea
| | - Eun Young Heo
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea
| | - Deog Kyeom Kim
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea
| | - Hee Soon Chung
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea
| | - Chang-Hoon Lee
- 1. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical center, Seoul, Republic of Korea ; 2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Ban GY, Kim MY, Yoo HS, Nahm DH, Ye YM, Shin YS, Park HS. Clinical features of elderly chronic urticaria. Korean J Intern Med 2014; 29:800-6. [PMID: 25378979 PMCID: PMC4219970 DOI: 10.3904/kjim.2014.29.6.800] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 06/26/2014] [Accepted: 07/28/2014] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND/AIMS Chronic urticaria (CU) is defined as itchy wheals lasting 6 weeks or more. As the aged population increases worldwide, it is essential to identify the specific features of this disease in the elderly population. METHODS We investigated the prevalence and clinical features of CU in elderly patients. Medical records of 837 CU patients from the outpatient Allergy Clinic of Ajou University Hospital, Korea were analyzed retrospectively. Patients with chronic spontaneous urticaria according to the EAACI/GA2LEN/EDF/WAO guidelines were included. Patients older than 60 years were defined as elderly. RESULTS Of the 837 patients, 37 (4.5%) were elderly. In elderly versus nonelderly CU patients, the prevalence of atopic dermatitis (AD) was significantly higher (37.8% vs. 21.7%, respectively; p = 0.022), while that of aspirin intolerance was lower (18.9% vs. 43.6%, respectively; p = 0.003) in terms of comorbid conditions. The prevalences of serum specific immunoglobulin E antibodies to staphylococcal enterotoxin A and staphylococcal enterotoxin B were considerably higher in elderly CU patients with AD than in those without AD (37.5% vs. 0%, respectively). CONCLUSIONS Elderly patients with CU had a higher prevalence of AD. Therefore, there is a need to recognize the existence of AD in elderly CU patients.
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Affiliation(s)
- Ga-Young Ban
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Mi-Yea Kim
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hye-Soo Yoo
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Dong-Ho Nahm
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Yoo-Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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Wardzyńska A, Kubsik B, Kowalski ML. Comorbidities in elderly patients with asthma: Association with control of the disease and concomitant treatment. Geriatr Gerontol Int 2014; 15:902-9. [PMID: 25243580 DOI: 10.1111/ggi.12367] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 12/26/2022]
Abstract
AIM The incidence of concomitant conditions increases with age. In elderly patients, the presence of comorbidities has been related to the course and severity of asthma. The aim of the present study was to assess the impact of comorbidities and concomitant treatment on asthma control and severity in older adults. METHODS A total of 93 elderly (age >65 years) and 78 younger (age 30-50 years) asthmatic patients were randomly selected from a database including 1755 asthmatics. Evaluation consisted of a questionnaire, spirometry and skin prick testing. RESULTS In elderly asthmatics, a higher incidence of chronic comorbidities (mean 8.4 vs 4.7; P < 0.001) and a higher number of prescribed medicines (7.4 vs 4.5, P < 0.001) were observed, but the severity of asthma and the intensity of anti-asthma treatment were similar to that seen in younger patients. Asthma control was not strikingly different between the groups. There was no correlation between the presence of comorbid conditions and asthma control, severity or frequency of exacerbations in older patients. Elderly patients treated with statins had a lower risk of asthma exacerbation (OR 0.39, 95% CI 0.18-0.84, P = 0.017), whereas treatment with proton pump inhibitors was associated with a higher risk of exacerbations in older adults (OR 1.84, 95% CI 1.07-3.18, P = 0.029) and higher disease severity in younger patients (OR 2.49, 95% CI 1.1-5.67, P = 0.029). CONCLUSION The higher prevalence of comorbidities observed in elderly asthmatics under specialist care do not seem to be associated with worsened asthma control or severity. However, concomitant medications can significantly affect asthma control in both elderly and younger asthmatics.
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Affiliation(s)
- Aleksandra Wardzyńska
- Department of Clinical Immunology, Rheumatology and Allergy, Healthy Aging Research Center, Medical University of Lodz, Lodz, Poland
| | | | - Marek Leszek Kowalski
- Department of Clinical Immunology, Rheumatology and Allergy, Healthy Aging Research Center, Medical University of Lodz, Lodz, Poland
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