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Brahim Errahmani M, Aichi M, Menaa M. Discriminant analysis and logistic regression on genetic history and environmental factors in children with asthma. Minerva Pediatr (Torino) 2024; 76:236-244. [PMID: 33845560 DOI: 10.23736/s2724-5276.21.06042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Asthma is known to be related to genetic and environmental factors, we aimed to identify the predictors discriminating between children with asthma and a control group in order to build typical profiles of these children. METHODS A multidimensional analysis covered children (58 with asthma and 217 as control group), under 17 years of age, involving environmental variables and medical history of these children and their families. RESULTS Chi-square tests highlighted significant links between variables as rhinitis and conjunctivitis (P<0.001). The results showed, in group of asthmatic children, significant high frequencies of allergies, mainly seasonal (P<0.001), rhinitis, family history more present in mothers (P=0.002) and in maternal aunts and uncles (P<0.02). Allergies were mostly present in mothers of asthmatic children (P=0.03). Children whose father, mother or both had asthma were significantly more numerous in asthmatic group (P=0.0007). A multiple correspondence analysis (MCA) identified two typical profiles of children, a first group of asthmatic children with positive modalities of family history, medical and environmental factors, a second, the control group (nA, non-asthmatic children), with essentially negative modalities of the variables. Logistic regression (LR) resulted in a final model which retained four significant predictors, rhinitis (P=0.01), atopic dermatitis (P=0.04), mother antecedents (P=0.03) and paternal uncle antecedents (P=0.008) with a globally appreciable predictive value (82%) of the Hosmer-Lemeshow Test. CONCLUSIONS These results allowed the drafting of a typical profile quantifying through a function of a few predictors, the variation of the probability for a child to develop an asthma.
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Affiliation(s)
- Mohamed Brahim Errahmani
- Department of Chemistry, Faculty of Science, Blida1 University, Blida, Algeria -
- Department of Cellular Biology, Faculty of Biological Sciences, Blida1 University, Blida, Algeria -
| | - Mériem Aichi
- Department of Cellular Biology, Faculty of Biological Sciences, Blida1 University, Blida, Algeria
| | - Mahdia Menaa
- Department of Cellular Biology, Faculty of Biological Sciences, Blida1 University, Blida, Algeria
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2
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Lee SW, Kim H, Byun Y, Baek YS, Choi CU, Kim JH, Kim K. Incidence of Cardiovascular Disease After Atopic Dermatitis Development: A Nationwide, Population-Based Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:231-245. [PMID: 37021508 PMCID: PMC10079521 DOI: 10.4168/aair.2023.15.2.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 04/07/2023]
Abstract
PURPOSE Despite increasing evidence for the potential association between atopic dermatitis (AD) and cardiovascular diseases (CVDs), results have still remained controversial. Therefore, this study investigated the association between AD and subsequent CVDs in adults newly diagnosed with AD. METHODS Datasets from the National Health Insurance Service-National Sample Cohort in South Korea from 2002 to 2015 were analyzed. The primary outcome was new-onset CVD, which included angina pectoris, myocardial infarction, stroke, or any revascularization procedure. The crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated in the AD group compared with the matched control group using the Cox proportional hazards regression models. RESULTS A total of 40,512 individuals with AD were matched with 40,512 control subjects without AD. The overall incidence of CVDs was 2,235 (5.5%) and 1,640 (4.1%) in the AD and matched control groups, respectively. In the adjusted model, AD was associated with an increased risk of CVDs (HR, 1.42; 95% CI, 1.33-1.52), angina pectoris (adjusted HR, 1.49; 95% CI, 1.36-1.63), myocardial infarction (adjusted HR, 1.40; 95% CI, 1.15-1.70), ischemic stroke (adjusted HR, 1.34; 95% CI, 1.20-1.49), and hemorrhagic stroke (adjusted HR, 1.26; 95% CI, 1.05-1.52). Most of the subgroup and sensitivity analysis results were consistent with those of the main analysis. CONCLUSIONS The current study found that adult patients newly diagnosed with AD were at significantly increased risk for subsequent CVDs, suggesting the need to consider early prevention strategies for CVDs targeting patients with AD.
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Affiliation(s)
- Seung Won Lee
- Institute of Pharmaceutical Science, Korea University, Sejong, Korea
| | - Hayeon Kim
- College of Pharmacy, Korea University, Sejong, Korea
| | - Youngjoo Byun
- Institute of Pharmaceutical Science, Korea University, Sejong, Korea
- College of Pharmacy, Korea University, Sejong, Korea
| | - Yoo Sang Baek
- Department of Dermatology, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- School of Pharmacy and Institute of New Drug Development, Jeonbuk National University, Jeonju, Korea
| | - Kyungim Kim
- Institute of Pharmaceutical Science, Korea University, Sejong, Korea
- College of Pharmacy, Korea University, Sejong, Korea.
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3
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Novak N, Worm M, Staubach P, Jutel M, Sager A, Pfaar O. Subcutaneous birch pollen allergen immunotherapy with a depigmented polymerized extract shows only sustained and long-term efficacy in a subgroup of monosensitized adults and adolescents with allergic rhinitis. Clin Transl Allergy 2022; 12:e12185. [PMID: 36225264 PMCID: PMC9533217 DOI: 10.1002/clt2.12185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/01/2022] [Indexed: 12/15/2022] Open
Abstract
Background Allergen immunotherapy (AIT) is an approved treatment for seasonal respiratory allergic diseases. A depigmented polymerized birch pollen extract for subcutaneous allergen immunotherapy (SCIT) has been demonstrated to be efficacious and safe in patients allergic to birch pollen and its homologous group. Objective To determine whether SCIT with a birch pollen formulation (5000 depigmented polymerized (DPP) units/mL) shows sustained and long‐term efficacy in adults and adolescents with birch‐pollen induced allergic rhinitis with or without intermittent asthma. Methods A multicentre (n = 66), double‐blind, placebo‐controlled Phase III clinical trial was performed in the Czech Republic, Finland, Germany, Latvia, Lithuania, Poland and Russia. Participants were randomized 2:1 to active treatment (birch 5000 DPP/ml) or placebo for three years of SCIT and followed up for two treatment‐free years. The primary efficacy endpoint was the EAACI's combined symptom and medication score for rhinoconjunctivitis (CSMSEAACI). Results A total of 973 participants were screened and 649 were randomized (active treatment: n = 434; placebo: n = 215). The intention‐to‐treat analysis of the CSMSEAACI in the overall study population did not demonstrate statistically significant differences in years 1, 2 and 3. In a post‐hoc analysis, among the subgroup of patients monosensitized to birch pollen allergen only (n = 200), we observed a statistically significant difference (active treatment vs. placebo) in the CSMSEAACI in year 2, 3 and 5. The AIT's safety profile was good. Conclusions SCIT with a depigmented polymerized birch pollen extract was safe. Sustained and long‐term efficacy in years 2, 3 and 5 in monosensitized patients, but not in polysensitized patients was demonstrated. (EudraCT 2012‐000414‐11)
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Affiliation(s)
- Natalija Novak
- Department of Dermatology and AllergologyUniversity of Bonn Medical CenterBonnGermany
| | - Margitta Worm
- Department of DermatologyAllergy and VenerologyDivision of Allergy and Immunology, CharitéUniversitätsmedizinBerlinGermany
| | - Petra Staubach
- Department of DermatologyUniversity Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Marek Jutel
- Department of Clinical ImmunologyWroclaw Medical UniversityWroclawPoland,ALL‐MED Medical Research InstituteWroclawPoland
| | | | - Oliver Pfaar
- Department of OtorhinolaryngologyHead and Neck SurgerySection of Rhinology and AllergyUniversity Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
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4
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Schäbitz A, Eyerich K, Garzorz-Stark N. So close, and yet so far away: The dichotomy of the specific immune response and inflammation in psoriasis and atopic dermatitis. J Intern Med 2021; 290:27-39. [PMID: 33428274 DOI: 10.1111/joim.13235] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/13/2020] [Accepted: 12/09/2020] [Indexed: 12/11/2022]
Abstract
Characterization of the complex interplay between cytokines, chemokines and microorganisms has led to a better understanding of the pathogenesis of both psoriasis and AD and resulted in new therapeutics targeting distinct immune responses. Psoriasis and AD share many characteristics: they are highly prevalent, chronic, cause primarily skin inflammation, but are associated with comorbidities, and come with a devastating quality of life due to itch and stigmatization. However, the pathogenesis of psoriasis and AD is opposing - psoriasis is dominated by a Th17 immune response that causes neutrophil migration, induction of innate immunity and exaggerated epithelial metabolism. Leading cytokines of this Th17 immune response are IL-17A and F, IL-22 and TNF-a. AD is characterized by Th2 immunity characterized by the signature cytokines IL-4 and IL-13 leading to an impaired epidermal barrier, dampened innate immunity and eosinophil migration. This review compares genetics, microbiome and T-cell infiltrate and resulting epithelial response in psoriasis and AD. Whilst the antagonistic course of psoriasis and AD is confirmed by response to specific biologics targeting the key cytokines of inflammation in psoriasis and AD, respectively, clinically overlapping phenotypes are challenging in our daily clinical practice. We conclude this review by summarizing what is known about these mixed phenotypes and how the identification of clinically relevant endotypes and molecular-driven decision-making is the next step in the field of dermato-immunology.
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Affiliation(s)
- A Schäbitz
- From the, Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - K Eyerich
- From the, Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology and Venereology, Unit of Dermatology, Karolinska University Hospital, Stockholm, Sweden.,Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
| | - N Garzorz-Stark
- From the, Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Dermatology and Allergy, Technical University of Munich, Munich, Germany
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5
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Renert-Yuval Y, Del Duca E, Pavel AB, Fang M, Lefferdink R, Wu J, Diaz A, Estrada YD, Canter T, Zhang N, Wagner A, Chamlin S, Krueger JG, Guttman-Yassky E, Paller AS. The molecular features of normal and atopic dermatitis skin in infants, children, adolescents, and adults. J Allergy Clin Immunol 2021; 148:148-163. [PMID: 33453290 DOI: 10.1016/j.jaci.2021.01.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/01/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although atopic dermatitis (AD) often presents in infancy and persists into adulthood, comparative characterization of AD skin among different pediatric age groups is lacking. OBJECTIVE We sought to define skin biopsy profiles of lesional and nonlesional AD across different age groups (0-5-year-old infants with disease duration <6 months, 6-11-year-old children, 12-17-year-old adolescents, ≥18-year-old adults) versus age-appropriate controls. METHODS We performed gene expression analyses by RNA-sequencing and real-time PCR (RT-PCR) and protein expression analysis using immunohistochemistry. RESULTS TH2/TH22 skewing, including IL-13, CCL17/thymus and activation-regulated chemokine, IL-22, and S100As, characterized the common AD signature, with a global pathway-level enrichment across all ages. Nevertheless, specific cytokines varied widely. For example, IL-33, IL-1RL1/IL-33R, and IL-9, often associated with early atopic sensitization, showed greatest upregulations in infants. TH17 inflammation presented a 2-peak curve, with highest increases in infants (including IL-17A and IL-17F), followed by adults. TH1 polarization was uniquely detected in adults, even when compared with adolescents, with significant upregulation in adults of IFN-γ and CXCL9/CXCL10/CXCL11. Although all AD age groups had barrier abnormalities, only adults had significant decreases in filaggrin expression. Despite the short duration of the disease, infant AD presented robust downregulations of multiple barrier-related genes in both lesional and nonlesional skin. Clinical severity scores significantly correlated with TH2/TH22-related markers in all pediatric age groups. CONCLUSIONS The shared signature of AD across ages is TH2/TH22-skewed, yet differential expression of specific TH2/TH22-related genes, other TH pathways, and barrier-related genes portray heterogenetic, age-specific molecular fingerprints.
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Affiliation(s)
- Yael Renert-Yuval
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY; Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ester Del Duca
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Dermatology, University Magna Graecia, Catanzaro, Italy
| | - Ana B Pavel
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Biomedical Engineering, University of Mississippi, Oxford, Miss
| | - Milie Fang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Rachel Lefferdink
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jianni Wu
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Aisleen Diaz
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yeriel D Estrada
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Talia Canter
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Ning Zhang
- Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Annette Wagner
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Sarah Chamlin
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - James G Krueger
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY
| | - Emma Guttman-Yassky
- Laboratory for Investigative Dermatology, The Rockefeller University, New York, NY; Department of Dermatology and Laboratory of Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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6
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Paller A, Jaworski JC, Simpson EL, Boguniewicz M, Russell JJ, Block JK, Tofte S, Dunn JD, Feldman SR, Clark AR, Schwartz G, Eichenfield LF. Major Comorbidities of Atopic Dermatitis: Beyond Allergic Disorders. Am J Clin Dermatol 2018; 19:821-838. [PMID: 30168085 DOI: 10.1007/s40257-018-0383-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The consequences of atopic dermatitis reach beyond the skin and past childhood. Patients with atopic dermatitis are at risk of developing allergic comorbidities, but less is known about the associations between atopic dermatitis and non-allergic conditions. Understanding these non-allergic comorbidities has the potential to improve patient outcomes and to help mitigate the cost and burdens associated with these conditions. Atopic dermatitis is associated with cutaneous bacterial infections, more severe forms/courses of cutaneous viral infections, and extra-cutaneous infections. Atopic dermatitis is also associated with several mental health comorbidities particularly attention-deficit hyperactivity disorder, anxiety, and depression. Data are largely inconsistent for specific cancers, but atopic dermatitis appears to protect against malignancy overall; severe long-term atopic dermatitis is associated with adult lymphomas. Atopic dermatitis may also be associated with obesity, cardiovascular disease, and autoimmune disease, particularly alopecia areata and gastrointestinal immune-mediated disorders. Although the causative mechanisms underlying these associations are poorly understood, treating physicians should be aware of associations in seeking to alleviate the burden for patients with atopic dermatitis.
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7
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Tabetri™ ( Tabebuia avellanedae Ethanol Extract) Ameliorates Atopic Dermatitis Symptoms in Mice. Mediators Inflamm 2018; 2018:9079527. [PMID: 29736153 PMCID: PMC5874978 DOI: 10.1155/2018/9079527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 01/03/2018] [Indexed: 11/24/2022] Open
Abstract
Tabebuia avellanedae has been traditionally used as an herbal remedy to alleviate various diseases. However, the plant's pharmacological activity in allergic and inflammatory diseases and its underlying mechanism are not fully understood. Therefore, we investigated the pharmacological activity of Tabetri (T. avellanedae ethanol extract (Ta-EE)) in the pathogenesis of AD. Its underlying mechanism was explored using an AD mouse model and splenocytes isolated from this model. Ta-EE ameliorated the AD symptoms without any toxicity and protected the skin of 2,4-dinitrochlorobenzene- (DNCB-) induced AD mice from damage and epidermal thickness. Ta-EE reduced the secreted levels of allergic and proinflammatory cytokines, including histamine, immunoglobulin E (IgE), interleukin- (IL-) 4, and interferon-gamma (IFN-γ) in the DNCB-induced AD mice. Ta-EE suppressed the mRNA expression of T helper 2-specific cytokines, IL-4 and IL-5, and the proinflammatory cytokine IFN-γ in the atopic dermatitis skin lesions of AD mice. Moreover, Ta-EE suppressed the mRNA expression of IL-4, IL-5, IFN-γ, and another proinflammatory cytokine, IL-12, in the Con A-stimulated splenocytes. It also suppressed IL-12 and IFN-γ in the LPS-stimulated splenocytes. Taken together, these results suggest that Ta-EE protects against the development of AD through the inhibition of mRNA expression of T helper 2-specific cytokines and other proinflammatory cytokines.
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8
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Czarnowicki T, Krueger JG, Guttman-Yassky E. Novel concepts of prevention and treatment of atopic dermatitis through barrier and immune manipulations with implications for the atopic march. J Allergy Clin Immunol 2017; 139:1723-1734. [PMID: 28583445 DOI: 10.1016/j.jaci.2017.04.004] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/07/2017] [Accepted: 04/13/2017] [Indexed: 12/16/2022]
Abstract
Skin barrier abnormalities have been suggested to play an essential role in initiation of early atopic dermatitis (AD). Antigen penetration through a compromised barrier likely leads to increased innate immune responses, antigen-presenting cell stimulation, and priming of overt cutaneous disease. In a TH2-promoting environment, T-cell/B-cell interactions occurring in regional lymph nodes lead to excessive IgE switch. Concurrent redistribution of memory T cells into the circulation not only leads to exacerbation of AD through T-cell skin infiltration but also spreads beyond the skin to initiate the atopic march, which includes food allergy, asthma, and allergic rhinitis. Possible primary interventions to prevent AD are focusing on improving skin barrier integrity, including supplementing barrier function with moisturizers. As for secondary prophylaxis in children with established AD, this can be stratified into prevention of disease exacerbations by using proactive approaches (with either topical corticosteroids or topical calcineurin inhibitors) in mild AD cases or the prevention of other atopic disorders that will probably mandate systemic immunosuppression in severe AD cases.
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Affiliation(s)
- Tali Czarnowicki
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - James G Krueger
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY
| | - Emma Guttman-Yassky
- Department of Dermatology and the Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY; Laboratory for Investigative Dermatology, Rockefeller University, New York, NY.
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9
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Udkoff J, Waldman A, Ahluwalia J, Borok J, Eichenfield LF. Current and emerging topical therapies for atopic dermatitis. Clin Dermatol 2017; 35:375-382. [DOI: 10.1016/j.clindermatol.2017.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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LeBovidge JS, Elverson W, Timmons KG, Hawryluk EB, Rea C, Lee M, Schneider LC. Multidisciplinary interventions in the management of atopic dermatitis. J Allergy Clin Immunol 2017; 138:325-34. [PMID: 27497275 DOI: 10.1016/j.jaci.2016.04.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 12/30/2022]
Abstract
Atopic dermatitis (AD) is the most common pediatric skin disease. AD has a significant effect on patient and family quality of life caused by intense pruritus, sleep disruption, dietary and nutritional concerns, and psychological stress associated with the disease and its management. Multidisciplinary approaches to AD care have been developed in appreciation of the complex interplay among biological, psychological, behavioral, and dietary factors that affect disease control and the wide range of knowledge, skills, and support that patients and families require to effectively manage and cope with this condition. Common components of multidisciplinary treatment approaches include medical evaluation and management by an AD specialist, education and nursing care, psychological and behavioral support, and nutritional assessment and guidance. Models of care include both clinical programs and structured educational groups provided as adjuncts to standard clinical care. Available evidence suggests beneficial effects of multidisciplinary interventions in improving disease severity and quality of life, particularly for patients with moderate-to-severe disease. Additional research is needed to identify the best candidates for the various multidisciplinary approaches and evaluate the cost-effectiveness of these programs.
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Affiliation(s)
- Jennifer S LeBovidge
- Allergy Program, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Wendy Elverson
- Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Mass
| | - Karol G Timmons
- Allergy Program, Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Elena B Hawryluk
- Harvard Medical School, Boston, Mass; Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Dermatology, Massachusetts General Hospital, Boston, Mass
| | - Corinna Rea
- Harvard Medical School, Boston, Mass; Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Mass
| | - Margaret Lee
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Dermatology, Boston University School of Medicine, Boston, Mass
| | - Lynda C Schneider
- Allergy Program, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
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11
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Esaki H, Brunner PM, Renert-Yuval Y, Czarnowicki T, Huynh T, Tran G, Lyon S, Rodriguez G, Immaneni S, Johnson DB, Bauer B, Fuentes-Duculan J, Zheng X, Peng X, Estrada YD, Xu H, de Guzman Strong C, Suárez-Fariñas M, Krueger JG, Paller AS, Guttman-Yassky E. Early-onset pediatric atopic dermatitis is T H 2 but also T H 17 polarized in skin. J Allergy Clin Immunol 2016; 138:1639-1651. [DOI: 10.1016/j.jaci.2016.07.013] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/17/2016] [Accepted: 07/04/2016] [Indexed: 12/20/2022]
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12
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Brunner PM, Silverberg JI, Guttman-Yassky E, Paller AS, Kabashima K, Amagai M, Luger TA, Deleuran M, Werfel T, Eyerich K, Stingl G. Increasing Comorbidities Suggest that Atopic Dermatitis Is a Systemic Disorder. J Invest Dermatol 2016; 137:18-25. [PMID: 27771048 DOI: 10.1016/j.jid.2016.08.022] [Citation(s) in RCA: 267] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 08/04/2016] [Accepted: 08/19/2016] [Indexed: 12/12/2022]
Abstract
Atopic dermatitis comorbidities extend well beyond the march to allergic conditions (food allergy, asthma, allergic rhinitis, allergic conjunctivitis, and eosinophilic esophagitis), suggesting both cutaneous and systemic immune activation. In reviewing atopic dermatitis comorbidities, Councilors of the International Eczema Council found a strong pattern of immune activation in peripheral blood and the propensity to both skin and systemic infections. Associations with cardiovascular, neuropsychiatric, and malignant diseases were increasingly reported, but confirmation of their link with atopic dermatitis requires longitudinal studies. Given the possibility of atopic dermatitis-related systemic immune activation, future investigations of new interventions should concurrently examine the impact on these comorbidities.
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Affiliation(s)
- Patrick M Brunner
- The Laboratory for Investigative Dermatology, The Rockefeller University, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emma Guttman-Yassky
- Department of Dermatology and the Laboratory for Inflammatory Skin Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy S Paller
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masayuki Amagai
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
| | - Thomas A Luger
- Department of Dermatology, University of Münster, Münster, Germany
| | - Mette Deleuran
- Department of Dermato-Venereology, Aarhus University Hospital, Aarhus C, Denmark
| | - Thomas Werfel
- Division of Immunodermatology and Allergy Research, Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Kilian Eyerich
- Department of Dermatology and Allergy, Technical University Munich, Munich, Germany
| | - Georg Stingl
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria
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13
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Bryce PJ. Balancing Tolerance or Allergy to Food Proteins. Trends Immunol 2016; 37:659-667. [PMID: 27600681 DOI: 10.1016/j.it.2016.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/09/2016] [Accepted: 08/10/2016] [Indexed: 01/22/2023]
Abstract
Dietary proteins usually induce immune tolerance, but may trigger life-threatening immune responses in the case of food allergy. The associated type 2 immunity, linked with specific IgE production and the activation of mast cells and basophils, is well understood but the mechanisms related to preventing food allergy are still being deciphered. Recent insights into the mechanisms that regulate oral tolerance and dietary antigen sampling have revealed unique regulatory events that occur during early life and into adulthood. Drawing from both recent clinical and experimental discoveries, this article focuses on current evidence for how several key stages of life present mechanistic points that might participate in tipping the balance between food protein tolerance and allergy.
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Affiliation(s)
- Paul J Bryce
- Division of Allergy-Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, 240 East Huron, Chicago, IL 60611, USA.
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Bao L, Alexander JB, Shi VY, Mohan GC, Chan LS. Interleukin-4 up-regulation of epidermal interleukin-19 expression in keratinocytes involves the binding of signal transducer and activator of transcription 6 (Stat6) to the imperfect Stat6 sites. Immunology 2015; 143:601-8. [PMID: 24943510 DOI: 10.1111/imm.12339] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/12/2014] [Accepted: 06/13/2014] [Indexed: 01/21/2023] Open
Abstract
Interleukin-19 (IL-19) plays an important role in asthma by stimulating T helper type 2 (Th2) cytokine production. Interestingly, IL-4, a key Th2 cytokine, in turn up-regulates IL-19 expression in bronchial epithelial cells, so forming a positive feedback loop. In atopic dermatitis (AD), another Th2 disease closely related to asthma, IL-19 is up-regulated in the skin. We propose to use IL-4 transgenic (Tg) mice and human keratinocyte culture to delineate the molecular mechanisms involved in the up-regulation of IL-19 in AD. IL-19 is similarly up-regulated in the skin of IL-4 Tg mice as in human AD. Next we show that IL-4 up-regulates IL-19 expression in keratinocytes. Interestingly, the up-regulation was suppressed by a pan-Janus kinase (Jak) inhibitor, suggesting that the Jak-signal transducer and activator of transcription (Jak-STAT) pathway may be involved. Dominant negative studies further indicate that STAT6, but not other STATs, mediates the up-regulation. Serial 5' deletion of the IL-19 promoter and mutagenesis studies demonstrate that IL-4 up-regulation of IL-19 in keratinocytes involves two imperfect STAT6 response elements. Finally, chromatin immunoprecipitation assay studies indicate that IL-4 increases the binding of STAT6 to its response elements in the IL-19 promoter. Taken together, we delineate the detailed molecular pathway for IL-4 up-regulation of IL-19 in keratinocytes, which may play an important role in AD pathogenesis.
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Affiliation(s)
- Lei Bao
- Department of Dermatology, University of Illinois, Chicago, IL, USA
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Di Lernia V. Therapeutic strategies in extrinsic atopic dermatitis: focus on inhibition of IL-4 as a new pharmacological approach. Expert Opin Ther Targets 2014; 19:87-96. [PMID: 25283256 DOI: 10.1517/14728222.2014.965682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Recent data about atopic dermatitis (AD) pathogenesis postulate that T cells and their related cytokines and chemokines are primarily responsible for the inflammatory responses. AREAS COVERED AD, the primary complex disease associated with filaggrin deficiency, is characterized by cutaneous inflammation driven by type 2 helper T (TH2) cells. TH2-related molecules, such as IL-4, IL-13, dominate the immune infiltrate. Experimental evidences suggest that these cytokines may be considered attractive therapeutic targets in AD, particularly in extrinsic AD with IgE overproduction. Recently, a fully human monoclonal antibody directed against the IL-4 receptor α subunit blocking IL-4 and IL-13 signaling has been evaluated in Phase I and Phase II clinical trials in patients with moderate-to-severe AD with significant improvement in disease severity. Phase III trials are ongoing. EXPERT OPINION Treatment of AD represents a therapeutic challenge. TH2 cytokine-targeted therapies represent promising treatment options that could improve the therapeutic armamentarium for AD. These therapies are likely to become future therapeutic options in AD, particularly in the extrinsic AD.
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Affiliation(s)
- Vito Di Lernia
- Arcispedale Santa Maria Nuova-IRCCS, Dermatology Unit , viale Risorgimento 68, 42123 Reggio Emilia , Italy
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Clinical Management of Atopic Dermatitis: Practical Highlights and Updates from the Atopic Dermatitis Practice Parameter 2012. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:361-9; quiz 370. [DOI: 10.1016/j.jaip.2014.02.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 02/25/2014] [Accepted: 02/26/2014] [Indexed: 11/20/2022]
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Lin JF, Liu PH, Huang TP, Lien ASY, Ou LS, Yu CH, Yang SL, Chang HH, Yen HR. Characteristics and prescription patterns of traditional Chinese medicine in atopic dermatitis patients: ten-year experiences at a medical center in Taiwan. Complement Ther Med 2013; 22:141-7. [PMID: 24559829 DOI: 10.1016/j.ctim.2013.12.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 09/26/2013] [Accepted: 12/03/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Complementary and alternative therapies in treating atopic dermatitis are not uncommon. However, substantial evidence and consensus on treating atopic dermatitis is lacking. The aim of this study is to investigate the characteristics and utilization of traditional Chinese medicine in patients with atopic dermatitis. DESIGN We retrospectively collected patients with atopic dermatitis at the Chang Gung Memorial Hospital in Taiwan between 2002 and 2011. Patients' demographic data, duration and frequency of treatment, serum total immunoglobulin E levels, and traditional Chinese medicine treatment principles and prescription were analyzed. RESULTS There were 4145 patients (8.8%) received traditional Chinese medicine therapy between 2002 and 2011. Among them, 2841 (68.54%) chose TCM only and 1304 (31.46%) chose to combine TCM and WM therapies. Those who chose combination therapy were younger, and needed more times of visit and longer duration of treatment. The most frequent comorbid conditions accompany atopic dermatitis were allergic rhinitis (46.06%) and asthma (21.46%). Among the 87,573 prescriptions written for Chinese medicine, the most frequently prescribed herbal formula and single herb were Xiao-Feng-San (Eliminate Wind Powder) (16.98%) and Bai-Xian-Pi (Cortex Dictamni) (12.68%), respectively. The most commonly used therapeutic principles of herbal formulas and single herbs were releasing exterior (20.23%) and clearing heat (41.93%), respectively. CONCLUSION Our hospital-based study characterized the utilization patterns of traditional Chinese medicine in atopic dermatitis patients. This information could be used as references for clinical application and provide valuable information for future clinical trials.
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Affiliation(s)
- Jing-Fan Lin
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Pi-Hua Liu
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tzu-Ping Huang
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Angela Shin-Yu Lien
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Liang-Shiou Ou
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chin-Hui Yu
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Shu-Ling Yang
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hen-Hong Chang
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Hung-Rong Yen
- Department of Traditional Chinese Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan; School of Chinese Medicine, China Medical University, Taichung 404, Taiwan.
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Eichenfield LF. Perspectives in atopic dermatitis-optimizing outcomes: introduction. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2012; 31:S1-S2. [PMID: 23021779 DOI: 10.1016/j.sder.2012.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Lawrence F Eichenfield
- University of California, San Diego School of Medicine, Rady Children's Hospital, San Diego, California, USA
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