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Runnstrom MC, Lamothe PA, Faliti CE, Cheedarla N, Moreno A, Suthar MS, Nahata R, Ravindran M, Haddad NS, Morrison-Porter A, Quehl H, Ramonell RP, Woodruff M, Anam F, Zhang R, Swenson C, Polito C, Neveu W, Patel R, Smirnova N, Nguyen DC, Kim C, Hentenaar I, Kyu S, Usman S, Ngo T, Guo Z, Wu H, Daiss JL, Park J, Manning KE, Wali B, Ellis ML, Sharma S, Holguin F, Cheedarla S, Neish AS, Roback JD, Sanz I, Eun-Hyung Lee F. Patients taking benralizumab, dupilumab, or mepolizumab have lower postvaccination SARS-CoV-2 immunity. J Allergy Clin Immunol 2024:S0091-6749(24)00420-2. [PMID: 38878020 DOI: 10.1016/j.jaci.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Biologic therapies inhibiting the IL-4 or IL-5 pathways are very effective in the treatment of asthma and other related conditions. However, the cytokines IL-4 and IL-5 also play a role in the generation of adaptive immune responses. Although these biologics do not cause overt immunosuppression, their effect in primary severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunization has not been studied completely. OBJECTIVE Our aim was to evaluate the antibody and cellular immunity after SARS-CoV-2 mRNA vaccination in patients on biologics (PoBs). METHODS Patients with severe asthma or atopic dermatitis who were taking benralizumab, dupilumab, or mepolizumab and had received the initial dose of the 2-dose adult SARS-CoV-2 mRNA vaccine were enrolled in a prospective, observational study. As our control group, we used a cohort of immunologically healthy subjects (with no significant immunosuppression) who were not taking biologics (NBs). We used a multiplexed immunoassay to measure antibody levels, neutralization assays to assess antibody function, and flow cytometry to quantitate Spike-specific lymphocytes. RESULTS We analyzed blood from 57 patients in the PoB group and 46 control subjects from the NB group. The patients in the PoB group had lower levels of SARS-CoV-2 antibodies, pseudovirus neutralization, live virus neutralization, and frequencies of Spike-specific B and CD8 T cells at 6 months after vaccination. In subgroup analyses, patients with asthma who were taking biologics had significantly lower pseudovirus neutralization than did subjects with asthma who were not taking biologics. CONCLUSION The patients in the PoB group had reduced SARS-CoV-2-specific antibody titers, neutralizing activity, and virus-specific B- and CD8 T-cell counts. These results have implications when considering development of a more individualized immunization strategy in patients who receive biologic medications blocking IL-4 or IL-5 pathways.
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Affiliation(s)
- Martin C Runnstrom
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Department of Medicine, Atlanta Veterans Affairs Healthcare System, Atlanta, Ga
| | - Pedro A Lamothe
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Caterina E Faliti
- Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Lowance Center for Human Immunology, Atlanta, Ga
| | - Narayanaiah Cheedarla
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Alberto Moreno
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Yerkes National Primate Research Center, Atlanta, Ga
| | - Mehul S Suthar
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Ga; Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Rishika Nahata
- Emory College of Arts and Sciences, Emory University, Atlanta, Ga
| | - Mayuran Ravindran
- J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, Ga
| | - Natalie S Haddad
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Andrea Morrison-Porter
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Hannah Quehl
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Richard P Ramonell
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Matthew Woodruff
- Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Lowance Center for Human Immunology, Atlanta, Ga
| | - Fabliha Anam
- Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Lowance Center for Human Immunology, Atlanta, Ga
| | - Rebeca Zhang
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Ga
| | - Colin Swenson
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Carmen Polito
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Wendy Neveu
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Rahulkumar Patel
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Natalia Smirnova
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Doan C Nguyen
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Lowance Center for Human Immunology, Atlanta, Ga
| | - Caroline Kim
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Ian Hentenaar
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Shuya Kyu
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Sabeena Usman
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Thuy Ngo
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Zhenxing Guo
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Ga
| | - Hao Wu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Ga
| | - John L Daiss
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Jiwon Park
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Kelly E Manning
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Ga; Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Bursha Wali
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Ga; Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Madison L Ellis
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, Ga; Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga
| | - Sunita Sharma
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Denver, Colo
| | - Fernando Holguin
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Denver, Colo
| | - Suneethamma Cheedarla
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Andrew S Neish
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Ga
| | - John D Roback
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Ga
| | - Ignacio Sanz
- Division of Rheumatology, Department of Medicine, Emory University School of Medicine, Atlanta, Ga; Lowance Center for Human Immunology, Atlanta, Ga
| | - F Eun-Hyung Lee
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Ga.
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Saito-Abe M, Yamamoto-Hanada K, Shoji K, Sato M, Irahara M, Taniguchi Y, Sekiyama M, Mise N, Ikegami A, Shimono M, Suga R, Sanefuji M, Ohga S, Oda M, Mitsubuchi H, Miyairi I, Ohya Y. Measles antibody seropositivity among children with allergic diseases: A cross-sectional study in the Japan Environment & Children's Pilot Study. PLoS One 2021; 16:e0257721. [PMID: 34551012 PMCID: PMC8457502 DOI: 10.1371/journal.pone.0257721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
Background The relationship between allergic individuals and their responsiveness to routine vaccines has rarely been investigated. This study examined whether the seroprevalence of measles antibody differed between children with and without allergic diseases in the general pediatric population. Methods The cross-sectional study was performed within a prospective general birth cohort (a pilot study of the Japan Environment & Children’s Pilot Study [JECS]) of children aged 8 years. The clinical history of allergic diseases, measles, and the concentration of measles immunoglobulin G titers in serum enzyme immunoassay were examined. Fisher’s exact tests were used to assess the relationships between the allergic characteristics of the children and their measles antibody positivity rates. Results This study included 162 children. Any allergic disease was reported in 75 (46.3%). The measles antibody positivity rate was 94.7% among children with any allergic diseases and 92.0% among children without allergic diseases. Our results revealed no differences in measles antibody seropositivity between children with allergies and controls. Conclusions Children with allergies mount and maintain a comparable immune response to the measles vaccine.
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Affiliation(s)
- Mayako Saito-Abe
- Medical Support Center for the Japan Environment and Children’s Study, National Center for Child Health and Development, Tokyo, Japan
- * E-mail:
| | - Kiwako Yamamoto-Hanada
- Medical Support Center for the Japan Environment and Children’s Study, National Center for Child Health and Development, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Miori Sato
- Medical Support Center for the Japan Environment and Children’s Study, National Center for Child Health and Development, Tokyo, Japan
| | - Makoto Irahara
- Medical Support Center for the Japan Environment and Children’s Study, National Center for Child Health and Development, Tokyo, Japan
| | - Yu Taniguchi
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Ibaraki, Japan
| | - Makiko Sekiyama
- Japan Environment and Children’s Study Programme Office, National Institute for Environmental Studies, Ibaraki, Japan
| | - Nathan Mise
- Department of Environmental and Preventive Medicine, Jichi Medical University, Tochigi, Japan
| | - Akihiko Ikegami
- Department of Environmental and Preventive Medicine, Jichi Medical University, Tochigi, Japan
| | - Masayuki Shimono
- Regional Center for Pilot Study of Japan Environment and Children’s Study, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Reiko Suga
- Regional Center for Pilot Study of Japan Environment and Children’s Study, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Masafumi Sanefuji
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masako Oda
- Department of Public Health, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Mitsubuchi
- Department of Neonatology, Kumamoto University Hospital, Kumamoto, Japan
| | - Isao Miyairi
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Yukihiro Ohya
- Medical Support Center for the Japan Environment and Children’s Study, National Center for Child Health and Development, Tokyo, Japan
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3
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Sheen YH, Kizilbash S, Ryoo E, Wi CI, Park M, Abraham RS, Ryu E, Divekar R, Juhn Y. Relationship between asthma status and antibody response pattern to 23-valent pneumococcal vaccination. J Asthma 2019; 57:381-390. [PMID: 30784333 DOI: 10.1080/02770903.2019.1575394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective: Asthma poses an increased risk for serious pneumococcal disease, but little is known about the influence of asthma status on the 23-valent serotype-specific pneumococcal antibody response. We examined differences in antibody titers between pre- and post-vaccination with 23-valent pneumococcal polysaccharide vaccine (PPSV-23) in relation to asthma status. Methods: Asthma status was retrospectively ascertained by the Predetermined Asthma Criteria in an existing vaccine cohort through comprehensive medical record review. Twenty-three serotype-specific pneumococcal antibody titers measured at baseline and 4-6 weeks post-vaccination were analyzed. Vaccine responses to PPSV-23 were calculated from pre- to post-vaccine titers for each of the serotypes. Results: Of the 64 eligible and enrolled subjects, 18 (28%) had asthma. Controls (i.e., subjects without asthma) demonstrated a statistically significant fold change response compared to their baseline for all serotypes, while those with asthma did not mount a significant response to serotypes 7F, 22F, and 23F. The overall vaccine response as measured by fold change over baseline was lower in subjects with asthma than controls. Conclusions: Poorer humoral immune responses to PPSV-23 as measured by fold change were more likely to be observed in subjects with asthma compared to controls. We recommend the consideration of asthma status when interpreting vaccine response for immune competence workup through larger studies. Further studies are warranted to replicate these findings.
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Affiliation(s)
- Youn H Sheen
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, CHA University School of Medicine, Seoul, Korea
| | - Sarah Kizilbash
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, School of Medicine, University of Minnesota, Twin Cities, MN, USA
| | - Eell Ryoo
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Pediatrics, Gil Hospital, Gachon University, Incheon, Korea
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
| | - Roshini S Abraham
- Division of Clinical Biochemistry and Immunology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Euijung Ryu
- Department of Health Sciences and Research, Mayo Clinic, Rochester, MN, USA
| | - Rohit Divekar
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN, USA
| | - Young Juhn
- Department of Pediatric and Adolescent Medicine/Internal Medicine, Mayo Clinic, Rochester, MN, USA
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4
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Totten AH, Xiao L, Luo D, Briles D, Hale JY, Crabb DM, Schoeb TR, Alishlash AS, Waites KB, Atkinson TP. Allergic airway sensitization impairs antibacterial IgG antibody responses during bacterial respiratory tract infections. J Allergy Clin Immunol 2018; 143:1183-1197.e7. [PMID: 30092287 DOI: 10.1016/j.jaci.2018.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 06/02/2018] [Accepted: 07/24/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae, an atypical human pathogen, has been associated with asthma initiation and exacerbation. Asthmatic patients have been reported to have higher carriage rates of M pneumoniae compared with nonasthmatic subjects and are at greater risk for invasive respiratory infections. OBJECTIVE We sought to study whether prior allergen sensitization affects the host response to chronic bacterial infection. METHODS BALB/cJ and IL-4 receptor α-/- mice were sensitized with ovalbumin (OVA) and then infected with M pneumoniae or Streptococcus pneumoniae. Immune parameters were analyzed at 30 days postinfection and included cellular profiles in bronchoalveolar lavage fluid (BALF) and serum IgG and IgE antibody levels to whole bacterial lysate, recombinant P1 adhesin, and OVA. Total lung RNA was examined for transcript levels, and BALF was examined for cytokine protein profiles. RESULTS Anti-M pneumoniae antibody responses were decreased in allergen-sensitized, M pneumoniae-infected animals compared with control animals, but OVA-specific IgG responses were unaffected. Similar decreases in anti-S pneumoniae antibody levels were found in OVA-sensitized animals. However, M pneumoniae, but not S pneumoniae, infection augmented anti-OVA IgE antibody responses. Loss of IL-4 receptor signaling partially restored anti-M pneumoniae antibody responses in IgG2a and IgG2b subclasses. Inflammatory cytokine levels in BALF from OVA-sensitized, M pneumoniae-infected or S pneumoniae-infected animals were reduced compared with those in uninfected OVA-sensitized control animals. Unexpectedly, airway hyperreactivity to methacholine was essentially ablated in M pneumoniae-infected, OVA-sensitized animals. CONCLUSIONS An established type 2-biased host immune response impairs the host immune response to respiratory bacterial infection in a largely pathogen-independent manner. Some pathogens, such as M pneumoniae, can augment ongoing allergic responses and inhibit pulmonary type 2 cytokine responses and allergic airway hyperreactivity.
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Affiliation(s)
- Arthur H Totten
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - Li Xiao
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Ala
| | - Danlin Luo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala
| | - David Briles
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Joanetha Y Hale
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, Ala
| | - Donna M Crabb
- Department of Pathology, Diagnostic Mycoplasma Laboratory, University of Alabama at Birmingham, Birmingham, Ala
| | - Trenton R Schoeb
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Ala
| | | | - Ken B Waites
- Department of Pathology, Diagnostic Mycoplasma Laboratory, University of Alabama at Birmingham, Birmingham, Ala
| | - T Prescott Atkinson
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Ala.
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Patel B, Wi CI, Hasassri ME, Divekar R, Absah I, Almallouhi E, Ryu E, King K, Juhn YJ. Heterogeneity of asthma and the risk of celiac disease in children. Allergy Asthma Proc 2018; 39:51-58. [PMID: 29279060 DOI: 10.2500/aap.2018.39.4100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although human leukocyte antigen (HLA)-DR and HLA-DQ genes and gluten play crucial roles in developing celiac disease (CD), most patients with these risk factors still do not develop CD, which indicates additional unrecognized risk factors. OBJECTIVE To determine the association between asthma and the risk of CD in children. METHODS We conducted a population-based retrospective case-control study in children who resided in Olmsted County, Minnesota. We identified children with CD (cases) between January 1, 1997, and December 31, 2014, and compared these with children without CD (controls) (1:2 matching). Asthma status was ascertained by using the predetermined asthma criteria (PAC) and the asthma predictive index (API). Data analysis included conditional logistic regression models and an unsupervised network analysis by using an independent phenome-wide association scan (PheWAS) data set. RESULTS Although asthma status as determined by using PAC was not associated with the risk of CD (odds ratio [OR] 1.4 [95% confidence interval {CI}, 0.8-2.5]; p = 0.2), asthma status by using the API was significantly associated (OR 2.8 [95% CI, 1.3-6.0]; p = 0.008). A subgroup analysis indicated that children with both asthma as determined by using PAC and a family history of asthma had an increased risk of CD compared with those without asthma (OR 2.28 [95% CI, 1.11-4.67]; p = 0.024). PheWAS data showed a cluster of asthma single nucleotide polymorphisms and patients with CD. CONCLUSION A subgroup of children with asthma who also had a family history of asthma seemed to be at an increased risk of CD, and, thus, the third factor that underlies the risk of CD might be related to genetic factors for asthma. Heterogeneity of asthma plays a role in determining the risk of asthma-related comorbidity.
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6
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Wi CI, Sohn S, Ali M, Krusemark E, Ryu E, Liu H, Juhn YJ. Natural Language Processing for Asthma Ascertainment in Different Practice Settings. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2018; 6:126-131. [PMID: 28634104 PMCID: PMC5733699 DOI: 10.1016/j.jaip.2017.04.041] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/20/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND We developed and validated NLP-PAC, a natural language processing (NLP) algorithm based on predetermined asthma criteria (PAC) for asthma ascertainment using electronic health records at Mayo Clinic. OBJECTIVE To adapt NLP-PAC in a different health care setting, Sanford Children Hospital, by assessing its external validity. METHODS The study was designed as a retrospective cohort study that used a random sample of 2011-2012 Sanford Birth cohort (n = 595). Manual chart review was performed on the cohort for asthma ascertainment on the basis of the PAC. We then used half of the cohort as a training cohort (n = 298) and the other half as a blind test cohort to evaluate the adapted NLP-PAC algorithm. Association of known asthma-related risk factors with the Sanford-NLP algorithm-driven asthma ascertainment was tested. RESULTS Among the eligible test cohort (n = 297), 160 (53%) were males, 268 (90%) white, and the median age was 2.3 years (range, 1.5-3.1 years). NLP-PAC, after adaptation, and the human abstractor identified 74 (25%) and 72 (24%) subjects, respectively, with 66 subjects identified by both approaches. Sensitivity, specificity, positive predictive value, and negative predictive value for the NLP algorithm in predicting asthma status were 92%, 96%, 89%, and 97%, respectively. The known risk factors for asthma identified by NLP (eg, smoking history) were similar to the ones identified by manual chart review. CONCLUSIONS Successful implementation of NLP-PAC for asthma ascertainment in 2 different practice settings demonstrates the feasibility of automated asthma ascertainment leveraging electronic health record data with a potential to enable large-scale, multisite asthma studies to improve asthma care and research.
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Affiliation(s)
- Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn
| | - Sunghwan Sohn
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Mir Ali
- Department of Pediatrics, Sanford Children's Hospital, Sioux Falls, SD
| | - Elizabeth Krusemark
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn
| | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Hongfang Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn.
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn.
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7
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Sohn S, Wang Y, Wi CI, Krusemark EA, Ryu E, Ali MH, Juhn YJ, Liu H. Clinical documentation variations and NLP system portability: a case study in asthma birth cohorts across institutions. J Am Med Inform Assoc 2017; 25:353-359. [PMID: 29202185 PMCID: PMC7378885 DOI: 10.1093/jamia/ocx138] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/20/2017] [Accepted: 10/25/2017] [Indexed: 12/11/2022] Open
Abstract
Objective To assess clinical documentation variations across health care institutions using different electronic medical record systems and investigate how they affect natural language processing (NLP) system portability. Materials and Methods Birth cohorts from Mayo Clinic and Sanford Children’s Hospital (SCH) were used in this study (n = 298 for each). Documentation variations regarding asthma between the 2 cohorts were examined in various aspects: (1) overall corpus at the word level (ie, lexical variation), (2) topics and asthma-related concepts (ie, semantic variation), and (3) clinical note types (ie, process variation). We compared those statistics and explored NLP system portability for asthma ascertainment in 2 stages: prototype and refinement. Results There exist notable lexical variations (word-level similarity = 0.669) and process variations (differences in major note types containing asthma-related concepts). However, semantic-level corpora were relatively homogeneous (topic similarity = 0.944, asthma-related concept similarity = 0.971). The NLP system for asthma ascertainment had anF-score of 0.937 at Mayo, and produced 0.813 (prototype) and 0.908 (refinement) when applied at SCH. Discussion The criteria for asthma ascertainment are largely dependent on asthma-related concepts. Therefore, we believe that semantic similarity is important to estimate NLP system portability. As the Mayo Clinic and SCH corpora were relatively homogeneous at a semantic level, the NLP system, developed at Mayo Clinic, was imported to SCH successfully with proper adjustments to deal with the intrinsic corpus heterogeneity.
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Affiliation(s)
- Sunghwan Sohn
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Yanshan Wang
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Euijung Ryu
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Mir H Ali
- Department of Pediatrics, Sanford Children's Hospital, Sioux Falls, SD, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Hongfang Liu
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Wi CI, Sohn S, Rolfes MC, Seabright A, Ryu E, Voge G, Bachman KA, Park MA, Kita H, Croghan IT, Liu H, Juhn YJ. Application of a Natural Language Processing Algorithm to Asthma Ascertainment. An Automated Chart Review. Am J Respir Crit Care Med 2017; 196:430-437. [PMID: 28375665 DOI: 10.1164/rccm.201610-2006oc] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
RATIONALE Difficulty of asthma ascertainment and its associated methodologic heterogeneity have created significant barriers to asthma care and research. OBJECTIVES We evaluated the validity of an existing natural language processing (NLP) algorithm for asthma criteria to enable an automated chart review using electronic medical records (EMRs). METHODS The study was designed as a retrospective birth cohort study using a random sample of 500 subjects from the 1997-2007 Mayo Birth Cohort who were born at Mayo Clinic and enrolled in primary pediatric care at Mayo Clinic Rochester. Performance of NLP-based asthma ascertainment using predetermined asthma criteria was assessed by determining both criterion validity (chart review of EMRs by abstractor as a gold standard) and construct validity (association with known risk factors for asthma, such as allergic rhinitis). MEASUREMENTS AND MAIN RESULTS After excluding three subjects whose respiratory symptoms could be attributed to other conditions (e.g., tracheomalacia), among the remaining eligible 497 subjects, 51% were male, 77% white persons, and the median age at last follow-up date was 11.5 years. The asthma prevalence was 31% in the study cohort. Sensitivity, specificity, positive predictive value, and negative predictive value for NLP algorithm in predicting asthma status were 97%, 95%, 90%, and 98%, respectively. The risk factors for asthma (e.g., allergic rhinitis) that were identified either by NLP or the abstractor were the same. CONCLUSIONS Asthma ascertainment through NLP should be considered in the era of EMRs because it can enable large-scale clinical studies in a more time-efficient manner and improve the recognition and care of childhood asthma in practice.
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Affiliation(s)
- Chung-Il Wi
- 1 Department of Pediatric and Adolescent Medicine.,2 Asthma Epidemiology Research Unit
| | - Sunghwan Sohn
- 3 Division of Biomedical Statistics and Informatics, and
| | - Mary C Rolfes
- 2 Asthma Epidemiology Research Unit.,4 Mayo Medical School, Rochester, Minnesota
| | | | - Euijung Ryu
- 3 Division of Biomedical Statistics and Informatics, and
| | - Gretchen Voge
- 1 Department of Pediatric and Adolescent Medicine.,2 Asthma Epidemiology Research Unit.,5 Division of Neonatology, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; and
| | - Kay A Bachman
- 6 Division of Allergic Diseases, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
| | - Miguel A Park
- 6 Division of Allergic Diseases, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
| | - Hirohito Kita
- 6 Division of Allergic Diseases, Mayo Clinic, Mayo Clinic, Rochester, Minnesota
| | - Ivana T Croghan
- 7 Department of Medicine Research, Mayo Clinic, Rochester, Minnesota
| | - Hongfang Liu
- 3 Division of Biomedical Statistics and Informatics, and
| | - Young J Juhn
- 1 Department of Pediatric and Adolescent Medicine.,2 Asthma Epidemiology Research Unit
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9
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Hasassri ME, Jackson ER, Ghawi H, Ryoo E, Wi CI, Bartlett MG, Volcheck GW, Moir CR, Ryu E, Juhn YJ. Asthma and Risk of Appendicitis in Children: A Population-Based Case-Control Study. Acad Pediatr 2017; 17:205-211. [PMID: 27964827 PMCID: PMC5337436 DOI: 10.1016/j.acap.2016.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 09/07/2016] [Accepted: 09/13/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess whether asthma is associated with risk of appendicitis in children. METHODS We used a population-based case-control study design using a comprehensive medical record review and predetermined criteria for appendicitis and asthma. All children (age younger than 18 years of age) who resided in Olmsted County, Minnesota, and developed appendicitis between 2006 and 2012 were matched to controls (1:1) with regard to birthday, gender, registration date, and index date. Asthma status was ascertained using predetermined criteria. Active (current) asthma was defined as the presence of asthma symptoms or asthma-related events (eg, medication use, clinic visits, emergency department, or hospitalization) within 1 year before the index date. Inactive asthma was defined as subjects without these events. A conditional logistic regression model was used. RESULTS Among the 309 appendicitis cases identified, when stratified according to asthma status, active asthma was associated with significantly increased risk of appendicitis compared with inactive asthma (odds ratio [OR] = 2.48; 95% confidence interval [CI], 1.22-5.03) and to no asthma (OR = 1.88; 95% CI, 1.07-3.27; overall P = .035). When controlling for potential confounders such as gender, age, and smoking status, active asthma was associated with a higher odds of developing appendicitis compared with nonasthmatic patients (adjusted OR = 1.75; 95% CI, 0.99-3.11) whereas inactive asthma was not (overall P = .049). Tobacco smoke exposure within 3 months was associated with an increased risk of appendicitis (adjusted OR = 1.66; 95% CI, 1.02-2.69). Among asthma medications, leukotriene receptor antagonists reduced the risk of appendicitis (OR = 0.18; 95% CI, 0.04-0.74). CONCLUSIONS Active asthma might be an unrecognized risk factor for appendicitis in children whereas a history of inactive asthma does not pose such risk. Further investigation exploring the underlying mechanisms is warranted.
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Affiliation(s)
| | | | - Husam Ghawi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Eell Ryoo
- Department of Pediatrics, Gil Hospital, Gachon University School of Medicine, Inchon, South Korea
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Pediatric Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn
| | - Mark G Bartlett
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minn
| | - Gerald W Volcheck
- Department of Pediatrics, Division of Allergic Diseases, Mayo Clinic, Rochester, Minn
| | | | - Euijung Ryu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine/Internal Medicine, Mayo Clinic, Rochester, Minn; Pediatric Asthma Epidemiology Research Unit, Mayo Clinic, Rochester, Minn.
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10
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Umaretiya PJ, Swanson JB, Kwon HJ, Grose C, Lohse CM, Juhn YJ. Asthma and risk of breakthrough varicella infection in children. Allergy Asthma Proc 2016; 37:207-15. [PMID: 27178889 DOI: 10.2500/aap.2016.37.3951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND We recently reported a more rapid waning of vaccine-induced humoral immunity (measles vaccine) in children with asthma. It is unknown if asthma affects susceptibility to vaccine-preventable diseases. OBJECTIVE To determine whether asthma is associated with an increased risk of vaccine-preventable disease, e.g., breakthrough varicella infection. METHODS This was a retrospective population-based case-control study that examined cases of breakthrough varicella among children between 2005 and 2011. Children with a diagnosis of breakthrough varicella infection in Olmsted County, Minnesota (infection of >42 days after vaccination) between 2005 and 2011 and two age- and sex-matched controls were enrolled for each case. Asthma status was determined by using predetermined criteria. Conditional logistic regression models were used to calculate matched odds ratios (OR) and their corresponding 95% confidence intervals (CI). RESULTS Of the 165 cases and their 330 matched controls, 48% were boys and the mean (standard deviation) age at the index date was 6.6 ± 3.5 years for both cases and controls. Of the 330 controls, 80 (24%) had two doses of the varicella vaccine compared with only 23 (14%) of the 165 cases (OR 0.29 [95% CI, 0.14-0.61]; p = 0.001). Children with a history of asthma ever had a higher risk of developing breakthrough varicella compared with those without a history of asthma (adjusted OR 1.63 [95% CI, 1.04-2.55]; p = 0.032) when adjusting for elapsed time since the first varicella vaccination and the number of varicella vaccine doses. CONCLUSIONS A history of asthma might be an unrecognized risk factor for breakthrough varicella infection. Children with asthma should follow the two-dose varicella vaccine policy.
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Affiliation(s)
- Puja J. Umaretiya
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
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11
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Yoo KH, Jacobson RM, Poland GA, Weaver A, Lee L, Chang T, Juhn YJ. Asthma status and waning of measles antibody concentrations after measles immunization. Pediatr Infect Dis J 2014; 33:1016-22. [PMID: 24830696 PMCID: PMC4216609 DOI: 10.1097/inf.0000000000000375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asthmatics have increased risks of common and serious microbial infections including vaccine preventable diseases. Little is known about whether asthma influences waning of humoral immunity. We assessed whether asthma status influences waning of anti-measles virus antibody concentrations over time. METHODS The study used a cross-sectional study cohort of healthy children who had been immunized with 1 dose of MMR-II at age approximately 15 months. Between 5 and 12 years of age, measles vaccine virus-specific antibody (IgG) values were measured by enzyme immunoassay and considered seropositive if the enzyme immunoassay index unit was ≥ 1. The medical records were reviewed to determine asthma status during the first 18 years of life by applying predetermined criteria for asthma. A least squares regression model was used to evaluate the effect of asthma status on the relationship between measles antibody titer and time elapsed between the initial measles vaccination and measurement of measles antibody concentrations. RESULTS Of the 838 eligible children, 281 (34%) met criteria for asthma. Measles antibody waned over time (r = -0.19, P < 0.001), specifically more rapidly in asthmatics (r = -0.30, P < 0.001, a decrease of -0.114 unit per year) than non-asthmatics (r = -0.13, P = 0.002, a decrease of -0.046 unit per year; P value for interaction = 0.010). This differential waning rate resulted in a lower mean (SD) measles antibody concentration [1.42 (0.67) vs. 1.67 (0.69), P = 0.008] and lower seropositivity rate (73% vs. 84%, P = 0.038) in asthmatics than non-asthmatics starting around 9.3 years after the initial measles vaccination. CONCLUSION Asthma status is associated with waning kinetics of measles antibody among children.
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Affiliation(s)
- Kwang Ha Yoo
- Department of Internal Medicine, KonKuk University College of Medicine, Seoul, Korea./Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905
| | - Robert M. Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905
| | | | - Amy Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905
| | - Linda Lee
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905
| | - Titus Chang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, 55905
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905
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12
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Wi CI, Park MA, Juhn YJ. Development and initial testing of Asthma Predictive Index for a retrospective study: an exploratory study. J Asthma 2014; 52:183-90. [PMID: 25158051 DOI: 10.3109/02770903.2014.952438] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma Predictive Index (API) has been used for predicting asthma in prospective or cross-sectional studies, not for a retrospective study. We aim to develop and validate API for a retrospective study. METHODS This is a cross-sectional study based on a convenience sample of children who participated in a previous retrospective cohort study. API was operationalized by two or more wheezing episodes in a year during the first 3 years of life PLUS one of the major or two of the minor criteria of the original API. We assessed validity of retrospective API against Predetermined Asthma Criteria (PAC) which has been extensively used in clinical studies for asthma. We assessed criterion validity by measuring kappa and agreement rate between API and PAC and construct validity by determining associations of API with known risk factors for asthma. RESULTS Of the eligible 105 children, 55 (52.4%) were male, 90 (85.7%) Caucasians, and the mean age (±SD) was 5.8 years (±1.5). API criteria was met by 15 (14.3%), compared to 33 (31.4%) by PAC, respectively. The agreement rate and kappa between API and definite asthma of PAC were 89.5% and 0.66 (p < 0.01). Atopic conditions, lower parental education, no history of breastfeeding and family history of asthma were significantly associated with risk of asthma by API. CONCLUSIONS Application of API to a retrospective study for ascertaining asthma status is suitable. Our study findings need to be replicated by future studies with a larger sample size.
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Affiliation(s)
- Chung-Il Wi
- Department of Pediatric and Adolescent Medicine
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13
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Patel AR, Zietlow J, Jacobson RM, Poland GA, Juhn YJ. Asthma and the immune response to MMR vaccine viruses in Somali immigrant children: a cross-sectional retrospective cohort study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 22:278-83. [PMID: 23636585 PMCID: PMC3914143 DOI: 10.4104/pcrj.2013.00039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: According to the ‘hygiene hypothesis’, an increase in microbial exposure in childhood leads to a T-helper cell 1 (Th1) predominant immune response and protection against asthma and atopic conditions. Aims: To assess the prevalence of asthma and other atopic conditions in Somali immigrants and to determine the humoral immune response to the measles, mumps, and rubella (MMR) vaccine viruses in Somali immigrants with asthma. Methods: A retrospective cohort study was conducted in Olmsted County, Minnesota. Study subjects were Somali immigrants who were born and lived in Africa during childhood and immigrated to the USA. The subjects had participated in a previous MMR vaccine study. Asthma was ascertained using predetermined asthma criteria after a thorough medical record review. An atopic condition was determined from physician-diagnosed ICD codes. Virus-specific IgG levels in response to the MMR vaccine viruses were determined using an enzyme immunoassay. Results: Of the 62 eligible subjects, 33 (53%) were female and 29 (47%) were male; 10 (16%) had asthma and 22 (35%) had other atopic conditions. There was no difference in the rubella (p=0.150) and measles (p=0.715) virus-specific IgG levels between the subjects with and without asthma. Mumps virus-specific IgG antibody levels were lower in those with asthma than in those without asthma (mean±SE 2.08±0.28 vs. 3.06±0.14, p=0.005). Conclusions: Our study results may not support the hygiene hypothesis. In addition, the previously reported abnormal T-cell development in Caucasian children with atopy can be considered even in Somali immigrants.
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Affiliation(s)
- Apurvi R Patel
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
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14
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Dhillon RK, Yawn BP, Yoo KH, Boyce TG, Jacobson RM, McGree ME, Weaver AL, Juhn YJ. Impact of Asthma on the Severity of Serious Pneumococcal Disease. ACTA ACUST UNITED AC 2014; Suppl 3. [PMID: 25243098 PMCID: PMC4166487 DOI: 10.4172/2161-1165.s3-001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We recently reported an increased risk of serious pneumococcal disease (SPD) in asthmatics. Little is known about the impact of asthma status on the severity of SPD. We compared the severity of serious pneumococcal disease (SPD) between patients with asthma and those without asthma. The study subjects were Rochester, Minnesota residents who developed SPD between 1964 and 1983. SPD and asthma status were ascertained by using explicit predetermined criteria Severity of SPD was assessed using intensive care unit (ICU) admission rate and total days of ICU stay and hospitalization associated with treatment for SPD. We found that there were no significant differences in severity outcomes between asthmatics (n=11) and non-asthmatics (n=163). Asthma status may increase the risk of SPD but not influence its severity. However, given a small sample size of our study, a larger study needs to be considered to clarify the relationship between asthma and severity of SPD.
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Affiliation(s)
- Ravneet K Dhillon
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, MN
| | - Kwang Ha Yoo
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN ; Department of Internal Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Thomas G Boyce
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Robert M Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | | | - Amy L Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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15
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Santillan Salas CF, Mehra S, Pardo Crespo MR, Juhn YJ. Asthma and severity of 2009 novel H1N1 influenza: a population-based case-control study. J Asthma 2013; 50:1069-76. [PMID: 23947393 PMCID: PMC4321687 DOI: 10.3109/02770903.2013.834505] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Asthma has been shown to be associated with an increased risk of the 2009 novel H1N1 influenza (H1N1) infection among children. However, little is known about the role of asthma in severity of H1N1 infection. OBJECTIVE To determine the association between asthma and other atopic conditions and severity of H1N1 infection. PATIENTS AND METHODS We conducted a population-based case-control study. Cases were all Olmsted County, MN residents admitted to the hospital within a week of a positive test for H1N1. Controls who had a positive H1N1 but were not admitted to hospital were individually matched to cases with regard to birth day, gender, clinic registration date, diagnostic method, and calendar month of influenza testing. Asthma was ascertained using predetermined criteria. Data were fit to conditional logistic regression models. RESULTS There were 46 eligible individuals admitted to hospitals with H1N1 infection during the study period. Ninety-seven controls were individually matched to their corresponding cases. Among cases, 23 (50%) were male and 29 (63.0%) were Caucasians. The median age at hospitalization was 20.7 years. Twenty-five (54.4%) cases had asthma before the date of hospitalization, compared to 33 (34.0%) controls (matched OR: 2.31; 95% CI, 1.13-4.73; p = 0.02). This association approached statistical significance after adjusting for all pertinent covariates (adjusted matched OR: 2.55; 95% CI, 0.98-6.64; p = 0.055). CONCLUSION Asthma may be associated with severe H1N1 infection. In addition to timely influenza vaccination for asthmatics, consideration for prophylactic treatment for unimmunized asthmatics with significant exposure to influenza and immunized asthmatics with early flu-like symptoms should be given.
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Affiliation(s)
| | - Sonia Mehra
- Department of Pediatric and Adolescent Medicine. Mayo Clinic Rochester, MN
| | - Maria R. Pardo Crespo
- Department of Pediatric and Adolescent Medicine. Mayo Clinic Rochester, MN
- Servicio Cantabro de Salud, Santander, Spain
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine. Mayo Clinic Rochester, MN
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16
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Santillan Salas CF, Mehra S, Pardo Crespo MR, Juhn YJ. Atopic conditions other than asthma and risk of the 2009 novel H1N1 infection in children: a case-control study. Allergy Asthma Proc 2013; 34:459-66. [PMID: 23998244 DOI: 10.2500/aap.2013.34.3686] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A recent study showed an increased risk of 2009 novel H1N1 influenza (H1N1) infection among asthmatic children. Little is known whether this is true for other atopic conditions. This study was designed to determine the association between atopic dermatitis and/or allergic rhinitis and the risk of H1N1 infection among children. We conducted a case-control study in Olmsted County, MN. We randomly selected children ≤18 years of age with a positive test for H1N1. Controls were randomly selected from a pool of residents with negative H1N1 tests and were matched to cases with regard to birthday, gender, clinic registration date, diagnostic test, and month of influenza testing using frequency matching. We compared the frequency of atopic conditions other than asthma between cases and their matched controls. We enrolled 168 cases and 172 controls. Among cases, 91 (54.2%) were male patients, and 106 (63.1%) were white. The median age of cases was 6.3 years (interquartile range, 3.1-11.5). Among cases, 79 (47.0%) had atopic dermatitis and/or allergic rhinitis diagnosed before or after the index date, whereas 54 (31.4%) controls had such conditions (odds ratio [OR], 1.89; 95% CI, 1.15-3.12; p = 0.012, adjusting for asthma status, 2008-2009 seasonal influenza vaccine, time of illness at index date, and other comorbid conditions). History of receiving 2008-2009 seasonal influenza vaccine was associated with H1N1 infection (adjusted OR, 2.06; 95% CI, 1.32-3.28; p = 0.002). Our results suggest an association between H1N1 infection and atopic conditions other than asthma. The association between 2008-2009 seasonal influenza vaccinations and the risk of H1N1 requires further investigation.
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17
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Wu ST, Sohn S, Ravikumar KE, Wagholikar K, Jonnalagadda SR, Liu H, Juhn YJ. Automated chart review for asthma cohort identification using natural language processing: an exploratory study. Ann Allergy Asthma Immunol 2013; 111:364-9. [PMID: 24125142 DOI: 10.1016/j.anai.2013.07.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND A significant proportion of children with asthma have delayed diagnosis of asthma by health care providers. Manual chart review according to established criteria is more accurate than directly using diagnosis codes, which tend to under-identify asthmatics, but chart reviews are more costly and less timely. OBJECTIVE To evaluate the accuracy of a computational approach to asthma ascertainment, characterizing its utility and feasibility toward large-scale deployment in electronic medical records. METHODS A natural language processing (NLP) system was developed for extracting predetermined criteria for asthma from unstructured text in electronic medical records and then inferring asthma status based on these criteria. Using manual chart reviews as a gold standard, asthma status (yes vs no) and identification date (first date of a "yes" asthma status) were determined by the NLP system. RESULTS Patients were a group of children (n = 112, 84% Caucasian, 49% girls) younger than 4 years (mean 2.0 years, standard deviation 1.03 years) who participated in previous studies. The NLP approach to asthma ascertainment showed sensitivity, specificity, positive predictive value, negative predictive value, and median delay in diagnosis of 84.6%, 96.5%, 88.0%, 95.4%, and 0 months, respectively; this compared favorably with diagnosis codes, at 30.8%, 93.2%, 57.1%, 82.2%, and 2.3 months, respectively. CONCLUSION Automated asthma ascertainment from electronic medical records using NLP is feasible and more accurate than traditional approaches such as diagnosis codes. Considering the difficulty of labor-intensive manual record review, NLP approaches for asthma ascertainment should be considered for improving clinical care and research, especially in large-scale efforts.
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Affiliation(s)
- Stephen T Wu
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
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18
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Urm SH, Yun HD, Fenta YA, Yoo KH, Abraham RS, Hagan J, Juhn YJ. Asthma and risk of selective IgA deficiency or common variable immunodeficiency: a population-based case-control study. Mayo Clin Proc 2013; 88:813-21. [PMID: 23910409 PMCID: PMC3753684 DOI: 10.1016/j.mayocp.2013.05.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 05/15/2013] [Accepted: 05/20/2013] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine the association between a history of asthma and a diagnosis of selective IgA deficiency (sIgAD)/common variable immunodeficiency (CVID). PATIENTS AND METHODS This population-based case-control study included residents of Olmsted County, Minnesota, who met the Pan-American Group for Immunodeficiency/European Society for Immunodeficiencies diagnostic criteria for sIgAD/CVID between January 1, 1964, through December 31, 2008. Each case had 4 age- and sex-matched controls (2 from the community and 2 from a list of individuals who had undergone an immune work-up). We ascertained asthma status by applying predetermined criteria for asthma. RESULTS We identified 39 cases: 26 (66.7%) had sIgAD and 13 (33.3%) had CVID. Of the 39 cases, 51.3% were men (n=20) and 97.1% were white (33 of 34 patients). The mean age at the index date (the time when criteria were met) of sIgAD/CVID was 34.2 years. Of the 39 cases, 9 (23.1%) had a history of asthma before the index date of sIgAD/CVID; of the 156 controls, 16 (10.3%) had a history of asthma before the index date (odds ratio, 2.77; 95% CI, 1.09-7.06; P=.03). A history of asthma (before or after the index date of sIgAD/CVID) was more prevalent in sIgAD/CVID cases (30.8%; n=12) than in matched controls (11.5%; n=18) (odds ratio, 3.57; 95% CI, 1.50-8.51; P=.01). CONCLUSION Asthmatic patients are more likely to have a diagnosis of sIgAD/CVID than nonasthmatic individuals. This association may potentially account for the increased risks of bacterial infections in some individuals with asthma.
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Affiliation(s)
- Sang-Hwa Urm
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
- Department of Preventive Medicine, Medical College, Inje University, Busan, South Korea
| | - Hyun Don Yun
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
- Department of Medicine, Harbor Hospital, Baltimore, MD
| | - Yilma A. Fenta
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, South Korea
| | - Roshini S. Abraham
- Division of Clinical Biochemistry and Immunology, Mayo Clinic, Rochester, MN
| | - John Hagan
- Division of Allergic Diseases, Mayo Clinic, Rochester, MN
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
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19
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Javed A, Yoo KH, Agarwal K, Jacobson RM, Li X, Juhn YJ. Characteristics of children with asthma who achieved remission of asthma. J Asthma 2013; 50:472-9. [PMID: 23514196 DOI: 10.3109/02770903.2013.787625] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To characterize two groups of asthmatics who had achieved remission and those who had not achieved remission of asthma. METHODS The study was a retrospective cohort study based on 117 asthmatic children who participated in a previous study. We categorized the children into two groups: asthmatics with remission versus asthmatics without remission. We defined remission of asthma as lack of symptoms/signs of asthma or asthma-related medications or health care services for at least three consecutive years. Long-term remission was defined by no relapse of asthma after achieving remission. We characterized these groups. RESULTS Of the 117 subjects, 70 (60%) were male, 91 (78%) were Caucasians, and the mean age at index date of asthma was 8.1 years. A total of 59 asthmatic children (50%) achieved remission and 28 asthmatics (24%) achieved long-term remission. Asthmatics with remission were more likely to be Caucasian (87%) compared to those without (69%) (p = .039) There were no differences in the frequency of visits for viral (0.3 vs. 0.4 per person-years, p = .29) or bacterial infections (0.7 vs. 0.5 per person-years, p = .49) between asthmatics with and without remission. Gender, socioeconomic status, smoking exposure, family history of asthma or atopy, breastfeeding history, peak flow meter availability, asthma action plan, and influenza vaccinations were not associated with remission. CONCLUSIONS Only half of asthmatic children accomplished remission of asthma ever and 24% of asthmatic children had long-term remission. Ethnicity may affect remission of asthma but microbial infections may not influence the likelihood of remission of asthma and vice versa.
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Affiliation(s)
- Asma Javed
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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20
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Juhn YJ, Frey D, Li X, Jacobson R. Streptococcus pyogenes upper respiratory infection and atopic conditions other than asthma: a retrospective cohort study. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:153-8. [PMID: 22270478 DOI: 10.4104/pcrj.2011.00110] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with asthma have an increased risk of Streptococcus pyogenes infection compared with those without asthma. It is unknown whether this is true for children with other atopic conditions such as atopic dermatitis or allergic rhinitis. AIMS To determine the risk of developing S. pyogenes infections of the upper respiratory tract in children and adolescents with atopic dermatitis and/or allergic rhinitis. METHODS We conducted a retrospective cohort study that followed a convenience sample of 340 healthy children. Atopic dermatitis or eczema and allergic rhinitis or hay fever were determined based on a physician diagnosis documented in medical records. All laboratory test results of cultures, rapid antigen detection, and polymerase chain reaction tests for S. pyogenes infections during the first 18 years of life were collected to compare the incidence of S. pyogenes infections between children with and without a physician diagnosis of atopic conditions. A Poisson regression was fit to determine the association between asthma and S. pyogenes infections, controlling for other covariates including asthma. RESULTS Of the 340 subjects, 327 were eligible for the study. Of these 327 subjects, 143 (44%) had atopic conditions other than asthma. The incidence of S. pyogenes infections in children with atopic conditions other than asthma and those without atopic conditions was 0.24 per person-year and 0.18 per person-year, respectively. The adjusted risk ratios for allergic rhinitis and atopic dermatitis were 1.36 (95% CI 1.07 to 1.66, p=0.011) and 1.30 (95% CI 0.98 to 1.71, p=0.06), respectively, controlling for asthma and other covariates. CONCLUSIONS In addition to asthma, allergic rhinitis but not atopic dermatitis is associated with an increased risk of S. pyogenes upper respiratory tract infections.
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Affiliation(s)
- Young J Juhn
- Department of Community Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55944, USA.
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Capili CR, Hettinger A, Rigelman-Hedberg N, Fink L, Boyce T, Lahr B, Juhn YJ. Increased risk of pertussis in patients with asthma. J Allergy Clin Immunol 2012; 129:957-63. [PMID: 22206778 PMCID: PMC3321509 DOI: 10.1016/j.jaci.2011.11.020] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 11/01/2011] [Accepted: 11/07/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND The recent pertussis outbreak in California highlights the effect of pertussis on public health. In 2004, a pertussis outbreak occurred in Olmsted County, Minnesota, despite a high vaccine uptake. This outbreak provided a natural experiment to assess the relationship between asthma and pertussis. OBJECTIVE We sought to determine whether asthmatic subjects have a higher risk of pertussis than nonasthmatic subjects. METHODS We conducted a population-based case-control study. There were 223 pertussis cases identified by means of PCR in 2004 and 2005. We identified age- and sex-matched control subjects from 5537 patients with negative test results for pertussis. We conducted a comprehensive medical record review and applied predetermined criteria to ascertain asthma status. Conditional logistic regression was fit to assess the effect of asthma status on the risk of pertussis. RESULTS Of the 223 subjects, 164 were eligible for the study, and 328 matched control subjects (1:2 matching) were enrolled. Of these 164 subjects, 50% were male, and 82% were white. The median age at the index date of pertussis was 14 years. Sixty-two (38%) of the 164 cases had asthma before the index date of pertussis compared with 85 (26%) of the 328 control subjects (odds ratio, 1.73; 95% CI, 1.12-2.67; P = 013). The population attributable risk percentage of asthma for risk of pertussis was 17%. CONCLUSIONS Given the high prevalence of asthma and the ongoing risk of pertussis throughout the United States, consideration of defining asthmatic subjects as a target group for pertussis vaccination (eg, replacing decennial tetanus-diphtheria booster with tetanus, diphtheria, and acellular pertussis vaccine for adolescents and adults) should be given.
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Affiliation(s)
| | | | | | - Lisa Fink
- Department of Pediatric and Adolescent Medicine, Mayo Clinic
| | - Thomas Boyce
- Department of Pediatric and Adolescent Medicine, Mayo Clinic
| | - Brian Lahr
- Department of Health Sciences Research, Mayo Clinic
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic
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22
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Yoo KH, Agarwal K, Butterfield M, Jacobson RM, Poland GA, Juhn YJ. Assessment of humoral and cell-mediated immune response to measles-mumps-rubella vaccine viruses among patients with asthma. Allergy Asthma Proc 2010; 31:499-506. [PMID: 21708062 PMCID: PMC3941466 DOI: 10.2500/aap.2010.31.3399] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Little is known about the influence of asthma status on humoral and cell-mediated immune responses to measles-mumps-rubella (MMR) vaccine viruses. We compared the virus-specific IgG levels and lymphoproliferative response of peripheral blood mononuclear cells to MMR vaccine viruses between asthmatic and nonasthmatic patients. The study subjects included 342 healthy children aged 12-18 years who had received two doses of the MMR vaccine. We ascertained asthma status by applying predetermined criteria. Of the 342 subjects, 230 were available for this study of whom 25 were definite asthmatic patients (10.9%) and the rest of subjects were nonasthmatic patients. The mean of the log-transformed lymphoproliferative responses between definite asthma and nonasthma who had a family history of asthma were for measles, 0.92 ± 0.31 versus 1.54 ± 0.17 (p = 0.125); for mumps, 0.98 ± 0.64 versus 2.20 ± 0.21 (p = 0.035); and for rubella, 0.12 ± 0.37 versus 0.97 ± 0.16 (p = 0.008), respectively, adjusting for the duration between the first MMR vaccination and determination of the immune responses. There were no such differences among children without a family history of asthma. MMR virus-specific IgG levels were not different between study subjects with or without asthma. The study findings suggest asthmatic patients may have a suboptimal cell-mediated immune response to MMR vaccine viruses and a family history of asthma modifies this effect.
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Affiliation(s)
- Kwang Ha Yoo
- Department of Internal Medicine, KonKuk University College of Medicine, Seoul, Korea
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kanishtha Agarwal
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael Butterfield
- The University of California, San Francisco, School of Medicine, San Francisco, California
| | - Robert M. Jacobson
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory A. Poland
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Young J. Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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Martyn MB, Molis W, Jacobson RM, Poland GA, Weaver AL, Juhn YJ. Human leukocyte antigen type and progression from onset of symptoms to development of asthma. Allergy Asthma Proc 2010; 31:120-5. [PMID: 20214848 DOI: 10.2500/aap.2010.31.3321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study investigated the influence of human leukocyte antigen (HLA) genes on the progression of asthma, from the initial onset of symptoms to when criteria for asthma are met. Study subjects were a subsample (n = 340) of 838 healthy children, aged 5-12 years, who participated in a previous study, and who had HLA data and asthma status. The duration in time from the initial onset of asthma symptoms documented in each subject's medical records to the index date when the subject first met criteria for asthma was determined. The time duration was compared between carriers and noncarriers of HLA genes of interest of the 340 original subjects with HLA data available, 114 children (33.5%) met criteria for asthma before 18 years of age. The median ages at onset of asthma symptoms and at the index date of asthma were 4.4 years and 7.2 years, respectively. The median time intervals between onset of symptoms and index date for HLA DRB1*11 carriers and noncarriers were 552 versus 61 days, respectively (p = 0.004). The same time intervals for HLA DQB1*0301 carriers and noncarriers were 420 versus 59 days, respectively (p = 0.012). However, HLA DQB1*0302 or DRB1*03 carriers had shorter median intervals, when compared with noncarriers (119 versus 266 days, respectively, p = 0.20; and 86 versus 258 days, respectively, p = 0.38) but they did not reach statistical significance. HLA type appears to influence the progression of asthma from initial symptoms to disease. Thus, genetic factors may affect the natural history of asthma.
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Molis WE, Bagniewski S, Weaver AL, Jacobson RM, Juhn YJ. Timeliness of diagnosis of asthma in children and its predictors. Allergy 2008; 63:1529-35. [PMID: 18925889 DOI: 10.1111/j.1398-9995.2008.01749.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is a paucity of literature using medical records to evaluate the timeliness of asthma diagnosis in children and the predictors associated with timeliness of asthma diagnosis. METHODS Subjects were obtained from a convenience sample of 839 children, aged 5-13 years. We conducted comprehensive medical record reviews for these children to determine their asthma status by applying predetermined criteria for asthma. Predictors were evaluated for an association with timeliness of asthma diagnosis. RESULTS Of 839 children, 276 children met the criteria for asthma before 18 years of age. Of these subjects, 97 had timely diagnosis of asthma while 179 did not have timely diagnosis of asthma with the median delay of 3.3 years. Children with definite asthma at the time of index date was three times more timely to be diagnosed with asthma [hazard ratios (HR) 3.3, 95% CI: 2.43-4.47, P < 0.001], compared to those with probable asthma. Children with a family history of asthma were more timely to be diagnosed with asthma (HR 1.36, 95% CI: 1.03-1.8, P = 0.031). Children with exercise-induced wheezing or bronchospasm were more timely to be diagnosed with asthma (HR 1.79, 95% CI: 0.95-3.36, P = 0.07), compared to those with spasmodic (or bronchospastic) cough. CONCLUSIONS Many asthmatic children are not diagnosed with asthma in a timely manner, especially in those without the commonly recognized factors associated with asthma. Health care providers need to be reminded that asthma can still occur in those without commonly recognized risk factors. Asthma guidelines need to emphasize this aspect.
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Affiliation(s)
- W E Molis
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN 55905, USA
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25
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Juhn YJ, Kita H, Yawn BP, Boyce TG, Yoo KH, McGree ME, Weaver AL, Wollan P, Jacobson RM. Increased risk of serious pneumococcal disease in patients with asthma. J Allergy Clin Immunol 2008; 122:719-723. [PMID: 18790525 DOI: 10.1016/j.jaci.2008.07.029] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Revised: 07/03/2008] [Accepted: 07/28/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Individuals with asthma have been reported to be at increased risk of invasive pneumococcal disease (IPD). These findings need to be confirmed in a different population-based study setting. OBJECTIVE We assessed whether serious pneumococcal disease (SPD), defined as an IPD, pneumococcal pneumonia, or both, was associated with asthma status. METHODS This is a retrospective case-control study using criteria-based methods for ascertaining SPD, as well as asthma. Subjects were residents of Rochester, Minnesota, who had SPD between 1964 and 1983 (the primarily pre-pneumococcal vaccine era) and their age- and sex-matched control subjects using 1:2 matching. Potential cases and control subjects were identified by using the Rochester Epidemiology project database and confirmed by medical record reviews. All cases and control subjects were merged with the database comprising the entire pool of Rochester residents with and without asthma between 1964 and 1983. RESULTS A total of 3941 records of potential patients with SPD were reviewed, and we identified 174 cases of SPD (51% male subjects and 94% white subjects). SPD was associated with a history of asthma among all ages (odds ratio, 2.4; 95% CI, 0.9-6.6; P = .09) and among adults (odds ratio, 6.7; 95% CI, 1.6-27.3; P = .01), controlling for high-risk conditions for IPD and smoking exposure. The population-attributable risk percentage was 17% in the adult population. CONCLUSION Adults with asthma might be at increased risk of SPD.
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Affiliation(s)
- Young J Juhn
- Departments of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.
| | - Hirohito Kita
- Departments of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Barbara P Yawn
- Department of Research, Olmsted Medical Center, Rochester, Minn
| | - Thomas G Boyce
- Departments of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
| | - Kwang H Yoo
- Departments of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn; Department of Internal Medicine, Kunkook University School of Medicine, Seoul, South Korea
| | - Michaela E McGree
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Amy L Weaver
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minn
| | - Peter Wollan
- Department of Research, Olmsted Medical Center, Rochester, Minn
| | - Robert M Jacobson
- Departments of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn
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Martyn M, Weaver AL, Jacobson RM, Juhn YJ. Characterization of the duration from onset of asthma symptoms to asthma disease. Ann Allergy Asthma Immunol 2008; 100:589-95. [PMID: 18592824 DOI: 10.1016/s1081-1206(10)60059-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known about factors associated with progression of childhood asthma from onset of symptoms to index date determined by medical records. OBJECTIVE To determine the duration between the onset of asthma symptoms to index date of asthma (ie, time when one met the criteria for asthma) and associated factors. METHODS Study participants came from a sample of 839 healthy children, aged 5 to 12 years, who had participated in a previous study. Comprehensive medical record reviews were conducted to determine first documentation of asthma symptoms and index date of asthma. Factors were evaluated for an association with the duration from onset of asthma symptoms to index date of asthma. RESULTS Of the study sample, 222 children met the criteria for asthma and had an available onset date of asthma symptoms. The median ages at onset of asthma symptoms and the index date were 5.6 and 7.6 years, respectively. The median duration between onset of asthma symptoms and index date was 2.9 months, and the mean was 17.2 months. There was a tendency for patients with a pet at home (P = .047), exercise-induced symptoms (P = .04), younger age at symptom onset (P = .05), and more severe asthma (P = .05) to have a shorter duration from onset of symptoms to index date. CONCLUSIONS The duration from onset of asthma symptoms to index date of asthma varies significantly depending on host and environmental factors. It does not necessarily correlate with commonly recognized risk factors for incidence or severity of asthma.
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Affiliation(s)
- Molly Martyn
- Mayo Medical School, Rochester, Minnesota 55905, USA
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Juhn YJ, Johnson SK, Hashikawa AH, Voigt RG, Campeau LJ, Yawn BP, Williams AR. The potential biases in studying the relationship between asthma and microbial infection. J Asthma 2008; 44:827-32. [PMID: 18097858 DOI: 10.1080/02770900701743804] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess bias in parent reports of asthma status of children and detection bias of medical records-based asthma ascertainment and to examine effects of such bias on the association between asthma status and infections. METHODS A prospective cohort study was conducted to compare the correlations between the frequency of acute illnesses and that of medical evaluations between children with or without asthma according to parental report and medical record review by following a group of children who were enrolled in the Mayo Clinic Sick Child Care Program in Rochester, Minnesota. Parents completed a self-administered questionnaire to determine asthma status of their child. Also, comprehensive medical record reviews were conducted to determine asthma status of each subject by applying predetermined criteria for asthma. RESULTS A convenience sample of 115 parents and their children participated in this study. The mean age of the parents who participated in the study was 32.8 years (standard deviation: 5.4 years); 93% were female (mothers); and 90% were white. Of the 115 children who participated in this study, 84% were reported to be white and 49% were female. The mean age of the children was 2 years (standard deviation: 1.0 year). Parents whose children had asthma by report appeared to be less likely to seek medical evaluations (Spearman's rho: 0.42,p = 0.11) when their children had acute illnesses, compared to those of non-asthmatic children (rho: 0.64,p < 0.001). Concerns that asthmatic patients (rho: 0.62,p < 0.001) are more likely to see health care providers and undergo medical evaluations and laboratory tests when they have acute illnesses than non-asthmatic patients (rho: 0.64,p < 0.001) are not supported by our study. CONCLUSION Parental report bias needs to be considered carefully when studying the relationship between asthma and microbial infection.
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Affiliation(s)
- Young J Juhn
- Mayo Clinic Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Abstract
The prevalence of atopic diseases has increased abruptly in recent years in most Westernized societies, making the question why this happened the topic of a heated debate. The best paradigm available to date to explain this steep rise, the 'hygiene hypothesis', supports that it is the excess 'cleanliness' of our environments that has led to the decline in the number of infectious stimuli that are necessary for the proper development of our immune system. Recent findings support that it is the combined effect that not only pathogenic, but also non-pathogenic microorganisms, and even their structural components,can exert on the immune system that deters from the development of atopic responses. Adding to these results are intriguing new findings on the effect different gene polymorphisms can have on an individual's predisposition to allergic diseases. The most important linkages produced, to date, include those among the genes for IL-4, IL-13, HLA-DRB, TNF, LTA,FCER1B, IL-4RA, ADAM33, TCR alpha/delta, PHF11, GPRA, TIM, p40, CD14, DPP10, T-bet, GATA-3, and FOXP3 and allergic disorders. The two parallel research efforts, epidemiologic and genetic, are only recently starting to converge,producing fascinating results on the effect particular gene-environment interactions might have in the development of atopy.The most important lesson learned through this tremendous research effort is that not only a small number but thousands and millions of separate risk factors act in concordance in the production of the allergic phenotype.
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Bibliography. Current world literature. Outcome measures. Curr Opin Allergy Clin Immunol 2007; 7:288-90. [PMID: 17489050 DOI: 10.1097/aci.0b013e3281fbd52a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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