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Castrodad-Rodríguez CA, Cheng J, Westerhoff M, Liang GH, Lin J, Nalbantoglu ILK, Hu S, Sekhri R, Panarelli NC. Clinical and Pathological Correlation in Concomitant Celiac Disease and Eosinophilic Esophagitis Suggests Separate Etiologies. Int J Surg Pathol 2024; 32:27-34. [PMID: 37050846 DOI: 10.1177/10668969231167526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Introduction. Recently, an increased risk of celiac disease or eosinophilic esophagitis has been postulated among patients with either of these disorders, prompting some to suggest a common underlying mechanism, whereas others maintain that their co-existence is coincidental. Methods. We compared clinical and pathological features of 29 patients meeting criteria for both celiac disease and eosinophilic esophagitis to 26 celiac disease and 26 eosinophilic esophagitis controls to determine whether any distinguished study patients from controls. Results. Eight (28%) study patients presented with symptoms of both celiac disease and eosinophilic esophagitis, whereas 14 (48%) had celiac disease symptoms only and 5 had (17%) esophageal symptoms only. Study patients had similar autoimmune and atopic conditions seen in both control groups. Histological severity of disease, including Marsh II-III duodenal histology (study specimens: 87%; controls: 89%), mean peak esophageal eosinophil counts (study specimens: 55/400x field; controls: 80/400X field, P = .1), and presence of eosinophil microabscesses, scale crust, and subepithelial fibrosis were also similar to controls. Gluten-free diet resolved celiac disease-related symptoms (19 of 20, 95%) and histology (10 of 12, 83%), but not esophageal symptoms or eosinophilia in most study patients. Conclusion. Patients with concomitant celiac disease and eosinophilic esophagitis lack distinguishing features compared to controls with celiac disease or eosinophilic esophagitis alone. The occurrence of both disorders is likely coincidental in most cases.
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Affiliation(s)
| | - Jerome Cheng
- Department of Pathology, The University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Maria Westerhoff
- Department of Pathology, The University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Guo Hua Liang
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jingmei Lin
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - ILKe Nalbantoglu
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Shaomin Hu
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Radhika Sekhri
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole C Panarelli
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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Conte M, Varraso R, Fournier A, Rothwell JA, Baglietto L, Fornili M, Sbidian E, Severi G. A prospective study of the association between living in a rural environment during childhood and risk of psoriasis. ENVIRONMENTAL RESEARCH 2023; 237:117062. [PMID: 37660877 DOI: 10.1016/j.envres.2023.117062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/04/2023] [Accepted: 08/31/2023] [Indexed: 09/05/2023]
Abstract
Psoriasis is one of the most common immune-mediated inflammatory diseases (IMIDs). Living in a rural environment during childhood is associated with a decreased risk of certain IMIDs, like asthma, in adulthood. However, its role in other IMIDs, such as psoriasis is still unclear. To evaluate the relationships between different factors related to the environment during childhood and the risk of psoriasis in adulthood we conducted a study in E3N, a French prospective cohort composed of 98 995 women. During the 1990-2018 follow-up of 72 154 study participants, we identified 1 967 incident cases of psoriasis from self-reports in self-administered structured questionnaires. During the 2004-2018 follow-up of 67 917 study participants, 188 moderate-to-severe cases of psoriasis were identified through self-reports and from data from a drug reimbursement database. We fitted Cox proportional hazards regression models with age as the time scale from which we estimated hazard ratios adjusted for putative confounders (aHRs). We found inverse associations with risk of psoriasis for rural birthplace [aHR: 0.89 (95%CI: 0.79-0.96)] and for having farming parents [aHR: 0.84 (95%CI: 0.72-0.97)]. For moderate-to-severe psoriasis we found a nominally similar inverse association with rural birthplace but not with having farming parents. Our results suggest that an exposure to a rural environment during childhood may be associated with a reduced risk of psoriasis. These findings may help to improve our understanding of the pathogenesis of psoriasis.
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Affiliation(s)
- Marco Conte
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Exposome and Heredity team, CESP, Villejuif, 94805, France
| | - Raphaëlle Varraso
- Université Paris-Saclay, UVSQ, Inserm, Integrative Respiratory Epidemiology Team, CESP, Villejuif, 94807, France
| | - Agnès Fournier
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Exposome and Heredity team, CESP, Villejuif, 94805, France
| | - Joseph A Rothwell
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Exposome and Heredity team, CESP, Villejuif, 94805, France
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56126, Italy
| | - Marco Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 56126, Italy
| | - Emilie Sbidian
- Hôpital Henri Mondor, Department of Dermatology, Créteil, 94010, France; Université Paris Est Créteil (UPEC), Epidemiology in Dermatology and Evaluation of Therapeutics (Epi-DermE), Créteil, 94010, France
| | - Gianluca Severi
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, Exposome and Heredity team, CESP, Villejuif, 94805, France; Department of Statistics, Computer Science and Applications « G. Parenti », University of Florence, Florence, 50134, Italy.
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Comparison of Previous Infectious and Allergic Diseases Between Patients with Kawasaki Disease and Propensity Score-matched Controls: A Nationwide Cohort Study. J Pediatr 2022; 255:207-213.e4. [PMID: 36528056 DOI: 10.1016/j.jpeds.2022.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/19/2022] [Accepted: 10/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine whether previous infectious and allergic diseases are associated with the development of Kawasaki disease in children. STUDY DESIGN This nationwide, population-based, case-control study used data from the Korean National Health Insurance claims database. The entire cohort consisted of patients younger than 5 years of age diagnosed with Kawasaki disease and 1:5 propensity score-matched controls from 2013 to 2019. The epidemiologic features and previous infectious or allergic diseases between the 2 groups were compared, and potential factors that could influence the association were identified. RESULTS In total, 32 964 patients diagnosed with Kawasaki disease and 164 820 controls were included. Patients with Kawasaki disease had more frequent diagnoses of previous sepsis or bacteremia (OR 1.41), acute pyelonephritis (OR 1.10), and otitis media (OR 1.24). In addition, Kawasaki disease was associated with previous diagnoses of atopic dermatitis (OR 1.05), urticaria (OR 1.08), and asthma (OR 1.05). The association between previous infectious or allergic diagnoses and Kawasaki disease was more prominent in younger patients (<2 years). However, intravenous immunoglobulin resistance, sex, and region of residence were not significant factors that consistently influenced the association between previous infectious or allergic diseases and Kawasaki disease. CONCLUSIONS Despite the increased rates of previous infectious and allergic diseases in patients with Kawasaki disease compared with controls, the association between allergic diseases and Kawasaki disease was weaker in our cohort than in previous studies.
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El‐Heis S, D’Angelo S, Curtis EM, Healy E, Moon RJ, Crozier SR, Inskip H, Cooper C, Harvey NC, Godfrey KM. Maternal antenatal vitamin D supplementation and offspring risk of atopic eczema in the first 4 years of life: evidence from a randomized controlled trial. Br J Dermatol 2022; 187:659-666. [PMID: 35763390 PMCID: PMC9804289 DOI: 10.1111/bjd.21721] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/14/2022] [Accepted: 06/26/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence linking prenatal maternal vitamin D supplementation with the offspring's risk of atopic eczema is inconsistent, with most data coming from observational studies. OBJECTIVES To examine the influence of maternal cholecalciferol supplementation during pregnancy on the risk of atopic eczema in the offspring at ages 12, 24 and 48 months. METHODS Within the UK Maternal Vitamin D Osteoporosis Study (MAVIDOS) double-blind, randomized placebo-controlled trial, we examined the relationship of maternal vitamin D supplementation during pregnancy with offspring atopic eczema at ages 12, 24 and 48 months. In MAVIDOS, pregnant women were allocated to either cholecalciferol 1000 IU per day or matched placebo, taken from around 14 weeks' gestation until delivery, with the primary outcome of neonatal whole-body bone mineral content. The prevalence of atopic eczema in the offspring was ascertained at ages 12 (n = 635), 24 (n = 610) and 48 (n = 449) months, based on the UK Working Party criteria for the definition of atopic dermatitis. The trial was registered with ISRCTN (82927713) and EudraCT (2007-001716-23). RESULTS The characteristics of mothers and offspring were similar between the intervention and placebo groups, apart from longer breastfeeding duration in the intervention group. Adjusting for breastfeeding duration, offspring of mothers who received cholecalciferol 1000 IU daily had a lower odds ratio (OR) of atopic eczema at age 12 months [OR 0·55, 95% confidence interval (CI) 0·32-0·97, P = 0·04]; this effect weakened and was not statistically significant at ages 24 months (OR 0·76, 95% CI 0·47-1·23) or 48 months (OR 0·75, 95% CI 0·37-1·52). The statistical interaction of intervention and breastfeeding duration in relation to eczema at age 12 months was not significant (P = 0·41), but stratification showed reduced infantile eczema risk in the intervention group for infants breastfed for ≥ 1 month (OR 0·48, 95% CI 0·24-0·94, P = 0·03) but not in those breastfed for < 1 month (OR 0·80, 95% CI 0·29-2·17, P = 0·66). CONCLUSIONS Our data provide the first randomized controlled trial evidence of a protective effect of antenatal cholecalciferol supplementation on the risk of infantile atopic eczema, with the effect potentially being via increased breast milk cholecalciferol levels. The findings support a developmental influence on atopic eczema, and point to a potentially modifiable perinatal influence on atopic eczema. What is already known about this topic? There are currently no antenatal interventions proven to reduce the incidence of infantile atopic eczema in the general population. However, observational studies have led to speculation that antenatal vitamin D supplementation may be beneficial.
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Affiliation(s)
- Sarah El‐Heis
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Stefania D’Angelo
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Elizabeth M. Curtis
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Eugene Healy
- Dermatopharmacology, Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Rebecca J. Moon
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Sarah R. Crozier
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthampton Science Park, Innovation CentreSouthamptonUK
| | - Hazel Inskip
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Nutrition Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Cyrus Cooper
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Nutrition Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Musculoskeletal Biomedical Research UnitUniversity of OxfordOxfordUK
| | - Nicholas C. Harvey
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Nutrition Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Keith M. Godfrey
- Medical Research Council Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Nutrition Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- Developmental SciencesUniversity of SouthamptonSouthamptonUK
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Augustine T, Kumar M, Al Khodor S, van Panhuys N. Microbial Dysbiosis Tunes the Immune Response Towards Allergic Disease Outcomes. Clin Rev Allergy Immunol 2022:10.1007/s12016-022-08939-9. [PMID: 35648372 DOI: 10.1007/s12016-022-08939-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 02/07/2023]
Abstract
The hygiene hypothesis has been popularized as an explanation for the rapid increase in allergic disease observed over the past 50 years. Subsequent epidemiological studies have described the protective effects that in utero and early life exposures to an environment high in microbial diversity have in conferring protective benefits against the development of allergic diseases. The rapid advancement in next generation sequencing technology has allowed for analysis of the diverse nature of microbial communities present in the barrier organs and a determination of their role in the induction of allergic disease. Here, we discuss the recent literature describing how colonization of barrier organs during early life by the microbiota influences the development of the adaptive immune system. In parallel, mechanistic studies have delivered insight into the pathogenesis of disease, by demonstrating the comparative effects of protective T regulatory (Treg) cells, with inflammatory T helper 2 (Th2) cells in the development of immune tolerance or induction of an allergic response. More recently, a significant advancement in our understanding into how interactions between the adaptive immune system and microbially derived factors play a central role in the development of allergic disease has emerged. Providing a deeper understanding of the symbiotic relationship between our microbiome and immune system, which explains key observations made by the hygiene hypothesis. By studying how perturbations that drive dysbiosis of the microbiome can cause allergic disease, we stand to benefit by delineating the protective versus pathogenic aspects of human interactions with our microbial companions, allowing us to better harness the use of microbial agents in the design of novel prophylactic and therapeutic strategies.
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Affiliation(s)
- Tracy Augustine
- Laboratory of Immunoregulation, Sidra Medicine, PO BOX 26999, Doha, Qatar
| | - Manoj Kumar
- Microbiome and Host-Microbes Interactions Laboratory, Sidra Medicine, Doha, Qatar
| | - Souhaila Al Khodor
- Microbiome and Host-Microbes Interactions Laboratory, Sidra Medicine, Doha, Qatar
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The impact of gender and sex in psoriasis: What to be aware of when treating women with psoriasis. Int J Womens Dermatol 2022; 8:e010. [PMID: 35619672 PMCID: PMC9112394 DOI: 10.1097/jw9.0000000000000010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/02/2022] [Indexed: 12/25/2022] Open
Abstract
Psoriasis is a common chronic inflammatory skin disease with an exceptionally high burden for women.
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7
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Cristofori F, D’Abramo FS, Rutigliano V, Dargenio VN, Castellaneta S, Piscitelli D, De Benedittis D, Indrio F, Raguseo LC, Barone M, Francavilla R. Esophageal Eosinophilia and Eosinophilic Esophagitis in Celiac Children: A Ten Year Prospective Observational Study. Nutrients 2021; 13:nu13113755. [PMID: 34836010 PMCID: PMC8625488 DOI: 10.3390/nu13113755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED The association between eosinophilic esophagitis and celiac disease is still controversial and its prevalence is highly variable. We aimed to investigate the prevalence of esophageal eosinophilia and eosinophilic esophagitis in a large group of children with celiac disease, prospectively followed over 11 years. METHODS Prospective observational study performed between 2008 and 2019. Celiac disease diagnosis was based on ESPGHAN criteria. At least four esophageal biopsies were sampled in patients who underwent endoscopy. The presence of at least 15 eosinophils/HPF on esophageal biopsies was considered suggestive of esophageal eosinophilia; at the same time, eosinophilic esophagitis was diagnosed according to the International Consensus Diagnostic Criteria for Eosinophilic Esophagitis. RESULTS A total of 465 children (M 42% mean age 7.1 years (range: 1-16)) were diagnosed with celiac disease. Three hundred and seventy patients underwent endoscopy, and esophageal biopsies were available in 313. The prevalence of esophageal eosinophilia in children with celiac disease was 1.6% (95% CI: 0.54-2.9%). Only one child was diagnosed as eosinophilic esophagitis; we calculated a prevalence of 0.3% (95% CI: 0.2-0.5%). The odds ratio for an association between eosinophilic esophagitis and celiac disease was at least 6.5 times higher (95% CI: 0.89-47.7%; p = 0.06) than in the general population. CONCLUSION The finding of an increased number of eosinophils (>15/HPF) in celiac patients does not have a clinical implication or warrant intervention, and therefore we do not recommend routine esophageal biopsies unless clinically indicated.
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Affiliation(s)
- Fernanda Cristofori
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Fulvio Salvatore D’Abramo
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy; (F.S.D.); (M.B.)
| | - Vincenzo Rutigliano
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Vanessa Nadia Dargenio
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Stefania Castellaneta
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Domenico Piscitelli
- Department of Emergency and Organ Transplantation, Section of Pathology, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy;
| | - Davide De Benedittis
- Department of Information Engineering, University of Pisa, Largo L. Lazzarino 2, 56122 Pisa, Italy;
| | - Flavia Indrio
- Department of Medical and Surgical Science, University of Foggia, Viale L. Pinto, 71122 Foggia, Italy;
| | - Lidia Celeste Raguseo
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
| | - Michele Barone
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy; (F.S.D.); (M.B.)
| | - Ruggiero Francavilla
- Interdisciplinary Department of Medicine, Pediatric Section “B. Trambusti”, University of Bari “Aldo Moro”, Via Amendola 207, 70126 Bari, Italy; (F.C.); (V.R.); (V.N.D.); (S.C.); (L.C.R.)
- Correspondence: ; Tel.: +39-080-5592063
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The Association of Bullous Pemphigoid With Atopic Dermatitis and Allergic Rhinitis-A Population-Based Study. Dermatitis 2021; 33:268-276. [PMID: 34570736 DOI: 10.1097/der.0000000000000792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although bullous pemphigoid (BP), atopic dermatitis (AD), and allergic rhinitis (AR) are associated with shared pathogenic mechanisms the epidemiological relationship between these conditions remains to be investigated. OBJECTIVE To evaluate the bidirectional association of BP with AD and AR. METHODS A population-based retrospective cohort study was performed comparing BP patients (n = 3924) with age-, sex-, and ethnicity-matched control subjects (n = 19,280), with respect to incident cases of AD and AR. A case-control design was additionally adopted to assess the odds of BP in individuals with a preexisting diagnosis of AD and AR. RESULTS The odds of BP was increased after a preexisting diagnosis of AD (fully adjusted odds ratio, 1.76; 95% confidence interval [CI], 1.44-2.15; P < 0.001) and AR (fully adjusted odds ratio, 1.13; 95% CI, 1.01-1.28; P = 0.047). Patients with BP were at an increased risk of subsequent AD (fully adjusted hazard ratio, 2.00; 95% CI, 1.60-2.51; P < 0.001) but not AR (fully adjusted hazard ratio, 1.00; 95% CI, 0.83-1.20; P = 0.997). Compared with other patients with BP, those with BP and comorbid AD and AR were more frequently managed by adjuvant drugs and long-term systemic and topical corticosteroids and had decreased all-cause mortality. CONCLUSIONS A history of AD and AR confers susceptibility to the development of BP. Awareness of this association may be of help for physicians managing patients with these diseases.
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Cunliffe A, Gran S, Ali U, Grindlay D, Lax SJ, Williams HC, Burden-Teh E. Can atopic eczema and psoriasis coexist? A systematic review and meta-analysis. SKIN HEALTH AND DISEASE 2021; 1:e29. [PMID: 35664974 PMCID: PMC9060081 DOI: 10.1002/ski2.29] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022]
Abstract
Importance Previous studies report both coexistence and mutual exclusivity of atopic eczema (AE) and psoriasis, but these have not been appraised systematically. Knowledge of such disease association throws light on disease mechanisms and may influence therapeutic choices. Objective To summarise evidence for AE and psoriasis occurring in the same person at the same point in time. Planned primary outcome was the incidence, prevalence or risk of psoriasis or eczema. Methods Ovid MEDLINE and Ovid Embase were searched from inception to 1st February 2020. The search strategy was built around the key terms ‘atopic eczema’, ‘psoriasis’ and ‘co‐existence’. Observational studies (cohort, case‐control, cross‐sectional and case‐series) with a minimum of 10 consecutive patients were included. There were no restrictions on participants, geography or language. Studies were selected, data extracted and critically appraised by two independent reviewers. Data were extracted on the method of diagnosis: health professional (dermatologist, criteria, other), self‐reported, not specified. Study quality was assessed using validated Joanna Brigg's Institute critical appraisal tools. A random‐effects model was used to combine studies. The effect of study quality on the pooled estimate was investigated using stratification. Heterogeneity was explored by subgroup analysis. Results This review included 31 studies and 20 523 individuals with psoriasis and 1 405 911 with AE. Eight studies reported the prevalence of AE in those with psoriasis and values ranged from 0.17% to 20%: the pooled prevalence was 2% (95% confidence interval [CI]: 1, 3). Seven studies reported the prevalence of psoriasis in those with AE and values ranged from 0.3% to 12.6%; the pooled prevalence was 2% (95% CI: 1, 3). Ten studies were assessed as low risk of bias. Geographical area, method of diagnosis, setting and whether the assessment of diagnosis was blinded, partly contributed to the heterogeneity. Conclusions This review provides some evidence for the coexistence of AE and psoriasis. Clinicians should be aware of coexistence at diagnosis, when selecting therapies and when reviewing poor response to treatment.
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Affiliation(s)
- A Cunliffe
- Nottingham University Hospitals NHS Trust Nottingham UK
| | - S Gran
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - U Ali
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - D Grindlay
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - S J Lax
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - H C Williams
- Nottingham University Hospitals NHS Trust Nottingham UK.,Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
| | - E Burden-Teh
- Nottingham University Hospitals NHS Trust Nottingham UK.,Centre of Evidence Based Dermatology School of Medicine University of Nottingham Nottingham UK
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10
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Kridin K, Ludwig RJ, Tzur Bitan D, Cohen AD. A History of Asthma Increases the Risk of Bullous Pemphigoid: Insights from a Large Population-Based Study. Dermatology 2021; 237:921-928. [PMID: 33640889 DOI: 10.1159/000512917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 11/10/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bullous pemphigoid (BP) and asthma both share a pathogenic role of eosinophils and immunoglobulin E (IgE) and favorable response for corticosteroids and omalizumab. However, the association between these conditions is yet to be investigated. We sought to estimate the risk of having BP among patients previously diagnosed with asthma and to characterize patients with coexistent BP and asthma. METHODS Utilizing the dataset of Clalit Health Services, a population-based case-control study was conducted comparing BP patients (n = 3,924) with age-, sex-, and ethnicity-matched control subjects (n = 19,280) regarding the presence of asthma. Logistic regression models were utilized for univariate and multivariate analyses. RESULTS The prevalence of preceding asthma was higher in patients with BP than in control subjects (11.1 vs. 7.9%, respectively; p < 0.001). A history of asthma was associated with a 50% increase in the risk of BP (OR 1.45; 95% CI 1.30-1.62). The association was not altered greatly after adjusting for demographics (adjusted OR 1.43; 95% CI 1.28-1.61) as well as for demographics and comorbidities (adjusted OR 1.40; 95% CI 1.25-1.57). The average (SD) latency between the diagnosis of asthma and the development of BP was 12.5 (14.7) years. When compared with other patients with BP, those with a dual diagnosis of BP and asthma were older, had higher BMI, and were more frequently managed by corticosteroids and immunosuppressive and immunomodulatory adjuvants. CONCLUSIONS Asthma confers a predisposition to the development of BP. Awareness of this association may be of help for physicians managing patients with BP and asthma. Further research is required to elucidate the mechanism underlying this observation.
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Affiliation(s)
- Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany, .,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel,
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel.,Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Iskandar IYK, Parisi R, Griffiths CEM, Ashcroft DM. Systematic review examining changes over time and variation in the incidence and prevalence of psoriasis by age and gender. Br J Dermatol 2020; 184:243-258. [PMID: 32358790 DOI: 10.1111/bjd.19169] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is a lack of any overview of changes over time and variation in the epidemiology of psoriasis with age and between genders. OBJECTIVES To perform a systematic review of published population-based studies on variations in psoriasis incidence and prevalence with age and between genders, and to explore trends in psoriasis epidemiology over time. METHODS Eleven electronic and regional databases were searched from their inception dates to October 2019. No language restrictions were applied. Studies were eligible if they reported on changes in psoriasis incidence and/or prevalence over time and/or by age group and gender. RESULTS In total 308 papers were critically appraised, from which 90 studies from 22 countries were included. Incidence data confirmed a clear bimodal age pattern in psoriasis onset, with the first and second peaks at around 30-39 and 60-69 years of age, respectively, and evidence suggesting that it presents slightly earlier in women than in men. Prevalence data showed an increasing trend with age until around 60 or 70 years, after which it decreases. Although there was lack of agreement on specific gender differences in psoriasis incidence and prevalence, a slight male predominance was reported in several studies. Studies worldwide suggested a stable or slightly decreasing trend in psoriasis incidence, while an increasing trend in psoriasis prevalence has been consistently reported. One particular challenge faced was the vastly different methodologies used in the included studies, which contributed to some of the heterogeneity of the results. CONCLUSIONS Studies on changes over time in the occurrence of psoriasis have contributed to a greater appreciation of the increasing burden of the disease. However, further research is required to determine the reasons driving the increase in psoriasis prevalence over time.
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Affiliation(s)
- I Y K Iskandar
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - R Parisi
- NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - C E M Griffiths
- NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,Dermatology Centre, Salford Royal NHS Foundation Trust, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - D M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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12
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Smew AI, Lundholm C, Sävendahl L, Lichtenstein P, Almqvist C. Familial Coaggregation of Asthma and Type 1 Diabetes in Children. JAMA Netw Open 2020; 3:e200834. [PMID: 32163166 PMCID: PMC7068230 DOI: 10.1001/jamanetworkopen.2020.0834] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE The association between atopic and autoimmune disease, particularly asthma and type 1 diabetes, has been debated. Further understanding of the underlying factors associated with the comorbidity in children is warranted. OBJECTIVES To assess the bidirectional association between asthma and type 1 diabetes and examine the possibility of a shared risk for the diseases by studying their pattern of familial coaggregation. DESIGN, SETTING, AND PARTICIPANTS A birth cohort study of children born from January 1, 2001, and followed up until December 31, 2015, was performed. Population data were obtained from multiple national Swedish registers. A total of 1 347 901 singleton children, live-born in Sweden between January 1, 2001, and December 31, 2013, were identified, and children with incomplete data were excluded. The remaining 1 284 748 children were linked to their biological full siblings, maternal and paternal half-siblings, cousins, and half-cousins. Data analysis was conducted from April 1, 2019, to January 17, 2020. MAIN OUTCOMES AND MEASURES Cases of asthma and type 1 diabetes were defined using a combination of diagnoses and medication prescriptions found in the registers. RESULTS In the cohort of 1 284 748 children, 660 738 children (51.4%) were boys; 121 809 children (9.5%) had asthma, 3812 children (0.3%) had type 1 diabetes, and 494 children had both asthma and type 1 diabetes, representing 0.4% of all asthma or 13% of all type 1 diabetes. Mean (SD) age at diagnosis was 3.0 (2.8) years for children with asthma, and 5.9 (3.3) years for those with type 1 diabetes. Asthma and type 1 diabetes were associated within individuals (odds ratio, 1.15; 95% CI, 1.05-1.27). Children with asthma had an increased risk of subsequent type 1 diabetes (hazard ratio, 1.16; 95% CI, 1.06-1.27); however, subsequent asthma risk did not differ substantially among children with type 1 diabetes (hazard ratio, 0.92; 95% CI, 0.75-1.12). Siblings of individuals with asthma were at an increased risk of type 1 diabetes (odds ratio, 1.27; 95% CI, 1.13-1.42) and vice versa. The results remained positive after controlling for the direct association of one disease with the other. CONCLUSIONS AND RELEVANCE This study appears to provide evidence for co-occurrence, importance of sequential appearance, and coaggregation of asthma and type 1 diabetes in children and their siblings. The findings may suggest shared familial factors contributing to the associations. Knowledge of the nature of the association could be of importance in future clinical practice.
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Affiliation(s)
- Awad I. Smew
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Sävendahl
- Pediatric Endocrinology Unit at Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
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Shalom G, Kridin K, Raviv KO, Freud T, Comaneshter D, Friedland R, Cohen AD, Ben-Amitai D. Atopic Dermatitis and Celiac Disease: A Cross-Sectional Study of 116,816 Patients. Am J Clin Dermatol 2020; 21:133-138. [PMID: 31679111 DOI: 10.1007/s40257-019-00474-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Both atopic dermatitis and celiac disease are often accompanied by other immune-mediated disorders. OBJECTIVE The objective of this study was to evaluate the potential association between atopic dermatitis and celiac disease in a broad community-based population. METHODS A cross-sectional observational design was used. Demographic and clinical data were collected for patients enrolled in a large health management organization who were diagnosed with atopic dermatitis by a dermatologist in 2002-17. The presence of celiac disease/celiac disease-related morbidities was recorded for the whole group, for adults (age > 18 years), and for adults with moderate-to-severe atopic dermatitis. Findings were compared with a matched control group without atopic dermatitis. RESULTS The study group included 116,816 patients of whom 45,157 were adults; 1909 adult patients had moderate-to-severe atopic dermatitis. Compared to the respective control subjects, the prevalence rate of celiac disease in the whole group was 0.6% vs. 0.4%; in the adults, 0.6% vs. 0.3%; and in the adults with moderate-to-severe atopic dermatitis, 0.8% vs. 0.3% (p < 0.001 for all). On multivariate analysis, atopic dermatitis was associated with a significantly higher prevalence of celiac disease (odds ratio = 1.609, 95% confidence interval 1.42-1.82, p < 0.001) in the entire study population and each subgroup. CONCLUSIONS We observed a significant association between atopic dermatitis and celiac disease. This association emphasizes the need for timely screening of gastrointestinal morbidities in individuals with atopic dermatitis to prevent long-term complications.
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Affiliation(s)
- Guy Shalom
- Clalit Health Services, Tel Aviv, Israel
- Division of Community Health, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Khalaf Kridin
- Department of Dermatology, Rambam Health Care Campus, P.O. Box 9602, Haifa, 31096, Israel.
| | - Keren-Or Raviv
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Tamar Freud
- Division of Community Health, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Doron Comaneshter
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Rivka Friedland
- Clalit Health Services, Tel Aviv, Israel
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon D Cohen
- Division of Community Health, Faculty of Health Sciences, Siaal Research Center for Family Medicine and Primary Care, Ben Gurion University of the Negev, Beer-Sheva, Israel
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Dan Ben-Amitai
- Clalit Health Services, Tel Aviv, Israel
- Pediatric Dermatology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Kronzer VL, Crowson CS, Sparks JA, Vassallo R, Davis JM. Investigating Asthma, Allergic Disease, Passive Smoke Exposure, and Risk of Rheumatoid Arthritis. Arthritis Rheumatol 2019; 71:1217-1224. [PMID: 30747496 DOI: 10.1002/art.40858] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/07/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is postulated to originate at mucosal surfaces, particularly the airway mucosa. To investigate this hypothesis, we determined the association between RA and asthma, passive smoke exposure, and age at start of smoking. METHODS For this case-control study, we identified 1,023 cases of RA (175 incident) within a single-center biobank population, using a rules-based algorithm that combined self-report with 2 diagnostic codes. Exposures were self-reported on biobank questionnaires. Logistic regression models were used to calculate the association of exposures with RA, adjusting for potential confounders. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. RESULTS After adjustment for allergies, urban environment, and passive smoke exposure, asthma was found to be associated with RA in the full cohort (OR 1.28 [95% CI 1.04-1.58; P = 0.02]) but not the incident RA cohort (OR 1.17 [95% CI 0.66-2.06; P = 0.60]). History of allergic disease was associated with RA in both the full cohort (OR 1.30 [95% CI 1.12-1.51; P < 0.001]) and the incident RA cohort (OR 1.61 [95% CI 1.11-2.33; P = 0.01]), especially food allergy, which was significantly associated with RA in the full cohort (OR 1.38 [95% CI 1.08-1.75; P = 0.01]) and showed a trend toward significance in the incident RA cohort (OR 1.83 [95% CI 0.97-3.45; P = 0.06]). Passive smoke exposure at home or work was not associated with RA. Finally, age at start of smoking was not associated with increased odds of developing RA in either the full cohort (OR 1.03 [95% CI 1.00-1.06; P = 0.03]) or the incident RA cohort (OR 1.00 [95% CI 0.92-1.08; P = 0.98]). CONCLUSION Asthma and allergies may be associated with increased risk of RA. Passive smoke exposure and early age at start of smoking do not appear to influence risk of RA.
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Affiliation(s)
| | | | - Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Fernández-Armenteros J, Gómez-Arbonés X, Buti-Solé M, Betriu-Bars A, Sanmartin-Novell V, Ortega-Bravo M, Martínez-Alonso M, Casanova-Seuma J. Epidemiology of Psoriasis. A Population-Based Study. ACTAS DERMO-SIFILIOGRAFICAS 2019. [DOI: 10.1016/j.adengl.2019.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Fernández-Armenteros JM, Gómez-Arbonés X, Buti-Solé M, Betriu-Bars A, Sanmartin-Novell V, Ortega-Bravo M, Martínez-Alonso M, Casanova-Seuma JM. Epidemiology of Psoriasis. A Population-Based Study. ACTAS DERMO-SIFILIOGRAFICAS 2018; 110:385-392. [PMID: 30587329 DOI: 10.1016/j.ad.2018.10.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/01/2018] [Accepted: 10/02/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Psoriasis is a chronic immunoinflammatory skin disease very frequent in the western world. Several authors have tried to calculate its prevalence in different regions, although most of them obtained the data from surveys and there are few publications from Mediterranean areas. The objective of our study was to analyze the prevalence and severity of psoriasis in Lleida (a northeastern region in Spain), identify age and sex specific differences and compare our results with other European series. MATERIALS AND METHODS A joint database of primary care medicine and the dermatology department was obtained from the entire province of Lleida with epidemiological data and psoriasis diagnosis and treatment codification. RESULTS A corrected database was obtained with 398,701 individuals and 6,868 of them (1.72%) were coded with the diagnosis of psoriasis. The prevalence was significantly higher in men than in women (1.88% vs 1.56%, OR=1.21, 95% CI: 1.15-1.27). The highest prevalence of psoriasis was found in the 61-70 years group (2.90%) and psoriasis in population under 18 years of age was 0.30%. In our sample, 7.27% of the patients were classified as moderate-severe psoriasis (499/6,868). CONCLUSION This study reports the prevalence and severity of psoriasis in a large Mediterranean region sample, obtaining the information through a electronic database. This study reveals a lower prevalence of psoriasis compared to other European countries, and the proportion of severe psoriasis (based on treatment criteria) is lower than in other studies. We emphasize that these differences could probably due to genetic background, life style and diet.
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Affiliation(s)
- J M Fernández-Armenteros
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España; Servicio de Dermatología, Hospital Universitari Arnau de Vilanova, Lleida, España.
| | - X Gómez-Arbonés
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España; Universidad de Lleida, Lleida, España
| | - M Buti-Solé
- Unitat de Suport a la Recerca, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Lleida, España; Institut Català de la Salut, Lleida, España
| | - A Betriu-Bars
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España; Unitat de Detecció i Tractament de les Malalties Aterotrombòtiques (UDETMA), Servicio de Nefrología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - V Sanmartin-Novell
- Servicio de Dermatología, Hospital Universitari Arnau de Vilanova, Lleida, España
| | | | | | - J M Casanova-Seuma
- Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, España; Servicio de Dermatología, Hospital Universitari Arnau de Vilanova, Lleida, España; Universidad de Lleida, Lleida, España
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17
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Persistent eosinophilia in rheumatoid arthritis: a prospective observational study. Rheumatol Int 2018; 39:245-253. [DOI: 10.1007/s00296-018-4191-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/29/2018] [Indexed: 12/30/2022]
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18
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Arshad Z, Rezapour-Firouzi S, Mohammadian M, Ebrahimifar. The Sources of Essential Fatty Acids for Allergic and Cancer Patients; a Connection with Insight into Mammalian Target of Rapamycin: A Narrative Review. Asian Pac J Cancer Prev 2018; 19:2391-2401. [PMID: 30255691 PMCID: PMC6249470 DOI: 10.22034/apjcp.2018.19.9.2391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Disturbance in essential fatty acids (EFA) metabolism plays a key role in autoimmune diseases, but EFA supplementation with sources of borage, evening primrose, hemp seed and fish oils was not effective in atopic and cancer diseases, as that seen in the case of multiple sclerosis. It seems that two complexes of the mammalian target of rapamycin (mTOR) signaling, mTORC1 and mTORC2, are congruent with the two bases of the Traditional Iranian Medicine (TIM) therapy, Cold and Hot nature, which are essential for the efficacy of functional oils for controlling immune responses in autoimmune diseases. Methods: We searched PubMed database, Web of Science (WOS), Google Scholar, Scopus and selected studies by predefined eligibility criteria. We then assessed their quality and extracted data. Results: The oils controlled by Cold or Hot nature may be helpful in maintaining homeostasis and preventing autoimmune diseases. In summary, studies of randomized controlled trials for allergy and cancer patients found no improvement in the signs or response to tests, despite a remarkable change in EFA fractions in the blood by supplementation with sources of borage, evening primrose, hemp seed and fish oils. In contrast, portulaca oleracea oil exhibited protective effects by anti-inflammatory properties via the PI3K/Akt/mTORC2 pathway with a deviation immune response to Th1 to treat atopic diseases and cancer. Conclusions: According to the concept of Traditional Iranian Medicine therapy, in contrast to Cold-nature oils, EFA supplementation with the sources of Hot-nature oilsis not suitable for the treatment of atopic and cancerous diseases.
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Affiliation(s)
- Zhila Arshad
- Department of Pathology of Anatomy, School of Medicine, Baku University of Medical Sciences, Baku, Azerbaijan. ,
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19
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Sweis IE, Cressey BC. Potential role of the common food additive manufactured citric acid in eliciting significant inflammatory reactions contributing to serious disease states: A series of four case reports. Toxicol Rep 2018; 5:808-812. [PMID: 30128297 PMCID: PMC6097542 DOI: 10.1016/j.toxrep.2018.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/19/2022] Open
Abstract
Citric acid naturally exists in fruits and vegetables. However, it is not the naturally occurring citric acid, but the manufactured citric acid (MCA) that is used extensively as a food and beverage additive. Approximately 99% of the world's production of MCA is carried out using the fungus Aspergillus niger since 1919. Aspergilus niger is a known allergen. The FDA placed MCA under the category of GRAS without any research to substantiate this claim. In 2016, 2.3 million tons of MCA were produced, predominantly in China, and approximately 70% is used as a food or beverage additive. There have been no scientific studies performed to evaluate the safety of MCA when ingested in substantial amounts and with chronic exposure. We present four case reports of patients with a history of significant and repetitive inflammatory reactions including respiratory symptoms, joint pain, irritable bowel symptoms, muscular pain and enervation following ingestion of foods, beverages or vitamins containing MCA. We believe that ingestion of the MCA may lead to a harmful inflammatory cascade which manifests differently in different individuals based on their genetic predisposition and susceptibility, and that the use of MCA as an additive in consumable products warrants further studies to document its safety.
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Affiliation(s)
- Iliana E. Sweis
- Department of Surgery, University of Illinois at Chicago, USA
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Strzępa A, Majewska-Szczepanik M, Lobo FM, Wen L, Szczepanik M. Broad spectrum antibiotic enrofloxacin modulates contact sensitivity through gut microbiota in a murine model. J Allergy Clin Immunol 2017; 140:121-133.e3. [DOI: 10.1016/j.jaci.2016.11.052] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 11/10/2016] [Accepted: 11/23/2016] [Indexed: 12/24/2022]
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Son DJ, Jung YY, Park MH, Lee HL, Song MJ, Yoo HS, Hwang DY, Han SB, Hong JT. Activated Natural Killer Cells Mediate the Suppressive Effect of Interleukin-4 on Tumor Development via STAT6 Activation in an Atopic Condition Melanoma Model. Neoplasia 2017; 19:537-548. [PMID: 28587956 PMCID: PMC5459571 DOI: 10.1016/j.neo.2017.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 01/02/2023] Open
Abstract
A protective effect of allergy for cancer has been suggested, but the results are somewhat conflicting, and the mechanism remains elusive. Interleukin-4 (IL-4) signaling has been identified as a potentially important pathway in the development of allergies and the suppression of cancer development. To evaluate the allergy responses in IL-4–mediated tumor development, we compared the growth of B16F10 melanoma cells in 4% phthalic anhydride (PA)-treated IL-4/Luc/CNS-1 transgenic mice (IL-4 mice) and acetone-olive oil (AOO)–treated IL-4 mice as a control for 3 weeks. Much higher allergic responses and natural killer (NK) and STAT6 activation were found in PA-treated IL-4 mice compared with AOO-treated IL-4 control mice. Tumor volume and weight showed an inverse association with the higher allergic response and were significantly reduced in the PA-treated IL-4 mice when compared with those of AOO-treated IL-4 control mice. Significantly higher activation of STAT6, as well as IL-4 and NK cell activation, was found in the tumor tissues of PA-treated IL-4 mice. Infiltration of immune cells and cytokine levels were also higher in the tumor tissues of PA-treated IL-4 mice. We further found that IL-4–activated NK-92MI cells showed increased anticancer effects in human melanoma cells. Overall, these results showed that allergy responses further accelerated the IL-4–induced inhibition of tumor development through the activation of STAT6 pathways.
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Affiliation(s)
- Dong Ju Son
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea
| | - Yu Yeon Jung
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea
| | - Mi Hee Park
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea
| | - Hye Lim Lee
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea
| | - Min Ji Song
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea; Department of Obstetrics and Gynecology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 64 Daeheung-ro, Jung-gu, Daejeon 34943, Republic of Korea
| | - Hwan-Soo Yoo
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea
| | - Dae Youn Hwang
- Department of Biomaterial Science, Pusan National University, Miryang, Kyungnam 50463, Republic of Korea
| | - Sang Bae Han
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
| | - Jin Tae Hong
- College of Pharmacy and Medical Research Center, Chungbuk National University, 194-31 Osongsaengmyeong 1-ro, Osong-eup, Heungduk-gu, Cheongju, Chungbuk 28160, Republic of Korea.
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Guo R, Zhou Y, Lu L, Cao L, Cao J. Atopy in children with juvenile systemic lupus erythematosus is associated with severe disease. PLoS One 2017; 12:e0177774. [PMID: 28545118 PMCID: PMC5435243 DOI: 10.1371/journal.pone.0177774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 05/03/2017] [Indexed: 01/22/2023] Open
Abstract
The influence of co-existing atopy on the prognosis of juvenile systemic lupus erythematosus (JSLE) was assessed in this study. Patients diagnosed with JSLE between October 2005 and April 2016 were enrolled in a prospective study and followed up for 2 years. Management of patients was evaluated using the systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) score and laboratory variables. Eighty JSLE patients were enrolled at diagnosis and divided into those with (n = 35) and without (n = 45) atopy. When compared with the non-atopic group, atopic patients showed higher SLEDAI-2K score at disease onset (16.09 vs. 11.18), higher erythrocyte sedimentation rate (52.89 vs. 38.27 mm/h), higher percentage of total B-cells (25.85 vs. 19.51%), lower percentage (7.26 vs. 9.03%) and cytotoxicity (9.92 vs. 11.32%) of natural killer cells, and lower complement C3 (0.51 vs. 0.69 g/L) (all p<0.05). At 1, 3, 6, 12, 18, and 24 months, JSLE patients with atopy reached higher SLEDAI-2K score and lower ΔSLEDAI-2K improvement rate (at 1 month, 8.34 vs. 4.71 and 43.63 vs. 57.95%, respectively; at 3 months, 8.57 vs. 2.62 and 48.39 vs. 75.10%, respectively; at 6 months, 6.91 vs. 2.38 and 53.59 vs. 77.26%, respectively; at 12 months, 4.71 vs. 1.80 and 69.54 vs. 84.10%, respectively; at 18 months, 4.66 vs. 2.02 and 68.14 vs. 82.93%, respectively; at 24 months, 8.57 vs. 2.62 and 70.00 vs. 81.88%, respectively; all p<0.05). During the 24 months of follow-up, the total number of disease flares was higher in JSLE patients with co-existing atopy (3.77 vs. 1.51, p<0.05), and the atopic group needed much more time to reach the stable condition of the disease (6.88 vs. 4.65 months, p<0.05). JSLE patients combined with co-existing atopy had more severe disease at diagnosis and poorer outcomes than JSLE patients without atopy.
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Affiliation(s)
- Ruru Guo
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Yanqing Zhou
- Department of Pediatrics, Central hospital of Jiading, Shanghai, P.R.China
| | - Liangjing Lu
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Lanfang Cao
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
| | - Junjia Cao
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P. R. China
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Abuabara K, Magyari AM, Hoffstad O, Jabbar-Lopez ZK, Smeeth L, Williams HC, Gelfand JM, Margolis DJ, Langan SM. Development and Validation of an Algorithm to Accurately Identify Atopic Eczema Patients in Primary Care Electronic Health Records from the UK. J Invest Dermatol 2017; 137:1655-1662. [PMID: 28428130 PMCID: PMC5883318 DOI: 10.1016/j.jid.2017.03.029] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/03/2017] [Accepted: 03/21/2017] [Indexed: 12/21/2022]
Abstract
Electronic health records hold great promise for clinical and epidemiologic research. Undertaking atopic eczema (AE) research using such data is challenging because of its episodic and heterogeneous nature. We sought to develop and validate a diagnostic algorithm that identifies AE cases based on codes used for electronic records used in the UK Health Improvement Network. We found that at least one of five diagnosis codes plus two treatment codes for any skin-directed therapy were likely to accurately identify patients with AE. To validate this algorithm, a questionnaire was sent to the physicians of 200 randomly selected children and adults. The primary outcome, positive predictive value for a physician-confirmed diagnosis of AE, was 86% (95% confidence interval = 80-91). Additional criteria increased the PPV up to 95% but would miss up to 89% of individuals with physician-confirmed AE. The first and last entered diagnosis codes for individuals showed good agreement with the physician-confirmed age at onset and last disease activity; the mean difference was 0.8 years (95% confidence interval = -0.3 to 1.9) and -1.3 years (95% confidence interval = -2.5 to -0.1), respectively. A combination of diagnostic and prescription codes can be used to reliably estimate the diagnosis and duration of AE from The Health Improvement Network primary care electronic health records in the UK.
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Affiliation(s)
- Katrina Abuabara
- Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, USA.
| | - Alexa M Magyari
- Department of Health Policy & Management, University of California Berkeley School of Public Health, Berkeley, California, USA
| | - Ole Hoffstad
- Department of Biostatistics, Epidemiology, and Bioinformatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zarif K Jabbar-Lopez
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London, London, UK
| | - Liam Smeeth
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hywel C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
| | - Joel M Gelfand
- Department of Biostatistics, Epidemiology, and Bioinformatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David J Margolis
- Department of Biostatistics, Epidemiology, and Bioinformatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sinead M Langan
- Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, UK
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24
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El-Heis S, Crozier SR, Healy E, Robinson SM, Harvey NC, Cooper C, Inskip HM, Baird J, Godfrey KM. Maternal stress and psychological distress preconception: association with offspring atopic eczema at age 12 months. Clin Exp Allergy 2017; 47:760-769. [PMID: 28218994 DOI: 10.1111/cea.12910] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/16/2017] [Accepted: 02/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Perinatal maternal stress and low mood have been linked to offspring atopic eczema. OBJECTIVES To examine the relation of maternal stress/mood with atopic eczema in the offspring, focusing particularly on stress/psychological distress preconception. METHODS At recruitment in the UK Southampton Women's Survey, preconception maternal reports of perceived stress in daily living and the effect of stress on health were recorded; in a subsample, psychological distress was assessed (12-item General Health Questionnaire). Infants were followed up at ages 6 (n = 2956) and 12 (n = 2872) months and atopic eczema ascertained (based on UK Working Party Criteria for the Definition of Atopic Dermatitis). At 6 months post-partum, mothers were asked if they had experienced symptoms of low mood since childbirth and completed the Edinburgh Postnatal Depression Scale. RESULTS Preconception perceived stress affecting health [OR 1.21 (95% CI 1.08-1.35), P = 0.001] and stress in daily living [OR 1.16 (1.03-1.30), P = 0.014] were associated with an increased risk of offspring atopic eczema at age 12 months but not at 6 months, robust to adjustment for potentially confounding variables. Findings were similar for maternal psychological distress preconception. Low maternal mood between delivery and 6 months post-partum was associated with an increased risk of infantile atopic eczema at age 12 months, but no significant association between post-natal mood and atopic eczema was seen after taking account of preconception stress. CONCLUSION AND CLINICAL RELEVANCE Our data provide novel evidence linking maternal stress at preconception to atopic eczema risk, supporting a developmental contribution to the aetiology of atopic eczema and pointing to potentially modifiable influences.
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Affiliation(s)
- S El-Heis
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - S R Crozier
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E Healy
- Dermatopharmacology, Faculty of Medicine, University of Southampton, Southampton, UK
| | - S M Robinson
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - N C Harvey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - H M Inskip
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J Baird
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - K M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Institute of Developmental Sciences, University of Southampton, Southampton, UK
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25
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Bourne T, Waltz M, Casper TC, Kavak K, Aaen G, Belman A, Benson L, Candee M, Chitnis T, Graves J, Greenberg B, Gorman M, Harris Y, Krupp L, Lotze T, Mar S, Ness J, Olsen C, Roalstad S, Rodriguez M, Rose J, Rubin J, Schreiner T, Tillema JM, Kahn I, Waldman A, Barcellos L, Waubant E, Weinstock-Guttman B. Evaluating the association of allergies with multiple sclerosis susceptibility risk and disease activity in a pediatric population. J Neurol Sci 2017; 375:371-375. [PMID: 28320170 DOI: 10.1016/j.jns.2017.02.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) and allergies are both considered to be related to imbalanced Th1 and Th2 immune responses. Previous studies evaluating the relationship between MS and allergies provide conflicting results. OBJECTIVE To assess allergies and asthma as risk factors for MS and as predictors of MS relapses in a pediatric cohort. METHODS The environment and genetic risk factors for pediatric MS study is a national case-control project with 16 participating US sites. An environmental questionnaire is used that includes history of allergies in the first five years of life. Case-control data are entered in the pediatric MS Network database and cases at 12 of the 16 sites enter relapse data prospectively. Annualized relapse rate was calculated for patients with follow-up and adjusted for age at disease onset, gender, race, ethnicity, and use of disease-modifying therapy (DMT). RESULTS We included 271 cases (mean age at disease onset of 15.7years and 62% female) and 418 controls. Relapse data were available for 193 cases. There was no difference in prevalence of allergies or asthma between cases and controls. Patients with food allergies had fewer relapses compared to patients without food allergies (0.14 vs 0.48, p=0.01). CONCLUSIONS While allergies and asthma are not associated with pediatric MS, cases with food allergies have fewer relapses compared to those without food allergies.
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Affiliation(s)
| | | | - T C Casper
- University of Utah, Pediatrics, United States
| | - K Kavak
- State University of New York, Neurology, United States
| | - G Aaen
- Loma Linda University, Neurology, United States
| | - A Belman
- SUNY Stony Brook, Neurology, United States
| | - L Benson
- Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center, United States
| | - M Candee
- University of Utah, Pediatrics, United States
| | - T Chitnis
- Brigham and Women's Hospital, Neurology, United States
| | - J Graves
- Multiple Sclerosis Center, University of California, San Francisco, CA, United States
| | - B Greenberg
- University of Texas Southwestern, Neurology, United States
| | - M Gorman
- Massachusetts General Hospital, Partners Pediatric Multiple Sclerosis Center, United States
| | - Y Harris
- University of Alabama at Birmingham, Pediatrics, United States
| | - L Krupp
- SUNY Stony Brook, Neurology, United States
| | - T Lotze
- Texas Children's Hospital, Child Neurology, United States
| | - S Mar
- Washington University St. Louis, Neurology, United States
| | - J Ness
- University of Alabama at Birmingham, Pediatrics, United States
| | - C Olsen
- University of Utah, Pediatrics, United States
| | - S Roalstad
- University of Utah, Pediatrics, United States
| | | | - J Rose
- University of Utah, Neurology, United States
| | - J Rubin
- Ann & Robert Lurie Children's Hospital of Chicago, Neurology, United States
| | - T Schreiner
- University of Colorado School of Medicine, Neurology, United States
| | | | - I Kahn
- Children's National Medical Center, Washington, United States
| | - A Waldman
- Children's Hospital of Philadelphia, Neurology, United States
| | - L Barcellos
- University of California Berkeley, United States
| | - E Waubant
- Multiple Sclerosis Center, University of California, San Francisco, CA, United States
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26
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Allergies: diseases closely related to cancer. BOLETIN MEDICO DEL HOSPITAL INFANTIL DE MEXICO 2016; 73:432-445. [PMID: 29421288 DOI: 10.1016/j.bmhimx.2016.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/20/2016] [Indexed: 12/15/2022] Open
Abstract
Allergies are hypersensitivity reactions that occur through specific type Th2 immunological mechanisms characterized by different soluble mediators, as well as specific cells of the immune system. In recent decades, evidence has emerged relating this disease with cancer development. However, most of the results of epidemiology studies have been controversial and contradictory. There are mainly two trends. While the first indicates that allergies can reduce the risk of cancer, the other indicates that they may increase this risk. The first trend can be explained by the immunosurveillance hypothesis, which states that the increased immune surveillance after the immune hyper-responsiveness can inhibit or exert a protective effect against the development of cancer. Similarly, the prophylaxis hypothesis suggests that the physical effects of allergy symptoms can prevent cancer by removing potential carcinogens. In contrast, the opposing hypothesis propose that there is a deviation of the immune response toward Th2, which favors the development of cancer, or that the process of chronic inflammation favors the generation of mutations, and therefore the development of cancer. With the purpose of understanding more about these two hypotheses, the main soluble and cellular factors of allergic diseases that could be playing a key role in the development or inhibition of cancer were considered in this review.
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27
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D'Angelo G, Marseglia L, Manti S, Colavita L, Cuppari C, Impellizzeri P, Arena S, Arrigo T, Salpietro C, Gitto E. Atopy and autoimmune thyroid diseases: melatonin can be useful? Ital J Pediatr 2016; 42:95. [PMID: 27814774 PMCID: PMC5096296 DOI: 10.1186/s13052-016-0305-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/18/2016] [Indexed: 11/25/2022] Open
Abstract
Recently, there has been growing interest in the relationship between allergic and autoimmune diseases. Allergy and autoimmunity can be considered two potential outcomes of dysregulated immunity and analysis of literature data shows a strong positive association between a history of Th2-mediated allergic disorders and Th1-mediated autoimmune disorders. Autoimmune thyroid diseases are the most common of all autoimmune pathological conditions. Currently, the mechanisms explaining an association among atopy, autoimmunity, and thyroid diseases are not fully understood. There are data in literature pointing to the relationship between melatonin and thyroid activity. Several studies have suggested a paracrine role for this molecule in the regulation of thyroid activity, documenting that administration, as an antioxidant, in thyroid tissues under conditions of increased oxidative stress, could be helpful to reduce the oxidative processes involved in autoimmune thyroid diseases. Although thyroid autoimmunity has been regularly associated with atopic conditions in children, the possible protective role of melatonin has not yet been investigated. This review summarizes what is known regarding the connection between atopy and autoimmune thyroid diseases, and analyses the probable beneficial action of melatonin.
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Affiliation(s)
- Gabriella D'Angelo
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy.
| | - Lucia Marseglia
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Sara Manti
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Laura Colavita
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Caterina Cuppari
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Pietro Impellizzeri
- Unit of Paediatric Surgery, Department of Paediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Salvatore Arena
- Unit of Paediatric Surgery, Department of Paediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Teresa Arrigo
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Carmelo Salpietro
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Eloisa Gitto
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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28
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Nakamura M, Lee K, Singh R, Zhu TH, Farahnik B, Abrouk M, Koo J, Bhutani T. Eczema as an adverse effect of anti-TNFα therapy in psoriasis and other Th1-mediated diseases: a review. J DERMATOL TREAT 2016; 28:237-241. [PMID: 27571340 DOI: 10.1080/09546634.2016.1230173] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION There have been rare reports of eczema occurring as an adverse effect of anti-tumor necrosis factor-alpha (TNFα) therapy. METHODS A literature search was conducted on PubMed for articles describing new onset or worsening of preexisting eczema during anti-TNFα therapy for the treatment of various inflammatory diseases. RESULTS Eczema as an adverse effect of anti-TNFα therapy may occur in approximately 5-20% of patients with various Th1-mediated inflammatory diseases such as psoriasis, inflammatory arthritis and inflammatory bowel disease. Personal history of atopy appears to increase this risk. Out of the anti-TNFα agents indicated for the treatment of moderate-to-severe psoriasis, infliximab may be more strongly associated with development or exacerbation of preexisting eczema. DISCUSSION Inhibitors of key mediators in the Th1 pathway such as TNFα are successful therapeutic targets for the treatment of various inflammatory conditions such as psoriasis, psoriatic arthritis, rheumatoid arthritis and inflammatory bowel disease. Blocking the Th1 pathway may create an imbalance favoring increased activity of the opposing Th2 pathway implicated in inflammatory conditions such as eczema. Further research is needed to better understand the role of the Th1/Th2 balance in various inflammatory diseases and how the immunologic environment is affected by immunotherapies.
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Affiliation(s)
- Mio Nakamura
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Kristina Lee
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Rasnik Singh
- b University of California Los Angeles, David Geffen School of Medicine at UCLA , Los Angeles , CA , USA
| | - Tian Hao Zhu
- c University of Southern California Keck School of Medicine , Los Angeles , CA , USA
| | | | - Michael Abrouk
- e University of California - Irvine, School of Medicine , Irvine , CA , USA
| | - John Koo
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
| | - Tina Bhutani
- a Department of Dermatology , University of California San Francisco , San Francisco , CA , USA
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29
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Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol 2016; 31:205-212. [PMID: 27573025 DOI: 10.1111/jdv.13854] [Citation(s) in RCA: 586] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/23/2016] [Indexed: 01/10/2023]
Abstract
To inform the WHO Global report on psoriasis, a new comprehensive worldwide systematic review of the epidemiology of psoriasis was undertaken. The aim of this study was to systematically review the worldwide literature regarding the epidemiology of psoriasis, including prevalence and incidence, in adults and in children. A search of 15 electronic medical databases was performed. Using a rigorous systematic protocol, eligible articles were analysed. No language, regional or temporal restrictions were applied. A total of 76 study observations met all eligibility criteria and were included in the systematic review. The estimates of the prevalence of psoriasis in adults ranged from 0.51% to 11.43%, and in children from 0% to 1.37%. Psoriasis is a common disease, occurring more frequently with advancing age. Limited data on the epidemiology of psoriasis are available. The available prevalence data come from only 20 countries, meaning there are huge geographic gaps in knowledge, especially from low- and middle-income settings.
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Affiliation(s)
- I M Michalek
- Medical University of Warsaw, Warsaw, Poland.,Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva 27, Switzerland
| | - B Loring
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva 27, Switzerland
| | - S M John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Osnabruck, Germany
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30
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Ozdogan S, Urganci N, Usta M, Uslu Kizilkan N. Prevalence of Asthma and Allergic Rhinitis in Children with Celiac Disease. IRANIAN JOURNAL OF PEDIATRICS 2016; In Press. [DOI: 10.5812/ijp.6358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
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31
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Qian Y, Culton DA, Jeong JS, Trupiano N, Valenzuela JG, Diaz LA. Non-infectious environmental antigens as a trigger for the initiation of an autoimmune skin disease. Autoimmun Rev 2016; 15:923-30. [PMID: 27396816 DOI: 10.1016/j.autrev.2016.07.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/13/2016] [Indexed: 12/20/2022]
Abstract
Pemphigus represents a group of organ specific autoimmune blistering disorders of the skin mediated by pathogenic autoantibodies with well-defined antigenic targets. While most of these diseases are sporadic, endemic forms of disease do exist. The endemic form of pemphigus foliaceus (also known as fogo selvagem, FS) exhibits epidemiological features that suggest exposure to hematophagous insect bites are a possible precipitating factor of this autoimmune disease, and provides a unique opportunity to study how environmental factors contribute to autoimmune disease development. FS patients and healthy individuals from endemic regions show an autoreactive IgM response that starts in early childhood and becomes restricted to IgG4 autoantibodies in FS patients. In searching for triggering environmental antigens, we have found that IgG4 and IgE autoantibodies from FS patients cross-react with a salivary antigen from sand flies. The presence of these cross-reactive antibodies and antibody genetic analysis confirming that these antibodies evolve from the same naïve B cells provides compelling evidence that this non-infectious environmental antigen could be the initial target of the autoantibody response in FS. Consequently, FS serves as an ideal model to study the impact of environmental antigens in the development of autoimmune disease.
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Affiliation(s)
- Ye Qian
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Donna A Culton
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Joseph S Jeong
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Nicole Trupiano
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jesus G Valenzuela
- Vector Molecular Biology Section, LMVR, National Institute of Allergy and Infectious Diseases, NIH, Rockville, MD 20852, USA
| | - Luis A Diaz
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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32
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Edwards LJ, Constantinescu CS. A prospective study of conditions associated with multiple sclerosis in a cohort of 658 consecutive outpatients attending a multiple sclerosis clinic. Mult Scler 2016; 10:575-81. [PMID: 15471376 DOI: 10.1191/1352458504ms1087oa] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The cause of multiple sclerosis (MS) remains unknown. It is largely regarded as being an inflammatory autoimmune disease and has been reported in association with other inflammatory/autoimmune diseases. We performed a prospective study in 658 consecutive patients diagnosed with MS attending our outpatient MS management clinic between June 2002 and June 2003. Prevalence of associated conditions in these patients was calculated and compared with values from population studies using chi-square tests, odds ratios and confidence intervals. The MS population had significantly increased rates of asthma, inflammatory bowel disease, type I diabetes mellitus, pernicious anaemia, autoimmune thyroid disease, uveitis, seronegative spondyloarthropathies, bipolar disorder and melanoma compared to the general population. Both T helper type 1 (Th1)-mediated and T helper type 2 (Th2)-mediated diseases were significantly increased compared to the general population. There were also interesting associations seen with polyglandular autoimmune syndrome and rare single case associations. MS is associated with several other conditions. This work does not give evidence for the hypothesis that MS and atopy, reflecting Th1 and Th2 polarization, respectively, are mutually exclusive. Further work, ideally with a matched control population, is indicated.
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Affiliation(s)
- L J Edwards
- Division of Clinical Neurology, Queen's Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK
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33
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Wei CC, Lin CL, Shen TC, Tsai JD. Atopic dermatitis and association of risk for primary immune thrombocytopenia and autoimmune diseases among children: A nationwide population-based cohort study. Medicine (Baltimore) 2016; 95:e4226. [PMID: 27442647 PMCID: PMC5265764 DOI: 10.1097/md.0000000000004226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Primary immune thrombocytopenia (ITP) is currently defined as an acquired autoimmune disorder with persistent thrombocytopenia. However, the temporal interaction between T helper type 2 cell (Th2)-mediated allergic diseases and T helper type 1 cell (Th1)-mediated ITP remains unknown. Atopic dermatitis (AD) is considered one of the first steps in the atopic march. Herein, we conducted a population-based cohort analysis to investigate the risk of ITP in children with AD in comparison with non-AD controls. We subsequently compared the occurrence of other autoimmune diseases in ITP children in both AD and non-AD cohorts. From 2000 to 2007, 120,704 children with newly diagnosed AD and 241,408 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of ITP in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and confidence intervals (CIs) were measured. Comparison of the occurrence of other autoimmune diseases in ITP between children with and without AD was analyzed. The incidence of ITP during the study period was 1.72-fold greater (95% CI: 1.13-2.62) in the AD cohort than in the non-AD cohort (6.96 vs 4.00 per 100,000 person-years). The risk was greatest among male children, children >2 years, those in densely populated areas, and those with white-collar parents. The HR of ITP in AD children increased significantly with the number of AD-related clinical visits (P < 0.001). The risk of developing ITP in the AD cohort was highest within the first 3 years after the diagnosis of AD (HR: 1.78; CI: 1.14-2.78). The AD cohort with ITP had a higher occurrence rate of other autoimmune diseases than the non-AD cohort with ITP. AD children had a greater risk of developing ITP and other autoimmune diseases. Further research is needed to clarify the role of allergy in the pathogenesis of ITP and autoimmune diseases.
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Affiliation(s)
- Chang-Ching Wei
- China Medical University Children's Hospital
- College of Medicine, China Medical University
| | - Cheng-Li Lin
- College of Medicine, China Medical University
- Management Office for Health Data, China Medical University Hospital
| | - Te-Chun Shen
- College of Medicine, China Medical University
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
| | - Jeng-Dau Tsai
- Department of Pediatrics, Chung Shan Medical University Hospital
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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34
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Pols DHJ, Wartna JB, Moed H, van Alphen EI, Bohnen AM, Bindels PJE. Atopic dermatitis, asthma and allergic rhinitis in general practice and the open population: a systematic review. Scand J Prim Health Care 2016; 34:143-50. [PMID: 27010253 PMCID: PMC4977936 DOI: 10.3109/02813432.2016.1160629] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/31/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine whether significant differences exist between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. METHODS Medline (OvidSP), PubMed Publisher, EMBASE, Google Scholar and the Cochrane Controlled Clinical Trials Register databases were systematically reviewed for articles providing data on the prevalence of asthma, allergic rhinitis and eczema in a GP setting. Studies were only included when they had a cross-sectional or cohort design and included more than 100 children (aged 0-18 years) in a general practice setting. All ISAAC studies (i.e. the open population) that geographically matched a study selected from the first search, were also included. A quality assessment was conducted. The primary outcome measures were prevalence of eczema, asthma and allergic rhinitis in children aged 0-18 years. RESULTS The overall quality of the included studies was good. The annual and lifetime prevalences of the atopic disorders varied greatly in both general practice and the open population. On average, the prevalence of atopic disorders was higher in the open population. CONCLUSION There are significant differences between the self-reported prevalence of atopic disorders in the open population compared with physician diagnosed prevalence of atopic disorders in general practice. Data obtained in the open population cannot simply be extrapolated to the general practice setting. This should be taken into account when considering a research topic or requirements for policy development. GPs should be aware of the possible misclassification of allergic disorders in their practice. Key Points Epidemiological data on atopic disorders in children can be obtained from various sources, each having its own advantages and limitations. On average, the prevalence of atopic disorders is higher in the open population. GPs should take into account the possible misclassification of atopic disorders in their practice population. Policymakers should be aware that data obtained in the open population cannot simply be extrapolated to the general practice setting.
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Affiliation(s)
- D. H. J. Pols
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Comprehensive epidemiological and genotype-phenotype analyses in a large European sample with idiopathic achalasia. Eur J Gastroenterol Hepatol 2016; 28:689-95. [PMID: 26882171 DOI: 10.1097/meg.0000000000000602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Although an eight-residue insertion in HLA-DQβ1 has been recently identified as a genetic risk factor for idiopathic achalasia, other risk factors are still unknown. In the present study, we carried out an epidemiological survey and a genotype-phenotype (G×P) analysis to gain further insights into the etiology of achalasia. METHODS We obtained medical data from 696 achalasia patients and 410 controls, as well as their first-degree relatives (2543 of patients and 1497 of controls). For the G×P analysis, we stratified the patients into HLA-DQβ1 insertion carriers and noncarriers. RESULTS Our data show that patients are more often affected by viral infections before achalasia onset (P<0.0001, most significantly for varicella zoster virus infections). In addition, allergic (P=0.0005) and autoimmune disorders (P=0.0007, most significantly for psoriasis and Sjögren's syndrome) represent comorbid disease conditions. First-degree relatives of patients also show higher prevalence rates of allergic disorders (P=0.0007) and psoriasis (P=0.016) compared with control relatives. Moreover, the G×P analysis reveals that achalasia is triggered by pregnancies in female HLA-DQβ1 insertion carriers (P=0.031). CONCLUSION Our data point to a role of viral infections in the development of achalasia. In addition, they provide evidence for a relationship between achalasia and allergic, as well as autoimmune, disorders. Furthermore, pregnancy seems to be a disease-triggering factor in female HLA-DQβ1 insertion carriers, which points to hormonal and/or immunosuppressive factors influencing disease development.
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Wulaningsih W, Holmberg L, Garmo H, Karagiannis SN, Ahlstedt S, Malmstrom H, Lambe M, Hammar N, Walldius G, Jungner I, Ng T, Van Hemelrijck M. Investigating the association between allergen-specific immunoglobulin E, cancer risk and survival. Oncoimmunology 2016; 5:e1154250. [PMID: 27471625 PMCID: PMC4938379 DOI: 10.1080/2162402x.2016.1154250] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 01/29/2016] [Accepted: 02/09/2016] [Indexed: 11/17/2022] Open
Abstract
Prior findings linking allergy and cancer have been inconsistent, which may be driven by diverse assessment methods. We used serum specific immunoglobulin E (IgE) against common inhalant allergens that was assessed prior to cancer diagnosis in studying this association. We selected 8,727 Swedish men and women who had measurements of serum allergen-specific IgE and total IgE between 1992 and 1996. Multivariable Cox regression using age as a timescale was performed to assess the associations of IgE sensitization, defined by any levels of serum specific IgE ≥35 kU/L, with risk of overall and specific cancers. A test for trend was performed by assigning scores derived from allergen-specific IgE levels at baseline as an ordinal scale. Kaplan-Meier curves and log-rank test were used to assess cancer survival by IgE sensitization status. During a mean follow-up of 16 year, 689 persons were diagnosed with cancer. We found an inverse association between IgE sensitization and cancer risk, with a hazard ratio (HR) of 0.83 and 95% confidence intervals (CI) of 0.70-0.99. A similar trend was seen with specific IgE scores overall (Ptrend = 0.007) and in women (Ptrend = 0.01). Although IgE sensitization was not associated with risk of common site-specific cancers, serum specific IgE scores were inversely associated with melanoma risk in men and women combined, and with risk of female breast and gynecological cancers combined. No association with survival was observed. The association between circulating IgE levels and incident cancer may point toward a role of T-helper 2 (TH2)-biased response in development of some cancers.
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Affiliation(s)
- Wahyu Wulaningsih
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK
- Division of Hematology/Oncology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia
| | - Lars Holmberg
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
- Regional Cancer Centre, Uppsala, Sweden
| | - Hans Garmo
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine, Faculty of Life Sciences and Medicine, King's College London, NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, UK
| | - Sophia N. Karagiannis
- St. John's Institute of Dermatology, Division of Genetics and Molecular Medicine, Faculty of Life Sciences and Medicine, King's College London, NIHR Biomedical Research Centre at Guy's and St. Thomas's Hospitals and King's College London, London, UK
| | - Staffan Ahlstedt
- Center of Allergy Research, Institute of Environmental Medicine, Karolinska Insitutet, Stockholm, Sweden
| | - Håkan Malmstrom
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lambe
- Regional Cancer Centre, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Hammar
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- AstraZeneca R&D, Mölndal, Sweden
| | - Göran Walldius
- Unit of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ingmar Jungner
- Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB Research, Stockholm, Sweden
| | - Tony Ng
- Richard Dimbleby Department of Cancer Research, Randall Division and Division of Cancer Studies, King's College London, London, UK
| | - Mieke Van Hemelrijck
- Cancer Epidemiology Group, Division of Cancer Studies, King's College London, London, UK
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Lin CH, Lin CL, Shen TC, Wei CC. Epidemiology and risk of juvenile idiopathic arthritis among children with allergic diseases: a nationwide population-based study. Pediatr Rheumatol Online J 2016; 14:15. [PMID: 26965056 PMCID: PMC4787040 DOI: 10.1186/s12969-016-0074-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 03/04/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Epidemiological research reveals that the incidence of allergic diseases and that of autoimmune diseases have been increasing in parallel, raising an interest in a potential link between the two disorders. However, the relationship between Th2-mediated allergic disease and Th1-mediated juvenile idiopathic arthritis (JIA) remains unclear. This population-based case-control study was aimed at investigating the development of childhood-onset allergic diseases and the subsequent risks of JIA. METHODS We included 329 children with JIA diagnosed between 2000 and 2008, and 1316 age- and sex-matched controls. The odds ratios of developing JIA were calculated to determine an association with preexisting allergic diseases. RESULTS The incidence rate of JIA in Taiwan between 2000 and 2008 was 1.33 cases per 100,000 children/year according to the International League of Associations for Rheumatology (ILAR) criteria. The children with a single allergic disease had an increased risk of JIA, with adjusted odds ratios of developing JIA of 1.44 for allergic conjunctivitis (95 % confidence interval [CI], 1.07-1.95), 1.50 for allergic rhinitis (1.15-1.96), and 1.44 for asthma (1.00-2.10). The adjusted odds ratios increased with the number of concurrent allergic diseases from 1.50 (95 % CI, 1.12-2.01) for those with only one allergic disease to 1.72 (1.24-2.38) for those with at least two allergic diseases. The adjusted odds ratios of those with at least two allergic diseases increased to 1.84 (95 % CI, 1.19-2.86) for boys and 2.54 (1.42-4.54) for those older than 12 years. The children who made two or more medical visits for associated allergic diseases per year had an increased risk of JIA. CONCLUSION Children with onset of allergic diseases were at increased risk of developing JIA. The increased risk was associated with the cumulative effect of concurrent allergic diseases and frequency of seeking medical care. Further study to investigate the role of Th2-mediated allergic diseases that contribute to the development of Th1-mediated JIA is warranted.
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Affiliation(s)
- Chien-Heng Lin
- Children’s Hospital of China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan ,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Te-Chun Shen
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan ,School of Medicine, China Medical University, No2, Yu-Der Road, Taichung, 40402 Taiwan
| | - Chang-Ching Wei
- Children's Hospital of China Medical University Hospital, Taichung, Taiwan. .,School of Medicine, China Medical University, No2, Yu-Der Road, Taichung, 40402, Taiwan.
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38
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Zivadinov R, Raj B, Ramanathan M, Teter B, Durfee J, Dwyer MG, Bergsland N, Kolb C, Hojnacki D, Benedict RH, Weinstock-Guttman B. Autoimmune Comorbidities Are Associated with Brain Injury in Multiple Sclerosis. AJNR Am J Neuroradiol 2016; 37:1010-6. [PMID: 26892983 DOI: 10.3174/ajnr.a4681] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/25/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND PURPOSE The effect of comorbidities on disease severity in MS has not been extensively characterized. We determined the association of comorbidities with MR imaging disease severity outcomes in MS. MATERIALS AND METHODS Demographic and clinical history of 9 autoimmune comorbidities confirmed by retrospective chart review and quantitative MR imaging data were obtained in 815 patients with MS. The patients were categorized on the basis of the presence/absence of total and specific comorbidities. We analyzed the MR imaging findings, adjusting for key covariates and correcting for multiple comparisons. RESULTS Two hundred forty-one (29.6%) study subjects presented with comorbidities. Thyroid disease had the highest frequency (n = 97, 11.9%), followed by asthma (n = 41, 5%), type 2 diabetes mellitus (n = 40, 4.9%), psoriasis (n = 33, 4%), and rheumatoid arthritis (n = 22, 2.7%). Patients with MS with comorbidities showed decreased whole-brain and cortical volumes (P < .001), gray matter volume and magnetization transfer ratio of normal-appearing brain tissue (P < .01), and magnetization transfer ratio of gray matter (P < .05). Psoriasis, thyroid disease, and type 2 diabetes mellitus comorbidities were associated with decreased whole-brain, cortical, and gray matter volumes (P < .05). Psoriasis was associated with a decreased magnetization transfer ratio of normal-appearing brain tissue (P < .05), while type 2 diabetes mellitus was associated with increased mean diffusivity (P < .01). CONCLUSIONS The presence of comorbidities in patients with MS is associated with brain injury on MR imaging. Psoriasis, thyroid disease, and type 2 diabetes mellitus comorbidities were associated with more severe nonconventional MR imaging outcomes.
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Affiliation(s)
- R Zivadinov
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center MR Imaging Clinical Translational Research Center (R.Z.)
| | - B Raj
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center
| | - M Ramanathan
- Department of Pharmaceutical Sciences (M.R.), School of Medicine and Biomedical Sciences, State University of New York, Buffalo, New York
| | - B Teter
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - J Durfee
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center
| | - M G Dwyer
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center
| | - N Bergsland
- From the, Department of Neurology (R.Z., B.R., J.D., M.G.D., N.B.), Buffalo Neuroimaging Analysis Center Magnetic Resonance Laboratory (N.B.), IRCCS Don Gnocchi Foundation, Milan, Italy
| | - C Kolb
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - D Hojnacki
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - R H Benedict
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
| | - B Weinstock-Guttman
- Department of Neurology (B.T., C.K., D.H., R.H.B., B.W.-G.), Jacobs MS Center, University at Buffalo, State University of New York, Buffalo, New York
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Gross CC, Schulte-Mecklenbeck A, Klinsing S, Posevitz-Fejfár A, Wiendl H, Klotz L. Dimethyl fumarate treatment alters circulating T helper cell subsets in multiple sclerosis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 3:e183. [PMID: 26767188 PMCID: PMC4701136 DOI: 10.1212/nxi.0000000000000183] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/01/2015] [Indexed: 11/15/2022]
Abstract
Objective: To evaluate the effect of dimethyl fumarate (DMF; Tecfidera, Biogen, Weston, MA) on CD4+ and CD8+ T cell subsets in patients with multiple sclerosis (MS). Methods: Peripheral lymphocyte subsets, including CD4+ and CD8+ memory cells and T helper (TH) cells TH1, TH2, TH17, and peripheral regulatory T cell (pTreg) subpopulations were analyzed before and 6 months after onset of DMF treatment. Results: CD4+ and CD8+ memory T cells were preferentially decreased compared to naive CD4+ and CD8+ T cell populations. Within the CD4+ memory T cell population, frequencies of TH1 cells were decreased, whereas those of TH2 cells were increased and those of TH17 cells remained unaltered. Accordingly, we observed decreased production of interferon γ, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor α, and interleukin (IL)-22 by CD4+ T cells under DMF treatment, whereas the frequency of IL-4- and IL-17A-producing CD4+ T cells remained unchanged. With regard to regulatory T cells, proportions of pTreg increased following DMF treatment. Conclusion: Our data demonstrate that DMF treatment of patients with MS affects predominantly memory T cells accompanied by a shift in TH cell populations, resulting in a shift toward anti-inflammatory responses. These findings indicate that monitoring of memory subsets might enhance vigilance of impaired antiviral immunity and that patients with TH1-driven disease might preferentially benefit from DMF treatment. Classification of Evidence: This study provides Class IV evidence that DMF might preferentially reduce CD4+ and CD8+ memory T cells in MS.
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Affiliation(s)
- Catharina C Gross
- Department of Neurology, University Hospital Münster, Münster, Germany
| | | | - Svenja Klinsing
- Department of Neurology, University Hospital Münster, Münster, Germany
| | | | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Münster, Germany
| | - Luisa Klotz
- Department of Neurology, University Hospital Münster, Münster, Germany
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Klamt S, Vogel M, Kapellen TM, Hiemisch A, Prenzel F, Zachariae S, Ceglarek U, Thiery J, Kiess W. Association between IgE-mediated allergies and diabetes mellitus type 1 in children and adolescents. Pediatr Diabetes 2015; 16:493-503. [PMID: 26189407 DOI: 10.1111/pedi.12298] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/10/2015] [Accepted: 06/22/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is characterized by an immunological reaction that is dominated by type-1 T helper (Th1) cells, whereas immunoglobulin E (IgE)-mediated allergies are associated with Th2 cell. According to the Th1/Th2-hypothesis, the immune system is said to either develop into the direction of Th1 or Th2 cells. This would mean that a child developing T1DM is unlikely to develop an IgE-mediated allergy and vice versa. OBJECTIVE The aim of the study was to investigate the association between the prevalence of T1DM and IgE-mediated allergies. METHODS We designed a prospective case control study with 94 children and adolescents with T1DM and 188 age- and sex-matched control children. The basis of our investigations was a questionnaire concerning the family and children's history as to the presence of IgE-mediated allergies. Moreover, the following blood investigations were done: total serum IgE, specific IgE antibodies to major inhalant allergens, and a multiplex cytokine analysis measuring levels of specific cytokines representing either Th1- or Th2- cytokines. RESULTS Children with T1DM reported the presence of IgE-mediated allergies significantly more often than children of the control group. Children with T1DM had significantly higher tumor necrosis factor alpha (TNFα) levels than healthy controls. Levels of interleukin-2 (IL-2) and IL-6 were higher in the groups of children with the presence of a personal history of allergies, regardless of the presence of T1DM. CONCLUSIONS Our results suggest that T1DM is associated with a higher risk of a self-reported presence of IgE-mediated allergies and that the Th1/Th2-hypothesis may be an oversimplification.
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Affiliation(s)
- Sabine Klamt
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.,Centre for Paediatric Research (CPL), University of Leipzig, Leipzig, Germany
| | - Mandy Vogel
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Centre for Paediatric Research (CPL), University of Leipzig, Leipzig, Germany
| | - Thomas M Kapellen
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.,Centre for Paediatric Research (CPL), University of Leipzig, Leipzig, Germany
| | - Andreas Hiemisch
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.,Centre for Paediatric Research (CPL), University of Leipzig, Leipzig, Germany
| | - Freerk Prenzel
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.,Centre for Paediatric Research (CPL), University of Leipzig, Leipzig, Germany
| | - Silke Zachariae
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Uta Ceglarek
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Joachim Thiery
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.,Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany.,Centre for Paediatric Research (CPL), University of Leipzig, Leipzig, Germany
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Craddock TJA, Harvey JM, Nathanson L, Barnes ZM, Klimas NG, Fletcher MA, Broderick G. Using gene expression signatures to identify novel treatment strategies in gulf war illness. BMC Med Genomics 2015; 8:36. [PMID: 26156520 PMCID: PMC4495687 DOI: 10.1186/s12920-015-0111-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 06/26/2015] [Indexed: 12/12/2022] Open
Abstract
Background Gulf War Illness (GWI) is a complex multi-symptom disorder that affects up to one in three veterans of this 1991 conflict and for which no effective treatment has been found. Discovering novel treatment strategies for such a complex chronic illness is extremely expensive, carries a high probability of failure and a lengthy cycle time. Repurposing Food and Drug Administration approved drugs offers a cost-effective solution with a significantly abbreviated timeline. Methods Here, we explore drug re-purposing opportunities in GWI by combining systems biology and bioinformatics techniques with pharmacogenomic information to find overlapping elements in gene expression linking GWI to successfully treated diseases. Gene modules were defined based on cellular function and their activation estimated from the differential expression of each module’s constituent genes. These gene modules were then cross-referenced with drug atlas and pharmacogenomic databases to identify agents currently used successfully for treatment in other diseases. To explore the clinical use of these drugs in illnesses similar to GWI we compared gene expression patterns in modules that were significantly expressed in GWI with expression patterns in those same modules in other illnesses. Results We found 19 functional modules with significantly altered gene expression patterns in GWI. Within these modules, 45 genes were documented drug targets. Illnesses with highly correlated gene expression patterns overlapping considerably with GWI were found in 18 of the disease conditions studied. Brain, muscular and autoimmune disorders composed the bulk of these. Conclusion Of the associated drugs, immunosuppressants currently used in treating rheumatoid arthritis, and hormone based therapies were identified as the best available candidates for treating GWI symptoms. Electronic supplementary material The online version of this article (doi:10.1186/s12920-015-0111-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Travis J A Craddock
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA. .,Graduate School of Computer and Information Sciences, Nova Southeastern University, Fort Lauderdale, USA. .,Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA. .,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA. .,Department of Medicine, University of Alberta, Edmonton, Canada.
| | | | - Lubov Nathanson
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Zachary M Barnes
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Miller School of Medicine, University of Miami, Miami, USA.,Miami Veterans Affairs Medical Center, Miami, USA.,Diabetes Research Institute, University of Miami, Miami, USA
| | - Nancy G Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Miller School of Medicine, University of Miami, Miami, USA.,Miami Veterans Affairs Medical Center, Miami, USA
| | - Mary Ann Fletcher
- Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Miller School of Medicine, University of Miami, Miami, USA
| | - Gordon Broderick
- Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, USA.,Institute for Neuro-Immune Medicine, Nova Southeastern University, 3440 South University Drive, Fort Lauderdale, FL, 33328, USA.,College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA.,Department of Medicine, University of Alberta, Edmonton, Canada
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Dharmaraj R, Hagglund K, Lyons H. Eosinophilic esophagitis associated with celiac disease in children. BMC Res Notes 2015; 8:263. [PMID: 26109172 PMCID: PMC4480992 DOI: 10.1186/s13104-015-1256-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 06/22/2015] [Indexed: 01/07/2023] Open
Abstract
Background Celiac disease (CD) and eosinophilic esophagitis (EoE) are distinct diseases of the gastrointestinal tract with specific clinico-pathological characteristics. Recent studies have found higher rates of EoE in patients with CD than in the general population. Our aim was to estimate the incidence of EoE among children who were diagnosed with CD over a 42-month period. Methods The study included patients diagnosed with CD based on endoscopy and histopathological findings between January 2010 and June 2013. Histopathology reports of esophageal biopsies were reviewed to identify all cases of EoE. The patients’ presenting symptoms, laboratory evaluations, endoscopic and histopathological findings, treatments, and follow-ups were analysed. Results Fifty-six patients with CD were identified, of whom six (10.7%) were diagnosed with both CD and EoE. Four of these patients presented with abdominal pain and diarrhea, two presented with failure to thrive, and three presented with food allergies. Endoscopic and histopathological changes typical of EoE were observed in all six patients. During follow-up, two patients showed significant improvement with the gluten-free diet and a proton-pump inhibitor (PPI). Two patients improved with the elimination diet and two patients were treated with topical corticosteroid therapy. Endoscopic appearance was normal in all children on follow-up endoscopy after treatment. Biopsy samples also showed resolution of the histologic features of EoE in all of the children. Conclusion The incidence of EoE in our cohort of children with CD was 10.7%, which is higher than what has been reported for the general population. In all children undergoing upper gastrointestinal endoscopy for suspected CD, coexistence of EoE should be considered.
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Affiliation(s)
- Rajmohan Dharmaraj
- Department of Pediatrics, St. John Providence Children's Hospital, Detroit, MI, 48236, USA.
| | - Karen Hagglund
- Department of Biostatistics, St. John Providence Children's Hospital, Detroit, MI, 48236, USA.
| | - Hernando Lyons
- Department of Pediatric Gastroenterology, St. John Providence Childern's Hospital, Wayne State University School of Medicine, Detroit, MI, 48236, USA.
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Egeberg A, Khalid U, Gislason GH, Mallbris L, Skov L, Hansen PR. Risk of psoriasis in patients with childhood asthma: a Danish nationwide cohort study. Br J Dermatol 2015; 173:159-64. [PMID: 25801416 DOI: 10.1111/bjd.13781] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2015] [Indexed: 01/21/2023]
Abstract
BACKGROUND Psoriasis and asthma are disorders driven by inflammation. Psoriasis may carry an increased risk of asthma, but the reverse relationship has not been investigated. OBJECTIVES To investigate the risk of psoriasis in subjects with childhood asthma in a nationwide Danish cohort. METHODS Data on all Danish individuals aged 6-14 years at study entry between 1 January 1997 and 31 December 2011 (n = 1,478,110) were linked at an individual level in nationwide registers. Incidence rates per 10,000 person-years were calculated, and incidence rate ratios (IRRs) adjusted for age, sex, concomitant medication and comorbidity were estimated by Poisson regression models. RESULTS There were 21,725 cases of childhood asthma and 6586 incident cases of psoriasis. There were 5697 and 889 incident cases of mild and severe psoriasis, respectively. The incidence rates of overall, mild and severe psoriasis were 4.49, 3.88 and 0.61 for the reference population, and 5.95, 5.18 and 0.83 for subjects with childhood asthma, respectively. The IRRs for overall, mild and severe psoriasis were 3.94 [95% confidence interval (CI) 2.16-7.17], 5.03 (95% CI 2.48-10.21) and 2.27 (95% CI 0.61-8.42) for patients with childhood asthma. CONCLUSIONS Childhood asthma was associated with a significantly increased risk of psoriasis. Further studies are warranted to determine the clinical significance and effects of therapeutic interventions on this association.
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Affiliation(s)
- A Egeberg
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
| | - U Khalid
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
| | - G H Gislason
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
| | - L Mallbris
- Unit of Dermatology and Venereology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - L Skov
- Department of Dermato-allergology, Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
| | - P R Hansen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, DK-2900, Denmark
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Zhilova MB, Chikin VV. Clinical efficacy of the rotation of phototherapy methods (PUVA therapy and mid-wavelength ultraviolet therapy (311 nm)) in patients with moderate to severe forms of psoriasis. VESTNIK DERMATOLOGII I VENEROLOGII 2015. [DOI: 10.25208/0042-4609-2015-91-1-67-75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Goal. To assess the therapeutic efficacy of the rotation of mid-wavelength ultraviolet therapy (311 nm) and PUVA therapy in patients with moderate to severe forms of psoriasis, and to assess the efficacy of mid-wavelength ultraviolet therapy (311 nm) in a multiple-course therapy. Materials and methods. The study involved 66 patients with moderate to severe forms of psoriasis who received multiple courses of treatment by methods of the PUVA therapy and narrowband mid-wavelength phototherapy (311 nm). The patients were divided into three groups: Group 1 (n = 20) - patients who received treatment in the form of mid-wavelength ultraviolet therapy (311 nm) after multiple courses of PUVA therapy; Group 2 (n = 26) - patients who received only multiple courses of PUVA therapy; Group 3 (n = 20) - patients who received only multiple courses of mid-wavelength ultraviolet therapy (311 nm). Results. The authors determined high efficacy (82.8%) of mid-wavelength ultraviolet therapy (311 nm) in patients with moderate to severe forms of psoriasis vulgaris who had previously received multiple courses of PUVA therapy. After multiple courses of long-term treatment by mid-wavelength ultraviolet therapy (311 nm), patients with moderate to severe forms of psoriasis had high efficacy of such multiple courses of treatment (85.78%). Conclusion. Patients with moderate to severe forms of psoriasis who had previously received multiple courses of PUVA therapy can be switched to mid-wavelength ultraviolet therapy (311 nm) with the maintenance of high efficacy of such treatment. The authors observed the absence of any adaptation to the spectral range of mid-wavelength ultraviolet therapy (311 nm) in case of multiple courses of treatment.
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Bested AC, Marshall LM. Review of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: an evidence-based approach to diagnosis and management by clinicians. REVIEWS ON ENVIRONMENTAL HEALTH 2015; 30:223-249. [PMID: 26613325 DOI: 10.1515/reveh-2015-0026] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
This review was written from the viewpoint of the treating clinician to educate health care professionals and the public about Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). It includes: the clinical definition of ME/CFS with emphasis on how to diagnose ME/CFS; the etiology, pathophysiology, management approach, long-term prognosis and economic cost of ME/CFS. After reading this review, you will be better able to diagnose and treat your patients with ME/CFS using the tools and information provided. Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex, chronic medical condition characterized by symptom clusters that include: pathological fatigue and malaise that is worse after exertion, cognitive dysfunction, immune dysfunction, unrefreshing sleep, pain, autonomic dysfunction, neuroendocrine and immune symptoms. ME/CFS is common, often severely disabling and costly. The Institute of Medicine (IOM) reviewed the ME/CFS literature and estimates that between 836,000 and 2.5 million Americans have ME/CFS at a cost of between 17 and 24 billion dollars annually in the US. The IOM suggested a new name for ME/CFS and called it Systemic Exertion Intolerance Disease (SEID). SEID's diagnostic criteria are less specific and do not exclude psychiatric disorders in the criteria. The 2010 Canadian Community Health Survey discovered that 29% of patients with ME/CFS had unmet health care needs and 20% had food insecurity--lack of access to sufficient healthy foods. ME/CFS can be severely disabling and cause patients to be bedridden. Yet most patients (80%) struggle to get a diagnosis because doctors have not been taught how to diagnose or treat ME/CFS in medical schools or in their post-graduate educational training. Consequently, the patients with ME/CFS suffer. They are not diagnosed with ME/CFS and are not treated accordingly. Instead of compassionate care from their doctors, they are often ridiculed by the very people from whom they seek help. The precise etiology of ME/CFS remains unknown, but recent advances and research discoveries are beginning to shed light on the enigma of this disease including the following contributors: infectious, genetic, immune, cognitive including sleep, metabolic and biochemical abnormalities. Management of patients with ME/CFS is supportive symptomatic treatment with a patient centered care approach that begins with the symptoms that are most troublesome for the patient. Pacing of activities with strategic rest periods is, in our opinion, the most important coping strategy patients can learn to better manage their illness and stop their post-exertional fatigue and malaise. Pacing allows patients to regain the ability to plan activities and begin to make slow incremental improvements in functionality.
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Weiss ST. Vitamin D and the HLA locus help to explain the relationship between autoimmune and allergic diseases. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 23:2-3. [PMID: 24553820 PMCID: PMC6442294 DOI: 10.4104/pcrj.2014.00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Scott T Weiss
- Professor of Medicine, Harvard Medical School; Associate Director, Channing Division of Network Medicine, Brigham and Women's Hospital, Boston MA, USA
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Maas T, Nieuwhof C, Passos VL, Robertson C, Boonen A, Landewé RB, Voncken JW, Knottnerus JA, Damoiseaux JG. Transgenerational occurrence of allergic disease and autoimmunity: general practice-based epidemiological research. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2014; 23:14-21. [PMID: 24449016 PMCID: PMC6442276 DOI: 10.4104/pcrj.2013.00108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Corresponding with the T helper cell type 1/T helper cell type 2 hypothesis, autoimmune and allergic diseases are considered pathologically distinct and mutually exclusive conditions. Co-occurrence of autoimmune disorders and allergy within patients, however, has been reported. Transgenerational co-occurrence of autoimmune and allergic disease has been less often described and may differ from the intra-patient results. Aims: To test the hypothesis that autoimmune disorders in parents are a risk factor for the development of an allergic disease in their offspring. Methods: Prospectively registered (by academic general practitioners) International Classifications of Primary Care (ICPC) for diagnoses of autoimmune disorders and allergy within families were evaluated (n=5,604 families) by performing multiple logistic regression analyses. Results: The presence of any ICPC-encoded autoimmune disorder in fathers appeared to be associated with an increased risk in their eldest children of developing an allergy (odds ratio (OR) 1.4, 95% CI 1.042 to 1.794). Psoriasis in fathers was particularly shown to be of influence (OR 1.5, 95% CI 1.061 to 2.117) and, although any ICPC-encoded autoimmune disease in mothers was found not to be of significance, the combined international code for registering rheumatoid arthritis/ankylosing spondylitis in mothers was OR 1.7 (95% CI 1.031 to 2.852). Conclusions: The occurrence of ICPC-encoded autoimmune disorders in parents, especially psoriasis and rheumatoid arthritis/ankylosing spondylitis, significantly increases the occurrence of allergic disease in their children. After validation in follow-up research in a larger sample, these results may lead to the inclusion of ‘parental autoimmune condition’ as a risk factor in the general practitioner's diagnostics of allergic disease.
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Affiliation(s)
- Tanja Maas
- Department of General Practice, Maastricht University, CAPHRI, Maastricht, The Netherlands
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Gascon M, Casas M, Morales E, Valvi D, Ballesteros-Gómez A, Luque N, Rubio S, Monfort N, Ventura R, Martínez D, Sunyer J, Vrijheid M. Prenatal exposure to bisphenol A and phthalates and childhood respiratory tract infections and allergy. J Allergy Clin Immunol 2014; 135:370-8. [PMID: 25445825 DOI: 10.1016/j.jaci.2014.09.030] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 09/17/2014] [Accepted: 09/22/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is growing concern that prenatal exposure to bisphenol A (BPA) and phthalates, which are widely used in consumer products, might affect susceptibility to infections and the development of allergy and asthma in children, but there are currently very few prospective studies. OBJECTIVE We sought to evaluate whether prenatal exposure to BPA and phthalates increases the risk of respiratory and allergic outcomes in children at various ages from birth to 7 years. METHODS We measured BPA and metabolites of high-molecular-weight phthalates, 4 di-(2-ethylhexyl) phthalate (DEHP) metabolites (Σ4DEHP) and mono-benzyl phthalate (MBzP), and 3 low-molecular-weight phthalate (LMWP) metabolites (Σ3LMWP) in urine samples collected during the first and third trimesters in pregnant women participating in the Infancia y Medio Ambiente-Sabadell birth cohort study. The occurrence of chest infections, bronchitis, wheeze, and eczema in children was assessed at ages 6 and 14 months and 4 and 7 years through questionnaires given to the mothers. Atopy (specific IgE measurement) and asthma (questionnaire) were assessed at ages 4 and 7 years, respectively. RESULTS The relative risks (RRs) of wheeze (RR, 1.20; 95% CI, 1.03-1.40; P = .02), chest infections (RR, 1.15; 95% CI, 1.00-1.32; P = .05), and bronchitis (RR, 1.18; 95% CI, 1.01-1.37; P = .04) at any age increased for each doubling in concentration of maternal urinary BPA. Σ4DEHP metabolites were associated with the same outcomes (wheeze: RR, 1.25; 95% CI, 1.04-1.50, P = .02; chest infections: RR, 1.15; 95% CI, 0.97-1.35; P = .11; bronchitis: RR, 1.20; 95% CI, 1.01-1.43; P = .04). MBzP was associated with higher risk of wheeze (RR, 1.15; 95% CI, 1.00-1.33; P = .05). The risk of asthma at age 7 years was also increased with increasing prenatal BPA, Σ4DEHP, and MBzP exposure. There were no other exposure-outcome associations. CONCLUSIONS Prenatal exposure to BPA and high-molecular-weight phthalates might increase the risk of asthma symptoms and respiratory tract infections throughout childhood.
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Affiliation(s)
- Mireia Gascon
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
| | - Maribel Casas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Eva Morales
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Damaskini Valvi
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Noelia Luque
- Departamento de Química Analítica, Universidad de Córdoba, Córdoba, Spain
| | - Soledad Rubio
- Departamento de Química Analítica, Universidad de Córdoba, Córdoba, Spain
| | - Núria Monfort
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Rosa Ventura
- Universitat Pompeu Fabra (UPF), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - David Martínez
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jordi Sunyer
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Martine Vrijheid
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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Fritsch P, Craddock TJA, del Rosario RM, Rice MA, Smylie A, Folcik VA, de Vries G, Fletcher MA, Klimas NG, Broderick G. Succumbing to the laws of attraction. ACTA ACUST UNITED AC 2014. [DOI: 10.4161/sysb.28948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Wei CC, Lin CL, Tsai JD, Shen TC, Sung FC. Increased Incidence of juvenile onset systemic lupus erythematosus in children with atopic dermatitis. Lupus 2014; 23:1494-9. [PMID: 25057040 DOI: 10.1177/0961203314543920] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Herein, we investigated the risk of juvenile-onset systemic lupus erythematosus (JSLE) in children with atopic dermatitis (AD). From 2000 to 2007, 192,357 children with newly diagnosed AD and 769,428 matched non-AD controls were identified. By the end of 2008, incidences and hazard ratios (HRs) of JSLE were measured. JSLE incidence in the AD cohort was 2.90-fold greater than that in the non-AD cohort (3.25 vs. 1.12 per 100,000 person-years), with a Cox model-measured adjusted HR of 2.92 (95% CI: 1.85-4.60); the risk of JSLE was greater for older children and girls. The AD-to-non-AD cohort HR was 6.6 (95% CI: 2.88-13.1) for children aged >12 years compared with 1.81 (95% CI: 0.98-3.32) for children aged ≤ 12 years. The HR of JSLE in AD children increased from 1.55 (95% CI: 0.88-2.76) for those with ≤ 3 clinical visits to 66.3 (95% CI: 33.1-132.8) for those with >6 visits (p < 0.0001, by trend test). The risk of developing SLE in the AD cohort was the highest within five years after AD diagnosis (HR: 4.02; 95% CI: 2.83-7.08). Children with AD are at a high risk of developing JSLE during their growth period.
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Affiliation(s)
- C-C Wei
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan College of Medicine, China Medical University, Taichung, Taiwan
| | - C-L Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - J-D Tsai
- Institute of Medicine, Chung Shan Medical University Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - T-C Shen
- College of Medicine, China Medical University, Taichung, Taiwan Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - F-C Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
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