Asthma, atopy and serious psychological distress: prevalence and risk factors among young people in the Melbourne atopy cohort study

Establishing subclasses of childhood eczema, their risk factors and prognosis

Background

The heterogeneity of development and progression of eczema suggests multiple underlying subclasses for which aetiology and prognosis may vary. A better understanding may provide a comprehensive overview of eczema development and progression in childhood. Thus, we aimed to determine longitudinal eczema subclasses based on assessments and identify their associations with risk factors and allergic outcomes.

Methods

A total of 619 participants with a family history of allergic disease were assessed at 24 time‐points from birth to 12 years. At each time, eczema was defined as the report of current rash treated with topical steroid‐based preparations. Longitudinal latent class analysis was used to determine eczema subclasses. Subsequent analyses using regression models assessed the associations between eczema subclasses and potential risk factors and allergic outcomes at 18‐ and 25‐year follow‐ups (eczema, allergic rhinitis, asthma and allergic sensitization).

Results

We identified five eczema subclasses ‘early‐onset persistent’, ‘early‐onset resolving’, ‘mid‐onset persistent’, ‘mid‐onset resolving’ and ‘minimal eczema’. Filaggrin null mutations were associated with the early‐onset persistent (OR = 2.58 [1.09–6.08]) and mid‐onset persistent class (OR = 2.58 [1.32–5.06]). Compared with ‘minimal eczema’, participants from early‐onset persistent class had higher odds of eczema (OR = 11.8 [5.20–26.6]) and allergic rhinitis (OR = 3.13 [1.43–6.85]) at 18 and at 25 years eczema (OR = 9.37 [3.17–27.65]), allergic rhinitis (OR = 3.26 [1.07–9.93]) and asthma (OR = 2.91 [1.14–7.43]). Likewise, mid‐onset persistent class had higher odds of eczema (OR = 2.59 [1.31–5.14]), allergic rhinitis (OR = 1.70 [1.00–2.89]) and asthma (OR = 2.00 [1.10–3.63]) at 18 and at 25 years eczema (OR = 6.75 [3.11–14–65]), allergic rhinitis (OR = 2.74 [1.28–5.88]) and asthma (OR = 2.50 [1.25–5.00]). Allergic and food sensitization in early life was more common in those in the persistent eczema subclasses.

Conclusion

We identified five distinct eczema subclasses. These classes were differentially associated with risk factors, suggesting differences in aetiology, and also with the development of allergic outcomes, highlighting their potential to identify high‐risk groups for close monitoring and intervention.

Duodenal eosinophilia and the link to anxiety: A population-based endoscopic study

INTRODUCTION

The concept of gut-to-brain communication via microbial or inflammatory pathways is gaining increased attention but genuine pathology directly linking gut perturbation to anxiety is lacking. We hypothesized that duodenal eosinophilia, as known to occur in functional dyspepsia (FD), may be an underlying cause of anxiety and may help explain the striking association between FD and anxiety.

METHODS

Randomly selected subjects from the national population register of Sweden completed the validated Abdominal Symptom Questionnaire; 1000 completed esophagogastroduodenoscopy and the Hospital Anxiety and Depression Scale questionnaire. Duodenal biopsies were obtained from 1^st (D1) and 2^nd portion (D2). Eligible subjects who underwent endoscopy (n = 887) were invited to participate in a 10-year follow-up study with the same questionnaires. Among endoscopy normal subjects, FD was identified by Rome criteria, and controls were symptom free. Duodenal eosinophilia was based on pre-defined cut-offs. Finding are reported as odds ratios (ORs) with 95% confidence interval and p-value.

RESULTS

The study population comprised 89 cases with FD and 124 healthy controls (mean age 62 years, SD 12, 34% male). Clinical anxiety at follow-up was elevated in those with D1 eosinophilia at baseline considering either new-onset anxiety (OR = 4.5, 95% CI 0.8, 23.8; p = 0.08) or follow-up anxiety adjusting for baseline anxiety (OR = 4.51 (95% CI 1.03, 19.81; p = 0.046).

CONCLUSION

Duodenal eosinophilia may potentially be a mechanism linked to anxiety independent of FD.

Atractylenolide III reduces NLRP3 inflammasome activation and Th1/Th2 imbalances in both in vitro and in vivo models of asthma

Paediatric asthma is a common inflammatory disease in children. Atractylenolide III is an active component of the Atractylodes rhizome, an herbal medicine that has been used as an asthma treatment. This study aimed to explore the effects and underlying mechanisms of atractylenolide III in IL-4-induced 16HBE cells and ovalbumin-induced asthmatic mice. The results showed that IL-4 stimulation significantly decreased, and atractylenolide III treatment increased, growth and apoptosis of 16HBE cells. In 16HBE cells, administration of atractylenolide III also significantly suppressed the IL-4-induced increases in the expression of cleaved caspase-1; apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC); and nucleotide-binding domain and leucine-rich repeat protein 3 (NLRP3). Moreover, the numbers of total leukocytes, neutrophils, eosinophils, and macrophages significantly increased in ovalbumin-induced mice, and then decreased after atractylenolide III treatment. In ovalbumin-induced asthmatic mice, atractylenolide III treatment also significantly inhibited NLRP3 inflammasome activation and restored the Th1/Th2 balance. These results indicate that atractylenolide III reduced NLRP3 inflammasome activation and regulated the Th1/Th2 balance in IL-4 induced 16HBE cells and ovalbumin-induced asthmatic mice, suggesting it has a protective effect that may be useful in the treatment of paediatric asthma.