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Rodinkova V, Yuriev S, Mokin V, Kryvopustova M, Shmundiak D, Bortnyk M, Kryzhanovskyi Y, Kurchenko A. Bayesian analysis suggests independent development of sensitization to different fungal allergens. World Allergy Organ J 2024; 17:100908. [PMID: 38800499 PMCID: PMC11126528 DOI: 10.1016/j.waojou.2024.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/05/2024] [Accepted: 04/18/2024] [Indexed: 05/29/2024] Open
Abstract
Background Fungi are known for their ability to cause allergies, but data on individual sensitization to them are insufficient. The purpose of the study was to carry out a comprehensive analysis of the fungal allergens' sensitization profile in the Ukrainian population and to determine both population and individual sensitivity to these allergens. Methods We utilized a set of ALEX allergy test data from 20,033 inhabitants of 17 regions of Ukraine from 1 to 89 years conducted in 2020-2022. A complex of programs in the Python language was developed and Bayesian network analysis was applied to determine the sensitivity combinations in individual patients to various fungal components. Results Sensitivity to Alt a 1 dominated and was observed in 79.39% of patients, and 62.17% of them were sensitive solely to Alt a 1. Exclusive sensitivity to Mala s 6 was second in individual patient profiles with a frequency of 4.06%. Combined sensitivity to Alt a 1 - Asp f 3 was third with a share of 3.28%. Pen ch and Cla h extracts stimulated the production of the lowest median sIgE levels. The highest median sIgE levels were for Alt a 1, Mala s 11 and Asp f 6, respectively. Median sIgE levels increased in adults compared to children for all components of Aspergillus fumigatus, as well as for Mala s 5 and Mala s 11. In the rest of the cases, they decreased in adults compared to children. The sensitization rates to fungi in general and specifically to Alternaria were lower in the western parts of Ukraine, especially in the Carpathian region, situated within the Broad-leaved Forest zone. The results of Bayesian modeling revealed that in the case of Alt a 1, the simultaneous absence of sensitivity to Cla h 8, Mala s 11, Mala s 5 and Mala s 6 molecules could condition the presence of sensitization to the major Alternaria allergen with a probability of 92.42%. In all other cases, there was a high probability of absence of sensitivity to particular allergen against the background of absence of sensitivity to other ones, which may indicate the independent development of sensitization to different fungal allergens. Conclusions Sensitivity to Alt a 1 dominated in the studied population with a lower rate in the western regions. The highest median sIgE levels were induced by Alt a 1, Mala s 11 and Asp f 6. Bayesian Analysis suggest a high probability of the independent development of sensitization to different fungal allergens. The idea that sensitization to one allergen may be protective against sensitization to another one(s) requires further clinical study.
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Affiliation(s)
- Victoria Rodinkova
- Department of Pharmacy, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
| | - Serhii Yuriev
- Department of Clinical Immunology and Allergology, Bohomolets National Medical University, Kyiv, Ukraine
- Medical Centre, DIVERO, Kyiv, Ukraine
| | - Vitalii Mokin
- Department of System Analysis and Information Technologies, Vinnytsia National Technical University, Vinnytsia, Ukraine
| | - Mariia Kryvopustova
- Medical Centre, DIVERO, Kyiv, Ukraine
- Department of Pediatrics No 2, Bohomolets National Medical University, Kyiv, Ukraine
| | - Dmytro Shmundiak
- Department of System Analysis and Information Technologies, Vinnytsia National Technical University, Vinnytsia, Ukraine
| | - Mykyta Bortnyk
- Department of Pharmacy, National Pirogov Memorial Medical University, Vinnytsia, Ukraine
- Vasyl’ Stus Donetsk National University, Vinnytsia, Ukraine
| | - Yevhenii Kryzhanovskyi
- Department of System Analysis and Information Technologies, Vinnytsia National Technical University, Vinnytsia, Ukraine
| | - Andrii Kurchenko
- Department of Clinical Immunology and Allergology, Bohomolets National Medical University, Kyiv, Ukraine
- Medical Centre, DIVERO, Kyiv, Ukraine
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2
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Shapiro A, Caballes NWS, Vera RN, Klein BS, Brennan PJ, Wu YF, Wiesner DL. Sensitization with Fungal Protease Allergen Establishes Long-Lived, Allergenic Th Cell Memory in the Lung. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2024; 212:1420-1427. [PMID: 38488501 PMCID: PMC11037450 DOI: 10.4049/jimmunol.2300694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/26/2024] [Indexed: 04/17/2024]
Abstract
Allergic asthma is a chronic inflammatory disease that affects millions of individuals worldwide. Exposure to allergens produced by a variety of otherwise harmless microbes, including fungi, predisposes individuals to immunopathologic disease upon subsequent encounters with allergen. We developed a mouse model that employs a purified protease produced by Aspergillus (Asp f 13) to investigate the contributions of CD4+ Th cells to recurrent lung inflammation. Notably, memory CD4+ T cells enhanced the eosinophil response of sensitized/rechallenged animals. In addition, memory CD4+ T cells maintained allergenic features, including expression of GATA-binding protein 3 and IL-5. Th2 memory T cells persisted in the peribronchiolar interstitium of the lung and expressed markers of tissue residence, such as CD69, CCR8, and IL-33R. Lastly, we identified a peptide epitope contained within Asp f 13 and generated a peptide-MHC class II tetramer. Using these tools, we further demonstrated the durability and exquisite sensitivity of memory T cells in promoting lung eosinophilia. Our data highlight important features of memory T cells that strengthen the notion that memory T cells are principal drivers of eosinophilic disease in murine models of allergic sensitization and episodic airway inflammation.
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Affiliation(s)
- Abigail Shapiro
- Center for Immunity and Inflammation, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
- Department of Medicine, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
| | - Nicolas W S Caballes
- Center for Immunity and Inflammation, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
- Department of Medicine, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
| | - Rebecca N Vera
- Center for Immunity and Inflammation, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
- Department of Medicine, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
| | - Bruce S Klein
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI
- Department of Medicine, University of Wisconsin-Madison, Madison, WI
- Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, WI
| | - Paul J Brennan
- Center for Immunity and Inflammation, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
- Department of Medicine, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
| | - Yen-Fei Wu
- Center for Immunity and Inflammation, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
- Department of Medicine, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
| | - Darin L Wiesner
- Center for Immunity and Inflammation, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
- Department of Medicine, NJ Medical School, Rutgers-The State University of New Jersey, Newark, NJ
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3
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Olsen Y, Arildskov E, Hansen SN, Pedersen M, Dharmage SC, Kloster M, Sigsgaard T. Outdoor Alternaria and Cladosporium spores and acute asthma. Clin Exp Allergy 2023; 53:1256-1267. [PMID: 37748858 DOI: 10.1111/cea.14397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Outdoor Alternaria and Cladosporium spores are ubiquitous. Few studies have assessed their impact on asthma hospitalizations providing conflicting results, mainly focused on vulnerable paediatric populations. We aimed to study the impact of outdoor Alternaria and Cladosporium concentrations on acute hospitalizations in the Capital Region of Denmark. METHODS This is a bi-directional case-crossover study with 26 years of national registry data at individual level on acute asthma hospitalizations and daily average data on Alternaria and Cladosporium, pollen (Artemisia, Poaceae), maximal temperature, and air pollution. Conditional logistic regression models were applied to assess the associations. Concentration quartiles at lag 0 were used for categorizing the exposure. RESULTS For lags 0-2, the odds of hospitalization were significantly higher for both Alternaria and Cladosporium at concentration quartile 2-4 compared with quartile 1. When stratified for age and sex, odds of hospitalization at Alternaria quartiles 2-4 were significantly higher in males below 40 years at lag 0-2, and at lag 0 in females (18-30 years), while quartiles 2-4 of Cladosporium concentrations were associated with significantly higher odds in boys (0-17 years) at lag 1-3, males (18-39 years) at lag 0-1, females (18-39 years) at lag 1-2, males (40-64 years) at lag 0-2, females (40-64 years) at lag 0 and 2, in seniors (65+ years) male at lag 1-2 and female at lag 0-1. The effect of Alternaria varied significantly depending on the level of Cladosporium (p < .0001). CONCLUSION Ambient Alternaria and Cladosporium spores can induce asthma hospitalizations. Males are more susceptible to both genera. Males and females under age 40 years are more susceptible to Alternaria.
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Affiliation(s)
- Yulia Olsen
- Institute of Public Health & Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Elias Arildskov
- Department of Public Health - Section of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Stefan Nygaard Hansen
- Department of Public Health - Section of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Marianne Pedersen
- Department of Public Health - Section of Environment, Occupation & Health, Aarhus University, Aarhus, Denmark
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | | | - Torben Sigsgaard
- Institute of Public Health & Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
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4
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Li H, Castro M, Denlinger LC, Erzurum SC, Fahy JV, Gaston B, Israel E, Jarjour NN, Levy BD, Mauger DT, Moore WC, Wenzel SE, Zein J, Bleecker ER, Meyers DA, Chen Y, Li X. Investigations of a combination of atopic status and age of asthma onset identify asthma subphenotypes. J Asthma 2023; 60:1843-1852. [PMID: 36940238 PMCID: PMC10528448 DOI: 10.1080/02770903.2023.2193634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/27/2023] [Accepted: 03/16/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Subphenotypes of asthma may be determined by age onset and atopic status. We sought to characterize early or late onset atopic asthma with fungal or non-fungal sensitization (AAFS or AANFS) and non-atopic asthma (NAA) in children and adults in the Severe Asthma Research Program (SARP). SARP is an ongoing project involving well-phenotyped patients with mild to severe asthma. METHODS Phenotypic comparisons were performed using Kruskal-Wallis or chi-square test. Genetic association analyses were performed using logistic or linear regression. RESULTS Airway hyper-responsiveness, total serum IgE levels, and T2 biomarkers showed an increasing trend from NAA to AANFS and then to AAFS. Children and adults with early onset asthma had greater % of AAFS than adults with late onset asthma (46% and 40% vs. 32%; P < 0.00001). In children, AAFS and AANFS had lower % predicted FEV1 (86% and 91% vs. 97%) and greater % of patients with severe asthma than NAA (61% and 59% vs. 43%). In adults with early or late onset asthma, NAA had greater % of patients with severe asthma than AANFS and AAFS (61% vs. 40% and 37% or 56% vs. 44% and 49%). The G allele of rs2872507 in GSDMB had higher frequency in AAFS than AANFS and NAA (0.63 vs. 0.55 and 0.55), and associated with earlier age onset and asthma severity. CONCLUSIONS Early or late onset AAFS, AANFS, and NAA have shared and distinct phenotypic characteristics in children and adults. AAFS is a complex disorder involving genetic susceptibility and environmental factors.
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Affiliation(s)
- Huashi Li
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Mario Castro
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Loren C. Denlinger
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Serpil C. Erzurum
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - John V. Fahy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California, USA
| | - Benjamin Gaston
- Wells Center for Pediatric Research and Riley Hospital for Children, Indiana University, Indianapolis, Indiana, USA
| | - Elliot Israel
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nizar N. Jarjour
- Department of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Bruce D. Levy
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - David T Mauger
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, USA
| | - Wendy C. Moore
- Department of Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Sally E. Wenzel
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joe Zein
- Lerner Research Institute and the Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eugene R. Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Deborah A. Meyers
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, USA
| | - Yin Chen
- Department of Pharmacology and Toxicology, School of Pharmacy, University of Arizona, Tucson, Arizona, USA
| | - Xingnan Li
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona, Tucson, Arizona, USA
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5
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Delgado J, Navarro A, Álvarez-Gutiérrez FJ, Cisneros C, Domínguez-Ortega J. [Unmet Needs in Severe Allergic Asthma]. OPEN RESPIRATORY ARCHIVES 2023; 5:100282. [PMID: 38053757 PMCID: PMC10694599 DOI: 10.1016/j.opresp.2023.100282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/19/2023] [Indexed: 12/07/2023] Open
Abstract
Severe asthma affects 3%-10% of the world's population, according to estimates by the Global Initiative for ASTHMA (GINA). Allergic asthma is one of the most common phenotypes of severe asthma and it is characterized by allergen-induced type 2 inflammation in which immunoglobulin E (IgE) is a key mediator, making it an important therapeutic target. The introduction of targeted biological therapies or treatments has entered the management for severe asthma in the era of precision medicine, and the goal of treatment is clinical remission of the disease. There is a significant percentage of patients with severe allergic asthma who do not respond to treatments and whose symptoms are not controlled. In this paper, a group of experts in the management of severe allergic asthma reviewed and evaluated the most relevant evidence regarding the pathophysiology and phenotypes of severe allergic asthma, the role of IgE in allergic inflammation, allergen identification, techniques, biomarkers and diagnostic challenges, available treatments and strategies for disease management, with a special focus on biological treatments. From this review, recommendations were developed and validated through a Delphi consensus process with the aim of offering improvements in the management of severe allergic asthma to the professionals involved and identifying the unmet needs in the management of this pathology.
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Affiliation(s)
- Julio Delgado
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | - Ana Navarro
- Unidad de Gestión Clínica, Alergología, Hospital Virgen Macarena, Sevilla, España
| | | | - Carolina Cisneros
- Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, España
| | - Javier Domínguez-Ortega
- Servicio de Alergia, Hospital Universitario La Paz, Instituto de Investigación IDiPAZ, Madrid, España
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6
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Nakayama T, Miyata J, Inoue N, Ueki S. Allergic fungal rhinosinusitis: What we can learn from allergic bronchopulmonary mycosis. Allergol Int 2023; 72:521-529. [PMID: 37442743 DOI: 10.1016/j.alit.2023.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/03/2023] [Indexed: 07/15/2023] Open
Abstract
Allergic fungal rhinosinusitis (AFRS) and allergic bronchopulmonary mycosis (ABPM) are inflammatory disorders of the respiratory tract resulting from type 1 and 3 hypersensitivity reactions against fungi. The hallmark features of both diseases are eosinophil infiltration into the airway mucosa caused by localized type 2 inflammation and concomitant viscid secretions in the airways. Eosinophilic mucin-induced compression of adjacent anatomic structures leads to bone erosion and central bronchiectasis in the upper and lower respiratory tracts, respectively. Although these diseases share common features in their pathogenesis, they also exhibit notable differences. Epidemiologic findings are diverse, with AFRS typically presenting at a younger age, exhibiting less complicated bronchial asthma, and displaying lower total immunoglobulin E levels in laboratory findings compared with ABPM. Furthermore, despite their similar pathogenesis, the rarity of sinio-bronchial allergic mycosis in both AFRS and ABPM underscores the distinctions between these two diseases. This review aims to clarify the similarities and differences in the pathogenesis of AFRS and ABPM to determine what can be learned about AFRS from ABPM, where more is known.
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Affiliation(s)
- Tsuguhisa Nakayama
- Department of Otorhinolaryngology and Head & Neck Surgery, Dokkyo Medical University, Tochigi, Japan.
| | - Jun Miyata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Natsuki Inoue
- Department of Otorhinolaryngology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Shigeharu Ueki
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
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7
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Corren J, Hanania NA, Busse WW, Sher LD, Altincatal A, Hardin M, Mannent LP, Amin N, Lederer DJ, Soler X, Jacob-Nara JA, Rowe PJ, Deniz Y. Efficacy of dupilumab in patients with uncontrolled, moderate-to-severe asthma with fungal sensitization. Clin Exp Allergy 2023; 53:1020-1030. [PMID: 37752621 DOI: 10.1111/cea.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Fungal sensitization (FS) exacerbates asthma in patients who have elevated type 2 inflammatory response. Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin (IL)-4 and IL-13, key and central drivers of type 2 inflammation in multiple diseases. OBJECTIVE This post hoc analysis, funded by the manufacturers of dupilumab, was conducted to assess dupilumab efficacy in patients from the phase 3 LIBERTY ASTHMA QUEST trial (NCT02414854) and TRAVERSE open-label extension (NCT02134028) study who had uncontrolled, moderate-to-severe asthma with type 2 inflammatory phenotype (defined as blood eosinophil count ≥150 cells/μL or FeNO ≥25 ppb) and with FS (defined as IgE specific to Alternaria alternata, Aspergillus fumigatus or Cladosporium herbarum >0.35 IU/mL). METHODS We evaluated annualized rate of severe exacerbations (AER), change from baseline in pre-bronchodilator (BD) forced expiratory volume in 1 s (FEV1 ), asthma control (per 5-item Asthma Control Questionnaire [ACQ-5]) and biomarker levels (blood eosinophil count, fractional exhaled nitric oxide [FeNO], total IgE, fungal-specific IgEs, thymus and activation-regulated chemokine [TARC] and eotaxin-3). RESULTS Dupilumab vs. placebo reduced AER, improved pre-BD FEV1 and asthma control (ACQ-5), and reduced serum IgE levels, blood eosinophil count, TARC, eotaxin-3 and FeNO in patients both with and without FS after 52 weeks of treatment in QUEST. Reductions in asthma exacerbation rates and improvements in all other variables were sustained over the TRAVERSE open-label extension study. CONCLUSION Dupilumab demonstrated efficacy during prolonged treatment in patients with uncontrolled, moderate-to-severe asthma with FS.
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Affiliation(s)
- Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - William W Busse
- UW Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lawrence D Sher
- Peninsula Research Associates, Rolling Hills Estates, California, USA
| | | | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | | | - Xavier Soler
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
| | | | | | - Yamo Deniz
- Regeneron Pharmaceuticals Inc., Tarrytown, New York, USA
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8
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Beeckmans H, Van Roy E, Kaes J, Sacreas A, Geudens V, Vermaut A, Willems L, Jin X, Bos S, Vanstapel A, Van Slambrouck J, Orlitova M, Vanaudenaerde B, Ceulemans LJ, Van Raemdonck D, Neyrinck AP, Godinas L, Dupont LJ, Verleden GM, Vos R. Aspergillus-Specific IgG Antibodies are Associated With Fungal-Related Complications and Chronic Lung Allograft Dysfunction After Lung Transplantation. Transpl Int 2023; 36:10768. [PMID: 36873745 PMCID: PMC9977785 DOI: 10.3389/ti.2023.10768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Fungal exposure and sensitization negatively affect outcomes in various respiratory diseases, however, the effect of fungal sensitization in lung transplant (LTx) recipients is still unknown. We performed a retrospective cohort study of prospectively collected data on circulating fungal specific IgG/IgE antibodies, and their correlation with fungal isolation, chronic lung allograft dysfunction (CLAD) and overall survival after LTx. 311 patients transplanted between 2014 and 2019 were included. Patients with elevated Aspergillus fumigatus or Aspergillus flavus IgG (10%) had more mold and Aspergillus species isolation (p = 0.0068 and p = 0.0047). Aspergillus fumigatus IgG was specifically associated with Aspergillus fumigatus isolation in the previous or consecutive year (AUC 0.60, p = 0.004 and AUC 0.63, p = 0.022, respectively). Elevated Aspergillus fumigatus or Aspergillus flavus IgG was associated with CLAD (p = 0.0355), but not with death. Aspergillus fumigatus, Aspergillus flavus or Aspergillus niger IgE was elevated in 19.3% of patients, but not associated with fungal isolation, CLAD or death. Mold isolation and Aspergillus species isolation from respiratory cultures were associated with CLAD occurrence (p = 0.0011 and p = 0.0005, respectively), and Aspergillus species isolation was also associated with impaired survival (p = 0.0424). Fungus-specific IgG could be useful in long-term follow-up post-LTx, as a non-invasive marker for fungal exposure, and thus a diagnostic tool for identifying patients at risk for fungal-related complications and CLAD.
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Affiliation(s)
- Hanne Beeckmans
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Elfri Van Roy
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Janne Kaes
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Annelore Sacreas
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Vincent Geudens
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Astrid Vermaut
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Lynn Willems
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Xin Jin
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Saskia Bos
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Arno Vanstapel
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Jan Van Slambrouck
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michaela Orlitova
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Bart Vanaudenaerde
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Laurens J Ceulemans
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Arne P Neyrinck
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Laurent Godinas
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory diseases, University Hospitals Leuven, Leuven, Belgium
| | - Lieven J Dupont
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory diseases, University Hospitals Leuven, Leuven, Belgium
| | - Geert M Verleden
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory diseases, University Hospitals Leuven, Leuven, Belgium
| | - Robin Vos
- Laboratory for Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases, Metabolism and Ageing, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Department of Respiratory diseases, University Hospitals Leuven, Leuven, Belgium
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9
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Recent Advances in the Allergic Cross-Reactivity between Fungi and Foods. J Immunol Res 2022; 2022:7583400. [PMID: 36249419 PMCID: PMC9568318 DOI: 10.1155/2022/7583400] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/29/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022] Open
Abstract
Airborne fungi are one of the most ubiquitous kinds of inhalant allergens which can result in allergic diseases. Fungi tend to grow in warm and humid environments with regional and seasonal variations. Their nomenclature and taxonomy are related to the sensitization of immunoglobulin E (IgE). Allergic cross-reactivity among different fungal species appears to be widely existing. Fungus-related foods, such as edible mushrooms, mycoprotein, and fermented foods by fungi, can often induce to fungus food allergy syndrome (FFAS) by allergic cross-reactivity with airborne fungi. FFAS may involve one or more target organs, including the oral mucosa, the skin, the gastrointestinal and respiratory tracts, and the cardiovascular system, with various allergic symptoms ranging from oral allergy syndrome (OAS) to severe anaphylaxis. This article reviews the current knowledge on the field of allergic cross-reactivity between fungal allergens and related foods, as well as the diagnosis and treatment on FFAS.
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Asthma, bronchitis respiratory symptoms, allergies and home environment: how are they related? Postepy Dermatol Alergol 2022; 39:729-738. [PMID: 36090730 PMCID: PMC9454342 DOI: 10.5114/ada.2021.109696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/10/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Home environmental conditions can affect the prevalence of childhood asthma and allergies. Aim To assess the relationship between the prevalence of childhood asthma, bronchitis, and allergies and the condition of the home environment. Material and methods In 2018 and 2019, a cross-sectional study on 2932 children from elementary schools in the Silesian Voivodship (Southern Poland) was conducted. The questionnaire was based on the International Study of Asthma and Allergies in Childhood (ISAAC). In order to determine the association between the home environment (presence of moulds, furry pets) and respiratory symptoms and diseases, a logistic regression analysis was performed by calculating the odds ratio (OR), determining p < 0.05 as the level of significance. Results Asthma risk factors were male sex, heating with solid fuel and presence of moulds. The prevalence of respiratory symptoms, bronchitis, and allergic diseases is statistically more common with the presence of moulds in dwellings. A protective effect of the presence of pets on the prevalence of asthma (OR = 0.77; 95% CI: 0.59–0.99), allergy to pet allergens (OR = 0.59; 95% CI: 0.45–0.76), allergy to house dust mite (OR = 0.70; 95% CI: 0.56–0.87) and wheeze in the last 12 months (OR = 0.70; 95% CI: 0.54–0.91) and ever (OR = 0.85; 95% CI: 0.70–1.02) was observed. Conclusions The study confirmed the known adverse influence of the presence of moulds and heating with solid fuel on the prevalence of asthma, bronchitis, respiratory symptoms and allergic diseases. The protective influence of pets on the occurrence of the health disorders under study was demonstrated.
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Climate Change Related Catastrophic Rainfall Events and Non-Communicable Respiratory Disease: A Systematic Review of the Literature. CLIMATE 2022. [DOI: 10.3390/cli10070101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Climate change is increasing the frequency and intensity of extreme precipitation events, the impacts of which disproportionately impact urban populations. Pluvial flooding and flooding related sewer backups are thought to result in an increase in potentially hazardous human-pathogen encounters. However, the extent and nature of associations between flooding events and non-communicable respiratory diseases such as chronic bronchitis, asthma, and chronic obstructive pulmonary disease (COPD) are not well understood. This research seeks to characterize the state of research on flooding and NCRDs through a systematic review of the scientific literature. We conducted a systematic search of PubMed, Web of Science, and Scopus for published scholarly research papers using the terms flooding, monsoon, and tropical storm with terms for common NCRDs such as asthma, COPD, and chronic bronchitis. Papers were included if they covered research studies on individuals with defined outcomes of flooding events. We excluded review papers, case studies, and opinion pieces. We retrieved 200 articles from PubMed, 268 from Web of Science and 203 from Scopus which comprised 345 unique papers. An initial review of abstracts yielded 38 candidate papers. A full text review of each left 16 papers which were included for the review. All papers except for one found a significant association between a severe weather event and increased risk for at least one of the NCRDs included in this research. Our findings further suggest that extreme weather events may worsen pre-existing respiratory conditions and increase the risk of development of asthma. Future work should focus on more precisely defining measure of health outcomes using validated tools to describe asthma and COPD exacerbations. Research efforts should also work to collect granular data on patients’ health status and family history and assess possible confounding and mediating factors such as neighborhood water mitigation infrastructure, housing conditions, pollen counts, and other environmental variables.
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Lin CH, Li YR, Kor CT, Lin SH, Ji BC, Lin MT, Chai WH. The Mediating Effect of Cytokines on the Association between Fungal Sensitization and Poor Clinical Outcome in Asthma. Biomedicines 2022; 10:biomedicines10061452. [PMID: 35740474 PMCID: PMC9220002 DOI: 10.3390/biomedicines10061452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Sensitization to fungal allergens is one of the proposed phenotypes in asthma. An association between fungal sensitization and worse clinical outcomes is apparent. Moreover, fungal sensitization in asthma that is associated with different type of immunological mechanism has been reported. How the role of cytokines mediates the association between fungal sensitization and poorer asthmatic outcomes remains unclear. We aimed to determine role of cytokines in the relationship between fungal sensitization and worse clinical outcomes in asthma. METHOD We conducted a prospective study to recruit adult patients with asthma. Data including age, sex, height, weight, smoking history, medication, emergency visit and admission, pulmonary function testing result, and Asthma Control Test (ACT) scores were collected. We used the automated BioIC method to measure fungal allergen sIgE in sera. Serum levels of Interleukin (IL) -4, IL-13, IL-6, IL-9, IL-10, IL-17 A, IL-22, Interferon (IFN) -γ, Immunoglobulin E (IgE), Tumor necrosis factor-α (TNF-α), and Transforming growth factor-β (TGF-β) were measured using ELISA. RESULT IL-6 and IL-17A had a significant positive correlation between sensitization and most fungi species compared to IgE. Sensitization to Candida albicans had strongly positive association both with IL-6 and IL-17A. However, only IL-17A had significant relationship with ED visit times. The mediation analysis result indicates that IL-17A had a significant positively mediating effect (ME) on the association between Candida albicans and ED visit times. CONCLUSION IL-17A is a potential mediator to link Candida albicans sensitization and ED visits for asthma. We suggest that patients with fungal sensitization, such as Candida albicans, have poorer outcomes associated with Th17-mediated immune response rather than Th2.
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Affiliation(s)
- Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (S.-H.L.); (B.-C.J.); (M.-T.L.); (W.-H.C.)
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung 402, Taiwan
- Ph.D. Program in Translational Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Department of Recreation and Holistic Wellness, MingDao University, Changhua 523, Taiwan
- Correspondence: ; Tel.: +886-4-7238595; Fax: +886-4-7232942
| | - Yi-Rong Li
- Thoracic Medicine Research Center, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Chew-Teng Kor
- Big Data Center, Changhua Christian Hospital, Changhua 500, Taiwan;
- Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 500, Taiwan
| | - Sheng-Hao Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (S.-H.L.); (B.-C.J.); (M.-T.L.); (W.-H.C.)
- Department of Recreation and Holistic Wellness, MingDao University, Changhua 523, Taiwan
- Thoracic Medicine Research Center, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Bin-Chuan Ji
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (S.-H.L.); (B.-C.J.); (M.-T.L.); (W.-H.C.)
| | - Ming-Tai Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (S.-H.L.); (B.-C.J.); (M.-T.L.); (W.-H.C.)
| | - Woei-Horng Chai
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (S.-H.L.); (B.-C.J.); (M.-T.L.); (W.-H.C.)
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Fomina DS, Mukhina OA, Lebedkina MS, Bobrikova EN, Sinyavkin DO, Chernov AA, Mikhailova VI. Registry analysis of patients with severe allergic asthma and clinically relevant sensitization to fungal allergens treated with genetically engineered biologics. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.3.201442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background. Fungal sensitization (FS) often escapes the attention of clinicians when assessing the spectrum of sensitization in patients with atopic diseases. According to cohort studies is found in 310% of the general population and in 720% of asthmatics; the proportion of patients with severe bronchial asthma (SBA) with HS ranges from 35 to 75%. Fungal conidia have a 1000-fold higher exposure and are among the most important clinically relevant allergens in asthma. Exposure to fungal allergens is capable of generating a sustained T2 response with production of proinflammatory cytokines such as IL-5 and 13, which is indirectly related to the severity of airway eosinophilia. The identification of specific serum IgE is considered the benchmark diagnostic sign of FS, and the encapsulated hydrophobic carrier polymer system is considered preferable to skin prick tests. The process of reclassifying diseases with fungal lung lesions is confusing treatment strategies, leaving the FS problem underestimated. A series of publications have shown that omalizumab and other biologics targeting IL-5 or IL-5 receptor (IL5R) alpha are effective in treating SBA with FS. However, there remains an unmet need in real clinical practice for standardized approaches to genetically engineered biological therapies (BT) for different phenotypes of SBA, especially those associated with impaired microbiological homeostasis and this type of sensitization.
Aim. Using retrospective analysis of clinical-dynamic observational data from patients on BT treatment in a real clinical setting to determine phenotypic features of severe allergic bronchial asthma with FS and to perform additional detailed analysis of a cohort of patients on anti-IgE therapy.
Materials and methods. A retrospective observational single-center registry study was conducted between June 2017 and August 2021 at the City Reference Center for Allergology and Immunology. The baseline cohort consisted of 198 patients with severe allergic AD who were in the initial phase of BT. Inclusion criteria: age of patients over 18 years; presence of severe allergic bronchial asthma. Complex initial examination of patients included determination of FS by two methods: ImmunoCap ISAC to fungal allergic components alt a1, alt 6 (fungi of genus Alternaria) and asp f1, asp f3, asp f6 (fungi of genus Aspergillus). Specific IgE determinations on fungal panels. Sensitization to fungi was detected in 47 people during allergy examination. The following criteria were considered in evaluation of response to omalizumab: AST score less than 19 and/or difference between initial AST score and this score in dynamics less than 3 points; FEV 1 score less than 80; combination of 2 listed criteria. The minimum period of BT was 16 weeks. Nonparametric methods of descriptive statistics were used: median, interquartile range. Differences were considered significant at p0.05. Data were statistically processed using nonparametric methods in IBM SPSS Statistics V-22 program. MannWhitney U-test and KruskalWallis one-way analysis of variance were used to compare quantitative characteristics. Fisher's 2 test was used to compare qualitative characteristics.
Results. Characteristics of the eosinophilic phenotype of SBA combined with FS: middle-aged patients, more often women, with relatively early onset of AD and high baseline eosinophil levels before prescription of biological drug therapy. Concomitant atopic dermatitis and food allergies are additional frequent features of this phenotype. Analysis of the effect of FS on achieving response to omalizumab and further consideration of switching to alternative therapy in SBA and FS patients showed the need to avoid premature revision and perform no earlier than the 10th month of therapy due to delayed response formation. Given the aggressive impact of FS on the barrier functions of the bronchial tree epithelium, it is advisable to test patients for FS at the initial diagnosis of AD. In the presence of atopic dermatitis and/or food allergy as T2 comorbidities in patients with SBA, early testing for FS and increased control of local and systemic inflammation are appropriate, which may improve long-term outcomes and reduce risks of further damage to natural barriers.
Conclusion. Further research on various aspects of FS and its role in allergic diseases is extremely relevant in the current context.
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Gupta AK, Quinlan EM. Fungal Lung. J Am Podiatr Med Assoc 2021; 111. [PMID: 34121121 DOI: 10.7547/20-269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Foot and nail care specialists spend a great portion of their day using nail drills to reduce nail thickness and smooth foot calluses. This process generates a large amount of dust, some of which is small enough to breathe in and deposit into the deepest regions of the respiratory tract, potentially causing health problems. Foot and nail dust often contains fungi, from both fungus-infected and healthy-appearing nails. Although the majority of healthy individuals can tolerate inhaled fungi, the immune systems of older, immunocompromised, and allergy-prone individuals often react using the inflammatory T helper cell type 2 pathway, leading to mucus overproduction, bronchoconstriction, and, in severe cases, lung tissue damage. To protect vulnerable podiatry professionals, wearing a surgical mask, using a water spray suppression system on nail drills, installing air filtration systems, and considering drilling technique can help reduce exposure to nail dust.
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Dhariwal J, Hearn AP, Kavanagh JE, d'Ancona G, Green L, Fernandes M, Thomson L, Roxas C, Kent BD, Nanzer AM, Jackson DJ. Real-World Effectiveness of Anti-IL-5/5R Therapy in Severe Atopic Eosinophilic Asthma with Fungal Sensitization. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2315-2320.e1. [PMID: 33689868 DOI: 10.1016/j.jaip.2021.02.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Severe asthma with fungal sensitization (SAFS) is a complex clinical phenotype associated with poorly controlled type 2 inflammation and significant morbidity from both the disease itself and a high steroid burden. OBJECTIVE To assess the effectiveness of biologic therapies targeting eosinophilic inflammation in SAFS. METHODS We assessed the effectiveness of treatment with mepolizumab or benralizumab in patients with SAFS, and compared outcomes with patients with severe atopic asthma without fungal sensitization and patients with severe nonatopic asthma. Baseline clinical characteristics and clinical outcomes at 48 weeks were evaluated. A subgroup analysis was performed of patients who met the criteria for allergic bronchopulmonary aspergillosis (ABPA) rather than SAFS. RESULTS A total of 193 patients treated with mepolizumab (n = 63) or benralizumab (n = 130) were included. Patients with SAFS had higher baseline IgE level compared with patients with severe atopic asthma without fungal sensitization and severe nonatopic asthma (733 ± 837 IU/mL vs 338 ± 494 and 142 ± 171, respectively; both P < .001). There were no other significant baseline differences in clinical characteristics between groups. At 48 weeks, there were significant improvements in 6-item asthma control questionnaire score and exacerbation frequency, and reduction in maintenance oral corticosteroid dose across all groups (all P < .05). No significant between-group differences in outcomes were observed at 48 weeks. Patients with ABPA (n = 9) had a significant reduction in exacerbation frequency (P = .013) with treatment. CONCLUSIONS Treatment with eosinophil-targeting biologics led to improvements in exacerbation frequency, oral corticosteroid requirements, and patient-reported outcomes in patients with SAFS, with a reduction in exacerbations in the subgroup of patients with ABPA. These data highlight the potential clinical utility of targeting eosinophilic inflammation in SAFS and ABPA.
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Affiliation(s)
- Jaideep Dhariwal
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Andrew P Hearn
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Joanne E Kavanagh
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gráinne d'Ancona
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Linda Green
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Mariana Fernandes
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Louise Thomson
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Cris Roxas
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Brian D Kent
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Department of Respiratory Medicine, St James' Hospital, Dublin, Ireland; School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Alexandra M Nanzer
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Service, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; Asthma UK Centre, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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Diamant Z, Hanania NA. Editorial: Dealing with asthma during the turbulent times of coronavirus disease-2019. Curr Opin Pulm Med 2021; 27:1-2. [PMID: 33105236 DOI: 10.1097/mcp.0000000000000745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Zuzana Diamant
- Department of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
- Department Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nicola A Hanania
- Airways Clinical Research Center, Section of Pulmonary and Care Medicine, Baylor College of Medicine, Houston, Texas, USA
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