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Lövquist A, Turesson A, Protudjer JLP, Zelander CF, Jonsson M. The needs of parents of children with allergic diseases in preschool and school: A focus-group study. J Pediatr Nurs 2024; 79:100-106. [PMID: 39244819 DOI: 10.1016/j.pedn.2024.08.028] [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: 04/04/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/10/2024]
Abstract
PURPOSE To describe the perceived physical and psychological needs of parents of children with allergic diseases and asthma regarding allergy management in preschools and schools. METHODS We conducted a semi-structured focus group study with parents of children (ages 2-13 years) with different types of allergic diseases with/without asthma living in Stockholm, Sweden. Data were analyzed qualitative with systematic text condensation. RESULTS Across 4 focus groups, involving 25 parents, four primary themes representing parents' expressed needs related to allergy management in preschools and schools emerged: (i) Well-implemented routines (to create an allergy-safe physical environment where personnel have clear responsibilities and communication); (ii) Allergy competence among personnel (basic and practical knowledge, being able to act in emergency situations); (iii) My child is to be treated equally (with equal conditions and for their child to being included); (iv) To feel trust (parents need to be understood, taken seriously and feel confident in the preschool/school personnel's ability to take care of their child in a secure way). CONCLUSION This qualitative study shows parents needs regarding general allergy management in preschool/school. These needs emphasized well implemented allergy routines, improved allergy knowledge and competence among personnel, importance of equal conditions for children with allergic disease and establishing a trustful allergy-supportive relationship with both parents and children. IMPLICATIONS IN PRACTICE The study findings provide crucial insights for school administrators, teachers, and health care professionals on how to improve allergy management in preschools and schools.
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Affiliation(s)
- Alexandra Lövquist
- Centre for Occupational and Environmental Medicine, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Annelie Turesson
- Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | | | - Marina Jonsson
- Centre for Occupational and Environmental Medicine, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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2
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Zhang J, Ni J, Kong W, Liu J, Chen Y. Various clinical manifestations of 223 patients with IgE deficiency in a tertiary hospital in China: A cross-sectional study. Medicine (Baltimore) 2024; 103:e38397. [PMID: 38875431 PMCID: PMC11175936 DOI: 10.1097/md.0000000000038397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/03/2024] [Accepted: 05/08/2024] [Indexed: 06/16/2024] Open
Abstract
High Immunoglobulin E(IgE) levels associated with hypersensitivity or parasitic infection were well established, but the clinical significance of ultra-low IgE was largely unknown. Previous studies indicated these patients have an elevated risk of cancer, but large-scale epidemiological studies on the prevalence and clinical manifestations of these ultra-low IgE patients are still lacking. A total of 62,997 patients who were admitted to the First Affiliated Hospital of Wenzhou Medical University and had IgE level tests from January 2010 to March 2020 were included. Patients with serum IgE levels < 2 IU/mL were defined to have ultra-low IgE. And the clinical characteristics of these patients were retrospectively analyzed based on electronic medical record system and follow-up. A total of 223 patients (223/62,997, 0.35%) had ultra-low IgE were documented in 62,997 patients who had IgE tests. Among the clinical manifestations of these 223 ultra-low IgE patients, infection ranked first (125/223, 56.05%), following allergic diseases (51/223, 22.87%), hematological disorders (37/223, 16.59%), tumor (27/223, 12.11%) and autoimmune diseases (23/223, 10.31%). To the best of our knowledge, we first reported that the prevalence and clinical characteristics of 223 ultra-low IgE patients in China. The most common comorbidities were infection, allergic diseases, hematological disorders, tumor and autoimmune diseases.
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Affiliation(s)
- Junwu Zhang
- Department of Clinical Laboratory, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Jinyao Ni
- Department of Pathology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wanzhong Kong
- Department of Clinical Laboratory, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, China
| | - Jinlin Liu
- Department of Clinical Laboratory, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
| | - Yanxia Chen
- Department of Rheumatology and Immunology, South China Hospital, Medical School, Shenzhen University, Shenzhen, China
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3
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Venter C. Immunonutrition: Diet Diversity, Gut Microbiome and Prevention of Allergic Diseases. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:545-561. [PMID: 37827976 PMCID: PMC10570780 DOI: 10.4168/aair.2023.15.5.545] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 10/14/2023]
Abstract
Allergic diseases are increasing both in morbidity and mortality. Genetic, environmental, and dietary factors may all be involved in this increase. Nutrition during pregnancy, breastfeeding, and early life may play a particularly important role in preventing allergic diseases. Based on current systematic reviews, the intake of specific nutrients has failed to prevent allergic disease. Prevention strategies have shifted their focus to the overall diet which can be described using diet diversity. Infant and maternal diet diversity in pregnancy has been associated with reduced allergy outcomes in childhood. Overall, diet also seems to have a marked effect on the microbiome compared to single foods. Factors that may negate the allergy-preventative effect of overall diet diversity include the addition of emulsifiers, advanced glycation end-product content, and overuse of commercial baby foods. There is a need to perform randomized controlled trials using overall dietary intake to support international food allergy guidelines. These studies should ideally be conducted by multi-professional teams.
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Affiliation(s)
- Carina Venter
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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4
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Czolk R, Ruiz‐Castell M, Hunewald O, Wanniang N, Le Coroller G, Hilger C, Vaillant M, Fagherazzi G, Morel‐Codreanu F, Ollert M, Kuehn A. Novel, computational IgE-clustering in a population-based cross-sectional study: Mapping the allergy burden. Clin Transl Allergy 2023; 13:e12292. [PMID: 37746799 PMCID: PMC10478827 DOI: 10.1002/clt2.12292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Even though the prevalence of allergies is increasing, population-based data are still scarce. As a read-out for chronic inflammatory information, new methods are needed to integrate individual biological measurements and lifestyle parameters to mitigate the consequences and costs of allergic burden for society. METHODS More than 480.000 data points were collected from 1462 Luxembourg adults during the representative, cross-sectional European Health Examination Survey, spanning health and lifestyle reports. Deep IgE-profiles based on unsupervised clustering were correlated with data of the health survey. FINDINGS 42.6% of the participants reported a physician-diagnosed allergy and 44% were found to be IgE-positive to at least one allergen or extract. The main sensitization sources were tree pollens followed by grass pollens and mites (52.4%, 51.8% and 40.3% of sensitized participants respectively), suggesting seasonal as well as perennial burden. The youngest group of participants (25-34 years old) showed the highest burden of sensitization, with 18.2% of them having IgE to 10 or more allergen groups. Unsupervised clustering revealed that the biggest cluster of 24.4% of participants was also the one with the highest medical need, marked by their multi-sensitization to respiratory sources. INTERPRETATION Our novel approach to analyzing large biosample datasets together with health information allows the measurement of the chronic inflammatory disease burden in the general population and led to the identification of the most vulnerable groups in need of better medical care.
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Affiliation(s)
- Rebecca Czolk
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
- Faculty of Science, Technology and MedicineUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Maria Ruiz‐Castell
- Epidemiology and Public Health Research UnitDepartment of Precision HealthLuxembourg Institute of HealthStrassenLuxembourg
| | - Oliver Hunewald
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
| | - Naphisabet Wanniang
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
- Faculty of Science, Technology and MedicineUniversity of LuxembourgEsch‐sur‐AlzetteLuxembourg
| | - Gwenaëlle Le Coroller
- Competence Center for Methodology and StatisticsTranslational Medicine Operations HubLuxembourg Institute of HealthStrassenLuxembourg
| | - Christiane Hilger
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
| | - Michel Vaillant
- Competence Center for Methodology and StatisticsTranslational Medicine Operations HubLuxembourg Institute of HealthStrassenLuxembourg
| | - Guy Fagherazzi
- Epidemiology and Public Health Research UnitDepartment of Precision HealthLuxembourg Institute of HealthStrassenLuxembourg
| | - Françoise Morel‐Codreanu
- Department of Allergology and ImmunologyCentre Hospitalier de Luxembourg‐Kanner KlinikLuxembourgLuxembourg
| | - Markus Ollert
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
- Department of Dermatology and Allergy CenterOdense Research Center for AnaphylaxisOdense University HospitalUniversity of Southern DenmarkOdenseDenmark
| | - Annette Kuehn
- Department of Infection and ImmunityLuxembourg Institute of HealthEsch‐sur‐AlzetteLuxembourg
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5
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Wise SK, Damask C, Roland LT, Ebert C, Levy JM, Lin S, Luong A, Rodriguez K, Sedaghat AR, Toskala E, Villwock J, Abdullah B, Akdis C, Alt JA, Ansotegui IJ, Azar A, Baroody F, Benninger MS, Bernstein J, Brook C, Campbell R, Casale T, Chaaban MR, Chew FT, Chambliss J, Cianferoni A, Custovic A, Davis EM, DelGaudio JM, Ellis AK, Flanagan C, Fokkens WJ, Franzese C, Greenhawt M, Gill A, Halderman A, Hohlfeld JM, Incorvaia C, Joe SA, Joshi S, Kuruvilla ME, Kim J, Klein AM, Krouse HJ, Kuan EC, Lang D, Larenas-Linnemann D, Laury AM, Lechner M, Lee SE, Lee VS, Loftus P, Marcus S, Marzouk H, Mattos J, McCoul E, Melen E, Mims JW, Mullol J, Nayak JV, Oppenheimer J, Orlandi RR, Phillips K, Platt M, Ramanathan M, Raymond M, Rhee CS, Reitsma S, Ryan M, Sastre J, Schlosser RJ, Schuman TA, Shaker MS, Sheikh A, Smith KA, Soyka MB, Takashima M, Tang M, Tantilipikorn P, Taw MB, Tversky J, Tyler MA, Veling MC, Wallace D, Wang DY, White A, Zhang L. International consensus statement on allergy and rhinology: Allergic rhinitis - 2023. Int Forum Allergy Rhinol 2023; 13:293-859. [PMID: 36878860 DOI: 10.1002/alr.23090] [Citation(s) in RCA: 79] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/11/2022] [Accepted: 09/13/2022] [Indexed: 03/08/2023]
Abstract
BACKGROUND In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR-Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR-Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence-based findings and recommendation from the full document. METHODS ICAR-Allergic Rhinitis 2023 employed established evidence-based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. RESULTS ICAR-Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. CONCLUSION The ICAR-Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.
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Affiliation(s)
- Sarah K Wise
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Cecelia Damask
- Otolaryngology-HNS, Private Practice, University of Central Florida, Lake Mary, Florida, USA
| | - Lauren T Roland
- Otolaryngology-HNS, Washington University, St. Louis, Missouri, USA
| | - Charles Ebert
- Otolaryngology-HNS, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Joshua M Levy
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Sandra Lin
- Otolaryngology-HNS, University of Wisconsin, Madison, Wisconsin, USA
| | - Amber Luong
- Otolaryngology-HNS, McGovern Medical School of the University of Texas, Houston, Texas, USA
| | - Kenneth Rodriguez
- Otolaryngology-HNS, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ahmad R Sedaghat
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Elina Toskala
- Otolaryngology-HNS, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Baharudin Abdullah
- Otolaryngology-HNS, Universiti Sains Malaysia, Kubang, Kerian, Kelantan, Malaysia
| | - Cezmi Akdis
- Immunology, Infectious Diseases, Swiss Institute of Allergy and Asthma Research, Davos, Switzerland
| | - Jeremiah A Alt
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | | | - Antoine Azar
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fuad Baroody
- Otolaryngology-HNS, University of Chicago, Chicago, Illinois, USA
| | | | | | - Christopher Brook
- Otolaryngology-HNS, Harvard University, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Raewyn Campbell
- Otolaryngology-HNS, Macquarie University, Sydney, NSW, Australia
| | - Thomas Casale
- Allergy/Immunology, University of South Florida College of Medicine, Tampa, Florida, USA
| | - Mohamad R Chaaban
- Otolaryngology-HNS, Cleveland Clinic, Case Western Reserve University, Cleveland, Ohio, USA
| | - Fook Tim Chew
- Allergy/Immunology, Genetics, National University of Singapore, Singapore, Singapore
| | - Jeffrey Chambliss
- Allergy/Immunology, University of Texas Southwestern, Dallas, Texas, USA
| | - Antonella Cianferoni
- Allergy/Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Anne K Ellis
- Allergy/Immunology, Queens University, Kingston, ON, Canada
| | | | - Wytske J Fokkens
- Otorhinolaryngology, Amsterdam University Medical Centres, Amsterdam, Netherlands
| | | | - Matthew Greenhawt
- Allergy/Immunology, Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amarbir Gill
- Otolaryngology-HNS, University of Michigan, Ann Arbor, Michigan, USA
| | - Ashleigh Halderman
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Jens M Hohlfeld
- Respiratory Medicine, Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Hannover Medical School, German Center for Lung Research, Hannover, Germany
| | | | - Stephanie A Joe
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Shyam Joshi
- Allergy/Immunology, Oregon Health and Science University, Portland, Oregon, USA
| | | | - Jean Kim
- Otolaryngology-HNS, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adam M Klein
- Otolaryngology-HNS, Emory University, Atlanta, Georgia, USA
| | - Helene J Krouse
- Otorhinolaryngology Nursing, University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Edward C Kuan
- Otolaryngology-HNS, University of California Irvine, Orange, California, USA
| | - David Lang
- Allergy/Immunology, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Matt Lechner
- Otolaryngology-HNS, University College London, Barts Health NHS Trust, London, UK
| | - Stella E Lee
- Otolaryngology-HNS, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Victoria S Lee
- Otolaryngology-HNS, University of Illinois Chicago, Chicago, Illinois, USA
| | - Patricia Loftus
- Otolaryngology-HNS, University of California San Francisco, San Francisco, California, USA
| | - Sonya Marcus
- Otolaryngology-HNS, Stony Brook University, Stony Brook, New York, USA
| | - Haidy Marzouk
- Otolaryngology-HNS, State University of New York Upstate, Syracuse, New York, USA
| | - Jose Mattos
- Otolaryngology-HNS, University of Virginia, Charlottesville, Virginia, USA
| | - Edward McCoul
- Otolaryngology-HNS, Ochsner Clinic, New Orleans, Louisiana, USA
| | - Erik Melen
- Pediatric Allergy, Karolinska Institutet, Stockholm, Sweden
| | - James W Mims
- Otolaryngology-HNS, Wake Forest University, Winston Salem, North Carolina, USA
| | - Joaquim Mullol
- Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Jayakar V Nayak
- Otolaryngology-HNS, Stanford University, Palo Alto, California, USA
| | - John Oppenheimer
- Allergy/Immunology, Rutgers, State University of New Jersey, Newark, New Jersey, USA
| | | | - Katie Phillips
- Otolaryngology-HNS, University of Cincinnati, Cincinnati, Ohio, USA
| | - Michael Platt
- Otolaryngology-HNS, Boston University, Boston, Massachusetts, USA
| | | | | | - Chae-Seo Rhee
- Rhinology/Allergy, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Sietze Reitsma
- Otolaryngology-HNS, University of Amsterdam, Amsterdam, Netherlands
| | - Matthew Ryan
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Joaquin Sastre
- Allergy, Fundacion Jiminez Diaz, University Autonoma de Madrid, Madrid, Spain
| | - Rodney J Schlosser
- Otolaryngology-HNS, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Theodore A Schuman
- Otolaryngology-HNS, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marcus S Shaker
- Allergy/Immunology, Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Aziz Sheikh
- Primary Care, University of Edinburgh, Edinburgh, Scotland
| | - Kristine A Smith
- Otolaryngology-HNS, University of Utah, Salt Lake City, Utah, USA
| | - Michael B Soyka
- Otolaryngology-HNS, University of Zurich, University Hospital of Zurich, Zurich, Switzerland
| | - Masayoshi Takashima
- Otolaryngology-HNS, Houston Methodist Academic Institute, Houston, Texas, USA
| | - Monica Tang
- Allergy/Immunology, University of California San Francisco, San Francisco, California, USA
| | | | - Malcolm B Taw
- Integrative East-West Medicine, University of California Los Angeles, Westlake Village, California, USA
| | - Jody Tversky
- Allergy/Immunology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Matthew A Tyler
- Otolaryngology-HNS, University of Minnesota, Minneapolis, Minnesota, USA
| | - Maria C Veling
- Otolaryngology-HNS, University of Texas Southwestern, Dallas, Texas, USA
| | - Dana Wallace
- Allergy/Immunology, Nova Southeastern University, Ft. Lauderdale, Florida, USA
| | - De Yun Wang
- Otolaryngology-HNS, National University of Singapore, Singapore, Singapore
| | - Andrew White
- Allergy/Immunology, Scripps Clinic, San Diego, California, USA
| | - Luo Zhang
- Otolaryngology-HNS, Beijing Tongren Hospital, Beijing, China
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6
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Multimorbidity of Allergic Conditions in Urban Citizens of Southern China: A Real-World Cross-Sectional Study. J Clin Med 2023; 12:jcm12062226. [PMID: 36983228 PMCID: PMC10059830 DOI: 10.3390/jcm12062226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/15/2023] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
Background: Extensive knowledge of allergic multimorbidities is required to improve the management of allergic diseases with the industrialization of China. However, the demography and allergen distribution patterns of allergic multimorbidities in China remain unclear, despite the increasing prevalence of allergies. Methods: This was a real-world, cross-sectional study of 1273 outpatients diagnosed with one or more allergic diseases in Guangzhou, the most populated city of southern China, with leading industrial and commercial centers, between April 2021 and March 2022. Seven allergic diseases (allergic rhinitis (AR), asthma (AS)/cough variant asthma (CVA), atopic dermatitis (AD)/eczema, food allergy (FA), allergic conjunctivitis (AC), drug allergy (DA), and anaphylaxis) were assessed. Positive rates of sensitization to different allergens were measured using an allergen detection system of the UniCAP (Pharmacia Diagnostics, Sweden) instrument platform to compare the groups of allergic multimorbidities against a single entity. Results: There were 659 (51.8%) males and 614 (48.2%) females aged from 4 months to 74 years included in the analysis. The study participants who were diagnosed with allergic diseases had an average of 1.6 diagnoses. Overall, 46.5% (592 of 1273) of the patients had more than one allergic condition, and allergic rhinitis was the most common type of multimorbidity. Women were more likely to suffer from an allergic disease alone, whereas allergic multimorbidities were more likely to be diagnosed in men (p = 0.005). In addition, allergic multimorbidities were common in all age groups, with an incidence ranging from 37.1% to 57.4%, in which children and adolescents were more frequently diagnosed with allergic multimorbidities than adults (18–60 years old) (all p < 0.05). Allergic multimorbidity was observed throughout the year. A difference in the positive rate of allergens sensitization and total immunoglobulin E (tIgE) levels between different allergic multimorbidities was observed. Conclusions: Allergic multimorbidities were very commonly found in nearly half of all patients with allergies. The proportion of allergic multimorbidities varied with the type of disease, sex, age, and allergen distribution pattern. These findings may help clinicians to develop “One health” strategies for the clinical management of allergic diseases.
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7
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Kilanowski A, Thiering E, Wang G, Kumar A, Kress S, Flexeder C, Bauer CP, Berdel D, von Berg A, Bergström A, Gappa M, Heinrich J, Herberth G, Koletzko S, Kull I, Melén E, Schikowski T, Peters A, Standl M. Allergic disease trajectories up to adolescence: Characteristics, early-life, and genetic determinants. Allergy 2023; 78:836-850. [PMID: 36069615 DOI: 10.1111/all.15511] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/27/2022] [Accepted: 08/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Allergic diseases often develop jointly during early childhood but differ in timing of onset, remission, and progression. Their disease course over time is often difficult to predict and determinants are not well understood. OBJECTIVES We aimed to identify trajectories of allergic diseases up to adolescence and to investigate their association with early-life and genetic determinants and clinical characteristics. METHODS Longitudinal k-means clustering was used to derive trajectories of allergic diseases (asthma, atopic dermatitis, and rhinitis) in two German birth cohorts (GINIplus/LISA). Associations with early-life determinants, polygenic risk scores, food and aeroallergen sensitization, and lung function were estimated by multinomial models. The results were replicated in the independent Swedish BAMSE cohort. RESULTS Seven allergic disease trajectories were identified: "Intermittently allergic," "rhinitis," "early-resolving dermatitis," "mid-persisting dermatitis," "multimorbid," "persisting dermatitis plus rhinitis," and "early-transient asthma." Family history of allergies was more prevalent in all allergic disease trajectories compared the non-allergic controls with stronger effect sizes for clusters comprising more than one allergic disease (e.g., RRR = 5.0, 95% CI = [3.1-8.0] in the multimorbid versus 1.8 [1.4-2.4] in the mild intermittently allergic cluster). Specific polygenic risk scores for single allergic diseases were significantly associated with their relevant trajectories. The derived trajectories and their association with genetic effects and clinical characteristics showed similar results in BAMSE. CONCLUSION Seven robust allergic clusters were identified and showed associations with early life and genetic factors as well as clinical characteristics.
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Affiliation(s)
- Anna Kilanowski
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Institute for Medical Information Processing, Biometry, and Epidemiology, Pettenkofer School of Public Health, LMU Munich, Munich, Germany.,Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Elisabeth Thiering
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, University of Munich Medical Center, Munich, Germany
| | - Gang Wang
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Ashish Kumar
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Sara Kress
- Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany.,Medical Research School Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Claudia Flexeder
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Lung Research (DZL), Munich, Germany.,Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Carl-Peter Bauer
- Department of Pediatrics, Technical University of Munich, Munich, Germany
| | - Dietrich Berdel
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Andrea von Berg
- Research Institute, Department of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Monika Gappa
- Evangelisches Krankenhaus Düsseldorf, Children's Hospital, Düsseldorf, Germany
| | - Joachim Heinrich
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany.,Allergy and Lung Health Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Gunda Herberth
- Department of Environmental Immunology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany.,Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs Children's and Youth Hospital, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Tamara Schikowski
- Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Chair of Epidemiology, Ludwig-Maximilians University, Munich, Germany
| | - Marie Standl
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Lung Research (DZL), Munich, Germany
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8
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Lopandić Z, Dragačević L, Kosanović D, Burazer L, Gavrović-Jankulović M, Minić R. Differences in mouse strains determine the outcome of Der p 2 allergy induction protocols. J Immunol Methods 2022; 511:113382. [PMID: 36323342 DOI: 10.1016/j.jim.2022.113382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
In vivo animal models can provide worthy information on various aspects of asthma mechanism and pathogenesis. The genetic predisposition and phenotype of mice may affect the immune response itself. Here we compare the early immune response to Der p 2 or HDM allergen extract upon injection and inhalation in BALB/c and C57BL/6 mice. Female C57BL/6 and BALB/c mice were immunized with Der p 2 allergen subcutaneously followed by inhalation of Der p 2 or HDM extract. After challenge, the mice were euthanized; blood, bronchoalveolar lavage (BAL), spleens and lungs were collected. Cells from BAL were identified by May-Grünwald Giemsa staining and lung leukocyte populations were analyzed by flow cytometry. Serum antibody levels of Der p 2 specific IgE, IgG, IgG1 and IgG2a were assessed by ELISA, and cytokine secretion (IL-4, IFN-γ and IL-10) was evaluated upon stimulation with Der p 2 or HDM extract. The Th2 immune response was confirmed by elevated allergen-specific immunoglobulin E (IgE) and the allergic reaction was evidenced by infiltration of eosinophils and/or neutrophils into BAL. We found that BALB/c mice were inefficient in integrating local with systemic immune response, evidenced by almost no IgG or IgE production upon one subcutaneous injection and subsequent inhalation of Der p 2 allergen; also, the bronchoalveolar lavage infiltrate in these mice consisted of neutrophil infiltration, unlike C57BL/6 mice in which eosinophilic infiltrate predominated. The differences between BALB/c and C57BL/6 mice strains could be exploited for generating different types of responses to the Der p 2 allergen.
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Affiliation(s)
- Zorana Lopandić
- Department of Biochemistry, Faculty of Chemistry, University of Belgrade, Studentski trg 16, 11000 Belgrade, Serbia
| | - Luka Dragačević
- Institute of Virology, Vaccines and Sera, Torlak, Vojvode Stepe 458, 11152 Belgrade, Serbia
| | - Dejana Kosanović
- Institute of Virology, Vaccines and Sera, Torlak, Vojvode Stepe 458, 11152 Belgrade, Serbia
| | - Lidija Burazer
- Institute of Virology, Vaccines and Sera, Torlak, Vojvode Stepe 458, 11152 Belgrade, Serbia
| | - Marija Gavrović-Jankulović
- Department of Biochemistry, Faculty of Chemistry, University of Belgrade, Studentski trg 16, 11000 Belgrade, Serbia
| | - Rajna Minić
- Institute of Virology, Vaccines and Sera, Torlak, Vojvode Stepe 458, 11152 Belgrade, Serbia; Group for Immunology, Institute for Medical Research, National Institute of Republic of Serbia, University of Belgrade, dr Subotića 4, Belgrade, Serbia.
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9
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Allergic Asthma in the Era of Personalized Medicine. J Pers Med 2022; 12:jpm12071162. [PMID: 35887659 PMCID: PMC9321181 DOI: 10.3390/jpm12071162] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/17/2023] Open
Abstract
Allergic asthma is the most common asthma phenotype and is characterized by IgE sensitization to airborne allergens and subsequent typical asthmatic symptoms after exposure. A form of type 2 (T2) airway inflammation underlies allergic asthma. It usually arises in childhood and is accompanied by multimorbidity presenting with the occurrence of other atopic diseases, such as atopic dermatitis and allergic rhinitis. Diagnosis of the allergic endotype is based on in vivo (skin prick tests) and/or in vitro (allergen-specific IgE levels, component-resolved diagnosis (CRD)) documentation of allergic sensitization. Biomarkers identifying patients with allergic asthma include total immunoglobulin E (IgE) levels, fractional exhaled nitric oxide (FeNO) and serum eosinophil counts. The treatment of allergic asthma is a complex procedure and requires a patient-tailored approach. Besides environmental control involving allergen avoidance measurements and cornerstone pharmacological interventions based on inhaled drugs, allergen-specific immunotherapy (AIT) and biologics are now at the forefront when it comes to personalized management of asthma. The current review aims to shed light on the distinct phenotype of allergic asthma, ranging over its current definition, clinical characteristics, pathophysiology and biomarkers, as well as its treatment options in the era of precision medicine.
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10
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Mitselou N, Andersson N, Bergström A, Kull I, Georgelis A, Hage M, Hedman AM, Almqvist C, Ludvigsson JF, Melén E. Preterm birth reduces the risk of IgE sensitization up to early adulthood: A population-based birth cohort study. Allergy 2022; 77:1570-1582. [PMID: 34486741 DOI: 10.1111/all.15077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/06/2021] [Accepted: 06/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Immunoglobulin E (IgE) sensitization is associated with asthma and allergic diseases. Gestational age influences early immune system development, thereby potentially affecting the process of tolerance induction to allergens. OBJECTIVE To study IgE sensitization to common allergens by gestational age from childhood up to early adulthood. METHODS Population-based birth cohort, data from the Swedish BAMSE study were used. Allergen-specific IgE antibodies to a mix of common food (fx5) and inhalant (Phadiatop) allergens were analysed at 4, 8, 16 and 24 years. Sensitization was defined as allergen-specific IgE ≥0.35 kUA /L to fx5 and/or Phadiatop at each time point. Using logistic regression and generalized estimated equations, adjusted odds ratios (aORs) for sensitization in relation to gestational age were calculated. Replication was sought within the Swedish twin study STOPPA. RESULTS In BAMSE, 3522 participants were screened for IgE antibodies during follow-up; of these, 197 (5.6%) were born preterm (<37 gestational weeks) and 330 (9.4%) post-term (≥42 weeks). Preterm birth reduced the risk of sensitization to common food and/or inhalant allergens up to early adulthood by 29% (overall aOR = 0.71; 95% CI: 0.52-0.98), and to food allergens specifically by 40% (overall aOR = 0.60; 95% CI: 0.38-0.93). No relation was found between post-term birth and IgE sensitization at any time point. Replication analyses in STOPPA (N = 675) showed similar risk estimates for sensitization to food and/or inhalant allergens (aOR = 0.72; 95% CI: 0.42-1.21), which resulted in a combined meta-analysis aOR = 0.71 (95% CI: 0.54-0.94). CONCLUSIONS Our study suggests an inverse association between preterm birth and long-term IgE sensitization.
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Affiliation(s)
- Niki Mitselou
- Department of Pediatrics Örebro University Hospital Örebro Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
| | - Anna Bergström
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
- Centre for Occupational and Environmental Medicine Region Stockholm Stockholm Sweden
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset Stockholm Sweden
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
| | - Antonios Georgelis
- Centre for Occupational and Environmental Medicine Region Stockholm Stockholm Sweden
| | - Marianne Hage
- Division of Immunology and Allergy Department of Medicine Solna Karolinska Institutet and Karolinska University Hospital Stockholm Sweden
| | - Anna M. Hedman
- 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
| | - Jonas F. Ludvigsson
- Department of Pediatrics Örebro University Hospital Örebro Sweden
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
- Division of Epidemiology and Public Health School of Medicine University of Nottingham Nottingham UK
- Department of Medicine Columbia University College of Physicians and Surgeons New York New York USA
| | - Erik Melén
- Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden
- Department of Clinical Science and Education Södersjukhuset Stockholm Sweden
- Sachs' Children and Youth Hospital Södersjukhuset Stockholm Sweden
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11
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Li Y, Liu C, Li H, Wang X. Exploring the role of basophil activation test in diagnosis of Dermatophagoides farinae sensitization and evaluation of therapeutic efficacy of subcutaneous immunotherapy in children. Scand J Immunol 2022; 96:e13168. [PMID: 35366340 DOI: 10.1111/sji.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/28/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE It aims to detect basophil activation ratio (%CD63+ ) in peripheral blood of children with allergic asthma and rhinitis by using Flow cytometry (FCM) , so as to analyze the application values and clinical relevance of the Basophil Activation Test (BAT) in diagnosis of Dermatophagoides farinae (Derf) sensitization and monitoring therapeutic efficacy of subcutaneous immunotherapy (SCIT). METHODS It was a prospective study. From the newly diagnosed children with asthma and rhinitis in our pediatric clinic, 39 patients diagnosed Derf sensitization and 15 patients not allergic to Derf were enrolled; another 4 healthy children were taken as control group. Using Derf extracts in concentration of 1 μg/ml, 10 μg/ml and 100 μg/ml as the stimulus, BAT results were expressed as %CD63+ in diagnosis of Derf sensitization and its correlation with skin prick tests (SPT), serum total IgE (tIgE), specific IgE (sIgE), sIgE/tIgE, specific IgG4 (sIgG4), FEV1%pred in pulmonary ventilation function, exhaled nitric oxide (FeNO), children asthma control test (C-ACT) and visual analogue scale (VAS) were observed. In sensitization group, %CD63+ , sIgG4 and clinical indicators were detected again from patients who had received SCIT to analyze their internal connections. RESULTS The average levels of %CD63+ in three concentrations showed an increasing concentration-dependent trend overall. %CD63+ in sensitization group was significantly higher than that in the other two groups. The analysis of ROC for Derf sensitization showed the area under the curve (AUC) for BAT in three concentrations were higher than that for sIgE whose AUC is 0.893. %CD63+ was positively correlated with SPT grade, sIgE, sIgE/tIgE and VAS, and negatively correlated with C-ACT. In patients receiving SCIT, %CD63+ became lower and sIgG4 level became higher than pretreatment. There was no obvious change in sIgG4 in those who hadn't received SCIT. CONCLUSIONS BAT is a reliable and non-invasive tool for diagnosis of Derf sensitization in children with asthma and rhinitis. CD63-based BAT has clinical value to monitor outcome of SCIT, and the change of basophil activation is inherently related to induction of sIgG4.
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Affiliation(s)
- Yifan Li
- Department of pediatrics, Second Hospital of Tianjin Medical University, Tianjin, China, 300211
| | - Changshan Liu
- Department of pediatrics, Second Hospital of Tianjin Medical University, Tianjin, China, 300211
| | - Huiqiang Li
- College of Medical Laboratory Science, Tianjin Medical University, Tianjin, China, 300203
| | - Xueyan Wang
- Department of pediatrics, Second Hospital of Tianjin Medical University, Tianjin, China, 300211
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12
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Zhao M, Liang Y, Song F, Ma L, Wang Y, Gao W, Tian J, Ying X, Shen C, Wang S, Jiao L, Wang Y, Sun X, Ma L, Ma X. Preventive Antenatal Educational Program on Allergic Diseases (PAEPAD) versus standard antenatal care for prevention of atopic dermatitis: study protocol for a single-centre, investigator-blinded randomised controlled trial. BMJ Open 2022; 12:e048083. [PMID: 35078832 PMCID: PMC8796218 DOI: 10.1136/bmjopen-2020-048083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Patient education serves an essential purpose in the long-term management of allergic diseases as a secondary prevention approach. However, evidence on using education for primary prevention is limited. This study aims to evaluate the effect of an educational intervention, that is, the Preventive Antenatal Educational Program on Allergic Diseases (PAEPAD), on infantile allergic disease incidences compared with the standard care. METHODS AND ANALYSIS This is a single-centre randomised controlled trial of expecting mother-children dyads in Daxing Teaching Hospital of Beijing, China. A total of 2266 expecting mothers will be recruited. Expecting mothers enlisted in the birth registry of Daxing Teaching Hospital of Capital Medical University and intend to give birth at this location will be screened for eligibility. Women aged≥18 years with less than 14+6 weeks of pregnancy who intends to remain resident in Daxing district for at least 2 years postpartum will be entered into the run-in phase. Randomisation will take place at 30 weeks of gestation. Women at high risk for miscarriage or intend to have abortions will be excluded. The participants will be allocated into two groups (ie, the PAEPAD and the standard care group) by random allocation (1:1). The PAEPAD group will receive a multidisciplinary education of neonatal care, including standard education as the control group and additional information on skincare of infants, sun protection, topical corticosteroids and an overview of atopic dermatitis (AD), whereas the standard care group will receive the standard neonatal care education carried out by obstetricians. Participants will be followed for 2 years. The primary outcome will be infantile AD cumulative incidence at 2 years postpartum. Secondary outcomes will include other AD outcomes, atopic march outcomes, knowledge outcomes and other maternal and neonatal outcomes. Data collection will be carried out using both electronic and paper questionnaires. Biological samples will also be collected longitudinally. ETHICS AND DISSEMINATION The study design was approved by the ethical committee of Capital Medical University Daxing Teaching Hospital, Beijing, China. The trial results will be published in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER ChiCTR registry (Trial ID: ChiCTR2000040463).
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Affiliation(s)
- Mutong Zhao
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yuan Liang
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Fengli Song
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Lili Ma
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Ying Wang
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Wanli Gao
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Jing Tian
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiangji Ying
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Chunping Shen
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shan Wang
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Lei Jiao
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Yang Wang
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaoyan Sun
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
| | - Lin Ma
- Dermatology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiuhua Ma
- Obstetrics and Gynecology, Beijing Daxing District People's Hospital, Daxing Teaching Hospital, Capital Medical University, Beijing, China
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13
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Bunne J, Hedman L, Perzanowski M, Bjerg A, Winberg A, Andersson M, Lundbäck B, Platts-Mills T, Rönmark E. The majority of children sensitized before school-age develop allergic disease before adulthood: a longitudinal population-based study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:577-585.e3. [PMID: 34695595 DOI: 10.1016/j.jaip.2021.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/17/2021] [Accepted: 10/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Allergic sensitization increases the risk of and asthma and allergic rhinitis, but the impact of age at onset of sensitization is less studied. OBJECTIVE To examine the cumulative incidence of asthma and rhinitis up to age 19 years in relation to age at onset of sensitization to airborne allergens. METHOD All children in grade one and two (median age 8 years) in two municipalities in Northern Sweden were invited to skin prick tests and a questionnaire about allergic diseases, and 88% participated. At ages 12 and 19 years the protocol was repeated, and n=1510 individuals participated in all three examinations. Specific IgE was collected in a random sample at age 19, n=770. Onset of sensitization was defined; ≤8 years, 8-12 years, 12-19 years, and never sensitized. Adjusted Poisson regression was utilized to calculate risk ratios. RESULTS At age 19, those sensitized ≤8 year had the highest risk of asthma (RR 4.68 (95%CI 3.14-6.97)) and rhinitis (RR 22.3 (95%CI 13.3-37.6)), and 84% had developed either asthma or rhinitis. The combination of sensitization ≤8 year and family history of allergic diseases rendered high risks for asthma (RR 10.6 (6.71-16.7)) and rhinitis (RR 36.3 (18.9-69.7). Individuals sensitized ≤8 year showed significantly highest level of sensitization, as judged by number of positive skin tests and titers of specific IgE. CONCLUSION The majority of individuals with sensitization ≤8 years developed asthma or rhinitis before young adulthood. The high level of sensitization in early sensitized contribute to the high incidence of allergic airway conditions.
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Affiliation(s)
- Joakim Bunne
- Department of Public Health and Clinical Medicine, Division of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden
| | - Linnea Hedman
- Department of Public Health and Clinical Medicine, Division of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden
| | - Matthew Perzanowski
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Anders Bjerg
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anna Winberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Sweden
| | - Martin Andersson
- Department of Public Health and Clinical Medicine, Division of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Platts-Mills
- Division of Allergy & Clinical Immunology, University of Virginia, Charlottesville, VA, USA
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Division of Sustainable Health, the OLIN unit, Umeå University, Umeå, Sweden.
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14
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Lee JY, Lee J, Huh DA, Moon KW. Association between environmental exposure to phthalates and allergic disorders in Korean children: Korean National Environmental Health Survey (KoNEHS) 2015-2017. Int J Hyg Environ Health 2021; 238:113857. [PMID: 34644676 DOI: 10.1016/j.ijheh.2021.113857] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/12/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Phthalates are common industrial chemicals that are used as plasticizers in plastics, personal care products, and building materials. Although these chemicals have been suspected as risk factors for allergic outcomes among children, inconsistent associations between environmental exposure to phthalates and allergic disorders have been found across different populations. Therefore, this study aimed to assess whether environmental phthalate exposure was associated with parent-reported current allergic symptoms (atopic dermatitis, AD; asthma; and allergic rhinitis, AR) and the index of allergic response (levels of serum total immunoglobulin E, IgE) in a nationally representative sample of children. METHODS In this study, children aged 3-17 years (n = 2208) were recruited from the Korean National Environmental Health Survey (KoNEHS) 2015-2017 to conduct an analysis of their current allergic symptoms. Among this number of children, the total IgE analysis included 806 participants because total IgE levels were only measured in children aged 12-17 years. RESULTS After adjusting for all covariates, mono-benzyl phthalate (MBzP) [OR (95% CI) = 1.15 (1.01, 1.30)], mono-(carboxyoctyl) phthalate (MCOP) [OR (95% CI) = 1.35 (1.02, 1.78)], and the sum of di-(2-ethylhexyl) phthalate metabolites (∑DEHP) [OR (95% CI) = 1.39 (1.09, 1.79)] were associated with increased odds of current AD. MCOP [OR (95% CI) = 1.19 (1.01, 1.40)], mono-(carboxynonyl) phthalate (MCNP) [OR (95% CI) = 1.24 (1.05, 1.45)], and ∑DEHP [OR (95% CI) = 1.22 (1.02, 1.44)] were also associated with increased odds of current AR. Individual DEHP metabolites showed similar associations with current AD and AR. In addition, MCNP was positively related to IgE levels [β (95% CI) = 0.26 (0.12, 0.40)]. MBzP [OR (95% CI) = 1.17 (1.01, 1.35)], MCOP [OR (95% CI) = 1.62 (1.12, 2.32)], and mono-(2-ethyl-5-oxohexyl) phthalate (MEOHP) [OR (95% CI) = 1.36 (1.06, 1.76)] showed positive relationships with allergic multimorbidity. Moreover, higher concentrations of MCNP were related to increased odds of experiencing both current AR and total IgE levels [OR (95% CI) = 1.98 (1.29, 3.04)], and children with elevated IgE levels (>100IU/mL) were more likely to have current AR associated with MCNP than those without elevated IgE levels (p = 0.007). Specifically, the relationship between MCNP and current AR was significantly mediated through alterations in IgE levels (14.7%), and MCNP also showed the positive association with current AR, independent of IgE (85.3%). CONCLUSION These results suggest that environmental exposure to phthalates may affect the immune system and increase the occurrence of allergic symptoms in children.
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Affiliation(s)
- Ju-Yeon Lee
- Department of Health and Safety Convergence Science, Korea University, Seoul, Republic of Korea; BK21 FOUR R&E Center for Learning Health System, Korea University, Seoul, Republic of Korea
| | - Jiyun Lee
- Department of Health and Safety Convergence Science, Korea University, Seoul, Republic of Korea; BK21 FOUR R&E Center for Learning Health System, Korea University, Seoul, Republic of Korea
| | - Da-An Huh
- Institute of Health Sciences, Korea University, Seoul, Republic of Korea
| | - Kyong Whan Moon
- BK21 FOUR R&E Center for Learning Health System, Korea University, Seoul, Republic of Korea; Department of Health and Environmental Science, Korea University, Seoul, Republic of Korea.
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15
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Agache I, Palmer E, Sanver D, Kirtland M, Shamji MH. Molecular allergology approach to allergic asthma. Mol Aspects Med 2021; 85:101027. [PMID: 34579961 DOI: 10.1016/j.mam.2021.101027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 07/26/2021] [Accepted: 09/15/2021] [Indexed: 12/25/2022]
Abstract
Allergic asthma is a frequently encountered and well described asthma phenotype. However, its precise mechanisms are less known. The tools for targeted selection of patients for an optimal response to intervention (prevention or treatment) are also lacking. Here we explore the potential of the molecular allergology approach to achieve a better understanding of allergic asthma mechanisms, a precise diagnosis and an optimal management of these patients.
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania.
| | - Elizabeth Palmer
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, London, UK
| | - Didem Sanver
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, London, UK; Necmettin Erbakan University, Engineering & Architecture Faculty, Department of Food Engineering, Konya, Turkey
| | - Max Kirtland
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, London, UK
| | - Mohamed H Shamji
- Imperial College, Faculty of Medicine, National Heart & Lung Institute, London, UK
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16
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Sigurdardottir ST, Jonasson K, Clausen M, Lilja Bjornsdottir K, Sigurdardottir SE, Roberts G, Grimshaw K, Papadopoulos NG, Xepapadaki P, Fiandor A, Quirce S, Sprikkelman AB, Hulshof L, Kowalski ML, Kurowski M, Dubakiene R, Rudzeviciene O, Bellach J, Yürek S, Reich A, Erhard SM, Couch P, Rivas MF, van Ree R, Mills C, Grabenhenrich L, Beyer K, Keil T. Prevalence and early-life risk factors of school-age allergic multimorbidity: The EuroPrevall-iFAAM birth cohort. Allergy 2021; 76:2855-2865. [PMID: 33934363 PMCID: PMC8453757 DOI: 10.1111/all.14857] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/04/2021] [Accepted: 02/22/2021] [Indexed: 01/01/2023]
Abstract
Background Coexistence of childhood asthma, eczema and allergic rhinitis is higher than can be expected by chance, suggesting a common mechanism. Data on allergic multimorbidity from a pan‐European, population‐based birth cohort study have been lacking. This study compares the prevalence and early‐life risk factors of these diseases in European primary school children. Methods In the prospective multicentre observational EuroPrevall‐iFAAM birth cohort study, we used standardized questionnaires on sociodemographics, medical history, parental allergies and lifestyle, and environmental exposures at birth, 12 and 24 months. At primary school age, parents answered ISAAC‐based questions on current asthma, rhinitis and eczema. Allergic multimorbidity was defined as the coexistence of at least two of these. Results From 10,563 children recruited at birth in 8 study centres, we included data from 5,572 children (mean age 8.2 years; 51.8% boys). Prevalence estimates were as follows: asthma, 8.1%; allergic rhinitis, 13.3%; and eczema, 12.0%. Allergic multimorbidity was seen in 7.0% of the whole cohort, ranging from 1.2% (Athens, Greece) to 10.9% (Madrid, Spain). Risk factors for allergic multimorbidity, identified with AICc, included family‐allergy‐score, odds ratio (OR) 1.50 (95% CI 1.32–1.70) per standard deviation; early‐life allergy symptoms, OR 2.72 (2.34–3.16) for each symptom; and caesarean birth, OR 1.35 (1.04–1.76). Female gender, OR 0.72 (0.58–0.90); older siblings, OR 0.79 (0.63–0.99); and day care, OR 0.81 (0.63–1.06) were protective factors. Conclusion Allergic multimorbidity should be regarded as an important chronic childhood disease in Europe. Some of the associated early‐life factors are modifiable and may be considered for prevention strategies.
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Affiliation(s)
- Sigurveig T. Sigurdardottir
- Landspitali University Hospital Reykjavik Iceland
- Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Kristjan Jonasson
- Department of Computer Science University of Iceland Reykjavík Iceland
| | - Michael Clausen
- Children's Hospital Reykjavik Reykjavik Iceland
- Department of Allergy Landspitali University Hospital Reykjavik Iceland
| | | | | | - Graham Roberts
- Human Development and Health & Clinical and Experimental Sciences Faculty of Medicine University of Southampton UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
| | - Kate Grimshaw
- Dietetic Department Salford Royal NHS Foundation Trust UK
- Clinical and Experimental Sciences Faculty of Medicine University of Southampton UK
- Division of Infection, Immunity and Respiratory Medicine School of Biological Sciences Manchester Institute of Biotechnology University of Manchester Manchester UK
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection, Immunity & Respiratory Medicine University of Manchester Manchester UK
| | - Paraskevi Xepapadaki
- Allergy Department 2nd Pediatric Clinic National and Kapodistrian University of Athens Athens Greece
| | - Ana Fiandor
- Department of Allergy La Paz University Hospital IdiPAZ Madrid Spain
| | - Santiago Quirce
- Department of Allergy La Paz University Hospital IdiPAZ Madrid Spain
| | - Aline B. Sprikkelman
- Department of Pediatric Pulmonology and Pediatric Allergology University Medical Center Groningen University of Groningen The Netherlands
| | - Lies Hulshof
- Department of Pediatric Pulmonology and Pediatric Allergology Emma Children's Hospital Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Marek L. Kowalski
- Department of Immunology, Allergy and Rheumatology Medical University of Lodz Lodz Poland
| | - Marcin Kurowski
- Department of Immunology, Allergy and Rheumatology Medical University of Lodz Lodz Poland
| | - Ruta Dubakiene
- Medical Faculty Clinic of Chest Diseases, Allergology and Immunology Vilnius University Vilnius Lithuania
| | - Odilija Rudzeviciene
- Faculty of Medicine Clinic of Children’s Diseases Vilnius University Vilnius Lithuania
| | - Johanna Bellach
- Department of Paediatric Pneumology and Immunology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Songül Yürek
- Department of Paediatric Pneumology and Immunology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Andreas Reich
- Epidemiology Unit German Rheumatism Research Centre Berlin Germany
| | - Sina Maria Erhard
- Institute of Social Medicine, Epidemiology and Health Economics Charité – Universitätsmedizin Berlin Berlin Germany
| | - Philip Couch
- Centre for Health Informatics School of Health Sciences The University of Manchester Manchester UK
| | | | - Ronald van Ree
- Departments of Experimental Immunology and of Otorhinolaryngology Amsterdam University Medical Centers Amsterdam The Netherlands
| | - Clare Mills
- Institute of Inflammation and Repair University of Manchester Manchester UK
| | - Linus Grabenhenrich
- Department for Infectious Disease Epidemiology Robert Koch‐Institut Berlin Germany
| | - Kirsten Beyer
- Department of Paediatric Pneumology and Immunology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics Charité – Universitätsmedizin Berlin Berlin Germany
- Institute of Clinical Epidemiology and Biometry University of Würzburg Würzburg Germany
- State Institute of Health Bavarian Health and Food Safety Authority Bad Kissingen Germany
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17
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Wu CY, Huang HY, Pan WC, Liao SL, Hua MC, Tsai MH, Lai SH, Yeh KW, Chen LC, Huang JL, Yao TC. Allergic diseases attributable to atopy in a population sample of Asian children. Sci Rep 2021; 11:16052. [PMID: 34362983 PMCID: PMC8346539 DOI: 10.1038/s41598-021-95579-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022] Open
Abstract
The proportion of allergic diseases attributable to atopy remains a subject of controversy. This study aimed to estimate the population risk of physician-diagnosed asthma, rhinitis and eczema attributed to atopy among a population sample of Asian school-age children. Asian children aged 5–18 years (n = 1321) in the Prediction of Allergies in Taiwanese CHildren (PATCH) study were tested for serum allergen-specific immunoglobulin E. Physician-diagnosed asthma, rhinitis and eczema were assessed by a modified International Study of Asthma and Allergies in Childhood questionnaire. Atopy was defined as the presence of serum allergen-specific immunoglobulin E. In this population-based study, 50.4% of the subjects with asthma, 46.3% with rhinitis, and 46.7% with eczema were attributable to atopy. The population attributable risk (PAR) of atopy for three allergic diseases was higher in adolescents (asthma, 54.4%; rhinitis, 59.6%; eczema, 49.5%) than younger children aged less than 10 years (asthma, 46.9%; rhinitis, 39.5%; eczema, 41.9%). Among the seven allergen categories, sensitization to mites had the highest PARs for all three allergic diseases (51.3 to 64.1%), followed by sensitization to foods (asthma, 7.1%; rhinitis, 10.4%; eczema 27.7%). In conclusion, approximately half (46.3 to 50.4%) of Asian children in Taiwan with allergic diseases are attributable to atopy.
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Affiliation(s)
- Chao-Yi Wu
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Yi Huang
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan, Taiwan
| | - Wen-Chi Pan
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Sui-Ling Liao
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan
| | - Man-Chin Hua
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan
| | - Ming-Han Tsai
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan.,Department of Pediatrics, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan
| | - Shen-Hao Lai
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan.,Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuo-Wei Yeh
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan, Taiwan.,School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan
| | - Li-Chen Chen
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Community Medicine Research Center, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan.,Department of Pediatrics, New Taipei Municipal TuCheng Hospital, 6 Sec. 2 Jinchen Road, Tucheng District, New Taipei, Taiwan
| | - Jing-Long Huang
- School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Community Medicine Research Center, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan. .,Department of Pediatrics, New Taipei Municipal TuCheng Hospital, 6 Sec. 2 Jinchen Road, Tucheng District, New Taipei, Taiwan.
| | - Tsung-Chieh Yao
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan, Taiwan. .,School of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan. .,Community Medicine Research Center, Chang Gung Memorial Hospital At Keelung, Keelung, Taiwan.
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18
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Jung M, Kim MJ, Kim S, Kyung Y, Kim M, Lee JY, Jeong HI, Lee BR, Kim J, Ahn K, Park YM. Effect of prenatal phthalate exposure on childhood atopic dermatitis: A systematic review and meta-analysis. Allergy Asthma Proc 2021; 42:e116-e125. [PMID: 34187630 DOI: 10.2500/aap.2021.42.210036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: The association between prenatal exposure to phthalate and childhood atopic dermatitis (AD) has previously been investigated; however, the results are inconsistent. Objective: We aimed to perform a systematic review and meta-analysis of birth cohort studies to investigate whether prenatal exposure to phthalate increases the risk of developing AD in children. Methods: We performed an electronic search of medical literature data bases. Studies were critically appraised, and a meta-analysis was performed. Results: Among 129 articles identified, 11 studies met the eligibility criteria. Included studies originated from Europe (n = 5), the United States (n = 4), and Asia (n = 2). The study sample size ranged from 147 to 1024 mother-child pairs. Quality assessment by using the Newcastle-Ottawa scale of all the studies had scores of ≥6. A meta-analysis of data from eight selected studies suggested that monobenzyl phthalate (MBzP) exposure was significantly associated with the risk of AD development (odds ratio 1.16 [95% confidence interval, 1.04-1.31]; I² = 17.36%). However, AD development was not associated with other phthalate metabolites, such as mono-(2-ethylhexyl) phthalate, monoethyl phthalate, mono-isobutyl phthalate, mono-n-butyl phthalate, and the sum of di-[2-ethylhexyl] phthalate on the development of AD (all p values were > 0.05). Conclusion: Our meta-analysis suggested that prenatal exposure to phthalates may be associated with the development of childhood AD. However, further research is needed because only MBzP showed statistical significance and the number of articles in the literature is still insufficient.
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Affiliation(s)
- Minyoung Jung
- From the Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Republic of Korea
| | - Min-Ji Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Seonwoo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Yechan Kyung
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Minji Kim
- Department of Pediatrics, Chungnam National University College of Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Ji Young Lee
- Department of Pediatrics, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - Hye-In Jeong
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Bo Ra Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Mean Park
- Department of Pediatrics, Konkuk University Medical Center, Seoul, Republic of Korea
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19
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Abstract
PURPOSE OF REVIEW Asthma is the most common chronic disease in pediatric age. Childhood-onset asthma, as opposed to adult-onset asthma, is typically characterized by a personal and often a family history of atopy and related markers of type 2-mediated inflammation. However, the interplay between atopy and asthma development is more complex than a linear dose-response relationship. RECENT FINDINGS Family and personal history of atopic diseases have been confirmed as major risk factors for asthma occurrence and persistence in children. Early life and multiple sensitizations to aeroallergens significantly increase the risk of asthma development in school age. Early life lower respiratory tract viral infections, especially caused by rhinovirus, also increase the susceptibility to atopic asthma in childhood. Human rhinovirus type C receptor CDHR3 polymorphisms have been shown to affect receptor epithelial expression, activation, and asthma development and exacerbation severity in children. Atopic sensitization and respiratory viral infections can synergistically enhance the susceptibility to asthma through multiple mechanisms, including the IgE-mediated inhibition of innate antiviral responses to rhinovirus. Emerging evidence shows that several nonatopic factors are also involved in the asthma pathogenesis in genetically predisposed individuals, including early life exposure to environmental factors, and lung and gut microbiome composition. SUMMARY The current review outlines recent data on the complex role of atopy in asthma pathogenesis and persistence, and addresses new research topics such as the role of epigenetics and the lung microbiome.
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20
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Papadopoulos NG, Aggelides X, Stamataki S, Prokopakis E, Katotomichelakis M, Xepapadaki P. New concepts in pediatric rhinitis. Pediatr Allergy Immunol 2021; 32:635-646. [PMID: 33475171 DOI: 10.1111/pai.13454] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/15/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022]
Abstract
Rhinitis-and especially allergic rhinitis (AR)-remains the most frequent hypersensitivity condition, affecting up to a quarter of the population and impacting the quality of life of individual patients and the health economy. Data, especially with respect to underlying pathophysiologic mechanisms, mainly derive from studies on adults and are subsequently extrapolated to the pediatric population. Therapeutic algorithms for children with rhinitis are long based on the same principles as in adults. We explore and describe novel aspects of rhinitis, ranging from mechanisms to disease classification, phenotypes, diagnostic and monitoring tools, and the use of treatments, with a focus on the traits of pediatric age groups.
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Affiliation(s)
- Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece.,Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
| | - Xenophon Aggelides
- Allergy Unit, 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Athens, Greece
| | - Sofia Stamataki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, University of Crete, School of Medicine, Heraklion, Greece
| | | | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
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21
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Chen S, Gu W, Wu M, Hao C, Zhu C, Shao X, Wang Y. Risk factors for recurrent wheezing after bronchiolitis in infants: 2-year follow up in China. BMC Infect Dis 2021; 21:250. [PMID: 33691633 PMCID: PMC7945297 DOI: 10.1186/s12879-021-05937-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 02/25/2021] [Indexed: 12/02/2022] Open
Abstract
Background Infants with bronchiolitis have an increased risk of developing recurrent wheezing and asthma. However, the risk factors for the development of recurrent wheezing after bronchiolitis remains controversial. Our study was to investigate risk factors of post-bronchiolitis recurrent wheezing. Methods Infants with bronchiolitis were enrolled from November 2016 through March 2017. Nasopharyngeal aspirates were obtained for detection of respiratory viruses which were analyzed by reverse transcriptase polymerase chain reaction (RT-PCR) and direct immunofluorescent assay. Serum cytokines including TSLP, IL2, IL13, TIMP-1, MMP-9, IL33, IL5, IL4, IL25, TNF- α and MIP-1α were measured by flow cytometry. Patients were followed up every 3 months for a duration of 2 years by telephone or at outpatient appointments. Results We enrolled 89 infants, of which 81 patients were successfully followed up. In total, 22.2% of patients experienced recurrent wheezing episodes. The proportion of patients with history of eczema, systemic glucocorticoid use and patients with moderate-to-severe disease were significantly higher in the recurrent wheezing group than the non-recurrent wheezing group (83.3% vs 52.4%; 66.7% vs 36.5%; 61.1% vs 33.3%, respectively, all P < 0.05); There were no significant differences between patients with and without recurrent wheezing episodes in the levels of TSLP, IL2, IL13, TIMP-1, MMP-9, IL33, IL5, IL4, IL25, TNF- α and MIP-1α (P > 0.05). Logistic regression analysis showed that history of eczema was an independent risk factor for post-bronchiolitis recurrent wheezing (odds ratio [OR] = 5.622; 95% confidence interval [CI], 1.3–24.9; P = 0.023). Conclusion The incidence of recurrent wheezing among infants after contracting bronchiolitis was 22.2% during a 2-year follow-up. History of eczema was the only independent risk factor identified and no correlation was found between the specific virus and disease severity in children with post-bronchiolitis recurrent wheezing.
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Affiliation(s)
- Sainan Chen
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Jingde Road No. 303, Suzhou, 215003, China
| | - Wenjing Gu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Jingde Road No. 303, Suzhou, 215003, China
| | - Min Wu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Jingde Road No. 303, Suzhou, 215003, China
| | - Chuangli Hao
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Jingde Road No. 303, Suzhou, 215003, China
| | - Canhong Zhu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Jingde Road No. 303, Suzhou, 215003, China
| | - Xuejun Shao
- Department of Laboratory Medicine, Department of Clinical laboratory, Children's Hospital of Soochow University, Jingde Road No. 303, Suzhou, 215003, China
| | - Yuqing Wang
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Jingde Road No. 303, Suzhou, 215003, China.
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22
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Nachshon L, Schwartz N, Goldberg MR, Schon Y, Cheryomukhin M, Katz Y, Elizur A. Characteristics and associated morbidities of young adults with misconceived food allergy: A cross-sectional study. EClinicalMedicine 2021; 33:100766. [PMID: 33718851 PMCID: PMC7933257 DOI: 10.1016/j.eclinm.2021.100766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Many patients with self-reported food allergy are not allergic but suffer from similar burdens. We aimed to characterize young adults with misconceived food allergy. METHODS A cross-sectional study of individuals (n = 12,592) aged 17-18 years, recruited to the Israel Defense Forces (IDF) at a single urban-area recruitment center over a six month-period. All participants underwent a comprehensive medical and psychological evaluation. Cognitive tests were performed and a Combined Intellectual-Education score assigned. Participants who reported food elimination due to allergy were skin-tested and underwent oral food challenges, when indicated. The characteristics, psychological evaluation and cognitive tests of individuals with no reported food allergy (n = 12,444), misconceived food allergy (n = 64) and true food allergy (n = 84) were compared. FINDINGS The prevalence of atopic co-morbidities was higher in recruits reporting compared to those not reporting food allergy while the rate of other co-morbidities was comparable. Anxiety disorder was diagnosed significantly more in individuals who reported food allergy (4·1%) compared to those who did not (1·7%) (p = 0·04). Further analysis revealed that this diagnosis was concentrated in individuals with misconceived (8/64, 12·5%) compared to true food allergy (2/84, 2·4%), (p = 0·02). Patients with misconceived food allergy were mostly of female sex, had lower Combined Intellectual-Education scores compared to patients with true (p = 0·001) and no reported food allergy (p = 0·01), and required the longest mean evaluation time (147·6 ± 109·4 days). INTERPRETATION Patients with misconceived food allergy have higher rates of anxiety disorder and are often from a lower educational level and of female sex. Medical and educational attention is required to improve care of this specific population. FUNDING The research reported in this publication was supported by the Israel Defense Forces (IDF) Medical Corps and Directorate of Defense Research & Development, Israeli Ministry of Defense (IMOD DDR&D).
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Affiliation(s)
- Liat Nachshon
- Allergy clinic, Israel Defense Forces Medical Corps, Israel
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
- Department of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Corresponding author.
| | | | - Michael R Goldberg
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | | | | | - Yitzhak Katz
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Arnon Elizur
- Institute of Allergy, Immunology and Pediatric Pulmonology, Shamir Medical Center, Zerifin, Israel
- Department of Pediatrics, Sackler Faculty of Medicine, Tel Aviv University, Israel
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23
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Ödling M, Wang G, Andersson N, Hallberg J, Janson C, Bergström A, Melén E, Kull I. Characterization of Asthma Trajectories from Infancy to Young Adulthood. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2368-2376.e3. [PMID: 33607340 DOI: 10.1016/j.jaip.2021.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Development of asthma is complicated by the multidimensional nature of the disease. OBJECTIVE To identify and characterize trajectories of asthma from infancy to young adulthood, and their associations with lung function and inflammatory and respiratory markers in adolescence and young adulthood. METHODS A latent class analysis was performed in a population-based cohort (N = 4089). Parental and self-reported symptoms of asthma were used to investigate asthma development. We characterized background factors, allergic comorbidity, and IgE sensitization and investigated associations with asthma markers. RESULTS A 4-class solution of asthma trajectories was identified: never/infrequent (n = 3291 [80.4%]), early-onset transient (n = 307 [7.5%]), adolescent-onset (n = 261 [6.4%]), and persistent asthma (n = 230 [5.6%]). Uncontrolled asthma was equally prevalent in the adolescent-onset and persistent asthma trajectory groups, at both age 16 (41.7% vs 42.4%; P = .90) and 24 years (53.7% vs 52.4%; P = .81). The persistent asthma trajectory group had a higher proportion of eosinophil counts greater than or equal to 0.3 (109 cells/L) at age 24 years compared with the adolescent-onset trajectory group (31.0% vs 18.5%; P < .01). CONCLUSIONS The adolescent-onset and persistent asthma trajectory groups had equal burdens of asthma control in adolescence and young adulthood. However, the persistent asthma trajectory group showed more signs of type 2 inflammation than the adolescent-onset trajectory group. This unbiased approach highlights the need of identifying patients with adolescent asthma to optimize care, because they suffer the same lack of asthma control as those with persistent asthma.
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Affiliation(s)
- Maria Ödling
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
| | - Gang Wang
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Sichuan, China; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jenny Hallberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Stockholm, Sweden
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24
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Ballardini N, Bergström A, Kull I, Almqvist C, Andersson N, Asarnoj A, Borres MP, Georgellis A, Pershagen G, Westman M, van Hage M, Melén E. Resolved allergen-specific IgE sensitization among females and early poly-sensitization among males impact IgE sensitization up to age 24 years. Clin Exp Allergy 2021; 51:849-852. [PMID: 33548093 DOI: 10.1111/cea.13846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Natalia Ballardini
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Catarina Almqvist
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Asarnoj
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Magnus P Borres
- Department of Women's and Children's Health, Uppsala University and Thermo Fisher Scientific, Uppsala, Sweden
| | - Antonis Georgellis
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm, Sweden
| | - Marit Westman
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Marianne van Hage
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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25
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Tomazic PV, Lang-Loidolt D. Current and emerging pharmacotherapy for pediatric allergic rhinitis. Expert Opin Pharmacother 2020; 22:849-855. [PMID: 32808819 DOI: 10.1080/14656566.2020.1808622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Allergic rhinitis (AR) is a global health problem in adults as well as the younger population, continuously increasing and posing a significant problem for patients, health care systems and economies. For the younger population, some aspects differ from treatment of adults, namely, prevention, compliance and adherence. AREAS COVERED This narrative review summarizes all the pharmacotherapeutic options with special focus on the pediatric population. Moreover, it elucidates prevention strategies as well as future developments of AR treatment. Currently, symptomatic therapy in the form of steroids and antihistamines is applied topically and systemically where steroids need to be administered with caution and for a very short term. The only disease-modifying and causal treatment is allergen immunotherapy administered sublingually and subcutaneously. Future and current novel therapeutic options are human monoclonal antibodies. EXPERT OPINION The greatest potential for future developments currently lie in allergen immunotherapy and here in different routes of administration and modification of (recombinant) allergens as well as immune-modulating adjuvants and nanoparticles. Secondly, monoclonal antibodies are promising molecules blocking and/or interfering with up- and downstream immune mechanisms. Another important aspect lies in prevention of allergic sensitization and disease progression through both AIT and biologics which is particularly true for the pediatric population.
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Affiliation(s)
- Peter Valentin Tomazic
- Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
| | - Doris Lang-Loidolt
- Department of General Otorhinolaryngology, Head and Neck Surgery, Medical University of Graz, Graz, Austria
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Khumalo J, Kirstein F, Scibiorek M, Hadebe S, Brombacher F. Therapeutic and prophylactic deletion of IL-4Ra-signaling ameliorates established ovalbumin induced allergic asthma. Allergy 2020; 75:1347-1360. [PMID: 31782803 PMCID: PMC7318634 DOI: 10.1111/all.14137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 10/12/2019] [Accepted: 11/07/2019] [Indexed: 12/14/2022]
Abstract
Background Allergic asthma is a chronic inflammatory airway disease driven predominantly by a TH2 immune response to environmental allergens. IL‐4Rα‐signaling is essential for driving TH2‐type immunity to allergens. Anti‐TH2 therapies have the potential to effectively reduce airway obstruction and inflammation in allergic asthma. Objective We investigated potential therapeutic effects of selective inhibition of this pathway in mice with established allergic airway disease. We further investigated whether IL‐4Rα disruption in systemically sensitized mice can prevent the onset of the disease. Methods We used RosacreERT2IL‐4Rα−/lox mice, a tamoxifen (TAM)‐inducible IL‐4Rα knockdown model to investigate the role of IL‐4/IL‐13 signaling prior to the onset of the disease and during the effector phase in the ovalbumin‐induced allergic airway disease. Results Inducible deletion of IL‐4Rα demonstrated therapeutic effects, on established allergic airway disease, and prevented the development of ovalbumin‐induced airway hyperreactivity, eosinophilia, and goblet cell metaplasia in allergen‐sensitized mice. Interestingly, IL‐4Rα knockdown after allergic sensitization did not induce TH17, a neutrophilic inflammatory response as observed in global IL‐4Rα‐deficient mice after intranasal allergen challenge. Conclusion Abrogation of IL‐4Rα signaling after allergic sensitization would have significant therapeutic benefit for TH2‐type allergic asthma.
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Affiliation(s)
- Jermaine Khumalo
- Division of Immunology, and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases Department of Pathology Faculty of Health Sciences University of Cape Town Cape Town South Africa
- Division of Immunology Health Science Faculty International Centre for Genetic Engineering and Biotechnology (ICGEB) and Institute of Infectious Diseases and Molecular Medicine (IDM) University of Cape Town Cape Town South Africa
| | - Frank Kirstein
- Division of Immunology, and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases Department of Pathology Faculty of Health Sciences University of Cape Town Cape Town South Africa
| | - Martyna Scibiorek
- Division of Immunology, and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases Department of Pathology Faculty of Health Sciences University of Cape Town Cape Town South Africa
- Division of Immunology Health Science Faculty International Centre for Genetic Engineering and Biotechnology (ICGEB) and Institute of Infectious Diseases and Molecular Medicine (IDM) University of Cape Town Cape Town South Africa
| | - Sabelo Hadebe
- Division of Immunology, and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases Department of Pathology Faculty of Health Sciences University of Cape Town Cape Town South Africa
| | - Frank Brombacher
- Division of Immunology, and South African Medical Research Council (SAMRC) Immunology of Infectious Diseases Department of Pathology Faculty of Health Sciences University of Cape Town Cape Town South Africa
- Division of Immunology Health Science Faculty International Centre for Genetic Engineering and Biotechnology (ICGEB) and Institute of Infectious Diseases and Molecular Medicine (IDM) University of Cape Town Cape Town South Africa
- Faculty of Health Sciences Wellcome Centre for Infectious Diseases Research in Africa (CIDRI‐Africa)Institute of Infectious Diseases and Molecular Medicine (IDM)University of Cape Town Cape Town South Africa
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Melén E, Bergström A, Kull I, Almqvist C, Andersson N, Asarnoj A, Borres MP, Georgellis A, Pershagen G, Westman M, van Hage M, Ballardini N. Male sex is strongly associated with IgE-sensitization to airborne but not food allergens: results up to age 24 years from the BAMSE birth cohort. Clin Transl Allergy 2020; 10:15. [PMID: 32489587 PMCID: PMC7247167 DOI: 10.1186/s13601-020-00319-w] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 05/07/2020] [Indexed: 12/11/2022] Open
Abstract
Background Up to half of the population in high-income countries has allergen-specific IgE antibodies. However, data regarding sex differences of IgE-sensitization from childhood to adulthood is limited. Objective To explore IgE-sensitization to common foods and airborne allergens in relation to sex over time in a population-based cohort followed up to young adulthood. Methods The Swedish population-based birth cohort BAMSE includes 4089 subjects who have been followed regularly with questionnaires and clinical investigations. A recent 24-year follow-up included 3069 participants (75%). Sera collected at 4, 8, 16 and 24 years were analyzed for IgE-antibodies to 14 common foods and airborne allergens. Results At 24 years sensitization to foods had decreased compared to previous follow-ups affecting 8.4%, while sensitization to airborne allergens was more common, affecting 42.2%. Male sex was associated with IgE-sensitization to airborne allergens at all ages (overall OR: 1.68, 95% CI 1.46–1.94) while there was no statistically significant association between sex and sensitization to food allergens (overall OR: 1.10, 95% CI 0.93–1.32). Levels of allergen-specific IgE did not differ significantly between males and females for any of the tested foods or airborne allergens at any age, following adjustment for multiple comparisons. Conclusion IgE-sensitization to airborne allergens increases with age up to young adulthood, whereas sensitization to food allergens seems to level off. Male sex is strongly associated with IgE-sensitization to airborne allergens from early childhood up to young adulthood. In contrast, there is little evidence for associations between sex and IgE-sensitization to foods.
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Affiliation(s)
- Erik Melén
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
| | - Catarina Almqvist
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, 171 76 Stockholm, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17 77 Stockholm, Sweden
| | - Niklas Andersson
- Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Anna Asarnoj
- Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, 171 76 Stockholm, Sweden.,Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Magnus P Borres
- Department of Women's and Children's Health, Uppsala University and Thermo Fisher Scientific, Uppsala, Sweden
| | - Antonis Georgellis
- Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Göran Pershagen
- Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, 113 65 Stockholm, Sweden
| | - Marit Westman
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Marianne van Hage
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Natalia Ballardini
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, 11883 Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
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28
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Rada S, Strohmaier S, Drucker AM, Eliassen AH, Schernhammer ES. Night shift work surrounding pregnancy and offspring risk of atopic disease. PLoS One 2020; 15:e0231784. [PMID: 32298373 PMCID: PMC7161965 DOI: 10.1371/journal.pone.0231784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/31/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Night shift work surrounding pregnancy may contribute to the risk of developing atopic diseases in offspring due to alterations in the prenatal environment, from stress. OBJECTIVE To examine the association of maternal night shift work surrounding pregnancy and offspring risk of developing atopic diseases from childhood to adolescence. METHODS We examined the association between night shift work before and during pregnancy among 4,044 mothers in the Nurses' Health Study II (NHSII) and atopic dermatitis, asthma and hay fever risk in 4,813 of their offspring enrolled in the Growing Up Today Study (GUTS). Mothers reported whether GUTS participants had ever been diagnosed with atopic dermatitis, asthma or hay fever in the GUTS Mothers' questionnaire. Generalized estimating equation regression models were used to estimate multivariable adjusted odds ratios (OR) and 95% confidence intervals (CIs). RESULTS There were no significant associations between pre-conception maternal night shift work and risk of atopic dermatitis, asthma or hay fever in their offspring. Among 545 mothers with information on night shift work during pregnancy, shift work also was not associated with atopic dermatitis, asthma or hay fever in the offspring. Stratified analyses by history of parental atopy and maternal chronotype showed some statistically significant findings, but they were inconsistent and no significant interaction was seen with increasing duration of night shift work. CONCLUSION In this study, night shift work before and during pregnancy did not increase offspring risk of developing atopic dermatitis, asthma or hay fever.
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Affiliation(s)
- Samantha Rada
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Strohmaier
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Aaron M. Drucker
- Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Women’s College Research Institute, Women’s College Hospital, Toronto, Canada
| | - A. Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Eva S. Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
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29
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Moon HG, Kim SJ, Lee MK, Kang H, Choi HS, Harijith A, Ren J, Natarajan V, Christman JW, Ackerman SJ, Park GY. Colony-stimulating factor 1 and its receptor are new potential therapeutic targets for allergic asthma. Allergy 2020; 75:357-369. [PMID: 31385613 PMCID: PMC7002247 DOI: 10.1111/all.14011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/10/2019] [Accepted: 07/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND A new approach targeting aeroallergen sensing in the early events of mucosal immunity could have greater benefit. The CSF1-CSF1R pathway has a critical role in trafficking allergens to regional lymph nodes through activating dendritic cells. Intervention in this pathway could prevent allergen sensitization and subsequent Th2 allergic inflammation. OBJECTIVE To examine the therapeutic effectiveness of CSF1 and CSF1R inhibition for blocking the dendritic cell function of sensing aeroallergens. METHODS We adopted a model of chronic asthma induced by a panel of three naturally occurring allergens and novel delivery system of CSF1R inhibitor encapsulated nanoprobe. RESULTS Selective depletion of CSF1 in airway epithelial cells abolished the production of allergen-reactive IgE, resulting in prevention of new asthma development as well as reversal of established allergic lung inflammation. CDPL-GW nanoprobe containing GW2580, a selective CSF1R inhibitor, showed favorable pharmacokinetics for inhalational treatment and intranasal insufflation delivery of CDPL-GW nanoprobe ameliorated asthma pathologies including allergen-specific serum IgE production, allergic lung and airway inflammation and airway hyper-responsiveness (AHR) with minimal pulmonary adverse reaction. CONCLUSION The inhibition of the CSF1-CSF1R signaling pathway effectively suppresses sensitization to aeroallergens and consequent allergic lung inflammation in a murine model of chronic asthma. CSF1R inhibition is a promising new target for the treatment of allergic asthma.
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Affiliation(s)
- Hyung-Geun Moon
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Seung-jae Kim
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Myoung Kyu Lee
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Homan Kang
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hak Soo Choi
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anantha Harijith
- Department of Pediatrics, University of Illinois at Chicago, IL, USA
| | - Jinhong Ren
- Center for Biomolecular Science, College of Pharmacy, University of Illinois at Chicago, IL, USA
| | - Viswanathan Natarajan
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
- Department of Pharmacology, University of Illinois at Chicago, IL, USA
| | - John W. Christman
- Section of Pulmonary, Critical Care, and Sleep Medicine, the Ohio State University, Davis Heart and Lung Research Center, Columbus, Ohio, USA
| | - Steven J. Ackerman
- Department of Biochemistry and Molecular Genetics, and Medicine, University of Illinois at Chicago, IL, USA
| | - Gye Young Park
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
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30
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Testa D, DI Bari M, Nunziata M, Cristofaro GDE, Massaro G, Marcuccio G, Motta G. Allergic rhinitis and asthma assessment of risk factors in pediatric patients: A systematic review. Int J Pediatr Otorhinolaryngol 2020; 129:109759. [PMID: 31734564 DOI: 10.1016/j.ijporl.2019.109759] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/07/2019] [Accepted: 10/26/2019] [Indexed: 01/02/2023]
Abstract
Allergic rhinitis (AR) is the most prevalent allergic disease in children and can be associated with asthma (A); this association can have significant effect on child's quality of life. The objective of this work was to systematically review existing literature on the risk factors of AR and A in children to better understand the link between these two diseases. We performed a literature search over the last 25 years in PubMed and Medline. Inclusion criteria comprised English language papers containing original human data with greater than 30 subjects and papers that statistically analyze the relationship between AR and A and the risk factor(s), in children population. A statistically significant correlation was found between children with AR and A and ambient Polycyclic Aromatic Hydrocarbons exposure, live in an industrialized city with elevated traffic, dampness and moulds exposure, electric cooking, male gender, single nucleotide polymorphisms in PTNP22 gene and CTLA-4 gene, fast food and margarine products consumption, use of paracetamol in last year, history of tuberculosis, parental atopy, high total serum IgE, antibiotics in uterus and infections in uterus exposure, history of formula feeding and caesarian section. A strong and complex link between AR and A was accounted: A represents a major risk factor for the onset of AR, that correlates with more severe asthmatic symptoms. Even the onset of A in a child with AR worsen it. The interaction of genetic and environmental risk factors and the consequent epigenetic, microbiota and immunological changes, were found to led to the development of AR and A in children, with both atopic and non-atopic pathways. Close monitoring of evidenced risk factors may help with an early recognize and treat A in patients with AR.
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Affiliation(s)
- Domenico Testa
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Matteo DI Bari
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michele Nunziata
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Generoso DE Cristofaro
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Massaro
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppina Marcuccio
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Gaetano Motta
- Clinic of Otorhinolaryngology, Head and Neck Surgery Unit, Department of Anesthesiology, Surgical and Emergency Science, University of Campania "Luigi Vanvitelli", Naples, Italy
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31
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Won NH, Park SH, Ahn SH, Kim CB, Kwon JH, Seo WH, Song DJ, Yoo Y. Clinical characteristics of allergic rhinitis and nonallergic rhinitis in Korean children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Na Hae Won
- Department of Pediatrics, Korea University Medical College, Seoul, Korea
| | - Sang Hyun Park
- Department of Pediatrics, Korea University Medical College, Seoul, Korea
| | - So Hyun Ahn
- Allergy Immunology Center, Korea University, Seoul, Korea
| | - Chae Bong Kim
- Environmental Health Center, Korea University Anam Hospital, Seoul, Korea
| | - Jung Hyun Kwon
- Department of Pediatrics, Korea University Medical College, Seoul, Korea
| | - Won Hee Seo
- Department of Pediatrics, Korea University Medical College, Seoul, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University Medical College, Seoul, Korea
| | - Young Yoo
- Department of Pediatrics, Korea University Medical College, Seoul, Korea
- Allergy Immunology Center, Korea University, Seoul, Korea
- Environmental Health Center, Korea University Anam Hospital, Seoul, Korea
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32
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Ji H, Hu Y, Zhang T, Wang Y, Shen L, Wang S, Chen M, Wei M, Yu G. Allergic Comorbidity of Asthma or Wheezing, Allergic Rhinitis, and Eczema: Result From 333 029 Allergic Children in Shanghai, China. Am J Rhinol Allergy 2019; 34:189-195. [PMID: 31640394 DOI: 10.1177/1945892419883238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Heyu Ji
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Hu
- Center for Medical Bioinformatics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Zhang
- Department of Gastroenterology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yizhong Wang
- Department of Gastroenterology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Li Shen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu Wang
- Department of Information, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Min Chen
- Department of Information, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mingyue Wei
- Department of Information, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Guangjun Yu
- Center for Medical Bioinformatics, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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33
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Ödling M, Jonsson M, Janson C, Melén E, Bergström A, Kull I. Lost in the transition from pediatric to adult healthcare? Experiences of young adults with severe asthma. J Asthma 2019; 57:1119-1127. [PMID: 31328590 DOI: 10.1080/02770903.2019.1640726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: Asthma is a multifaceted disease, and severe asthma is likely to be persistent. Patients with severe asthma have the greatest burden and require more healthcare resources than those with mild-to-moderate asthma. The majority with asthma can be managed in primary care, while some patients with severe asthma warrant referral for expert advice regarding management. In adolescence, this involves a transition from pediatric to adult healthcare. This study aimed to explore how young adults with severe asthma experienced the transition process.Methods: Young adults with severe asthma were recruited from an ongoing Swedish population-based cohort. Qualitative data were obtained through individual interviews (n = 16, mean age 23.4 years), and the transcribed data were analyzed with systematic text condensation.Results: Four categories emerged based on the young adults' experiences: "I have to take responsibility", "A need of being involved", "Feeling left out of the system", and "Lack of engagement". The young adults felt they had to take more responsibility, did not know where to turn, and experienced fewer follow-ups in adult healthcare. Further, they wanted healthcare providers to involve them in self-management during adolescence, and in general, they felt that their asthma received insufficient support from healthcare providers.Conclusions: Based on how the young adults with severe asthma experienced the transition from pediatric to adult healthcare, it is suggested that healthcare providers together with each patient prepare, plan, and communicate in the transition process for continued care in line with transition guidelines.
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Affiliation(s)
- Maria Ödling
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Marina Jonsson
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Anna Bergström
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Stockholm, Sweden
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34
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Thøstesen LM, Kofoed PE. Allergic sensitization among Danish infants at 13 months of age. IMMUNITY INFLAMMATION AND DISEASE 2019; 7:183-190. [PMID: 31190476 PMCID: PMC6688077 DOI: 10.1002/iid3.260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/16/2019] [Indexed: 12/23/2022]
Abstract
Background Sensitization means elevated number of specific immunoglobulin E, either measured by skin prick test or in blood samples. Sensitization is associated with, but not synonymous with, allergic disease. Methods The Danish Calmette Study was conducted from 2012 to 2015 at three Danish hospitals, with the aim of exploring nonspecific effects of neonatal Bacillus Calmette‐Guérin vaccination. Participants at Kolding Hospital were invited to have a blood sample analyzed for allergic sensitization at 13 months of age. Telephone interviews gave information about allergic symptoms, and the children were examined for signs of atopic dermatitis at 3 and 13 months. Results Of the 1241 children included in the Danish Calmette Study in Kolding 1066 (86%) had a blood sample drawn, representing 36% of the invited families. The blood sample cohort had a relatively high percentage of atopic predisposition (66.6%) and most mothers had a medium or long education. We found 90 infants (8.4%) to be sensitized, with sensitization against food items (milk, egg, peanut, and hazelnut) being the most common. Atopic dermatitis was found in 19% of the children, and it was significantly associated with sensitization against egg, peanut, wheat, cat, and dog. Conclusion In a partly selected Danish cohort, sensitization was present in 8% at 13 months of age, especially sensitization against food items. Children with atopic dermatitis were significantly more sensitized (16.6%). However, most sensitized children did not have any allergic symptoms at this age.
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Affiliation(s)
- Lisbeth M Thøstesen
- Department of Pediatrics, Herning Hospital, Herning, Denmark.,CVIVA, Research Center for Vitamins and Vaccines, Statens Serum Institut, København, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Poul-Erik Kofoed
- CVIVA, Research Center for Vitamins and Vaccines, Statens Serum Institut, København, Denmark.,Department of Pediatrics, Kolding Hospital, Kolding, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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35
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Jiang Y, Gruzieva O, Wang T, Forno E, Boutaoui N, Sun T, Merid SK, Acosta-Pérez E, Kull I, Canino G, Antó JM, Bousquet J, Melén E, Chen W, Celedón JC. Transcriptomics of atopy and atopic asthma in white blood cells from children and adolescents. Eur Respir J 2019; 53:13993003.00102-2019. [PMID: 30923181 DOI: 10.1183/13993003.00102-2019] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/02/2019] [Indexed: 02/07/2023]
Abstract
Early allergic sensitisation (atopy) is the first step in the development of allergic diseases such as atopic asthma later in life. Genes and pathways associated with atopy and atopic asthma in children and adolescents have not been well characterised.A transcriptome-wide association study (TWAS) of atopy and atopic asthma in white blood cells (WBCs) or whole blood was conducted in a cohort of 460 Puerto Ricans aged 9-20 years (EVA-PR study) and in a cohort of 250 Swedish adolescents (BAMSE study). Pathway enrichment and network analyses were conducted to further assess top findings, and classification models of atopy and atopic asthma were built using expression levels for the top differentially expressed genes (DEGs).In a meta-analysis of the study cohorts, both previously implicated genes (e.g. IL5RA and IL1RL1) and genes not previously reported in TWASs (novel) were significantly associated with atopy and/or atopic asthma. Top novel genes for atopy included SIGLEC8 (p=8.07×10-13), SLC29A1 (p=7.07×10-12) and SMPD3 (p=1.48×10-11). Expression quantitative trait locus analyses identified multiple asthma-relevant genotype-expression pairs, such as rs2255888/ALOX15 Pathway enrichment analysis uncovered 16 significantly enriched pathways at adjusted p<0.01, including those relevant to T-helper cell type 1 (Th1) and Th2 immune responses. Classification models built using the top DEGs and a few demographic/parental history variables accurately differentiated subjects with atopic asthma from nonatopic control subjects (area under the curve 0.84).We have identified genes and pathways for atopy and atopic asthma in children and adolescents, using transcriptome-wide data from WBCs and whole blood samples.
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Affiliation(s)
- Yale Jiang
- Division of Pulmonary Medicine, Dept of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.,School of Medicine, Tsinghua University, Beijing, China.,These two authors contributed equally to this work
| | - Olena Gruzieva
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,These two authors contributed equally to this work
| | - Ting Wang
- Division of Pulmonary Medicine, Dept of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Erick Forno
- Division of Pulmonary Medicine, Dept of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Nadia Boutaoui
- Division of Pulmonary Medicine, Dept of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tao Sun
- Dept of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Simon K Merid
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Inger Kull
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Josep M Antó
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Jean Bousquet
- CESP, Inserm U1018, Villejuif, France.,University Hospital, Montpellier, France
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,These three authors are joint senior authors
| | - Wei Chen
- Division of Pulmonary Medicine, Dept of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.,These three authors are joint senior authors
| | - Juan C Celedón
- Division of Pulmonary Medicine, Dept of Pediatrics, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA .,These three authors are joint senior authors
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36
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Agache I, Lau S, Akdis CA, Smolinska S, Bonini M, Cavkaytar O, Flood B, Gajdanowicz P, Izuhara K, Kalayci O, Mosges R, Palomares O, Papadopoulos NG, Sokolowska M, Angier E, Fernandez‐Rivas M, Pajno G, Pfaar O, Roberts G, Ryan D, Sturm GJ, Ree R, Varga EM, Wijk RG, Yepes‐Nuñez J, Jutel M. EAACI Guidelines on Allergen Immunotherapy: House dust mite-driven allergic asthma. Allergy 2019; 74:855-873. [PMID: 31095767 DOI: 10.1111/all.13749] [Citation(s) in RCA: 163] [Impact Index Per Article: 32.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/12/2019] [Indexed: 12/14/2022]
Abstract
Allergen immunotherapy (AIT) has been in use for the treatment of allergic disease for more than 100 years. Asthma treatment relies mainly on corticosteroids and other controllers recommended to achieve and maintain asthma control, prevent exacerbations, and improve quality of life. AIT is underused in asthma, both in children and in adults. Notably, patients with allergic asthma not adequately controlled on pharmacotherapy (including biologics) represent an unmet health need. The European Academy of Allergy and Clinical Immunology has developed a clinical practice guideline providing evidence-based recommendations for the use of house dust mites (HDM) AIT as add-on treatment for HDM-driven allergic asthma. This guideline was developed by a multi-disciplinary working group using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. HDM AIT was separately evaluated by route of administration and children and adults: subcutaneous (SCIT) and sublingual AIT (SLIT), drops, and tablets. Recommendations were formulated for each. The important prerequisites for successful treatment with HDM AIT are (a) selection of patients most likely to respond to AIT and (b) use of allergen extracts and desensitization protocols of proven efficacy. To date, only AIT with HDM SLIT-tablet has demonstrated a robust effect in adults for critical end points (exacerbations, asthma control, and safety). Thus, it is recommended as an add-on to regular asthma therapy for adults with controlled or partially controlled HDM-driven allergic asthma (conditional recommendation, moderate-quality evidence). HDM SCIT is recommended for adults and children, and SLIT drops are recommended for children with controlled HDM-driven allergic asthma as the add-on to regular asthma therapy to decrease symptoms and medication needs (conditional recommendation, low-quality evidence).
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Affiliation(s)
- Ioana Agache
- Faculty of Medicine Department of Allergy and Clinical Immunology Transylvania University Brasov Brasov Romania
| | - Susanne Lau
- Department for Pediatric Pneumology, Immunology and Intensive Care Charité Universität Medizin Berlin Germany
| | - Cezmi A. Akdis
- University of Zürich Swiss Institute of Allergy and Asthma Research (SIAF) Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - Sylwia Smolinska
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- “ALL‐MED” Medical Research Institute Wroclaw Poland
| | - Matteo Bonini
- National Heart and Lung Institute (NHLI) Royal Brompton Hospital & Imperial College London UK
| | - Ozlem Cavkaytar
- Faculty of Medicine Department of Pediatric Allergy Istanbul Medeniyet University Goztepe Training and Research Hospital Istanbul Turkey
| | - Breda Flood
- European Federation of Allergy and Airways Diseases, Patients Association Brussels Belgium
| | - Pawe Gajdanowicz
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
| | | | - Omer Kalayci
- Hacettepe University School of Medicine Ankara Turkey
| | - Ralph Mosges
- Universität zu Koln Institute of Medical Statistics, Informatics and Epidemiology (IMSIE) Koln Germany
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology Complutense University of Madrid Madrid Spain
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity and respiratory medicine University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic University of Athens Athens Greece
| | - Milena Sokolowska
- University of Zürich Swiss Institute of Allergy and Asthma Research (SIAF) Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | | | | | - Giovanni Pajno
- Allergy Unit Department of Pediatrics University of Messina Messina Italy
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Graham C. Roberts
- The David Hide Asthma and Allergy Research Centre St Mary's Hospital Newport Isle of Wight UK
- NIHR Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
- Faculty of Medicine University of Southampton Southampton UK
| | - Dermot Ryan
- Usher Institute of Population Health Sciences and Informatics University of Edinburgh Edinburgh UK
- Asthma UK Centre for Applied Research The University of Edinburgh Edinburgh UK
| | - Gunter J. Sturm
- Department of Dermatology and Venerology Medical University of Graz Graz Austria
- Outpatient Allergy Clinic Reumannplaz Vienna Austria
| | - Ronald Ree
- Department of Experimental Immunology Academic Medical Center University of Amsterdam Amsterdam The Netherlands
- Department of Otorhinolaryngology Academic Medical Center University of Amsterdam Amsterdam The Netherlands
| | - Eva M. Varga
- Department of Pediatric and Adolescent Medicine Respiratory and Allergic Disease Division Medical University of Graz Graz Austria
| | - Roy Gerth Wijk
- Section of Allergology Department of Internal Medicine Erasmus Medical Center Rotterdam The Netherlands
| | | | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- “ALL‐MED” Medical Research Institute Wroclaw Poland
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Wu JH, Jerng JS, Su CC. Insidious-onset, non-wheezing carteolol-induced asthma in an atopic patient without asthma history. BMJ Case Rep 2019; 12:12/4/e229343. [PMID: 30948417 DOI: 10.1136/bcr-2019-229343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Carteolol, a non-selective beta-antagonist with a potential risk of severe bronchial constriction in patients with asthma, is one of the most commonly prescribed medication for managing ocular pressure in glaucoma. We present a case of a 24-year-old woman with a history of atopy but no known asthma who presented an insidious onset of clinical manifestations compatible with drug-induced asthma after the initiation of carteolol for ocular hypertension control. The patient developed progressive chest tightness and dyspnoea for 2 months before the pulmonary function test revealed a positive bronchoprovocation response. She reported significant improvement of respiratory symptoms within 2 weeks after the discontinuation of carteolol, and a negative provocation response was later confirmed by repeat pulmonary function test. In conclusion, eye drops with non-selective beta-antagonising effect can induce asthmatic symptoms in patients without a previous diagnosis of asthma and should be administered with caution in patients with associated risk factors.
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Affiliation(s)
- Jo-Hsuan Wu
- National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jih-Shuin Jerng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Chia Su
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
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38
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IgE sensitization in a cohort of adolescents in southern Sweden and its relation to allergic symptoms. Clin Mol Allergy 2019; 17:6. [PMID: 30983886 PMCID: PMC6444864 DOI: 10.1186/s12948-019-0110-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/25/2019] [Indexed: 11/30/2022] Open
Abstract
Background There is a strong and consistent association between IgE sensitization and allergy, wheeze, eczema and food hypersensitivity. These conditions are also found in non-sensitized humans, and sensitization is found among individuals without allergy-related diseases. The aim of this study was to analyse the sensitization profile in a representative sample of the population, and to relate patterns of allergens and allergen components to allergic symptoms. Methods A population of 195 adolescents took part in this clinical study, which included a self-reported questionnaire and in vitro IgE testing. Results Sensitization to airborne allergens was significantly more common than sensitization to food allergens, 43% vs. 14%, respectively. IgE response was significantly higher in airborne allergens among adolescents with rhinitis (p < 0.001) and eczema (p < 0.01). Among 53 children with allergic symptoms according to the questionnaire, 60% were sensitized. Sensitization to food allergens was found among those with rhinitis, but only to PR-10 proteins. None of the participants had IgE to seed storage proteins. Conclusion The adolescents in this study, taken from a normal Swedish population, were mainly sensitized to grass pollen and rarely to specific food allergens. The major grass pollen allergen Phl p 1 was the main sensitizer, followed by Cyn d 1 and Phl p 2. Sixty-one percent reporting any allergic symptom were sensitized, and the allergen components associated with wheeze and rhinoconjunctivitis were Fel d 4, Der f 2 and Can f 5.
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Pyrhönen K, Kulmala P, Näyhä S, Läärä E. Diverse age-incidence patterns of atopic sensitization in an unselected Finnish population up to 12 years. Ann Allergy Asthma Immunol 2019; 122:522-531.e3. [PMID: 30853358 DOI: 10.1016/j.anai.2019.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/08/2019] [Accepted: 02/28/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND The temporal sequence in which allergic sensitization to different allergens emerges is not well characterized at the level of general population. OBJECTIVE We describe the incidence patterns of atopic sensitization to different allergens from birth up to 12 years of age in an unselected Finnish population. METHODS The study population comprised all children born between 2001 and 2006 identified from the nationwide population register as residents of the province of South Karelia, Finland (n = 5564). The results of allergy tests (22,380 results from skin prick tests, immunoglobulin E [IgE] antibodies, and open food challenges [OFCs], performed in 1827 children) were collected from patient records of all the health care units in the area. RESULTS The incidence rates of positive results for food and animal allergens as well as positive OFCs for cow's milk showed prominent peaks at 5 months of age. Positive results for pollen allergens started to emerge after 1.5 years of age. The 12-year cumulative incidence of sensitization to food, animal, pollen, and any allergens was 12%, 8%, 10%, and 18%, respectively. The cumulative incidence of sensitization to house dust mites was 1% and to molds or latex less than 1%. Firstborn boys had the highest, and those who were not firstborn girls and children born in rural municipalities had the lowest early incidence of sensitization to inhalation allergens. CONCLUSION In the unselected population, the atopic sensitization against food and animal allergens began before 6 months of age and was followed by sensitization to pollen allergens before 2 years of age. Primary prevention of sensitization to food and inhalation allergens should therefore occur in early infancy.
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Affiliation(s)
- Kaisa Pyrhönen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.
| | - Petri Kulmala
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Biomedicine Research Unit, Medical Microbiology and Immunology, University of Oulu, Oulu, Finland
| | - Simo Näyhä
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Esa Läärä
- Research Unit for Mathematical Sciences, University of Oulu, Oulu, Finland
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40
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Dahlberg M, Everhov ÅH. Risk of Appendicitis in IgE-Mediated Allergy. JAMA Pediatr 2019; 173:290-291. [PMID: 30615025 DOI: 10.1001/jamapediatrics.2018.4850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Martin Dahlberg
- Department of Clinical Science and Education, Stockholm South General Hospital, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Stockholm South General Hospital, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Åsa H Everhov
- Department of Clinical Science and Education, Stockholm South General Hospital, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Stockholm South General Hospital, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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41
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Hallberg J, Ballardini N, Almqvist C, Westman M, van Hage M, Lilja G, Bergström A, Kull I, Melén E. Impact of IgE sensitization and rhinitis on inflammatory biomarkers and lung function in adolescents with and without asthma. Pediatr Allergy Immunol 2019; 30:74-80. [PMID: 30341960 DOI: 10.1111/pai.12994] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/10/2018] [Accepted: 10/02/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Both allergic and non-allergic rhinitis are associated with worse asthma control. However, it is unclear how IgE sensitization and/or rhinitis are associated with lung function. We therefore evaluated the effect of rhinitis and sensitization on lung function, including the periphery of the airway system, and inflammatory biomarkers in individuals with and without asthma. METHODS Participants in the BAMSE longitudinal birth cohort study underwent measures of spirometry, impulse oscillometry, and FeNO at age 16 years. Questionnaires were used to obtain data on asthma and rhinitis. Blood samples were analyzed for eosinophils and allergen-specific IgE. RESULTS Groups based on the combination of asthma, rhinitis, and sensitization were compared to a healthy reference group. Lower FEV1 /FVC levels were seen for groups with asthma only (adjusted mean difference -2.8% units (95% CI -4.7; -1.0), P < 0.01), asthma with sensitization (-2.0 (-3.9; -0.2), P < 0.05), and asthma with sensitization and rhinitis (-2.5 (-3.6; -1.4), P < 0.001). The index of peripheral airway resistance R5-20 was higher in groups with asthma and sensitization (adjusted median difference 94.9 Pa L-1 s-1 (95% CI 60.4; 129.3), P < 0.001), as well as asthma with sensitization and rhinitis (36.9(15.0; 58.8), P < 0.01). These groups also had increased FeNO and blood eosinophil levels. CONCLUSIONS We found signs of peripheral airway obstruction and increased levels of inflammatory biomarkers in the presence of allergic asthma, irrespective of rhinitis status. Despite having a reduced FEV1 /FVC, peripheral airway engagement was not seen in non-sensitized adolescents with asthma. We suggest that small airway disease is a feature related to the eosinophilic inflammation in allergic asthma in adolescence.
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Affiliation(s)
- Jenny Hallberg
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Natalia Ballardini
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,St John's Institute of Dermatology, King's College London, London, UK
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Marit Westman
- Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.,Department of Ear- Nose and Throat Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne van Hage
- Immunology and Allergy Unit, Department of Medicine Solna, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Lilja
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center of Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Inger Kull
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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42
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Mortz CG, Andersen KE, Poulsen LK, Kjaer HF, Broesby-Olsen S, Bindslev-Jensen C. Atopic diseases and type I sensitization from adolescence to adulthood in an unselected population (TOACS) with focus on predictors for allergic rhinitis. Allergy 2019; 74:308-317. [PMID: 30307618 DOI: 10.1111/all.13630] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/26/2018] [Accepted: 10/01/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND While much is known on childhood atopic diseases, knowledge about persistence of atopic diseases from childhood to adulthood is limited. We therefore aimed to study the clinical course of atopic diseases and type I sensitization prospectively in an unselected cohort of adolescents followed into adulthood. METHODS A cohort of unselected 8th-grade school children (mean age 14 years) established in 1995 and followed up in 2010 were evaluated with questionnaire, clinical examination, skin prick tests and measurements of specific IgE. RESULTS The lifetime prevalence of atopic diseases was high and increased significantly from adolescence (31%) to adulthood (57%); particularly allergic rhinitis increased with an incidence rate of 17.5/1000 person-years. Childhood predictors for adult allergic rhinitis were atopic dermatitis, asthma and asymptomatic sensitization to pollen and house dust mite. Among those with asymptomatic sensitization in adolescence, 53%-78% developed allergic rhinitis in adulthood. Furthermore, type I sensitization increased significantly from adolescence to adulthood mostly due to increased sensitization to pollen. Type I sensitization was found mainly in those with allergic rhinitis. A high number of adults had oral allergy symptoms due to the high number of birch pollen allergic individuals. CONCLUSION Persistence of atopic diseases in adulthood is common, and a high proportion of the adult population is sensitized giving a high prevalence of allergic rhinitis. Many with asymptomatic sensitization in adolescence will develop allergic rhinitis in adult life. The focus should be on prevention of atopic diseases and sensitization already in childhood.
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Affiliation(s)
- Charlotte G. Mortz
- Department of Dermatology and Allergy Centre; Odense Research Centre for Anaphylaxis (ORCA); Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Klaus E. Andersen
- Institute of Clinical research; University of Southern Denmark; Odense Denmark
| | - Lars K. Poulsen
- Allergy Clinic; Copenhagen University Hospital at Gentofte; Copenhagen Denmark
| | - Henrik F. Kjaer
- Department of Dermatology and Allergy Centre; Odense Research Centre for Anaphylaxis (ORCA); Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Sigurd Broesby-Olsen
- Department of Dermatology and Allergy Centre; Odense Research Centre for Anaphylaxis (ORCA); Odense University Hospital; University of Southern Denmark; Odense Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre; Odense Research Centre for Anaphylaxis (ORCA); Odense University Hospital; University of Southern Denmark; Odense Denmark
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Zhai J, Zou Y, Liu J, Jin X, Ma C, Li J, Guo R, Huang B. Analysis of the predicting factors of recurrent wheezing in infants. Ital J Pediatr 2019; 45:19. [PMID: 30696464 PMCID: PMC6352350 DOI: 10.1186/s13052-019-0609-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/03/2019] [Indexed: 12/23/2022] Open
Abstract
Background Clinically, asthma in children under 5 years old is under estimated because lack of diagnostic criteria. The current study was, therefore, designed to identify the predicting factors for recurrent wheezing in infants. Methods One hundred forty-five infants under 3-year old hospitalized with respiratory diseases were enrolled into this study. Patients were followed up for one-year period after being discharged from the hospital and were, then, divided into recurrent wheezing group and non-recurrent wheezing group based on whether there was recurrent wheezing or not. Wheezing or recurrent wheezing was specifically monitored in addition to blood tests for allergic and respiratory diseases. Results The prevalence of eczema and respiratory syncytial virus (RSV) infection were significantly higher in recurrent wheezing group than in control group (74.2% vs 45.8%; 32.3% vs. 13.3%, respectively, both P < 0.05); the percentage of blood eosinophil and serum eosinophil-derived neurotoxin (EDN) concentration at admission were also higher in recurrent wheezing group than in control group (3.10 ± 2.54% vs. 1.31 ± 1.15%; 68.67 ± 55.05 ng/mL vs. 27. 36 ± 19.51 ng/mL; respectively, both P < 0.001). Multivariate logistic regression analysis on eosinophil count and serum EDN concentration in predicting recurrent wheezing revealed that the eosinophil count showed the lowest sensitivity (51.6%) and highest specificity (90.4%), with the area under the ROC curve (AUC) of 0.752 ± 0.041; and that, in contrast, the serum EDN showed the highest sensitivity (88.7%) and lowest specificity (56.6%), with AUC of 0.795 ± 0.037. Conclusion Combination of eosinophil count and serum EDN measurement may be better to predict the risk of recurrent wheezing in early life of childhood.
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Affiliation(s)
- Jia Zhai
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Yingxue Zou
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China.
| | - Jie Liu
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Xingnan Jin
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Cuian Ma
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Jiao Li
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Run Guo
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Bing Huang
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
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44
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Simonyté Sjödin K, Hammarström M, Rydén P, Sjödin A, Hernell O, Engstrand L, West CE. Temporal and long-term gut microbiota variation in allergic disease: A prospective study from infancy to school age. Allergy 2019; 74:176-185. [PMID: 29786876 DOI: 10.1111/all.13485] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Compositional changes in the early-life gut microbiota have been implicated in IgE-associated allergic diseases, but there is lack of longitudinal studies. We examined gut microbiota development from infancy to school age in relation to onset of IgE-associated allergic diseases. At 8 years of age, we also examined the relationship between gut microbiota and T-cell regulation, estimated as responses to polyclonal T-cell activation. METHODS Stool samples were collected from 93 children at 4, 6, 13 months, and 8 years of age. The gut microbiota was profiled using 16S rRNA gene sequencing. Peripheral blood was drawn from all children, and mononuclear cells were polyclonally activated. Levels of IL-10 and FOXP3 mRNA copies were determined using real-time quantitative reverse transcriptase-PCR. RESULTS At 8 years of age, 21 children were diagnosed with IgE-associated allergic disease and 90% displayed allergic comorbidity. Seventy-two children were nonallergic and nonsensitized. Statistical tests with multiple testing corrections demonstrated temporal underrepresentation of Ruminococcus and consistent underrepresentation of Bacteroides, Prevotella, and Coprococcus in allergic compared to nonallergic children from infancy to school age. The gut microbiota of the allergic 8-year-olds was enriched in Bifidobacterium and depleted of Lactobacillus, Enterococcus, and Lachnospira. In allergic 8-year-olds, Faecalibacterium correlated with IL-10 mRNA levels (rs = 0.49, Padj = 0.02) with the same trend for FOXP3 (rs = 0.39, Padj = 0.08). CONCLUSIONS We identified both temporal and long-term variation in the differential abundance of specific bacterial genera in children developing IgE-associated allergic disease. Improved dietary interventions aiming at expanding immune-modulatory taxa could be studied for prevention of allergic disease.
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Affiliation(s)
| | - M.‐L. Hammarström
- Department of Clinical Microbiology, Immunology Umeå University Umeå Sweden
| | - P. Rydén
- Department of Mathematics and Mathematical Statistics Umeå University Umeå Sweden
| | - A. Sjödin
- Division of CBRN Security and Defense FOI – Swedish Defense Research Agency Umeå Sweden
| | - O. Hernell
- Department of Clinical Sciences, Pediatrics Umeå University Umeå Sweden
| | - L. Engstrand
- Department of Microbiology Tumor and Cell Biology and Science for Life Laboratory Karolinska Institutet Stockholm Sweden
| | - C. E. West
- Department of Clinical Sciences, Pediatrics Umeå University Umeå Sweden
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45
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Bakaki PM, Horace A, Dawson N, Winterstein A, Waldron J, Staley J, Pestana Knight EM, Meropol SB, Liu R, Johnson H, Golchin N, Feinstein JA, Bolen SD, Kleinman LC. Defining pediatric polypharmacy: A scoping review. PLoS One 2018; 13:e0208047. [PMID: 30496322 PMCID: PMC6264483 DOI: 10.1371/journal.pone.0208047] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/09/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Lack of consensus regarding the semantics and definitions of pediatric polypharmacy challenges researchers and clinicians alike. We conducted a scoping review to describe definitions and terminology of pediatric polypharmacy. METHODS Medline, PubMed, EMBASE, CINAHL, PsycINFO, Cochrane CENTRAL, and the Web of Science Core Collection databases were searched for English language articles with the concepts of "polypharmacy" and "children". Data were extracted about study characteristics, polypharmacy terms and definitions from qualifying studies, and were synthesized by disease conditions. RESULTS Out of 4,398 titles, we included 363 studies: 324 (89%) provided numeric definitions, 131 (36%) specified duration of polypharmacy, and 162 (45%) explicitly defined it. Over 81% (n = 295) of the studies defined polypharmacy as two or more medications or therapeutic classes. The most common comprehensive definitions of pediatric polypharmacy included: two or more concurrent medications for ≥1 day (n = 41), two or more concurrent medications for ≥31 days (n = 15), and two or more sequential medications over one year (n = 12). Commonly used terms included polypharmacy, polytherapy, combination pharmacotherapy, average number, and concomitant medications. The term polypharmacy was more common in psychiatry literature while epilepsy literature favored the term polytherapy. CONCLUSIONS Two or more concurrent medications, without duration, for ≥1 day, ≥31 days, or sequentially for one year were the most common definitions of pediatric polypharmacy. We recommend that pediatric polypharmacy studies specify the number of medications or therapeutic classes, if they are concurrent or sequential, and the duration of medications. We propose defining pediatric polypharmacy as "the prescription or consumption of two or more distinct medications for at least one day". The term "polypharmacy" should be included among key words and definitions in manuscripts.
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Affiliation(s)
- Paul M. Bakaki
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Alexis Horace
- Department of Clinical Sciences, University of Louisiana at Monroe College of Pharmacy, Monroe, Louisiana, United States of America
| | - Neal Dawson
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States of America
- Center for Health Care Research and Policy, MetroHealth, Cleveland, Ohio, United States of America
| | - Almut Winterstein
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, Florida, United States of America
- Department of Epidemiology & Biostatistics, University of Florida, Gainesville, Florida, United States of America
| | - Jennifer Waldron
- Division of Pediatric Neurology and Epilepsy, Rainbow Babies and Children’s Hospital, University Hospitals, Cleveland, Ohio, United States of America
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Jennifer Staley
- Rainbow Babies and Children’s Hospital, University Hospitals, Cleveland, Ohio, United States of America
| | - Elia M. Pestana Knight
- Epilepsy Center/ Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Sharon B. Meropol
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Rainbow Babies and Children’s Hospital, University Hospitals, Cleveland, Ohio, United States of America
- UH Rainbow Center for Child Health and Policy, University Hospitals, Cleveland, Ohio, United States of America
| | - Rujia Liu
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Hannah Johnson
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
| | - Negar Golchin
- School of Pharmacy, University of Washington, Seattle, Washington, United States of America
| | - James A. Feinstein
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Shari D. Bolen
- Department of Population & Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States of America
- Department of Medicine, MetroHealth Medical Center, Cleveland, Ohio, United States of America
- Center for Health Care Research and Policy, MetroHealth, Cleveland, Ohio, United States of America
| | - Lawrence C. Kleinman
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America
- Rainbow Babies and Children’s Hospital, University Hospitals, Cleveland, Ohio, United States of America
- UH Rainbow Center for Child Health and Policy, University Hospitals, Cleveland, Ohio, United States of America
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46
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Bakaki PM, Staley J, Liu R, Dawson N, Golchin N, Horace A, Johnson H, Waldron J, Winterstein A, Kleinman LC, Bolen SD. A transdisciplinary team approach to scoping reviews: the case of pediatric polypharmacy. BMC Med Res Methodol 2018; 18:102. [PMID: 30286720 PMCID: PMC6172739 DOI: 10.1186/s12874-018-0560-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/18/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Polypharmacy can be either beneficial or harmful to children. We conducted a scoping review to examine the concept of pediatric polypharmacy: its definition, prevalence, extent and gaps in research. In this manuscript, we report our transdisciplinary scoping review methodology. METHODS After establishing a transdisciplinary team, we iteratively developed standard operating procedures for the study's search strategy, inclusion/exclusion criteria, screening, and data extraction. We searched eight bibliographic databases, screened abstracts and full text articles, and extracted data from included studies using standardized forms. We held regular team meetings and performed ongoing internal validity measurements to maintain consistent and quality outputs. RESULTS With the aid of EPPI Reviewer collaborative software, our transdisciplinary team of nine members performed dual reviews of 363 included studies after dual screening of 4398 abstracts and 1082 full text articles. We achieved overall agreement of 85% and a kappa coefficient of 0.71 (95% CI 0.68-0.74) while screening full text articles. The screening and review processes required about seven hours per extracted study. The two pharmacists, an epidemiologist, a neurologist, and a librarian on the review team provided internal consultation in these key disciplines. A stakeholder group of 10 members with expertise in evidence synthesis, research implementation, pediatrics, mental health, epilepsy, pharmacoepidemiology, and pharmaceutical outcomes were periodically consulted to further characterize pediatric polypharmacy. CONCLUSIONS A transdisciplinary approach to scoping reviews, including internal and external consultation, should be considered when addressing complex cross-disciplinary questions.
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Affiliation(s)
- Paul M Bakaki
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Jennifer Staley
- Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA
| | - Rujia Liu
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Neal Dawson
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - Negar Golchin
- School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Alexis Horace
- Department of Clinical Sciences, University of Louisiana at Monroe College of Pharmacy, Monroe, LA, USA
| | - Hannah Johnson
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jennifer Waldron
- Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lawrence C Kleinman
- Rainbow Babies and Children's Hospital, University Hospitals, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA.,The Center for Child Health and Policy at Rainbow, University Hospitals, Cleveland, OH, USA
| | - Shari D Bolen
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106, USA.,Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA.,Center for Health Care Research and Policy, Case Western Reserve University at the MetroHealth System, Cleveland, OH, USA
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47
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Yii ACA, Tay T, Choo XN, Koh MSY, Tee AKH, Wang D. Precision medicine in united airways disease: A "treatable traits" approach. Allergy 2018; 73:1964-1978. [PMID: 29869791 DOI: 10.1111/all.13496] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 12/21/2022]
Abstract
United airways disease (UAD) is the concept that the upper and lower airways, which are anatomically and immunologically related, form a single organ. According to this concept, upper and lower airway diseases are frequently comorbid because they reflect manifestations of a single underlying disease at different sites of the respiratory tract. Allergic asthma-allergic rhinitis is the archetypal UAD, but emerging data indicate that UAD is a heterogeneous condition and consists of multiple phenotypes (observable clinical characteristics) and endotypes (pathobiologic mechanisms). The UAD paradigm also extends to myriad sinonasal diseases (eg, chronic rhinosinusitis with or without nasal polyps) and lower airway diseases (eg, bronchiectasis, chronic obstructive pulmonary disease). Here, we review currently known phenoendotypes of UAD and propose a "treatable traits" approach for the classification and management of UAD, wherein pathophysiological mechanisms and factors contributing to disease are identified and targeted for treatment. Treatable traits in UAD can be analyzed according to a framework comprising airway inflammation (eosinophilic, neutrophilic), impaired airway mucosal defense (impaired mucociliary clearance, antibody deficiency), and exogenous cofactors (allergic sensitizers, tobacco smoke, microbes). Appreciation of treatable traits is necessary in advancing the effort to deliver precise treatments and achieve better outcomes in patients with UAD.
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Affiliation(s)
- A. C. A. Yii
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - T.‐R. Tay
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - X. N. Choo
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - M. S. Y. Koh
- Department of Respiratory and Critical Care Medicine Singapore General Hospital Singapore
- Duke‐National University of Singapore Medical School Singapore
| | - A. K. H. Tee
- Department of Respiratory and Critical Care Medicine Changi General Hospital Singapore
| | - D.‐Y. Wang
- Department of Otolaryngology National University of Singapore Singapore
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48
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Schramm D, Reuter M, Grabenhenrich LB, Schuster A, Lex C, Bauer CP, Hoffmann U, Forster J, Zepp F, Bergmann RL, Bergmann KE, Wahn U, Keil T, Lau S. What does lung function tell us about respiratory multimorbidity in childhood and early adulthood? Results from the MAS birth cohort study. Pediatr Allergy Immunol 2018; 29:481-489. [PMID: 29604118 DOI: 10.1111/pai.12901] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Interaction between respiratory multimorbidity and lung function has not been examined in longitudinal population studies. We aimed to assess the association of multimorbidity of asthma and rhinitis with lung function and bronchial hyperresponsiveness in comparison with single and no allergies from early school age to young adulthood. METHODS In 1990, the Multicenter Allergy Study birth cohort recruited 1314 newborns from 5 German cities. At 7, 13, and 20 years, we performed lung function and bronchial challenge tests. We assessed symptoms, medications, and doctor's diagnoses for asthma and rhinitis for 3 outcomes: current multimorbidity (both coexisting), asthma only, and rhinitis only. RESULTS From 7 to 20 years, multimorbidity prevalence more than doubled from 3.5% to 7.7%, current asthma only (without rhinitis co-occurring) decreased by half from 2.8% to 1.3%, and current rhinitis only (without asthma co-occurring) increased from 14.3% to 41.6%. Resting lung function parameters differed between allergic and asymptomatic participants but showed no considerable differences between the allergic phenotypes. Frequency and severity of bronchial hyperresponsiveness were particularly associated with multimorbidity. At the age of 20 years, participants with multimorbidity showed a clearly higher severity in hyperresponsiveness compared to participants who suffered only asthma (P = .049) or rhinitis (P = .008) or were asymptomatic (P < .001). CONCLUSION Single lung function measurements from childhood ongoing do not seem to discriminate between subjects with multimorbidity, single allergies, and no allergy. Our results show that multimorbidity is associated with more severe symptoms compared to those suffering only a single allergic disease.
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Affiliation(s)
- Dirk Schramm
- Department of Paediatrics, Heinrich-Heine-University, Duesseldorf, Germany
| | - Marvin Reuter
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Linus B Grabenhenrich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antje Schuster
- Department of Paediatrics, Heinrich-Heine-University, Duesseldorf, Germany
| | - Christiane Lex
- Department of Paediatric Cardiology and Intensive Care Medicine with Paediatric Respiratory Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Carl-Peter Bauer
- Department of Pediatrics, Technical University of Munich, Munich, Germany
| | - Ute Hoffmann
- Department of Pediatrics, Technical University of Munich, Munich, Germany
| | | | - Fred Zepp
- Center for Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Renate L Bergmann
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karl E Bergmann
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Wahn
- Department of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Lau
- Department of Pediatric Pneumology and Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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49
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Sun SM, Wang YY, Zhang Q, Liu L, Meng G, Yao ZX, Wu HM, Xia Y, Bao X, Gu YQ, Wang HL, Shi HB, Xu HY, Wang X, Zhou M, Jiao HL, Jia QY, Wang BM, Niu KJ. Serum levels of immunoglobulins in an adult population and their relationship with nonalcoholic fatty liver disease. J Dig Dis 2018; 19:498-507. [PMID: 29989347 DOI: 10.1111/1751-2980.12646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 06/23/2018] [Accepted: 07/05/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Few studies have reported the association between nonalcoholic fatty liver disease (NAFLD) and immunoglobulins. In this study, we aimed to investigate the relationship between serum immunoglobulin levels and NAFLD in a Chinese adult population. METHODS We performed a cross-sectional study including 11 261 Chinese adults. NAFLD was diagnosed based on the Chinese Guidelines for the diagnosis and treatment of fatty liver diseases and an alcohol intake of <70 g/week in women and <140 g/week in men, and serum immunoglobulin (Ig) levels were determined using immune nephelometry. Multiple logistic regression analysis was done to assess relationships between concentrations of serum immunoglobulins and NAFLD. RESULTS Of the 11 261 adults recruited from January 2010 to December 2015, the prevalence of NAFLD was 40.8% (n = 4598). The geometric mean levels of IgG, IgM, IgE and IgA were 1177.49 mg/dL (95% confidence interval [CI] 1173.07-1181.93), 93.56 mg/dL (95% CI 92.70-94.42), 30.70 IU/mL (95% CI 29.92-31.49) and 216.64 mg/dL (95% CI 214.95-218.34), respectively. Compared with the lowest quintile, the multivariable adjusted odds ratio (95% CI) of NAFLD for the highest quintile of IgG, IgM, IgE, and IgA were 0.78 (0.66-0.92), 0.71 (0.60-0.84), 0.98 (0.84-1.15) and 1.41 (1.21-1.66), respectively. CONCLUSION Increased IgA and decreased IgG and IgM levels are independently associated with NAFLD prevalence. Further research is needed to explore the causal association between serum immunoglobulins and NAFLD.
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Affiliation(s)
- Shao Mei Sun
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China
| | - Yan Yan Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Qing Zhang
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Liu
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China
| | - Ge Meng
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zhan Xin Yao
- Tianjin Institute of Health and Environmental Medicine, Tianjin, China
| | - Hong Mei Wu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yang Xia
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xue Bao
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Ye Qing Gu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hong Lei Wang
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Hong Bin Shi
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China
| | - Hai Yan Xu
- Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xing Wang
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China
| | - Ming Zhou
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China
| | - Huan Li Jiao
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China.,Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin, China
| | - Qi Yu Jia
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China
| | - Bang Mao Wang
- Department of Gastroenterology, Tianjin Medical University General Hospital, Tianjin, China
| | - Kai Jun Niu
- Health Management Center, Tianjin Medical University General Hospital, Tianjin, China.,Nutritional Epidemiology Institute and School of Public Health, Tianjin Medical University, Tianjin, China
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50
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Siroux V, Ballardini N, Soler M, Lupinek C, Boudier A, Pin I, Just J, Nadif R, Anto JM, Melen E, Valenta R, Wickman M, Bousquet J. The asthma-rhinitis multimorbidity is associated with IgE polysensitization in adolescents and adults. Allergy 2018; 73:1447-1458. [PMID: 29331026 DOI: 10.1111/all.13410] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Children with multimorbid asthma and rhinitis show IgE polysensitization to several allergen sources. This association remains poorly studied in adolescents and adults using defined allergen molecules. We investigated IgE sensitization patterns towards a broad panel of aeroallergen components in adults and adolescents with a focus on individuals with asthma and rhinitis multimorbidity. METHODS IgE reactivity to 64 micro-arrayed aeroallergen molecules was determined with the MeDALL-chip in samples from the French EGEA study (n = 840, age = 40.7 ± 17.1) and the Swedish population-based birth cohort BAMSE (n = 786, age = 16 ± 0.26). The age- and sex-adjusted associations between the number of IgE-reactive allergen molecules (≥0.3 ISU) and the asthma-rhinitis phenotypes were assessed using a negative binomial model. RESULTS Groups representing 4 phenotypes were identified: no asthma-no rhinitis (A-R-; 30% in EGEA and 54% in BAMSE), asthma alone (A+R-; 11% and 8%), rhinitis alone (A-R+; 15% and 24%) and asthma-rhinitis (A+R+; 44% and 14%). The numbers of IgE-reactive aeroallergen molecules significantly differed between phenotypes (median in A-R-, A+R-, A-R+ and A+R+: 0, 1, 2 and 7 in EGEA and 0, 0, 3 and 5 in BAMSE). As compared to A-R- subjects, the adjusted ratio of the mean number of IgE-reactive molecules was higher in A+R+ than in A+R- or A-R+ (10.0, 5.4 and 5.0 in EGEA and 7.2, 0.7 and 4.8 in BAMSE). CONCLUSION The A+R+ phenotype combined the sensitization pattern of both the A-R+ and A+R- phenotypes. This multimorbid polysensitized phenotype seems to be generalizable to various ages and allergenic environments and may be associated with specific mechanisms.
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Affiliation(s)
- V. Siroux
- Inserm, CNRS, IAB; University Grenoble Alpes; Grenoble France
| | - N. Ballardini
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- St John's Institute of Dermatology; King's College London; London UK
| | - M. Soler
- Inserm, CNRS, IAB; University Grenoble Alpes; Grenoble France
| | - C. Lupinek
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
| | - A. Boudier
- Inserm, CNRS, IAB; University Grenoble Alpes; Grenoble France
| | - I. Pin
- Inserm, CNRS, IAB; University Grenoble Alpes; Grenoble France
- Department of Pediatrics; CHU Grenoble Alpes; Grenoble France
| | - J. Just
- Allergology Department; Children Hospital Armand Trousseau; Paris France
- Inserm, UMR-S 1136 INSERM; UPMC; Paris France
| | - R. Nadif
- Inserm, U1168; VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches; Villejuif France
- UMR-S 1168; Univ Versailles St-Quentin-en-Yvelines; Montigny le Bretonneux France
| | - J. M. Anto
- ISGLoBAL; Centre for Research in Environmental Epidemiology (CREAL); Barcelona Spain
| | - E. Melen
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
| | - R. Valenta
- Division of Immunopathology; Department of Pathophysiology and Allergy Research; Center for Pathophysiology, Infectiology and Immunology; Medical University of Vienna; Vienna Austria
- NRC Institute of Immunology FMBA of Russia; Moscow Russia
| | - M. Wickman
- Institute of Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs’ Children and Youth Hospital; Södersjukhuset; Stockholm Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Eskilstuna Sweden
| | - J. Bousquet
- Inserm, U1168; VIMA: Aging and Chronic Diseases, Epidemiological and Public Health Approaches; Villejuif France
- UMR-S 1168; Univ Versailles St-Quentin-en-Yvelines; Montigny le Bretonneux France
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