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Piotin A, Godet J, Domis N, de Blay F. Rhinoconjunctivitis severity induced by cat exposure influences early and late asthmatic responses: Evidence from an environmental exposure chamber. Clin Exp Allergy 2024; 54:596-606. [PMID: 38660824 DOI: 10.1111/cea.14485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 03/10/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The impact of allergic rhinoconjunctivitis on the early (EAR) and late asthmatic response (LAR) has yet to be assessed during optimal allergen exposure conditions. OBJECTIVE We aimed to assess predictive factors of the EAR and LAR and to evaluate the relation between rhinitis, conjunctivitis and asthma induced by cat allergen exposure in an environmental exposure chamber (EEC). METHODS Data from two cohort studies involving asthmatic patients with cat allergy who performed a cat allergen exposure challenge in ALYATEC EEC were analysed. Spirometry, visual analogue scale (VAS) for asthma, VAS for rhinitis, Total Nasal Symptoms Score, Total Ocular Symptoms Score (TOSS), Rhinoconjunctivitis Total Symptoms Score and Abelson score were used to assess asthma, rhinitis and conjunctivitis during and after exposure. RESULTS An EAR occurred in 65.1% of patients, 32.1% of whom had a LAR. The diameter of the prick test to cat allergens and non-specific bronchial hypersensitivity level were independent risk factors for EAR (p < .05). No independent risk factors for LAR were identified. Rhinoconjunctivitis severity during exposure correlated with the asthma VAS during EAR and LAR (p < .05). Allergen exposure time needed to trigger an EAR correlated with the Abelson score during exposure (p < .05). The asthma VAS and TOSS during exposure correlated with faster LAR occurrence (p < .05). CONCLUSION Prick test size and non-specific bronchial hypersensitivity level were confirmed as independent predictive factors of EAR during allergen exposure in an EEC. This study demonstrated the relation between the severity of rhinitis, conjunctivitis and asthma induced by allergen exposure for both EAR and LAR.
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Affiliation(s)
- Anays Piotin
- Division of Asthma and Allergy, Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
- Physiology and Functional Exploration Service, University Hospital of Strasbourg, Strasbourg, France
| | - Julien Godet
- Public Health Department, Strasbourg University Hospital, Strasbourg, France
| | - Nathalie Domis
- ALYATEC Environmental Exposure Chamber, Strasbourg, France
| | - Frédéric de Blay
- Division of Asthma and Allergy, Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France
- ALYATEC Environmental Exposure Chamber, Strasbourg, France
- EA 3070 Federation of Translational Medicine, FHU Homicare, University of Strasbourg, Strasbourg, France
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Liu JB, Qian XJ, Wu Y, Jie XY, Jiang P. Effect of different inhalant allergens on T-cell subsets in adults with bronchial asthma. J Asthma 2024:1-9. [PMID: 38828898 DOI: 10.1080/02770903.2024.2363942] [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: 01/18/2024] [Accepted: 05/30/2024] [Indexed: 06/05/2024]
Abstract
OBJECTIVE We analyzed the impact of different inhalant allergens on T-lymphocyte subsets in patients diagnosed with bronchial asthma. METHODS The study included 57 bronchial asthma patients and 22 healthy controls. Asthma patients were categorized into dust mite, animal hair, pollen, and mold groups. Flow cytometry was used to measure the cells in the case group and control group. These T-lymphocyte subset markers were evaluated among patients with bronchial asthma caused by different allergens as well as between the case group and control group. RESULTS Peripheral blood CD4+ T-cells, CD8+ T-cells, CD4/CD8 ratio, and Th17/Treg ratios were all higher in the case group than in the control group (p < 0.05). Peripheral blood T-lymphocyte subsets were compared among the four groups, and it was found that there were statistical differences in the Th17/Treg ratio among the four groups (p < 0.05). There were no significant differences observed among the four groups in terms of CD3+ cells, CD4+ cells, CD8+ cells, Th1 cells, Th2 cells, Th17 cells, Treg cells, Th9 cells, and Th22 cells. Further pairwise comparison was made, and the results suggested that the peripheral blood Th17/Treg ratio in the pollen mixed group was lower than that in the dust mite mixed group, animal hair mixed group, and mold mixed group (p < 0.05). CONCLUSION Patients with bronchial asthma show varied T-lymphocyte subset responses to different inhalant allergens. Elevated CD4+ T cells and Th17 cells in peripheral blood could indicate asthma risk. However, small sample size may introduce bias to these findings.
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Affiliation(s)
- Jiang-Bo Liu
- Department of Respiratory Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Xue-Jiao Qian
- Department of Respiratory Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Yu Wu
- Department of Respiratory Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Xue-Yan Jie
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ping Jiang
- Department of Respiratory Medicine, Tianjin First Central Hospital, Tianjin, China
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Liu J, Qian X, Jie X, Jiang P. Effects of different inhalant allergens on lung functions in adult patients with bronchial asthma. Immun Inflamm Dis 2023; 11:e1118. [PMID: 38156394 PMCID: PMC10750435 DOI: 10.1002/iid3.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/23/2023] [Accepted: 12/09/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE To analyze the effects of different types of inhalant allergens on the lung functions of adult patients with bronchial asthma. METHODS This cross-sectional study included a total of 47 adults diagnosed with bronchial asthma at the Respiratory Outpatient Department of Tianjin First Central Hospital. Patients were divided into non-sensitized and sensitized groups based on the number of positive allergens detected and classified into four groups (the dust mite mixed group, animal dander mixed group, pollen-mixed group, and mold mixed group) based on the type of positive allergen detected. They were tested for the serum concentration of allergen-specific immunoglobulin E (sIgE) using a fluorescence immunoassay analyzer, and lung function was assessed using a pulmonary function testing machine. One-way analysis of variance was used to compare normally distributed data, while the rank sum test was utilized for non-normally distributed data. RESULTS There was no statistically significant difference in lung function indicators between these two groups (p > .05). There were statistically significant differences in forced expiratory volume in one second as a percentage of the predicted value (FEV1 %pred) (p = .028), FEV1 /forced vital capacity as a percentage of the predicted value; (FVC%pred) (p = .016), peak expiratory flow as a percentage of the predicted value (PEF%pred) (p = .001), forced expiratory flow at 50% of the predicted value of forced vital capacity (FEF50%pred) (p = .003), forced expiratory flow at 75% of the predicted value of forced vital capacity (FEF75%pred) (p = .023), and maximal midexpiratory flow (MM)EF75/25%pred (p = .002) among the four groups. The pollen-mixed group had higher PEF%pred (pollen vs. animal dander, p = .067; pollen vs. dust-mites, p = .008; pollen vs. molds, p = .001) and MMEF75/25%pred (pollen vs. animal dander, p = .048; pollen vs. dust-mites, p = .003; pollen vs. molds, p = .001) than the other three groups. The pollen-mixed group had higher FEF50%pred than the dust-mites mixed group (p = .008) and molds-mixed group (p = .001). The pollen-mixed group had higher FEF75%pred (p = .005), FEV1 %pred (p = .001), and FEV1 /FVC%pred (p = .001) than the molds-mixed group. CONCLUSION Different inhalant allergens had different effects on lung functions in adults with asthma.
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Affiliation(s)
- Jiangbo Liu
- Department of Respiratory MedicineTianjin First Central HospitalTianjinChina
| | - Xuejiao Qian
- Department of Respiratory MedicineTianjin First Central HospitalTianjinChina
| | - Xueyan Jie
- Department of Pulmonary and Critical Care MedicineSecond Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Ping Jiang
- Department of Respiratory MedicineTianjin First Central HospitalTianjinChina
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Klein M, Plante S, Boulay MÈ, Boulet LP, Chakir J. Discrepancy in the suppressive function of regulatory T cells in allergic asthmatic vs. allergic rhinitis subjects upon low-dose allergen challenges. FRONTIERS IN ALLERGY 2023; 4:1296601. [PMID: 38106504 PMCID: PMC10722309 DOI: 10.3389/falgy.2023.1296601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
Background Regulatory T cells (Tregs) contribute to the maintenance of immunological tolerance. There is evidence of impaired function of these cells in people with asthma and allergy. In this study, we evaluated and compared the function of Tregs in allergic asthmatic and allergic non-asthmatic patients, both before and after low-dose allergen challenges. Methods Three groups of subjects were recruited for a baseline evaluation: healthy controls without allergy or asthma, allergic asthmatic subjects, and allergic non-asthmatic subjects. All of them were subjected to expiratory flow measurements, sputum induction, and blood sampling. In addition, both groups of allergic subjects underwent low-dose allergen challenges. Tregs were isolated from whole blood using CD4+CD25high and CD127low staining. The suppression function was measured by flow cytometry. The levels of IL-10, IFN-γ, IgG4, IgA, and TGF-β were measured using ELISA, and sputum Foxp3 was evaluated using qRT-PCR. Results The suppressive function of Tregs in healthy controls was significantly higher than in allergic asthmatic or allergic non-asthmatic subjects. Repeated exposure to low doses of allergen increased the suppressor function of Tregs in allergic non-asthmatic subjects but decreased it in allergic asthmatic subjects. Foxp3 gene expression was increased in induced sputum in allergic non-asthmatic subjects, whereas it did not change in asthmatic subjects. Serum IL-10 level was decreased in allergic asthmatic subjects after allergen challenge but not in allergic non-asthmatic subjects. IFN-γ level increased upon allergen challenge in allergic non-asthmatic subjects. IgG4 level was higher in allergic non-asthmatic subjects than in allergic asthmatic subjects. Conclusions Low-dose allergen challenges stimulate the suppressor function of Tregs in non-asthmatic allergic subjects but not in allergic asthmatic subjects.
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Affiliation(s)
| | | | | | | | - Jamila Chakir
- Centre de Recherche de l’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, QC, Canada
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Durr SM, Davis B, Gauvreau G, Cockcroft D. Allergen bronchoprovocation: correlation between FEV 1 maximal percent fall and area under the FEV 1 curve and impact of allergen on recovery. Allergy Asthma Clin Immunol 2023; 19:8. [PMID: 36681834 PMCID: PMC9867859 DOI: 10.1186/s13223-023-00759-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/04/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND House dust mite (HDM) induces greater responses than other allergens during allergen bronchoprovocation (ABP) testing. The two standardized methods for reporting results of ABP tests are the maximal percent fall in forced expiratory volume in one second (FEV1, max; %) and the area under the FEV1 vs time curve (AUC; %FEV1 x min). The relationship between these methods has not been previously investigated. AIMS We aimed to measure the correlation between FEV1, max and AUC during the early asthmatic response (EAR) and the late asthmatic response (LAR), and to determine if the EAR recovery period for HDM would be longer than other allergens (cat, grass, horse, and ragweed). METHODS We retrospectively calculated the AUC and correlation between FEV1, max and AUC during the EAR(0-2 h) and LAR(3-7 h) for each allergen. We compared EAR(0-3 h) and LAR(3-7 h) FEV1, max, AUC and absolute difference in FEV1, max to the most recovered FEV1 (FEV1, min). We performed pairwise comparisons of correlation and slope values using Fischer's r to z transformation and t-tests, respectively. AUC and absolute differences in FEV1, max and FEV1, min were compared using a one-way ANOVA test, followed by a post-hoc Scheffe test. RESULTS Correlation between the FEV1, max and AUC during the EAR(0-2 h) (n = 221) was 0.807, and was 0.798 during the LAR(3-7 h) (n = 157 of 221), (difference p = 0.408). The EAR(0-3 h) AUC and FEV1, max did differ between allergens (both p < 0.0001) but the LAR(3-7 h) AUC and FEV1, max did not (p = 0.548 and 0.824, respectively). HDM did not have a larger AUC or FEV1, max, than all other allergens during the EAR(0-3 h) or the LAR(3-7 h). The absolute difference between the FEV1, max and FEV1, min during the EAR(0-3 h) did not differ between allergens (p = 0.180). CONCLUSION The FEV1, max and AUC for both the EAR(0-2 h) and LAR(3-7 h) had excellent correlation, with no significant difference. Thus, significant bronchoconstriction will likely result in a longer recovery period. There was no evidence of delayed EAR(0-3 h) recovery following HDM challenges, so HDM did not induce a larger response compared to all the other allergens examined. REGISTRATION Not registered. This is not a clinical trial. (This study is a retrospective analysis of data collected during several registered trials.).
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Affiliation(s)
- Sarah-Marie Durr
- grid.25152.310000 0001 2154 235XDepartment of Medicine, University of Saskatchewan, Saskatoon, SK Canada
| | - Beth Davis
- grid.25152.310000 0001 2154 235XDepartment of Medicine, University of Saskatchewan, Saskatoon, SK Canada
| | - Gail Gauvreau
- grid.25073.330000 0004 1936 8227Department of Medicine, McMaster University, Hamilton, ON Canada
| | - Donald Cockcroft
- grid.25152.310000 0001 2154 235XDepartment of Medicine, University of Saskatchewan, Saskatoon, SK Canada ,grid.412271.30000 0004 0462 8356Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N0W8 Canada
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Abstract
INTRODUCTION The numerous links between allergic rhinitis and asthma have been extensively explored in the last two decades, gaining great concern within the scientific community. These two conditions frequently coexist in the same patient and share numerous pathogenetic and pathophysiological mechanisms. AREAS COVERED We reviewed major pathophysiological, epidemiological, and clinical links between allergic rhinitis and asthma. We also provided a comprehensive discussion of allergic rhinitis treatment according to current guidelines, with a particular focus on the relevance of allergic rhinitis therapies in patients with comorbid asthma. EXPERT OPINION We believe that there are several unmet needs for our patients, however, there are promising advances forecasted for the future. Although allergic rhinitis is a recognized risk factor for asthma, a proper asthma detection and prevention plan in allergic rhinitis patients is not available. Allergen immunotherapy (AIT) represents a promising preventive strategy and may deserve an earlier positioning in allergic rhinitis management. A multidisciplinary approach should characterize the journey of patients with respiratory allergies, with an adequate referral to specialized Allergy/Asthma centers. Molecular Allergy Diagnosis may provide support for optimal AIT use. Finally, a possible evolution of biological treatment can be envisaged, mainly if biosimilars decrease such therapies' costs.
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Li J, Hu Y, Li H, Lin Y, Tong S, Li Y. Assessing the impact of air pollutants on clinical visits for childhood allergic respiratory disease induced by house dust mite in Shanghai, China. Respir Res 2022; 23:48. [PMID: 35248029 PMCID: PMC8897928 DOI: 10.1186/s12931-022-01967-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/21/2022] [Indexed: 01/16/2023] Open
Abstract
Background The prevalence of allergic respiratory disease (ARD) is increasing worldwide during the last few decades, causing a great disease burden especially for children. Air pollution has been increasingly considered as a potential contributor to this trend, but its role in ARD induced by house dust mite (HDM-ARD) remains unclear, especially in time-series study. Methods A positive reporting of respiratory allergy to named allergens was included by serum specific IgE testing. A time series Quasi-Poisson regression with distributed lag non-linear model, combined with generalized linear model was used to examine the effects of air pollutants on ARD, HDM-ARD and ARD induced by non-house dust mite (NHDM-ARD). Results A total of 16,249 cases of ARD, including 8,719 HDM-ARD and 8,070 NHDM-ARD from 1 Jan 2013 to 31 Dec 2017 were involved in this study. Air pollutants were significantly associated with clinical visits for childhood ARD and HDM-ARD. Exposure to higher O3 and interquartile range (IQR) increment in O3 (40.6 µg/m3) increased the risks of clinical visits for childhood HDM-ARD (RRlag0-5 for the 95th percentile of O3: 1.26, 95% confidence interval (CI): 1.03, 1.55; RRlag0-5 for IQR increment (40.6 µg/m3): 1.09, 95% CI: 1.01, 1.17) and ARD (RRlag0-5 for the 95th percentile of O3: 1.19, 95% CI: 1.03, 1.38; RRlag0-5 for IQR increment (40.6 µg/m3): 1.06, 95% CI: 1.01, 1.12). In addition, higher O3 was associated with increased RR of boys with ARD (RRlag0-5 for the 95th percentile: 1.26, 95% CI: 1.05, 1.51; RRlag0-5 for IQR increment (40.6 µg/m3): 1.09, 95% CI: 1.02, 1.16) and HDM-ARD (RRlag0-5 for the 95th percentile: 1.36, 95% CI: 1.06, 1.75; RRlag0-5 for IQR increment (40.6 µg/m3): 1.11, 95% CI: 1.02, 1.22), but not in girls. Conclusions Exposure to O3 appeared to be a trigger of clinical visits for childhood ARD, especially for HDM-ARD and boys. These findings provide novel evidence on the impact of air pollution on HDM-ARD, which may have significant implications for designing effective intervention programs to control and prevent childhood ARD, especially HDM-ARD, in China and other similar developing countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-01967-1.
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Gauvreau GM, Davis BE, Scadding G, Boulet LP, Bjermer L, Chaker A, Cockcroft DW, Dahlén B, Fokkens W, Hellings P, Lazarinis N, O'Byrne PM, Tufvesson E, Quirce S, Van Maaren M, de Jongh FH, Diamant Z. Allergen Provocation Tests in Respiratory Research: Building on 50 Years of Experience. Eur Respir J 2022; 60:13993003.02782-2021. [PMID: 35086834 PMCID: PMC9403392 DOI: 10.1183/13993003.02782-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/29/2021] [Indexed: 11/05/2022]
Abstract
Allergen provocation test is an established model of allergic airway diseases, including asthma and allergic rhinitis, allowing the study of allergen-induced changes in respiratory physiology and inflammatory mechanisms in sensitised individuals as well as their associations. In the upper airways, allergen challenge is focused on the clinical and pathophysiological sequelae of the early allergic response and applied both as a diagnostic tool and in research settings. In contrast, the bronchial allergen challenge has almost exclusively served as a research tool in specialised research settings with a focus on the late asthmatic response and the underlying type 2 inflammation. The allergen-induced late asthmatic response is also characterised by prolonged airway narrowing, increased non-specific airway hyperresponsiveness and features of airway remodelling including the small airways, and hence, allows the study of several key mechanisms and features of asthma. In line with these characteristics, the allergen challenge has served as a valued tool to study the crosstalk of the upper and lower airways and in proof of mechanism studies of drug development. In recent years, several new insights into respiratory phenotypes and endotypes including the involvement of the upper and small airways, innovative biomarker sampling methods and detection techniques, refined lung function testing as well as targeted treatment options, further shaped the applicability of the allergen provocation test in precision medicine. These topics, along with descriptions of subject populations and safety, in line with the updated GINA2021, will be addressed in this paper.
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Affiliation(s)
- Gail M Gauvreau
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Beth E Davis
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Guy Scadding
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Louis-Philippe Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, University of Laval, Laval, Quebec, Canada
| | - Leif Bjermer
- Department of Clinical Sciences Lund, Respiratory medicine and Allergology, Lund University, Lund, Sweden
| | - Adam Chaker
- TUM School of Medicine, Dept. of Otolaryngology and Center of Allergy and Environment, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Donald W Cockcroft
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Barbro Dahlén
- Department of Medicine, Huddinge Karolinska Institutet, Stockholm, Sweden
| | - Wyste Fokkens
- Department of Otorhinolaryngology, Faculty of Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Peter Hellings
- Department of Otorhinolaryngology, Faculty of Medicine, University of Amsterdam, Amsterdam, Netherlands
| | - Nikolaos Lazarinis
- Department of Medicine, Huddinge Karolinska Institutet, Stockholm, Sweden
| | - Paul M O'Byrne
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ellen Tufvesson
- Department of Clinical Sciences Lund, Respiratory medicine and Allergology, Lund University, Lund, Sweden
| | - Santiago Quirce
- Department of Allergy, La Paz University Hospital, IdiPAZ, and CIBER de Enfermedades Respiratorias CIBERES, Madrid, Spain
| | | | - Frans H de Jongh
- Faculty of Engineering Technology, University of Twente, Enschede, Netherlands
| | - Zuzana Diamant
- Department of Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium.,Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital, Lund University, Lund, Sweden.,Department of Pharmacology & Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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de Blay F, Gherasim A, Casale TB, Doyen V, Bernstein D. Which patients with asthma are most likely to benefit from allergen immunotherapy? J Allergy Clin Immunol 2022; 149:833-843. [DOI: 10.1016/j.jaci.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 10/19/2022]
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Zhu Z, Wang H, Xie Y, An J, Hu Q, Xia S, Li J, O'Byrne P, Zheng J, Zhong N. Response of upper and lower airway inflammation to bronchial challenge with house dust mite in Chinese asthmatics: a pilot study. J Thorac Dis 2021; 13:4988-4998. [PMID: 34527337 PMCID: PMC8411141 DOI: 10.21037/jtd-20-2876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 07/15/2021] [Indexed: 01/14/2023]
Abstract
Background Allergen nasal challenge can induce increase of eosinophils in sputum, but report about eosinophilic inflammation in upper airway after allergen bronchial challenge in Chinese asthmatics was rare. The article aims to evaluate response of upper and lower airways to house dust mite (HDM) allergen bronchial challenge. Methods HDM allergen bronchial challenge was carried out in asthmatic patients with allergic rhinitis (AR). Bronchial methacholine challenge and blood test were performed before and at 24 hours after allergen challenge. Nasal lavage and induced sputum for differential cells count and fractional exhaled nitric oxide (FeNO) measurement were performed before, 7 and 24 hours after allergen challenge. Results Eighteen asthmatic patients with AR underwent HDM allergen bronchial challenge with no serious adverse events reported. Fifteen patients showed dual asthmatic response (DAR), while 2 patients showed early (EAR) and 1 late asthmatic response (LAR) only. At 24 hours after allergen bronchial challenge testing, average PC20FEV1 to methacholine significantly decreased (1.58 to 0.81 mg/mL, P=0.03), while both FeNO and the percentage of eosinophils in blood and sputum were significantly increased [52.0 (54.0) to 69.0 (56.0) ppb, P=0.01; 4.82% to 6.91%, P<0.001; 20.70% to 27.86%, P=0.03, respectively], but with no significant differences found in the percentage of eosinophils in nasal lavage (39.36% to 38.58%, P=0.89). However, at 7 hours after allergen challenge, the eosinophils in sputum were significant increased to 40.45% (P<0.001), but there was an increase (39.36% to 48.07%) with no statistical difference (P=0.167) found in nasal lavage. Conclusions HDM allergen bronchial challenge induced different response of airway inflammation in upper and lower airways.
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Affiliation(s)
- Zheng Zhu
- Department of Allergy and Clinical Immunology, State Key Lab of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hongyu Wang
- State Key Lab of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Medicine, Firestone Institute for Respiratory Health, the Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Yanqing Xie
- State Key Lab of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaying An
- State Key Lab of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiurong Hu
- Department of Allergy and Clinical Immunology, State Key Lab of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shu Xia
- State Key Lab of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jing Li
- Department of Allergy and Clinical Immunology, State Key Lab of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Paul O'Byrne
- Department of Medicine, Firestone Institute for Respiratory Health, the Research Institute of St. Joe's Hamilton, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Jinping Zheng
- State Key Lab of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Lab of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Chen H, Li J, Cheng L, Gao Z, Lin X, Zhu R, Yang L, Tao A, Hong H, Tang W, Guo Y, Huang H, Sun J, Lai H, Lei C, Liu G, Xiang L, Chen Z, Ma H, Chan AWM, Hao C, Sun B. China Consensus Document on Allergy Diagnostics. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:177-205. [PMID: 33474855 PMCID: PMC7840865 DOI: 10.4168/aair.2021.13.2.177] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/14/2020] [Accepted: 08/29/2020] [Indexed: 01/22/2023]
Abstract
The prevalence of allergic diseases has increased dramatically in recent years in China, affecting the quality of life in 40% of the population. The identification of allergens is the key to the diagnosis of allergic diseases. Presently, several methods of allergy diagnostics are available in China, but they have not been standardized. Additionally, cross-sensitization and co-sensitization make allergy diagnostics even more complicated. Based on 4 aspects of allergic disease (mechanism, diagnosis procedures, allergen detection in vivo and in vitro as well as the distribution map of the most important airborne allergens in China) and by referring to the consensus of the European Society of Allergy and Clinical Immunology, the World Allergy Organization, and the important literature on allergy diagnostics in China in recent years, we drafted this consensus of allergy diagnostics with Chinese characteristics. It aims to standardize the diagnostic methods of allergens and provides a reference for health care givers. The current document was prepared by a panel of experts from the main stream of professional allergy associations in China.
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Affiliation(s)
- Hao Chen
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jing Li
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Lei Cheng
- Department of Otorhinolaryngology & Clinical Allergy Center, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Zhongshan Gao
- Allergy Research Center, Zhejiang University, Hangzhou, China
| | - Xiaoping Lin
- Department of Allergy, Northern Theater General Hospital, Shenyang, China
| | - Rongfei Zhu
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Yang
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ailin Tao
- Department of Allergy, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,The State Key Laboratory of Respiratory Disease, Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Haiyu Hong
- Allergy Center, Department of Otorhinolaryngology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | - Wei Tang
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yinshi Guo
- Department of Allergy and Immunology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huaiqiu Huang
- Department of Dermatology and Venereology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinlyu Sun
- Department of Allergy, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - He Lai
- Department of Allergy, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.,The State Key Laboratory of Respiratory Disease, Guangdong Provincial Key Laboratory of Allergy & Clinical Immunology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Cheng Lei
- Department of Pediatrics, Kiang Wu Hospital, Macau, China
| | - Guanghui Liu
- Department of Allergy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Allergy, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Li Xiang
- Department of Allergy, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhuanggui Chen
- Department of Pediatrics and Department of Allergy, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Han Ma
- Department of Dermatology and Venereology, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China
| | | | - Chuangli Hao
- Department of Respirology, Children's Hospital, Soochow University, Suzhou, China.
| | - Baoqing Sun
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China.
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12
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Doyen V, Casset A, Divaret-Chauveau A, Khayath N, Peiffer G, Bonniaud P, Dalphin JC, De Blay F. [Diagnosis of allergy in asthma]. Rev Mal Respir 2020; 37:243-256. [PMID: 32057505 DOI: 10.1016/j.rmr.2019.07.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 07/06/2019] [Indexed: 01/01/2023]
Abstract
Allergy is a hypersensitivity reaction induced by immunological mechanisms. In asthma, allergy has a complex role and is usually IgE mediated. Allergy must be evaluated during the work up but evidence of IgE sensitivity does not mean that allergens play a role in the pathophysiology of the disease. The clinical relevance of the sensitivity has to be considered. This paper describes current available tools to screen for IgE sensitivity, allergen exposure and their role in asthma.
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Affiliation(s)
- V Doyen
- Clinique d'immuno-allergologie, université Libre de Bruxelles (ULB), CHU Brugmann, place Van Gehuchten, 4, 1020 Bruxelles, Belgique.
| | - A Casset
- CNRS, CAMB UMR7199, université de Strasbourg, 67000 Strasbourg, France
| | - A Divaret-Chauveau
- Unité d'allergologie pédiatrique, hôpital d'enfants, CHRU de Nancy, 54000 Nancy, France; EA3450 développement adaptation et handicap (DevAH), université de Lorraine, 54000 Nancy, France; UMR 6249 Chrono-environment, CNRS et université de Franche-Comté, Besançon, France
| | - N Khayath
- Chest diseases department, Strasbourg University Hospital, 1, place de l'Hôpital, 67000 Strasbourg, France; Federation of translational medicine EA 3070, University of Strasbourg, BP426, 67091 Strasbourg, France
| | - G Peiffer
- Service de pneumologie, CHU Metz-Thionville, 57000 Metz, France
| | - P Bonniaud
- Service de pneumologie et soins intensifs respiratoires, hôpital François-Mitterrand, CHU Dijon-Bourgogne, 21079 Dijon, France
| | - J-C Dalphin
- UMR 6249 Chrono-environment, CNRS et université de Franche-Comté, Besançon, France; Service de pneumologie, CHU de Besançon, Besançon, France
| | - F De Blay
- Chest diseases department, Strasbourg University Hospital, 1, place de l'Hôpital, 67000 Strasbourg, France; Federation of translational medicine EA 3070, University of Strasbourg, BP426, 67091 Strasbourg, France
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13
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Khayath N, Doyen V, Gherasim A, Radu C, Choual I, Beck N, Jacob A, Schoettel F, Vecellio L, Domis N, de Blay F. Validation of Strasbourg environmental exposure chamber (EEC) ALYATEC ® in mite allergic subjects with asthma. J Asthma 2019; 57:140-148. [PMID: 30919704 DOI: 10.1080/02770903.2018.1563902] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Environmental Exposure Chamber (EEC) should have standardized and controlled allergenic and non-allergenic exposures to perform reproducible clinical studies. The aim was to demonstrate that mite exposure in the Alyatec® EEC could induce early (EAR) and/or late asthmatic reactions (LAR) in at least 60% of subjects allergic to mite.Methods: The EEC has a volume of 147-m3 with 20 seats. The nebulized particle number, airborne Der p1, endotoxins, and volatile organic compound (VOC) concentrations were measured. Twenty-four asthmatics allergic to mite were randomly exposed to 15, 25, and 46 ng/m3 Der p1. Specificity was assessed in not mite-sensitized asthmatics.Results: No significant endotoxin or VOC contamination was measured. The mean inter-assay CVs were 12.5% for the airborne particle number and 28.7% for airborne Der p1 concentrations. For the three Der p1 concentrations, at least 88% of the subjects developed EAR and/or LAR, and at least 46% developed a dual response. No reaction occurred with placebo or in the control group. No severe bronchial reaction occurred.Conclusions: The Alyatec® EEC demonstrated a tight control of allergenic and non-allergenic exposures. The EEC was clinically validated, with airborne Der p1 levels close to levels found in natural settings.
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Affiliation(s)
- Naji Khayath
- Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France.,Federation of Translational Medicine EA 3070, University of Strasbourg, Strasbourg, France
| | - Virginie Doyen
- Clinics of Immuno-Allergology, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Carmen Radu
- Biocluster des Haras, ALYATEC®, Strasbourg, France
| | | | - Nicole Beck
- Biocluster des Haras, ALYATEC®, Strasbourg, France
| | - Audrey Jacob
- Biocluster des Haras, ALYATEC®, Strasbourg, France
| | | | | | | | - Frédéric de Blay
- Chest Diseases Department, Strasbourg University Hospital, Strasbourg, France.,Federation of Translational Medicine EA 3070, University of Strasbourg, Strasbourg, France.,Biocluster des Haras, ALYATEC®, Strasbourg, France
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14
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Revez JA, Killian KJ, O'Byrne PM, Boulet LP, Upham JW, Gauvreau GM, Ferreira MAR. Sputum cytology during late-phase responses to inhalation challenge with different allergens. Allergy 2018; 73:1470-1478. [PMID: 29337345 DOI: 10.1111/all.13415] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND In mouse models of allergic asthma, exposure to different allergens can trigger distinct inflammatory subtypes in the airways. We investigated whether this observation extends to humans. METHODS We compared the frequency of sputum inflammatory subtypes between mild allergic asthma subjects (n = 129) exposed to different allergens in inhalation challenge tests. These tests were performed using a standardized protocol as part of clinical trials of experimental treatments for asthma, prior to drug randomization. Five allergen types were represented: the house dust mites Dermatophagoides pteronyssinus and Dermatophagoides farinae, ragweed, grass, and cat. RESULTS Of 118 individuals with a sputum sample collected before allergen challenge (baseline), 45 (38%) had paucigranulocytic, 51 (43%) eosinophilic, 11 (9%) neutrophilic, and 11 (9%) mixed granulocytic sputum. Of note, most individuals with baseline paucigranulocytic sputum developed eosinophilic (48%) or mixed granulocytic (43%) sputum 7 hours after allergen challenge, highlighting the dynamic nature of sputum inflammatory subtype in asthma. Overall, there was no difference in the frequency of sputum inflammatory subtypes following challenge with different allergen types. Similar results were observed at 24 hours after allergen challenge. CONCLUSIONS Unlike reported in mice, in humans the sputum inflammatory subtype observed after an allergen-induced asthma exacerbation is unlikely to be influenced by the type of allergen used.
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Affiliation(s)
- J. A. Revez
- QIMR Berghofer Medical Research Institute; Brisbane QLD Australia
| | - K. J. Killian
- Division of Respirology; Department of Medicine; McMaster University; Hamilton ON Canada
| | - P. M. O'Byrne
- Division of Respirology; Department of Medicine; McMaster University; Hamilton ON Canada
| | - L.-P. Boulet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec - Université Laval; Quebec City Canada
| | - J. W. Upham
- Translational Research Institute; University of Queensland; Brisbane QLD Australia
| | - G. M. Gauvreau
- Division of Respirology; Department of Medicine; McMaster University; Hamilton ON Canada
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15
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Burge PS, Moore VC, Robertson AS, Walters GI. Do laboratory challenge tests for occupational asthma represent what happens in the workplace? Eur Respir J 2018; 51:13993003.00059-2018. [PMID: 29748310 DOI: 10.1183/13993003.00059-2018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/02/2018] [Indexed: 11/05/2022]
Abstract
Specific inhalation challenge (SIC) is the diagnostic reference standard for occupational asthma; however, a positive test cannot be considered truly significant unless it can be reproduced by usual work exposures. We have compared the timing and responses during SIC in hospital to Oasys analysis of serial peak expiratory flow (PEF) during usual work exposures.All workers with a positive SIC to occupational agents between 2006 and 2015 were asked to measure PEF every 2 h from waking to sleeping for 4 weeks during usual occupational exposures. Responses were compared between the laboratory challenge and the real-world exposures at work.All 53 workers with positive SIC were included. 49 out of 53 had records suitable for Oasys analysis, 14 required more than one attempt and all confirmed occupational work-related changes in PEF. Immediate SIC reactors and deterioration within the first 2 h of starting work were significantly correlated with early recovery, and late SIC reactors and a delayed start to workplace deterioration were significantly correlated with delayed recovery. Dual SIC reactions had features of immediate or late SIC reactions at work rather than dual reactions.The concordance of timings of reactions during SIC and at work provides further validation for the clinical significance of each test.
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Affiliation(s)
- P Sherwood Burge
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| | - Vicky C Moore
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
| | | | - Gareth I Walters
- Occupational Lung Disease Unit, Birmingham Heartlands Hospital, Birmingham, UK
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16
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Roberts G, Boyle R, Bryce PJ, Crane J, Hogan SP, Saglani S, Wickman M, Woodfolk JA. Developments in the field of clinical allergy in 2015 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2017; 46:1389-1397. [PMID: 27748974 DOI: 10.1111/cea.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
In the second of two papers, we describe developments in the field of clinical allergy as documented by Clinical and Experimental Allergy in 2015. Epidemiology, clinical allergy, asthma and rhinitis are all covered.
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Affiliation(s)
- G Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK. .,NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK. .,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK.
| | - R Boyle
- Paediatric Research Unit, Imperial College London, London, UK
| | - P J Bryce
- Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - M Wickman
- Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden
| | - J A Woodfolk
- Allergy Division, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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17
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Stenberg H, Diamant Z, Ankerst J, Bjermer L, Tufvesson E. Small airway involvement in the late allergic response in asthma. Clin Exp Allergy 2017; 47:1555-1565. [PMID: 28940836 DOI: 10.1111/cea.13036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/02/2017] [Accepted: 09/17/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Allergy and asthma are closely linked. Inhalation of allergen induces an early allergic response (EAR) within the airways of allergic asthmatic subjects, which is followed by a late allergic response (LAR) in approximately 50% of the subjects. The LAR is defined as a drop in forced expiratory volume in 1 second (FEV1 ) from baseline usually occurring 4-8 hours after exposure and is believed to affect small airways. However, FEV1 is insensitive to changes in small airway physiology. OBJECTIVE Our aim was to investigate and compare the pathophysiological processes in large and small airways during the EAR and the LAR and to characterize subjects with both an EAR and a LAR (dual responders) versus those with an EAR only (single responders). METHODS Thirty-four subjects with allergic asthma underwent an inhaled allergen challenge. Lung physiology was assessed by spirometry, impulse oscillometry (IOS), body plethysmography, inert gas washout, single breath methane dilution carbon monoxide diffusion and exhaled breath temperature (EBT), at baseline and repeatedly for 23 hours post-allergen challenge. RESULTS Peripheral airway resistance, air trapping and ventilation heterogeneity were significantly increased in dual responders (n = 15) compared to single responders (n = 19) 6-8 hours post-challenge. Parameters of peripheral airway resistance and ventilation heterogeneity, measured with IOS and inert gas washout, respectively, correlated at baseline and during the allergic airway response in all subjects. CONCLUSION The LAR involves increased resistance and ventilation defects within the peripheral airways. Alternative definitions of the LAR including small airways pathophysiology could be considered. CLINICAL RELEVANCE Small airway dysfunction during the LAR suggests that dual responders may have more extensive airway pathology and underscores the relevance of small airways assessment in asthma.
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Affiliation(s)
- H Stenberg
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Z Diamant
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden.,Department of Clinical Pharmacy and Pharmacology, QPS-NL, The University Medical Center, University of Groningen, Groningen, the Netherlands
| | - J Ankerst
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - L Bjermer
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - E Tufvesson
- Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
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18
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Kowal K, Gielicz A, Sanak M. The effect of allergen-induced bronchoconstriction on concentration of 5-oxo-ETE in exhaled breath condensate of house dust mite-allergic patients. Clin Exp Allergy 2017; 47:1253-1262. [PMID: 28763131 DOI: 10.1111/cea.12990] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 06/27/2017] [Accepted: 07/22/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Arachidonic acid metabolites regulate several aspects of airway function including inflammation, muscle contraction and mucous secretion. OBJECTIVE The aim of this study was to evaluate concentration of selected 5-lipoxygenase- and cyclooxygenase-derived eicosanoids in exhaled breath condensate (EBC) during allergen-induced bronchoconstriction. METHODS The study was performed on 24 allergic rhinitis/asthma patients sensitized to a house dust mite (HDM) Dermatophagoides pteronyssinus (Dp) and 13 healthy controls (HCs). Bronchial challenge with Dp extract was performed only in the allergic patients. EBC samples were collected before (T0 ) and during Dp-induced bronchoconstriction (TEAR ). Eicosanoid concentration was measured using HPLC-tandem mass spectrometry. RESULTS Significant bronchoconstriction after Dp challenge was demonstrated in 15 patients (Rs), while in 9 patients (NRs) no asthmatic response could be detected. At T0 the most abundant eicosanoids in EBC of HDM-allergic patients were LTB4 and 5-oxo-ETE, while in HCs EBC concentration of LTB4 was significantly greater than that of 5-oxo-ETE. Allergen challenge resulted in significant increase in EBC concentration of 5-oxo-ETE, LTD4 and 8-iso-PGE2 only in Rs. At TEAR , the relative change of 5-oxo-ETE concentration in EBC correlated with decrease of peripheral blood eosinophilia (R = -0.774; P = .0012). Moreover, the relative increase of 5-oxo-ETE in EBC at TEAR significantly correlated with the severity of the subsequent late asthmatic response (R = 0.683, P = .007). CONCLUSION Our study demonstrates significant up-regulation of 5-oxo-ETE synthesis in HDM-allergic patients and indicates possible involvement of that mediator in the pathogenesis of allergic asthma.
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Affiliation(s)
- K Kowal
- Department of Allergology and Internal Medicine, Medical University of Bialystok, Bialystok, Poland.,Department of Experimental Allergology and Immunology, Medical University of Bialystok, Bialystok, Poland
| | - A Gielicz
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - M Sanak
- Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
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19
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Navarro AM, Delgado J, Muñoz-Cano RM, Dordal MT, Valero A, Quirce S. Allergic respiratory disease (ARD), setting forth the basics: proposals of an expert consensus report. Clin Transl Allergy 2017; 7:16. [PMID: 28533901 PMCID: PMC5437581 DOI: 10.1186/s13601-017-0150-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/03/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The variability of symptoms observed in patients with respiratory allergy often hampers classification based on the criteria proposed in guidelines on rhinitis and asthma. OBJECTIVES We assessed specific aspects of allergic respiratory disease (ARD) that are not explicitly addressed in the guidelines in order to issue specific recommendations and thus optimize clinical practice. METHODS Using the Delphi technique, 40 Spanish allergists were surveyed to reach consensus on 71 items related to ARD. RESULTS Consensus was achieved for 95.7% of the items. These included the following: the clinical manifestations of ARD are heterogeneous and individual airborne allergens can be related to specific clinical profiles; the optimal approach in patients with ARD is based on the global assessment of rhinoconjunctivitis and asthma; aeroallergens are largely responsible for the clinical features and severity of the disease; and clinical expression is associated with the period of environmental exposure to the allergen. Pharmacological treatment of ARD is often based on the intensity of symptoms recorded during previous allergen exposures and cannot always be administered following a step-up approach, as recommended in clinical practice guidelines. Allergen immunotherapy (AIT) is the only option for overall treatment of respiratory symptoms using an etiological approach. AIT can modify the prognosis of ARD and should therefore be considered a valuable first-line treatment. CONCLUSIONS The present study highlights gaps in current asthma and rhinitis guidelines and addresses specific aspects of ARD, such as global assessment of both asthma and rhinitis or the specific role of variable allergen exposure in the clinical expression of the disease.
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Affiliation(s)
- Ana M. Navarro
- UGC of Allergy, Hospital El Tomillar , Carretera Alcalá - Dos Hermanas km 6, 41700 Dos Hermanas, Seville Spain
| | - Julio Delgado
- UGC of Allergy, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Rosa M. Muñoz-Cano
- Allergy Unit, Pneumology Department, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - M. Teresa Dordal
- Allergy Service, Hospital Municipal, Badalona Serveis Assistencials, Badalona, Spain
- Allergy Service, Sant Pere Claver Fundació Sanitària, Barcelona, Spain
| | - Antonio Valero
- Allergy Unit, Pneumology Department, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
| | - Santiago Quirce
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | - Behalf of the ARD Study Group
- UGC of Allergy, Hospital El Tomillar , Carretera Alcalá - Dos Hermanas km 6, 41700 Dos Hermanas, Seville Spain
- UGC of Allergy, Hospital Universitario Virgen Macarena, Seville, Spain
- Allergy Unit, Pneumology Department, Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain
- Allergy Service, Hospital Municipal, Badalona Serveis Assistencials, Badalona, Spain
- Allergy Service, Sant Pere Claver Fundació Sanitària, Barcelona, Spain
- Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
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20
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Clifford RL, Jones MJ, MacIsaac JL, McEwen LM, Goodman SJ, Mostafavi S, Kobor MS, Carlsten C. Inhalation of diesel exhaust and allergen alters human bronchial epithelium DNA methylation. J Allergy Clin Immunol 2016; 139:112-121. [PMID: 27321436 DOI: 10.1016/j.jaci.2016.03.046] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND Allergic disease affects 30% to 40% of the world's population, and its development is determined by the interplay between environmental and inherited factors. Air pollution, primarily consisting of diesel exhaust emissions, has increased at a similar rate to allergic disease. Exposure to diesel exhaust may play a role in the development and progression of allergic disease, in particular allergic respiratory disease. One potential mechanism underlying the connection between air pollution and increased allergic disease incidence is DNA methylation, an epigenetic process with the capacity to integrate gene-environment interactions. OBJECTIVE We sought to investigate the effect of allergen and diesel exhaust exposure on bronchial epithelial DNA methylation. METHODS We performed a randomized crossover-controlled exposure study to allergen and diesel exhaust in humans, and measured single-site (CpG) resolution global DNA methylation in bronchial epithelial cells. RESULTS Exposure to allergen alone, diesel exhaust alone, or allergen and diesel exhaust together (coexposure) led to significant changes in 7 CpG sites at 48 hours. However, when the same lung was exposed to allergen and diesel exhaust but separated by approximately 4 weeks, significant changes in more than 500 sites were observed. Furthermore, sites of differential methylation differed depending on which exposure was experienced first. Functional analysis of differentially methylated CpG sites found genes involved in transcription factor activity, protein metabolism, cell adhesion, and vascular development, among others. CONCLUSIONS These findings suggest that specific exposures can prime the lung for changes in DNA methylation induced by a subsequent insult.
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Affiliation(s)
- Rachel L Clifford
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meaghan J Jones
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia L MacIsaac
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa M McEwen
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah J Goodman
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sara Mostafavi
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada; Canadian Institute for Advanced Research, Toronto, Ontario, Canada
| | - Michael S Kobor
- Centre for Molecular Medicine and Therapeutics, Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada; Canadian Institute for Advanced Research, Toronto, Ontario, Canada; Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Carlsten
- Air Pollution Exposure Laboratory, Chan-Yeung Centre for Occupational and Environmental Lung Disease, Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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