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Jensen SK, Melgaard ME, Pedersen CET, Yang L, Vahman N, Thyssen JP, Schoos AMM, Stokholm J, Bisgaard H, Chawes B, Bønnelykke K. Limited clinical role of blood eosinophil levels in early life atopic disease: A mother-child cohort study. Pediatr Allergy Immunol 2023; 34:e14050. [PMID: 38010010 DOI: 10.1111/pai.14050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/10/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Blood eosinophil count is a well-established biomarker of atopic diseases in older children and adults. However, its predictive role for atopic diseases in preschool children is not well established. OBJECTIVE To investigate the association between blood eosinophil count in children and development of atopic diseases up to age 6 years. METHODS We investigated blood eosinophil count at age 18 months and 6 years in relation to recurrent wheeze/asthma, atopic dermatitis, allergic rhinitis, and allergic sensitization during the first 6 years of life in the two Copenhagen Prospective Studies on Asthma in Childhood cohorts (n = 1111). Blood eosinophil count was investigated in association with remission of existing atopic disease, current atopic disease, and later development of atopic disease. RESULTS Blood eosinophil count at 18 months was not associated with current wheezing/asthma or atopic dermatitis, while blood eosinophil count at age 6 years was associated with increased occurrence of current wheezing/asthma (OR = 1.1; 1.04-1.16, p = .0005), atopic dermatitis (OR = 1.06; 1.01-1.1, p = .02), and allergic rhinitis (OR = 1.11; 1.05-1.18, p = .0002). Blood eosinophil count at 18 months did not predict persistence or development of recurrent wheeze/asthma or atopic dermatitis at age 6 years. CONCLUSION Blood eosinophil count at 18 months was not associated with current wheezing/asthma or atopic dermatitis and did not predict persistence or development of disease. This implies a limited clinical role of blood eosinophil levels in early-life atopic disease and questions the clinical value of blood eosinophil counts measured in toddlers as a predictive biomarker for subsequent atopic disease in early childhood.
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Affiliation(s)
- Signe Kjeldgaard Jensen
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mathias Elsner Melgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Casper-Emil Tingskov Pedersen
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Luo Yang
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nilo Vahman
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ann-Marie M Schoos
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
| | - Jakob Stokholm
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Pediatrics, Slagelse Hospital, Slagelse, Denmark
- Section of Microbiology and Fermentation, Department of Food Science, University of Copenhagen, Copenhagen, Denmark
| | - Hans Bisgaard
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Chawes
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- Copenhagen Prospective Studies on Asthma in Childhood (COPSAC), Department of Pediatrics, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Romero-Tapia SDJ, Becerril-Negrete JR, Castro-Rodriguez JA, Del-Río-Navarro BE. Early Prediction of Asthma. J Clin Med 2023; 12:5404. [PMID: 37629446 PMCID: PMC10455492 DOI: 10.3390/jcm12165404] [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: 06/30/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
The clinical manifestations of asthma in children are highly variable, are associated with different molecular and cellular mechanisms, and are characterized by common symptoms that may diversify in frequency and intensity throughout life. It is a disease that generally begins in the first five years of life, and it is essential to promptly identify patients at high risk of developing asthma by using different prediction models. The aim of this review regarding the early prediction of asthma is to summarize predictive factors for the course of asthma, including lung function, allergic comorbidity, and relevant data from the patient's medical history, among other factors. This review also highlights the epigenetic factors that are involved, such as DNA methylation and asthma risk, microRNA expression, and histone modification. The different tools that have been developed in recent years for use in asthma prediction, including machine learning approaches, are presented and compared. In this review, emphasis is placed on molecular mechanisms and biomarkers that can be used as predictors of asthma in children.
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Affiliation(s)
- Sergio de Jesus Romero-Tapia
- Health Sciences Academic Division (DACS), Juarez Autonomous University of Tabasco (UJAT), Villahermosa 86040, Mexico
| | - José Raúl Becerril-Negrete
- Department of Clinical Immunopathology, Universidad Autónoma del Estado de México, Toluca 50000, Mexico;
| | - Jose A. Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330077, Chile;
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Grandinetti R, Fainardi V, Caffarelli C, Capoferri G, Lazzara A, Tornesello M, Meoli A, Bergamini BM, Bertelli L, Biserna L, Bottau P, Corinaldesi E, De Paulis N, Dondi A, Guidi B, Lombardi F, Magistrali MS, Marastoni E, Pastorelli S, Piccorossi A, Poloni M, Tagliati S, Vaienti F, Gregori G, Sacchetti R, Mari S, Musetti M, Antodaro F, Bergomi A, Reggiani L, Caramelli F, De Fanti A, Marchetti F, Ricci G, Esposito S. Risk Factors Affecting Development and Persistence of Preschool Wheezing: Consensus Document of the Emilia-Romagna Asthma (ERA) Study Group. J Clin Med 2022; 11:6558. [PMID: 36362786 PMCID: PMC9655250 DOI: 10.3390/jcm11216558] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 07/30/2023] Open
Abstract
Wheezing at preschool age (i.e., before the age of six) is common, occurring in about 30% of children before the age of three. In terms of health care burden, preschool children with wheeze show double the rate of access to the emergency department and five times the rate of hospital admissions compared with school-age asthmatics. The consensus document aims to analyse the underlying mechanisms involved in the pathogenesis of preschool wheezing and define the risk factors (i.e., allergy, atopy, infection, bronchiolitis, genetics, indoor and outdoor pollution, tobacco smoke exposure, obesity, prematurity) and the protective factors (i.e., probiotics, breastfeeding, vitamin D, influenza vaccination, non-specific immunomodulators) associated with the development of the disease in the young child. A multidisciplinary panel of experts from the Emilia-Romagna Region, Italy, addressed twelve key questions regarding managing preschool wheezing. Clinical questions have been formulated by the expert panel using the PICO format (Patients, Intervention, Comparison, Outcomes). Systematic reviews have been conducted on PubMed to answer these specific questions and formulate recommendations. The GRADE approach has been used for each selected paper to assess the quality of the evidence and the degree of recommendations. Based on a panel of experts and extensive updated literature, this consensus document provides insight into the pathogenesis, risk and protective factors associated with the development and persistence of preschool wheezing. Undoubtedly, more research is needed to improve our understanding of the disease and confirm the associations between certain factors and the risk of wheezing in early life. In addition, preventive strategies must be promoted to avoid children's exposure to risk factors that may permanently affect respiratory health.
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Affiliation(s)
- Roberto Grandinetti
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Carlo Caffarelli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Gaia Capoferri
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Angela Lazzara
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marco Tornesello
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Aniello Meoli
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Barbara Maria Bergamini
- Paediatric Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University of Modena and Reggio Emilia, 41125 Modena, Italy
| | - Luca Bertelli
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Loretta Biserna
- Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Paolo Bottau
- Paediatrics Unit, Imola Hospital, 40026 Imola, Italy
| | | | - Nicoletta De Paulis
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Arianna Dondi
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Battista Guidi
- Hospital and Territorial Paediatrics Unit, Pavullo, 41026 Pavullo Nel Frignano, Italy
| | | | - Maria Sole Magistrali
- Paediatrics and Neonatology Unit, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy
| | - Elisabetta Marastoni
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | | | - Alessandra Piccorossi
- Paediatrics and Paediatric Intensive Care Unit, Cesena Hospital, AUSL Romagna, 47521 Cesena, Italy
| | - Maurizio Poloni
- Paediatrics Unit, Rimini Hospital, AUSL Romagna, 47921 Rimini, Italy
| | | | - Francesca Vaienti
- Paediatrics Unit, G.B. Morgagni—L. Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy
| | - Giuseppe Gregori
- Primary Care Pediatricians, AUSL Piacenza, 29121 Piacenza, Italy
| | | | - Sandra Mari
- Primary Care Pediatricians, AUSL Parma, 43126 Parma, Italy
| | | | | | - Andrea Bergomi
- Primary Care Pediatricians, AUSL Modena, 41125 Modena, Italy
| | | | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessandro De Fanti
- Paediatrics Unit, Santa Maria Nuova Hospital, AUSL-IRCCS of Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Federico Marchetti
- Paediatrics and Neonatology Unit, Ravenna Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Giampaolo Ricci
- Pediatric Clinic, Scientific Institute for Research and Healthcare (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
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Chatziparasidis G, Bush A. Enigma variations: The multi-faceted problems of pre-school wheeze. Pediatr Pulmonol 2022; 57:1990-1997. [PMID: 35652262 DOI: 10.1002/ppul.26027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/27/2022] [Accepted: 05/31/2022] [Indexed: 11/08/2022]
Abstract
Numerous publications on wheezing disorders in children younger than 6 years have appeared in the medical literature over the last decades with the aim of shedding light on the mechanistic pathways (endotypes) and treatment. Nevertheless, there is yet no consensus as to the appropriate way to manage preschool wheeze mainly because of the lack of a clear definition of "preschool asthma" and the paucity of scientific evidence concerning its underlying endotypes. A symptom-based approach is inadequate since the human airway can respond to external stimuli with a limited range of symptoms and signs, including cough and wheeze, and these manifestations represent the final expression of many clinical entities with potentially different pathophysiologies requiring different individualized treatments. Hence, new studies challenge the symptom-based approach and promote the importance of managing the wheezy child based on the "airway phenotype." This will enable the clinician to identify not only the child with a serious underlying pathology (e.g., a structural airway disorder or immunodeficiency) who is in need of prompt and specific treatment but also increase the specificity of treatment for the child with symptoms suggestive of an "asthma" syndrome. In the latter case, focus should be given to the identification of treatable traits. This review summarizes the current understanding in management of preschool wheezing and highlights the unmet need for further research.
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Affiliation(s)
- Grigorios Chatziparasidis
- Department of Paediatrics, Metropolitan Hospital, Athens, and Primary Cilia Dyskinesia Unit, University of Thessaly, Volos, Greece
| | - Andrew Bush
- Departments of Paediatrics and Paediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust and Imperial College, London, UK
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5
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Abstract
The diagnosis of asthma can be particularly difficult in young children, in whom wheezing is not always synonym with asthma. It is also difficult to predict which preschool children with wheeze will go on to be true asthmatics. In this chapter, we will characterize preschool wheezing and asthma and discuss early risk factors for the development of severe asthma. We will also review risk factors for severe acute wheezing in young children. Finally, we will describe the natural history and prognosis of wheezing and some of the attempts at early identification of children who will develop severe asthma.
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Affiliation(s)
- Erick Forno
- Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA USA
| | - Sejal Saglani
- Imperial College London, National Heart & Lung Institute, London, UK
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6
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Lee YJ, Fujisawa T, Kim CK. Biomarkers for Recurrent Wheezing and Asthma in Preschool Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:16-28. [PMID: 30479074 PMCID: PMC6267183 DOI: 10.4168/aair.2019.11.1.16] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/08/2018] [Accepted: 09/10/2018] [Indexed: 01/21/2023]
Abstract
Wheezing is one of the characteristic symptoms of asthma, but all preschool children with wheezing are not diagnosed with asthma. Preschool children are not cooperative enough to participate in spirometry and invasive tests. Thus, there is no conventional method to diagnose asthma in preschool children. We reviewed studies on non-invasive biomarkers for assessing asthma in preschool children. Specimens that can be easily obtained by non-invasive methods are blood, exhaled breath and urine. Eosinophils, eosinophil cationic protein and eosinophil-derived neurotoxin (EDN) in blood are helpful in evaluating eosinophilic inflammation of the airways. Exhaled breath contains nitric oxide, volatile organic compounds, various cytokines and mediators as analytical components. Fraction of exhaled nitric oxide has been used to assess the degree of eosinophil inflammation and has been standardized in school-age children and adults, but not yet in preschool children. Exhaled breath condensate (EBC) pH and various cytokines/mediators that are detected in EBC seem to be promising biomarkers for assessing asthma, but need more standardization and validation. There are several biomarkers useful for assessing asthma, but none are ideal. Some biomarkers need standardized methods of obtaining samples from uncooperative preschool children for clinical use and require sufficient validation. Recently, another activated eosinophil marker, serum EDN, has shown promising results as a biomarker for recurrent wheezing and asthma in preschool children.
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Affiliation(s)
- Yong Ju Lee
- Department of Pediatrics, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
| | | | - Chang Keun Kim
- Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea.,SKIMS-BIO Co., Ltd. Seoul, Korea.
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Castro-Rodriguez JA, Cifuentes L, Martinez FD. Predicting Asthma Using Clinical Indexes. Front Pediatr 2019; 7:320. [PMID: 31463300 PMCID: PMC6707805 DOI: 10.3389/fped.2019.00320] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/15/2019] [Indexed: 12/14/2022] Open
Abstract
Asthma is no longer considered a single disease, but a common label for a set of heterogeneous conditions with shared clinical symptoms but associated with different cellular and molecular mechanisms. Several wheezing phenotypes coexist at preschool age but not all preschoolers with recurrent wheezing develop asthma at school-age; and since at the present no accurate single screening test using genetic or biochemical markers has been developed to determine which preschooler with recurrent wheezing will have asthma at school age, the asthma diagnosis still needs to be based on clinical predicted models or scores. The purpose of this review is to summarize the existing and most frequently used asthma predicting models, to discuss their advantages/disadvantages, and their accomplishment on all the necessary consecutive steps for any predictive model. Seven most popular asthma predictive models were reviewed (original API, Isle of Wight, PIAMA, modified API, ucAPI, APT Leicestersher, and ademAPI). Among these, the original API has a good positive LR~7.4 (increases the probability of a prediction of asthma by 2-7 times), and it is also simple: it only requires four clinical parameters and a peripheral blood sample for eosinophil count. It is thus an easy model to use in any rural or urban health care system. However, because its negative LR is not good, it cannot be used to rule out the development of asthma.
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Affiliation(s)
- Jose A Castro-Rodriguez
- Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Lorena Cifuentes
- Division of Pediatrics, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, United States
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Soh JE, Kim KM, Kwon JW, Kim HY, Seo JH, Kim HB, Lee SY, Jang GC, Song DJ, Kim WK, Jung YH, Hong SJ, Shim JY. Recurrent wheeze and its relationship with lung function and airway inflammation in preschool children: a cross-sectional study in South Korea. BMJ Open 2017; 7:e018010. [PMID: 28993393 PMCID: PMC5640071 DOI: 10.1136/bmjopen-2017-018010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Relationship between recurrent wheeze and airway function and inflammation in preschool children is not fully known. OBJECTIVE To investigate the relationship between recurrent wheeze and airway inflammation, lung function, airway hyper-reactivity (AHR) and atopy in preschool children. DESIGN Observational study, comparing forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and mid-forced expiratory flow (FEF25%-75%), dose-response slope (DRS), exhaled nitric oxide (eNO) and atopic sensitisation between children with recurrent wheeze and those without. SETTING Population-based, cross-sectional study in Seoul and the Gyeonggi province of Korea conducted as a government-funded programme to perform standardised measurement of the prevalence of allergic diseases, and related factors, in preschool children. PARTICIPANTS 900 children aged 4-6 years. PRIMARY AND SECONDARY OUTCOME MEASURES: eNO, FEV1/FVC, FEF25%-75%, DRS, atopic sensitisation and allergic diseases. METHODS Children completed the modified International Study of Asthma and Allergies in Childhood questionnaire and underwent eNO assessments, spirometry, methacholine bronchial provocation tests and skin prick tests. Recurrent wheeze was defined as having a lifetime wheeze of more than three episodes, based on the questionnaire. The frequency of hospitalisation and emergency room visits was also obtained by means of the questionnaire. 'Current' wheeze was defined as having symptoms or treatments within the past 12 months. RESULTS The prevalence of recurrent wheeze was 13.4%. Children with recurrent wheeze showed a higher prevalence of lifetime or current allergic rhinitis (p=0.01 and p=0.002, respectively) and lifetime atopic dermatitis (p=0.007). Children with recurrent wheeze showed lower FEV1/FVC (p=0.033) and FEF25%-75% (p=0.004), and higher eNO levels (p=0.013) than those without recurrent wheeze. However, the DRS, prevalence of atopic sensitisation and serum IgE levels were not significantly different between the two groups. CONCLUSIONS Recurrent wheeze in preschool children may be associated with airway inflammation and diminished airway function, but not with AHR or atopy.
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Affiliation(s)
- Ji Eun Soh
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung-Moon Kim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Republic of Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Gwang-Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Ilsan, Republic of Korea
| | - Dae-Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Young-Ho Jung
- Department of Pediatrics, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Moustaki M, Loukou I, Tsabouri S, Douros K. The Role of Sensitization to Allergen in Asthma Prediction and Prevention. Front Pediatr 2017; 5:166. [PMID: 28824890 PMCID: PMC5535113 DOI: 10.3389/fped.2017.00166] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/13/2017] [Indexed: 12/11/2022] Open
Abstract
The burden of asthma in childhood is considerable worldwide, although some populations are much more affected than others. Many attempts have been made by different investigators to identify the factors that could predict asthma development or persistence in childhood. In this review, the relation between atopic sensitization as an indicator of allergy and asthma in childhood will be discussed. Cross sectional studies, carried out in different countries, failed to show any firm correlation between asthma and atopic sensitization. Birth cohort mainly of infants at high risk for asthma and case-control studies showed that atopic sensitization was a risk factor for current asthma in children older than 6 years. In general, clear relations are observed mostly in affluent Western countries, whereas in less affluent countries, the picture is more heterogeneous. For the prediction of asthma development or persistence in school age children, other prerequisites should also be fulfilled such as family history of asthma and wheezing episodes at preschool age. Despite the conductance of different studies regarding the potential role of allergen avoidance for the primary prevention of childhood asthma, it does not seem that this approach is of benefit for primary prevention purposes. However, the identification of children at risk for asthma is of benefit as these subjects could be provided with the best management practices and with the appropriate secondary prevention measures.
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Affiliation(s)
- Maria Moustaki
- Cystic Fibrosis Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Ioanna Loukou
- Cystic Fibrosis Unit, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Sophia Tsabouri
- Department of Paediatrics, Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Konstantinos Douros
- Pediatric Allergy and Respiratory Unit, 3rd Department of Pediatrics, "Attikon" Hospital, University of Athens School of Medicine, Athens, Greece
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Gabet S, Just J, Couderc R, Bousquet J, Seta N, Momas I. Early polysensitization is associated with allergic multimorbidity in PARIS birth cohort infants. Pediatr Allergy Immunol 2016; 27:831-837. [PMID: 27501330 DOI: 10.1111/pai.12622] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Profiles of allergic sensitization are poorly documented in infancy. Relations between early sensitization and allergic morbidity need to be clarified. METHODS This study dealt with children involved in the Pollution and Asthma Risk: an Infant Study (PARIS), a population-based prospective birth cohort. Allergic sensitization to twelve food and four inhalant allergens was assessed at 18 months and defined by a specific immunoglobulin E (IgE) level ≥0.35 kUA /l. Health data were collected by standardized questionnaires at 2 and 6 years. Early allergic profiles were identified by an unsupervised cluster analysis based on health data at 2 years and IgE measurements. Profiles were compared with regard to allergic morbidity and multimorbidity at 6 years. RESULTS Sensitization to any allergen concerned 13.6% of infants. By cluster analysis, 1525 infants were grouped into three profiles: 89.2% not or rarely sensitized (only 3.7% of sensitized), 9.2% mainly sensitized to one or few allergens (45.2% of monosensitized and 45.9% of paucisensitized) and 1.6% all polysensitized. The prevalence of doctor-diagnosed asthma, rhinitis, eczema, food allergy and multimorbidity at 2 years increased from profile one to profile three (p-trend <0.001). At 6 years, symptoms of current asthma, rhinitis, eczema and multimorbidity were significantly more frequent in the last two profiles. CONCLUSIONS This study highlights, as early as 18 months of age, three profiles of increasing severity with regard to allergic sensitization and diseases. These profiles also differ in terms of allergic morbidity at 6 years. Early sensitization can predict allergic multimorbidity in childhood, and in the case of early polysensitization, multimorbidity is more frequent as soon as infancy.
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Affiliation(s)
- Stephan Gabet
- EA 4064 Épidémiologie environnementale, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Cellule Cohorte, Direction de l'Action Sociale, de l'Enfance et de la Santé, Mairie de Paris, Paris, France
| | - Jocelyne Just
- Centre de l'Asthme et des Allergies, Groupe Hospitalier d'Enfants Trousseau-La Roche Guyon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rémy Couderc
- Service de Biochimie et Biologie Moléculaire, Hôpital d'Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean Bousquet
- VIMA: Vieillissement et maladies chroniques. Approches épidémiologiques et de santé publique, U1168, INSERM, Paris, France.,UMR-S 1168, Université de Versailles Saint-Quentin, Versailles, France
| | - Nathalie Seta
- EA 4064 Épidémiologie environnementale, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Département de Biochimie, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Momas
- EA 4064 Épidémiologie environnementale, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Cellule Cohorte, Direction de l'Action Sociale, de l'Enfance et de la Santé, Mairie de Paris, Paris, France
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11
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Gaillard EA, McNamara PS, Murray CS, Pavord ID, Shields MD. Blood eosinophils as a marker of likely corticosteroid response in children with preschool wheeze: time for an eosinophil guided clinical trial? Clin Exp Allergy 2016; 45:1384-95. [PMID: 25809678 DOI: 10.1111/cea.12535] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Childhood wheezing is common particularly in children under the age of 6 years and in this age group is generally referred to as preschool wheezing. Particular diagnostic and treatment uncertainties exist in these young children due to the difficulty in obtaining objective evidence of reversible airways narrowing and inflammation. A diagnosis of asthma depends on the presence of relevant clinical signs and symptoms and the demonstration of reversible airways narrowing on lung function testing, which is difficult to perform in young children. Few treatments are available and inhaled corticosteroids are the recommended preventer treatment in most international asthma guidelines. There is, however, considerable controversy about its effectiveness in children with preschool wheeze and a corticosteroid responder phenotype has not been established. These diagnostic and treatment uncertainties in conjunction with the knowledge of corticosteroid side effects, in particular the reduction of growth velocity, have resulted in a variable approach to inhaled corticosteroid prescribing by medical practitioners and a reluctance in carers to regularly administer the treatment. Identifying children who are likely responders to corticosteroid therapy would be a major benefit in the management of this condition. Eosinophils have emerged as a promising biomarker of corticosteroid responsive airways disease, and evaluation of this biomarker in sputum has successfully been employed to direct management in adults with asthma. Obtaining sputum from young children is time consuming and difficult, and it is hard to justify more invasive procedures such as a bronchoscopy in young children routinely. Recently, in children, interest has shifted to assessing the value of less invasive biomarkers of likely corticosteroid response and the biomarker 'blood eosinophils' has emerged as an attractive candidate. The aim of this review was to summarize the evidence for blood eosinophils as a predictive biomarker for corticosteroid responsive disease with a particular focus on the difficult area of preschool wheeze.
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Affiliation(s)
- E A Gaillard
- Department of Infection Immunity and Inflammation, NIHR Leicester Respiratory Biomedical Research Unit, Institute for Lung Health, University of Leicester, Leicester, Leicestershire, UK
| | - P S McNamara
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Alder Hey Children's Hospital, Liverpool, Merseyside, UK
| | - C S Murray
- Respiratory and Allergy Centre, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - I D Pavord
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - M D Shields
- Centre for Infection and Immunity, Health Sciences, Queen's University Belfast, Belfast, UK
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12
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Bannier MAGE, van de Kant KDG, Jöbsis Q, Dompeling E. Biomarkers to predict asthma in wheezing preschool children. Clin Exp Allergy 2016; 45:1040-50. [PMID: 25409553 DOI: 10.1111/cea.12460] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Wheezing in preschool children is a very common symptom. An adequate prediction of asthma in these children is difficult and cannot be reliably assessed with conventional clinical tools. The study of potential predictive biomarkers in various media, ranging from invasive sampling (e.g. bronchoscopy) to non-invasive sampling (lung function testing and exhaled breath analysis), was comprehensively reviewed. The evolution in biomarker discovery has resulted in an 'omics' approach, in which hundreds of biomarkers in the field of genomics, proteomics, metabolomics, and 'breath-omics' can be simultaneously studied. First, results on gene expression and exhaled breath profiles in predicting an early asthma diagnosis are promising. However, many hurdles need to be overcome before clinical implementation is possible. To reliably predict asthma in a wheezing child, probably a holistic approach is needed, combining clinical information with blood sampling, lung function tests, and potentially exhaled breath analysis. The further development of predictive, non-invasive biomarkers may eventually improve an early asthma diagnosis in wheezing preschool children and assist clinicians in early treatment decision-making.
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Affiliation(s)
- M A G E Bannier
- Department of Paediatric Respiratory Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - K D G van de Kant
- Department of Paediatric Respiratory Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Q Jöbsis
- Department of Paediatric Respiratory Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - E Dompeling
- Department of Paediatric Respiratory Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands
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13
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Amat F, Saint-Pierre P, Bourrat E, Nemni A, Couderc R, Boutmy-Deslandes E, Sahraoui F, Pansé I, Bagot M, Foueré S, Just J. Early-onset atopic dermatitis in children: which are the phenotypes at risk of asthma? Results from the ORCA cohort. PLoS One 2015; 10:e0131369. [PMID: 26107938 PMCID: PMC4479437 DOI: 10.1371/journal.pone.0131369] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/31/2015] [Indexed: 11/29/2022] Open
Abstract
Background Atopic dermatitis (AD) is known to predate asthma and other atopic disorders described under the term “atopic march”. However, this classic sequence is not always present and only a few studies have addressed children at risk of developing asthma. The objective of this study is to define early-onset AD phenotypes leading to asthma. Methods We performed a cluster analysis with 9 variables of 214 infants with early-onset AD prospectively enrolled in the ORCA cohort and followed each year on the occurrence of asthma until the age of 6. Results We identified 3 clusters - cluster 1 (n = 94) with low to no sensitization to food (27.7%) or aeroallergens (10.6%) and moderate AD severity (SCORAD 25.29 +/- 14.6) called “AD with low sensitization”; - cluster 2 (n = 84) characterized by a higher AD severity (SCORAD 32.66+/-16.6) and frequent sensitization to food (98.9%) or aeroallergens (26.2%), most likely multiple (96.4% for food allergens), called “AD with multiple sensitizations” - cluster 3 (n = 36) with parental history, moderate AD severity (SCORAD 24.46+/-15.7), moderate rate of sensitization to food allergens (38.9%) (exclusively single) with no sensitization to aeroallergens, called “AD with familial history of asthma”. Percentages of children suffering from asthma at the age of 6 were higher in clusters 2 and 3 (36.1% and 33.3% respectively versus 14.9% in cluster 1, p<0.01). Conclusion Two phenotypes in infants with early-onset AD convey a higher risk of developing asthma during childhood: multiple sensitization and familial history of asthma.
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Affiliation(s)
- Flore Amat
- Department of Allergology—Centre de l’Asthme et des Allergies, Hôpital d’Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Equipe EPAR, Institut Pierre Louis d’Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
- UPMC Univ Paris 06, Sorbonne Universités, Paris, France
- * E-mail:
| | - Philippe Saint-Pierre
- Equipe EPAR, Institut Pierre Louis d’Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
- UPMC Univ Paris 06, Sorbonne Universités, Paris, France
- Laboratory of Theoretical and Applied Statistics-Laboratoire de Statistiques Théoriques et Appliquées, UPMC Univ Paris 06, Sorbonne Universités, Paris, France
| | - Emmanuelle Bourrat
- Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ariane Nemni
- Department of Allergology—Centre de l’Asthme et des Allergies, Hôpital d’Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Rémy Couderc
- Laboratory of Biochemistry and Molecular Biology- Laboratoire de Biochimie et Biologie Moléculaire, Hôpital d’Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Boutmy-Deslandes
- Department of Biostatistics and Medical Informatics-Service de Biostatistiques et informatique médicale, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
- U717, INSERM, Université Paris 7, Paris, France
| | - Fatiha Sahraoui
- Department of Allergology—Centre de l’Asthme et des Allergies, Hôpital d’Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Pansé
- Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Martine Bagot
- Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sébastien Foueré
- Department of Dermatology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jocelyne Just
- Department of Allergology—Centre de l’Asthme et des Allergies, Hôpital d’Enfants Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France
- Equipe EPAR, Institut Pierre Louis d’Epidémiologie et de Santé Publique, UMR_S1136, INSERM, Paris, France
- UPMC Univ Paris 06, Sorbonne Universités, Paris, France
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14
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Wheezing exacerbations in early childhood: evaluation, treatment, and recent advances relevant to the genesis of asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 2:537-43. [PMID: 25213046 PMCID: PMC4190166 DOI: 10.1016/j.jaip.2014.06.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 06/16/2014] [Accepted: 06/17/2014] [Indexed: 12/01/2022]
Abstract
Children who begin wheezing during early childhood are frequently seen by health care providers in primary care, in hospitals, and in emergency departments, and by allergists and pulmonologists. When a young child, such as the 2 year-old patient presented here, is evaluated for wheezing, a frequent challenge for clinicians is to determine whether the symptoms represent transient, viral-induced wheezing or whether sufficient risk factors are present to suspect that the child may experience recurrent wheezing and develop asthma. Most factors that influence prognosis are not mutually exclusive, are interrelated (ie, cofactors), and often represent gene-environment interactions. Many of these risk factors have been, and continue to be, investigated in prospective studies to decipher their relative importance with the goal of developing new therapies and interventions in the future. The etiologies of wheezing in young children, diagnostic methods, treatment, prognostic factors, and potential targets for prevention of the development of asthma are discussed.
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15
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Klaassen EMM, van de Kant KDG, Jöbsis Q, van Schayck OCP, Smolinska A, Dallinga JW, van Schooten FJ, den Hartog GJM, de Jongste JC, Rijkers GT, Dompeling E. Exhaled biomarkers and gene expression at preschool age improve asthma prediction at 6 years of age. Am J Respir Crit Care Med 2015; 191:201-7. [PMID: 25474185 DOI: 10.1164/rccm.201408-1537oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE A reliable asthma diagnosis is difficult in wheezing preschool children. OBJECTIVES To assess whether exhaled biomarkers, expression of inflammation genes, and early lung function measurements can improve a reliable asthma prediction in preschool wheezing children. METHODS Two hundred two preschool recurrent wheezers (aged 2-4 yr) were prospectively followed up until 6 years of age. At 6 years of age, a diagnosis (asthma or transient wheeze) was based on symptoms, lung function, and asthma medication use. The added predictive value (area under the receiver operating characteristic curve [AUC]) of biomarkers to clinical information (assessed with the Asthma Predictive Index [API]) assessed at preschool age in diagnosing asthma at 6 years of age was determined with a validation set. Biomarkers in exhaled breath condensate, exhaled volatile organic compounds (VOCs), gene expression, and airway resistance were measured. MEASUREMENTS AND MAIN RESULTS At 6 years of age, 198 children were diagnosed (76 with asthma, 122 with transient wheeze). Information on exhaled VOCs significantly improved asthma prediction (AUC, 89% [increase of 28%]; positive predictive value [PPV]/negative predictive value [NPV], 82/83%), which persisted in the validation set. Information on gene expression of toll-like receptor 4, catalase, and tumor necrosis factor-α significantly improved asthma prediction (AUC, 75% [increase of 17%]; PPV/NPV, 76/73%). This could not be confirmed after validation. Biomarkers in exhaled breath condensate and airway resistance (pre- and post- bronchodilator) did not improve an asthma prediction. The combined model with VOCs, gene expression, and API had an AUC of 95% (PPV/NPV, 90/89%). CONCLUSIONS Adding information on exhaled VOCs and possibly expression of inflammation genes to the API significantly improves an accurate asthma diagnosis in preschool children. Clinical trial registered with www.clinicaltrial.gov (NCT 00422747).
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16
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Another predictive score for childhood asthma: the search remains. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2014; 2:716-8. [PMID: 25439362 DOI: 10.1016/j.jaip.2014.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 10/14/2014] [Indexed: 11/23/2022]
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17
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Just J, Deslandes-Boutmy E, Amat F, Desseaux K, Nemni A, Bourrat E, Sahraoui F, Pansé I, Bagot M, Fouéré S. Natural history of allergic sensitization in infants with early-onset atopic dermatitis: results from ORCA Study. Pediatr Allergy Immunol 2014; 25:668-73. [PMID: 25283304 DOI: 10.1111/pai.12287] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early-onset atopic dermatitis (AD) is a particular phenotype that may convey a risk of developing multiple sensitizations to allergens but little is known about the pathway of sensitization. The aims of this study were to describe the natural history of sensitization to allergens for this phenotype and to identify the most predictive marker associated with the risk of developing sensitization to inhaled allergens in a well-selected cohort of infants with AD. METHODS Infants with active AD were enrolled and prospectively explored for biological markers of atopy every year until the age of 6 yr. Allergic sensitization was defined as the presence of positive specific IgEs to allergens and multiple sensitizations as being sensitized to ≥2 allergens. Elevated blood eosinophilia was defined as an eosinophil blood count ≥470 eosinophils/mm(3) and elevated total IgE as a serum IgE level ≥45 kU/l. RESULTS Two hundred and twenty-nine infants were included. Elevated blood eosinophilia was observed at baseline in 60 children (26.2%) and elevated total IgE in 85 (37.1%). When elevated at baseline, eosinophilia and IgE levels remained significantly higher during the follow-up period. Sensitization to food allergens decreased from 58% to 34%, whereas sensitization to inhaled allergens increased over time from 17% to 67%. Initial multiple sensitizations to food allergens were the most predictive factor for the risk of developing sensitization to inhaled allergens at 6 yr (OR 3.72 [1.68-8.30] p < 0.001). CONCLUSIONS In the early-onset AD phenotype, multiple sensitization to food allergens conveys a higher risk of sensitization to inhaled allergens than single sensitization.
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Affiliation(s)
- Jocelyne Just
- AP-HP- Service d'Allergologie Pédiatrique, Hôpital d'Enfants Armand-Trousseau, Paris, France; INSERM, UMR S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe EPAR, Paris, France
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18
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Belgrave DCM, Custovic A, Simpson A. Characterizing wheeze phenotypes to identify endotypes of childhood asthma, and the implications for future management. Expert Rev Clin Immunol 2014; 9:921-36. [PMID: 24128156 DOI: 10.1586/1744666x.2013.836450] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
It is now a commonly held view that asthma is not a single disease, but rather a set of heterogeneous diseases sharing common symptoms. One of the major challenges in treating asthma is understanding these different asthma phenotypes and their underlying biological mechanisms. This review gives an epidemiological perspective of our current understanding of the different phenotypes that develop from birth to childhood that come under the umbrella term 'asthma'. The review focuses mainly on publications from longitudinal birth cohort studies where the natural history of asthma symptoms is observed over time in the whole population. Identifying distinct pathophysiological mechanisms for these different phenotypes will potentially elucidate different asthma endotypes, ultimately leading to more effective treatment and management strategies.
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Affiliation(s)
- Danielle C M Belgrave
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
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19
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Moussu L, Saint-Pierre P, Panayotopoulos V, Couderc R, Amat1 F, Just J. Determinants of allergic rhinitis in young children with asthma. PLoS One 2014; 9:e97236. [PMID: 24831804 PMCID: PMC4022721 DOI: 10.1371/journal.pone.0097236] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background In the preschool period, allergic rhinitis (AR) is infrequent and thus under-diagnosed. However, recent works have highlighted the occurrence of AR in toddlers although the causes of AR in this young population remain unknown. The objective of this study was to identify determinants of AR in young children with asthma. Methods We carried out a case-control study of 227 children with active asthma and enrolled in the Trousseau Asthma Program. AR and other allergic diseases (asthma, food allergy and eczema) were diagnosed by medical doctors using standardized questionnaires. Parental history of AR and asthma, biological markers of atopy (total IgE, blood eosinophilia, allergic sensitization towards food and aeroallergens) and environmental parameters were also collected. Results Forty one of the children (18.1%) had AR. By univariate logistic regression analysis, AR was mainly associated with peanut sensitization (OR = 6.75; p = 0.002); food allergy (OR = 4.31; p = 0.026); mold exposure (OR = 3.81 p<0.01) and parental history of AR (OR = 1.42; p = 0.046). Due to the strong link between food allergy and peanut sensitization three models of multivariate logistic regression were performed and confirmed that AR is associated with peanut sensitization but also food allergy and mold exposure. A random forest analysis was also performed to explain AR. The results reinforced the logistic analysis that peanut sensitization and mold exposure were the principal determinants of AR. Conclusions & Clinical Relevance These results stress the importance of investigating AR in young children with asthma to potentially diagnose a particularly severe allergic asthmatic phenotype. Moreover, these data evoke the hypothesis that peanut could be an aeroallergen.
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Affiliation(s)
- Lise Moussu
- Allergology department, Centre de l′Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau (Assistance Publique Hôpitaux de Paris) - Université Pierre et Marie Curie, Paris, France
| | - Philippe Saint-Pierre
- Laboratoire de Statistiques Théoriques et Appliquées, Université Pierre et Marie Curie, Paris, France
| | - Virginie Panayotopoulos
- Allergology department, Centre de l′Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau (Assistance Publique Hôpitaux de Paris) - Université Pierre et Marie Curie, Paris, France
| | - Rémy Couderc
- Service de Biochimie et Biologie Moléculaire, Hôpital d'Enfants Armand-Trousseau (Assistance Publique Hôpitaux de Paris), Paris, France
| | | | - Jocelyne Just
- Allergology department, Centre de l′Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau (Assistance Publique Hôpitaux de Paris) - Université Pierre et Marie Curie, Paris, France
- * E-mail:
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20
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Abstract
Preschool children (ie, those aged 5 years or younger) with wheeze consume a disproportionately high amount of health-care resources compared with older children and adults with wheeze or asthma, representing a diagnostic challenge. Although several phenotype classifications have been described, none have been validated to identify individuals responding to specific therapeutic approaches. Several risk factors related to genetic, prenatal, and postnatal environment are associated with preschool wheezing. Findings from several cohort studies have shown that preschool children with wheeze have deficits in lung function at 6 years of age that persisted until early and middle adulthood, suggesting increased susceptibility in the first years of life that might lead to persistent sequelae. Daily inhaled corticosteroids seem to be the most effective therapy for recurrent wheezing in trials of children with interim symptoms or atopy; intermittent high-dose inhaled corticosteroids are effective in moderate-to-severe viral-induced wheezing without interim symptoms. The role of leukotriene receptor antagonist is less clear. Interventions to modify the short-term and long-term outcomes of preschool wheeze should be a research priority.
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Affiliation(s)
- Francine M Ducharme
- Clinical Research and Knowledge Transfer on Childhood Asthma Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada; Department of Paediatrics, University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada.
| | - Sze M Tse
- Clinical Research and Knowledge Transfer on Childhood Asthma Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada; Department of Paediatrics, University of Montreal, Montreal, QC, Canada
| | - Bhupendrasinh Chauhan
- Clinical Research and Knowledge Transfer on Childhood Asthma Unit, Research Centre, Sainte-Justine University Health Centre, Montreal, QC, Canada
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21
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Just J, Saint-Pierre P, Gouvis-Echraghi R, Boutin B, Panayotopoulos V, Chebahi N, Ousidhoum-Zidi A, Khau CA. Wheeze phenotypes in young children have different courses during the preschool period. Ann Allergy Asthma Immunol 2013; 111:256-261.e1. [PMID: 24054360 DOI: 10.1016/j.anai.2013.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/10/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Rules for predicting the course of asthma in wheezy infants have low specificity. OBJECTIVE To determine if the novel phenotypes-mild early viral wheeze (EVW), atopic multiple-trigger wheeze (MTW), and nonatopic uncontrolled wheeze (NAUW)-have different courses during the preschool period. METHODS Part of the prospectively followed Trousseau Asthma Program cohort was phenotyped using cluster analysis with 12 parameters (sex, asthma severity and control with inhaled corticosteroid [ICS], parental asthma, allergic rhinitis, eczema, food allergy, EVW or MTW, and allergen exposure trigger). Wheezing trajectories were assessed by crossing the original phenotypes with the phenotypes obtained at 5 years. RESULTS Four clusters were identified at 5 years of age: asymptomatic children (n = 47) with no wheezing (98%), children with mild EVW (n = 40, 87% with EVW, 50% with EVW controlled with low-dose ICS), those with atopic MTW (n = 30, 100% with MTW, only 17% with MTW controlled with low-dose ICS, more significant for pollen asthmatic trigger), and those with atopic severe UW (n = 33, 63% with UW uncontrolled despite high doses of ICS, more significant for allergic rhinitis and dust as asthmatic trigger). Those with mild EVW became asymptomatic or remained with mild EVW. Those with atopic MTW remained with atopic MTW and those with NAUW developed severe UW in most cases. CONCLUSION These results show that remission is most frequently observed in mild EVW and that no remission is observed in atopic MTW.
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Affiliation(s)
- Jocelyne Just
- Centre de l'Asthme et des Allergies, Hôpital d'Enfants Armand-Trousseau, Université Pierre et Marie Curie, Paris, France.
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22
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Abstract
Allergic diseases are a public health problem in industrialized countries due to the increasing number of allergies related to Western lifestyle. The multiplicity of organs affected by allergy (skin (atopic dermatitis), airway epithelium (respiratory allergy), and digestive tract (food allergy)) worsens the prognosis of each of the allergic diseases and specially asthma. The importance of allergy in management of asthma is also underlined by the risk of fatal or near fatal acute asthma attacks due to multiple allergic sensitizations. Preliminary studies suggest that specific treatment of allergy could change the asthma course.
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23
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Amat F, Guillemot-Lambert N, Labbe A, Saint-Pierre P, Annesi-Maesano I, Just J. Déterminer le phénotype de l’asthme pour mieux le traiter. Arch Pediatr 2013. [DOI: 10.1016/s0929-693x(13)71386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Singer F, Luchsinger I, Inci D, Knauer N, Latzin P, Wildhaber JH, Moeller A. Exhaled nitric oxide in symptomatic children at preschool age predicts later asthma. Allergy 2013; 68:531-8. [PMID: 23414302 DOI: 10.1111/all.12127] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prediction of asthma in young children with respiratory symptoms is hampered by the lack of objective measures applicable in clinical routine. In this prospective study in a preschool children cohort, we assessed whether the fraction of exhaled nitric oxide (FeNO), a biomarker of airway inflammation, is associated with asthma at school age. METHODS At baseline, IgE and eosinophils were measured in the blood, and FeNO was measured offline in 391 children aged 3-47 months with lower airway symptoms. We developed an asthma predictive index (API) including high FeNO as major criterion. At follow-up, primary outcome was physician-diagnosed asthma based on standardized interviews in those children reaching school age (n = 166). RESULTS FeNO was significantly elevated in those children with later asthma (68/166) as compared to children not developing asthma. Median (IQR) FeNO was 10.5 (6.6-17.2) vs. 7.4 (5.3-10.3) ppb. Per 5 ppb FeNO increase, the odds ratio (95% CI) for asthma increased by 2.44 (1.61-3.70) without changing when adjusting for confounders. Using the new API, children scored at risk had 58.0% probability for later asthma, whereas the negative predictive value was 78.2%, which was comparable to the classical API. CONCLUSIONS In this cohort of high-risk preschool children, elevated FeNO is associated with increased risk for school-age asthma. The new API including FeNO identifies children at risk of later asthma comparably to the classical API, but does not require blood sampling.
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Affiliation(s)
- F. Singer
- Division of Respiratory Medicine; University Children's Hospital Bern; University of Bern; Bern; Switzerland
| | - I. Luchsinger
- Division of Respiratory Medicine; University Children′s Hospital Zurich; Zurich; Switzerland
| | - D. Inci
- Division of Respiratory Medicine; University Children's Hospital Bern; University of Bern; Bern; Switzerland
| | - N. Knauer
- Division of Respiratory Medicine; University Children′s Hospital Zurich; Zurich; Switzerland
| | - P. Latzin
- Division of Respiratory Medicine; University Children's Hospital Bern; University of Bern; Bern; Switzerland
| | | | - A. Moeller
- Division of Respiratory Medicine; University Children′s Hospital Zurich; Zurich; Switzerland
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Risk factors and characteristics of respiratory and allergic phenotypes in early childhood. J Allergy Clin Immunol 2012; 130:389-96.e4. [PMID: 22846748 DOI: 10.1016/j.jaci.2012.05.054] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 05/21/2012] [Accepted: 05/22/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Unsupervised approaches can be used to analyze complex respiratory and allergic disorders. OBJECTIVE We investigated the respiratory and allergic phenotypes of children followed in the Pollution and Asthma Risk: An Infant Study (PARIS) birth cohort. METHODS Information on respiratory and allergic disorders, medical visits, and medications was collected during medical examinations of children at 18 months of age; biomarker data were also collected (total and allergen-specific IgE levels and eosinophilia). Phenotypes were determined by using latent class analysis. Associated risk factors were determined based on answers to questionnaires about environmental exposures. RESULTS Apart from a reference group, which had a low prevalence of respiratory symptoms or allergies (n=1271 [69.4%]), 3 phenotypes were identified. On the basis of clinical signs of severity and use of health care resources, we identified a mild phenotype (n=306 [16.7%]) characterized by occasional mild wheeze and 2 severe phenotypes separated by atopic status. The atopic severe phenotype (n=59 [3.2%]) included 49 (83%) children with wheezing and was characterized by a high prevalence of atopy (61% with allergenic sensitization) and atopic dermatitis (78%). In contrast, atopy was rare among children with the nonatopic severe phenotype (n=195 [11%]); this group included 88% of the children with recurrent wheezing. Risk factors for respiratory disease included parental history of asthma, male sex, siblings, day care attendance, exposure to tobacco smoke or molds, indoor renovations, and being overweight, although these factors did not have similar affects on risk for all phenotypes. CONCLUSION Atopy should be taken into account when assessing the risk of severe exacerbations (that require hospital-based care) in wheezing infants; precautions should be taken against respiratory irritants and molds and to prevent children from becoming overweight.
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Herr M, Just J, Nikasinovic L, Foucault C, Le Marec AM, Giordanella JP, Momas JI. Influence of host and environmental factors on wheezing severity in infants: findings from the PARIS birth cohort. Clin Exp Allergy 2012; 42:275-83. [PMID: 22288513 DOI: 10.1111/j.1365-2222.2011.03933.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Determinants of wheezing severity are poorly documented in infants. OBJECTIVES To study the determinants of wheezing severity in infants aged 18 months followed-up in the PARIS (« Pollution and Asthma Risk : an Infant Study ») birth cohort. METHODS Data on wheezing disorders, medical visits and medications, as well as biological markers of atopy, were collected during a medical examination at age 18 months. Severe wheeze was defined as wheeze that required inhaled corticosteroid and/or hospital-based care. Environmental exposures were assessed prospectively with regular questionnaires. Risk factors for wheeze in the first 18 months of life were assessed by multivariate regression models. RESULTS Participation in the medical examination concerned 48.2% of the original cohort. Prevalence of wheeze was 560/1879 (35.7%) and was influenced by male gender, parental history of asthma, siblings, daycare attendance, heavy parental smoking at home, and carpet covered floor in the child's bedroom. Being overweight increased the risk of wheeze by 62% (OR = 1.62, 95%CI 1.13-2.32). In addition, trends towards an increased risk of wheeze were found in infants exposed to daily use of cleaning sprays and to renovation activities. Conversely, the presence of a cat reduced the risk of wheeze (OR = 0.65, 95%CI 0.47-0.89), without any evidence of healthy-pet keeping effect. Severe wheeze concerned 286 of the wheezers (42.7%). The prevalence of severe wheeze was related to atopy, and risk of severe wheeze was in particular increased in infants having eosinophilia (OR = 1.76, 95%CI 1.21-2.55) or being sensitized to ≥ 2 allergens (OR = 1.88, 95%CI 1.13-3.14). CONCLUSIONS AND CLINICAL RELEVANCE Whilst risk factors for wheeze before 18 months of age are factors related to infections, indoor air pollution, and being overweight, the severity of wheeze is mainly due to the atopic status of the child. We suggest that atopy should be further considered in the assessment of wheezing severity in infants.
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Affiliation(s)
- M Herr
- Univ Paris Descartes, Sorbonne Paris Cité, Laboratoire Santé Publique et Environnement, Paris, France
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Just J, Gouvis-Echraghi R, Couderc R, Guillemot-Lambert N, Saint-Pierre P. Novel severe wheezy young children phenotypes: boys atopic multiple-trigger and girls nonatopic uncontrolled wheeze. J Allergy Clin Immunol 2012; 130:103-10.e8. [PMID: 22502798 DOI: 10.1016/j.jaci.2012.02.041] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/09/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Recurrent wheezing during infancy is a heterogeneous disorder that has been associated with early-onset asthma. OBJECTIVE To identify phenotypes of severe recurrent wheezing and therapeutic approaches. METHODS We performed cluster analysis with 20 variables of 551 children with active asthma, younger than 36 months old, and enrolled in the Trousseau Asthma Program. RESULTS We identified 3 independent clusters of children with wheezing. Cluster 1, mild episodic viral wheeze (n= 327), consisted of children with wheezing related only to colds (71%), mild disease (76%), and mainly normal chest x-ray results. Cluster 2, nonatopic uncontrolled wheeze (n = 157), was characterized by moderate to severe disease (91%), uncontrolled wheezing despite high doses of inhaled corticosteroids (55%), parents with asthma, and increased levels of ferritine. Cluster 3, atopic multiple-trigger wheeze (n = 67), included more children with multiple-trigger wheeze (68%) than did clusters 1 or 2; eczema (75%); a positive result from the Phadiatop Infant test (90%); increased levels of IgE, IgA, and IgG; and abnormal results from chest x-rays. In separate analysis, 1 parameter for boys (increased total level of IgE) and 2 parameters for girls (wheezing severity and increased total level of IgE) properly classified 90% of boys and 83% of girls in the appropriate cluster. Significant associations were found between overcrowding, molds and cockroaches at home, and atopic multiple-trigger wheeze and between day-care attendance and nonatopic uncontrolled wheeze in other parts. CONCLUSION We identified different phenotypes of recurrent wheezing in young children by using cluster analysis with usual variables. These phenotypes require confirmation in longer, follow-up studies.
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Affiliation(s)
- Jocelyne Just
- Centre de l'Asthme et des Allergies, Groupe Hospitalier Trousseau-La Roche Guyon, University Paris 06, Paris, France.
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Vial Dupuy A, Amat F, Pereira B, Labbe A, Just J. A simple tool to identify infants at high risk of mild to severe childhood asthma: the persistent asthma predictive score. J Asthma 2011; 48:1015-21. [PMID: 22022892 DOI: 10.3109/02770903.2011.626481] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recurrent wheezing in infants is a recognized risk factor for the development of childhood asthma. We sought to develop an easy-to-use persistent asthma predictive score (PAPS) in a population of young recurrent wheezers. METHODS We retrospectively studied clinical and biological data of infants under 2 years of age presenting recurrent wheezing and evaluated current asthma at 6 years of age using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Multivariate analysis was performed to select predictive variables to generate a PAPS. The score was then tested on another cohort for independent validation. RESULTS Two hundred infants were included in the cohort used to create the PAPS, and 227 in the validation cohort. In the first population, 47% of the children had developed asthma at 6 years of age, including 33% with mild to severe persistent asthma. Three parameters independently predicted persistent asthma: family history of asthma, personal atopic dermatitis, and multiple allergen sensitizations. Based on these variables, the PAPS showed 42% sensitivity, 90% specificity, 67% positive predictive value, and 76% negative predictive value for the prediction of persistent asthma. It was able to discriminate future persistent asthmatic from nonfuture persistent asthmatic children, with an accuracy of 74% in the initial population and 67% in the validation population. CONCLUSIONS The PAPS, based on three easy-to-obtain variables, could help the physician in clinical practice to identify infants at high risk for persistent childhood asthma, and thus better evaluate the need for secondary preventive measures.
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Affiliation(s)
- Amandine Vial Dupuy
- Centre de l'Asthme et des Allergies, Groupe Hospitalier Trousseau-La Roche Guyon, Assistance Publique - Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France
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Lefevre F, Moreau D, Sémon E, Kalaboka S, Annesi-Maesano I, Just J. Maternal depression related to infant's wheezing. Pediatr Allergy Immunol 2011; 22:608-13. [PMID: 21781174 DOI: 10.1111/j.1399-3038.2011.01155.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether maternal psychological status is related to infant's wheezing. STUDY DESIGN In a case-control study conducted in Paris in cases aged less than 36 months suffering from wheezing and matched healthy controls, mothers filled a standardized questionnaire on child's health and the State Trait Anxiety Inventory form Y-B and the Beck Depression Inventory short form. Cases underwent also routine clinical and biological assessments. The statistical analysis used the propensity score analysis to control for selection bias. RESULTS Hundred and thirty-eight wheezers and hundred and nine controls participated in the study. After adjustment for confounders, maternal depressive symptoms at the period of the survey according to the Beck Inventory were more significantly found in the cases than in others (p < 0.01). A trend was found for maternal depression during pregnancy. Among the cases, 10.6% suffered from severe asthma, 84.8% took inhaled corticosteroids (ICs), 17.4% had positive specific immunoglobulin E (IgE) to allergens and 11.5% hypereosinophilia. The more the mother was depressed according to the Beck Inventory, the more the infant's asthma was severe (OR = 4.25, 95% CI: 1.14, 15.9 between severe infant's wheezing and severe maternal depression). No relationship was observed between mother's depressive symptoms and ICs taken by the infant, allergic sensitization or eosinophilia. CONCLUSION Our findings support the hypothesis of a link between maternal depression and infant's wheezing and its severity early in life independent of allergic status. Consequences of our study include the need to assess depressive symptoms in mothers of infants with asthma.
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Affiliation(s)
- Françoise Lefevre
- Centre de l'Asthme et des Allergies, Groupe Hospitalier Trousseau-La Roche Guyon, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris6, Paris, France
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Herr M, Nikasinovic L, Foucault C, Le Marec AM, Giordanella JP, Just J, Momas I. Can early household exposure influence the development of rhinitis symptoms in infancy? Findings from the PARIS birth cohort. Ann Allergy Asthma Immunol 2011; 107:303-9. [PMID: 21962089 DOI: 10.1016/j.anai.2011.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/09/2011] [Accepted: 07/11/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND Allergic rhinitis (AR) has become the most prevalent chronic allergic disorder in childhood, and the role of environment has been questioned, particularly in early life. OBJECTIVE To investigate the risk factors for rhinitis symptoms in infants included in the PARIS (Pollution and Asthma Risk: an Infant Study) birth cohort. METHODS Infants were invited to participate at age 18 months in a health examination conducted by a pediatrician. Allergic rhinitis was defined as the presence of rhinitis symptoms (runny nose, blocked nose, sneezing in the absence of a cold) combined with biological atopy (elevated total immunoglobulin E [IgE], specific IgE, or eosinophilia) and nonallergic rhinitis (NAR) as symptoms without biological atopy. Information about indoor exposures and lifestyle was collected during a telephone interview when the child was 1 month of age. Risk factors for AR and NAR were studied by using a polytomous regression model. RESULTS The prevalence of AR and NAR was 70/1,850 (3.8%) and 99/1,850 (5.4%), respectively. Allergic rhinitis and NAR did not share similar risk factors. Male sex (odds ratio [OR] = 1.99 [1.19-3.32]), parental history of AR (OR = 1.89 [1.16-3.08]), low socioeconomic class (OR = 2.23 [1.05-4.72] for low vs high level), and the presence of cockroaches in the home (OR = 3.15 [1.67-5.96]) were risk factors for AR. Conversely, the presence of particle-board furniture less than 12 months old in the child's bedroom was associated with an increased risk of NAR (OR = 1.87 [1.21-2.90]). CONCLUSIONS This study should raise awareness about the impact of indoor exposures, particularly with regard to cockroaches and particle-board furniture, because they could influence the occurrence of noninfectious rhinitis.
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Affiliation(s)
- Marie Herr
- Université Paris Descartes, Laboratoire Santé Publique et Environnement, Paris, France
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Amat F, Vial A, Pereira B, Petit I, Labbe A, Just J. Predicting the long-term course of asthma in wheezing infants is still a challenge. ISRN ALLERGY 2011; 2011:493624. [PMID: 23724229 PMCID: PMC3658573 DOI: 10.5402/2011/493624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 06/05/2011] [Indexed: 12/04/2022]
Abstract
Background. In recurrent wheezing infants, it is important to identify those likely to remain asthmatic in order to propose appropriate long-term management.
Objective. To establish predictive factors for persistent asthma at adolescence in a population of recurrent wheezing infants.
Methods. Retrospective study of 227 infants. Inclusion criteria were age under 36 months, a history of at least three wheezing episodes assessed via a doctor-led ISAAC questionnaire and a standardized allergy testing programme. At 13 years, active asthma was assessed by questionnaire.
Results. Risk factors for asthma persisting into adolescence were allergic sensitization to multiple airborne allergens (OR 4.6, CI-95% (1.9–11.2) P = 0.001), initial atopic dermatitis (OR 3.4, CI-95% (1.9–6.3) P < 0.001), severe recurrent wheezing (OR 2.3, CI-95% (1.3–4.2) P = 0.007), and hypereosinophilia ≥470/mm3 (OR 2.2, CI-95% (1.07–4.7) P = 0.033).
Conclusion. While it is still difficult to predict the long-term course of asthma, atopy remains the major risk factor for persistent asthma.
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Affiliation(s)
- Flore Amat
- Asthma and Allergies Centre, Armand-Trousseau Children Hospital, University Pierre and Marie Curie-Paris 6, Paris, France
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Castro-Rodriguez JA, Cifuentes L, Rodríguez-Martínez CE. The asthma predictive index remains a useful tool to predict asthma in young children with recurrent wheeze in clinical practice. J Allergy Clin Immunol 2011; 127:1082-3. [PMID: 21458660 DOI: 10.1016/j.jaci.2011.01.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Accepted: 01/10/2011] [Indexed: 11/17/2022]
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Herr M, Clarisse B, Nikasinovic L, Foucault C, Le Marec AM, Giordanella JP, Just J, Momas I. Does allergic rhinitis exist in infancy? Findings from the PARIS birth cohort. Allergy 2011; 66:214-21. [PMID: 20804465 DOI: 10.1111/j.1398-9995.2010.02467.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early onset of allergic rhinitis (AR) is poorly described, and rhinitis symptoms are often attributed to infections. This study analyses the relations between AR-like symptoms and atopy in infancy in the PARIS (Pollution and Asthma Risk: an Infant Study) birth cohort. METHODS Data on AR-like symptoms (runny nose, blocked nose, sneezing apart from a cold) were collected using a standardized questionnaire administered during the health examination at age 18 months included in the follow-up of the PARIS birth cohort. Parental history of allergy and children's atopy blood markers (blood eosinophilia ≥470 eosinophils/mm(3) , total immunoglobulin E ≥45 U/ml and presence of allergen-specific IgE) were assessed. Associations were studied using multivariate logistic regression models adjusted for potential confounders. RESULTS Prevalence of AR-like symptoms in the past year was 9.1% of the 1850 toddlers of the study cohort. AR-like symptoms and dry cough apart from a cold were frequent comorbid conditions. Parental history of AR in both parents increased the risk of suffering from AR-like symptoms with an OR 2.09 (P=0.036). Significant associations were found with the presence of concurrent biological markers of atopy, especially blood eosinophilia and sensitization to house dust mite (OR 1.54, P=0.046 and OR 2.91, P=0.042) whereas there was no relation with sensitization to food. CONCLUSIONS These results support the hypothesis that AR could begin as early as 18 months of life. Suspicion of AR should be reinforced in infants with parental history of AR or biological evidence of atopy, particularly blood eosinophilia and sensitization to inhalant allergens.
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Affiliation(s)
- M Herr
- Laboratoire Santé Publique et Environnement, Faculté des Sciences Pharmaceutiques et Biologiques,Université Paris Descartes, 4 avenue de l’Observatoire, Paris, France
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Castro-Rodriguez JA. The Asthma Predictive Index: a very useful tool for predicting asthma in young children. J Allergy Clin Immunol 2010; 126:212-6. [PMID: 20624655 DOI: 10.1016/j.jaci.2010.06.032] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/20/2010] [Accepted: 06/22/2010] [Indexed: 12/14/2022]
Abstract
Recurrent wheezing is a common problem in young children: approximately 40% of children wheeze in their first year of life. However, only 30% of preschoolers with recurrent wheezing still have asthma at the age of 6 years. Nevertheless, asthma, the most prevalent chronic disease in children, is difficult to diagnose in infants and preschoolers. This article reviews the importance of determining at an early age which infants/preschoolers will have asthma later in life, analyzes the pros and cons of different predictive indices, and discusses the efficacy of the Asthma Predictive Index.
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Affiliation(s)
- Jose A Castro-Rodriguez
- Departments of Pediatrics and Family Medicine, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
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Just J, Belfar S, Wanin S, Pribil C, Grimfeld A, Duru G. Impact of innate and environmental factors on wheezing persistence during childhood. J Asthma 2010; 47:412-6. [PMID: 20528595 DOI: 10.3109/02770900903584035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Persistent asthma in adults starts often early in childhood and is associated with alterations in respiratory function that occur early in life. OBJECTIVES The aim of this study was to evaluate the importance of innate and environmental factors associated with occurrence of asthma during childhood in a population of recurrent wheezing infants followed prospectively. METHODS A cohort of infants less than 30 months old with recurrent wheezing was established in order to assess severity of respiratory symptoms and to look for the presence of atopy and environmental risk factors. At the age of 6 years, they were reevaluated with respect to remission or persistence of wheezing over the previous 12-month period. RESULTS Data were available for 219 subjects aged 15 +/- 5 months. In 27% of the infants with recurrent wheeze, wheezing persisted until the age of 6 years. In multivariate analysis, stepwise logit analysis showed that the risk factors for persistent wheezing are eosinophilia >or=470/mm(3), allergenic sensitization, and a father with asthma. Environmental factors present during the first year of life that protect from persistence of wheezing are ( 1 ) breastfeeding for longer than 3 months, ( 2 ) pets at home, and ( 3 ) >or=3 siblings. The detection rate for persistent wheezing in this model is 72%. The persistence score showed good specificity 91% but low sensitivity 35%. CONCLUSION This study confirms the role of atopic host factors on wheezing persistence during childhood and detected protective environmental factors.
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Affiliation(s)
- Jocelyne Just
- Centre de l'Asthme et des Allergies, Groupe Hospitalier Trousseau-La Roche Guyon, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris 6, Paris, France.
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Response to budesonide among atopic and non-atopic infants/preschoolers with recurrent wheezing. Allergol Immunopathol (Madr) 2010; 38:31-6. [PMID: 19875223 DOI: 10.1016/j.aller.2009.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 09/11/2009] [Indexed: 11/23/2022]
Abstract
BACKGROUND The treatment in non-atopic young children with recurrent wheezing remains controversial. OBJECTIVE The aim of the study was to compare the response of inhaled budesonide in atopic versus non-atopic infants/preschoolers with recurrent wheezing (more than three episodes in the last year or one episode per month in the last three months). METHODS One hundred and seventy three infants/preschoolers (mean age 1.58+/-0.9 yrs) with recurrent wheezing without previous use of inhaled corticosteroids were enrolled and divided into two categories: atopics (eosinophils in peripheral blood > or =4%) and non-atopics (<4%). Both groups were treated with budesonide (200 mcg bid delivered by MDI and spacer) for three months. The primary outcome was the prevalence of wheezing exacerbation episodes at the end of the treatment. RESULTS Thirty-seven out of 173 (21.4%) were atopics and they were significantly younger, more frequently with a father with asthma, maternal grandparents with asthma and rhinitis, paternal and maternal grandparents with eczema, and higher number of wheezing episodes in the last year than non-atopics. At the end of the study, among those with good compliance (>70% of the weekly doses), the proportion of wheezing episodes were similar among atopics and non-atopics (57.7% vs. 44.1%, p=0.25, respectively); the number of exacerbations requiring emergency department (ED) visits and hospital admission were also similar. CONCLUSION Regular budesonide therapy may decrease the episodes of wheezing in infants/preschoolers with recurrent wheezing, independently of atopy.
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