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Abstract
Background: Asthma is a frequent and potentially life-threatening disease that complicates many pregnancies. There are extensive data with regard to the diagnosis and treatment of asthma during pregnancy. Medical providers require an up-to-date summary of the critical aspects of asthma management during pregnancy. Objective: This review aimed to summarize the available data from clinical trials, cohort studies, expert opinions, and guideline recommendations with regard to asthma in pregnancy. Methods: A search through PubMed was conducted by using keywords previously mentioned and MeSH (Medical Subject Headings) terminology. Clinical trials, observational studies, expert opinions, guidelines, and other reviews were included. The quality of the studies was assessed, and data were extracted and summarized. Results: Asthma worsens in ∼40% of pregnant women, which can be associated with maternal and fetal complications. Physiologic changes in the respiratory, cardiovascular, and immune systems during pregnancy play a critical role in the manifestations of asthma. The diagnosis and the treatment of asthma are similar to that of patients who are not pregnant. Nonetheless, concern for fetal malformations, preterm birth, and low birth weight must be considered when managing pregnant patients with asthma. Importantly, cornerstones of the pharmacotherapy of asthma seem to be safe during pregnancy. Conclusion: Asthma in pregnancy is associated with adverse outcomes. Roadblocks to management include associated comorbidities, medication nonadherence, atopy, lack of education, and smoking habits. These need to be acknowledged and addressed for successful asthma management during pregnancy.
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Management of Asthma Exacerbations in the Emergency Department. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:2599-2610. [PMID: 33387672 DOI: 10.1016/j.jaip.2020.12.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 02/06/2023]
Abstract
Asthma exacerbations occur across a wide spectrum of chronic severity; they contribute to millions of emergency department (ED) visits in both children and adults every year. Management of asthma exacerbations is an important part of the continuum of asthma care. The best strategy for ED management of an asthma exacerbation is early recognition and intervention, continuous monitoring, appropriate disposition, and, once improved, multifaceted transitional care that optimizes subacute and chronic asthma management after ED discharge. This article concisely reviews ED evaluation, treatment, disposition, and postdischarge care for patients with asthma exacerbations, based on high-quality evidence (eg, systematic reviews from the Cochrane Collaboration) and current international guidelines (eg, the National Asthma Education and Prevention Program Expert Panel Report 3, Global Initiative for Asthma, and Australian guidelines). Special populations (young children, pregnant women, and the elderly) also are addressed. Despite advances in asthma science, there remain many important evidence gaps in managing ED patients with asthma exacerbation. This article summarizes several of these controversial areas and challenges that merit further investigation.
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Robijn AL, Barker D, Gibson PG, Giles WB, Clifton VL, Mattes J, Peek MJ, Barrett HL, Seeho SK, Callaway LK, Abbott A, Attia J, Wark PA, Jensen ME, Murphy VE. Factors Associated with Nonadherence to Inhaled Corticosteroids for Asthma During Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1242-1252.e1. [PMID: 33039640 DOI: 10.1016/j.jaip.2020.09.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/14/2020] [Accepted: 09/16/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Nonadherence is common among pregnant women prescribed inhaled corticosteroids (ICS) for asthma and may have serious consequences for mother and baby. Factors associated with ICS nonadherence have not been determined in this population. OBJECTIVES To determine factors associated with {1} nonadherence to ICS in early-mid pregnancy (cross-sectional) and {2} persistent nonadherence to ICS during pregnancy (longitudinal). METHODS Data used come from 3 prospective studies (2004-2019) involving women with asthma recruited by 23 weeks' gestation (N = 1614). Demographics, asthma history, and current symptoms were assessed, and spirometry was performed at baseline and throughout pregnancy. Women self-reported current medication use and number of ICS doses missed in the past week. Nonadherence was defined as ≥20% of prescribed dosages missed in the past week (baseline) and on at least 2 occasions during follow-up (persistent). Factors associated with ICS nonadherence were examined using backward stepwise logistic regression. RESULTS Of 610 (38%) women prescribed ICS at baseline, 236 (39%) were classified as nonadherent. Of 612 (38%) women prescribed ICS during at least 2 follow-up visits, 149 (24%) were classified as persistent nonadherent. Factors associated with nonadherence at baseline were current or ex-smoking, non-Caucasian/non-Indigenous ethnicity, adult diagnosis of asthma, and lower lung function. Factors associated with persistent nonadherence to ICS were lower maternal age, higher parity, and no prescribed ICS at baseline. CONCLUSION Young multiparous non-Caucasian/non-Indigenous mothers are at increased risk of being nonadherent to ICS during pregnancy. Strategies to improve ICS nonadherence should address maternal smoking and target women who (re-)initiate ICS use in pregnancy.
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Affiliation(s)
- Annelies L Robijn
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Warwick B Giles
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Vicki L Clifton
- Mater Research Institute, University of Queensland, Translational Research Institute, South Brisbane, QLD, Australia
| | - Joerg Mattes
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Peadiatric Respiratory and Sleep Medicine Department, John Hunter Children's Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Michael J Peek
- ANU Medical School, College of Health and Medicine, The Australian National University, Garran, ACT, Australia
| | - Helen L Barrett
- Chronic disease biology and care, Mater Research Institute, University of Queensland, Brisbane, QLD, Australia; Department of Endocrinology, Mater Adult Hospital, Mater Health Services, Brisbane, QLD, Australia
| | - Sean K Seeho
- Department of Obstetrics and Gynaecology, Sydney Medical School Northern, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
| | - Leonie K Callaway
- Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Alistair Abbott
- Department of Respiratory and Sleep Medicine, Nepean Hospital, Kingswood, NSW, Australia; Nepean Clinical School, University of Sydney, Sydney, NSW, Australia
| | - John Attia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Peter A Wark
- Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia; Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Megan E Jensen
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Vanessa E Murphy
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
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Phototherapy for neonatal hyperbilirubinemia and childhood eczema, rhinitis and wheeze. Pediatr Neonatol 2019; 60:28-34. [PMID: 29678409 PMCID: PMC6129174 DOI: 10.1016/j.pedneo.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 08/24/2017] [Accepted: 03/20/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The pathogenesis of allergic diseases in childhood may be attributed to influences of early environmental stimuli on fetal and neonatal immune regulation. Neonatal hyperbilirubinemia is common in the Asian population and up to 20% of infants require phototherapy. We examined the hypothesis that phototherapy for neonatal hyperbilirubinemia modulates the infant's risk of developing eczema, rhinitis and wheeze in the Growing Up in Singapore Towards healthy Outcomes (GUSTO) birth cohort. METHOD Interviewers collected information on demographics, lifestyle, birth data and allergic outcomes. Atopic sensitization was assessed through skin prick testing (SPT) to aeroallergens and food allergens. RESULTS A total of 135 (12.8%) children underwent phototherapy for neonatal hyperbilirubinemia. Infants who underwent phototherapy were of a significantly lower mean (SD) gestational age [37.5 (2.5) weeks] compared to those who did not [38.5 (1.2) weeks p < 0.01]. A higher proportion of infants born by Caesarean section underwent phototherapy compared to those who were born vaginally (17.5% vs 10.7%, p < 0.01). There were no differences in prevalence of allergen sensitization, eczema, rhinitis and early onset wheeze with use of nebulizer in the first 5 years of life between subjects that underwent phototherapy and those that did not. There were also no associations between mean bilirubin peak levels within the phototherapy group with development of eczema, rhinitis and early onset wheeze in the first 5 years of life. CONCLUSION We found no evidence for a link between phototherapy for neonatal hyperbilirubinemia and childhood allergic outcomes in this prospective mother-offspring cohort. TRIAL REGISTRATION NCT01174875 Registered 1 July 2010, retrospectively registered.
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Korhonen L, Seiskari T, Lehtonen J, Puustinen L, Surcel H, Haapala A, Niemelä O, Virtanen SM, Honkanen H, Karjalainen M, Ilonen J, Veijola R, Knip M, Lönnrot M, Hyöty H. Enterovirus infection during pregnancy is inversely associated with atopic disease in the offspring. Clin Exp Allergy 2018; 48:1698-1704. [DOI: 10.1111/cea.13280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 08/12/2018] [Accepted: 09/01/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Laura Korhonen
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
- Department of Dermatology Tampere University Hospital Tampere Finland
- Allergy Centre Tampere University Hospital Tampere Finland
| | - Tapio Seiskari
- Department of Clinical Microbiology Fimlab Laboratories Ltd Tampere Finland
| | - Jussi Lehtonen
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Leena Puustinen
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Heljä‐Marja Surcel
- National Institute for Health and Welfare Oulu Finland
- Biobank Borealis of Northern Finland Oulu University Hospital Oulu Finland
| | - Anna‐Maija Haapala
- Department of Clinical Microbiology Fimlab Laboratories Ltd Tampere Finland
| | - Onni Niemelä
- Department of Laboratory Medicine and Medical Research Unit Seinäjoki Central Hospital and University of Tampere Seinäjoki Finland
| | - Suvi M. Virtanen
- Unit of Nutrition National Institute for Health and Welfare Helsinki Finland
- Faculty of Social Sciences/Health Sciences University of Tampere Tampere Finland
- Center for Child Health Research University of Tampere Tampere University Hospital Tampere Finland
- The Science Center Pirkanmaa Hospital District Tampere Finland
| | - Hanna Honkanen
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
| | - Mira Karjalainen
- Department of Pediatrics PEDEGO Research Unit Medical Research Center Oulu University Hospital and University of Oulu Oulu Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory Institute of Biomedicine University of Turku Turku Finland
- Clinical Microbiology Turku University Hospital Turku Finland
| | - Riitta Veijola
- Department of Pediatrics PEDEGO Research Unit Medical Research Center Oulu University Hospital and University of Oulu Oulu Finland
| | - Mikael Knip
- Children's Hospital University of Helsinki and Helsinki University Hospital Helsinki Finland
- Research Programs Unit, Diabetes and Obesity University of Helsinki Helsinki Finland
- Folkhälsan Research Center Helsinki Finland
- Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Maria Lönnrot
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
- Department of Dermatology Tampere University Hospital Tampere Finland
- Allergy Centre Tampere University Hospital Tampere Finland
| | - Heikki Hyöty
- Department of Virology Faculty of Medicine and Life Sciences University of Tampere Tampere Finland
- Department of Clinical Microbiology Fimlab Laboratories Ltd Tampere Finland
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Robijn AL, Jensen ME, Gibson PG, Powell H, Giles WB, Clifton VL, Mattes J, Peek MJ, Barrett HL, Seeho SK, Callaway LK, Abbott A, Attia J, Wark PA, Murphy VE. Trends in asthma self-management skills and inhaled corticosteroid use during pregnancy and postpartum from 2004 to 2017. J Asthma 2018; 56:594-602. [PMID: 29716412 DOI: 10.1080/02770903.2018.1471709] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Asthma exacerbations and medication non-adherence are significant clinical problems during pregnancy. While asthma self-management education is effective, the number of education sessions required to maximise asthma management knowledge and inhaler technique and whether improvements persist postpartum, are unknown. This paper describes how asthma knowledge, skills, and inhaled corticosteroid (ICS) use have changed over time. METHODS Data were obtained from 3 cohorts of pregnant women with asthma recruited in Newcastle, Australia between 2004 and 2017 (N = 895). Medication use, adherence, knowledge, and inhaler technique were compared between cohorts. Changes in self-management knowledge/skills and women's perception of medication risk to the fetus were assessed in 685 women with 5 assessments during pregnancy, and 95 women who had a postpartum assessment. RESULTS At study entry, 41%, 29%, and 38% of participants used ICS in the 2004, 2007, and 2013 cohorts, respectively (p = 0.017), with 40% non-adherence in each cohort. Self-management skills of pregnant women with asthma did not improve between 2004 and 2017 and possession of a written action plan remained low. Maximum improvements were reached by 3 sessions for medications knowledge and one session for inhaler technique, and were maintained postpartum. ICS adherence was maximally improved after one session, but not maintained postpartum. Perceived risk of asthma medications on the fetus was highest for corticosteroid-containing medication; and was significantly reduced following education. CONCLUSIONS There was a high prevalence of non-adherence and poor self-management skills in all cohorts. More awareness of the importance of optimal asthma management during pregnancy is warranted, since no improvements were observed over the past decade.
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Affiliation(s)
- Annelies L Robijn
- a Priority Research Centre Grow Up Well, School of Medicine and Public Health , University of Newcastle, Hunter Medical Research Institute , New Lambton Heights , NSW , Australia
| | - Megan E Jensen
- a Priority Research Centre Grow Up Well, School of Medicine and Public Health , University of Newcastle, Hunter Medical Research Institute , New Lambton Heights , NSW , Australia
| | - Peter G Gibson
- a Priority Research Centre Grow Up Well, School of Medicine and Public Health , University of Newcastle, Hunter Medical Research Institute , New Lambton Heights , NSW , Australia.,b Priority Research Centre for Healthy Lungs , University of Newcastle and Hunter Medical Research Institute , Newcastle , NSW , Australia.,c Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , NSW , Australia
| | - Heather Powell
- b Priority Research Centre for Healthy Lungs , University of Newcastle and Hunter Medical Research Institute , Newcastle , NSW , Australia.,c Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , NSW , Australia
| | - Warwick B Giles
- a Priority Research Centre Grow Up Well, School of Medicine and Public Health , University of Newcastle, Hunter Medical Research Institute , New Lambton Heights , NSW , Australia
| | - Vicki L Clifton
- d Department of Mothers', Babies and Women's Health , Mater Research Institute-University of Queensland, Translational Research Institute , South Brisbane , QLD , Australia
| | - Joerg Mattes
- a Priority Research Centre Grow Up Well, School of Medicine and Public Health , University of Newcastle, Hunter Medical Research Institute , New Lambton Heights , NSW , Australia.,e Peadiatric Respiratory and Sleep Medicine Department , John Hunter Children's Hospital , Newcastle , NSW , Australia
| | - Michael J Peek
- f ANU Medical School, College of Health and Medicine , The Australian National University , Garran , ACT , Australia
| | - Helen L Barrett
- g Chronic Disease Biology and Care, Mater Research Institute , University of Queensland , Brisbane , QLD , Australia.,h Department of Endocrinology , Mater Adult Hospital, Mater Health Services , Brisbane , QLD , Australia
| | - Sean K Seeho
- i Department of Obstetrics and Gynaecology , Sydney Medical School Northern, University of Sydney, Royal North Shore Hospital , St Leonards, Sydney , NSW , Australia
| | - Leonie K Callaway
- j Women's and Newborn Services , Royal Brisbane and Women's Hospital , Brisbane , QLD , Australia.,k University of Queensland Centre for Clinical Research, Faculty of Medicine , The University of Queensland , Brisbane , QLD , Australia
| | - Alistair Abbott
- l Department of Respiratory and Sleep Medicine , Nepean Hospital , Kingswood , NSW , Australia.,m Nepean Clinical School , University of Sydney , Sydney , NSW , Australia
| | - John Attia
- a Priority Research Centre Grow Up Well, School of Medicine and Public Health , University of Newcastle, Hunter Medical Research Institute , New Lambton Heights , NSW , Australia
| | - Peter A Wark
- b Priority Research Centre for Healthy Lungs , University of Newcastle and Hunter Medical Research Institute , Newcastle , NSW , Australia.,c Department of Respiratory and Sleep Medicine , John Hunter Hospital , Newcastle , NSW , Australia
| | - Vanessa E Murphy
- a Priority Research Centre Grow Up Well, School of Medicine and Public Health , University of Newcastle, Hunter Medical Research Institute , New Lambton Heights , NSW , Australia
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Bonham CA, Patterson KC, Strek ME. Asthma Outcomes and Management During Pregnancy. Chest 2017; 153:515-527. [PMID: 28867295 DOI: 10.1016/j.chest.2017.08.029] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/26/2017] [Accepted: 08/21/2017] [Indexed: 01/15/2023] Open
Abstract
Asthma during pregnancy poses a common, increasingly prevalent threat to the health of women and their children. The present article reviews recent insights gained from the epidemiology of asthma during pregnancy, demonstrating the many short- and long-term risks to mother and fetus incurred by poorly controlled maternal asthma. We further discuss emerging evidence that active management of asthma during pregnancy can positively influence and perhaps completely mitigate these poor outcomes. Recent high-quality trials examining best methods for asthma treatment are reviewed and synthesized to offer an evidence-based pathway for comprehensive treatment of asthma in the outpatient setting. Safe and effective medications, as well as nonpharmacologic interventions, for asthma during pregnancy are discussed, and treatment options for related conditions of pregnancy, including depression, rhinitis, and gastroesophageal reflux, are presented. Throughout, we emphasize that an effective treatment strategy relies on a detailed patient evaluation, patient education, objective measurement of asthma control, and frequent and supportive follow-up. The cardiovascular and respiratory physiology of pregnancy is reviewed, as well as its implications for the management of patients with asthma, including patients requiring intubation and mechanical ventilation. For the situation when outpatient asthma management has failed, an approach to the critically ill pregnant patient with status asthmaticus is detailed. Multidisciplinary teams that include pulmonary specialists, obstetricians, primary care providers, nurses, pharmacists, and asthma educators improve the care of pregnant women with asthma.
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Affiliation(s)
- Catherine A Bonham
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.
| | - Karen C Patterson
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA; Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Mary E Strek
- Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
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Breastfeeding and perinatal exposure, and the risk of asthma and allergies. Curr Opin Allergy Clin Immunol 2017; 16:231-6. [PMID: 27054317 DOI: 10.1097/aci.0000000000000266] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Exposures during the perinatal period, a phase of rapid development, may have a profound and sustained effect on disease risk. In particular, perinatal exposures may influence the development and maturation of the infant immune system and the risk of allergic disease. We aimed to summarize the current literature on perinatal exposures and the risk of asthma and allergic disease RECENT FINDINGS Increased risk of offspring wheeze or asthma was found for: maternal obesity and hypertension during pregnancy; febrile illness, gynaecological, and viral respiratory infections in pregnancy; exposure to bisphenol A and phthalates in pregnancy and childhood; exposure to smoking in utero; low birth weight; caesarean section and neonatal hyperbilirubinaemia. Reduced risk of offspring atopic eczema was found for hookworm infection in pregnancy and reduced risk of offspring wheeze was associated with increased pregnancy dietary intake of vitamin E and zinc. Higher levels of selenium in pregnancy were associated with less risk of asthma in genetically susceptible offspring. Early life pet ownership was associated with a decrease in atopic asthma but an increase in nonatopic asthma risk. SUMMARY A diverse range of exposures were associated with allergic disease risk, highlighting the susceptibility of children during the perinatal period. Clinicians should reinforce public health messages concerning maternal obesity, smoking, and breastfeeding. The infant gut microbiome is emerging as an important hypothesis, which may mediate the relationship between many perinatal exposures and allergic disease.
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Shi T, He Y, Sun W, Wu Y, Li L, Jie Z, Su X. Respiratory Syncytial virus infection compromises asthma tolerance by recruiting interleukin-17A-producing cells via CCR6-CCL20 signaling. Mol Immunol 2017; 88:45-57. [PMID: 28599122 DOI: 10.1016/j.molimm.2017.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 12/14/2022]
Abstract
Asthma tolerance can be induced by breast-feeding or oral feeding with ovalbumin (OVA). Anergy or deletion of specific T cells and generation of T regulatory cells might contribute to this process. However, whether respiratory syncytial virus (RSV) infection would affect asthma tolerance is not very clear. Here, we first established asthma and oral tolerance mouse models and then analyzed airway hypersensitivity and asthma-related genes in the lung, CCR6-expressing IL-17A+ cells in the lungs, hilar or mesenteric lymph nodes (HLN or MLN) among control, asthmatic, tolerized, RSV infection, and RSV-infected asthmatic and tolerized groups. We also administrated CCL20 or IL-17A neutralizing antibody to RSV-infected tolerized mice to test whether RSV infection would mobilize CCR6-expressing IL-17A+ cells from MLN to the infected lungs. We found that tolerized mice infected with RSV developed asthma-like responses manifested by increasing airway hypersensitivity, exacerbating peribronchial inflammation, elevating lung asthma-related genes (Il17a, Mu5ac, and Gob5), accumulating CCR6-expressing IL-17A+ cells in the lungs and HLN with a reduction of this cell population in MLN. CCL20-CCR6 co-expression in RSV-infected tolerized MLN was reduced. Neutralization of CCL20 reduced CD3+CD4+CCR6+ cells in the RSV-infected tolerized HLN. Neutralization of IL-17A mitigated the compromising effects of RSV infection on asthma tolerance. Taken together, RSV infection impairs asthma tolerance by recruiting IL-17A-producing cells via CCR6-CCL20 signaling. The findings provide novel insight into exacerbation and therapeutic strategy of asthma under RSV infection.
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Affiliation(s)
- Tianyun Shi
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Yanchao He
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Wei Sun
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Yi Wu
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China
| | - Ling Li
- CAS Key Laboratory of Molecular Virology & Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, 200031, University of Chinese Academy of Sciences, China
| | - Zhijun Jie
- Department of Respiratory Medicine, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 200240, China.
| | - Xiao Su
- CAS Key Laboratory of Molecular Virology & Immunology, Unit of Respiratory Infection and Immunity, Institut Pasteur of Shanghai, Chinese Academy of Sciences, 200031, University of Chinese Academy of Sciences, China.
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Fonceca AM, Chopra A, Levy A, Noakes PS, Poh MWP, Bear NL, Prescott S, Everard ML. Infective respiratory syncytial virus is present in human cord blood samples and most prevalent during winter months. PLoS One 2017; 12:e0173738. [PMID: 28437435 PMCID: PMC5402929 DOI: 10.1371/journal.pone.0173738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 02/17/2017] [Indexed: 11/18/2022] Open
Abstract
Background Human respiratory syncytial virus (RSV) remains the most common cause of severe lower respiratory tract disease amongst infants, and continues to cause annual epidemics of respiratory disease every winter worldwide. Demonstrating placental transmission of viable RSV in human samples is a major paradigm shift in respiratory routes considered likely for RSV transmission. Methods Droplet digital PCR (ddPCR) was used to identify RSV present in cord blood mononucleocytes (CBM). CBMs testing positive for RSV were treated with phytohemagglutinin (PHA), PHA and nitric oxide (NO) or PHA, NO and palivizumab, and co-cultured with HeLa cell monolayers. Subsequent immuno-staining for RSV was used to visualize infective viral plaques. Results RSV was detected in 26 of 45 samples (57.7%) by ddPCR. CBM’s collected in winter were more likely to test positive for RSV (17/21 samples, risk = 80%, OR = 7.08; 95% CI 1.80–27.80; p = 0.005) compared to non-winter months (9/24 samples, 37.5%). RSV plaques were observed in non-treated and treated co-cultured HeLa monolayers. Conclusions Demonstrating active RSV in CBMs suggests in utero transmission of infective virus to the fetus without causing overt disease. This is likely to have an important impact on immune development as well as future virus-host interactions, thereby warranting further investigation.
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Affiliation(s)
- Angela Mary Fonceca
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia Australia
- * E-mail:
| | - Abha Chopra
- Institute of Immunity and Infectious Diseases (IIID), Murdoch University, Murdoch, Western Australia, Australia
| | - Avram Levy
- PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia
- School of Pathology and Laboratory Medicine University of Western Australia, Queen Elizabeth II Medical Centre, Nedlands, Western Australia, Australia
| | | | - Matthew Wee-Peng Poh
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia Australia
| | - Natasha Leanne Bear
- Child and adolescent health service (CAHS), Department of Health, Subiaco, Western Australia, Australia
| | - Susan Prescott
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia Australia
- Telethon Kids Institute, Subiaco, Western Australia, Australia
- Child and adolescent health service (CAHS), Department of Health, Subiaco, Western Australia, Australia
| | - Mark Lloyd Everard
- School of Paediatrics and Child Health, University of Western Australia, Subiaco, Western Australia Australia
- Child and adolescent health service (CAHS), Department of Health, Subiaco, Western Australia, Australia
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Mastrorilli C, Posa D, Cipriani F, Caffarelli C. Asthma and allergic rhinitis in childhood: what's new. Pediatr Allergy Immunol 2016; 27:795-803. [PMID: 27862336 DOI: 10.1111/pai.12681] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 12/23/2022]
Abstract
Novel approaches are currently offered for the diagnostic workup and therapeutic management of allergic rhinitis and asthma. New predictive biomarkers of allergy and asthma are available. Primary and secondary prevention, earlier intervention, and modification of the natural history of allergic rhinitis and asthma are being intensively investigated. This review highlights advances in the understanding of the etiology, diagnosis, and management of atopic airway diseases in childhood, as well as prenatal and early-life risk factors and strategies for prevention.
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Affiliation(s)
- Carla Mastrorilli
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.,Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Daniela Posa
- Department of Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Francesca Cipriani
- Pediatric Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Carlo Caffarelli
- Pediatric Clinic, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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12
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Caminati M, Durić-Filipović I, Arasi S, Peroni DG, Živković Z, Senna G. Respiratory allergies in childhood: Recent advances and future challenges. Pediatr Allergy Immunol 2015; 26:702-10. [PMID: 26582212 DOI: 10.1111/pai.12509] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 12/17/2022]
Abstract
The burden of allergic airway diseases still represents a major health problem in childhood. Despite many different options are currently available for the diagnostic work-up and management, the overall disease control in terms of impact on quality of life, morbidity and mortality, is not yet satisfactory. The extreme variability of individual risk factors and severity determinants may account for it. On the other side, the knowledge of the multifaceted allergy background could pave the way to primary prevention, early intervention and disease course modification. In fact, most of current research is focusing on the identification of biological and clinical predictive markers of allergy and asthma onset. This review aims at summarizing the latest achievements concerning the complex inter-relation between genetic predisposition and environmental factors, and their impact on prevention strategies and early identification of at risk subjects. An update on the diagnostic and monitoring tools as well as an insight into the newest treatments options is also provided.
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Affiliation(s)
- Marco Caminati
- Allergy Unit, Verona University and General Hospital, Verona, Italy
| | | | - Stefania Arasi
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - Diego G Peroni
- Department of Pediatrics, University of Ferrara, Ferrara, Italy.,International Inflammation (in-FLAME) Network of the World Universities Network, Ferrara, Italy
| | - Zorica Živković
- Children's Hospital for Lung Diseases and Tuberculosis, Medical Center 'Dr Dragisa Misovic', Belgrade, Serbia.,Faculty of Pharmacy, European University, Novi Sad, Serbia
| | - Gianenrico Senna
- Allergy Unit, Verona University and General Hospital, Verona, Italy
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13
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Abstract
Complex multifactorial diseases such as allergic rhinitis and asthma are not only becoming an increasing burden to healthcare systems, but especially affect the life quality of children and families suffering from their allergic symptoms. Also physicians are challenged by the multifaceted diseases as their work involves not only the often difficult decisions on case-adapted diagnostics, treatment, and monitoring, but also possible preventive measures. This review gives an outline of the latest scientific developments related to the etiology, diagnosis, and management of allergic airway diseases in childhood, as well as prenatal and early life risk factors and strategies for prevention.
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Affiliation(s)
- Stephanie Hofmaier
- Department of Paediatric Pneumology & Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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14
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Murphy VE, Mattes J, Powell H, Baines KJ, Gibson PG. Respiratory viral infections in pregnant women with asthma are associated with wheezing in the first 12 months of life. Pediatr Allergy Immunol 2014; 25:151-8. [PMID: 24329935 PMCID: PMC7168064 DOI: 10.1111/pai.12156] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2013] [Indexed: 01/13/2023]
Abstract
BACKGROUND There are few studies investigating the relationship between respiratory viral infection in pregnancy and asthma in the offspring, and none among mothers with asthma. Infants of mothers with asthma are more likely to wheeze and have a higher risk of developing asthma than infants of non-asthmatic mothers. METHODS A prospective cohort study of viral infection in pregnancy was conducted between 2007 and 2009, and a subgroup of infants of mothers with asthma was followed up at 6 and 12 months of age. During common colds, nasal and throat swabs were collected from mothers and respiratory viruses detected by polymerase chain reaction. Respiratory health of infants was assessed by parent-completed questionnaire. RESULTS Twelve-month-old infants whose mothers had confirmed viral infections in pregnancy (n = 26) reported more frequent wheeze (40% had 4-12 wheeze attacks compared with 0%), sleep disturbed by wheeze (1 night per week or more in 60% vs. 11%), beta agonist treatment for wheeze (27% vs. 0%), prolonged colds (2 wk or longer 31% vs. 0%), more eczema (40% vs. 6.3%), and parent-perceived asthma (32% vs. 0%), compared with infants whose mothers had common colds without laboratory-confirmed viral infection (n = 16). CONCLUSIONS This study demonstrates a relationship between maternal respiratory viral infection in pregnancy and wheezing illness in infants of mothers with asthma. Viral infections are the most common cause of asthma exacerbations in pregnancy, and infants of asthmatic mothers are at increased risk of asthma themselves. Further research is needed to elucidate the mechanisms involved.
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Affiliation(s)
- Vanessa E Murphy
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
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15
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Affiliation(s)
- Gunilla Hedlin
- Department of Women's and Children's Health, and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
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