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Glaumann S, Lilja G, Nopp A, Nilsson C. Positive Phadiatop Infant (Phinf) can predict allergic disease during childhood. Pediatr Allergy Immunol 2020; 31:994-996. [PMID: 32340076 DOI: 10.1111/pai.13266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/27/2020] [Accepted: 04/09/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Susanne Glaumann
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Solna, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Gunnar Lilja
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Solna, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Anna Nopp
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Solna, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Caroline Nilsson
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Solna, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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2
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Mikhail I, Grayson MH. Asthma and viral infections: An intricate relationship. Ann Allergy Asthma Immunol 2019; 123:352-358. [PMID: 31276807 PMCID: PMC7111180 DOI: 10.1016/j.anai.2019.06.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/11/2019] [Accepted: 06/24/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To synthesize available data related to the complex associations among viral infections, atopy, and asthma. DATA SOURCES Key historical articles, articles highlighted in our recent review of most significant recent asthma advancements, and findings from several birth cohorts related to asthma and viral infections were reviewed. In addition, PubMed was searched for review articles and original research related to the associations between viral infection and asthma, using the search words asthma, viral infections, atopy, development of asthma, rhinovirus (RV), and respiratory syncytial virus (RSV). STUDY SELECTIONS Articles were selected based on novelty and relevance to our topic of interest, the role of asthma and viral infections, and possible mechanisms to explain the association. RESULTS There is a large body of evidence demonstrating a link between early viral infections (especially RV and RSV) and asthma inception and exacerbations. RV-induced wheezing is an important risk factor for asthma only when atopy is present, with much evidence supporting the idea that sensitization is a risk factor for early RV-induced wheezing, which in turn is a risk factor for asthma. RSV, on the other hand, is a more important risk factor for nonatopic asthma, with severe infections conferring greater risk. CONCLUSION There are important differences in the development of atopic and nonatopic asthma, with several proposed mechanisms explaining the association between viral infections and the development of asthma and asthma exacerbations. Understanding these complex associations is important for developing asthma prevention strategies and targeted asthma therapies.
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Affiliation(s)
- Irene Mikhail
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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Leino A, Lukkarinen M, Turunen R, Vuorinen T, Söderlund-Venermo M, Vahlberg T, Camargo CA, Bochkov YA, Gern JE, Jartti T. Pulmonary function and bronchial reactivity 4 years after the first virus-induced wheezing. Allergy 2019; 74:518-526. [PMID: 30144084 PMCID: PMC6387855 DOI: 10.1111/all.13593] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/27/2018] [Accepted: 08/03/2018] [Indexed: 01/12/2023]
Abstract
Background Wheezing illnesses among young children are common and are a risk factor for asthma. However, determinants of childhood bronchial reactivity, a key feature of asthma, are largely unknown. The aim of this study was to determine how patient characteristics during the first severe virus‐induced wheezing episode are associated with pulmonary function at preschool age. Methods Study consisted of 76 children presenting with their first wheezing episode at the ages of 3 to 23 months. At study entry, viral etiology, rhinovirus genome load, atopic and clinical characteristics, and standardized questionnaire were analyzed. At 4‐year follow‐up visit, impulse oscillometry with exercise challenge was performed. Results At study entry, the mean age of the children was 12 months (SD 6.0), 57 (75%) were rhinovirus positive, and 22 (30%) were sensitized. At follow‐up visit four years later, the mean age of the children was 60 months (SD 7.9) and 37 (49%) were using asthma medication regularly (discontinued before testing in 25 [68%] children). Bronchial reactivity (≥35% change in mean crude values of resistance) after exercise challenge or bronchodilation was present in nine (12%) children. Children with atopic sensitization at the time of the first wheezing episode were more often likely to develop bronchial reactivity (odds ratio 8.8, P = 0.03) than the children without sensitization. No other significant associations were found. Conclusions Atopic sensitization at the time of the first severe wheezing episode is an important early risk factor for increased bronchial reactivity at preschool age.
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Affiliation(s)
- Annamari Leino
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital and University of Turku; Turku Finland
| | - Minna Lukkarinen
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital and University of Turku; Turku Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine; University of Turku; Turku Finland
| | - Riitta Turunen
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital and University of Turku; Turku Finland
- Department of Clinical Virology; Turku University Hospital and Department of Virology; Turku University; Turku Finland
| | - Tytti Vuorinen
- Department of Clinical Virology; Turku University Hospital and Department of Virology; Turku University; Turku Finland
| | | | - Tero Vahlberg
- Department of Biostatistics; University of Turku and Turku University Hospital; Turku Finland
| | - Carlos A. Camargo
- Department of Emergency Medicine and Division of Rheumatology, Allergy and Immunology; Department of Medicine; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Yury A. Bochkov
- Department of Pediatrics; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
| | - James E. Gern
- Department of Pediatrics; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
- Department of Medicine; School of Medicine and Public Health; University of Wisconsin; Madison Wisconsin
| | - Tuomas Jartti
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital and University of Turku; Turku Finland
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Lund RJ, Osmala M, Malonzo M, Lukkarinen M, Leino A, Salmi J, Vuorikoski S, Turunen R, Vuorinen T, Akdis C, Lähdesmäki H, Lahesmaa R, Jartti T. Atopic asthma after rhinovirus-induced wheezing is associated with DNA methylation change in the SMAD3 gene promoter. Allergy 2018; 73:1735-1740. [PMID: 29729188 PMCID: PMC6055882 DOI: 10.1111/all.13473] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2018] [Indexed: 12/22/2022]
Abstract
Children with rhinovirus‐induced severe early wheezing have an increased risk of developing asthma later in life. The exact molecular mechanisms for this association are still mostly unknown. To identify potential changes in the transcriptional and epigenetic regulation in rhinovirus‐associated atopic or nonatopic asthma, we analyzed a cohort of 5‐year‐old children (n = 45) according to the virus etiology of the first severe wheezing episode at the mean age of 13 months and to 5‐year asthma outcome. The development of atopic asthma in children with early rhinovirus‐induced wheezing was associated with DNA methylation changes at several genomic sites in chromosomal regions previously linked to asthma. The strongest changes in atopic asthma were detected in the promoter region of SMAD3 gene at chr 15q22.33 and introns of DDO/METTL24 genes at 6q21. These changes were validated to be present also at the average age of 8 years.
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Affiliation(s)
- R. J. Lund
- Turku Centre for Biotechnology; University of Turku and Åbo Akademi University; Turku Finland
| | - M. Osmala
- Department of Information and Computer Science; Aalto University; Helsinki Finland
| | - M. Malonzo
- Department of Information and Computer Science; Aalto University; Helsinki Finland
| | - M. Lukkarinen
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital; University of Turku; Turku Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine; University of Turku; Turku Finland
| | - A. Leino
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital; University of Turku; Turku Finland
| | - J. Salmi
- Turku Centre for Biotechnology; University of Turku and Åbo Akademi University; Turku Finland
| | - S. Vuorikoski
- Turku Centre for Biotechnology; University of Turku and Åbo Akademi University; Turku Finland
| | - R. Turunen
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital; University of Turku; Turku Finland
- Department of Virology; University of Turku; Turku Finland
| | - T. Vuorinen
- Department of Virology; University of Turku; Turku Finland
- Department of Clinical Virology; Turku University Hospital; Turku Finland
| | - C. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF); Christine Kühne-Center for Allergy Research and Education (CK-CARE); University of Zürich; Davos Switzerland
| | - H. Lähdesmäki
- Department of Information and Computer Science; Aalto University; Helsinki Finland
| | - R. Lahesmaa
- Turku Centre for Biotechnology; University of Turku and Åbo Akademi University; Turku Finland
| | - T. Jartti
- Department of Paediatrics and Adolescent Medicine; Turku University Hospital; University of Turku; Turku Finland
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Koistinen A, Lukkarinen M, Turunen R, Vuorinen T, Vahlberg T, Camargo CA, Gern J, Ruuskanen O, Jartti T. Prednisolone for the first rhinovirus-induced wheezing and 4-year asthma risk: A randomized trial. Pediatr Allergy Immunol 2017; 28:557-563. [PMID: 28660720 PMCID: PMC7168117 DOI: 10.1111/pai.12749] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Previous findings show that corticosteroid treatment during the first acute wheezing episode may reduce recurrent wheezing in children with high rhinovirus genome load at 12-month follow-up. Longer-term effects have not been investigated prospectively. METHODS After PCR confirmation of rhinovirus from nasopharyngeal aspirate, 79 children with the first acute wheezing episode were randomized to receive orally prednisolone or placebo for 3 days. The initiation of asthma control medication before the age of 5 years was confirmed from medical record and/or from parental interview. The outcome was the time to initiation of regular asthma control medication. Interaction analysis examined rhinovirus genome load. RESULTS Fifty-nine (75%) children completed the follow-up. Asthma control medication was initiated in 40 (68%) children at the median age of 20 months. Overall, prednisolone did not affect the time to initiation of asthma control medication when compared to placebo (P=.99). Rhinovirus load modified the effect of prednisolone regarding the time to initiation of asthma control medication (P-value for interaction=.04). In children with high rhinovirus load (>7000 copies/mL; n=23), the risk for initiation of medication was lower in the prednisolone group compared to the placebo group (P=.05). In the placebo group, asthma medication was initiated to all children with high rhinovirus load (n=9) during the 14 months after the first wheezing episode. CONCLUSIONS Overall, prednisolone did not affect the time to initiation of asthma control medication when compared to placebo. However, prednisolone may be beneficial in first-time wheezing children whose episode was severe and associated with high rhinovirus load. (ClinicalTrials.gov, NCT00731575).
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Affiliation(s)
- Annamari Koistinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Minna Lukkarinen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Riitta Turunen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.,Department of Clinical Virology, Turku University Hospital, Turku, Finland
| | - Tytti Vuorinen
- Department of Clinical Virology, Turku University Hospital, Turku, Finland
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Carlos A Camargo
- Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.,Division of Rheumatology, Allergy and Immunology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - James Gern
- The Departments of Pediatrics and Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Olli Ruuskanen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Tuomas Jartti
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
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Rhinovirus-induced first wheezing episode predicts atopic but not nonatopic asthma at school age. J Allergy Clin Immunol 2017; 140:988-995. [PMID: 28347734 PMCID: PMC7172285 DOI: 10.1016/j.jaci.2016.12.991] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 12/12/2016] [Accepted: 12/23/2016] [Indexed: 12/30/2022]
Abstract
Background Persistent childhood asthma is mainly atopy driven. However, limited data exist on the risk factors for childhood asthma phenotypes. Objective We sought to identify risk factors at the first severe wheezing episode for current asthma 7 years later and separately for atopic and nonatopic asthma. Methods One hundred twenty-seven steroid-naive children with the first severe wheezing episode (90% hospitalized/10% emergency department treated) were followed for 7 years. The primary outcome was current asthma at age 8 years, which was also analyzed separately as atopic and nonatopic asthma. Risk factors, including sensitization, viral cause, and other main asthma risk factors, were analyzed. Results At study entry, median age was 11 months (interquartile range, 6-16 months); 17% were sensitized, and 98% were virus positive. Current asthma (n = 37) at 8 years was divided into atopic (n = 19) and nonatopic (n = 18) asthma. The risk factors for current atopic asthma at study entry were sensitization (adjusted odds ratio [OR], 12; P < .001), eczema (adjusted OR, 4.8; P = .014), and wheezing with rhinovirus (adjusted OR, 5.0; P = .035). The risk factors for nonatopic asthma were the first severe respiratory syncytial virus/rhinovirus–negative wheezing episode (adjusted OR, 8.0; P = .001), first wheezing episode at age less than 12 months (adjusted OR, 7.3; P = .007), and parental smoking (adjusted OR, 3.8; P = .028). Conclusions The data suggest diverse asthma phenotypes and mechanisms that can be predicted by using simple clinical markers at the time of the first severe wheezing episode. These findings are important for designing early intervention strategies for secondary prevention of asthma.
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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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