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Starshinova A, Borozinets A, Kulpina A, Sereda V, Rubinstein A, Kudryavtsev I, Kudlay D. Bronchial Asthma and COVID-19: Etiology, Pathological Triggers, and Therapeutic Considerations. PATHOPHYSIOLOGY 2024; 31:269-287. [PMID: 38921725 PMCID: PMC11206645 DOI: 10.3390/pathophysiology31020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
Bronchial asthma (BA) continues to be a difficult disease to diagnose. Various factors have been described in the development of BA, but to date, there is no clear evidence for the etiology of this chronic disease. The emergence of COVID-19 has contributed to the pandemic course of asthma and immunologic features. However, there are no unambiguous data on asthma on the background and after COVID-19. There is correlation between various trigger factors that provoke the development of bronchial asthma. It is now obvious that the SARS-CoV-2 virus is one of the provoking factors. COVID-19 has affected the course of asthma. Currently, there is no clear understanding of whether asthma progresses during or after COVID-19 infection. According to the results of some studies, a significant difference was identified between the development of asthma in people after COVID-19. Mild asthma and moderate asthma do not increase the severity of COVID-19 infection. Nevertheless, oral steroid treatment and hospitalization for severe BA were associated with higher COVID-19 severity. The influence of SARS-CoV-2 infection is one of the protective factors. It causes the development of severe bronchial asthma. The accumulated experience with omalizumab in patients with severe asthma during COVID-19, who received omalizumab during the pandemic, has strongly suggested that continued treatment with omalizumab is safe and may help prevent the severe course of COVID-19. Targeted therapy for asthma with the use of omalizumab may also help to reduce severe asthma associated with COVID-19. However, further studies are needed to prove the effect of omalizumab. Data analysis should persist, based on the results of the course of asthma after COVID-19 with varying degrees of severity.
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Affiliation(s)
- Anna Starshinova
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia;
| | - Anastasia Borozinets
- Medical Department, I.M. Sechenov First Moscow State Medical University, 197022 Moscow, Russia
| | - Anastasia Kulpina
- Medical Department, Saint Petersburg State Pediatric Medical University, 194100 St. Petersburg, Russia;
| | - Vitaliy Sereda
- Medical Department, Saint Petersburg State University, 199034 St. Petersburg, Russia;
| | - Artem Rubinstein
- Department of immunology, Institution of Experimental Medicine, 197376 St. Petersburg, Russia;
| | - Igor Kudryavtsev
- Almazov National Medical Research Centre, 197341 St. Petersburg, Russia;
- Department of immunology, Institution of Experimental Medicine, 197376 St. Petersburg, Russia;
| | - Dmitry Kudlay
- Institute of Immunology FMBA of Russia, 115478 Moscow, Russia;
- Department of Pharmacognosy and Industrial Pharmacy, Faculty of Fundamental Medicine, Lomonosov Moscow State University, 119991 Moscow, Russia
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Majewska-Szczepanik M, Kowalczyk P, Askenase PW, Szczepanik M. Natural killer cell-mediated contact dermatitis-like reaction induced by treatment with TLR3 ligand poly(I:C). Contact Dermatitis 2023; 89:230-240. [PMID: 37463838 PMCID: PMC10530359 DOI: 10.1111/cod.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Poly(I:C) is recognised by endosomal Toll-like receptor 3 (TLR3) and activates cytotoxic CD8(+) lymphocytes and natural killer (NK) cells. It has been shown that the viral TLR3 agonist induces robust and long-lasting T-cell-mediated responses. In addition, TLR3 modulates the contact hypersensitivity reaction. OBJECTIVE This study aimed to determine whether poly(I:C) injection can induce NK-mediated hapten reactivity in mice. METHODS Mice were treated with poly(I:C), and their response to dinitrofluorobenzene hapten was measured by assessing ear swelling and serum interferon gamma (IFN-γ) production. Adoptive cell transfer and cell sorting were used to investigate the mechanism of the reaction, and the phenotype of poly(I:C)-activated liver NK cells was determined by flow cytometry analysis. RESULTS The results showed that poly(I:C) administration increased ear swelling, serum IFN-γ levels and the response to hapten in both immunocompetent and T- and B-cell-deficient mice. Only liver poly(I:C)-activated DX5(+) NK cells were able to transfer reactivity to hapten into a naive recipient. Induction of liver NK cells after poly(I:C) administration was TLR3/TRIF- and IFN-γ-dependent, interleukin 12-independent, and not modulated by MyD88. CONCLUSION This study provides new insights into how poly(I:C) stimulates NK-mediated reactivity to hapten and suggests that liver NK cells may modulate the immune response to non-pathogenic factors during viral infection.
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Affiliation(s)
- Monika Majewska-Szczepanik
- Department of Medical Physiology, Chair of Biomedical Sciences, Faculty of Health Sciences, Institute of Physiotherapy, Jagiellonian University Medical College, 31-126 Krakow, Poland
- Department of Internal Medicine, Section of Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, USA
| | - Paulina Kowalczyk
- Chair of Biomedical Sciences, Faculty of Health Sciences, Institute of Physiotherapy, Jagiellonian University Medical College, 31-034 Krakow, Poland
| | - Philip W Askenase
- Department of Internal Medicine, Section of Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, USA
| | - Marian Szczepanik
- Department of Internal Medicine, Section of Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, USA
- Chair of Biomedical Sciences, Faculty of Health Sciences, Institute of Physiotherapy, Jagiellonian University Medical College, 31-034 Krakow, Poland
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Plaza Moral V, Alobid I, Álvarez Rodríguez C, Blanco Aparicio M, Ferreira J, García G, Gómez-Outes A, Garín Escrivá N, Gómez Ruiz F, Hidalgo Requena A, Korta Murua J, Molina París J, Pellegrini Belinchón FJ, Plaza Zamora J, Praena Crespo M, Quirce Gancedo S, Sanz Ortega J, Soto Campos JG. GEMA 5.3. Spanish Guideline on the Management of Asthma. OPEN RESPIRATORY ARCHIVES 2023; 5:100277. [PMID: 37886027 PMCID: PMC10598226 DOI: 10.1016/j.opresp.2023.100277] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide. Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists. Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
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Affiliation(s)
| | - Isam Alobid
- Otorrinolaringología, Hospital Clinic de Barcelona, España
| | | | | | - Jorge Ferreira
- Hospital de São Sebastião – CHEDV, Santa Maria da Feira, Portugal
| | | | - Antonio Gómez-Outes
- Farmacología clínica, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, España
| | - Noé Garín Escrivá
- Farmacia Hospitalaria, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | | | - Javier Korta Murua
- Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San, Sebastián, España
| | - Jesús Molina París
- Medicina de familia, semFYC, Centro de Salud Francia, Fuenlabrada, Dirección Asistencial Oeste, Madrid, España
| | | | - Javier Plaza Zamora
- Farmacia comunitaria, Farmacia Dr, Javier Plaza Zamora, Mazarrón, Murcia, España
| | | | | | - José Sanz Ortega
- Alergología Pediátrica, Hospital Católico Universitario Casa de Salud, Valencia, España
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Bakakos A, Sotiropoulou Z, Vontetsianos A, Zaneli S, Papaioannou AI, Bakakos P. Epidemiology and Immunopathogenesis of Virus Associated Asthma Exacerbations. J Asthma Allergy 2023; 16:1025-1040. [PMID: 37791040 PMCID: PMC10543746 DOI: 10.2147/jaa.s277455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/16/2023] [Indexed: 10/05/2023] Open
Abstract
Asthma is a common airway disease, affecting millions of people worldwide. Although most asthma patients experience mild symptoms, it is characterized by variable airflow limitation, which can occasionally become life threatening in the case of a severe exacerbation. The commonest triggers of asthma exacerbations in both children and adults are viral infections. In this review article, we will try to investigate the most common viruses triggering asthma exacerbations and their role in asthma immunopathogenesis, since viral infections in young adults are thought to trigger the development of asthma either right away after the infection or at a later stage of their life. The commonest viral pathogens associated with asthma include the respiratory syncytial virus, rhinoviruses, influenza and parainfluenza virus, metapneumovirus and coronaviruses. All these viruses exploit different molecular pathways to infiltrate the host. Asthmatics are more prone to severe viral infections due to their unique inflammatory response, which is mostly characterized by T2 cytokines. Unlike the normal T1 high response to viral infection, asthmatics with T2 high inflammation are less potent in containing a viral infection. Inhaled and/or systematic corticosteroids and bronchodilators remain the cornerstone of asthma exacerbation treatment, and although many targeted therapies which block molecules that viruses use to infect the host have been used in a laboratory level, none has been yet approved for clinical use. Nevertheless, further understanding of the unique pathway that each virus follows to infect an individual may be crucial in the development of targeted therapies for the commonest viral pathogens to effectively prevent asthma exacerbations. Finally, biologic therapies resulted in a complete change of scenery in the treatment of severe asthma, especially with a T2 high phenotype. All available data suggest that monoclonal antibodies are safe and able to drastically reduce the rate of viral asthma exacerbations.
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Affiliation(s)
- Agamemnon Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Zoi Sotiropoulou
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Angelos Vontetsianos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Stavroula Zaneli
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Andriana I Papaioannou
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Petros Bakakos
- 1st University Department of Respiratory Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
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Liu T, Huang Z, Zhu H, An N, Gan H, Xue M, Zheng P, Sun B. Association between urban garbage exposure and allergic diseases among sanitation practitioners: A cross-sectional study. World Allergy Organ J 2023; 16:100754. [PMID: 37588125 PMCID: PMC10426333 DOI: 10.1016/j.waojou.2023.100754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 02/15/2023] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
Background The prevalence of allergic diseases has increased significantly in China over the last few decades, and there have been very few reports of allergic diseases in certain occupational specialties, with almost no reports among sanitation workers. Objective Our objective was to investigate the prevalence of allergic diseases and the prevalence of common allergen sensitization in the population engaged in sanitation, and to try to answer the connection between urban garbage waste exposure and the development of allergic diseases. Methods We conducted a cross-sectional survey of people working in sanitation-related jobs in Liwan District, Guangzhou, China. A total of 893 people completed the questionnaire for this study, and 500 of them were further screened and tested for allergens specific IgE and IgG4. Combining the questionnaire and test results, we investigated the incidence of allergy disorders and patterns of sensitization to allergens in this community, and evaluated the presence of occupational-related risk factors in this particular population. Results Of the 893 sanitation workers, 166 (18.59%) self-reported allergic diseases, predominantly suffering from allergic rhinitis (AR) (n = 98, 10.97%), followed by drug allergy (n = 31, 3.47%), atopic dermatitis (n = 27, 3.02%), food allergy (n = 21, 2.35%), and asthma (n = 9, 1.00%), in that order. In addition to dust mites (32.20%), which had the highest sensitization rate, the subject population had relatively high sensitization rates to ragweed (7.00%) and moulds mixture (8.20%) when compared with the rates of sensitization to moulds and ragweed in the general population; the top 3 sIgG4 positivity rates were egg (50.00%), milk (10.20%), and soybean (9.40%). The prevalence of self-reported AR was higher in office managers (the control group) than in cleaning staff (the exposed group), but there was no difference in sIgE positivity for serum allergens between the 2 groups. The chance of having AR may increase with management positions (crude OR 2.20, 95% CI 1.38-3.50), P = 0.001). Conclusion This is the first study to investigate the prevalence of allergy illnesses in the sanitation workforce in mainland China. We identified a community of real sanitation workers with high ragweed and mycobacterial sensitization rates. Urban cleaning may be protective factor against AR at the symptom level, but the serological results did not show this to be the case.
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Affiliation(s)
| | | | | | - Nairui An
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Hui Gan
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Mingshan Xue
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Peiyan Zheng
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
| | - Baoqing Sun
- Department of Clinical Laboratory, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510120, China
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Triasih R, Setyowireni D, Nurani N, Setyati A. Prevalence, Management, and Risk Factors of Asthma Among School-Age Children in Yogyakarta, Indonesia. J Asthma Allergy 2023; 16:23-32. [PMID: 36636706 PMCID: PMC9830052 DOI: 10.2147/jaa.s392733] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Childhood asthma in developing countries has been increasing, but underdiagnosed and undertreated. We reported prevalence, management, and risk factors of asthma among school-age children in Yogyakarta, Indonesia. Patients and Methods We recruited children aged 6-7 years and 13-14 years attending schools in all districts in Yogyakarta, Indonesia. The schools were randomly selected via cluster random sampling. We used the Indonesian version of the Global Asthma Network (GAN) questionnaire, and the methodology employed by this study was in accordance with the GAN's protocol. Results A total of 2106 children aged 6-7 years and 3142 adolescents aged 13-14 years were eligible for analysis. The prevalence of current wheeze in children and adolescents was similar, which was 4.6%. Inhalation therapy was reported in <30% of those with asthma. Risk factors for current wheeze in children were wheezing in infancy period, ever had pneumonia, the house was passed by trucks every day, and fast-food consumption in the previous 12 months; whereas exclusive breastfeeding for more than 6 months decreased the risk of current wheeze. In adolescence, obesity, consumption of fast food once or twice a week, and paracetamol in the previous 12 months increased the risk of current wheeze. Conclusion The prevalence of current wheeze in children and adolescents in Indonesia was quite low. The use of inhalation therapy was limited. Respiratory problems during infancy, environmental, and nutritional factors play a role in the development of asthma.
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Affiliation(s)
- Rina Triasih
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia,Correspondence: Rina Triasih, Department of Pediatrics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/ Dr. Sardjito Hospital, Jl. Kesehatan 1, Yogyakarta, 55284, Indonesia, Tel +62 81392764269, Fax +6274 583745, Email
| | - Dwikisworo Setyowireni
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Neti Nurani
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Amalia Setyati
- Department of Pediatrics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada /Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Hossain MM, Abdulla F, Rahman A. Prevalence and determinants of wasting of under-5 children in Bangladesh: Quantile regression approach. PLoS One 2022; 17:e0278097. [PMID: 36417416 PMCID: PMC9683614 DOI: 10.1371/journal.pone.0278097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Wasting is perhaps one of the signs of malnutrition that has been linked to the deaths of children suffering from malnutrition. As a result, understanding its correlations and drivers is critical. Using quantile regression analysis, this research aims to contribute to the discussion on under-5 malnutrition by analyzing the predictors of wasting in Bangladesh. METHODS AND MATERIALS The dataset was extracted from the 2017-18 Bangladesh demographic and health survey (BDHS) data. The weight-for-height (WHZ) z-score based anthropometric indicator was used in the study as the target variable. The weighted sample constitutes 8,334 children of under-5 years. However, after cleaning the missing values, the analysis is based on 8,321 children. Sequential quantile regression was used for finding the contributing factors. RESULTS The findings of this study depict that the prevalence of wasting in children is about 8 percent and only approximately one percent of children are severely wasted in Bangladesh. Age, mother's BMI, and parental educational qualification, are all major factors of the WHZ score of a child. The coefficient of the female child increased from 0.1 to 0.2 quantiles before dropping to 0.75 quantile. For a child aged up to three years, the coefficients have a declining tendency up to the 0.5 quantile, then an increasing trend. Children who come from the richest households had 16.3%, 3.6%, and 15.7% higher WHZ scores respectively than children come from the poorest households suggesting that the risk of severe wasting in children under the age of five was lower in children from the wealthiest families than in children from the poorest families. The long-term malnutrition indicator (wasting) will be influenced by the presence of various childhood infections and vaccinations. Furthermore, a family's economic position is a key determinant in influencing a child's WHZ score. CONCLUSIONS It is concluded that socioeconomic characteristics are correlated with the wasting status of a child. Maternal characteristics also played an important role to reduce the burden of malnutrition. Thus, maternal nutritional awareness might reduce the risk of malnutrition in children. Moreover, the findings disclose that to enrich the nutritional status of children along with achieving Sustainable Development Goal (SDG)-3 by 2030, a collaborative approach should necessarily be taken by the government of Bangladesh, and non-governmental organizations (NGOs) at the community level in Bangladesh.
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Affiliation(s)
- Md. Moyazzem Hossain
- Department of Statistics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- School of Mathematics, Statistics & Physics, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Faruq Abdulla
- Department of Applied Health and Nutrition, RTM Al Kabir Technical University (RTM-AKTU), Sylhet, Bangladesh
| | - Azizur Rahman
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, New South Wales, Australia
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van Meel ER, Mensink-Bout SM, den Dekker HT, Ahluwalia TS, Annesi-Maesano I, Arshad SH, Baïz N, Barros H, von Berg A, Bisgaard H, Bønnelykke K, Carlsson CJ, Casas M, Chatzi L, Chevrier C, Dalmeijer G, Dezateux C, Duchen K, Eggesbø M, van der Ent C, Fantini M, Flexeder C, Frey U, Forastiere F, Gehring U, Gori D, Granell R, Griffiths LJ, Inskip H, Jerzynska J, Karvonen AM, Keil T, Kelleher C, Kogevinas M, Koppen G, Kuehni CE, Lambrechts N, Lau S, Lehmann I, Ludvigsson J, Magnus MC, Mélen E, Mehegan J, Mommers M, Nybo Andersen AM, Nystad W, Pedersen ESL, Pekkanen J, Peltola V, Pike KC, Pinot de Moira A, Pizzi C, Polanska K, Popovic M, Porta D, Roberts G, Santos AC, Schultz ES, Standl M, Sunyer J, Thijs C, Toivonen L, Uphoff E, Usemann J, Vafeidi M, Wright J, de Jongste JC, Jaddoe VWV, Duijts L. Early-life respiratory tract infections and the risk of school-age lower lung function and asthma: a meta-analysis of 150 000 European children. Eur Respir J 2022; 60:2102395. [PMID: 35487537 PMCID: PMC9535116 DOI: 10.1183/13993003.02395-2021] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 03/09/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Early-life respiratory tract infections might affect chronic obstructive respiratory diseases, but conclusive studies from general populations are lacking. Our objective was to examine if children with early-life respiratory tract infections had increased risks of lower lung function and asthma at school age. METHODS We used individual participant data of 150 090 children primarily from the EU Child Cohort Network to examine the associations of upper and lower respiratory tract infections from age 6 months to 5 years with forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), FEV1/FVC, forced expiratory flow at 75% of FVC (FEF75%) and asthma at a median (range) age of 7 (4-15) years. RESULTS Children with early-life lower, not upper, respiratory tract infections had a lower school-age FEV1, FEV1/FVC and FEF75% (z-score range: -0.09 (95% CI -0.14- -0.04) to -0.30 (95% CI -0.36- -0.24)). Children with early-life lower respiratory tract infections had a higher increased risk of school-age asthma than those with upper respiratory tract infections (OR range: 2.10 (95% CI 1.98-2.22) to 6.30 (95% CI 5.64-7.04) and 1.25 (95% CI 1.18-1.32) to 1.55 (95% CI 1.47-1.65), respectively). Adjustment for preceding respiratory tract infections slightly decreased the strength of the effects. Observed associations were similar for those with and without early-life wheezing as a proxy for early-life asthma. CONCLUSIONS Our findings suggest that early-life respiratory tract infections affect development of chronic obstructive respiratory diseases in later life, with the strongest effects for lower respiratory tract infections.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sara M Mensink-Bout
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Herman T den Dekker
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Tarunveer S Ahluwalia
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Isabella Annesi-Maesano
- Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France
| | - Syed Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Nour Baïz
- Sorbonne Université and INSERM, Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Andrea von Berg
- Research Institute, Dept of Pediatrics, Marien-Hospital Wesel, Wesel, Germany
| | - Hans Bisgaard
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Bønnelykke
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian J Carlsson
- COPSAC (Copenhagen Prospective Studies on Asthma in Childhood), Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maribel Casas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Leda Chatzi
- Dept of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Geertje Dalmeijer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carol Dezateux
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Karel Duchen
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | | | - Cornelis van der Ent
- Dept of Pediatric Pulmonology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria Fantini
- Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Claudia Flexeder
- Institute of Epidemiology I, Helmholtz Zentrum München, Munich, Germany
| | - Urs Frey
- University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | | | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Davide Gori
- Dept of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Raquel Granell
- MRC Intergrative Epidemiology Unit, Dept of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lucy J Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Hazel Inskip
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Joanna Jerzynska
- Dept of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Anne M Karvonen
- Dept of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzberg, Germany
- State Institute for Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - Cecily Kelleher
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Manolis Kogevinas
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- National School of Public Health, Athens, Greece
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Gudrun Koppen
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health Unit, Mol, Belgium
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Paediatric Respiratory Medicine, Children's University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Nathalie Lambrechts
- Flemish Institute for Technological Research (VITO), Environmental Risk and Health Unit, Mol, Belgium
| | - Susanne Lau
- Dept of Pediatric Pulmonology, Immunology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Irina Lehmann
- Dept of Environmental Immunology, Helmholtz Centre for Environmental Research Leipzig - UFZ, Leipzig, Germany
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital and Division of Pediatrics, Dept of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Maria Christine Magnus
- MRC Intergrative Epidemiology Unit, Dept of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Erik Mélen
- Dept of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sach's Children Hospital, Stockholm, Sweden
| | - John Mehegan
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Monique Mommers
- Dept of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Wenche Nystad
- Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eva S L Pedersen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Juha Pekkanen
- Dept of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
- Dept of Public Health, University of Helsinki, Helsinki, Finland
| | - Ville Peltola
- Dept of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | | | | | - Costanza Pizzi
- Dept of Medical Sciences, University of Turin, Turin, Italy
| | - Kinga Polanska
- Dept of Environmental Epidemiology, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Maja Popovic
- Dept of Medical Sciences, University of Turin, Turin, Italy
| | - Daniela Porta
- Dept of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
- NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ana Cristina Santos
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Erica S Schultz
- Dept of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Sach's Children Hospital, Stockholm, Sweden
| | - Marie Standl
- Institute of Epidemiology I, Helmholtz Zentrum München, Munich, Germany
- German Research Center for Environmental Health, Munich, Germany
| | - Jordi Sunyer
- ISGlobal, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Carel Thijs
- Dept of Epidemiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Laura Toivonen
- Dept of Pediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Eleonora Uphoff
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jakob Usemann
- University Children's Hospital Basel (UKBB), University of Basel, Basel, Switzerland
| | - Marina Vafeidi
- Dept of Social Medicine, University of Crete, Heraklion, Greece
| | - John Wright
- Born in Bradford, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Johan C de Jongste
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Liesbeth Duijts
- Dept of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Dept of Pediatrics, Division of Neonatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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9
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De Souza MM, Koltes DA, Beiki H, Sales MA, Tsai T, Maxwell CV, Zhao J, Koltes JE. Early-Life Exposure of Pigs to Topsoil Alters miRNA and mRNA Expression in Peripheral Blood Mononuclear Cells. Front Genet 2022; 13:886875. [PMID: 36081988 PMCID: PMC9445269 DOI: 10.3389/fgene.2022.886875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
Exposure to less-hygienic conditions during early childhood has been associated with stimulation and development of the immune system. A recent study indicated that exposure of piglets to soil-borne microbes during lactation was related with modulation of gut microbiota and immune function. To identify the potential molecular mechanisms and pathways impacted by early-life topsoil exposure, we analyzed the messenger RNA (mRNA) and micro-RNA (miRNA) expression in peripheral blood mononuclear cells (PBMCs) from these piglets. Total RNA was extracted from the PBMCs of piglets exposed to topsoil only from d 4–d 21 of life (mRNA n = 6; miRNA n = 5) or unexposed control pigs (mRNA n = 6; miRNA n = 8) at 11, 20, and 56 days of age. Small RNA and mRNA were sequenced with 50-bp single-end reads using Illumina chemistry. Sequence data were quality checked with FASTQC software and aligned to the Sscrofa 11.1 genome with the STAR aligner for mRNA and mirDeep2 for miRNA. Differential expression (DE) analysis was performed using PROC Glimmix of SAS to evaluate changes in expression due to topsoil exposure over time with genes declared DE at a false discovery rate (FDR) of q < 0.10. A total of 138 mRNA and 21 miRNAs were identified as DE for the treatment by age interaction. Ontology enrichment analysis of DE mRNA revealed Gene ontology (GO) terms directly involved in the connection between T-cell and antigen-presenting cells that are associated with T-cell activation. Key regulatory genes identified include PTPRJ, ITGB3, TRBV30, CD3D, mir-143, mir-29, and mir-148a. While these results require validation, this study provides data supporting the hypothesis that less-hygienic environments during early life may contribute to the development of the immune system.
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Affiliation(s)
- M. M. De Souza
- Department of Animal Science, Iowa State University, Ames, IA, United States
| | - D. A. Koltes
- Department of Animal Science, Iowa State University, Ames, IA, United States
| | - H. Beiki
- Department of Animal Science, Iowa State University, Ames, IA, United States
| | - M. A. Sales
- Department of Animal Science, University of Arkansas-Division of Agriculture, Fayetteville, AR, United States
| | - T. Tsai
- Department of Animal Science, University of Arkansas-Division of Agriculture, Fayetteville, AR, United States
| | - C. V. Maxwell
- Department of Animal Science, University of Arkansas-Division of Agriculture, Fayetteville, AR, United States
| | - J. Zhao
- Department of Animal Science, University of Arkansas-Division of Agriculture, Fayetteville, AR, United States
| | - J. E. Koltes
- Department of Animal Science, Iowa State University, Ames, IA, United States
- *Correspondence: J. E. Koltes,
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10
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Augustine T, Kumar M, Al Khodor S, van Panhuys N. Microbial Dysbiosis Tunes the Immune Response Towards Allergic Disease Outcomes. Clin Rev Allergy Immunol 2022:10.1007/s12016-022-08939-9. [PMID: 35648372 DOI: 10.1007/s12016-022-08939-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 02/07/2023]
Abstract
The hygiene hypothesis has been popularized as an explanation for the rapid increase in allergic disease observed over the past 50 years. Subsequent epidemiological studies have described the protective effects that in utero and early life exposures to an environment high in microbial diversity have in conferring protective benefits against the development of allergic diseases. The rapid advancement in next generation sequencing technology has allowed for analysis of the diverse nature of microbial communities present in the barrier organs and a determination of their role in the induction of allergic disease. Here, we discuss the recent literature describing how colonization of barrier organs during early life by the microbiota influences the development of the adaptive immune system. In parallel, mechanistic studies have delivered insight into the pathogenesis of disease, by demonstrating the comparative effects of protective T regulatory (Treg) cells, with inflammatory T helper 2 (Th2) cells in the development of immune tolerance or induction of an allergic response. More recently, a significant advancement in our understanding into how interactions between the adaptive immune system and microbially derived factors play a central role in the development of allergic disease has emerged. Providing a deeper understanding of the symbiotic relationship between our microbiome and immune system, which explains key observations made by the hygiene hypothesis. By studying how perturbations that drive dysbiosis of the microbiome can cause allergic disease, we stand to benefit by delineating the protective versus pathogenic aspects of human interactions with our microbial companions, allowing us to better harness the use of microbial agents in the design of novel prophylactic and therapeutic strategies.
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Affiliation(s)
- Tracy Augustine
- Laboratory of Immunoregulation, Sidra Medicine, PO BOX 26999, Doha, Qatar
| | - Manoj Kumar
- Microbiome and Host-Microbes Interactions Laboratory, Sidra Medicine, Doha, Qatar
| | - Souhaila Al Khodor
- Microbiome and Host-Microbes Interactions Laboratory, Sidra Medicine, Doha, Qatar
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11
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Nagasaki T, Tabuchi T, Matsumoto H, Horimukai K. Age-specific associations of early daycare, older siblings, severe airway infection, and preterm birth with subsequent atopic diseases. Pediatr Allergy Immunol 2022; 33:e13771. [PMID: 35470939 DOI: 10.1111/pai.13771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/20/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The effects of infection and developmental adaptations in infancy on the prevalence of subsequent atopy-related diseases at different ages during childhood are not fully determined. This study aims to examine the similarities and differences in the age-specific association of asthma, allergic rhinitis/conjunctivitis, and atopic dermatitis with early-life infection-related factors (i.e., daycare, older siblings, and severe airway infection) and developmental adaptations (i.e., preterm birth and rapid weight gain) in children. METHODS In this longitudinal cohort study (n = 47,015), children were followed from 0.5 to 11 years. The potential risks and protective factors, including daycare attendance at 0.5 years, existence of older siblings, history of hospitalization due to cold/bronchitis/bronchiolitis/pneumonia during 0.5-1.5 years, preterm birth, and rapid weight gain in the first 2.5 years, were assessed using multivariable logistic regression with adjustments for potential confounders. RESULTS A protective association was observed between early-life daycare attendance and asthma at 5.5-9 years, which disappeared after 10 years. A protective association was also noted throughout childhood between early daycare attendance and older siblings with allergic rhinitis/conjunctivitis. However, the association between early daycare and atopic dermatitis was found to be risky during childhood. In contrast, the early-life history of hospitalization owing to cold/bronchitis/bronchiolitis/pneumonia was identified to be a risk factor for developing both asthma and allergic rhinitis/conjunctivitis. Preterm birth was a significant risk factor for childhood asthma. CONCLUSION Different age-specific patterns were demonstrated in the relationship between early daycare, severe airway infection, preterm birth, and atopy-related diseases in childhood.
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Affiliation(s)
- Tadao Nagasaki
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takahiro Tabuchi
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine & Allergology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kenta Horimukai
- Department of Pediatrics, Jikei University Katsushika Medical Center, Tokyo, Japan
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12
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Duong QA, Pittet LF, Curtis N, Zimmermann P. Antibiotic exposure and adverse long-term health outcomes in children: a systematic review and meta-analysis. J Infect 2022; 85:213-300. [PMID: 35021114 DOI: 10.1016/j.jinf.2022.01.005] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antibiotics are among the most commonly used drugs in children. In addition to inducing antibiotic resistance, antibiotic exposure has been associated with long-term adverse health outcomes. METHODS A systematic search using PRISMA Guidelines to identify original studies reporting associations between antibiotic exposure and long-term adverse health outcomes in children. Overall pooled estimates of the odds ratios (ORs) were obtained using fixed or random-effects models. RESULTS We identified 160 observational studies investigating 21 outcomes in 22,103,129 children. Antibiotic exposure was associated with an increased risk of atopic dermatitis (OR 1.40, 95% confidence interval (CI) 1.30-1.52, p<0.01), allergic symptoms (OR 1.93, 95%CI 1.66-2.26, p<0.01), food allergies (OR 1.35, 95%CI 1.20-1.52, p<0.01), allergic rhinoconjunctivitis (OR 1.66, 95%CI 1.51-1.83, p<0.01), wheezing (OR 1.81, 95%CI 1.65-1.97, p<0.01), asthma (OR 1.96, 95%CI 1.76-2.17, p<0.01), increased weight gain or overweight (OR 1.18, 95%CI 1.11-1.26, p<0.01), obesity (OR 1.21, 95%CI 1.05-1.40, p<0.01), juvenile idiopathic arthritis (OR 1.74, 95%CI 1.21-2.52, p<0.01), psoriasis (OR 1.75, 95%CI 1.44-2.11, p<0.01), autism spectrum disorders (OR 1.19, 95%CI 1.04-1.36, p=0.01) and neurodevelopment disorders (OR 1.29, 95%CI 1.09-1.53, p<0.01). Dose-response effects and stronger effects with broad-spectrum antibiotic were often reported. Antibiotic exposure was not associated with an altered risk of allergic sensitisation, infantile colic, abdominal pain, inflammatory bowel disease, celiac disease, type 1 diabetes, fluorosis, and attention deficit hyperactivity disorder. CONCLUSION Although a causal association cannot be determined from these studies, the results support the meticulous application of sound antibiotic stewardship to avoid potential adverse long-term health outcomes.
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Affiliation(s)
- Quynh Anh Duong
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Laure F Pittet
- Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Unit of Pediatric Infectious Diseases, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland.
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13
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Brittan MS, Moss A, Watson JD, Federico MJ, Rice JD, Dempsey AF, Ambroggio L. Association between early childhood lower respiratory tract infections and subsequent asthma. J Asthma 2021; 59:2143-2153. [PMID: 34706607 DOI: 10.1080/02770903.2021.1999469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We examined the relationship between recurrent lower respiratory tract infections (LRTI) in young children and subsequent childhood asthma outcomes. METHODS Retrospective cohort study using 2009-2017 Colorado All Payer Claims Database to assess 0- to 2-year-old children with visits due to LRTI and acute gastroenteritis (AGE). The primary exposure was number of LRTI visits prior to 2 years of age. Children with AGE served as the no LRTI comparator group. The primary outcome was incident asthma, defined by ICD-9 (490.XX) or ICD-10 (J45.9XX) codes, in the same children between 3 and 9 years of age. Multivariable accelerated failure time (AFT) models were used to estimate the effect of LRTI visits on median time to asthma diagnosis. Sensitivity analyses were performed using more conservative asthma diagnostic criteria and with hospitalized children only. RESULTS Of 38,441 eligible subjects, 32,729 had ≥1 LRTI and 5,712 had AGE (no LRTI) between 0 and 2 years of age. Children with ≥3 LRTI visits had an 80% decrease in median time to asthma diagnosis relative to those with AGE visits only (time ratio [TR] 0.2; 95% CI 0.16, 0.24). Children with ≥3 LRTI hospitalizations had a 98% reduction in median time to asthma diagnosis relative to those with AGE hospitalizations only (TR 0.02; 95% CI 0.01, 0.07). History of atopy, wheezing, and family history of asthma documented prior to 2 years of age were also associated with earlier asthma diagnosis. CONCLUSIONS Recurrent LRTIs, especially LRTI hospitalizations, before 2 years of age are associated with earlier diagnosis of pediatric asthma.
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Affiliation(s)
- Mark S Brittan
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, Aurora, CO, USA
| | - Angela Moss
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, Aurora, CO, USA
| | - John D Watson
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora, CO, USA
| | - Monica J Federico
- The Breathing Institute and Section of Pulmonary Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora, CO, USA
| | - John D Rice
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, Aurora, CO, USA.,The Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Amanda F Dempsey
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora, CO, USA.,Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Denver, Aurora, CO, USA
| | - Lilliam Ambroggio
- Section of Pediatric Hospital Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora, CO, USA.,Section of Pediatric Emergency Medicine, Children's Hospital Colorado, University of Colorado Denver, Aurora, CO, USA
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14
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Does the epithelial barrier hypothesis explain the increase in allergy, autoimmunity and other chronic conditions? Nat Rev Immunol 2021; 21:739-751. [PMID: 33846604 DOI: 10.1038/s41577-021-00538-7] [Citation(s) in RCA: 526] [Impact Index Per Article: 131.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 02/07/2023]
Abstract
There has been a steep increase in allergic and autoimmune diseases, reaching epidemic proportions and now affecting more than one billion people worldwide. These diseases are more common in industrialized countries, and their prevalence continues to rise in developing countries in parallel to urbanization and industrialization. Intact skin and mucosal barriers are crucial for the maintenance of tissue homeostasis as they protect host tissues from infections, environmental toxins, pollutants and allergens. A defective epithelial barrier has been demonstrated in allergic and autoimmune conditions such as asthma, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, eosinophilic esophagitis, coeliac disease and inflammatory bowel disease. In addition, leakiness of the gut epithelium is also implicated in systemic autoimmune and metabolic conditions such as diabetes, obesity, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis and autoimmune hepatitis. Finally, distant inflammatory responses due to a 'leaky gut' and microbiome changes are suspected in Alzheimer disease, Parkinson disease, chronic depression and autism spectrum disorders. This article introduces an extended 'epithelial barrier hypothesis', which proposes that the increase in epithelial barrier-damaging agents linked to industrialization, urbanization and modern life underlies the rise in allergic, autoimmune and other chronic conditions. Furthermore, it discusses how the immune responses to dysbiotic microbiota that cross the damaged barrier may be involved in the development of these diseases.
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15
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Hammond AM, Monir RL, Schoch JJ. The role of the pediatric cutaneous and gut microbiomes in childhood disease: A review. Semin Perinatol 2021; 45:151452. [PMID: 34272085 DOI: 10.1016/j.semperi.2021.151452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Infancy and early childhood are crucial periods in the development of the human microbiome and shape the trajectory of microbial colonization, immune system development, and systemic disease. We review the development of the skin and gut microbiomes, their connection to the immune system, and their relevance to common pediatric pathologies. FINDINGS Beginning after birth, and likely even in utero, colonization of the skin and the gut occur in parallel, influenced by external factors. This colonization, in turn, dictates maturation of the immune system and contributes to conditions from atopic dermatitis to sepsis. Emerging literature is identifying links between the gut and skin microbiomes. CONCLUSION The gut and skin microbiomes are associated with pediatric disease states. Immune and microbial plasticity make this unique period an ideal target for intervention. Investigating the purposeful manipulation of the pediatric microbiome may lead to novel treatment and prevention strategies.
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Affiliation(s)
| | - Reesa L Monir
- University of Florida College of Medicine, Gainesville, FL, USA; Department of Dermatology, Gainesville, FL, USA.
| | - Jennifer J Schoch
- University of Florida College of Medicine, Gainesville, FL, USA; Department of Dermatology, Gainesville, FL, USA.
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16
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Hasunuma H, Yoda Y, Tokuda N, Taniguchi N, Takeshima Y, Shima M, The Japan Environment and Children's Study (JECS) Group. Effects of early-life exposure to dust mite allergen and endotoxin on the development of asthma and wheezing: The Japan Environment and Children's Study. Clin Transl Allergy 2021; 11:e12071. [PMID: 34691391 PMCID: PMC8514641 DOI: 10.1002/clt2.12071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/18/2021] [Accepted: 09/22/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The effects of early-life exposure to house dust mite allergen and endotoxin on the development of asthma are unclear in the literature. We investigated the association of early-life exposure (0-36 months old) to house dust mite allergen and endotoxin with asthma incidence. METHODS In this novel, large-scale, nationwide birth cohort study, 5017 participants were randomly selected from those who met the eligibility criteria. House dust was vacuum-sampled from the children's mattresses within homes and assayed for the presence of dust mite allergen (Der 1) and endotoxin. The participants were classified into four quartiles (Q1-Q4) according to exposure levels. We defined the incidence of asthma and wheezing using questionnaires at 12, 24, and 36 months old. Odds ratios (ORs) of the incidence of asthma and wheezing by age in Der 1 and endotoxin exposure level were estimated using logistic regression. RESULTS The cumulative incidence rates of asthma and wheezing during 0-36 months were 10.4% and 38.1%, respectively. Significant ORs were observed in asthma onset during 12-24 months old, asthma onset during 24-36 months old, and wheezing onset during 0-12 months old in the Q4 Der 1 group. In the Q4 endotoxin group, significant positive associations between endotoxin exposure and asthma (OR 2.00, 95% confidence interval [CI]: 1.03-3.85) and wheezing (OR 1.78, 95% CI: 1.01-3.12) onset during 24-36 months old were found. CONCLUSIONS Our results indicated that high levels of early-life exposure to Der 1 and endotoxin in mattresses may be involved in the development of asthma.
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Affiliation(s)
- Hideki Hasunuma
- Department of Public HealthHyogo College of MedicineNishinomiyaJapan
- Hyogo Regional Centre for the Japan Environment and Children's StudyNishinomiyaJapan
| | - Yoshiko Yoda
- Department of Public HealthHyogo College of MedicineNishinomiyaJapan
| | - Narumi Tokuda
- Hyogo Regional Centre for the Japan Environment and Children's StudyNishinomiyaJapan
| | - Naoko Taniguchi
- Hyogo Regional Centre for the Japan Environment and Children's StudyNishinomiyaJapan
- Department of PediatricsHyogo College of MedicineNishinomiyaJapan
| | | | - Masayuki Shima
- Department of Public HealthHyogo College of MedicineNishinomiyaJapan
- Hyogo Regional Centre for the Japan Environment and Children's StudyNishinomiyaJapan
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17
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Association between vesicoureteral reflux, urinary tract infection and antibiotics exposure in infancy and risk of childhood asthma. PLoS One 2021; 16:e0257531. [PMID: 34547047 PMCID: PMC8454937 DOI: 10.1371/journal.pone.0257531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Background The use of antibiotics for treating infection in childhood and their association with increased risk of asthma remain controversial. Infants diagnosed with vesicoureteral reflux (VUR) belong to a unique population who are administered antibiotics for a long time and are susceptible to recurrent UTI. It is interesting to study the risk of asthma in these infants with or without VUR. Methods Taiwanese children born between 2000 and 2007 were enrolled in population-based birth cohort study. Participants diagnosed with VUR and UTI within first year were classified into four groups (VUR, UTI, VUR and UTI, and control). We calculated follow-up person-years for each participant from the index date until the asthma diagnosis, their withdrawal from the insurance system (because of death or loss to follow-up), or till the end of 2008. The risk of asthma was compared between the 4 cohorts by using Cox proportional hazards model analysis, adjusted hazard ratio (aHR), and 95% confidence interval (95% CI). Results Children diagnosed with VUR (n = 350), UTI (n = 15542), VUR and UTI (n = 1696), and randomly selected controls (n = 17588) were enrolled. The overall rate of incidence of asthma was found to be 1.64-fold, 1.45-fold, and 1.17-fold higher in the UTI, VUR/UTI, and VUR cohorts than in the controls (5.60, 5.07, and 4.10 vs. 3.17 per 100 person-years), respectively. After adjusting the potential factors, the overall risk of asthma remained the highest in UTI (aHR: 1.74, 95% CI : 1.65 to 1.80) followed by VUR/UTI (aHR: 1.56, 95% CI : 1.40 to 1.75) and VUR cohorts (aHR: 1.25, 95% CI: 0.96 to 1.62). The incidence of asthma was higher in boys than in girls. Conclusion The nationwide retrospective cohort study demonstrated that short-term therapeutic dose of antibiotics for UTI in infants with or without VUR has a positive correlation with the prevalence of childhood asthma. Significant risk of childhood asthma was not observed when VUR cohort was exposed to long-term low-dose of prophylactic antibiotics.
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Lubyayi L, Mpairwe H, Nkurunungi G, Lule SA, Nalwoga A, Webb EL, Levin J, Elliott AM. Infection-exposure in infancy is associated with reduced allergy-related disease in later childhood in a Ugandan cohort. eLife 2021; 10:66022. [PMID: 34550875 PMCID: PMC8457824 DOI: 10.7554/elife.66022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 09/16/2021] [Indexed: 01/16/2023] Open
Abstract
Background Lack of early infection-exposure has been associated with increased allergy-related disease (ARD) susceptibility. In tropical Africa, little is known about which infections contribute to development of ARDs, and at which time. Methods We used latent class analysis to characterise the early infection-exposure of participants in a Ugandan birth cohort and assessed ARDs in later childhood. Results Of 2345 live births, 2115 children (90%) had data on infections within the first year of life while 1179 (50%) had outcome data at 9 years. We identified two latent classes of children based on first-year infection-exposure. Class 1 (32% membership), characterised by higher probabilities for malaria (80%), diarrhoea (76%), and lower respiratory tract infections (LRTI) (22%), was associated with lower prevalence of wheeze, eczema, rhinitis, and Dermatophagoides skin prick test (SPT) positivity at 9 years. Based on 5-year cumulative infection experience, class 1 (31% membership), characterised by higher probabilities for helminths (92%), malaria (79%), and LRTI (45%), was associated with lower probabilities of SPT positivity at 9 years. Conclusions In this Ugandan birth cohort, early childhood infection-exposure, notably to malaria, helminths, LRTI, and diarrhoea, is associated with lower prevalence of atopy and ARDs in later childhood. Funding This work was supported by several funding sources. The Entebbe Mother and Baby Study (EMaBS) was supported by the Wellcome Trust, UK, senior fellowships for AME (grant numbers 064693, 079110, 95778) with additional support from the UK Medical Research Council. LL is supported by a PhD fellowship through the DELTAS Africa Initiative SSACAB (grant number 107754). ELW received funding from MRC Grant Reference MR/K012126/1. SAL was supported by the PANDORA-ID-NET Consortium (EDCTP Reg/Grant RIA2016E-1609). HM was supported by the Wellcome's Institutional Strategic Support Fund (grant number 204928/Z/16/Z).
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Affiliation(s)
- Lawrence Lubyayi
- Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Johannesburg, South Africa
| | - Harriet Mpairwe
- Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Gyaviira Nkurunungi
- Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Swaib A Lule
- Institute for Global Health, University College London, London, United Kingdom
| | - Angela Nalwoga
- Immuno-modulation and Vaccines Programme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emily L Webb
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan Levin
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Johannesburg, South Africa
| | - Alison M Elliott
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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19
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Deckers J, Marsland BJ, von Mutius E. Protection against allergies: Microbes, immunity, and the farming effect. Eur J Immunol 2021; 51:2387-2398. [PMID: 34415577 DOI: 10.1002/eji.202048938] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/08/2021] [Accepted: 08/17/2021] [Indexed: 12/19/2022]
Abstract
The prevalence of asthma and other allergic diseases has rapidly increased in "Westernized" countries over recent decades. This rapid increase suggests the involvement of environmental factors, behavioral changes or lifestyle, rather than genetic drift. It has become increasingly clear that the microbiome plays a key role in educating the host immune system and, thus, regulation of disease susceptibility. This review will focus on recent advances uncovering immunological and microbial mechanisms that protect against allergies, in particular, within the context of a farming environment. A whole body of epidemiological data disclosed the nature of the protective exposures in a farm. Current evidence points toward an important role of the host microbiome in setting an immunological equilibrium that determines progression toward, or protection against allergic diseases. Conclusive mechanistic insights on how microbial exposures prevent from developing allergic diseases in humans are still lacking but findings from experimental models reveal plausible immunological mechanisms. Gathering further knowledge on these mechanisms and confirming their relevance in humans is of great importance to develop preventive strategies for children at risk of developing allergies.
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Affiliation(s)
- Julie Deckers
- Laboratory of Immunoregulation and Mucosal Immunology, VIB Center for Inflammation Research, Ghent (Zwijnaarde), Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Benjamin J Marsland
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Erika von Mutius
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,German Center for Lung Research, München, Germany.,Dr. von Hauner Children's Hospital, Ludwig Maximilian University of Munich, Munich, Germany
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20
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Karakioulaki M, Papakonstantinou E, Goulas A, Stolz D. The Role of Atopy in COPD and Asthma. Front Med (Lausanne) 2021; 8:674742. [PMID: 34490286 PMCID: PMC8418108 DOI: 10.3389/fmed.2021.674742] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/26/2021] [Indexed: 12/31/2022] Open
Abstract
Common to several allergic diseases is the generation of immunoglobulin E (IgE) by plasma cells, when exposed to an innocuous antigen. Asthma and chronic obstructive pulmonary disease (COPD) are two prevalent chronic airway inflammatory diseases. Asthma is mediated in some patients through eosinophilic inflammatory mechanisms that include allergic sensitization and Th2-mediated immune airway response. COPD, on the other hand is mainly considered a Th1-mediated inflammatory process with neutrophilic predominance or a non-Th2 inflammation, occasionally associated with the presence of airway bacteria or viruses. IgE production appears to play an important role in the development of both COPD and asthma, as it has been associated to respiratory symptoms, lung function, bacterial and viral infections, airway remodeling and bronchial hyperreactivity in both diseases. The aim of this review is to summarize all current data concerning the role of specific and total IgE in COPD and asthma and to highlight similarities and differences in view of possible therapeutic interventions.
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Affiliation(s)
- Meropi Karakioulaki
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel, Basel, Switzerland
- First Laboratory of Pharmacology, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Papakonstantinou
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel, Basel, Switzerland
- First Laboratory of Pharmacology, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Goulas
- First Laboratory of Pharmacology, Department of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel, Basel, Switzerland
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21
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Komlósi ZI, van de Veen W, Kovács N, Szűcs G, Sokolowska M, O'Mahony L, Akdis M, Akdis CA. Cellular and molecular mechanisms of allergic asthma. Mol Aspects Med 2021; 85:100995. [PMID: 34364680 DOI: 10.1016/j.mam.2021.100995] [Citation(s) in RCA: 118] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 12/21/2022]
Abstract
Asthma is a chronic disease of the airways, which affects more than 350 million people worldwide. It is the most common chronic disease in children, affecting at least 30 million children and young adults in Europe. Asthma is a complex, partially heritable disease with a marked heterogeneity. Its development is influenced both by genetic and environmental factors. The most common, as well as the most well characterized subtype of asthma is allergic eosinophilic asthma, which is characterized by a type 2 airway inflammation. The prevalence of asthma has substantially increased in industrialized countries during the last 60 years. The mechanisms underpinning this phenomenon are incompletely understood, however increased exposure to various environmental pollutants probably plays a role. Disease inception is thought to be enabled by a disadvantageous shift in the balance between protective and harmful lifestyle and environmental factors, including exposure to protective commensal microbes versus infection with pathogens, collectively leading to airway epithelial cell damage and disrupted barrier integrity. Epithelial cell-derived cytokines are one of the main drivers of the type 2 immune response against innocuous allergens, ultimately leading to infiltration of lung tissue with type 2 T helper (TH2) cells, type 2 innate lymphoid cells (ILC2s), M2 macrophages and eosinophils. This review outlines the mechanisms responsible for the orchestration of type 2 inflammation and summarizes the novel findings, including but not limited to dysregulated epithelial barrier integrity, alarmin release and innate lymphoid cell stimulation.
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Affiliation(s)
- Zsolt I Komlósi
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Nagyvárad Sqr. 4, 1089, Budapest, Hungary.
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), Hermann-Burchard Strasse 9, CH7265, Davos Wolfgand, Switzerland; Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland
| | - Nóra Kovács
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Nagyvárad Sqr. 4, 1089, Budapest, Hungary; Lung Health Hospital, Munkácsy Mihály Str. 70, 2045, Törökbálint, Hungary
| | - Gergő Szűcs
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, Nagyvárad Sqr. 4, 1089, Budapest, Hungary; Department of Pulmonology, Semmelweis University, Tömő Str. 25-29, 1083, Budapest, Hungary
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), Hermann-Burchard Strasse 9, CH7265, Davos Wolfgand, Switzerland; Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland
| | - Liam O'Mahony
- Department of Medicine and School of Microbiology, APC Microbiome Ireland, University College Cork, Ireland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), Hermann-Burchard Strasse 9, CH7265, Davos Wolfgand, Switzerland; Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), Hermann-Burchard Strasse 9, CH7265, Davos Wolfgand, Switzerland; Christine Kühne - Center for Allergy Research and Education, Davos, Switzerland
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22
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The intersect of genetics, environment, and microbiota in asthma-perspectives and challenges. J Allergy Clin Immunol 2021; 147:781-793. [PMID: 33678251 DOI: 10.1016/j.jaci.2020.08.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/07/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023]
Abstract
In asthma, a significant portion of the interaction between genetics and environment occurs through microbiota. The proposed mechanisms behind this interaction are complex and at times contradictory. This review covers recent developments in our understanding of this interaction: the "microbial hypothesis" and the "farm effect"; the role of endotoxin and genetic variation in pattern recognition systems; the interaction with allergen exposure; the additional involvement of host gut and airway microbiota; the role of viral respiratory infections in interaction with the 17q21 and CDHR3 genetic loci; and the importance of in utero and early-life timing of exposures. We propose a unified framework for understanding how all these phenomena interact to drive asthma pathogenesis. Finally, we point out some future challenges for continued research in this field, in particular the need for multiomic integration, as well as the potential utility of asthma endotyping.
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23
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Li W, Liu Q, Chen Y, Yang B, Huang X, Li Y, Zhang JJ. Effects of indoor environment and lifestyle on respiratory health of children in Chongqing, China. J Thorac Dis 2020; 12:6327-6341. [PMID: 33209472 PMCID: PMC7656398 DOI: 10.21037/jtd.2020.03.102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The prevalence of certain respiratory diseases of children in China appears to be on the rise in recent decades. This study aims to explore residential environmental factors that may affect respiratory diseases and lung function of children and to assess the effects of lifestyle (diet and exercise) on lung function. Methods The study was conducted in Chongqing, southwest of China in June, 2017. Information on respiratory diseases was obtained from 2,126 primary school children through a family questionnaire by purposive sampling. In addition, a random sample of 771 children participating in the family-questionnaire was selected for physical measurements and lung function test as well as lifestyle questionnaire survey. Chi-square test and multivariate logistic regressions were used to analyze the relationship between indoor environment and children's respiratory diseases. The effects of indoor environment and lifestyle on lung function indices were analyzed by t-test, variance analysis, and univariate and multivariate linear regression methods. Results Among residential environmental factors, indoor ventilation and air circulation were significant associated with children's respiratory health outcomes. The use of air conditioning for more than 8 h/day in summer was a risk factor for asthma with an adjusted odds ratio (AOR) of 1.99, bronchitis (AOR =1.62), and allergic rhinitis (AOR =1.51). Ventilation for less than 12 h per day during summer increased the risk for allergic rhinitis (AOR =1.40). Children living in homes with an opened kitchen had the risk of developing allergic rhinitis 1.51 times higher than children living in homes with a closed kitchen. Indoor dampness and mold were significantly associated with increased risks for childhood asthma (AOR =2.16), bronchitis (AOR =1.55) and allergic rhinitis (AOR =1.55). The frequent use of hygienic incense and mosquito coils also increased the risk for asthma (AOR =2.58) and bronchitis (AOR =1.42) in children. The multiple linear regression results showed that frequent use of air fresheners reduced children's peak expiratory flow (PEF) and small airway function (FEF25-75) after potential influencing factors were adjusted for. Analyses of lifestyle variables showed that increased lung function (FVC, FEV1, FEV3) was associated with increasing consumption of vegetable and fruit as well as increasing time of physical exercise. Conclusions This study identified the following residential risk factors for children's respiratory diseases in Chongqing: poor indoor ventilation, home dampness and mold presence, and frequent use of hygienic incense and mosquito coils. Frequent use of air fresheners is associated with reduced lung function in children. High frequency consumption of vegetables, fruits and dairy products as well as daily exercise for more than 1 hour have positive effects on children's lung development.
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Affiliation(s)
- Wenyan Li
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China
| | - Qin Liu
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China
| | - Yiwen Chen
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China
| | - Bo Yang
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China
| | - Xin Huang
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China
| | - Yueyue Li
- School of Public Health and Management, Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing 400016, China
| | - Junfeng Jim Zhang
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, NC, USA.,Duke Kunshan University, Kunshan 215316, China.,Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
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24
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Immunomodulatory effect of different extracts from Angiostrongylus cantonensis on airway inflammation in an allergic asthma model. Parasitol Res 2020; 119:3719-3728. [PMID: 32955617 DOI: 10.1007/s00436-020-06884-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 09/13/2020] [Indexed: 10/23/2022]
Abstract
This study aimed to evaluate the effects of early-life exposure to different extracts of Angiostrongylus cantonensis (A. cantonensis) on airway inflammation in an allergic asthma model. The total soluble extract (TE) and the soluble extracts of the digestive (AcD), reproductive (AcR), and cuticle (AcC) systems of A. cantonensis were used for immunisation before ovalbumin (OVA)-sensitisation/challenge in an OVA-induced allergic asthma model. The initial hypothesis of the study was that some soluble extract of the systems (AcD, AcR, or AcC) could be more potent to the modulation of inflammation than the TE. Our data, however, shows that immunisation with the TE is more promising because it decreased the high influx of inflammatory cells on airways and promoted an increase of interferon-γ (IFN-ɣ) and interleukin-10 (IL-10) levels. Besides this, the immunisation with the TE also led to a reduction of goblet cells and mucus overproduction in the lung tissue of asthmatic mice. We believe that the extracts have a distinct capacity to modulate the immune system, due to the TE possessing a greater variability of molecules, which together leads to control of airway inflammation. In conclusion, this is the first study to reveal that the TE of A. cantonensis adult worms has a greater potential for developing a novel therapeutic for allergic asthma.
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25
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Kim SY, Oh DJ, Choi HG. Asthma increases the risk of herpes zoster: a nested case-control study using a national sample cohort. Allergy Asthma Clin Immunol 2020; 16:52. [PMID: 32944021 PMCID: PMC7491354 DOI: 10.1186/s13223-020-00453-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/15/2020] [Indexed: 01/20/2023] Open
Abstract
Background This study aimed to complement previous studies on the risk of herpes zoster in the asthmatic adult population. Methods The Korean Health Insurance Review and Assessment Service—National Sample Cohort (HIRA-NSC) from 2002 through 2013 was used. A total of 64,152 participants with herpes zoster were matched for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia with 239,780 participants who were included as a control group. In both the herpes zoster and control groups, previous history of asthma were investigated. The crude and adjusted odds ratios (ORs) and 95% confidence intervals (CI) of asthma for herpes zoster were analyzed using unconditional logistic regression analysis. Subgroup analyses were conducted according to age and sex. Results Approximately 16.2% (9728/59,945) and 12.8% (30,752/239,780) of participants in the herpes zoster and control groups, respectively, had a previous history of asthma (P < 0.001). The herpes zoster group demonstrated a 1.32-times higher odds of asthma than the control group (95% CI 1.28–1.35, P < 0.001). The increased odds of asthma in the herpes zoster group persisted in all the age and sex subgroups. Conclusions The odds for asthma were higher in the herpes zoster group.
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Affiliation(s)
- So Young Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | - Dong Jun Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-Si, Gyeonggi-do 14068 Republic of Korea.,Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
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Abstract
PURPOSE OF REVIEW This review summarizes recent progress in our understanding how environmental adjuvants promote the development of asthma. RECENT FINDINGS Asthma is a heterogeneous set of lung pathologies with overlapping features. Human studies and animal models suggest that exposure to different environmental adjuvants activate distinct immune pathways, which in turn give rise to distinct forms, or endotypes, of allergic asthma. Depending on their concentrations, inhaled TLR ligands can activate either type 2 inflammation, or Th17 differentiation, along with regulatory responses that function to attenuate inflammation. By contrast, a different category of environmental adjuvants, proteases, activate distinct immune pathways and prime predominantly type 2 immune responses. Asthma is not a single disease, but rather a group of pathologies with overlapping features. Different endotypes of asthma likely arise from perturbations of distinct immunologic pathways during allergic sensitization.
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Affiliation(s)
- Donald N Cook
- Immunogenetics Group, Immunity, Inflammation and Disease Laboratory, National Institute of Environmental Health Sciences, National Institutes of Health, 111 T.W. Alexander Dr., Research Triangle Park, Durham, NC, 27709, USA.
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27
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Yang J, Kim EK, Park HJ, McDowell A, Kim YK. The impact of bacteria-derived ultrafine dust particles on pulmonary diseases. Exp Mol Med 2020; 52:338-347. [PMID: 32203101 PMCID: PMC7156658 DOI: 10.1038/s12276-019-0367-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 01/04/2023] Open
Abstract
The relationship between ambient particulate matter exposure and health has been well established. Ultrafine particles (UFP) with a diameter of 100 nm or less are known to increase pulmonary disease risk. Biological factors in dust containing UFP can cause severe inflammatory reactions. Pulmonary diseases develop primarily as a result of chronic inflammation caused by immune dysfunction. Thus, this review focuses on the adverse pulmonary effects of biological UFP, principally lipopolysaccharide (LPS), and bacterial extracellular vesicles (EVs), in indoor dust and the pathophysiological mechanisms involved in the development of chronic pulmonary diseases. The impact of LPS-induced pulmonary inflammation is based primarily on the amount of inhaled LPS. When relatively low levels of LPS are inhaled, a cascade of immune responses leads to Th2 cell induction, and IL-5 and IL-13 released by Th2 cells contributes to asthma development. Conversely, exposure to high levels of LPS induces a Th17 cell response, leading to increased production of IL-17, which is associated with asthma, COPD, and lung cancer incidence. Responses to bacterial EV exposure can similarly be broadly divided based on whether one of two mechanisms, either intracellular or extracellular, is activated, which depends on the type of the parent cell. Extracellular bacteria-derived EVs can cause neutrophilic inflammation via Th17 cell induction, which is associated with asthma, emphysema, COPD, and lung cancer. On the other hand, intracellular bacteria-derived EVs lead to mononuclear inflammation via Th1 cell induction, which increases the risk of emphysema. In conclusion, future measures should focus on the overall reduction of LPS sources in addition to the improvement of the balance of inhaled bacterial EVs in the indoor environment to minimize pulmonary disease risk.
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Affiliation(s)
- Jinho Yang
- Institute of MD Healthcare Inc., Seoul, Republic of Korea
- Department of Health and Safety Convergence Science, Graduate School of Korea University, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Institute of MD Healthcare Inc., Seoul, Republic of Korea
| | - Hyeon Ju Park
- Institute of MD Healthcare Inc., Seoul, Republic of Korea
| | | | - Yoon-Keun Kim
- Institute of MD Healthcare Inc., Seoul, Republic of Korea.
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28
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Souza FCD, Mocellin M, Ongaratto R, Leitão LADA, Friedrich FO, Silveira VD, Scotta MC, Pitrez PM, Pinto LA. OM-85 BV for primary prevention of recurrent airway infections: a pilot randomized, double-blind, placebo-controlled study. EINSTEIN-SAO PAULO 2020; 18:eAO5262. [PMID: 32130328 PMCID: PMC7032885 DOI: 10.31744/einstein_journal/2020ao5262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 10/03/2019] [Indexed: 11/10/2022] Open
Abstract
Objective To compare the frequency of respiratory tract infections in children treated with OM-85 BV and placebo during the 3-month therapy period, and observation for a further 3 months after treatment. Methods A randomized, double-blind, placebo-controlled trial was conducted with 54 children (6 months to 5 years old) with no past history of recurrent respiratory infections attending daycare center. Family members were instructed to administer one capsule per day for 10 consecutive days, for 3 months of OM-85 BV or placebo. Telephone interviews were conducted every 30 days. Results There was no significant difference in the number of respiratory infections between the groups. The mean number of respiratory tract infection in the OM-85 BV Group in the first 3 months was 0.92±0.87, and in the Placebo Group was 0.74±1.02, and at 6 months it was 1.62±1.47 and 1.03±1.34, respectively. Conclusion OM-85 BV was not effective in the primary prevention of respiratory tract infections. Although most authors recommend the use of this immunostimulant in children with a history of recurrent respiratory infections, more studies are needed to define its usefulness in the primary prevention of respiratory infections in healthy children exposed to few risk factors.
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Affiliation(s)
| | - Magáli Mocellin
- Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre , RS , Brazil
| | - Renata Ongaratto
- Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre , RS , Brazil
| | | | | | | | | | - Paulo Márcio Pitrez
- Pontifícia Universidade Católica do Rio Grande do Sul , Porto Alegre , RS , Brazil
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Hassan MZ, Chowdhury MAB, Hassan I, Chowdhury F, Schaefer N, Chisti MJ. Respiratory viral infection in early life and development of asthma in childhood: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15419. [PMID: 31045799 PMCID: PMC6504274 DOI: 10.1097/md.0000000000015419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/04/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Respiratory viruses are the leading cause of early life wheezing that may contribute to the development of childhood asthma leading to increasing morbidity and socioeconomic burden. The aim of this review is to identify whether respiratory viral infections during first year of life were associated with development of childhood asthma. METHODS We will search major scientific databases (MEDLINE, CINAHL, Web of Science, Cochrane Library, and ClinicalTrials.gov) using truncated and phrase-searched keywords and relevant subject headings. Observational studies including case-control studies, cohort studies, and randomized control trails published in English will be included in this review. Case reports, qualitative studies, and narrative overviews will be excluded. Exposure will be defined as laboratory-confirmed viral respiratory tract infection in the first year of life and outcome will be defined as development of asthma between ages 5 and 18 years. Effect sizes in bivariate and multivariate analyses will be presented as odds or prevalence ratios. We will explore for heterogeneity of the standard errors across the studies, and if appropriate, we will perform a meta-analysis using a random-effects model to present a summary estimate of the odds or prevalence ratios. RESULTS This review will assess whether respiratory viral infections during first year of life increases the risk of childhood asthma development. CONCLUSIONS This systematic review will evaluate published literature, assessing the link between early life viral infection and childhood asthma. Pooled data may provide evidence that infantile respiratory viral infection results in higher incidence of recurrent wheezing and asthma, thereby stimulating further research into the cost-effectiveness of pharmaceutical interventions such as vaccines and nonpharmaceutical interventions such as hand-washing and respiratory hygiene promotion to young children. Implementing the results of such research may then reduce the burden of acute viral respiratory infections and subsequent recurrent wheezing and asthma. SYSTEMATIC REVIEW REGISTRATION This systematic review has been registered on PROSPERO (CRD42018105519).
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Affiliation(s)
- Md Zakiul Hassan
- Respiratory Infections Research Group, Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | | | - Imran Hassan
- Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Fahmida Chowdhury
- Respiratory Infections Research Group, Programme for Emerging Infections, Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - Nancy Schaefer
- Health Science Center Libraries, University of Florida, Gainesville, Florida
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Prevalence of and factors associated with adult-onset asthma in different ethnic groups: The HELIUS study. Respir Med 2019; 150:113-119. [PMID: 30961936 DOI: 10.1016/j.rmed.2019.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/31/2019] [Accepted: 02/15/2019] [Indexed: 02/02/2023]
Abstract
Little is known about adult-onset asthma in different ethnic groups. The aim of this study was to examine ethnic differences in the prevalence of adult-onset asthma and factors associated with this phenotype. Cross-sectional data of 23,356 participants of the HELIUS study were used, including Dutch, South-Asian Surinamese, African Surinamese, Moroccan, Turkish and Ghanaian origin participants. Adult-onset asthma was defined as: self-reported asthma symptoms or start of asthma-medication at age ≥18 years combined with a smoking history <10 pack years. The prevalence of adult-onset asthma and its association with potential risk factors were assessed by logistic regression analyses. The adjusted prevalence of adult-onset asthma was higher in the Turkish, Moroccan and South-Asian Surinamese groups (4.9-6.0%) compared to the Dutch, Ghanaian and African Surinamese origin groups (2.4-2.6%). In addition to ethnicity, age, female sex, BMI, and doctors' diagnosis of nasal allergy/hay fever and chronic sinusitis/polyps were independently associated with adult-onset asthma. There are significant differences in the adjusted prevalence of adult-onset asthma among six ethnic groups.
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Lau S, Matricardi PM, Wahn U, Lee YA, Keil T. Allergy and atopy from infancy to adulthood. Ann Allergy Asthma Immunol 2019; 122:25-32. [DOI: 10.1016/j.anai.2018.05.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 11/29/2022]
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Yurtsever N, Soyyigit S, Sozener ZC, Mungan D, Kose SK, Misirligil Z. Is Adenoidectomy and/or Tonsillectomy a Risk Factor for Allergic Diseases and Asthma in Adulthood? Eurasian J Med 2018; 50:152-155. [PMID: 30515033 DOI: 10.5152/eurasianjmed.2018.17182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective To determine the relationship between adenoidectomy and/or tonsillectomy in childhood and allergic diseases in adulthood. Materials and Methods A survey investigating the history of adenoidectomy and/or tonsillectomy was administered to patients that were followed-up by our department between January and June 2014 with the diagnosis of asthma, allergic rhinitis, urticaria-angioedema, drug allergy, food allergy, and venom allergy; patients willing to participate were included in the study. The relationship and risk ratios were analyzed. Results Totally, 510 (female/male: 379/131) patients were included in the study: 248 with asthma, 205 with rhinitis, 82 with drug allergy, 73 with urticaria, 24 with food allergy, and 14 with venom allergy. Of these, 65 (12.7%) had undergone adenoidectomy and/or tonsillectomy. Of these 65 patients, 41 had asthma, 33 had allergic rhinitis, and 28 had other allergic diseases. No relation between the history of atopy and adenoidectomy and/or tonsillectomy (p=0.129) was detected; however, there was a positive correlation between asthma and patients aged <15 years having a history of tonsillectomy and/or adenoidectomy (p=0.020). The risk of asthma was determined to be increased by 1.96 fold among the patients, provided the patient had undergone adenoidectomy and/or tonsillectomy (confidence interval [CI]:1.14-3.36). No connection was observed between atopic and non-atopic asthmatic patients in relation to adenoidectomy and/or tonsillectomy (p=0.46). No relationship was observed between allergic rhinitis and adenoidectomy and/or tonsillectomy. Conclusion Adenoidectomy and/or tonsillectomy in childhood increase the risk of asthma in adulthood, whereas it does not increase the risk of atopy. This result signifies the criticality of adenoidectomy or tonsillectomy in the pathogenesis of asthma.
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Affiliation(s)
- Nalan Yurtsever
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Sadan Soyyigit
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Celebi Sozener
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - Dilsad Mungan
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
| | - S Kenan Kose
- Department of Biostatistics, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Misirligil
- Division of Allergy and Immunology, Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey
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Abstract
Purpose of review The aim of this paper is to review and summarize the current knowledge of prevention of airway allergy. Recent findings Allergic rhinitis and asthma are allergic airway diseases. Due to their increasing incidence and socioeconomic burden, allergic airway diseases have recently gained attention worldwide. The primary prevention of allergic airway diseases focuses on offspring’s gestational and childhood environment, such as maternal smoking and diet during pregnancy and breastfeeding as well as exposure to environmental microbes and irritants. Summary Asthma and allergic rhinitis are a major public health problem worldwide. They have increasing prevalence and thus attempts to their prevention are mandatory. Rapid action needs to be taken to restrain smoking among children and adolescents in order to prevent burden of allergic airway diseases. Exposure to pollution and environmental issues concerning hygiene and lifestyle would also need to be actively addressed. More evidence is still needed in order to draw linings concerning maternal diet and other factors during the offspring’s whole life span.
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Vaiserman A, Koliada A, Lushchak O. Developmental programming of aging trajectory. Ageing Res Rev 2018; 47:105-122. [PMID: 30059788 DOI: 10.1016/j.arr.2018.07.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/12/2022]
Abstract
There is accumulating evidence that aging phenotype and longevity may be developmentally programmed. Main mechanisms linking developmental conditions to later-life health outcomes include persistent changes in epigenetic regulation, (re)programming of major endocrine axes such as growth hormone/insulin-like growth factor axis and hypothalamic-pituitary-adrenal axis and also early-life immune maturation. Recently, evidence has also been generated on the role of telomere biology in developmental programming of aging trajectory. In addition, persisting changes of intestinal microbiota appears to be crucially involved in these processes. In this review, experimental and epidemiological evidence on the role of early-life conditions in programming of aging phenotypes are presented and mechanisms potentially underlying these associations are discussed.
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Acute respiratory infections in early childhood and risk of asthma at age 7 years. J Allergy Clin Immunol 2018; 143:407-410.e6. [PMID: 30194991 DOI: 10.1016/j.jaci.2018.08.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/14/2018] [Accepted: 08/25/2018] [Indexed: 11/22/2022]
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Modaresi M, Pourvali A, Azizi G, Taher RR, Alinia T, Reisi M. Association of childhood croup and increased incidence of airway hyperreactivity in adulthood. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2018; 7:97. [PMID: 30159343 PMCID: PMC6088820 DOI: 10.4103/jehp.jehp_138_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Some evidence suggests that childhood croup could be associated with increased incidence of adulthood bronchial reactivity, but its significance is uncertain. The aim of the present study was to evaluate the long-term outcome of early life croup. PATIENTS AND METHODS This case-control study was conducted in 2010-2012 in Isfahan, Iran. The case group consisted of 164 adolescents with a history of severe croup in early life and an equal number of healthy controls without any history of croup or other chronic or recurrent respiratory diseases. The two groups were compared according to pulmonary function tests and bronchial reactivity (exercise challenge test). Statistical analyses were performed using the SPSS software package, version 20 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered significant. RESULTS Baseline spirometric values (forced expiratory volume in 1st s (FEV1), forced volume capacity (FVC), FEV1/FVC, and forced expiratory flow at 25%-75% (FEF25-75) were similar in case and control groups. A reduction in FEV1 and FEF25-75 after exercise challenge test was seen in 9% and 12.8% of patients, respectively, whereas this was reduced in only 4.2% and 6.1% of the controls (P = 0.034 and P = 0.021, respectively). CONCLUSION Our findings suggest that childhood croup might be a predisposing factor for bronchial hyperreactivity in adulthood. Longitudinal studies are necessary to confirm the clinical significance of these findings.
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Affiliation(s)
- Mohammadreza Modaresi
- Department of Pediatric Pulmonary, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Pourvali
- Department of Pediatric Pulmonology, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Azizi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Reza Rezaee Taher
- Department of Pediatrics, Ziaeian Hospital, Tehran University of Medical Sciences, Teharan, Iran
| | - Tina Alinia
- Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Science, Tehran, Iran
| | - Mohsen Reisi
- Department of Pediatric Pulmonology, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
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Ramette A, Spycher BD, Wang J, Goutaki M, Beardsmore CS, Kuehni CE. Longitudinal Associations Between Respiratory Infections and Asthma in Young Children. Am J Epidemiol 2018; 187:1714-1720. [PMID: 29546394 PMCID: PMC6070097 DOI: 10.1093/aje/kwy053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 03/07/2018] [Indexed: 12/18/2022] Open
Abstract
We examined temporal dependencies between repeated assessments of respiratory tract infections (RTIs) and asthma in children in the Leicester Respiratory Cohort, Leicestershire, United Kingdom. Information associated with asthma (i.e., doctor diagnosis, health care visits, wheeze frequency) and RTIs (i.e., cold duration and frequency, cough with colds, ear infections) in the previous 12 months was assessed repeatedly at ages 1, 4, and 6 years for children born between April 1996 and April 1997. We determined associations between contemporaneous and lagged measures of asthma and RTIs, using structural equation modelling. In 1,995 children, asthma was positively associated with contemporaneous infections. Asthma at age 6 years was positively associated with asthma at age 4 years (regression coefficient = 0.87; 95% confidence interval (CI): 0.76, 0.97), but not with asthma at age 1 year (regression coefficient = -0.01; 95% CI: -0.14, 0.11). We found no evidence for direct protective effect of infections at age 1 year on asthma either at age 4 (regression coefficient = -0.20; 95% CI: -0.51, 0.10) or 6 (regression coefficient = 0.24; 95% CI: -0.04, 0.52) years. Adjusting for potential confounders did not qualitatively change those relationships. Based on our findings, we suggest that asthma at age 6 years is directly influenced by asthma history and only indirectly, if at all, by earlier infection episodes. We found little support for a protective effect of preschool infections on asthma at early school age.
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Affiliation(s)
- Alban Ramette
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ben D Spycher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Jingying Wang
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Myrofora Goutaki
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Respiratory Medicine, Children’s University Hospital of Bern, University of Bern, Bern, Switzerland
| | - Caroline S Beardsmore
- Division of Child Health, Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Claudia E Kuehni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Pediatric Respiratory Medicine, Children’s University Hospital of Bern, University of Bern, Bern, Switzerland
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Wypych TP, Marsland BJ. Antibiotics as Instigators of Microbial Dysbiosis: Implications for Asthma and Allergy. Trends Immunol 2018; 39:697-711. [PMID: 29655522 DOI: 10.1016/j.it.2018.02.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/14/2018] [Accepted: 02/20/2018] [Indexed: 02/07/2023]
Abstract
The human body and its resident microbiota form a complex ecosystem, shaped by both inherited and environmental factors. The use of antibiotics represents an extreme example of environmental pressure and can broadly disrupt the microbial landscape. The benefits that antibiotics have brought to modern medicine are unquestionable; however, their overuse comes with consequences, including the potential for secondary infections by opportunistic pathogens and the spread of antibiotic resistance. Here, we discuss the implications of microbial dysbiosis driven by antibiotics, with a focus on potential links with allergy and asthma. We review epidemiological data on humans, as well as mechanistic studies performed in animal models, and highlight gaps in current knowledge, which if addressed, could drive the design of novel therapeutic strategies and improved clinical care.
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Affiliation(s)
- Tomasz P Wypych
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Epalinges, Switzerland.
| | - Benjamin J Marsland
- Faculty of Biology and Medicine, University of Lausanne, Service de Pneumologie, CHUV, Epalinges, Switzerland; Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC, Australia.
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Swartz A, Collier T, Young CA, Cruz E, Bekmezian A, Coffman J, Celedon J, Alkon A, Cabana MD. The effect of early child care attendance on childhood asthma and wheezing: A meta-analysis. J Asthma 2018; 56:252-262. [PMID: 29630417 DOI: 10.1080/02770903.2018.1445268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Research evidence offers mixed results regarding the relationship between early child care attendance and childhood asthma and wheezing. A meta-analysis was conducted to synthesize the current research evidence of the association between early child care attendance and the risk of childhood asthma and wheezing. METHOD Peer reviewed studies published from 1964-January 2017 were identified in MEDLINE, CINAL, and EMBASE using MeSH headings relevant to child care and asthma. Two investigators independently reviewed the selected articles from this search. All relevant articles that met our inclusion criteria were selected for further analysis. Data were extracted from studies that had sufficient data to analyze the odds of asthma or wheezing among children who attended child care. RESULTS The meta-analysis of 32 studies found that (1) early child care attendance is protective against asthma in children 3-5 years of age but not for children with asthma 6 years of age or older. (2) Early child care attendance increases the risk of wheezing among children 2 years of age or younger, but not the risk of wheezing for children over 2 years of age. CONCLUSIONS This meta-analysis shows that early child care attendance is not significantly associated with the risk of asthma or wheeze in children 6 years of age or older.
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Affiliation(s)
- Alicia Swartz
- a Family Health Care Nursing , University of California San Francisco School of Nursing , San Francisco , CA , USA
| | - Tina Collier
- b Department of Testing Services , American Dental Association , Chicago , IL , USA
| | - Chelsea Anne Young
- c Psychiatry, University of California San Francisco , San Francisco , CA , USA
| | - Eddie Cruz
- d Pediatrics, University of California San Francisco , San Francisco , CA , USA
| | - Arpi Bekmezian
- d Pediatrics, University of California San Francisco , San Francisco , CA , USA
| | - Janet Coffman
- e Institute for Health Policy Studies , University of California San Francisco , San Francisco , CA , USA
| | - Juan Celedon
- f Pediatrics , University of Pittsburgh , Pittsburgh , PA , USA
| | - Abbey Alkon
- a Family Health Care Nursing , University of California San Francisco School of Nursing , San Francisco , CA , USA
| | - Michael D Cabana
- d Pediatrics, University of California San Francisco , San Francisco , CA , USA
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MACKINNON N, ZAMMIT S, LEWIS G, JONES PB, KHANDAKER GM. Association between childhood infection, serum inflammatory markers and intelligence: findings from a population-based prospective birth cohort study. Epidemiol Infect 2018; 146:256-264. [PMID: 29198208 PMCID: PMC5851035 DOI: 10.1017/s0950268817002710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 01/16/2023] Open
Abstract
A link between infection, inflammation, neurodevelopment and adult illnesses has been proposed. The objective of this study was to examine the association between infection burden during childhood - a critical period of development for the immune and nervous systems - and subsequent systemic inflammatory markers and general intelligence. In the Avon Longitudinal Study of Parents and Children, a prospective birth cohort in England, we examined the association of exposure to infections during childhood, assessed at seven follow-ups between age 1·5 and 7·5 years, with subsequent: (1) serum interleukin 6 and C-reactive protein (CRP) levels at age 9; (2) intelligence quotient (IQ) at age 8. We also examined the relationship between inflammatory markers and IQ. Very high infection burden (90+ percentile) was associated with higher CRP levels, but this relationship was explained by body mass index (adjusted odds ratio (OR) 1·19; 95% confidence interval (CI) 0·95-1·50), maternal occupation (adjusted OR 1·23; 95% CI 0·98-1·55) and atopic disorders (adjusted OR 1·24; 95% CI 0·98-1·55). Higher CRP levels were associated with lower IQ; adjusted β = -0·79 (95% CI -1·31 to -0·27); P = 0·003. There was no strong evidence for an association between infection and IQ. The findings indicate that childhood infections do not have an independent, lasting effect on circulating inflammatory marker levels subsequently in childhood; however, elevated inflammatory markers may be harmful for intellectual development/function.
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Affiliation(s)
- N. MACKINNON
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - S. ZAMMIT
- Centre for Mental Health, Addiction and Suicide Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - G. LEWIS
- Division of Psychiatry, University College London, London, UK
| | - P. B. JONES
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - G. M. KHANDAKER
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Nagahori C, Kinjo Y, Tchuani JP, Yamauchi T. Malnutrition among vaccinated children aged 0-5 years in Batouri, Republic of Cameroon. J Gen Fam Med 2017; 18:365-371. [PMID: 29264066 PMCID: PMC5729315 DOI: 10.1002/jgf2.104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 02/06/2017] [Indexed: 11/29/2022] Open
Abstract
Objectives Malnutrition continues to contribute to a high infant mortality rate. This study aimed to determine the prevalence of malnutrition and its potential association with the time at which complementary feeding was introduced among children aged 0-5 years in Batouri, Republic of Cameroon. Methods Mothers (n=212) were interviewed using a structured questionnaire. Child height or length, and weight measurements were determined and the appropriate Z-scores calculated. Multiple regression analysis was performed with the values of all nutritional status indicators as dependent variables and the time of commencing complementary feeding, and the child's age and sex, as independent variables. Results The prevalence of stunting (height/length for age<-2 standard deviation [SD]), underweight (weight for age<-2SD), and wasting (weight for height/length<-2SD) was 45.8%, 30.2%, and 11.3%, respectively. Even taking into consideration the biological variables, there was a significant association in the effects of time of starting complementary foods on the nutritional status indicators. Furthermore, adding socio-economic variables did not produce a rise in adjusted R2 values for all age group models concerned. Conclusions Approximately 30% of the children in the study region were underweight, and approximately half of the children exhibited stunting, indicating chronic malnutrition. Commencing complementary feeding at an appropriate time had a positive effect on nutritional status from approximately 2 years of age.
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Affiliation(s)
- Chikako Nagahori
- Department of Nursing Okinawa Prefectural College of Nursing Naha Japan
| | - Yoshihide Kinjo
- Department of Nursing Okinawa Prefectural College of Nursing Naha Japan
| | - Jean Paul Tchuani
- Batouri District Health Office Ministry of Public Health Batouri Cameroon
| | - Taro Yamauchi
- Faculty of Health Sciences Hokkaido University Sapporo Japan
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Skevaki C, Hudemann C, Matrosovich M, Möbs C, Paul S, Wachtendorf A, Alashkar Alhamwe B, Potaczek DP, Hagner S, Gemsa D, Garn H, Sette A, Renz H. Influenza-derived peptides cross-react with allergens and provide asthma protection. J Allergy Clin Immunol 2017; 142:804-814. [PMID: 29132960 DOI: 10.1016/j.jaci.2017.07.056] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 07/04/2017] [Accepted: 07/19/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The hygiene hypothesis is the leading concept to explain the current asthma epidemic, which is built on the observation that a lack of bacterial contact early in life induces allergic TH2 immune responses. OBJECTIVE Because little is known about the contribution of respiratory tract viruses in this context, we evaluated the effect of prior influenza infection on the development of allergic asthma. METHODS Mice were infected with influenza and, once recovered, subjected to an ovalbumin- or house dust mite-induced experimental asthma protocol. Influenza-polarized effector memory T (Tem) cells were transferred adoptively to allergen-sensitized animals before allergen challenge. A comprehensive in silico analysis assessed homologies between virus- and allergen-derived proteins. Influenza-polarized Tem cells were stimulated ex vivo with candidate peptides. Mice were immunized with a pool of virus-derived T-cell epitopes. RESULTS In 2 murine models we found a long-lasting preventive effect against experimental asthma features. Protection could be attributed about equally to CD4+ and CD8+ Tem cells from influenza-infected mice. An in silico bioinformatic analysis identified 4 influenza- and 3 allergen-derived MHC class I and MHC class II candidate T-cell epitopes with potential antigen-specific cross-reactivity between influenza and allergens. Lymphocytes from influenza-infected mice produced IFN-γ and IL-2 but not IL-5 on stimulation with the aforementioned peptides. Immunization with a mixture of the influenza peptides conferred asthma protection, and peptide-immunized mice transferred protection through CD4+ and CD8+ Tem cells. CONCLUSION For the first time, our results illustrate heterologous immunity of virus-infected animals toward allergens. This finding extends the original hygiene hypothesis.
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Affiliation(s)
- Chrysanthi Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | - Christoph Hudemann
- Institute of Laboratory Medicine and Pathobiochemistry, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | | | - Christian Möbs
- Department of Dermatology and Allergology, Philipps University Marburg, Marburg, Germany
| | - Sinu Paul
- La Jolla Institute for Allergy and Immunology, La Jolla, Calif
| | - Andreas Wachtendorf
- Institute of Laboratory Medicine and Pathobiochemistry, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | - Bilal Alashkar Alhamwe
- Institute of Laboratory Medicine and Pathobiochemistry, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | - Daniel P Potaczek
- Institute of Laboratory Medicine and Pathobiochemistry, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany; John Paul II Hospital, Krakow, Poland
| | - Stefanie Hagner
- Institute of Laboratory Medicine and Pathobiochemistry, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | - Diethard Gemsa
- Institute of Laboratory Medicine and Pathobiochemistry, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | - Holger Garn
- Institute of Laboratory Medicine and Pathobiochemistry, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany
| | | | - Harald Renz
- Institute of Laboratory Medicine and Pathobiochemistry, Member of the German Center for Lung Research (DZL), Philipps University Marburg, Marburg, Germany.
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van Meel ER, den Dekker HT, Elbert NJ, Jansen PW, Moll HA, Reiss IK, de Jongste JC, Jaddoe VWV, Duijts L. A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma. Thorax 2017. [PMID: 29101282 DOI: 10.1136/thoraxjnl‐2017‐210149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Early-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent. OBJECTIVE We examined the associations of early-life respiratory tract infections with lung function and asthma in school-aged children. METHODS This study among 5197 children born between April 2002 and January 2006 was embedded in a population-based prospective cohort study. Information on physician-attended upper and lower respiratory tract infections until age 6 years (categorised into ≤ 3 and >3-6 years) was obtained by annual questionnaires. Spirometry measures and physician-diagnosed asthma were assessed at age 10 years. RESULTS Upper respiratory tract infections were not associated with adverse respiratory outcomes. Compared with children without lower respiratory tract infections ≤3 years, children with lower respiratory tract infections ≤3 years had a lower FEV1, FVC, FEV1:FVC and forced expiratory flow at 75% of FVC (FEF75) (Z-score (95% CI): ranging from -0.22 (-0.31 to -0.12) to -0.12 (-0.21 to -0.03)) and an increased risk of asthma (OR (95% CI): 1.79 (1.19 to 2.59)). Children with lower respiratory tract infections >3-6 years had an increased risk of asthma (3.53 (2.37 to 5.17)) only. Results were not mediated by antibiotic or paracetamol use and not modified by inhalant allergic sensitisation. Cross-lagged modelling showed that results were not bidirectional and independent of preschool wheezing patterns. CONCLUSION Early-life lower respiratory tract infections ≤3 years are most consistently associated with lower lung function and increased risk of asthma in school-aged children.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Herman T den Dekker
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niels J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Irwin K Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Johan C de Jongste
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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van Meel ER, den Dekker HT, Elbert NJ, Jansen PW, Moll HA, Reiss IK, de Jongste JC, Jaddoe VWV, Duijts L. A population-based prospective cohort study examining the influence of early-life respiratory tract infections on school-age lung function and asthma. Thorax 2017; 73:167-173. [PMID: 29101282 DOI: 10.1136/thoraxjnl-2017-210149] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 09/27/2017] [Accepted: 10/09/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early-life respiratory tract infections could affect airway obstruction and increase asthma risk in later life. However, results from previous studies are inconsistent. OBJECTIVE We examined the associations of early-life respiratory tract infections with lung function and asthma in school-aged children. METHODS This study among 5197 children born between April 2002 and January 2006 was embedded in a population-based prospective cohort study. Information on physician-attended upper and lower respiratory tract infections until age 6 years (categorised into ≤ 3 and >3-6 years) was obtained by annual questionnaires. Spirometry measures and physician-diagnosed asthma were assessed at age 10 years. RESULTS Upper respiratory tract infections were not associated with adverse respiratory outcomes. Compared with children without lower respiratory tract infections ≤3 years, children with lower respiratory tract infections ≤3 years had a lower FEV1, FVC, FEV1:FVC and forced expiratory flow at 75% of FVC (FEF75) (Z-score (95% CI): ranging from -0.22 (-0.31 to -0.12) to -0.12 (-0.21 to -0.03)) and an increased risk of asthma (OR (95% CI): 1.79 (1.19 to 2.59)). Children with lower respiratory tract infections >3-6 years had an increased risk of asthma (3.53 (2.37 to 5.17)) only. Results were not mediated by antibiotic or paracetamol use and not modified by inhalant allergic sensitisation. Cross-lagged modelling showed that results were not bidirectional and independent of preschool wheezing patterns. CONCLUSION Early-life lower respiratory tract infections ≤3 years are most consistently associated with lower lung function and increased risk of asthma in school-aged children.
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Affiliation(s)
- Evelien R van Meel
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Herman T den Dekker
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Niels J Elbert
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Pauline W Jansen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Institute of Psychology, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Henriëtte A Moll
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Irwin K Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Johan C de Jongste
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Neonatology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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45
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Lin TH, Su HH, Kang HY, Chang TH. The Interactive Roles of Lipopolysaccharides and dsRNA/Viruses on Respiratory Epithelial Cells and Dendritic Cells in Allergic Respiratory Disorders: The Hygiene Hypothesis. Int J Mol Sci 2017; 18:ijms18102219. [PMID: 29065558 PMCID: PMC5666898 DOI: 10.3390/ijms18102219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 12/15/2022] Open
Abstract
The original hygiene hypothesis declares "more infections in early childhood protect against later atopy". According to the hygiene hypothesis, the increased incidence of allergic disorders in developed countries is explained by the decrease of infections. Epithelial cells and dendritic cells play key roles in bridging the innate and adaptive immune systems. Among the various pattern-recognition receptor systems of epithelial cells and dendritic cells, including toll-like receptors (TLRs), nucleotide-binding oligomerization domain (NOD)-like receptors (NLRs) and others, TLRs are the key systems of immune response regulation. In humans, TLRs consist of TLR1 to TLR10. They regulate cellular responses through engagement with TLR ligands, e.g., lipopolysaccharides (LPS) acts through TLR4 and dsRNA acts through TLR3, but there are certain common components between these two TLR pathways. dsRNA activates epithelial cells and dendritic cells in different directions, resulting in allergy-related Th2-skewing tendency in epithelial cells, and Th1-skewing tendency in dendritic cells. The Th2-skewing effect by stimulation of dsRNA on epithelial cells could be suppressed by the presence of LPS above some threshold. When LPS level decreases, the Th2-skewing effect increases. It may be via these interrelated networks and related factors that LPS modifies the allergic responses and provides a plausible mechanism of the hygiene hypothesis. Several hygiene hypothesis-related phenomena, seemingly conflicting, are also discussed in this review, along with their proposed mechanisms.
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Affiliation(s)
- Tsang-Hsiung Lin
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 81362, Taiwan.
| | - Hsing-Hao Su
- Department of Otorhinolaryngology-Head & Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
| | - Hong-Yo Kang
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Kaohsiung 81362, Taiwan.
- Hormone Research Center and Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan.
| | - Tsung-Hsien Chang
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan.
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan.
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46
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The immunology of the allergy epidemic and the hygiene hypothesis. Nat Immunol 2017; 18:1076-1083. [PMID: 28926539 DOI: 10.1038/ni.3829] [Citation(s) in RCA: 259] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/04/2017] [Indexed: 12/18/2022]
Abstract
The immunology of the hygiene hypothesis of allergy is complex and involves the loss of cellular and humoral immunoregulatory pathways as a result of the adoption of a Western lifestyle and the disappearance of chronic infectious diseases. The influence of diet and reduced microbiome diversity now forms the foundation of scientific thinking on how the allergy epidemic occurred, although clear mechanistic insights into the process in humans are still lacking. Here we propose that barrier epithelial cells are heavily influenced by environmental factors and by microbiome-derived danger signals and metabolites, and thus act as important rheostats for immunoregulation, particularly during early postnatal development. Preventive strategies based on this new knowledge could exploit the diversity of the microbial world and the way humans react to it, and possibly restore old symbiotic relationships that have been lost in recent times, without causing disease or requiring a return to an unhygienic life style.
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47
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Bolat E, Arikoglu T, Sungur MA, Batmaz SB, Kuyucu S. Prevalence and risk factors for wheezing and allergic diseases in preschool children: A perspective from the Mediterranean coast of Turkey. Allergol Immunopathol (Madr) 2017; 45:362-368. [PMID: 28410872 DOI: 10.1016/j.aller.2017.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/18/2016] [Accepted: 01/07/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of the present study was to determine the prevalence and risk factors of allergic diseases in preschool children from one of the biggest cities in the Mediterranean Region of Turkey. METHODS The study population included 396 preschool children attending to urban daycare centres in Mersin. In the first stage, a comprehensive standardised questionnaire modified from the International Study of Asthma and Allergies in Childhood (ISAAC) was employed. In the second stage, serum food and inhalant specific IgE, and skin tests were performed in 45 children with frequent wheezing and 28 children with no wheezing. RESULTS The prevalence of ever wheezing, current wheezing, physician-diagnosed asthma, allergic rhinitis and eczema were 53% (210), 33.3% (132), 27.3% (108), 13.4% (53) and 8.3% (33), respectively. A family history of atopy (OR=2.5, 95% CI: 1.3-4.7, p=0.004), dampness at home (OR=2.4, 95% CI: 1.2-4.8, p=0.008), a history of intestinal parasites (OR=4.3, 95% CI: 1.7-10.9, p=0.002), previous history of pneumonia (OR=6.9, 95% CI: 1.9-25.9, p=0.004), initiation of complementary foods before the age of three months (OR=6.1, 95%CI: 1.4-26.9, p=0.02) and presence of food allergy (OR=3.1, 95% CI: 1.1-9.2, p=0.03) were found to be significant risk factors for physician-diagnosed asthma. The risk factors for frequent wheezing were maternal smoking during pregnancy (OR=5.2, 95% CI: 0.9-28.7, p=0.05) and high serum IgE levels (OR=2.9, 95% CI: 0.9-9.0, p=0.05) at borderline significance. CONCLUSION Our study was the first epidemiological study in preschool children in the Mediterranean region of Turkey and demonstrated a high prevalence of asthma and allergic diseases, probably related to humid climatic properties in addition to other environmental and genetic factors.
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Affiliation(s)
- E Bolat
- Metrolife Hospital, Department of Pediatrics, Urfa, Turkey
| | - T Arikoglu
- Mersin University, Faculty of Medicine, Department of Pediatric Allergy and Immunology, Mersin, Turkey.
| | - M A Sungur
- Düzce University, Department of Biostatistics and Medical Informatics, Düzce, Turkey
| | - S B Batmaz
- Tokat State Hospital, Department of Pediatric Allergy and Immunology, Tokat, Turkey
| | - S Kuyucu
- Mersin University, Faculty of Medicine, Department of Pediatric Allergy and Immunology, Mersin, Turkey
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48
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Regulatory T cells in allergic diseases. J Allergy Clin Immunol 2017; 138:639-652. [PMID: 27596705 DOI: 10.1016/j.jaci.2016.06.003] [Citation(s) in RCA: 279] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022]
Abstract
The pathogenesis of allergic diseases entails an ineffective tolerogenic immune response to allergens. Regulatory T (Treg) cells play a key role in sustaining immune tolerance to allergens, yet mechanisms by which Treg cells fail to maintain tolerance in patients with allergic diseases are not well understood. We review current concepts and established mechanisms regarding how Treg cells regulate different components of allergen-triggered immune responses to promote and maintain tolerance. We will also discuss more recent advances that emphasize the "dual" functionality of Treg cells in patients with allergic diseases: how Treg cells are essential in promoting tolerance to allergens but also how a proallergic inflammatory environment can skew Treg cells toward a pathogenic phenotype that aggravates and perpetuates disease. These advances highlight opportunities for novel therapeutic strategies that aim to re-establish tolerance in patients with chronic allergic diseases by promoting Treg cell stability and function.
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49
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Cipriani F, Calamelli E, Ricci G. Allergen Avoidance in Allergic Asthma. Front Pediatr 2017; 5:103. [PMID: 28540285 PMCID: PMC5423906 DOI: 10.3389/fped.2017.00103] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/21/2017] [Indexed: 01/31/2023] Open
Abstract
Allergic asthma is the most frequent disease among the chronic respiratory disorders in pediatric age with an important social impact. In the last years, many efforts have been made to identify effective preventive approaches to get a better control of symptoms and to obtain the best future outcomes for the patients. In patients with allergic asthma triggered by the exposure to indoor allergens, the avoidance is the first intervention to prevent the appearance or the worsening of bronchial symptoms. This review article summarized the most recent evidence from literature about the efficacy of specific control interventions for the most important allergens. Even if a wide spectrum of interventions has been suggested and may help to reduce exposure to trigger allergy for sensitized patients suffering from respiratory allergy, evidence supporting the efficacy of these approaches is still weak and subject of controversy. However, the exposure control to specific airborne allergens is still widely recommended and may be effective as part of a holistic approach to reduce the severity of allergic respiratory symptoms in sensitized individuals.
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Affiliation(s)
- Francesca Cipriani
- Pediatric Unit, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Calamelli
- Pediatric Unit, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Pediatric and Neonatology Unit, Imola Hospital, Bologna, Italy
| | - Giampaolo Ricci
- Pediatric Unit, S. Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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50
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Smith-Norowitz TA, Carvajal-Raga S, Weedon J, Joks R, Norowitz KB, Weaver D, Durkin HG, Hammerschlag MR, Kohlhoff S. Increased seroprevalence of Enterovirus 71 IgE antibodies in asthmatic compared with non-asthmatic children. Ir J Med Sci 2017; 186:495-503. [PMID: 27440276 DOI: 10.1007/s11845-016-1480-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/13/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Asthma is a common pediatric chronic inflammatory airway disease. Respiratory viral infections are frequent infectious triggers for exacerbations of asthma. OBJECTIVE We sought to determine whether Enterovirus 71 (EV71), a ubiquitous virus that causes systemic inflammatory responses in children but is not a known respiratory pathogen, can also serve as an infectious trigger for asthma. METHODS Specific EV71 IgE and IgM antibodies (Abs), total serum IgE, and IL-2 and IL-4 cytokine levels in serum of asthmatic and non-asthmatic children (N = 42, ages 5-19; N = 35, ages 1-20, respectively) were measured (ELISA). RESULTS Asthmatic children had higher EV71 IgE Ab levels than non-asthmatic (P < 0.001). Non-asthmatic children had significantly higher EV71 IgM Ab levels than asthmatic (P < 0.001). Despite low serum IgE levels of non-asthmatic, compared with asthmatic (P < 0.001), the non-asthmatic children produced significantly more IL-2 and IL-4 than asthmatic (P < 0.001; P < 0.001). The ages of the asthmatics, but not the non-asthmatics had a significant effect on the levels of EV 71 IgE Abs (P = 0.02; P = 0.356). A test of difference between these two slopes was significant. However, the ages of the non-asthmatic, but not the asthmatic children had a significant effect on the levels of EV 71 IgM Abs; a test of difference between these two slopes was significant. CONCLUSIONS Increased specific EV71 IgE Ab responses may indicate that EV71 infection may also be an infectious trigger in asthma. However, the role of specific EV71 IgM Abs, Th2 cytokines, and age in non-asthmatic children should be further studied.
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Affiliation(s)
- T A Smith-Norowitz
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA.
- Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA.
| | - S Carvajal-Raga
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA
| | - J Weedon
- Statistical Design and Analysis Research Division, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - R Joks
- Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
- Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - K B Norowitz
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA
| | - D Weaver
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA
| | - H G Durkin
- Department of Pathology, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
- Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
| | - M R Hammerschlag
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA
| | - S Kohlhoff
- Department of Pediatrics, State University of New York Downstate Medical Center, Box 49, 450 Clarkson Ave., Brooklyn, New York, 11203, USA
- Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, New York, 11203, USA
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