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Arrais M, Maricoto T, Nwaru BI, Cooper PJ, Gama JM, Brito M, Taborda-Barata L. Helminth infections and allergic diseases: systematic review and meta-analysis of the global literature. J Allergy Clin Immunol 2021; 149:2139-2152. [PMID: 34968529 DOI: 10.1016/j.jaci.2021.12.777] [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: 07/02/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION There is considerable research interest in the role of helminth infections in the development of allergic diseases. However, findings from previous studies are mixed. Existing systematic reviews of these studies are outdated. We performed a systematic review of the global literature on the association between helminth infections and development and clinical outcomes of allergic diseases. METHODS We searched Cochrane Library, MEDLINE, EMBASE, ISI Web of Science, PubMed, Global Index Medicus, Scielo, KoreaMed, Google Scholar, and Lilacs for studies published up to January 2020. We included observational epidemiological studies (cohort, case-control and cross-sectional studies) of children and adults reporting associations between helminth infections and asthma, allergic rhinitis, eczema and atopy. We performed random-effects meta-analysis to summarize the effect estimates. RESULTS We included 80 studies with 99,967 participants. In the meta-analyses, we did not observe an overall association between helminth infections and allergic diseases. There was, however, evidence that A. lumbricoides infections was associated with an increased risk of bronchial hyperreactivity in children (RR:1.41, 95%CI: 1.17-1.70; I2=50, p for I2=0.09), and was associated with an increased risk of atopy among helminth-infected adults (RR:1.37, 95%CI: 1.18-1.61; I2=52, p for I2=0.02). We found no study that addressed the association between helminth infection and clinical outcomes of allergic diseases. The overall strength of the underlying evidence was low to moderate. CONCLUSION Helminth infections may increase the risk of bronchial hyperreactivity in children and atopy in adults. Well-designed longitudinal cohorts may help clarify potential causal associations between chronic helminth infections and allergic diseases.
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Affiliation(s)
- Margarete Arrais
- Department of Pulmonology, Military Hospital, Luanda, Angola; CISA - Centro de Investigação em Saúde de Angola, Caxito, Bengo, Angola; GRUBI - Systematic Reviews Group, University of Beira Interior, Covilhã, Portugal
| | - Tiago Maricoto
- GRUBI - Systematic Reviews Group, University of Beira Interior, Covilhã, Portugal; Aveiro Healthcare Centre, Aveiro-Aradas Family Health Unit, Aveiro, Portugal; Faculty of Health Sciences, University of Beira Interior, CACB-Clinical Academic Centre of Beiras, Covilhã, Portugal.
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Philip J Cooper
- Institute of Infection and Immunity, St George's University of London, London, UK; School of Medicine, International University of Ecuador, Quito, Ecuador
| | - Jorge Mr Gama
- GRUBI - Systematic Reviews Group, University of Beira Interior, Covilhã, Portugal; Centre of Mathematics and Applications, Faculty of Sciences, University of Beira Interior, Covilha, Portugal
| | - Miguel Brito
- CISA - Centro de Investigação em Saúde de Angola, Caxito, Bengo, Angola; Health and Technology Research Center (H&TRC), Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Portugal
| | - Luis Taborda-Barata
- GRUBI - Systematic Reviews Group, University of Beira Interior, Covilhã, Portugal; CICS- Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal; Department of Allergy and Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
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Taghipour A, Rostami A, Sepidarkish M, Ghaffarifar F. Is Ascaris lumbricoides a risk factor for development of asthma? A systematic review and meta-analysis. Microb Pathog 2020; 142:104099. [PMID: 32101769 DOI: 10.1016/j.micpath.2020.104099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/18/2020] [Accepted: 02/22/2020] [Indexed: 11/12/2022]
Abstract
There are numerous epidemiological and experimental evidences to suggest that Ascaris lumbricoides infection is a neglected risk factor for development of asthma. For this purpose, we conducted a systematic review and meta-analysis for better understanding of this relationship. Systematic searching (PubMed, Scopus, Web of Science and Google Scholar) was done, up to September 30, 2019 to identify the relevant studies. We applied random-effects meta-analysis model to generate the overall odds ratio (OR) and 95% confidence intervals (CIs). Heterogeneity was assessed with I2 and τ2 statistic. Finally, 19 studies (totally 25 datasets), including 14 datasets with microscopic methods (1830 asthmatic patients (APs) and 3802 healthy controls (HCs)) and 11 datasets with serological methods (1543 APs and 3507 HCs) met the eligibility criteria. Considering to the serological methods, our results demonstrated that the APs had higher seroprevalence rate of A. lumbricoides (48.3% vs. 35.1%) than HCs, showing a significant association (pooled crude OR, 1.53; 95%CI, 1.07-2.18). Moreover, microscopic methods showed a higher prevalence of A. lumbricoides infection in the APs compared to the HCs (37.2% vs. 30.2%), but no significant association was found between APs and HCs (pooled crude OR, 1.19; 95%CI, 0.92-1.55). After adjustment for confounders, results showed no significant association for both serological (pooled adjusted OR, 1.43; 95%CI, 0.93-2.19) and microscopic (pooled adjusted OR, 1.05; 95%CI, 0.78-1.42) methods. Despite heterogeneous results, accurate and better quality studies are needed to determine the effect of A. lumbricoides infection on induction or exacerbation of asthma.
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Affiliation(s)
- Ali Taghipour
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Ali Rostami
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahdi Sepidarkish
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Ghaffarifar
- Department of Parasitology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Ascaris Larval Infection and Lung Invasion Directly Induce Severe Allergic Airway Disease in Mice. Infect Immun 2018; 86:IAI.00533-18. [PMID: 30249744 DOI: 10.1128/iai.00533-18] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/13/2018] [Indexed: 11/20/2022] Open
Abstract
Ascaris lumbricoides (roundworm) is the most common helminth infection globally and a cause of lifelong morbidity that may include allergic airway disease, an asthma phenotype. We hypothesize that Ascaris larval migration through the lungs leads to persistent airway hyperresponsiveness (AHR) and type 2 inflammatory lung pathology despite resolution of infection that resembles allergic airway disease. Mice were infected with Ascaris by oral gavage. Lung AHR was measured by plethysmography and histopathology with hematoxylin and eosin (H&E) and periodic acid-Schiff (PAS) stains, and cytokine concentrations were measured by using Luminex Magpix. Ascaris-infected mice were compared to controls or mice with allergic airway disease induced by ovalbumin (OVA) sensitization and challenge (OVA/OVA). Ascaris-infected mice developed profound AHR starting at day 8 postinfection (p.i.), peaking at day 12 p.i. and persisting through day 21 p.i., despite resolution of infection, which was significantly increased compared to controls and OVA/OVA mice. Ascaris-infected mice had a robust type 2 cytokine response in both the bronchoalveolar lavage (BAL) fluid and lung tissue, similar to that of the OVA/OVA mice, including interleukin-4 (IL-4) (P < 0.01 and P < 0.01, respectively), IL-5 (P < 0.001 and P < 0.001), and IL-13 (P < 0.001 and P < 0.01), compared to controls. By histopathology, Ascaris-infected mice demonstrated early airway remodeling similar to, but more profound than, that in OVA/OVA mice. We found that Ascaris larval migration causes significant pulmonary damage, including AHR and type 2 inflammatory lung pathology that resembles an extreme form of allergic airway disease. Our findings indicate that ascariasis may be an important cause of allergic airway disease in regions of endemicity.
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Tchidjou HK, Vescio MF, Serafinelli J, Giampaolo R, Jenkner A, Tadonkeng MC, Avellis L, Fiocchi A, Pezzotti P, Rezza G, Rossi P. Susceptibility to allergy in adoptive children: a cross-sectional study at "Bambino Gesù Children's Hospital". Ital J Pediatr 2018; 44:3. [PMID: 29301554 PMCID: PMC5755410 DOI: 10.1186/s13052-017-0440-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 12/14/2017] [Indexed: 11/13/2022] Open
Abstract
Background Prevalence of allergy has steeply increased during the past few decades, particularly in high-income countries. The development of atopy could present different characteristics in internationally adopted children with regard to incidence, specific patterns of allergies and timing of occurrence. We aimed to investigate the occurrence of allergic diseases among adopted children in Italy. Methods We collected demographic information, preadoption immunization data, infectious diseases screening results, immunological status, and performed hematological and biochemical tests according to a standardized protocol in 108 adopted children. Results At initial visit (mean age was 5.7 ± 3.2 years), 48 children displayed elevated total serum IgE levels with a prevalence of 56.5% (95%CI: 0.45; 0.67). The prevalences of children screened positive for one or more food allergens and inhalants were 30.1% (95%CI: 19.9%; 42.0%) and 34.3% (95%CI: 23.3%; 46.6%) respectively, only 9 children exhibited abnormal absolute eosinophil counts, 23 (21.3%) had a parasitic infection and 60 (55.6%) had received at least one dose of vaccine. Conclusions Children without medical records or with a past medical history suggestive of atopy should perform a thorough allergy evaluation at the time of adoption. Our study offers also a glimpse at the vaccination status and immune-allergic profiles of recent migrant children in Italy.
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Affiliation(s)
- Hyppolite K Tchidjou
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Maria Fenicia Vescio
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Jessica Serafinelli
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Rosaria Giampaolo
- Department of Pediatric Medicine, University Department of Pediatrics (DPUO), Children's Hospital Bambino Gesù, Rome, Italy
| | - Alessandro Jenkner
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | | | - Luca Avellis
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Alessandro Fiocchi
- Division of Allergy, University Department of Pediatrics (DPUO), Children's Hospital Bambino Gesù, Rome, Italy
| | - Patrizio Pezzotti
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Rezza
- Epidemiology Unit, Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paolo Rossi
- Division of Immunology and Infectious Diseases, University-Hospital Pediatric Department (DPUO), Bambino Gesù Children Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
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Schabussova I, Wiedermann U. Allergy and worms: let's bring back old friends? Wien Med Wochenschr 2014; 164:382-91. [PMID: 25281198 DOI: 10.1007/s10354-014-0308-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 08/20/2014] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW In order to survive in their host, parasitic worms (helminths) have evolved cunning strategies to manipulate the host immune system, some of which may lead to protection from immune dysregulatory diseases such as allergy. Thus, loss of exposure to helminths due to a highly hygienic life style might have contributed to the fact that living in an industrialized country is being associated with an increased prevalence of allergic diseases. However, it must be pointed out that certain helminth infections can in fact induce an allergic phenotype. Factors such as different parasite species, timing of infection in relation to allergic sensitization, or duration and intensity of infection may influence the association between helminth infections and the development or clinical course of allergic disease. In the present article, we review studies that have explored the interaction between helminth infections and allergy in epidemiological and experimental studies. Furthermore, the possibility of using helminths or helminth-derived molecules for the treatment of allergic diseases is discussed with a focus on evidence from clinical trials. RECENT FINDINGS During the past 10 years, many exciting and important studies have found that certain helminth infections protect against the development of allergic diseases. Not surprisingly, several clinical trials investigated the effects of deliberate exposure to parasites like porcine whipworm (Trichuris suis) or hookworm (Necator americanus) to develop "helminth therapies". Although they proved to be a safe option to control aberrant inflammation, the final goal is to identify the parasite-derived immunnomodulatory molecules responsible for protective effects.
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Affiliation(s)
- Irma Schabussova
- Institut für Spezifische Prophylaxe und Tropenmedizin, Medizinische Universität Wien, Kinderspitalgasse 15, 1090, Vienna, Austria,
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