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Banzon TM, Phipatanakul W. Environmental Interventions for Asthma. Semin Respir Crit Care Med 2022; 43:720-738. [PMID: 35803266 DOI: 10.1055/s-0042-1749453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Exposure and sensitization to environmental factors play a fundamental role in asthma development and is strongly associated with asthma morbidity. While hereditary factors are critical determinants of asthma, exposures to environmental factors are implicated in the phenotypic expression of asthma and have been strongly associated in the risk of its development. Significant interest has thus been geared toward potentially modifiable environmental exposures which may lead to the development of asthma. Allergen exposure, in particular indoor allergens, plays a significant role in the pathogenesis of asthma, and remediation is a primary component of asthma management. In the home, multifaceted and multitargeted environmental control strategies have been shown to reduce home exposures and improve asthma outcomes. In addition to the home environment, assessment of the school, daycare, and workplace environments of patients with asthma is necessary to ensure appropriate environmental control measures in conjunction with medical care. This article will discuss the role of the environment on asthma, review targeted environmental therapy, and examine environmental control measures to suppress environmental exposures in the home and school setting.
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Affiliation(s)
- Tina M Banzon
- Deparmtent of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wanda Phipatanakul
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.,Division of Immunology, Clinical Research Center, Boston Children's Hospital, Asthma, Allergy and Immunology, Boston, Massachusetts
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2
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Kalayci O, Miligkos M, Pozo Beltrán CF, El-Sayed ZA, Gómez RM, Hossny E, Le Souef P, Nieto A, Phipatanakul W, Pitrez PM, Xepapadaki P, Jiu-Yao W, Papadopoulos NG. The role of environmental allergen control in the management of asthma. World Allergy Organ J 2022; 15:100634. [PMID: 35341023 PMCID: PMC8917313 DOI: 10.1016/j.waojou.2022.100634] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 01/08/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022] Open
Abstract
Allergen exposure may exacerbate asthma symptoms in sensitized patients. Allergen reduction or avoidance measures have been widely utilized; however, there is ongoing controversy on the effectiveness of specific allergen control measures in the management of children with asthma. Often, allergen avoidance strategies are not recommended by guidelines because they can be complex or burdensome, although individual patients may benefit. Here we explore the potential for intervention against exposure to the major allergens implicated in asthma (ie, house dust mites, indoor molds, rodents, cockroaches, furry pets, and outdoor molds and pollens), and subsequent effects on asthma symptoms. We critically assess the available evidence regarding the clinical benefits of specific environmental control measures for each allergen. Finally, we underscore the need for standardized and multifaceted approaches in research and real-life settings, which would result in the identification of more personalized and beneficial prevention strategies.
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3
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Ali Z, Jemec GBE, Ulrik CS. Associations between maternal and environmental exposures on atopic disease in the offspring of mothers with asthma. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:862-870. [PMID: 34145785 PMCID: PMC8342200 DOI: 10.1002/iid3.441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/19/2021] [Accepted: 04/07/2021] [Indexed: 11/22/2022]
Abstract
Background and Objective Available data on the impact of perinatal and environmental factors on atopic diseases in the offspring are sparse and conflicting. We, therefore, investigated the impact of these factors on the risk of atopic diseases in the offspring of women with asthma. Methods Pregnant women referred to give birth at Copenhagen University Hospital‐Hvidovre, Denmark, have since 2007 been invited to participate in the Management of Asthma during Pregnancy program. Women with diagnosed asthma, currently prescribed asthma medication, first visit to the respiratory out‐patient clinic within the first 18 weeks of pregnancy that completed an online questionnaire about atopic diseases in their child were included in the current study. Results Five hundred and seventy‐one pregnancies were included. Among the off‐spring, 113 children (21%) had doctor‐diagnosed asthma, 178 (31%) atopic dermatitis (AD), and 55 (32%) both AD and doctor‐diagnosed asthma. AD in the offspring was associated with having a dog at home (odds ratio [OR], 2.56; 95% confidence interval [CI], [1.40–4.67], p = .002), whereas having a cat at home was associated with a higher risk of asthma in the offspring (OR, 2.16; 95% CI, [1.14–4.11], p = .02). The associations remained significant after adjusting for maternal age, smoking status, allergy, treatment with inhaled corticosteroids, forced expiratory volume in 1 s less than 80% predicted, uncontrolled asthma, and history of pre‐pregnancy asthma exacerbations. No association was found between gestational weight gain (GWG) in first trimester and total GWG and atopic disease in the offspring. Conclusion Having pets at home is associated with AD and asthma in the offspring of mothers with asthma.
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Affiliation(s)
- Zarqa Ali
- Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Pulmonary Medicine, Hvidovre Hospital, Hvidovre, Denmark
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Hosoki K, Jaruga P, Itazawa T, Aguilera-Aguirre L, Coskun E, Hazra TK, Boldogh I, Dizdaroglu M, Sur S. Excision release of 5?hydroxycytosine oxidatively induced DNA base lesions from the lung genome by cat dander extract challenge stimulates allergic airway inflammation. Clin Exp Allergy 2018; 48:1676-1687. [PMID: 30244512 DOI: 10.1111/cea.13284] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 06/15/2018] [Accepted: 07/15/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ragweed pollen extract (RWPE) induces TLR4-NFκB-CXCL-dependent recruitment of ROS-generating neutrophils to the airway and OGG1 DNA glycosylase-dependent excision of oxidatively induced 8-OH-Gua DNA base lesions from the airway epithelial cell genome. Administration of free 8-OH-Gua base stimulates RWPE-induced allergic lung inflammation. These studies suggest that stimulation of innate receptors and their adaptor by allergenic extracts initiates excision of a set of DNA base lesions that facilitate innate/allergic lung inflammation. OBJECTIVE To test the hypothesis that stimulation of a conserved innate receptor/adaptor pathway by allergenic extracts induces excision of a set of pro-inflammatory oxidatively induced DNA base lesions from the lung genome that stimulate allergic airway inflammation. METHODS Wild-type (WT), Tlr4KO, Tlr2KO, Myd88KO, and TrifKO mice were intranasally challenged once or repeatedly with cat dander extract (CDE), and innate or allergic inflammation and gene expression were quantified. We utilized GC-MS/MS to quantify a set of oxidatively induced DNA base lesions after challenge of naïve mice with CDE. RESULTS A single CDE challenge stimulated innate neutrophil recruitment that was partially dependent on TLR4 and TLR2, and completely on Myd88, but not TRIF. A single CDE challenge stimulated MyD88-dependent excision of DNA base lesions 5-OH-Cyt, FapyAde, and FapyGua from the lung genome. A single challenge of naïve WT mice with 5-OH-Cyt stimulated neutrophilic lung inflammation. Multiple CDE instillations stimulated MyD88-dependent allergic airway inflammation. Multiple administrations of 5-OH-Cyt with CDE stimulated allergic sensitization and allergic airway inflammation. CONCLUSIONS AND CLINICAL RELEVANCE We show for the first time that CDE challenge stimulates MyD88-dependent excision of DNA base lesions. Our data suggest that the resultant-free base(s) contribute to CDE-induced innate/allergic lung inflammation. We suggest that blocking the MyD88 pathway in the airways with specific inhibitors may be a novel targeted strategy of inhibiting amplification of innate and adaptive immune inflammation in allergic diseases by oxidatively induced DNA base lesions.
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Affiliation(s)
- Koa Hosoki
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Medical Branch, Galveston, Texas
| | - Pawel Jaruga
- Biomolecular Measurement Division National Institute of Standards and Technology, Gaithersburg, Maryland
| | - Toshiko Itazawa
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Medical Branch, Galveston, Texas
| | | | - Erdem Coskun
- Biomolecular Measurement Division National Institute of Standards and Technology, Gaithersburg, Maryland
| | - Tapas K Hazra
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas.,Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Istvan Boldogh
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas.,Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Texas
| | - Miral Dizdaroglu
- Biomolecular Measurement Division National Institute of Standards and Technology, Gaithersburg, Maryland
| | - Sanjiv Sur
- Department of Internal Medicine, Division of Allergy and Immunology, University of Texas Medical Branch, Galveston, Texas.,Sealy Center for Molecular Medicine, University of Texas Medical Branch, Galveston, Texas
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5
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Simoneti CS, Ferraz E, Menezes MB, Icuma TR, Vianna EO. Cat ownership is associated with increased asthma prevalence and dog ownership with decreased spirometry values. ACTA ACUST UNITED AC 2018; 51:e7558. [PMID: 30365724 PMCID: PMC6207287 DOI: 10.1590/1414-431x20187558] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/15/2018] [Indexed: 11/22/2022]
Abstract
The association between pet ownership and the development of allergic and respiratory diseases has been the aim of several studies, however, the effects of exposure in adults remain uncertain. The aims of the present study were to investigate the prevalence of asthma and lung function status among dog and cat owners. This cross-sectional study was performed at two universities with students and workers who were allocated into 3 groups according to pet ownership in the previous year: cat owners, dog owners, and no pets (control group). Subjects underwent spirometry, bronchial challenge test with mannitol, skin prick tests, and questionnaires about animal exposures and respiratory symptoms. Control group comprised 125 subjects; cat owner group, 51 subjects; and dog owner group, 140 subjects. Cat owners had increased asthma prevalence (defined by symptoms and positive bronchial challenge test), but no changes in lung function compared to the control group. The dog owner group had lower spirometry values (forced expiratory volume in one second and lower forced vital capacity), but similar asthma prevalence, compared to the control group. In the cat owner group, excess of asthma may have an immunological basis, since we found an association with atopy. Although we did not have endotoxin data from volunteers' households, we postulated that low values of lung function were associated to exposure to endotoxins present in environments exposed to dogs.
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Affiliation(s)
- C S Simoneti
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E Ferraz
- Departamento de Fisioterapia, Centro Regional Universitário de Espírito Santo do Pinhal, Espírito Santo do Pinhal, SP, Brasil
| | - M B Menezes
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - T R Icuma
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - E O Vianna
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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Patelis A, Gunnbjornsdottir M, Alving K, Borres MP, Högman M, Janson C, Malinovschi A. Allergen extract vs. component sensitization and airway inflammation, responsiveness and new-onset respiratory disease. Clin Exp Allergy 2017; 46:730-40. [PMID: 26243058 DOI: 10.1111/cea.12607] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/20/2015] [Accepted: 07/19/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The absence of IgE sensitization to allergen components in the presence of sensitization to the corresponding extract has been reported, but its clinical importance has not been studied. OBJECTIVE To evaluate the clinical significance of IgE sensitization to three aeroallergen extracts and the corresponding components in relation to the development of respiratory disease. METHODS A total of 467 adults participated in the European Community Respiratory Health Survey (ECRHS) II and 302 in ECRHS III, 12 years later. IgE sensitization to allergen extract and components, exhaled nitric oxide (FeNO) and bronchial responsiveness to methacholine were measured in ECRHS II. Rhinitis and asthma symptoms were questionnaire-assessed in both ECRHS II and III. RESULTS A good overall correlation was found between IgE sensitization to extract and components for cat (r = 0.83), timothy (r = 0.96) and birch (r = 0.95). However, a substantial proportion of subjects tested IgE positive for cat and timothy allergen extracts but negative for the corresponding components (48% and 21%, respectively). Subjects sensitized to both cat extract and components had higher FeNO (P = 0.008) and more bronchial responsiveness (P = 0.002) than subjects sensitized only to the extract. Further, subjects sensitized to cat components were more likely to develop asthma (P = 0.005) and rhinitis (P = 0.007) than subjects sensitized only to cat extract. CONCLUSION Measurement of IgE sensitization to cat allergen components would seem to have a higher clinical value than extract-based measurement, as it related better to airway inflammation and responsiveness and had a higher prognostic value for the development of asthma and rhinitis over a 12-year period.
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Affiliation(s)
- A Patelis
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - M Gunnbjornsdottir
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - K Alving
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - M P Borres
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Thermo Fisher Scientific, Immunodiagnostics, Uppsala, Sweden
| | - M Högman
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.,Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - C Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - A Malinovschi
- Department of Medical Sciences: Clinical Physiology, Uppsala University, Uppsala, Sweden
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7
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Patelis A, Dosanjh A, Gunnbjörnsdottir M, Borres MP, Högman M, Alving K, Janson C, Malinovschi A. New data analysis in a population study raises the hypothesis that particle size contributes to the pro-asthmatic potential of small pet animal allergens. Ups J Med Sci 2016; 121:25-32. [PMID: 26610050 PMCID: PMC4812054 DOI: 10.3109/03009734.2015.1109569] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The size of inhaled particles influences where they deposit and theoretically should be important for the development of airway inflammation and responsiveness. Our aim was to assess if sensitization to smaller-sized aeroallergens relates to higher prevalence of treated asthma, increased airway responsiveness, and airway and systemic inflammation. METHODS Molecular-based IgE antibody determination was done in 467 subjects. Sensitized subjects were grouped based on the particle size of the aeroallergen: (1) Large particles only (mainly pollen); (2) Medium-sized particles (sensitized to mainly mite and mold and possibly to large particles); and 3) Small particles (sensitized to pet allergens and possibly to medium- and/or large-sized particles). Airway responsiveness to methacholine, exhaled nitric oxide (FENO), and serum eosinophil cationic protein (S-ECP) were measured. Asthma and rhinitis were questionnaire-assessed. RESULTS Subjects sensitized to small particles had higher prevalence of treated asthma (35% versus 10%, P < 0.001), higher FENO50 (32 versus 17 ppb, P < 0.001), higher S-ECP (10 versus 7.5 ng/mL, P = 0.04), and increased bronchial responsiveness (dose-response slope, 5.6 versus 7.5, P < 0.001) compared with non-atopics. This was consistent after adjusting for potential confounders. Sensitization to only large or to medium and possibly also large aeroallergen particles was not related to any of these outcomes after adjustments. CONCLUSIONS Sensitization to smaller particles was associated with a higher prevalence of asthma under treatment, higher airway responsiveness, and airway and systemic inflammation. Mapping of IgE sensitization to small particles might help to detect subjects having increased airway and systemic inflammation and bronchial responsiveness, indicating increased risk of developing asthma.
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Affiliation(s)
- Antonios Patelis
- a Department of Medical Sciences , Respiratory, Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
| | - Amrita Dosanjh
- b Department of Pediatrics , Scripps Hospital , San Diego , CA , USA
| | - Maria Gunnbjörnsdottir
- a Department of Medical Sciences , Respiratory, Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
| | - Magnus P Borres
- c Thermo Fisher Scientific , Uppsala , Sweden
- d Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Marieann Högman
- a Department of Medical Sciences , Respiratory, Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
- e Centre for Clinical Research, Uppsala University/Region Gävleborg , Sweden
| | - Kjell Alving
- d Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden
| | - Christer Janson
- a Department of Medical Sciences , Respiratory, Allergy and Sleep Research, Uppsala University , Uppsala , Sweden
| | - Andrei Malinovschi
- f Department of Medical Sciences , Clinical Physiology, Uppsala University , Uppsala , Sweden
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8
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Arga M, Bakirtas A, Topal E, Turktas I. Can exhaled nitric oxide be a surrogate marker of bronchial hyperresponsiveness to adenosine 5'-monophosphate in steroid-naive asthmatic children? Clin Exp Allergy 2015; 45:758-66. [PMID: 25378028 DOI: 10.1111/cea.12447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/14/2014] [Accepted: 10/28/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The interrelation between airway inflammation, bronchial hyperresponsiveness (BHR) and atopy remains controversial. OBJECTIVE The aim of this study was to document whether exhaled nitric oxide (eNO) may be used as a surrogate marker that predicts BHR to adenosine 5'-monophosphate (AMP) in steroid-naive school children with asthma. METHODS This study was a retrospective analysis of steroid-naive school age children with atopic and non-atopic asthma. All patients whose eNO levels had been measured and who had been challenged with both methacholine (MCH) and AMP were included. Receiver operation characteristic analysis was performed, in both the atopic and the non-atopic groups, to evaluate the ability of eNO to detect the BHR to AMP. RESULTS One hundred and sixteen patients, sixty-nine (59.5%) of whom had been atopic, were included in the analysis. In the atopic group, eNO values were significantly higher in patients with BHR to AMP compared to those without BHR to AMP (51.9 ± 16.9 p.p.b. vs. 33.7 ± 16.4 p.p.b.; P < 0.001), whereas in the non-atopic group, the differences were not statistically significant (29.7 ± 16.9 p.p.b. vs. 22.6 ± 8.1 p.p.b.; P = 0.152). In the atopic group, eNO levels (R(2) : 0.401; β: 0.092; 95% CI: 1.19-14.42; OR: 7.12; P = 0.008) were found to be the only independent factor for BHR to AMP, whereas none of the parameters predicted BHR to AMP in the non-atopic group. The best cut-off value of eNO that significantly predicts BHR to AMP was 33.3 p.p.b. in the atopic group (P < 0.001), whereas a significant cut-off value for eNO that predicts BHR to AMP was not determined in the non-atopic group (P = 0.142). An eNO ≤ 17.4 p.p.b. has 100% negative predictive values and 100% sensitivity and 60.47% PPV for prediction of BHR to AMP in the atopic group. CONCLUSIONS Exhaled NO may be used to predict BHR to AMP in atopic but not in non-atopic steroid-naïve asthmatic children.
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Affiliation(s)
- M Arga
- Department of Pediatric Allergy and Asthma, Gazi University Faculty of Medicine, Ankara, Turkey
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Chen CM, Thiering E, Zock JP, Villani S, Olivieri M, Modig L, Jarvis D, Norbäck D, Verlato G, Heinrich J. Is there a threshold concentration of cat allergen exposure on respiratory symptoms in adults? PLoS One 2015; 10:e0127457. [PMID: 26035304 PMCID: PMC4452769 DOI: 10.1371/journal.pone.0127457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/15/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Cat allergen concentrations higher than 8 μg/g in settled house dust, have been suggested to provoke exacerbation of allergic respiratory symptoms. However, whether the 8 μg/g of indoor cat allergen concentration is indeed the minimal exposure required for triggering the asthma related respiratory symptoms or the development of sensitization has not yet been confirmed. We studied the associations between domestic cat allergen concentrations and allergic symptoms in the European Community Respiratory Health Survey II, with the aim of confirming this suggested threshold. METHODS Cat allergen concentrations were measured in the mattress dust of 3003 participants from 22 study centres. Levels of specific immunoglobulin E to cat allergens were measured in serum samples using an immunoassay. Information on allergic symptoms, medication use, home environment and smoking was obtained from a face-to-face interview. RESULTS Domestic cat allergen concentrations were not associated with allergic/ asthmatic symptoms in the entire study population, nor in the subset sensitized to cat allergen. We also found no association among individuals exposed to concentrations higher than 8 μg/g. However, exposure to medium cat allergen concentrations (0.24-0.63 μg/g) was positively associated with reported asthmatic respiratory symptoms in subjects who have experienced allergic symptoms when near animals. CONCLUSIONS The proposed 8 μg/g threshold of cat allergen concentrations for the exacerbation of allergic/ respiratory symptoms was not confirmed in a general European adult population. Potential biases attributable to avoidance behaviours and an imprecise exposure assessment cannot be excluded.
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Affiliation(s)
- Chih-Mei Chen
- Paediatric Epidemiology, Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medical Centre Berlin, Berlin, Germany; Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Elisabeth Thiering
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
| | - Jan-Paul Zock
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Simona Villani
- Department of Health Sciences, University of Pavia, Pavia, Italy
| | - Mario Olivieri
- Unit of Occupational Medicine, University Hospital of Verona, Verona, Italy
| | - Lars Modig
- Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Deborah Jarvis
- Respiratory Epidemiology and Public Health Group, Imperial College London, London, United Kingdom
| | - Dan Norbäck
- Department of Medical Science, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
| | - Giuseppe Verlato
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
| | - Joachim Heinrich
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
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10
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Bakolis I, Heinrich J, Zock JP, Norbäck D, Svanes C, Chen CM, Accordini S, Verlato G, Olivieri M, Jarvis D. House dust-mite allergen exposure is associated with serum specific IgE but not with respiratory outcomes. INDOOR AIR 2015; 25:235-244. [PMID: 24920489 DOI: 10.1111/ina.12137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 06/04/2014] [Indexed: 06/03/2023]
Abstract
Exposure to house dust has been associated with asthma in adults, and this is commonly interpreted as a direct immunologic response to dust-mite allergens in those who are IgE sensitized to house dust-mite. Mattress house dust-mite concentrations were measured in a population-based sample of 2890 adults aged between 27 and 56 years living in 22 centers in 10 countries. Generalized linear mixed models were employed to explore the association of respiratory symptoms with house dust-mite concentrations, adjusting for individual and household confounders. There was no overall association of respiratory outcomes with measured house dust-mite concentrations, even in those who reported they had symptoms on exposure to dust and those who had physician-diagnosed asthma. However, there was a positive association of high serum specific IgE levels to HDM (>3.5 kUA /l) with mattress house dust-mite concentrations and a negative association of sensitization to cat with increasing house dust-mite concentrations. In conclusion, there was no evidence that respiratory symptoms in adults were associated with exposure to house dust-mite allergen in the mattress, but an association of house mite with strong sensitization was observed.
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Affiliation(s)
- I Bakolis
- Small Area Health Statistics Unit, MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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11
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Jo EJ, Kim MY, Lee SE, Lee SY, Kim MH, Song WJ, Kim SH, Kang HR, Chang YS, Cho SH, Min KU. Eosinophilic airway inflammation and airway hyperresponsiveness according to aeroallergen sensitization pattern in patients with lower airway symptoms. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 6:39-46. [PMID: 24404392 PMCID: PMC3881399 DOI: 10.4168/aair.2014.6.1.39] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 03/04/2013] [Accepted: 04/15/2013] [Indexed: 11/20/2022]
Abstract
Purpose Sensitization to specific allergens may be important in the development of allergic airway inflammation and airway hyperresponsiveness (AHR). We evaluated the effect of specific aeroallergen sensitization on eosinophilic airway inflammation and AHR. Methods We reviewed retrospectively the clinical data of subjects who underwent skin prick tests to aeroallergens, induced sputum analysis, and methacholine bronchial provocation tests to evaluate lower airway symptoms as well as analyzed the associations between the pattern of aeroallergen sensitization and sputum eosinophilia or AHR. Results Of the 1,202 subjects be enrolled, 534 (44.4%) were sensitized to at least one aeroallergen in skin tests. AHR was demonstrated in 23.5% and sputum eosinophilia in 38.8%. Sputum eosinophilia was significantly associated with sensitization to perennial allergens (OR, 1.9; 95% CI, 1.4-2.5), house dust mite (OR, 1.7; 95% CI, 1.3-2.3), dog (OR, 1.9; 95% CI, 1.1-3.3), and cat (OR, 2.1; 95% CI, 1.4-3.4). AHR was associated with sensitization to perennial allergens (OR, 2.7; 95% CI, 2.0-3.7), house dust mite (OR, 2.2; 95% CI, 1.6 3.2), Alternaria (OR, 2.3; 95% CI, 1.2-4.7), and cat (OR, 2.7; 95% CI, 1.7-4.3). Sensitization to more perennial allergens increased the risk for sputum eosinophilia and AHR. There was no relationship with individual seasonal allergens. Conclusion The development of airway eosinophilic inflammation and AHR in an adult Korean population was associated with sensitization to perennial allergens rather than seasonal allergens.
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Affiliation(s)
- Eun-Jung Jo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Yeong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Seung-Eun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Suh-Young Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye-Ryun Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
| | - Kyung-Up Min
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul, Korea
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Patelis A, Gunnbjörnsdottir M, Malinovschi A, Matsson P, Onell A, Högman M, Alving K, Janson C. Population-based study of multiplexed IgE sensitization in relation to asthma, exhaled nitric oxide, and bronchial responsiveness. J Allergy Clin Immunol 2012; 130:397-402.e2. [PMID: 22633327 DOI: 10.1016/j.jaci.2012.03.046] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 03/21/2012] [Accepted: 03/26/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND IgE sensitization is an important risk factor for the development of asthma. OBJECTIVE The aim of this study was to investigate the IgE antibody profile for a broad spectrum of allergen molecules in asthmatic patients. METHODS Participants from the European Community Respiratory Health Survey II (n=467) were tested with ImmunoCAP ISAC against 103 allergen molecules. The presence of bronchial hyperresponsiveness was measured with a methacholine challenge test and bronchial inflammation with fraction of exhaled nitric oxide (Feno). RESULTS A total of 38% of the controls and 72% of the asthmatic patients were sensitized against at least 1 of the allergen components (P<.0001). Asthma was independently related to having IgE antibodies against pollen (odds ratio=2.2) and perennial airway allergens (odds ratio=5.6), increased Feno was independently related to having IgE antibodies against food allergens and perennial allergens, while bronchial responsiveness was independently associated with having IgE antibodies against only perennial allergens. Sensitization to food allergens was related to asthma and increased Feno if IgE antibody against pollen allergens was present. Simultaneous sensitization to perennial, pollen, and food allergens involves the highest risk of asthma (odds ratio=18.3), bronchial inflammation, and responsiveness. CONCLUSIONS Feno, bronchial responsiveness, and the risk of asthma increase with multiple sensitizations to different allergen groups. We show for the first time that the presence of IgE antibodies against food allergens is independently associated with increased Feno and increases the risk of asthma in subjects with simultaneous sensitization to pollen allergens.
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Affiliation(s)
- Antonios Patelis
- Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
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Ciprandi G, Cirillo I, Signori A. Impact of allergic rhinitis on bronchi: an 8-year follow-up study. Am J Rhinol Allergy 2011; 25:e72-6. [PMID: 21679504 DOI: 10.2500/ajra.2011.25.3607] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Allergic rhinitis is considered a strong risk factor for the onset of asthma. However, few studies addressed this issue from a functional point of view. The aim of this study was to follow up a group of patients with allergic rhinitis to investigate the onset of possible spirometric abnormalities and/or bronchial hyperreactivity (BHR). METHODS Eighty-nine patients with moderate-severe persistent allergic rhinitis were prospectively and consecutively evaluated; 940 controls were also included in the study. Clinical examination, skin-prick test, spirometry, and methacholine challenge were performed in all patients every 2 years for 8 years. RESULTS The number of patients with forced expiratory flow at 25 and 75% of pulmonary volume of <70% of predicted significantly increased during the observation time. At baseline, no subjects had BHR; whereas 34 patients had BHR after 8 years. Sensitization to mites, birch, and Parietaria as well as rhinitis duration are risk factors for these changes. CONCLUSION This study highlights the close link between upper and lower airways and suggests that spirometry should be performed in patients with allergic rhinitis.
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Affiliation(s)
- Giorgio Ciprandi
- Department of Internal Medicine, Azienda Ospedaliera Universitaria San Martino-University of Genoa, Italy.
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14
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Indoor environment and children's health: recent developments in chemical, biological, physical and social aspects. Int J Hyg Environ Health 2011; 215:1-18. [PMID: 21889403 DOI: 10.1016/j.ijheh.2011.07.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Revised: 07/22/2011] [Accepted: 07/25/2011] [Indexed: 12/11/2022]
Abstract
Much research is being carried out into indoor exposure to harmful agents. This review focused on the impact on children's health, taking a broad approach to the indoor environment and including chemical, microbial, physical and social aspects. Papers published from 2006 onwards were reviewed, with regards to scientific context. Most of publications dealt with chemical exposure. Apart from the ongoing issue of combustion by-products, most of these papers concerned semi volatile organic compounds (such as phthalates). These may be associated with neurotoxic, reprotoxic or respiratory effects and may, therefore, be of particular interest so far as children are concerned. In a lesser extent, volatile organic compounds (such as aldehydes) that have mainly respiratory effects are still studied. Assessing exposure to metals is still of concern, with increasing interest in bioaccessibility. Most of the papers on microbial exposure focused on respiratory tract infections, especially asthma linked to allergens and bio-aerosols. Physical exposure includes noise and electromagnetic fields, and articles dealt with the auditory and non auditory effects of noise. Articles on radiofrequency electromagnetic fields mainly concerned questions about non-thermal effects and papers on extremely low-frequency magnetic fields focused on the characterization of exposure. The impact of the indoor environment on children's health cannot be assessed merely by considering the effect of these different types of exposure: this review highlights new findings and also discusses the interactions between agents in indoor environments and also with social aspects.
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Högman M, Malinovschi A, Norbäck D, Janson C. Added value with extended NO analysis in atopy and asthma. Clin Physiol Funct Imaging 2011; 31:294-9. [PMID: 21672137 DOI: 10.1111/j.1475-097x.2011.01017.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Assessments of the usefulness of exhaled nitric oxide (NO) in the treatment of asthma have given conflicting results. It is not always obvious if atopic status has been tested in these evaluations. OBJECTIVES The aim of the study is to use extended NO analysis to characterize subjects from a random sample populations with focus on rhinitis and asthma. METHODS Data were extracted from the European Community Respiratory Health Survey II. A subgroup from the Uppsala site that had had their NO measured at multiple flow rates was included (n = 284). The nonlinear model for NO parameters was used. Atopy was defined as having a titre against at least one of the tested allergens ≥0·35 kU l(-1) . Bronchial responsiveness was assessed by methacholine challenge. RESULTS Subjects with non-atopic rhinitis or non-atopic asthma could not be separated from healthy subjects regarding NO parameters. There was a gradual increase with atopy in airway diffusion rate (D(aw) NO); healthy subject 8·0 (7·3, 8·8), healthy atopic 8·8 (6·7, 11·5), atopic rhinitis 10·6 (9·0, 12·4) and atopic asthma 11·2 (9·9, 28·3) ml s(-1) [geometrical mean (CI(95%) )]. There was a correlation between bronchial responsiveness and D(aw) NO in atopic rhinitis (r = -0·41, P<0·01), and bronchial responsiveness and airway wall content of NO (C(aw) NO) in atopic asthma (r = -0·56, P<0·001). CONCLUSION It is of importance to characterize atopic status when evaluating the association between NO and asthma. Our results indicate that the use of extended NO analysis, with particular attention to D(aw) NO and C(aw) NO, may be useful in monitoring treatment for rhinitis and asthma.
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Affiliation(s)
- Marieann Högman
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, Sweden.
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Möhrenschlager M, Ring J, Lauener R. Possible in-cabin exposure to cat allergen: a 2010 airline survey on live animal transport and a review of literature. Allergy 2010; 65:1496-8. [PMID: 20557299 DOI: 10.1111/j.1398-9995.2010.02400.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- M Möhrenschlager
- Department of Dermatology and Allergology, Allergieklinik-Hochgebirgsklinik, Herman-Burchard-Str. 1, CH-7265 Davos, Switzerland.
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Abstract
Children who are referred to specialist care with asthma that does not respond to treatment (problematic severe asthma) are a heterogeneous group, with substantial morbidity. The evidence base for management is sparse, and is mostly based on data from studies in children with mild and moderate asthma and on extrapolation of data from studies in adults with severe asthma. In many children with severe asthma, the diagnosis is wrong or adherence to treatment is poor. The first step is a detailed diagnostic assessment to exclude an alternative diagnosis ("not asthma at all"), followed by a multidisciplinary approach to exclude comorbidities ("asthma plus") and to assess whether the child has difficult asthma (improves when the basic management needs, such as adherence and inhaler technique, are corrected) or true, therapy-resistant asthma (still symptomatic even when the basic management needs are resolved). In particular, environmental causes of secondary steroid resistance should be identified. An individualised treatment plan should be devised depending on the clinical and pathophysiological characterisation. Licensed therapeutic approaches include high-dose inhaled steroids, the Symbicort maintenance and reliever (SMART) regimen (with budesonide and formoterol fumarate), and anti-IgE therapy. Unlicensed treatments include methotrexate, azathioprine, ciclosporin, and subcutaneous terbutaline infusions. Paediatric data are needed on cytokine-specific monoclonal antibody therapies and bronchial thermoplasty. However, despite the interest in innovative approaches, getting the basics right in children with apparently severe asthma will remain the foundation of management for the foreseeable future.
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Affiliation(s)
- Andrew Bush
- Imperial School of Medicine, National Heart and Lung Institute, Royal Brompton Hospital, London, UK.
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Problematic, severe asthma in children: a new concept and how to manage it. Acta Med Litu 2010. [DOI: 10.2478/v10140-010-0007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Almqvist C, Garden F, Kemp AS, Li Q, Crisafulli D, Tovey ER, Xuan W, Marks GB. Effects of early cat or dog ownership on sensitisation and asthma in a high-risk cohort without disease-related modification of exposure. Paediatr Perinat Epidemiol 2010; 24:171-8. [PMID: 20415774 DOI: 10.1111/j.1365-3016.2010.01095.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Variation in the observed association between pet ownership and allergic disease may be attributable to selection bias and confounding. The aim of this study was to suggest a method to assess disease-related modification of exposure and second to examine how cat acquisition or dog ownership in early life affects atopy and asthma at 5 years. Information on sociodemographic factors and cat and dog ownership was collected longitudinally in an initially cat-free Australian birth cohort based on children with a family history of asthma. At age 5 years, 516 children were assessed for wheezing, and 488 for sensitisation. Data showed that by age 5 years, 82 children had acquired a cat. Early manifestations of allergic disease did not foreshadow a reduced rate of subsequent acquisition of a cat. Independent risk factors for acquiring a cat were exposure to tobacco smoke at home odds ratio (OR) 1.92 [95% confidence interval (CI) 1.13, 3.26], maternal education < or =12 years OR 1.95 [1.08, 3.51] and dog ownership OR 2.23 [1.23, 4.05]. Cat or dog exposure in the first 5 years was associated with a decreased risk of any allergen sensitisation, OR 0.50 [0.28, 0.88] but no association with wheeze OR 0.96 [0.57, 1.61]. This risk was not affected by age at which the cat was acquired or whether the pet was kept in- or outdoors. In conclusion, cat or dog ownership reduced the risk of subsequent atopy in this high-risk birth cohort. This cannot be explained by disease-related modification of exposure. Public health recommendations on the effect of cat and dog ownership should be based on birth cohort studies where possible selection bias has been taken into account.
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Affiliation(s)
- Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics and Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden.
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Does Exposure to Indoor Allergens Contribute to the Development of Asthma and Allergy? Curr Allergy Asthma Rep 2009; 10:49-55. [DOI: 10.1007/s11882-009-0082-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gent JF, Belanger K, Triche EW, Bracken MB, Beckett WS, Leaderer BP. Association of pediatric asthma severity with exposure to common household dust allergens. ENVIRONMENTAL RESEARCH 2009; 109:768-74. [PMID: 19473655 PMCID: PMC2706291 DOI: 10.1016/j.envres.2009.04.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 04/13/2009] [Accepted: 04/20/2009] [Indexed: 05/04/2023]
Abstract
BACKGROUND Reducing exposure to household dust inhalant allergens has been proposed as one strategy to reduce asthma. OBJECTIVE To examine the dose-response relationships and health impact of five common household dust allergens on disease severity, quantified using both symptom frequency and medication use, in atopic and non-atopic asthmatic children. METHODS Asthmatic children (N=300) aged 4-12 years were followed for 1 year. Household dust samples from two indoor locations were analyzed for allergens including dust mite (Der p 1, Der f 1), cat (Fel d 1), dog (Can f 1), cockroach (Bla g 1). Daily symptoms and medication use were collected in monthly telephone interviews. Annual disease severity was examined in models including allergens, specific IgE sensitivity and adjusted for age, gender, atopy, ethnicity, and mother's education. RESULTS Der p 1 house dust mite allergen concentration of 2.0 microg/g or more from the main room and the child's bed was related to increased asthma severity independent of allergic status (respectively, OR 2.93, 95% CI 1.37, 6.30 for 2.0-10.0 microg/g and OR 2.55 95% CI 1.13, 5.73 for 10.0 microg/g). Higher pet allergen levels were associated with greater asthma severity, but only for those sensitized (cat OR 2.41 95% CI 1.19, 4.89; dog OR 2.06 95% CI 1.01, 4.22). CONCLUSION Higher levels of Der p 1 and pet allergens were associated with asthma severity, but Der p 1 remained an independent risk factor after accounting for pet allergens and regardless of Der p 1 specific IgE status.
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Affiliation(s)
- Janneane F Gent
- Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church Street, 6th Floor, New Haven, CT 06510, USA.
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Bush A, Hedlin G, Carlsen KH, de Benedictis F, Lodrup-Carlsen K, Wilson N. Severe childhood asthma: a common international approach? Lancet 2008; 372:1019-21. [PMID: 18805316 DOI: 10.1016/s0140-6736(08)61422-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6JJ, UK.
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The value of FeNO measurement in asthma management: the motion for Yes, it's NO--or, the wrong end of the Stick! Paediatr Respir Rev 2008; 9:127-31. [PMID: 18513673 DOI: 10.1016/j.prrv.2007.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The utility of measurements of exhaled nitric oxide (FeNO) will likely depend on context, being most helpful in moderate and severe asthma, rather than mild asthmatics and community based studies. Atopy on its own is a cause of elevation in FeNO. Adult and paediatric studies have clearly established that measurement of some aspect of airway inflammation is part of state of the art management of asthma, but it is as yet unclear which of several techniques is most useful. The relationship between FeNO and sputum eosinophils is relatively loose, but this does not preclude it being a useful test in clinical practice. In fact, there are only poor correlations between sputum, proximal mucosal, and distal eosinophils, and the importance of these different compartments is unclear. A low FeNO in the setting of supposedly poorly controlled asthma should cast doubt on the diagnosis. We certainly cannot treat an isolated elevation in FeNO, which may be due to a simple viral cold, or constitutional. If FeNO is elevated, particularly if asthma is uncontrolled, it suggests an imbalance between anti-inflammatory therapy and pro-inflammatory environmental influences. Inadequate anti-inflammatory therapy may be due to the prescribed dose being too low; the drug delivery device not being used correctly; or the medication not being taken. Adverse pro-inflammatory environmental influences driving up FeNO include IgE and non-IgE mediated allergen sensitivity in the home, and even in the child's school. Novel technology allows home monitoring of FeNO, but the role of these devices is less clear. Although more data is needed properly to define the role of FeNO measurements in clinical practice, there is sufficient data already published to conclude that 'inflammometry' is an important part of asthma management at the more severe end of the spectrum, and that FeNO measurements are probably the most useful at the moment.
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Abstract
The systematic avoidance of indoor allergens by modification of houses, furnishings, or hygiene practices has long been advocated to reduce both the incidence of allergic diseases in at-risk infants and exacerbations or symptoms in those previously sensitized with such a disease. However, such advocacy is now under challenge, due to both a lack of evidence of clinical efficacy of avoidance measures and rapidly changing models of disease causation and pathology. This article reviews the current dilemmas in understanding the complexity of allergen sources, disease risks, nature of bioaerosol exposure, and the inadequacies of many available methods.
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Affiliation(s)
- Euan R Tovey
- University of Sydney, New South Wales 2006, Australia.
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25
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Affiliation(s)
- Wendy C Moore
- Center for Human Genomics and Department of Internal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA.
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