1
|
Shigehara K, Kamekura R, Ikegami I, Sakamoto H, Yanagi M, Kamiya S, Kodama K, Asai Y, Miyajima S, Nishikiori H, Uno E, Yamamoto K, Takano K, Chiba H, Ohnishi H, Ichimiya S. Circulating T follicular helper 2 cells, T follicular regulatory cells and regulatory B cells are effective biomarkers for predicting the response to house dust mite sublingual immunotherapy in patients with allergic respiratory diseases. Front Immunol 2023; 14:1284205. [PMID: 38111589 PMCID: PMC10726700 DOI: 10.3389/fimmu.2023.1284205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
The relationships between T follicular helper (Tfh) cells and antigen-specific immunoglobulins (sIgs) in patients with allergic respiratory diseases who are receiving antigen immunotherapy (AIT) have not been fully clarified. Therefore, we started to perform house dust mite sublingual immunotherapy (HDM-SLIT) for 20 patients with atopic asthma comorbid with allergic rhinitis (AA+AR) who were already receiving ordinary treatments including inhaled corticosteroid (ICS). We examined percentages of circulating T follicular helper (cTfh) and regulatory (cTfr) cells and percentages of circulating regulatory T (cTreg) and B (cBreg) cells by FACS and we examined levels of Der-p/f sIgs by ELISA. Based on the symptom score (asthma control questionnaire: ACQ) and medication score ((global initiative for asthma: GINA) treatment step score) in patients with AA, the patients were divided into responders and non-responders. The percentage of cTfh2 cells significantly decreased and the percentage of cTfh1 cells significantly increased within the first year. Der-p/f sIgEs decreased after a transient elevation at 3 months in both groups. Notably, the percentage of cTfh2 cells and the ratio of cTfh2/cBreg cells and Der-p/f sIgEs greatly decreased in responders from 6 months to 12 months. The percentages of cTfr and cTreg cells showed significant negative correlations with the percentage of cTfh2 cells. The percentage of IL-4+ cTfh cells were significantly decreased and the percentage of IFN-γ+ cTfh cells were increased before treatment to 24 months in 6 patients examined (4 responders and 2 non-responders). We performed multi plelogistic regression analysis based on these results, the ratios of cTfh2/cTfr cells and cTfh2/cBreg cells at the start of therapy were statistically effective biomarkers for predicting the response to HDM-SLIT in patients with AA+AR.
Collapse
Affiliation(s)
- Katsunori Shigehara
- Department of Human Immunology, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
- Ai Medical Clinic, Sapporo, Japan
| | - Ryuta Kamekura
- Department of Human Immunology, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Otolaryngology and Head and Neck Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ippei Ikegami
- Department of Human Immunology, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Sakamoto
- Department of Human Immunology, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Otolaryngology and Head and Neck Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masahiro Yanagi
- Department of Human Immunology, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shiori Kamiya
- Department of Human Immunology, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
- Department of Dermatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kentaro Kodama
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuichiro Asai
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satsuki Miyajima
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirotaka Nishikiori
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Eiji Uno
- Ai Medical Clinic, Sapporo, Japan
| | - Keisuke Yamamoto
- Department of Otolaryngology and Head and Neck Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kenichi Takano
- Department of Otolaryngology and Head and Neck Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirofumi Chiba
- Department of Respiratory Medicine and Allergology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shingo Ichimiya
- Department of Human Immunology, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| |
Collapse
|
2
|
Fillard A, Licari A, Molinari N, Marseglia G, Demoly P, Caimmi D. Sensitivity of FEV 1 and Clinical Parameters in Children With a Suspected Asthma Diagnosis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:238-247. [PMID: 36280139 DOI: 10.1016/j.jaip.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Asthma is the most common chronic disease in children and a robust diagnosis is crucial to optimize patient care and reduce its burden. To diagnose asthma in children, the Global Initiative for Asthma (GINA) recommendations propose a 12% improvement in forced expiratory volume in 1 second (FEV1) after a bronchodilation test. Nevertheless, such a criterion is rarely confirmed in these patients in clinical practice. OBJECTIVE The objective of this study was to evaluate the sensitivity of spirometric and clinical parameters in identifying children with possible asthma. METHODS The VERI-VEMS Study is a multicenter international retrospective cohort study. Data were collected, from January 2008 until January 2019, for all consecutive children (aged 5-18 years), with a diagnosis of asthma, who performed a spirometry at the time of the diagnosis. We compared the sensitivity of the reversibility criterion proposed by GINA guidelines, with other spirometric and clinical variables, using physician-diagnosed asthma and response to treatment as the standard. RESULTS The study included 871 children. The reversibility criterion of 12% of FEV1 showed a sensitivity of 30.4%. The 3 best spirometric or clinical criteria were the presence of dry cough, or wheezing or atopy and dry cough, or wheezing or exercise-induced dyspnea, with a sensitivity reaching 99.5%, with no added value of the spirometric parameters in the calculation of the cumulated sensitivity for the diagnosis of pediatric asthma. CONCLUSIONS Postbronchodilator reversibility of 12%, although essential for patients' follow-up, has an insufficient low sensitivity in reaching a diagnosis of asthma in pediatric patients, compared with a combination of clinical symptoms, that show a better sensitivity. Further studies on specificity will help clarify the role of this change in the diagnostic paradigm in formally diagnosing children with asthma.
Collapse
Affiliation(s)
- Anouchka Fillard
- Allergy Unit, Département de Pneumologie et Addictology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France
| | - Amelia Licari
- Pediatric Unit, University of Pavia, San Matteo Hospital, Pavia, Italy
| | - Nicolas Molinari
- Department of Statistics, IMAG UMR5149 S, University Hospital of Montpellier, Montpellier, France; Debrest Institute of Epidemiology and Public Health (IDESP), UMR UA11, University of Montpellier - INSERM, Montpellier, France
| | | | - Pascal Demoly
- Allergy Unit, Département de Pneumologie et Addictology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France; Debrest Institute of Epidemiology and Public Health (IDESP), UMR UA11, University of Montpellier - INSERM, Montpellier, France
| | - Davide Caimmi
- Allergy Unit, Département de Pneumologie et Addictology, Arnaud de Villeneuve Hospital, University Hospital of Montpellier, Montpellier, France; Debrest Institute of Epidemiology and Public Health (IDESP), UMR UA11, University of Montpellier - INSERM, Montpellier, France.
| |
Collapse
|
3
|
Malizia V, Ferrante G, Cilluffo G, Gagliardo R, Landi M, Montalbano L, Fasola S, Profita M, Licari A, Marseglia GL, La Grutta S. Endotyping Seasonal Allergic Rhinitis in Children: A Cluster Analysis. Front Med (Lausanne) 2022; 8:806911. [PMID: 35155483 PMCID: PMC8825866 DOI: 10.3389/fmed.2021.806911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Seasonal Allergic Rhinitis (SAR) is a heterogeneous inflammatory disease. We hypothesized that a cluster analysis based on the evaluation of cytokines in nasal lavage (NL) could characterize distinctive SAR endotypes in children. Methods This cross-sectional study enrolled 88 children with SAR. Detailed medical history was obtained by well-trained physicians. Quality of life and sleep quality were assessed through standardized questionnaires [Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) and Pittsburgh Sleep Quality Index (PSQI) respectively]. Children were grouped through K-means clustering using Interleukin (IL)-5, IL-17, IL-23, and Interferon (INF)-γ in NL. Results Out of the 88 patients enrolled, 80 were included in the cluster analysis, which revealed three SAR endotypes. Cluster 1 showed lower levels of IL-5 and IL-17 and intermediate levels of IL-23 and IFN-γ; Cluster 2 had higher levels of IL-5 and intermediate levels of IL-17, IL-23, and IFN-γ; Cluster 3 showed higher levels of IL-17, IL-23, and IFN-γ and intermediate levels of IL-5. Cluster 1 showed intermediate values of nasal pH and nasal nitric oxide (nNO), and a lower percentage of neutrophils at nasal cytology than Clusters 2 and 3. Cluster 2 had a lower level of nasal pH, a higher nNO, higher scores in the ocular domain of PRQLQ, and worse sleep quality than Clusters 1 and 3. Cluster 3 showed a higher percentage of neutrophils at nasal cytology than Clusters 1 and 2. Conclusions Our study identified three endotypes based on the evaluation of cytokines in NL, highlighting that childhood SAR is characterized by heterogeneous inflammatory cytokines.
Collapse
Affiliation(s)
- Velia Malizia
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giuliana Ferrante
- Paediatric Unit, Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, University of Verona, Verona, Italy
| | - Giovanna Cilluffo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Rosalia Gagliardo
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Massimo Landi
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy.,Pediatric National Healthcare System, Turin, Italy
| | - Laura Montalbano
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Salvatore Fasola
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Mirella Profita
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Foundation IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania La Grutta
- Department of Biomedicine, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| |
Collapse
|
4
|
Immunological and microRNA Features of Allergic Rhinitis in the Context of United Airway Disease. SINUSITIS 2021. [DOI: 10.3390/sinusitis5010005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inflammation of the upper respiratory tract in patients with allergic rhinitis (AR) may contribute to lower respiratory airways’ inflammation. T-helper 17 (Th17) cells and related cytokines are also involved in the immunological mechanism of AR along with the classical Th2 cells. It is hypothesized that upon Th2 pressure, the inflammatory response in the lungs may lead to Th17-induced neutrophilic inflammation. However, the findings for interleukin-17 (IL-17) are bidirectional. Furthermore, the role of Th17 cells and their counterpart—T regulatory cells—remains unclear in AR patients. It was also shown that a regulator of inflammation might be the individual circulating specific non-coding microRNAs (miRNAs), which were distinctively expressed in AR and bronchial asthma (BA) patients. However, although several circulating miRNAs have been related to upper and lower respiratory tract diseases, their function and clinical value are far from being clarified. Still, they can serve as noninvasive biomarkers for diagnosing, characterizing, and providing therapeutic targets for anti-inflammatory treatment along with the confirmed contributors to the pathogenesis—Th17 cells and related cytokines. The narrow pathogenetic relationship between the nose and the bronchi, e.g., upper and lower respiratory tracts, confirms the concept of unified airway diseases. Thus, there is no doubt that AR and BA should be diagnosed, managed, and treated in an integrated manner.
Collapse
|
5
|
Watanabe H, Asada K, Shirai T, Torii H, Yoshimura K, Kusafuka K. Eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis during nivolumab and ipilimumab. Respirol Case Rep 2020; 8:e00638. [PMID: 32742660 PMCID: PMC7390999 DOI: 10.1002/rcr2.638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/16/2022] Open
Abstract
Immune-related adverse events (irAEs) are induced by immune checkpoint inhibitors (ICIs) which are administered for many cancers. There are many irAEs such as endocrine abnormalities, interstitial lung disease, and colitis. However, irAEs associated with type 2 (T2) inflammation are less known. We herein report a 71-year-old woman who developed eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis (ECRS) simultaneously during combination therapy with nivolumab and ipilimumab for renal cell carcinoma. After two cycles of therapy, she developed cough and nasal congestion with high level of fractioned exhaled nitric oxide and blood eosinophil count, and nasal polyps with eosinophil infiltration in bilateral nasal cavities. She was diagnosed with eosinophilic airway inflammation and ECRS, and treated with corticosteroid inhalation, steroid nasal spray, and nasal irrigation, resulting in symptom reduction. Although they are relatively rare irAEs of ICIs, clinicians should consider these diseases associated with T2 inflammation and treat appropriately.
Collapse
Affiliation(s)
- Hirofumi Watanabe
- Department of Respiratory MedicineShizuoka General HospitalShizuokaJapan
| | - Kazuhiro Asada
- Department of Respiratory MedicineShizuoka General HospitalShizuokaJapan
| | - Toshihiro Shirai
- Department of Respiratory MedicineShizuoka General HospitalShizuokaJapan
| | - Hiroko Torii
- Department of Otorhinolaryngology, Head and Neck SurgeryShizuoka General HospitalShizuokaJapan
| | - Koji Yoshimura
- Department of UrologyShizuoka General HospitalShizuokaJapan
| | | |
Collapse
|
6
|
King GG, Farrow CE, Chapman DG. Dismantling the pathophysiology of asthma using imaging. Eur Respir Rev 2019; 28:28/152/180111. [PMID: 30996039 DOI: 10.1183/16000617.0111-2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/01/2019] [Indexed: 11/05/2022] Open
Abstract
Asthma remains an important disease worldwide, causing high burden to patients and healthcare systems and presenting a need for better management and ultimately prevention and cure. Asthma is a very heterogeneous condition, with many different pathophysiological processes. Better measurement of those pathophysiological processes are needed to better phenotype disease, and to go beyond the current, highly limited measurements that are currently used: spirometry and symptoms. Sophisticated three-dimensional lung imaging using computed tomography and ventilation imaging (single photon emission computed tomography and positron emission tomography) and magnetic resonance imaging and methods of lung imaging applicable to asthma research are now highly developed. The body of current evidence suggests that abnormalities in structure and ventilatory function measured by imaging are clinically relevant, given their associations with disease severity, exacerbation risk and airflow obstruction. Therefore, lung imaging is ready for more widespread use in clinical trials and to become part of routine clinical assessment of asthma.
Collapse
Affiliation(s)
- Gregory G King
- Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia .,Woolcock Institute of Medical Research and Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre of Excellence in Severe Asthma, Newcastle, Australia
| | - Catherine E Farrow
- Dept of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Australia.,Woolcock Institute of Medical Research and Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Centre of Excellence in Severe Asthma, Newcastle, Australia
| | - David G Chapman
- Woolcock Institute of Medical Research and Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, Australia
| |
Collapse
|
7
|
Naydenova K, Velikova T, Dimitrov V. Interactions of allergic rhinitis and bronchial asthma at mucosal immunology level. AIMS ALLERGY AND IMMUNOLOGY 2019. [DOI: 10.3934/allergy.2019.1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
8
|
Hamada S, Tatsumi S, Kobayashi Y, Matsumoto H, Yasuba H. Radiographic Evidence of Sinonasal Inflammation in Asthma-Chronic Obstructive Pulmonary Disease Overlap Syndrome: An Underrecognized Association. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1657-1662. [PMID: 28460847 DOI: 10.1016/j.jaip.2017.03.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 02/21/2017] [Accepted: 03/30/2017] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sinonasal inflammation on both clinical examinations and imaging significantly impacts both asthma and chronic obstructive pulmonary disease (COPD). OBJECTIVE The objective of this study was to examine the association between sinonasal inflammation and asthma-COPD overlap syndrome (ACOS). METHODS A total of 112 patients with a ratio of forced expiratory volume in 1 s to forced vital capacity of less than 70% were enrolled. COPD, asthma, and ACOS were clinically diagnosed according to the 2014 Global Initiative for Asthma and Global Initiative for Chronic Obstructive Lung Disease guidelines. Sinonasal inflammatory condition was evaluated using sinus computed tomography, and its severity was assessed according to the Lund-Mackay staging (LMS) system. Ethmoid sinus-dominant shadow was defined as the presence of greater LMS scores for the anterior and posterior ethmoid sinuses than for the maxillary sinus. RESULTS COPD, asthma, and ACOS were diagnosed in 55 (49.1%), 39 (34.8%), and 18 patients (16.1%), respectively. The frequency of radiographic evidence of sinonasal inflammation in patients with COPD, asthma, ACOS was 60.0%, 94.9%, and 72.2%, respectively. Patients with ACOS and COPD had only mild radiographic evidence of sinonasal inflammation (LMS score, 1-7), whereas moderate (LMS score, 8-11) and severe (LMS score, ≥12) radiographic evidence of sinonasal inflammation were detected only in patients with asthma. Furthermore, the frequency of ethmoid sinus-dominant shadow was significantly higher in patients with asthma than in those with COPD and ACOS. CONCLUSIONS Radiographic evidence of sinonasal inflammation was a common comorbidity in ACOS. Future studies are required to examine the role of sinonasal inflammation in ACOS.
Collapse
Affiliation(s)
- Satoshi Hamada
- Department of Respiratory Medicine, Hikone Municipal Hospital, Hikone, Japan; Department of Airway Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan.
| | - Shuji Tatsumi
- Department of Airway Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yoshiki Kobayashi
- Department of Otolaryngology, Kansai Medical University, Osaka, Japan
| | - Hisako Matsumoto
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hirotaka Yasuba
- Department of Airway Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| |
Collapse
|
9
|
Association of primary immune thrombocytopenia and common allergic diseases among children. Pediatr Res 2015; 77:597-601. [PMID: 25580738 DOI: 10.1038/pr.2015.6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 10/08/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Growing evidence has revealed a link between autoimmune and allergic diseases. However, few studies have assessed the relationship between allergic diseases and primary immune thrombocytopenia (ITP), an autoimmune disease frequently occurring in children. This population-based case-control study investigated the association between common allergic diseases and the subsequent risk of developing ITP during childhood. METHODS This study investigated 1,203 children younger than 18 y of age who were diagnosed with ITP between 1998 and 2008, as well as 4,812 frequency-matched controls. The odds ratios of the association between ITP and preexisting allergic diseases were calculated. RESULTS Children with every type of allergic disease examined in this study (except asthma) exhibited an increased risk of developing ITP; the lowest adjusted odds ratio (aOR) was 1.39 for allergic conjunctivitis (95% confidence interval (CI) = 1.09-1.79), whereas the greatest aOR was 1.84 for allergic rhinitis (95% CI = 1.49-2.27). The aORs increased with the number of concurrent allergic diseases to 2.89 (95% CI = 1.98-4.22) for children with at least three allergic diseases. CONCLUSION Children with atopic diathesis have a greater risk of subsequently developing ITP. The fundamental determinants of this relationship warrant further study.
Collapse
|
10
|
Abstract
Current literature related to asthma diagnosis, epidemiology, pathogenesis, and treatment linked with rhinosinusitis is important. Asthma is very heterogeneous; new theories and treatments are emerging. It is a growing epidemic among children and adults in the United States and the severity of asthma is caused by many factors such as lack of education, poor early recognition, decreased symptom awareness, improper medications, and phenotypic changes. Genetic variation, innate immune genes, those involved in tissue remodeling and arachidonic acid metabolism, and inflammatory mediators might contribute to the pathogenesis of chronic rhinosinusitis (CRS) linked with asthma. This extensive review addresses concepts of the burden of asthma and sinusitis, altered innate immunity, adaptive immunity, asthma remodeling, the airway epithelium, the role of airway smooth muscle cells, united allergic airway, genetics, an integral part in asthma, and CRS. In addition, the role of vitamin D in both asthma and CRS in the elderly and pediatric population, various treatment options, and exhaled nitric oxide are briefly addressed.
Collapse
Affiliation(s)
- Marianne Frieri
- Department of Medicine, Division of Allergy Immunology Nassau University Medical Center, East Meadow, New York, USA
| |
Collapse
|
11
|
Tsilochristou OA, Douladiris N, Makris M, Papadopoulos NG. Pediatric allergic rhinitis and asthma: can the march be halted? Paediatr Drugs 2013; 15:431-40. [PMID: 23955538 DOI: 10.1007/s40272-013-0043-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The strong epidemiologic and pathophysiologic link between allergic rhinitis (AR) and asthma has led to the concept of 'united airways disease' or 'respiratory allergy', implying that allergy, in its widest sense, underlies this clinical syndrome. Progression from AR to asthma is frequent and part of the 'atopic march'. Since pediatric immune responses are more adaptable and therefore may be more amenable to treatment, interventions at early childhood are characterized by a higher chance to affect the natural history of respiratory allergy. Although current treatments are quite effective in alleviating respiratory allergy symptoms, it has proven much more difficult to confirm any influence on the progression of the disease. Much more promising is the field of specific allergen immunotherapy, where current evidence, although not yet of ideal robustness, points towards a disease-modifying effect. In addition, newer or emerging, possibly more effective or more targeted interventions are promising in the preventive sense.
Collapse
Affiliation(s)
- Olympia A Tsilochristou
- Allergy Unit "D. Kalogeromitros," Medical School, "Attikon" University Hospital, 1, Rimini str, 124 62, Chaidari, Athens, Greece,
| | | | | | | |
Collapse
|
12
|
Association between allergic rhinitis and asthma control in Peruvian school children: a cross-sectional study. BIOMED RESEARCH INTERNATIONAL 2013; 2013:861213. [PMID: 23984414 PMCID: PMC3741928 DOI: 10.1155/2013/861213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Asthma and allergic rhinitis are highly prevalent conditions that cause major illness worldwide. This study aimed to assess the association between allergic rhinitis and asthma control in Peruvian school children. METHODS A cross-sectional study was conducted among 256 children with asthma recruited in 5 schools from Lima and Callao cities. The outcome was asthma control assessed by the asthma control test. A score test for trend of odds was used to evaluate the association between allergic rhinitis severity and the prevalence of inadequate asthma control. A generalized linear regression model was used to estimate the adjusted prevalence ratios of inadequate asthma control. RESULTS Allergic rhinitis was present in 66.4% of the population with asthma. The trend analysis showed a positive association between allergic rhinitis and the probability of inadequate asthma control (P < 0.001). It was associated with an increased prevalence of inadequate asthma control, with adjusted prevalence ratios of 1.53 (95% confidence interval: 1.19-1.98). CONCLUSION This study indicates that allergic rhinitis is associated with an inadequate level of asthma control, giving support to the recommendation of evaluating rhinitis to improve asthma control in children.
Collapse
|