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Shin YH, Kim JH, Lee SH, Lee SY, Park YM, Choi EJ, Paek EY, Song KB, Park MJ, Jung S, Yoon J, Suh DI, Kim KW, Ahn K, Hong SJ. Allergic rhinitis phenotypes with distinct transcriptome profiles in children: A birth cohort. J Allergy Clin Immunol 2024; 153:1319-1329. [PMID: 38242217 DOI: 10.1016/j.jaci.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/23/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Allergic rhinitis (AR) phenotypes in childhood are unclear. OBJECTIVES This study sought to determine AR phenotypes and investigate their natural course and clinical and transcriptomic characteristics. METHODS Latent class trajectory analysis was used for phenotyping AR in 1050 children from birth through 12 years using a birth cohort study. Blood transcriptome analyses were performed to define the underlying mechanisms of each phenotype. RESULTS Five AR phenotypes were identified: early onset (n = 88, 8.4%), intermediate transient (n = 110, 10.5%), late onset (n = 209, 19.9%), very late onset (n=187, 17.8%), and never/infrequent (n = 456, 43.4%). Children with early-onset AR were associated with higher AR severity and sensitizations to foods at age 1 year and inhalants at age 3 years and asthma symptoms, but not with bronchial hyperresponsiveness (BHR). Children with late-onset AR phenotype associated with sensitizations to various foods at age 1 year but not from age 3 years, and to inhalants from age 7 years and with asthma with BHR. Children with very late-onset AR phenotype associated with sensitizations to foods throughout preschool age and to inhalants at ages 7 and 9 years and with asthma with BHR. Transcriptome analysis showed that early-onset AR was associated with viral/bacterial infection-related defense response, whereas late-onset AR was associated with T cell-related immune response. CONCLUSIONS Early-onset AR phenotype was associated with sensitization to foods and inhalants at an early age and asthma symptoms, but not with BHR, whereas very late- and late-onset AR phenotypes were positively associated with sensitization to inhalants and asthma with BHR. Transcriptomic analyses indicated that early- and late-onset AR phenotypes had distinct underlying mechanisms related to AR as well.
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Affiliation(s)
- Youn Ho Shin
- Department of Pediatrics, The Catholic University of Korea, Yeouido St Mary's Hospital, Seoul, Korea
| | - Jeong-Hyun Kim
- Department of Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Si-Hyeon Lee
- Department of Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Yoon Mee Park
- Department of Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Eum Ji Choi
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Young Paek
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Kun-Baek Song
- Department of Pediatrics, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Min Ji Park
- Department of Pediatrics, Hallym Sacred Heart Hospital, Anyang, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jisun Yoon
- Department of Pediatrics, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea.
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Bonner K, Roberts G. Does allergy explain why some children have severe asthma? Clin Exp Allergy 2018; 48:1594-1605. [PMID: 30019503 DOI: 10.1111/cea.13234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 06/30/2018] [Accepted: 07/15/2018] [Indexed: 12/13/2022]
Abstract
Asthma is a common disease in childhood with a minority of affected children having severe therapy-resistant asthma (STRA). Children with STRA can be differentiated from those with mild-moderate disease by greater allergic sensitization, increased eosinophilic airway inflammation, increased airway remodelling and reduced corticosteroid responsiveness. The aetiology of STRA in children is multifactorial but allergy seems to play a key role. Many children with asthma have coexisting allergic disease, and severe rhinitis seems to be an important driver of STRA in children. Allergies to foods, moulds, pollen and pets have also been associated with severe asthma exacerbations. Identifying allergens that are driving asthma symptoms in children with STRA may provide additional strategies for improving their disease control. Avoidance strategies may be possible. Additional monoclonal antibody therapy with Omalizumab or Mepolizumab may be helpful in children with clinically important polysensitization.
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Affiliation(s)
- Katie Bonner
- Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK.,Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
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Lam SC, Yeung CCY, Chan JHM, Lam DWC, Lam AHY, Annesi-Maesano I, Bousquet J. Adaptation of the Score for Allergic Rhinitis in the Chinese Population: Psychometric Properties and Diagnostic Accuracy. Int Arch Allergy Immunol 2017; 173:213-224. [DOI: 10.1159/000477727] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/23/2017] [Indexed: 12/27/2022] Open
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Amaral R, Carneiro AC, Wandalsen G, Fonseca JA, Sole D. Control of Allergic Rhinitis and Asthma Test for Children (CARATKids): Validation in Brazil and cutoff values. Ann Allergy Asthma Immunol 2017; 118:551-556.e2. [PMID: 28366584 DOI: 10.1016/j.anai.2017.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/16/2017] [Accepted: 02/13/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) assesses asthma and allergic rhinitis control in children younger than 12 years. OBJECTIVE To validate the Brazilian Portuguese version of the CARATKids and to define the cutoff values for identifying uncontrolled disease. METHODS Children aged 6 to 12 years with asthma and allergic rhinitis were studied (n = 102). CARATKids, childhood Asthma Control Test (cACT), total nasal symptom score (TNSS), and visual analog scale (VAS) scores were obtained at baseline and after 4 to 6 weeks. Internal consistency, test-retest reliability, responsiveness, and validity of the Brazilian CARATKids were assessed according to the Consensus-based Standards for the Selection of Health Measurements Instruments checklist. The minimal clinically important difference (MCID) was evaluated using distribution and anchor methods. Spearman correlations were used to compare CARATKids scores with external measures of control. Receiver operating characteristic curve analysis was performed to establish cutoff values. RESULTS Fifty children completed both visits. The Cronbach α and intraclass correlation coefficient of CARATKids were 0.81 and 0.85, respectively. The Guyatt responsiveness index was -1.34, and within-patient change in clinically unstable patients (n = 31) was significant (P = .02). As for cross-sectional and longitudinal validity, correlation coefficients ranged from 0.58 to 0.77 (P < .001) and 0.30 to 0.57 (P < .05), respectively. The estimated MCID for CARATKids was 3. The optimal cutoffs (sensitivity and specificity) to exclude uncontrolled and controlled disease were 3 or less (97% and 67%) and 6 or greater (56% and 96%), respectively. CONCLUSION CARATKids is a reliable and valid tool to assess asthma and allergic rhinitis control in Brazilian children. A score of 6 or higher on CARATKids identifies uncontrolled disease, and a score of 3 or lower excludes poor disease control.
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Affiliation(s)
- Rita Amaral
- Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal; Allergy Unit, CUF Porto Institute and Hospital, Porto, Portugal
| | - Ana C Carneiro
- Federal University of São Paulo, São Paulo, Brazil; Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Gustavo Wandalsen
- Federal University of São Paulo, São Paulo, Brazil; Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - João A Fonseca
- Centre for Research in Health Technologies and Information Systems, Faculty of Medicine, University of Porto, Porto, Portugal; Allergy Unit, CUF Porto Institute and Hospital, Porto, Portugal.
| | - Dirceu Sole
- Federal University of São Paulo, São Paulo, Brazil; Escola Paulista de Medicina, São Paulo, SP, Brazil
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Lee E, Lee SH, Kim YH, Cho HJ, Yoon J, Yang SI, Jung YH, Kim HY, Seo JH, Kwon JW, Kim HB, Lee SY, Kwon HJ, Hong SJ. Association of atopy phenotypes with new development of asthma and bronchial hyperresponsiveness in school-aged children. Ann Allergy Asthma Immunol 2017; 118:542-550.e1. [PMID: 28364972 DOI: 10.1016/j.anai.2017.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/20/2016] [Accepted: 02/13/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although previous studies have investigated the association between atopy phenotypes and allergic diseases, atopy characterizations in association with the development of allergic diseases remain poorly understood. OBJECTIVE To identify atopy phenotypes in school-age children and to evaluate the association between atopy phenotypes and allergic diseases. METHODS We enrolled 616 children with atopy defined as 1 or more positive allergen responses on skin prick tests and 665 children without atopy from the Children's Health and Environmental Research (CHEER) study. All children were followed up for 4 years at 2-year intervals. Atopy phenotypes were classified using latent class analysis. RESULTS Four atopy phenotypes were characterized: later sensitization to indoor allergens (cluster 1); multiple early sensitization (cluster 2); early sensitization to outdoor allergens, especially Alternaria, and later sensitization to indoor allergens, including Aspergillus (cluster 3); and early sensitization to indoor allergens and later sensitization to outdoor allergens (cluster 4). New cases of asthma during follow-up were increased in clusters 2 and 3 (adjusted odds ratio [aOR], 2.76 and 4.25, respectively). The risk of new-onset bronchial hyperresponsiveness was highest in cluster 3 (aOR, 5.03). Clusters 2 and 4 had an increased risk of allergic rhinitis (aOR, 7.21 and 2.37, respectively). CONCLUSION Identification of atopy phenotypes facilitates prediction of the development of asthma and bronchial hyperresponsiveness in school-age children. Our study suggests prevention of additional sensitization is required to modify the progression of allergic diseases.
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Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Gwangju, Korea
| | - Si Hyeon Lee
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Sonapa-gu, Seoul, Korea
| | - Young-Ho Kim
- Department of Pediatrics, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Hyun-Ju Cho
- Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Sonapa-gu, Seoul, Korea
| | - Jisun Yoon
- Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Sonapa-gu, Seoul, Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Young-Ho Jung
- Department of Pediatrics, CHA University School of Medicine, Seongnam, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - So Yeon Lee
- Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Sonapa-gu, Seoul, Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Sonapa-gu, Seoul, Korea.
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Nemati S, Jafari Shakib R, Shakiba M, Araghi N, Azimi SZ. Allergic Rhinitis in Adults with Chronic Suppurative Otitis Media. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2015; 27:261-6. [PMID: 26788473 PMCID: PMC4710877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/15/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chronic suppurative otitis media (CSOM) is considered one of the most common causes of acquired hearing impairment in developing countries. CSOM is a multifactorial persistent inflammatory disease of the middle ear. A distinct pathophysiologic mechanism linking allergic rhinitis (AR) and CSOM remains to evolve. The purpose of this study was to investigate the association between AR and CSOM in adults.This was a case-control study. MATERIALS AND METHODS The subjects were 62 adults (23 male, 39 female) with established CSOM and 61 healthy controls. CSOM was diagnosed when there was a history of chronic (persisting for at least 3 months) otorrhea, accumulation of mucopurulent exudates in the external auditory canal or middle ear and/or perforated tympanic membrane on otoscopy. All participants were evaluated for the presence of AR by clinical evaluation of allergic symptoms, and underwent a skin-prick test for 23 common regional allergens. Statistical analysis was performed using SPSS version 16. RESULTS The prevalence of clinical rhinitis (allergic and non-allergic) was significantly higher among the cases compared with controls (62.5% vs. 37.5%, P=0.02). The prevalence of AR (proven by positive skin-prick test) was also significantly higher among affected adults than controls (24.6% and 13.8%, respectively). Adjusting for age, a logistic regression model showed that there was a significant difference between the two groups. Patients with AR and non-AR were at 3.27- (95% CI=1.15-9.29; P=0.036) and 2.57-(95% CI=1.01-6.57; P=0.048) fold increased risk of developing CSOM, respectively, compared with healthy individuals. CONCLUSION The study showed a higher prevalence of AR in CSOM patients than in controls. It may be valuable to evaluate and control this factor in these patients.
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Affiliation(s)
- Shadman Nemati
- Sinonasal Diseases Research Centre, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Reza Jafari Shakib
- Department of Immunology, Faculty of Medicine, Guilan University of Medical Sciences, Rasht, Iran.
| | - Maryam Shakiba
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of medical Sciences, Tehran, Iran.
| | - Nematollah Araghi
- Department of Otolaryngology, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Seyyede Zeinab Azimi
- Sinonasal Diseases Research Centre, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
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