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Sangchan T, Koosakulchai V, Sangsupawanich P, Srisuk B, Yuenyongviwat A. Trends of aeroallergen sensitization among children with respiratory allergy in Southern Thailand. Asia Pac Allergy 2024; 14:103-107. [PMID: 39220568 PMCID: PMC11365656 DOI: 10.5415/apallergy.0000000000000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background Respiratory allergy significantly impacts children's health and quality of life, with inhaled allergens serving as prevalent triggers for respiratory symptoms. Aeroallergen sensitization, confirmed through the skin prick test (SPT), naturally evolves over time and is influenced by environmental factors specific to each region. Objective This study aimed to review the updated 6-year trend of aeroallergen sensitization among children with asthma and allergic rhinitis in Southern Thailand. Methods This retrospective study involved a review of patients aged ≤15 years diagnosed with asthma and/or allergic rhinitis, who underwent the SPT using 12 standardized aeroallergens. Results The medical records of 1,393 children were reviewed, with 63% being male, and the mean age was 7.4 ± 3.3 years. Among them, 55.5% presented with allergic rhinitis alone, followed by 31.6% with asthma and allergic rhinitis, and 12.9% with asthma alone. Over the 6-year period, house dust mites emerged as the most common sensitized allergen, followed closely by cockroaches, maintaining a consistent trend of sensitization. Dermatophagoides pteronyssinus ranked as the predominant sensitized allergen across all diagnoses (63% in asthma with allergic rhinitis, 52.7% in allergic rhinitis, and 43.5% in asthma). Children diagnosed with both asthma and allergic rhinitis exhibited a higher prevalence of sensitization to house dust mites, cockroaches, Johnson grass, acacia, Candida albicans, and cat pelts compared with those with asthma or allergic rhinitis alone. Additionally, the prevalence of house dust mite and cockroach sensitization was notably higher in older children (≥5 years old) with respiratory allergies. Conclusion House dust mites and cockroaches emerge as the 2 most prevalent sensitized aeroallergens among children diagnosed with asthma and/or allergic rhinitis, exhibiting consistent trends of sensitization over the past 6 years. The persistence of these causative allergens underscores the importance of meticulous environmental control measures for children affected by respiratory allergies.
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Affiliation(s)
- Taksaporn Sangchan
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Vanlaya Koosakulchai
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pasuree Sangsupawanich
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Bunrat Srisuk
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Araya Yuenyongviwat
- Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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Chaudhary F, Lee W, Escander T, Agrawal DK. Exploring the Complexities of Atopic Dermatitis: Pathophysiological Mechanisms and Therapeutic Approaches. JOURNAL OF BIOTECHNOLOGY AND BIOMEDICINE 2024; 7:314-328. [PMID: 39119011 PMCID: PMC11309089 DOI: 10.26502/jbb.2642-91280155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
Atopic dermatitis (AD) is a prevalent inflammatory skin condition impacting both children and adults globally, with a prevalence of 15-30%. It ranks as the most prevalent skin disorder based on disability-adjusted life-years by the World Health Organization. It presents with symptoms like skin irritation, redness, dryness, itchiness, and vesicular blisters and commonly coexists with other atopic symptoms like allergic rhinitis, asthma, and food allergies. The pathophysiology involves a complex interplay of genetic predispositions, immunological dysfunctions, and environmental factors leading to tissue inflammation and disrupted skin barrier integrity. Alopecia areata is characterized by nonscarring hair loss and shares correlations with AD including a higher prevalence of atopic diseases, shared intracellular mechanisms involving the JAK-STAT pathway, and potential treatment overlap such as dupilumab. These correlations could direct new areas of research and increased insight for both diseases. Treatment of AD requires a personalized approach due to its complex, multifactorial nature integrating nonpharmacological interventions like skin hydration and trigger avoidance as well as topical and systemic approaches, if necessary, with topical corticosteroids being the first line for flares; long term corticosteroid use poses risk for adverse effects like skin atrophy. Severe cases may require systemic treatments or phototherapy. Future treatment prospects include targeting the dysbiotic microbiome and identifying biomarkers for tailored therapeutic strategies, emphasizing the importance of personalized medicine in optimizing AD management.
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Affiliation(s)
- Fihr Chaudhary
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766, USA
| | - Wismmy Lee
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766, USA
| | - Tony Escander
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766, USA
| | - Devendra K Agrawal
- Department of Translational Research, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona CA 91766, USA
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3
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Swed S, Sawaf B, Al-Obeidat F, Hafez W, Rakab A, Alibrahim H, Nasif MN, Alghalyini B, Zia Zaidi AR, Alshareef L, Alqatati F, Zamrath Zahir F, Ahmed AI, Alom M, Sultan A, AlMahmoud A, Bakkour A, Cherrez-Ojeda I. Asthma prevalence among United States population insights from NHANES data analysis. Sci Rep 2024; 14:8059. [PMID: 38580691 PMCID: PMC10997649 DOI: 10.1038/s41598-024-58429-5] [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: 11/27/2023] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
Asthma is a prevalent respiratory condition that poses a substantial burden on public health in the United States. Understanding its prevalence and associated risk factors is vital for informed policymaking and public health interventions. This study aims to examine asthma prevalence and identify major risk factors in the U.S. POPULATION Our study utilized NHANES data between 1999 and 2020 to investigate asthma prevalence and associated risk factors within the U.S. POPULATION We analyzed a dataset of 64,222 participants, excluding those under 20 years old. We performed binary regression analysis to examine the relationship of demographic and health related covariates with the prevalence of asthma. The study found that asthma affected 8.7% of the U.S. POPULATION Gender emerged as a significant factor, with 36.0% of asthma patients being male and 64.0% female (p < 0.001). Individuals aged 60 and older having the highest asthma prevalence at 34.0%. Non-Hispanic whites had the highest prevalence at 46.4%, followed by non-hispanic blacks at 26.0%. In contrast, Mexican Americans and other hispanic individuals had lower rates, at 9.6% and 9.0%, respectively. Females were 1.76 times more likely to have asthma than males (p < 0.001). Obese individuals had a 1.74 times higher likelihood of current asthma compared to underweight individuals (p < 0.001). Notably, both Non-Hispanic Whites and Non-Hispanic Blacks showed higher odds of current asthma compared to Mexican Americans (with adjusted odds ratios of 2.084 and 2.096, respectively, p < 0.001). The research findings indicate that asthma is prevalent in 8.7% of the U.S. POPULATION Our study highlights that individuals who are female, have low income, are obese, and smoke have the highest likelihood of being affected by asthma. Therefore, public health policies should prioritize addressing these risk factors in their preventive strategies.
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Affiliation(s)
- Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Feras Al-Obeidat
- Associate Professor at the College of Technological Innovation at Zayed University, Abu Dhabi - Khalifa City, FF2-0-032; Abu Dhabi Campus, Abu Dhabi, UAE
| | - Wael Hafez
- NMC Royal Hospital, 16Th Street, Khalifa City, Abu Dhabi, UAE
- Assistant Professor; Internal Medicine Department, Medical Research and Clinical Studies Institute,, The National Research Centre, 33 El Buhouth St, Ad Doqi, Dokki, Cairo Governorate 12622, Cairo, Egypt
| | | | | | | | - Baraa Alghalyini
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdul Rehman Zia Zaidi
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Fadel Alqatati
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Mulham Alom
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Anas Sultan
- Department of Internal Medicine, Pulmonary Division, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Abdullah AlMahmoud
- Internal Medicine, Gastroenterology, Hepatology; Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Saudi Arabia
| | | | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
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Kim CK, Callaway Z, Park JS, Pawankar R, Fujisawa T. Biomarkers in allergen immunotherapy: Focus on eosinophilic inflammation. Asia Pac Allergy 2024; 14:32-38. [PMID: 38482456 PMCID: PMC10932480 DOI: 10.5415/apallergy.0000000000000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/20/2023] [Indexed: 11/02/2024] Open
Abstract
Asthma and allergic rhinitis (AR) are 2 of the most common chronic inflammatory disorders and they appear to be on the rise. Current pharmacotherapy effectively controls symptoms but does not alter the underlying pathophysiology. Allergen immunotherapy (AIT) is an evidence-based therapy for asthma and AR and has been recognized as the only therapeutic method that actually modifies the allergic disease process. There is a lack of objective markers that accurately and reliably reflect the therapeutic benefits of AIT. A biomarker indicating patients that would benefit most from AIT would be invaluable. Eosinophilic inflammation is a cardinal feature of many allergic diseases. Biomarkers that accurately reflect this inflammation are needed to better diagnose, treat, and monitor patients with allergic disorders. This review examines the current literature regarding AIT's effects on eosinophilic inflammation and biomarkers that may be used to determine the extent of these effects.
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Affiliation(s)
- Chang-Keun Kim
- Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Zak Callaway
- Asthma and Allergy Center, Inje University Sanggye Paik Hospital, Seoul, Korea
- Science Division, Mahidol University International College, Nakhon Pathom, Thailand
| | - Jin-Sung Park
- Department of Pediatrics, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Takao Fujisawa
- Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
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5
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Cheng DT, Wee LYJ, Teoh OH, Thomas B. Approach to difficult-to-treat asthma in childhood: a narrative review. Singapore Med J 2024:00077293-990000000-00095. [PMID: 38363652 DOI: 10.4103/singaporemedj.smj-2023-137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/02/2023] [Indexed: 02/18/2024]
Abstract
ABSTRACT Asthma is a major chronic disease affecting children, and children with difficult-to-treat asthma account for a disproportionate share of resource utilisation and healthcare costs. This review presents a comprehensive and up-to-date overview of the treatment strategies in difficult-to-treat paediatric asthma. Mimickers of asthma must first be ruled out, and the diagnosis confirmed with objective tests whenever possible. The effect of comorbid conditions such as obesity, smoking, other atopic conditions and psychosocial factors on asthma control and severity should be considered. Treatment can then be optimised by implementing personalised strategies, including the use of appropriate drug delivery devices and adherence monitoring. Biologics can be an alternative treatment option for selected patients but should not be a substitute for addressing poor adherence. Many patients with difficult-to-treat asthma may not have severe asthma, and the physician should work with patients and families to achieve good asthma control via an individualised approach.
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Affiliation(s)
- Duo-Tong Cheng
- Department of Paediatrics, Respiratory Medicine Service, KK Women's and Children's Hospital, Singapore
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6
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Olsen Y, Arildskov E, Hansen SN, Pedersen M, Dharmage SC, Kloster M, Sigsgaard T. Outdoor Alternaria and Cladosporium spores and acute asthma. Clin Exp Allergy 2023; 53:1256-1267. [PMID: 37748858 DOI: 10.1111/cea.14397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/08/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Outdoor Alternaria and Cladosporium spores are ubiquitous. Few studies have assessed their impact on asthma hospitalizations providing conflicting results, mainly focused on vulnerable paediatric populations. We aimed to study the impact of outdoor Alternaria and Cladosporium concentrations on acute hospitalizations in the Capital Region of Denmark. METHODS This is a bi-directional case-crossover study with 26 years of national registry data at individual level on acute asthma hospitalizations and daily average data on Alternaria and Cladosporium, pollen (Artemisia, Poaceae), maximal temperature, and air pollution. Conditional logistic regression models were applied to assess the associations. Concentration quartiles at lag 0 were used for categorizing the exposure. RESULTS For lags 0-2, the odds of hospitalization were significantly higher for both Alternaria and Cladosporium at concentration quartile 2-4 compared with quartile 1. When stratified for age and sex, odds of hospitalization at Alternaria quartiles 2-4 were significantly higher in males below 40 years at lag 0-2, and at lag 0 in females (18-30 years), while quartiles 2-4 of Cladosporium concentrations were associated with significantly higher odds in boys (0-17 years) at lag 1-3, males (18-39 years) at lag 0-1, females (18-39 years) at lag 1-2, males (40-64 years) at lag 0-2, females (40-64 years) at lag 0 and 2, in seniors (65+ years) male at lag 1-2 and female at lag 0-1. The effect of Alternaria varied significantly depending on the level of Cladosporium (p < .0001). CONCLUSION Ambient Alternaria and Cladosporium spores can induce asthma hospitalizations. Males are more susceptible to both genera. Males and females under age 40 years are more susceptible to Alternaria.
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Affiliation(s)
- Yulia Olsen
- Institute of Public Health & Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Elias Arildskov
- Department of Public Health - Section of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Stefan Nygaard Hansen
- Department of Public Health - Section of Biostatistics, Aarhus University, Aarhus, Denmark
| | - Marianne Pedersen
- Department of Public Health - Section of Environment, Occupation & Health, Aarhus University, Aarhus, Denmark
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | | | - Torben Sigsgaard
- Institute of Public Health & Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
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7
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Steininger H, Moltzau-Anderson J, Lynch SV. Contributions of the early-life microbiome to childhood atopy and asthma development. Semin Immunol 2023; 69:101795. [PMID: 37379671 DOI: 10.1016/j.smim.2023.101795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
The rapid rise in atopy and asthma in industrialized nations has led to the identification of early life environmental factors that promote these conditions and spurred research into how such exposures may mediate the trajectory to childhood disease development. Over the past decade, the human microbiome has emerged as a key determinant of human health. This is largely due to the increasing appreciation for the myriad of non-mutually exclusive mechanisms by which microbes tune and train host immunity. Microbiomes, particularly those in early life, are shaped by extrinsic and intrinsic factors, including many of the exposures known to influence allergy and asthma risk. This has led to the over-arching hypothesis that such exposures mediate their effect on childhood atopy and asthma by altering the functions and metabolic productivity of microbiomes that shape immune function during this critical developmental period. The capacity to study microbiomes at the genetic and molecular level in humans from the pre-natal period into childhood with well-defined clinical outcomes, offers an unprecedented opportunity to identify early-life and inter-generational determinants of atopy and asthma outcomes. Moreover, such studies provide an integrative microbiome research framework that can be applied to other chronic inflammatory conditions. This review attempts to capture key studies in the field that offer insights into the developmental origins of childhood atopy and asthma, providing novel insights into microbial mediators of maladaptive immunity and chronic inflammatory disease in childhood.
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Affiliation(s)
- Holly Steininger
- Division of Gastroenterology, University of California, San Francisco, USA; Benioff Center for Microbiome Medicine, Department of Medicine, University of California, San Francisco, USA
| | - Jacqueline Moltzau-Anderson
- Division of Gastroenterology, University of California, San Francisco, USA; Benioff Center for Microbiome Medicine, Department of Medicine, University of California, San Francisco, USA
| | - Susan V Lynch
- Division of Gastroenterology, University of California, San Francisco, USA; Benioff Center for Microbiome Medicine, Department of Medicine, University of California, San Francisco, USA.
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8
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Chang HY, Lee ZM, Chang LS, Feng WL, Yang YH, Ou-Yang MC. Perinatal Characteristics and the Sensitization to Cow Milk, Egg Whites and Wheat in Children up to 3 Years of Age. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050860. [PMID: 37238408 DOI: 10.3390/children10050860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023]
Abstract
Food sensitization in early life identifies children at risk of developing allergic diseases. We investigated the sensitization to cow milk (CM), egg whites, and wheat. Newborns and infants under 3 years of age with available specific immunoglobulin E (sIgE) data were identified. A retrospective survey was conducted using data from the Chang Gung Research Database. Perinatal characteristics, such as singleton or multiples in a single pregnancy, parity, meconium staining, maternal age, spontaneous delivery or cesarean section, meconium passage, weeks of gestation, birth length, body weight, head and chest circumferences, and season, were obtained. The data on sIgE were collected, and a logistic regression model was used to determine the odds of sensitization. Positive sIgE for CM and egg whites was more likely to occur in boys than in girls. Early-life egg white and wheat sensitization was associated with increased birth body length and weight. A multivariate analysis indicated an association between egg white sIgE positivity and logarithmic total IgE. Higher total IgE levels and younger age were associated with egg white sensitization, and elevated weight and length at birth were linked to food sensitization, particularly to egg whites and wheat.
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Affiliation(s)
- Hsin-Yu Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Zon-Min Lee
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- Department of Pharmacy, Tajen University, Pingtung 907, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Ling Feng
- The Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Yao-Hsu Yang
- Health Information and Epidemiology Laboratory, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi 613, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Mei-Chen Ou-Yang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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9
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Wang Z, He Y, Li Q, Zhao Y, Zhang G, Luo Z. Network analyses of upper and lower airway transcriptomes identify shared mechanisms among children with recurrent wheezing and school-age asthma. Front Immunol 2023; 14:1087551. [PMID: 36776870 PMCID: PMC9911682 DOI: 10.3389/fimmu.2023.1087551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/16/2023] [Indexed: 01/30/2023] Open
Abstract
Background Predicting which preschool children with recurrent wheezing (RW) will develop school-age asthma (SA) is difficult, highlighting the critical need to clarify the pathogenesis of RW and the mechanistic relationship between RW and SA. Despite shared environmental exposures and genetic determinants, RW and SA are usually studied in isolation. Based on network analysis of nasal and tracheal transcriptomes, we aimed to identify convergent transcriptomic mechanisms in RW and SA. Methods RNA-sequencing data from nasal and tracheal brushing samples were acquired from the Gene Expression Omnibus. Combined with single-cell transcriptome data, cell deconvolution was used to infer the composition of 18 cellular components within the airway. Consensus weighted gene co-expression network analysis was performed to identify consensus modules closely related to both RW and SA. Shared pathways underlying consensus modules between RW and SA were explored by enrichment analysis. Hub genes between RW and SA were identified using machine learning strategies and validated using external datasets and quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Finally, the potential value of hub genes in defining RW subsets was determined using nasal and tracheal transcriptome data. Results Co-expression network analysis revealed similarities in the transcriptional networks of RW and SA in the upper and lower airways. Cell deconvolution analysis revealed an increase in mast cell fraction but decrease in club cell fraction in both RW and SA airways compared to controls. Consensus network analysis identified two consensus modules highly associated with both RW and SA. Enrichment analysis of the two consensus modules indicated that fatty acid metabolism-related pathways were shared key signals between RW and SA. Furthermore, machine learning strategies identified five hub genes, i.e., CST1, CST2, CST4, POSTN, and NRTK2, with the up-regulated hub genes in RW and SA validated using three independent external datasets and qRT-PCR. The gene signatures of the five hub genes could potentially be used to determine type 2 (T2)-high and T2-low subsets in preschoolers with RW. Conclusions These findings improve our understanding of the molecular pathogenesis of RW and provide a rationale for future exploration of the mechanistic relationship between RW and SA.
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Affiliation(s)
- Zhili Wang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yu He
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qinyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yan Zhao
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Guangli Zhang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
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10
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Shibata R, Fujiogi M, Nanishi M, Ooka T, Mansbach JM, Teach SJ, Hasegawa K, Camargo CA. Total immunoglobulin E in infant bronchiolitis and risk of developing asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2761-2763.e2. [PMID: 35803539 DOI: 10.1016/j.jaip.2022.06.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/07/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Ryohei Shibata
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
| | - Michimasa Fujiogi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Makiko Nanishi
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Tadao Ooka
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Health Science, University of Yamanashi, Chuo, Yamanashi, Japan
| | - Jonathan M Mansbach
- Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Stephen J Teach
- Division of Emergency Medicine, Children's National Hospital, Washington, DC
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
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11
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Ghosalkar S, Singh P, Ravikumar P. Emerging topical drug delivery approaches for the treatment of Atopic dermatitis. J Cosmet Dermatol 2021; 21:536-549. [PMID: 34935274 DOI: 10.1111/jocd.14685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/15/2021] [Accepted: 12/01/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Atopic dermatitis is a chronic, relapsing skin inflammation disease that generally affects 20% of children and 1-3% of adults. It is characterized by pruritus, inflammatory skin lesions, and skin barrier defect. The pillar treatment is topical therapies that have shown great adherence and incredible results in alleviating symptoms of atopic dermatitis. Topical corticosteroids and calcineurin inhibitors have shown improvement in the symptoms of atopic dermatitis but have certain side effects. There is need to develop new therapies or novel drug delivery approaches which can overcome drawbacks of the conventional formulation and increase the therapeutic efficacy. AIM The scope of this review is to describe the new topical therapies including phosphodiesterase inhibitors, Janus kinase inhibitors, and nano-formulations such as nanoemulsion, polymeric and lipid nanoparticles, vesicular system, and micelles. METHODS The article reviews and discusses the published literature of the topical drug delivery approaches for treatment of Atopic dermatitis. RESULTS The reported literature highlighted the benefits of novel topical formulations exhibiting targeted drug delivery, better penetration, enhanced therapeutic efficacy, and overcome systemic side effects. CONCLUSION Literature indicated that the new therapies and novel drug delivery approaches found to be the therapeutically more effective in increasing the efficacy of drugs and reducing the side effects in comparison with the conventional treatments for Atopic dermatitis. This has provided a way to modify and develop more such formulations for dermal delivery.
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Affiliation(s)
- Shruti Ghosalkar
- Department of Pharmaceutics, SVKM's Dr Bhanuben Nanavati College of Pharmacy, Vile Parle (W), Mumbai, 400056, India
| | - Prabha Singh
- Department of Pharmaceutics, SVKM's Dr Bhanuben Nanavati College of Pharmacy, Vile Parle (W), Mumbai, 400056, India
| | - Padmini Ravikumar
- Department of Pharmaceutics, SVKM's Dr Bhanuben Nanavati College of Pharmacy, Vile Parle (W), Mumbai, 400056, India
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Kumar M, Gupta RK, Kumar R, Spalgais S, Mavi AK, Singh K. Cockroach exposure and its allergy sensitization in asthma patients. Monaldi Arch Chest Dis 2021; 91. [PMID: 33985325 DOI: 10.4081/monaldi.2021.1685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
Asthma is a heterogeneous disease with distinct phenotypes. Serum tIgE, SSIgE and SPT are the methods of evaluating allergen sensitization. The present study evaluates the exposure and sensitization to cockroach (Periplaneta americana) antigens in asthma patients in a metropolitan city of India. The study enrolled 200 consecutive bronchial asthma patients, diagnosed as per GINA guidelines. As per history of exposure to cockroaches, the patients are divided in two groups as exposed and non-exposed asthmatic. All the enrolled subjects underwent SPT against common aeroallergens including cockroach, spirometry and estimation of tIgE level and SSIgE against cockroach. Out of 200 asthma patients, a total of 114 (57%) asthmatic were found SPT positive against one of the common aeroallergens, of which 68 (34%) showed SPT sensitivity against cockroach. A total of 103 (51.5%) patients were found exposed to cockroaches. In the cockroach exposed group, the mean serum tIgE was found significantly higher than the non-exposed group (569.31±224.64 vs 479.29±237 IU/ml; p=0.007). The mean SSIgE against cockroach in exposed groups was found not significant than non-expose group (4.87±11.19 vs 4.11±8.39 KUA/L; p=0.589). The mean tIgE was also not significant in atopic compared to non-atopic asthmatic (553.25±218.12 IU/ml vs 489.1±251.16 IU/ml; p=0.056). The mean SSIgE against cockroach was 5.66±10.45 KUA/L for atopic and 2.96±8.98 KUA/L for non-atopic (p=0.054). The airway obstruction was almost the same in both groups. Asthmatic patients who were exposed to cockroach and atopic had high tIgE, SSIgE levels and SPT positivity against cockroach antigen compared to non-exposed patients.
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Affiliation(s)
- Manoj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Rajesh Kumar Gupta
- Department of Applied Chemistry, School of Vocational Studies and Applied Sciences, Gautam Buddha University, Greater Noida U.P.
| | - Raj Kumar
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Sonam Spalgais
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Anil Kumar Mavi
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
| | - Kamal Singh
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi.
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Vu K, Lou W, Tun HM, Konya TB, Morales-Lizcano N, Chari RS, Field CJ, Guttman DS, Mandal R, Wishart DS, Azad MB, Becker AB, Mandhane PJ, Moraes TJ, Lefebvre DL, Sears MR, Turvey SE, Subbarao P, Scott JA, Kozyrskyj AL. From Birth to Overweight and Atopic Disease: Multiple and Common Pathways of the Infant Gut Microbiome. Gastroenterology 2021; 160:128-144.e10. [PMID: 32946900 DOI: 10.1053/j.gastro.2020.08.053] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/23/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Few studies, even those with cohort designs, test the mediating effects of infant gut microbes and metabolites on the onset of disease. We undertook such a study. METHODS Using structural equation modeling path analysis, we tested directional relationships between first pregnancy, birth mode, prolonged labor and breastfeeding; infant gut microbiota, metabolites, and IgA; and childhood body mass index and atopy in 1667 infants. RESULTS After both cesarean birth and prolonged labor with a first pregnancy, a higher Enterobacteriaceae/Bacteroidaceae ratio at 3 months was the dominant path to overweight; higher Enterobacteriaceae/Bacteroidaceae ratios and Clostridioides difficile colonization at 12 months were the main pathway to atopic sensitization. Depletion of Bifidobacterium after prolonged labor was a secondary pathway to overweight. Influenced by C difficile colonization at 3 months, metabolites propionate and formate were secondary pathways to child outcomes, with a key finding that formate was at the intersection of several paths. CONCLUSIONS Pathways from cesarean section and first pregnancy to child overweight and atopy share many common mediators of the infant gut microbiome, notably C difficile colonization.
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Affiliation(s)
- Khanh Vu
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hein M Tun
- School of Public Health, University of Hong Kong, Hong Kong
| | - Theodore B Konya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Radha S Chari
- Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - David S Guttman
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, Ontario, Canada
| | - Rupasri Mandal
- The Metabolomics Innovation Centre, Edmonton, Alberta, Canada
| | - David S Wishart
- The Metabolomics Innovation Centre, Edmonton, Alberta, Canada
| | - Meghan B Azad
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allan B Becker
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Piush J Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Theo J Moraes
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Diana L Lefebvre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Malcolm R Sears
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Stuart E Turvey
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Padmaja Subbarao
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - James A Scott
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Anita L Kozyrskyj
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Obstetrics and Gynecology, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis. J Clin Med 2020; 9:jcm9124009. [PMID: 33322440 PMCID: PMC7764222 DOI: 10.3390/jcm9124009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 12/28/2022] Open
Abstract
Bronchiectasis and asthma may share some characteristics and some patients may have both conditions. The present study aimed to examine the rationale of prophylactic inhaled corticosteroids (ICS) prescription in children with bronchiectasis. Data of children with radiologically established bronchiectasis were retrospectively reviewed. Episodes of dyspnea and wheezing, spirometric indices, total serum IgE, blood eosinophil counts, sensitization to aeroallergens, and air-trapping on expiratory CT scans, were recorded. The study included 65 children 1.5–16 years old, with non-CF bronchiectasis. Episodes of dyspnea or wheezing were reported by 22 (33.8%) and 23 (35.4%), respectively. Skin prick tests to aeroallergens (SPTs) were positive in 15 (23.0%) patients. Mosaic pattern on CT scans was observed in 37 (56.9%) patients. Dyspnea, presence of mosaic pattern, positive reversibility test, and positive SPTs were significantly correlated with the prescription of ICS. The prescription of ICS in children with bronchiectasis is more likely when there are certain asthma-like characteristics. The difficulty to set the diagnosis of real asthma in cases of bronchiectasis may justify the decision of clinicians to start an empirical trial with ICS in certain cases.
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15
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Drago G, Ruggieri S, Cuttitta G, La Grutta S, Ferrante G, Cibella F. Determinants of Allergic Sensitization, Asthma and Lung Function: Results from a Cross-Sectional Study in Italian Schoolchildren. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145087. [PMID: 32674528 PMCID: PMC7400051 DOI: 10.3390/ijerph17145087] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 12/13/2022]
Abstract
Prenatal smoking exposure and early-life respiratory infections are major determinants of asthma during childhood. We investigate the factors influencing allergic sensitization (AS), asthma, and lung function in children and the balance between individual and environmental characteristics at different life stages. 1714 children aged 7–16 years and living in southern Italy were investigated using a parental questionnaire, skin prick tests, and spirometry. We found 41.0% AS prevalence: among children without parental history of asthma, male sex, maternal smoking during pregnancy (MatSmoke), and acute respiratory diseases in the first two years of life (ARD2Y) were significant risk factors for AS. MatSmoke was associated (OR = 1.79) with ARD2Y, and this association was influenced by sex. ARD2Y was, in turn, a significant risk factor (OR = 8.53) for childhood current asthma, along with AS (OR up to 3.03) and rhinoconjuctivitis (OR = 3.59). Forced mid-expiratory flow (FEF25–75%) was negatively affected by ARD2Y, with a sex-related effect. Thus, males exposed to MatSmoke had significantly lower FEF25–75% than unexposed males. Despite the difficulty of discriminating among the complex interactions underlying the development of allergic respiratory diseases, ARD2Y appears to strongly influence both asthma and lung function during childhood. In turn, ARD2Y is influenced by prenatal exposure to tobacco smoke with a sex-dependent effect.
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Affiliation(s)
- Gaspare Drago
- National Research Council of Italy, Institute for Biomedical Research and Innovation, 90146 Palermo, Italy; (G.D.); (S.R.); (G.C.); (S.L.G.)
| | - Silvia Ruggieri
- National Research Council of Italy, Institute for Biomedical Research and Innovation, 90146 Palermo, Italy; (G.D.); (S.R.); (G.C.); (S.L.G.)
| | - Giuseppina Cuttitta
- National Research Council of Italy, Institute for Biomedical Research and Innovation, 90146 Palermo, Italy; (G.D.); (S.R.); (G.C.); (S.L.G.)
| | - Stefania La Grutta
- National Research Council of Italy, Institute for Biomedical Research and Innovation, 90146 Palermo, Italy; (G.D.); (S.R.); (G.C.); (S.L.G.)
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy;
| | - Fabio Cibella
- National Research Council of Italy, Institute for Biomedical Research and Innovation, 90146 Palermo, Italy; (G.D.); (S.R.); (G.C.); (S.L.G.)
- Correspondence:
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16
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Nyambuya TM, Dludla PV, Mxinwa V, Nkambule BB. Obesity-related asthma in children is characterized by T-helper 1 rather than T-helper 2 immune response: A meta-analysis. Ann Allergy Asthma Immunol 2020; 125:425-432.e4. [PMID: 32561508 DOI: 10.1016/j.anai.2020.06.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Asthma is a chronic inflammatory condition characterized by T-helper (TH) 2 polarization. In children, the prevalence of obesity is associated with an increased incidence of asthma. Notably, obesity is linked with TH1-mediated inflammation and has been identified as a major risk factor for asthma. OBJECTIVE To investigate the impact of obesity on TH1 (tumor necrosis factor α, interferon gamma, interleukin (IL)-6, IL-8) and TH2 (IL-4, IL-5, IL-10, IL-13) immune responses in children with asthma. METHODS We searched the MEDLINE and gray literature electronic databases for eligible studies from inception up until April 2020. The quality of included studies and evidence was independently assessed by 2 reviewers. The random-effects model was used in this meta-analysis, and outcomes were reported as standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS Overall, 5 studies comprising 482 participants met the inclusion criteria. The meta-analysis revealed an increased TH2-mediated immune response in lean people with asthma compared with controls without asthma (SMD: -1.15 [95% CI: -1.93, 0.36]; I2 = 93%; pH < .001). However, in obese people with asthma, there was polarization toward TH1 immune response compared with lean people with asthma (SMD: -0.43 [95% CI: -0.79, -0.08]; I2 = 88%, pH < .001). CONCLUSION This meta-analysis reveals that there are differences in immune responses mediated by T-helper cells in lean and obese children with asthma. Moreover, and not unique to asthma, obesity polarizes the immune response toward TH1 rather than the classical TH2. This could be an important aspect to understand to establish effective therapeutic targets for obese children with asthma.
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Affiliation(s)
- Tawanda Maurice Nyambuya
- School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Department of Health Sciences, Faculty of Health and Applied Sciences, Namibia University of Science and Technology, Windhoek, Namibia.
| | - Phiwayinkosi Vusi Dludla
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona, Italy; Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg, South Africa
| | - Vuyolwethu Mxinwa
- School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Bongani Brian Nkambule
- School of Laboratory Medicine and Medical Sciences (SLMMS), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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17
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Miao Q, Xiang L, Guan H, Liu Y, Li Z, Ren Y, Xu W. Factors related to disagreement between self-reported versus objective measurement of allergen sensitization at a tertiary pediatric center in Beijing, China. BMC Pediatr 2020; 20:259. [PMID: 32466755 PMCID: PMC7254731 DOI: 10.1186/s12887-020-02148-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 05/14/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The objectives of present study were to examine the level of disagreement between self-reported and objective measurement of sensitization to common inhalant allergens, and to explore the potential risk factors that might contribute to this discrepancy. METHODS A total of 215 children were enrolled from pediatric clinics at a tertiary pediatric center in Beijing, China. A survey questionnaires regarding self-perceived sensitization was completed by participants' parents/caregiver, meanwhile, skin prick testing(SPT) was performed as objective assessment of sensitization. Extent of agreement between self-reported versus SPT-measured sensitization to individual allergen was calculated using Cohen's kappa (κ) coefficient. Multivariable regression analyses were used to determine the factors associated with discrepancy between self-reported and objective measurement of sensitization. RESULTS 119(55.3%) patients have reported to be sensitized to at least one of inhalant allergen, whereas 167(77.7%) patients had a positive skin testing response. Agreement between self-perceived and actual aeroallergen sensitization was moderate for mites(κ = 0.518) and grass pollen mix(κ = 0.451), moreover, fair agreement was observed for mold(κ = 0.316) and cockroach(κ = 0.297), respectively. There was a least agreement between perceived and actual sensitization observed for pet dander, with a kappa coefficient of 0.005. Subjects' age, atopy history, ownership of pet may increase the risk of disagreement, moreover, background factors of informant, like: age, education level, and the relationship with enrolled subjects, were linked to the incidence of disagreement between self-reported sensitization in comparison with SPT results. CONCLUSION Questionnaire-based self-assessment is easy way to collect clinical information on allergen sensitization; however, the accuracy of questionnaire-derived information is more likely to be influenced by respondent's background factors. The information from the questionnaire report is considered to be more reliable when in combination with objective assessment of sensitization, including blood IgE testing and SPT.
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Affiliation(s)
- Qing Miao
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China.
| | - Li Xiang
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China.
| | - Hui Guan
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
| | - Yongge Liu
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
| | - Zhen Li
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
| | - Yixin Ren
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
| | - Wei Xu
- Department of Allergy, Beijng Children's Hospital, Capital Medical Univeristy, National Center for Children's Health, Beijing, 100045, People's Republic of China
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Anthracopoulos MB, Everard ML. Asthma: A Loss of Post-natal Homeostatic Control of Airways Smooth Muscle With Regression Toward a Pre-natal State. Front Pediatr 2020; 8:95. [PMID: 32373557 PMCID: PMC7176812 DOI: 10.3389/fped.2020.00095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/24/2020] [Indexed: 12/20/2022] Open
Abstract
The defining feature of asthma is loss of normal post-natal homeostatic control of airways smooth muscle (ASM). This is the key feature that distinguishes asthma from all other forms of respiratory disease. Failure to focus on impaired ASM homeostasis largely explains our failure to find a cure and contributes to the widespread excessive morbidity associated with the condition despite the presence of effective therapies. The mechanisms responsible for destabilizing the normal tight control of ASM and hence airways caliber in post-natal life are unknown but it is clear that atopic inflammation is neither necessary nor sufficient. Loss of homeostasis results in excessive ASM contraction which, in those with poor control, is manifest by variations in airflow resistance over short periods of time. During viral exacerbations, the ability to respond to bronchodilators is partially or almost completely lost, resulting in ASM being "locked down" in a contracted state. Corticosteroids appear to restore normal or near normal homeostasis in those with poor control and restore bronchodilator responsiveness during exacerbations. The mechanism of action of corticosteroids is unknown and the assumption that their action is solely due to "anti-inflammatory" effects needs to be challenged. ASM, in evolutionary terms, dates to the earliest land dwelling creatures that required muscle to empty primitive lungs. ASM appears very early in embryonic development and active peristalsis is essential for the formation of the lungs. However, in post-natal life its only role appears to be to maintain airways in a configuration that minimizes resistance to airflow and dead space. In health, significant constriction is actively prevented, presumably through classic negative feedback loops. Disruption of this robust homeostatic control can develop at any age and results in asthma. In order to develop a cure, we need to move from our current focus on immunology and inflammatory pathways to work that will lead to an understanding of the mechanisms that contribute to ASM stability in health and how this is disrupted to cause asthma. This requires a radical change in the focus of most of "asthma research."
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Affiliation(s)
| | - Mark L. Everard
- Division of Paediatrics & Child Health, Perth Children's Hospital, University of Western Australia, Perth, WA, Australia
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19
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Prevention of Allergic Asthma with Allergen Avoidance Measures and the Role of Exposome. Curr Allergy Asthma Rep 2020; 20:8. [PMID: 32103354 DOI: 10.1007/s11882-020-0901-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW It is well known that combination of sensitization and exposure to inhaled environmental allergens is related to both the development and elicitation of symptoms of asthma and that avoidance of allergens would exert beneficial effects in the prevention and control of the disease. Other important factors include the relevance of other allergens, exposure to sensitizing agents also outside patient's home, exposure to irritants (like chemical air pollutants), and the involvement of the patient with a correct education. It is also likely that clinical phase of allergic airway disease and the degree of airways remodeling represent relevant factors for the clinical outcome of allergen avoidance procedure. We reviewed existing evidence on prevention of asthma through allergen avoidance. RECENT FINDINGS The management of respiratory allergy is a complex strategy (including prevention, drugs, immunological, and educational interventions). In addition, it is difficult in real life to distinguish the efficacy of single interventions. However, a combined strategy is likely to produce clinical results. A combined strategy is likely to produce satisfactory management of asthma. Allergens are an important trigger factor for the development of symptoms of respiratory allergy, and avoidance measures are able to reduce allergen levels. It is likely that clinical phase of allergic airway disease and the degree of airways remodeling represents relevant factors for the clinical outcome of allergen avoidance procedures. Considering the management of respiratory allergy is a complex strategy; it is difficult in real life to distinguish the efficacy of single interventions. However, further studies better quantifying the effects of allergens are needed.
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Oluwole O, Rennie DC, Afanasieva A, Lawson JA. Personal and early life factors associated with new-onset asthma, remission, and persistence of asthma in a 2-year follow-up of schoolchildren. J Asthma 2020; 58:488-496. [PMID: 31906746 DOI: 10.1080/02770903.2019.1709865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The natural course of childhood asthma, after its onset, is characterized by periods of persistence, relapse and remission. To investigate personal and early life factors associated with new-onset asthma, persistence and remission among children. METHODS The study was conducted in the province of Saskatchewan, Canada. Children in grades Kindergarten to Grade 8 (ages 5-14 years) participated in a cross-sectional study in 2013. In 2015, we approached those who gave consent in 2013 to be re-contacted, creating a prospective cohort. Data were collected using questionnaires in both years. Participants in 2013 who also had data in 2015 (25%: n = 324/1,348) had their asthma status reclassified and longitudinal descriptors were applied: "no asthma", "new-onset asthma", "persistent" or "remission". Personal and early life factors associations with asthma outcomes in 2015 were evaluated. RESULTS Among those without asthma in 2013 (n = 245), the incidence of new-onset asthma in 2015 was 7.2%. Among those with asthma in 2013 (n = 79), 47.1% had remission and 52.9% had persistent asthma in 2015. Parental history of asthma (adjusted odds ratio (aOR): 4.99; 95% confidence interval (CI): 1.88-28.27), early life respiratory infection (aOR: 1.92; 95%CI: 1.47-7.88), early life allergy [aOR: 6.39; 95%CI: 1.34-30.58) and early life infection (aOR: 4.99; 95%CI: 1.19-20.93) were associated with new onset asthma. Similarly, while parental history of asthma (aOR: 1.13; 95%CI: 0.29-4.34), early life respiratory infection (aOR: 2.71; 95%CI: 0.70-10.45), and early life ear infection (aOR: 1.34; 95%CI: 0.36-5.05) were also positively association with persistent asthma, the associations were not statistically significant. CONCLUSION Parental history of asthma, early life respiratory infection and allergy might not only influence the onset of childhood asthma but also be associated with asthma persistence.
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Affiliation(s)
- Oluwafemi Oluwole
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Donna C Rennie
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anna Afanasieva
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Joshua A Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.,Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Toppila‐Salmi S, Chanoine S, Karjalainen J, Pekkanen J, Bousquet J, Siroux V. Risk of adult-onset asthma increases with the number of allergic multimorbidities and decreases with age. Allergy 2019; 74:2406-2416. [PMID: 31269237 DOI: 10.1111/all.13971] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/14/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim was to study the association between allergic multimorbidity and adult-onset asthma considering the number of allergic diseases and the age effect. METHODS We used population-based data from Finnish national registers including 1205 adults over 30 years of age with recently diagnosed asthma (age range: 30-93), matched for gender, age, and living region with one or two controls (n = 2050). Allergic rhinitis (AR), allergic conjunctivitis (AC), and allergic dermatitis (AD) were defined from self-completed questionnaire. Conditional logistic regression adjusted on potential confounders (smoking, growing in countryside, childhood hospitalized infection/pneumonia, parental asthma/allergy, parental smoking, education level, professional training, number of siblings, and birth order) was applied to estimate the asthma risk associated with allergic multimorbidity. RESULTS A total of 1118 cases with asthma and 1772 matched controls were included [mean (SD, min-max) 53 (11, 31-71) years, 37% men)]. AR, AC, and AD were reported by 50.2%, 39.6%, and 33.8%, respectively, among subjects with asthma and 26.1%, 20.0%, and 23.5%, respectively, among controls. Compared to nonatopics, adult-onset asthma increased with the number of allergic diseases; adjusted OR for asthma [95% CI] associated with 1, 2, and 3 allergic diseases was 1.95 [1.52-2.49], 2.87 [2.19-3.77], and 4.26 [3.07-5.90], respectively. The association between adult-onset asthma and ≥ 1 allergic multimorbidity decreased with increasing age (3.52 [2.51-4.94], 2.44 [1.74-3.42], and 1.68 [1.04-2.71]) in subjects < 50 years, 50-62 years, and > 62 years, respectively (p for age*≥1 allergic multimorbidity interaction, 0.002). CONCLUSIONS Adult-onset asthma was positively associated with the number of allergic diseases, and this association decreases with age.
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Affiliation(s)
- Sanna Toppila‐Salmi
- Haartman Institute, Medicum University of Helsinki Helsinki Finland
- Skin and Allergy Hospital Helsinki University Hospital and University of Helsinki Helsinki Finland
| | - Sebastien Chanoine
- Institute for Advanced Biosciences UGA / Inserm U 1209 / CNRS UMR 5309 Joint Research Center Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health La Tronche France
- Pôle Pharmacie CHU Grenoble Alpes Grenoble France
- Université Grenoble Alpes Grenoble France
| | | | - Juha Pekkanen
- Department of Public Health University of Helsinki Helsinki Finland
- Environmental Health National Institute for Health and Welfare Kuopio Finland
| | - Jean Bousquet
- Fondation FMC VIA‐LR & MACVIA‐France Montpellier France
- INSERM U 1168 VIMA: Ageing and chronic Diseases Epidemiological and Public Health Approaches Villejuif France
- UMR‐S 1168 Université Versailles St‐Quentin‐en‐Yvelines Montigny le Bretonneux France
- Euforea Brussels Belgium
| | - Valérie Siroux
- Institute for Advanced Biosciences UGA / Inserm U 1209 / CNRS UMR 5309 Joint Research Center Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health La Tronche France
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Schulten V, Frazier A, Calatroni A, Kattan M, Bacharier LB, O'Connor GT, Sandel MT, Wood RA, Wheatley LM, Togias A, Visness CM, Dresen A, Gern JE, Sette A. The association of allergic sensitization patterns in early childhood with disease manifestations and immunological reactivity at 10 years of age. Clin Exp Allergy 2019; 49:1087-1094. [PMID: 31046157 DOI: 10.1111/cea.13406] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/01/2019] [Accepted: 04/14/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Allergy to German cockroach (CR) is common in urban environments and is an important allergen in children with asthma. OBJECTIVE We hypothesize that the evolution of allergic sensitization and clinical disease is associated with distinct patterns of allergen-specific T cell reactivity. To test this hypothesis, a subset of high-risk inner-city children participating in the URECA (Urban Environment and Childhood Asthma) birth cohort were selected to evaluate CR-specific T cell reactivity from three distinct groups based on acquisition of aeroallergen sensitivity from ages 2 to 10: low atopy with minimal to no sensitivity (n = 26), early-onset allergic sensitization (n = 25) and late-onset allergic sensitization (n = 25). METHODS Using pools of previously identified CR-derived T cell epitopes, we characterized the allergen-specific T cell response in these 76 subjects from blood samples obtained at age 10. CR-specific production of IL-5, IFNγ and IL-10 was measured by ELISPOT following two-week in vitro culture with CR extract. RESULTS T cell responses were significantly higher in the early-onset atopy group compared to low atopy (P = 0.01), and a trend for higher cytokine production in the late onset compared to the low atopy cohort was also observed (P = 0.06). T cell responses were similar between early- and late-onset cohorts. Furthermore, a comparison of T cell reactivity between asthmatic and non-asthmatic individuals revealed significantly higher cytokine production in asthmatics compared to non-asthmatics (P = 0.02) within both the CR-allergic and non-allergic cohorts. CONCLUSIONS AND CLINICAL RELEVANCE In conclusion, the present study reports that higher T cell reactivity is associated with allergen sensitization and asthma. Interestingly, no significant difference in T cell reactivity was observed in allergic children with early-onset versus late-onset atopy.
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Affiliation(s)
| | - April Frazier
- La Jolla Institute for Immunology, La Jolla, California
| | | | - Meyer Kattan
- Department of Pediatrics, Columbia University, New York, New York
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - George T O'Connor
- Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Megan T Sandel
- Department of Pediatrics, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts
| | - Robert A Wood
- Department of Pediatrics, John Hopkins University Medical Center, Baltimore, Maryland
| | - Lisa M Wheatley
- National Institute of Allergy, Infectious Diseases, Bethesda, Maryland
| | - Alkis Togias
- National Institute of Allergy, Infectious Diseases, Bethesda, Maryland
| | | | - Amy Dresen
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - James E Gern
- Department of Pediatrics, University of Wisconsin, Madison, Wisconsin
| | - Alessandro Sette
- La Jolla Institute for Immunology, La Jolla, California.,Department of Medicine, University of California San Diego, La Jolla, California
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23
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Johansson E, Biagini Myers JM, Martin LJ, He H, Ryan P, LeMasters GK, Bernstein DI, Lockey J, Khurana Hershey GK. Identification of two early life eczema and non-eczema phenotypes with high risk for asthma development. Clin Exp Allergy 2019; 49:829-837. [PMID: 30830718 DOI: 10.1111/cea.13379] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/06/2019] [Accepted: 02/25/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The "atopic march" has been considered a linear progression starting with eczema and culminating with development of asthma. Not all asthma cases, however, are preceded by eczema, and not all children with eczema go on to develop asthma. OBJECTIVE The aim of this study was to explore the impact of allergic sensitization patterns on the association between early eczema and later childhood asthma. Given the numerous reported associations of the ciliary gene KIF3A with the atopic march, we also examined the impact of KIF3A risk allele rs12186803 on our analyses. METHODS We studied 505 participants in the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS), a prospective birth cohort, with longitudinal eczema and asthma outcomes as well as prospective data regarding timing of sensitization to foods and aeroallergens. KIF3A genotypes were available on all children. RESULTS Two high-risk groups were identified: one with and one without early eczema. The high-risk group with early eczema was more likely to be sensitized to food allergens, while the group without early eczema was more likely to be polysensitized to aeroallergens. The KIF3A rs12186803 risk allele interacted with food sensitization to increase asthma risk in children with eczema (P = 0.02). In children without eczema, asthma was associated with the interaction between rs12186803 and aeroallergen sensitization (P = 0.007). CONCLUSIONS & CLINICAL RELEVANCE KIF3A interacted differentially with sensitization pattern to increase the risk of asthma in two high-risk groups of children with and without early eczema. Given the reported role of KIF3A in epithelial cell functioning, the results add evidence to the hypothesis that an impaired epithelial barrier is a key aspect in the development of allergic disease.
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Affiliation(s)
- Elisabet Johansson
- Department of Pediatrics, University of Cincinnati, Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jocelyn M Biagini Myers
- Department of Pediatrics, University of Cincinnati, Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lisa J Martin
- Department of Pediatrics, University of Cincinnati, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hua He
- Department of Pediatrics, University of Cincinnati, Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Patrick Ryan
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Grace K LeMasters
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - David I Bernstein
- Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - James Lockey
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Gurjit K Khurana Hershey
- Department of Pediatrics, University of Cincinnati, Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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24
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Zhai J, Zou Y, Liu J, Jin X, Ma C, Li J, Guo R, Huang B. Analysis of the predicting factors of recurrent wheezing in infants. Ital J Pediatr 2019; 45:19. [PMID: 30696464 PMCID: PMC6352350 DOI: 10.1186/s13052-019-0609-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/03/2019] [Indexed: 12/23/2022] Open
Abstract
Background Clinically, asthma in children under 5 years old is under estimated because lack of diagnostic criteria. The current study was, therefore, designed to identify the predicting factors for recurrent wheezing in infants. Methods One hundred forty-five infants under 3-year old hospitalized with respiratory diseases were enrolled into this study. Patients were followed up for one-year period after being discharged from the hospital and were, then, divided into recurrent wheezing group and non-recurrent wheezing group based on whether there was recurrent wheezing or not. Wheezing or recurrent wheezing was specifically monitored in addition to blood tests for allergic and respiratory diseases. Results The prevalence of eczema and respiratory syncytial virus (RSV) infection were significantly higher in recurrent wheezing group than in control group (74.2% vs 45.8%; 32.3% vs. 13.3%, respectively, both P < 0.05); the percentage of blood eosinophil and serum eosinophil-derived neurotoxin (EDN) concentration at admission were also higher in recurrent wheezing group than in control group (3.10 ± 2.54% vs. 1.31 ± 1.15%; 68.67 ± 55.05 ng/mL vs. 27. 36 ± 19.51 ng/mL; respectively, both P < 0.001). Multivariate logistic regression analysis on eosinophil count and serum EDN concentration in predicting recurrent wheezing revealed that the eosinophil count showed the lowest sensitivity (51.6%) and highest specificity (90.4%), with the area under the ROC curve (AUC) of 0.752 ± 0.041; and that, in contrast, the serum EDN showed the highest sensitivity (88.7%) and lowest specificity (56.6%), with AUC of 0.795 ± 0.037. Conclusion Combination of eosinophil count and serum EDN measurement may be better to predict the risk of recurrent wheezing in early life of childhood.
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Affiliation(s)
- Jia Zhai
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Yingxue Zou
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China.
| | - Jie Liu
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Xingnan Jin
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Cuian Ma
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Jiao Li
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Run Guo
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
| | - Bing Huang
- The second department of respiration, Tianjin Children's Hospital, Tianjin, 300074, China
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