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Gao YQ, Seah JJ, Wang ML, Tang QP, Wang DY, Bi XY, Han HW, Zhang TS, Ma J. An unusually high prevalence of allergic rhinitis at high altitudes in 6-7 year old children - An epidemiological study. World Allergy Organ J 2024; 17:100887. [PMID: 38742158 PMCID: PMC11089395 DOI: 10.1016/j.waojou.2024.100887] [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: 10/13/2023] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives To compare the epidemiology and disease patterns of allergic rhinitis (AR) at 2 different altitudes in children aged 6-7 years, and subsequently to compare with and augment data from international studies. Materials and methods This is a multistage, clustered and stratified random sample study. The study area comprises 2 distinct areas within Yunnan Province, China. Low altitude was represented by Xishuangbanna Prefecture (XB), while high altitude was represented by Diqing Prefecture (DiQ). Each study area was subdivided into 3 sub-areas, and children aged 6-7 years were randomly sampled based on proportion-weighted sampling. The area studied includes the well-known area of Shangri-La city. Questionnaires were distributed and jointly completed by study participants and their parents or guardians, under the guidance of professional medical staff. Results 2796 valid questionnaires out of 2933 distributed were obtained (survey response rate 95.3%). The prevalence of AR is statistically significantly higher at high altitude (DiQ, 36.0%, 95%CI 33.2-38.8) as compared to low altitude (XB, 19.7%, 95%CI 17.8-21.6) (p < 0.001). Both areas studied had a greater prevalence of AR compared to international data. In both XB and DiQ, male gender, history of early antibiotic use, urban place of birth and place of residence, presence of smokers within the same household, family history of allergic diseases (such as atopic dermatitis), as well as higher parental educational level were all associated with a higher prevalence of AR (p < 0.05). In DiQ, the prevalence of AR in Han ethnicity was greater than that of ethnic minorities (p < 0.05). In XB, being a single child was associated with an increased prevalence of AR compared to those who had siblings (p < 0.05). Conclusion Our study found that the prevalence of AR is relatively greater at higher altitudes. Genetic and environmental factors both play an important role in the pathogenesis of AR. While altitude may be an important environmental factor, confounding factors may include humidity, temperature and distribution pattern of common aeroallergens.
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Affiliation(s)
- Ying-Qin Gao
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Jun Jie Seah
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mei-Lan Wang
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Qing-ping Tang
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - De-Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xian-Yun Bi
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Hua-wei Han
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Tie-Song Zhang
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
| | - Jing Ma
- Department of Otolaryngology, Head and Neck Surgery, Kunming Children's Hospital, Kunming, China
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Torres-Duque CA, Alí-Munive A, Severiche-Bueno D, Durán-Silva M, Aguirre-Franco CE, González-Florez A, Pareja-Zabala MJ, Jiménez-Maldonado L, Gonzalez-Garcia M. Tropical high altitude and severe asthma in adults: house dust mite sensitization and phenotypic distribution. J Asthma 2024; 61:222-231. [PMID: 37801283 DOI: 10.1080/02770903.2023.2263072] [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: 06/14/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND There is a lack of information on house dust mite (HDM) sensitization and phenotype distribution in patients with severe asthma (SA) living permanently at high-altitude (HA) in tropical regions, which may be different. OBJECTIVE The aim of this study was to characterize adults with SA in a tropical high altitude city (2,640 m): Bogotá, Colombia. MATERIAL AND METHODS This observational cross-sectional study included severe asthmatic outpatients (n = 129) referred to the ASMAIRE program of the Fundación Neumológica Colombiana in Bogotá (2,640 m). Clinical history, spirometry, total IgE, blood eosinophils, and skin prick test (SPT), including HDM allergens, were performed. Phenotype definitions: Allergic/atopic (AA): IgE ≥100 IU/mL and/or at least one positive SPT; eosinophilic (EOS): blood eosinophils ≥300 cells/µL; type 2-high: AA and/or EOS phenotype; type 2-low: non-AA/non-EOS phenotype (IgE <100 IU/mL, negative SPT, and blood eosinophils <300 cells/µL). RESULTS A total of 129 adults with SA were included, 79.8% female. Phenotype distribution: AA: 61.2%; EOS: 37.2%; type 2-high: 72.1%; type 2-low: 27.9%. Among AA patients, HDM sensitization was present in 87% and 34.9% were non-eosinophilic. There was a significant overlap between the phenotypes. CONCLUSIONS In contrast to non-tropical high-altitude regions, we found a high frequency of HDM sensitization in patients with AA phenotype living in a tropical high-altitude city. We also found a discrete lower frequency of EOS phenotype with no other significant differences in the phenotypic distribution compared to that described at low altitudes. We propose that tropical location may modify the effect of high altitude on HDM concentrations and allergenicity.
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Affiliation(s)
- Carlos A Torres-Duque
- Asmaire Program and Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chía, Colombia
| | - Abraham Alí-Munive
- Asmaire Program and Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chía, Colombia
| | - Diego Severiche-Bueno
- Asmaire Program and Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chía, Colombia
| | - Mauricio Durán-Silva
- Asmaire Program and Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chía, Colombia
| | - Carlos E Aguirre-Franco
- Asmaire Program and Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chía, Colombia
| | - Angélica González-Florez
- Asmaire Program and Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - María José Pareja-Zabala
- Asmaire Program and Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Libardo Jiménez-Maldonado
- Asmaire Program and Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chía, Colombia
| | - Mauricio Gonzalez-Garcia
- Asmaire Program and Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chía, Colombia
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Biologie von Hausstaub- und Vorratsmilben. ALLERGO JOURNAL 2022. [DOI: 10.1007/s15007-022-5637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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4
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Kim E, Park S, Kim S, Choi Y, Cho JH, Kim G. Is altitude a determinant of the health benefits of nature exposure? A systematic review and meta-analysis. Front Public Health 2022; 10:1021618. [PMID: 36504926 PMCID: PMC9732270 DOI: 10.3389/fpubh.2022.1021618] [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: 08/18/2022] [Accepted: 11/11/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Nature exposure is a widely accepted option for promoting public health owing to the recent surge of scientific evidence. However, the actual settings to facilitate this initiative is yet to be extensively reviewed. In this systematic review, we have aimed to provide an up-to-date summary of interventional studies investigating the psycho-physiological effects of forests and urban forests, including details on their physical settings, and investigate an effect-modifying role of altitude and summarize data on the magnitude and shape of the association. Methods A keyword search using five electronic academic databases (PubMed, Embase, PsycINFO, Web of Science, and Scopus) was conducted to identify relevant articles published in English from the inception year to the end of February 2022. The methodological quality was evaluated using the ROBINS-I or ROB2 tool, depending on the study design. Meta-regression and random effects model were jointly used to examine the relationship between altitude and health outcomes. Results We included 27 eligible studies and 31 cases extracted from 19 studies were used for the meta-analysis. In the meta-regression, we observed a non-linear association between altitude and psycho-physiological effects. Altitude had a positive quadratic association with anxiety (p < 0.000, adjusted R 2 = 96.79%), depression (p < 0.000, adjusted R 2 = 98.78%), and fatigue (p < 0.000, adjusted R 2 = 64.74%) alleviating effects. Conversely, altitude demonstrated a negative non-linear association with the blood pressure-lowering effect (p = 0.009, adjusted R 2 = 32.83%). Additionally, the thermal index (THI) and illuminance (lx) levels were significantly associated with effect sizes of psychological restoration. Discussion This review provides moderate-certainty evidence for an effect-modifying role of altitude. The meta-regression results suggested the optimal and minimal altitude ranges for psychological restoration and physiological relaxation, respectively. Despite some limitations, the study findings provide a significant basis for utilizing altitude, which is easily accessible and simple, to promote the health benefits of nature-based initiatives. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022310894, identifier: CRD42022310894.
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Tong S, Yin Y, Bao Y. Climatotherapy for asthma: Research progress and prospect. ENVIRONMENTAL RESEARCH 2022; 214:113988. [PMID: 35964665 DOI: 10.1016/j.envres.2022.113988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
Asthma affects over 300 million people globally and is a cause of substantial burden of disease, including both premature death and reduced quality of life in people of all ages. Although both genetic and environmental factors play an important role in the pathogenesis of asthma, the rising trend of asthma and other allergic diseases over recent decades is thought to be largely caused by alteration in environmental conditions. Thus, a considerable amount of attention has been paid to environmental modification for the treatment and management of asthma, including household allergen reduction and/or irritant removal. More advanced environmental modification strategies (e.g., health resort medical rehabilitation, high-altitude climate therapy and multiple-hit interventions) have also been suggested. Research advances have been made over the past decades, but major challenges and opportunities coexist in this emerging field. Concerted efforts are required to tackle these formidable challenges.
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Affiliation(s)
- Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China; Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.
| | - Yong Yin
- Department of Respiratory Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yixiao Bao
- Department of Respiratory Disease, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Response to high-altitude triggers in seasonal asthmatics on and off inhaled corticosteroid treatment. World Allergy Organ J 2022; 15:100698. [PMID: 36254181 PMCID: PMC9513265 DOI: 10.1016/j.waojou.2022.100698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/26/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022] Open
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Fieten KB, Drijver‐Messelink MT, Cogo A, Charpin D, Sokolowska M, Agache I, Taborda‐Barata LM, Eguiluz‐Gracia I, Braunstahl GJ, Seys SF, den Berge M, Bloch KE, Ulrich S, Cardoso‐Vigueros C, Kappen JH, Brinke AT, Koch M, Traidl‐Hoffmann C, da Mata P, Prins DJ, Pasmans SGMA, Bendien S, Rukhadze M, Shamji MH, Couto M, Oude Elberink H, Peroni DG, Piacentini G, Weersink EJM, Bonini M, Rijssenbeek‐Nouwens LHM, Akdis CA. Alpine altitude climate treatment for severe and uncontrolled asthma: An EAACI position paper. Allergy 2022; 77:1991-2024. [PMID: 35113452 PMCID: PMC9305916 DOI: 10.1111/all.15242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/14/2022] [Accepted: 01/30/2022] [Indexed: 12/30/2022]
Abstract
Currently available European Alpine Altitude Climate Treatment (AACT) programs combine the physical characteristics of altitude with the avoidance of environmental triggers in the alpine climate and a personalized multidisciplinary pulmonary rehabilitation approach. The reduced barometric pressure, oxygen pressure, and air density, the relatively low temperature and humidity, and the increased UV radiation at moderate altitude induce several physiological and immunological adaptation responses. The environmental characteristics of the alpine climate include reduced aeroallergens such as house dust mites (HDM), pollen, fungi, and less air pollution. These combined factors seem to have immunomodulatory effects controlling pathogenic inflammatory responses and favoring less neuro‐immune stress in patients with different asthma phenotypes. The extensive multidisciplinary treatment program may further contribute to the observed clinical improvement by AACT in asthma control and quality of life, fewer exacerbations and hospitalizations, reduced need for oral corticosteroids (OCS), improved lung function, decreased airway hyperresponsiveness (AHR), improved exercise tolerance, and improved sinonasal outcomes. Based on observational studies and expert opinion, AACT represents a valuable therapy for those patients irrespective of their asthma phenotype, who cannot achieve optimal control of their complex condition despite all the advances in medical science and treatment according to guidelines, and therefore run the risk of falling into a downward spiral of loss of physical and mental health. In the light of the observed rapid decrease in inflammation and immunomodulatory effects, AACT can be considered as a natural treatment that targets biological pathways.
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8
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Fieten KB, John SM, Nowak D. Secondary and Tertiary Prevention: Medical Rehabilitation. Handb Exp Pharmacol 2021; 268:449-470. [PMID: 34196810 DOI: 10.1007/164_2021_511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Allergies are a major public health burden, and targeted measures are required in terms of prevention and treatment. The most common allergic conditions encompass atopic dermatitis (AD), food allergy (FA), allergic asthma (AA), and allergic rhino-conjunctivitis (AR). Primary prevention aims at preventing the onset of allergic disease, before the disease process begins. Secondary prevention aims at preventing progression and exacerbation of allergic disease whereas tertiary prevention aims at reducing disease burden in patients with established disease, by allergen immunotherapy (AIT) or medical rehabilitation. Rehabilitation programs are used for treatment of AA and AD and usually consist of extensive patient assessment, optimization of treatment management, patient education, and behavioral interventions, ideally involving a multidisciplinary treatment team and sometimes provided in a specific climate, usually alpine or maritime. Similarly, prevention of occupational skin diseases requires interdisciplinary approaches on the level of secondary and tertiary preventive intervention; if this is provided, then prevention programs have proven highly (cost-) effective. Unfortunately, the recently published Minimal Standards of Prevention of these dermatoses, underlining especially the importance of meticulous allergological diagnosis and subsequent multidisciplinary patient education, are so far being adhered to only in very few European countries.
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Affiliation(s)
- Karin B Fieten
- Swiss Institute of Allergy and Asthma Research (SIAF), Davos, Switzerland.
| | | | - Dennis Nowak
- Munich Center of Health Sciences, Munich, Germany
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de Nijs SB, Krop EJM, Portengen L, Rijssenbeek-Nouwens LH, de Vries D, Weersink EJM, Heijerman HGM, Heederik DJJ, Lammers JWJ. Effectiveness of pulmonary rehabilitation at high-altitude compared to sea-level in adults with severe refractory asthma. Respir Med 2020; 171:106123. [PMID: 32846334 DOI: 10.1016/j.rmed.2020.106123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 08/15/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Beneficial effects of pulmonary rehabilitation at high-altitude (HAPR) in patients with severe refractory asthma have been reported earlier, but evidence for the effectiveness is limited. AIM To investigate the effectiveness of high-altitude pulmonary rehabilitation to comparable treatment at sea-level (LAPR) on patient outcome parameters. METHODS Adults with severe refractory asthma living in The Netherlands were included. Treatment consisted of a 12-week personalized multidisciplinary rehabilitation program either at high-altitude (Davos Switzerland) (n = 93) or in a tertiary lung center at sea-level in The Netherlands (n = 45). At baseline, after treatment, and during 12 months follow-up asthma related quality of life (AQLQ), asthma control (ACQ), pulmonary function and OCS-dose were assessed. Patients could not be randomized resulting in different asthma populations. Groups were compared using linear regression analysis (ANCOVA) adjusted for baseline values, in addition to age, atopy, smoking history, BMI and gender. RESULTS After treatment, and at 12 months follow-up, improved AQLQ(0.92,p < 0.001 and 0.82,p = 0.001, respectively), ACQ(-0.87,p < 0.001 and -0.69,p = 0.008, respectively) and lower maintenance OCS dose (Unadjusted linear regression analysis-5.29 mg, p = 0.003 and Crude Odds Ratio-1.67, p = 0.003, respectively) were observed in the HAPR-group compared to the LAPR group. Patients receiving HAPR also had less asthma exacerbations (≥1 exacerbation: 20% vs 60%,p < 0.001) and showed improvement in lung function (%predFEV1 3.4%,p = 0.014) compared to the LAPR group, but at 12 months no differences between groups were observed. CONCLUSION HAPR resulted in a larger improvement in patient outcome parameters compared to LAPR, on the long run the improvement in patient reported symptoms and lower maintenance OCS-dose persists. Underlying factors that explain this observed effect need to be investigated.
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Affiliation(s)
- S B de Nijs
- Department of Respiratory Medicine, University Medical Center Utrecht, the Netherlands; Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - E J M Krop
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - L Portengen
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | | | - D de Vries
- Merem Asthma Center Heideheuvel, Hilversum, the Netherlands
| | - E J M Weersink
- Department of Respiratory Medicine, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
| | - H G M Heijerman
- Department of Respiratory Medicine, University Medical Center Utrecht, the Netherlands.
| | - D J J Heederik
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - J W J Lammers
- Department of Respiratory Medicine, University Medical Center Utrecht, the Netherlands
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Abiad HF, Alameddine VM, Hallit S, Torbey PH, Mroueh S, Yazbek N, Asmar E, Hage P, Fares GA, Samarani M, Khalife MCF. Aeroallergen sensitization in Lebanese asthmatic children: the results of a cohort national study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:5597-5605. [PMID: 31858416 DOI: 10.1007/s11356-019-07234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 12/02/2019] [Indexed: 06/10/2023]
Abstract
Atopic asthma is characterized by the presence of sensitization to common aeroallergens, which tends to have a worse prognosis than non-atopic asthma. The objectives were to determine the prevalence of aeroallergens sensitization in the Lebanese pediatric asthmatic population and determine the relationship between allergens sensitization (indoor and outdoor) and age, area of residence and altitude. A sample, consisting of 919 asthmatic children (aged 1 to 18 years, from 2010 until 2017), underwent skin prick testing (SPT) with 21 common allergens: 5 grasses (cocksfoot, sweet vernal-grass, rye-grass, meadow grass, timothy), Parietaria, olive, Dermatophagoides pteronyssinus and Dermatophagoides farina (DP-DF), dog and cat dander, Alternaria longipens, Aspergillus fumigatus and nidulans, Cupressaceae, pine, German cockroach, and 4 cereals (oat, wheat, barley, maize). Seven hundred fifty-two patients had positive SPT. The distribution of sensitization was as follows: DP-DF 59%; 5 grasses 34%; 4 cereals 33.9%; cat 29.9%; Alternaria 27.9%; Parietaria 23%; dog 21.9%; olive 20.5%; Aspergillus mix 18.6%; Cupressaceae 18.2%; pine 17%; cockroach 15.3%. House dust mites sensitization was frequent at lower altitude (< 900 m) (56.3%) and in the whole country (a median prevalence of 53.05%) except for the Beqaa region (negative HDM in 82.4%). Non-atopic asthma was more frequent in early childhood (40.5% at 1-4 years vs 11.2% at 11-18 years). The sensitization rate increased with age, starting at 5 years. Higher age (aOR = 1.24) and altitude less than 900 m compared with ≥ 900 m (aOR = 2.03) were significantly associated with the presence of aeroallergens in children. House dust mites and grasses are the most common allergens in Lebanese asthmatic children. Non-atopic asthma is more frequent at early age. Lebanese children with asthma showed a polysensitized pattern starting at 5 years.
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Affiliation(s)
- Hala Feghali Abiad
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
- Asthma Center of the Childhood Protection and Care, Association in Beirut, Hazmieh, Lebanon
| | | | - Souheil Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.
| | - Paul-Henry Torbey
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Asthma Center of the Childhood Protection and Care, Association in Beirut, Hazmieh, Lebanon
| | - Salman Mroueh
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Asthma Center of the Childhood Protection and Care, Association in Beirut, Hazmieh, Lebanon
| | - Nelly Yazbek
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Asthma Center of the Childhood Protection and Care, Association in Beirut, Hazmieh, Lebanon
| | - Edgard Asmar
- Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
- Asthma Center of the Childhood Protection and Care, Association in Beirut, Hazmieh, Lebanon
| | - Pierre Hage
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
- Asthma Center of the Childhood Protection and Care, Association in Beirut, Hazmieh, Lebanon
| | - George Abi Fares
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - Marie Samarani
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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Aeroallergen Exposure and Spread in the Modern Era. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1835-1842. [PMID: 30390901 DOI: 10.1016/j.jaip.2018.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 01/29/2023]
Abstract
Since the initial discovery of aeroallergens in the 20th century, our understanding of their properties including sources and factors influencing their spread continues to expand. Both habits of daily living and the presence of environmental factors such as exposure to animals or pollution can influence susceptibility to atopic disease. Because relevant allergens may vary in individuals and communities, it is necessary to understand the physical properties of environmental aeroallergens that are associated with clinical disease to explain symptoms and to implement successful integrated interventions. The objective of this review was to present an overview of aeroallergens and the environmental factors influencing their current distribution. Using historical studies along with recent advancements, we will give an up-to-date description of the physical characteristics and aerodynamics of aeroallergens in addition to location, quantities, and timing of exposure.
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Acevedo N, Zakzuk J, Caraballo L. House Dust Mite Allergy Under Changing Environments. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2019; 11:450-469. [PMID: 31172715 PMCID: PMC6557771 DOI: 10.4168/aair.2019.11.4.450] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/12/2019] [Accepted: 03/15/2019] [Indexed: 12/11/2022]
Abstract
Environmental variations induced by industrialization and climate change partially explain the increase in prevalence and severity of allergic disease. One possible mechanism is the increase in allergen production leading to more exposure and sensitization in susceptible individuals. House dust mites (HDMs) are important sources of allergens inducing asthma and rhinitis, and experimentally they have been demonstrated to be very sensitive to microenvironment modifications; therefore, global or regional changes in temperature, humidity, air pollution or other environmental conditions could modify natural HDM growth, survival and allergen production. There is evidence that sensitization to HDMs has increased in some regions of the world, especially in the subtropical and tropical areas; however, the relationship of this increase with environmental changes is not so clear as has reported for pollen allergens. In this review, we address this point and explore the effects of current and predicted environmental changes on HDM growth, survival and allergen production, which could lead to immunoglobulin E (IgE) sensitization and allergic disease prevalence. We also assess the role of adjuvants of IgE responses, such as air pollution and helminth infections, and discuss the genetic and epigenetic aspects that could influence the adaptive process of humans to drastic and relatively recent environmental changes we are experiencing.
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Affiliation(s)
- Nathalie Acevedo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia
| | - Josefina Zakzuk
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia.
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Schroer B, Aalberse RC. Clinical Allergy at the Interface of Sticky Dust Particles and Crystal-Clear Proteins. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:1866-1868. [PMID: 30390903 DOI: 10.1016/j.jaip.2018.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Brian Schroer
- Cleveland Clinic Children's Hospital, Cleveland, Ohio.
| | - Rob C Aalberse
- Sanquin Research, Department of Immunopathology, Amsterdam, The Netherlands; Landsteiner Laboratory, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Duenas-Meza E, Torres-Duque CA, Correa-Vera E, Suárez M, Vásquez C, Jurado J, Del Socorro Medina M, Barón O, Pareja-Zabala MJ, Giraldo-Cadavid LF. High prevalence of house dust mite sensitization in children with severe asthma living at high altitude in a tropical country. Pediatr Pulmonol 2018; 53:1356-1361. [PMID: 29938928 DOI: 10.1002/ppul.24079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/06/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Some studies, mainly in Europe, have shown a low level of sensitization to house dust mite (HDM) allergens at high altitude (HA). Differently, some others in tropical countries have shown a higher level. The aim of this study was to evaluate allergens sensitization, including HDM, in children with severe asthma (SA), residents at HA in a tropical middle-income developing country. METHODS Observational, analytical, cross-sectional study in children aged 6-15 years old with SA at HA (2640 m). Skin prick tests (SPT), serum IgE, exhaled fraction of nitric oxide (FENO ), spirometry, and asthma questionnaire (ACT) were performed. Associations were explored by Pearson or Spearman coefficients. RESULTS We included 61 children. Most patients were male (61.3%), median age: 10 years (Interquartile range [IQR]: 8-12), median BMI: 17 kg/m2 (IQR: 16-20); Median of positive SPT: 2 (IQR: 2-3). At least one SPT was positive in 88.7% of patients and 87.9% were positive for at least one HDM. Serum IgE: 348 UI/mL (IQR: 154-760) and FENO : 22 ppb (IQR: 9-41). Prebronchodilator values were (% predicted): FVC: 109.7% (±15.5%), FEV1 : 98.4% (±16.3); FEV1 /FVC: 82% (±8%). SPT were inversely correlated with the FEV1 /FVC (Rho: -0.34; 95% CI: -0.55 a -0.09; P = 0.008). CONCLUSIONS These children with SA living at HA in a tropical middle-income developing country have a high prevalence of HDM sensitization. One explanation for this might be that tropical conditions, such as temperature and humidity, could modify the effect of the altitude on asthma.
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Affiliation(s)
- Elida Duenas-Meza
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia.,Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
| | - Carlos A Torres-Duque
- Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
| | | | - Miguel Suárez
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Catalina Vásquez
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Jenny Jurado
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia
| | | | - Oscar Barón
- Pediatric Pulmonology Section, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - María J Pareja-Zabala
- Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
| | - Luis F Giraldo-Cadavid
- Research Department, Fundación Neumológica Colombiana, Bogotá, Colombia.,Universidad de La Sabana, Bogotá, Colombia
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Vargas MH, Becerril-Ángeles M, Medina-Reyes IS, Rascón-Pacheco RA. Altitude above 1500 m is a major determinant of asthma incidence. An ecological study. Respir Med 2017; 135:1-7. [PMID: 29414446 DOI: 10.1016/j.rmed.2017.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/17/2017] [Accepted: 12/18/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Previous studies suggest an inverse correlation between asthma and altitude. In the present work, we performed an in-depth analysis of asthma incidence in the 758 Mexican counties covered by the largest medical institution in the country (∼37.5 million insured subjects), and evaluated its relationships with altitude and other factors. METHODS Asthma incidence in each county was calculated from new cases diagnosed by family physicians. Other variables in the same counties, including selected diseases, geographical variables, and socioeconomic factors, were also obtained and their association with asthma was evaluated through bivariate and multivariate analyses. RESULTS Median asthma incidence was 296.2 × 100,000 insured subjects, but tended to be higher in those counties located on or near the coast. When asthma incidence was plotted against altitude, a two-stage pattern was evident: asthma rates were relatively stable in counties located below an altitude of ∼1500 m, while these rates progressively decreased as altitude increased beyond this level (rS = -0.51, p < .001). Multivariate analysis showed that, once each variable was adjusted by the potential influence of the others, asthma incidence was inversely correlated with altitude (standardized β coefficient, -0.577), helminthiasis (-0.173), pulmonary tuberculosis (-0.130), and latitude (-0.126), and was positively correlated with acute respiratory tract infection (0.382), pneumonia (0.289), type 2 diabetes (0.138), population (0.108), and pharyngotonsillitis (0.088), all with a p ≤ .001. CONCLUSION Our study showed that altitude higher than ∼1500 m comprises a major factor in determining asthma incidence, with the risk of new-onset asthma decreasing as altitude increases. Other less influential conditions were also identified.
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Affiliation(s)
- Mario H Vargas
- Unidad de Investigación Médica en Enfermedades Respiratorias, Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Departamento de Investigación en Hiperreactividad Bronquial, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Martín Becerril-Ángeles
- Departamento de Alergia e Inmunología Clínica, Hospital de Especialidades, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
| | - Ismael Seth Medina-Reyes
- División de Información Epidemiológica, Coordinación de Vigilancia Epidemiológica y Apoyo en Contingencias, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ramón Alberto Rascón-Pacheco
- División de Información Epidemiológica, Coordinación de Vigilancia Epidemiológica y Apoyo en Contingencias, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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16
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Stemeseder T, Schweidler B, Doppler P, Klinglmayr E, Moser S, Lueftenegger L, Himly M, Lang R, Zumbach J, Oostingh GJ, Hawranek T, Bathke AC, Gadermaier G. Exposure to Indoor Allergens in Different Residential Settings and Its Influence on IgE Sensitization in a Geographically Confined Austrian Cohort. PLoS One 2017; 12:e0168686. [PMID: 28045938 PMCID: PMC5207653 DOI: 10.1371/journal.pone.0168686] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/05/2016] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Exposure to indoor allergens is crucial for IgE sensitization and development of allergic symptoms. Residential settings influence the allergen amount in house dust and hence allergic sensitization. Within this study, we investigated allergen exposure and molecule-based IgE levels in a geographically confined region and evaluated the impact of housing, pets and cleaning. METHODS 501 adolescents from Salzburg, Austria participated in this cross-sectional study. House dust samples were examined regarding major mite, cat, dog, and mold allergens using a multiplex assay. Serum samples of participants were analyzed for specific IgE to Der p 1, Der p 2, Fel d 1, Can f 1 and Alt a 1 using the multiplex array ImmunoCAP ISAC. Information on allergies, living areas, dwelling form (house, flat, farm), pets, and household cleanliness were obtained by a questionnaire. RESULTS In investigated house dust samples, the concentration of cat allergen was highest while the prevalence of mold allergens was very low. Participants showed IgE sensitization to Der p 1 (13.2%), Der p 2 (18.2%), Fel d 1 (14.4%), Can f 1 (2.4%) and Alt a 1 (2.0%). In alpine regions, lower mite allergen concentrations were detected which correlated with reduced IgE levels. A trend for increased sensitization prevalence from rural to alpine to urban regions was noted. Living on farms resulted in lower sensitization prevalence to mite and cat allergens, even though exposure to mites was significantly elevated. The presence of cats was associated with a lower sensitization rate and IgE levels to cat and mite allergens, and less frequent allergic diseases. Cleaning did not impact allergen concentrations, while IgE reactivity to mites and allergic diseases were more pronounced when living in cleaner homes. CONCLUSION Allergen exposure to indoor allergens was influenced by setting of homes. Living in a farm environment and having a cat at home showed a protective effect for IgE sensitization and allergies. This cross-sectional study in combination with hereditary and lifestyle factors enables development of risk schemes for a more efficient management and potential prevention of allergic diseases.
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Affiliation(s)
- Teresa Stemeseder
- Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Bettina Schweidler
- Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Patrick Doppler
- Department of Mathematics, University of Salzburg, Salzburg, Austria
| | - Eva Klinglmayr
- Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Stephanie Moser
- School of Education, University of Salzburg, Salzburg, Austria
- TUM School of Education, Technical University of Munich, Munich, Germany
| | - Lisa Lueftenegger
- Department of Dermatology, Paracelsus Medical University Salzburg, Salzburg, Austria
- Biomedical Sciences, Salzburg University of Applied Sciences, Puch/Salzburg, Austria
| | - Martin Himly
- Department of Molecular Biology, University of Salzburg, Salzburg, Austria
| | - Roland Lang
- Department of Dermatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Joerg Zumbach
- Department of Mathematics, University of Salzburg, Salzburg, Austria
| | - Gertie J. Oostingh
- Biomedical Sciences, Salzburg University of Applied Sciences, Puch/Salzburg, Austria
| | - Thomas Hawranek
- Department of Dermatology, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Arne C. Bathke
- Department of Mathematics, University of Salzburg, Salzburg, Austria
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