Association of Sensitization to Different Aeroallergens With Airway Function and Nasal Patency in Urban Children

Window of opportunity for respiratory oscillometry: A review of recent research

Oscillometry has been around for almost 70 years, but there are still many unknowns. The test is performed during tidal breathing and is therefore free from patient-dependent factors that could influence the results. The Forced Oscillation Technique (FOT), which requires minimal patient cooperation, is gaining ground, particularly with elderly patients and children. In pulmonology, it is a valuable tool for assessing obstructive conditions (with a distinction between central and peripheral obstruction) and restrictive disorders (intrapulmonary and extrapulmonary). Its sensitivity allows the assessment of bronchodilator and bronchoconstrictor responses. Different lung diseases show different patterns of changes in FOT, especially studied in asthma and chronic obstructive pulmonary disease. Because of these differences, many studies have analysed the usefulness of this technique in different areas of medicine. In this paper, the authors would like to present the basics of oscillometry with the areas of its most recent clinical applications.

Association of phthalate exposure and airway dysfunction with mediation by serum periostin

BACKGROUND

Phthalates can cause respiratory and immunological disorders. However, little is known about the role of serum periostin and YKL-40 levels in mediating the effects of phthalates. We investigated the mediating role of these biomarkers in the relationship between phthalates and airway dysfunction.

METHODS

A total of 487 children (aged 10-12 years old) were examined. Four high-molecular-weight phthalate (HMWP) [Σ₄ HMWP] metabolites and 3 low-molecular-weight phthalate (LMWP) [Σ₃ LMWP] metabolites in urine samples were measured. Serum periostin and YKL-40 levels were measured. Airway function was measured using impulse oscillometry. A mediation model was used to quantify the mediating effects of periostin and YKL-40 on airway dysfunction.

RESULTS

After adjustment for height, gender, BMI z-score, aeroallergen sensitization, secondary smoking, and vitamin D level, the level of urinary Σ₃ LMWP metabolites was significantly associated with respiratory system resistance at 5 Hz (Rrs5; adjusted β: 0.020, 95% CI: 0.005-0.034; p = .010). The levels of urinary Σ₄ HMWP and Σ₃ LMWP metabolites were significantly associated with periostin level, but not with YKL-40 level. In addition, the periostin level was associated with Rrs5 (adjusted β: 0.048, 95% CI: 0.015-0.081; p = .005) and Rrs20-5 (adjusted β: 0.040, 95% CI: 0.011-0.069; p = .007). Serum periostin level had a significant effect in mediating the relationship between Σ₃ LMWP and Rrs5 (13.9%, 95% CI: 10.7-77.0; p < .001).

CONCLUSION

Exposure to LMWPs was significantly associated with airway dysfunction, and this effect was partially attributable to increased serum periostin level.

The potential pathways underlying the association of propyl-paraben exposure with aeroallergen sensitization and EASI score using metabolomics analysis

Propyl-paraben exposure is associated with aeroallergen sensitization, but its association with atopic dermatitis (AD) is inconclusive. No studies have been conducted on the metabolomic pathways underlying these associations. We investigated the associations between propyl-paraben exposure and aeroallergen sensitization, AD, and Eczema Area and Severity Index (EASI) score and identified the underlying pathways using untargeted metabolomics analysis. We enrolled 455 children in a general population study. Skin prick tests were performed with the assessment of EASI score. Urinary propyl-, butyl-, ethyl-, and methyl-paraben levels were measured. Untargeted metabolomics analysis was performed on the first and fifth urine propyl-paraben quintile groups. The highest urine propyl-paraben quintile group was associated with aeroallergen sensitization, but not with AD. Glycine, threonine, serine, ornithine, isoleucine, arabinofuranose, d-lyxofuranose, citrate, and picolinic acid levels were higher, whereas palmitic acid and 2-palmitoylglycerol levels were lower in the highest quintile propyl-paraben group, than in the lowest quintile group. The propyl-paraben-induced metabolic perturbations were associated with serine and glycine metabolisms, branched-chain amino acid metabolism, and ammonia recycling. Propyl-paraben exposure was associated with aeroallergen sensitization and EASI score, partially via metabolomic changes related with oxidative stress, mTOR, peroxisome proliferator-activated receptors pathway, aryl hydrocarbon receptor signaling pathways, and tricarboxylic acid cycle.

Serum vitamin D level is associated with smell dysfunction independently of aeroallergen sensitization, nasal obstruction, and the presence of allergic rhinitis in children

BACKGROUND

Smell dysfunction is highly prevalent worldwide and has adverse effects on quality of life. Smell loss in rhinitis subjects is mainly caused by mechanical obstruction of odorant transmission due to mucosal type 2 inflammation. We determined the association of 25-hydroxyvitamin D (25[OH]D) levels with the severity of smell dysfunction in children.

METHODS

We measured the olfactory threshold score in a total of 518 children (10-12 years old, 264 boys) using the Sniffin' Sticks kit, and the children were divided into tertiles according to olfactory threshold score. We also assessed serum 25[OH]D level, common aeroallergen-specific immunoglobulin E, rhinitis severity with visual analog scale, and the Total Four Symptom Score, and pre- and post-decongestant nasal patency with acoustic rhinometry.

RESULTS

The children with 25(OH)D deficiency had significantly reduced mean olfactory threshold scores when compared to those with 25(OH)D levels of ≥20.0 ng/mL (6.56 ± 3.54 and 7.28 ± 3.87, respectively, P = .036). The proportion of loss of smell function and pre-decongestant nasal patency significantly associated with low 25(OH)D levels (chi-square trend test, P for trend = .007). Likewise, after adjustment for confounders, children with smell loss (third tertile) were significantly associated with low 25(OH)D level (aβ=-0.062, 95% CI=-0.064 to -0.060, P = .009) independent of aeroallergen sensitization, and a low pre-decongestant nasal patency.

CONCLUSIONS

25-Hydroxyvitamin D is significantly associated with smell dysfunction independent of aeroallergen sensitization, nasal obstruction, and the presence of allergic rhinitis. This finding may provide insight into the mechanisms involved in the development of olfactory dysfunction.

Bacterial Microbiota-derived Extracellular Vesicles in Children With Allergic Airway Diseases: Compositional and Functional Features

PURPOSE

Bacterial extracellular vesicles (EVs) play crucial roles in bacteria-host interactions. Due to their cargo, EVs are considered fingerprints of the parent cell, which are detectable in body fluids. We studied the composition and function of bacterial microbiota-derived EVs genes in urine to evaluate whether they have specific characteristics concerning allergic airway disease.

METHODS

Subjects were from elementary school surveys and classified into 3 groups according to questionnaires and sensitization to aeroallergens: the allergic airway group (AA, n = 16), atopic controls (AC, n = 7) and healthy controls (HC, n = 26). The bacterial EVs were isolated from voided urine samples, their nucleic acid was extracted for 16S ribosomal RNA pyrosequencing and then characterized using α-diversity, β-diversity, network analysis, intergroup comparison of bacterial composition and predicted functions, and correlation with total immunoglobulin E (IgE), eosinophils% and fractional exhaled NO.

RESULTS

The compositional α-diversity was the highest in AA, while functional α-diversity was the highest in HC. AA had a distinct clustering with the least intersample variation. Klebsiella, Haemophilus, members from Lachnospiraceae and Ruminococcaceae, and the pathways of sphingolipid and glycerolipid metabolism, and biosynthesis of peptidoglycan and lysine were the highest in AA and positively correlated with total IgE or eosinophil%. Genetic information processing function contributed to 48% of the intergroup variance and was the highest in AA. Diaphorobacter, Acinetobacter, and the pathways of short-chain fatty acids and anti-oxidants metabolism, lysine and xenobiotic degradation, and lipopolysaccharide biosynthesis were the lowest in AA and negatively correlated with total IgE or eosinophil%. The bacterial composition and function in AC were closer to those in HC. The bacterial network was remarkably dense in HC.

CONCLUSIONS

The bacterial microbiota-derived EVs in urine possess characteristic features in allergic airway disease with a remarkable correlation with total IgE and eosinophil%. These findings suggest that they may play important roles in allergic airway diseases.

Assessment of vitamin D, exercise, and lipid profile associated with excessive daytime sleepiness in school children

Previous research reported associations of excessive daytime sleepiness (EDS) with a low vitamin D level, obesity, and sexual maturity. The aim of this study was to identify the association and rank the importance of these with EDS. This study examined 618 children who were 10-12 year-old. The pediatric daytime sleepiness scale (PDSS) was used to evaluate EDS and sleep patterns. EDS was defined as a total PDSS score above 17. We ranked the importance of the relationship of these factors with EDS using random forest analysis. EDS (n = 111, 18%) was positively associated with more advanced pubertal stage in girls, chronic cough, urticaria, and allergic rhinitis. Multivariable analysis with adjustment for confounding indicated that children with low level of 25-hydroxyvitaminD₃ (25(OH)D₃ (<20 ng/mL) and high-density lipoprotein-cholesterol (HDL-C) (<40 mg/dL) levels had an increased risk of EDS (25(OH)D₃:adjusted odds ratio [aOR] = 1.73; 95% confidence interval [CI]: 1.06 to 2.81; P = 0.028; HDL-C: aOR = 2.84; 95% CI: 1.05 to 7.68; P = 0.039). Random forest analysis indicated that 25(OH)D₃ level, exercise, and body mass index (BMI) were over three. This study indicated high levels of 25-(OH)D₃ and HDL-C and performing regular exercise decreased the risk of EDS.

Prevalence and distribution patterns of allergens among children with asthma and asthma-like symptoms in Shanghai, China

Objective

We aimed to identify the prevalence and distribution patterns of allergens among Chinese children with asthma/asthma-like symptoms (ALS).

Methods

A total of 3479 children with asthma/ALS were enrolled. Skin prick test (SPT) was used to test the allergen-specific IgE. We analysed allergens prevalence and distribution, and its relationship with demographic characteristics.

Results

Aeroallergens prevalence was higher than that of food allergens (p < 10^− 4). Boys had higher aeroallergens prevalence than that in girls (p < 10^− 4). Significant difference of aeroallergens prevalence among cases with different parental allergy history was observed (p < 10^− 4). Age was positively associated with aeroallergens prevalence before the age of 11.5 (P < 10^− 4), particularly before the age of 2.42 (P < 10^− 4). Age was negatively associated with aeroallergens prevalence after the age of 11.5 (P = 0.021). Age was negatively associated with food allergens prevalence before the age of 3.42 (P < 10^− 4). Age was associated with the intensity of dermatophagoides farinae (DF)/house dust mite (HDM) allergens (P < 10^− 4). Age was negatively associated with the intensity of shrimp, and crab allergens before the age of 3.3 and 3.3, respectively (P = 0.012, < 10^− 4). Boys had higher intensity of DF and HDM allergens than that in girls (P < 10^− 4, P < 10^− 4). Significant differences of the intensity of DF and HDM allergens among groups with different parental allergy history were noted (P < 10^− 4, P < 10^− 4).

Conclusions

Boys and parental allergy history were associated with higher prevalence and intenstity of aeroallergens. Age was positively and negatively associated with aeroallergens prevalence before and after the age of 11.5, respectively. Age was negatively associated with food allergens prevalence before the age of 3.42.