1
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Clay S, Alladina J, Smith NP, Visness CM, Wood RA, O'Connor GT, Cohen RT, Khurana Hershey GK, Kercsmar CM, Gruchalla RS, Gill MA, Liu AH, Kim H, Kattan M, Bacharier LB, Rastogi D, Rivera-Spoljaric K, Robison RG, Gergen PJ, Busse WW, Villani AC, Cho JL, Medoff BD, Gern JE, Jackson DJ, Ober C, Dapas M. Gene-based association study of rare variants in children of diverse ancestries implicates TNFRSF21 in the development of allergic asthma. J Allergy Clin Immunol 2024; 153:809-820. [PMID: 37944567 PMCID: PMC10939893 DOI: 10.1016/j.jaci.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/25/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Most genetic studies of asthma and allergy have focused on common variation in individuals primarily of European ancestry. Studying the role of rare variation in quantitative phenotypes and in asthma phenotypes in populations of diverse ancestries can provide additional, important insights into the development of these traits. OBJECTIVE We sought to examine the contribution of rare variants to different asthma- or allergy-associated quantitative traits in children with diverse ancestries and explore their role in asthma phenotypes. METHODS We examined whole-genome sequencing data from children participants in longitudinal studies of asthma (n = 1035; parent-identified as 67% Black and 25% Hispanic) to identify rare variants (minor allele frequency < 0.01). We assigned variants to genes and tested for associations using an omnibus variant-set test between each of 24,902 genes and 8 asthma-associated quantitative traits. On combining our results with external data on predicted gene expression in humans and mouse knockout studies, we identified 3 candidate genes. A burden of rare variants in each gene and in a combined 3-gene score was tested for its associations with clinical phenotypes of asthma. Finally, published single-cell gene expression data in lower airway mucosal cells after allergen challenge were used to assess transcriptional responses to allergen. RESULTS Rare variants in USF1 were significantly associated with blood neutrophil count (P = 2.18 × 10-7); rare variants in TNFRSF21 with total IgE (P = 6.47 × 10-6) and PIK3R6 with eosinophil count (P = 4.10 × 10-5) reached suggestive significance. These 3 findings were supported by independent data from human and mouse studies. A burden of rare variants in TNFRSF21 and in a 3-gene score was associated with allergy-related phenotypes in cohorts of children with mild and severe asthma. Furthermore, TNFRSF21 was significantly upregulated in bronchial basal epithelial cells from adults with allergic asthma but not in adults with allergies (but not asthma) after allergen challenge. CONCLUSIONS We report novel associations between rare variants in genes and allergic and inflammatory phenotypes in children with diverse ancestries, highlighting TNFRSF21 as contributing to the development of allergic asthma.
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Affiliation(s)
- Selene Clay
- Department of Human Genetics, University of Chicago, Chicago, Ill.
| | - Jehan Alladina
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Neal P Smith
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Mass; Massachusetts General Hospital Cancer Center, Boston, Mass
| | | | - Robert A Wood
- Pediatric Allergy and Immunology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md
| | - George T O'Connor
- Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Robyn T Cohen
- Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | | | - Carolyn M Kercsmar
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rebecca S Gruchalla
- Internal Medicine and Pediatrics, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Michelle A Gill
- Pediatric Infectious Diseases, St. Louis Children's Hospital, St Louis, Mo
| | - Andrew H Liu
- Breathing Institute, Children's Hospital Colorado, Aurora, Colo
| | - Haejin Kim
- Allergy and Immunology, Henry Ford Health, Detroit, Mich
| | - Meyer Kattan
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Deepa Rastogi
- Division of Pulmonology and Sleep Medicine, Children's National Hospital, Washington, DC
| | - Katherine Rivera-Spoljaric
- Department of Pediatric Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St Louis, Mo
| | - Rachel G Robison
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn; Ann & Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Rockville, Md
| | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Alexandra-Chloe Villani
- Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, Mass; Massachusetts General Hospital Cancer Center, Boston, Mass
| | - Josalyn L Cho
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Benjamin D Medoff
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass; Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Matthew Dapas
- Department of Human Genetics, University of Chicago, Chicago, Ill
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2
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Biagini JM, Martin LJ, He H, Bacharier LB, Gebretsadik T, Hartert TV, Jackson DJ, Kim H, Miller RL, Rivera-Spoljaric K, Schauberger EM, Singh AM, Visness CM, Wegienka G, Ownby DR, Gold DR, Martinez FD, Johnson CC, Wright AL, Gern JE, Khurana Hershey GK. Performance of the Pediatric Asthma Risk Score across Diverse Populations. NEJM Evid 2023; 2:EVIDoa2300026. [PMID: 38320177 DOI: 10.1056/evidoa2300026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Performance of PARS across Diverse PopulationsThe methods to determine whether a toddler is likely to develop asthma by 5 to 10 years of age were developed and validated in homogenous populations. The Pediatric Asthma Risk Score was tested to determine whether this score was a reliable predictor in diverse populations, and it functioned well when tested with data from a broad range of backgrounds.
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Affiliation(s)
- Jocelyn M Biagini
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
| | - Lisa J Martin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati
| | - Hua He
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati
| | | | - Tebeb Gebretsadik
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville
| | - Tina V Hartert
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Haejin Kim
- Department of Internal Medicine, Henry Ford Health, Detroit
| | - Rachel L Miller
- Department of Medicine, Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York
| | | | - Eric M Schauberger
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Anne Marie Singh
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Ganesa Wegienka
- Department of Public Health Sciences, Henry Ford Health System, Detroit
| | - Dennis R Ownby
- Department of Public Health Sciences, Henry Ford Health System, Detroit
| | - Diane R Gold
- The Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston
| | - Fernando D Martinez
- Asthma and Airways Disease Research Center, Department of Pediatrics, College of Medicine, University of Arizona, Tucson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, College of Medicine, University of Arizona, Tucson
| | | | - Anne L Wright
- Asthma and Airways Disease Research Center, Department of Pediatrics, College of Medicine, University of Arizona, Tucson
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, College of Medicine, University of Arizona, Tucson
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati
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3
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Miller RL, Schuh H, Chandran A, Aris IM, Bendixsen C, Blossom J, Breton C, Camargo CA, Canino G, Carroll KN, Commodore S, Cordero JF, Dabelea DM, Ferrara A, Fry RC, Ganiban JM, Gern JE, Gilliland FD, Gold DR, Habre R, Hare ME, Harte RN, Hartert T, Hasegawa K, Khurana Hershey GK, Jackson DJ, Joseph C, Kerver JM, Kim H, Litonjua AA, Marsit CJ, McEvoy C, Mendonça EA, Moore PE, Nkoy FL, O'Connor TG, Oken E, Ownby D, Perzanowski M, Rivera-Spoljaric K, Ryan PH, Singh AM, Stanford JB, Wright RJ, Wright RO, Zanobetti A, Zoratti E, Johnson CC. Incidence rates of childhood asthma with recurrent exacerbations in the US Environmental influences on Child Health Outcomes (ECHO) program. J Allergy Clin Immunol 2023; 152:84-93. [PMID: 36972767 PMCID: PMC10330473 DOI: 10.1016/j.jaci.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Descriptive epidemiological data on incidence rates (IRs) of asthma with recurrent exacerbations (ARE) are sparse. OBJECTIVES This study hypothesized that IRs for ARE would vary by time, geography, age, and race and ethnicity, irrespective of parental asthma history. METHODS The investigators leveraged data from 17,246 children born after 1990 enrolled in 59 US with 1 Puerto Rican cohort in the Environmental Influences on Child Health Outcomes (ECHO) consortium to estimate IRs for ARE. RESULTS The overall crude IR for ARE was 6.07 per 1000 person-years (95% CI: 5.63-6.51) and was highest for children aged 2-4 years, for Hispanic Black and non-Hispanic Black children, and for those with a parental history of asthma. ARE IRs were higher for 2- to 4-year-olds in each race and ethnicity category and for both sexes. Multivariable analysis confirmed higher adjusted ARE IRs (aIRRs) for children born 2000-2009 compared with those born 1990-1999 and 2010-2017, 2-4 versus 10-19 years old (aIRR = 15.36; 95% CI: 12.09-19.52), and for males versus females (aIRR = 1.34; 95% CI 1.16-1.55). Black children (non-Hispanic and Hispanic) had higher rates than non-Hispanic White children (aIRR = 2.51; 95% CI 2.10-2.99; and aIRR = 2.04; 95% CI: 1.22-3.39, respectively). Children born in the Midwest, Northeast and South had higher rates than those born in the West (P < .01 for each comparison). Children with a parental history of asthma had rates nearly 3 times higher than those without such history (aIRR = 2.90; 95% CI: 2.43-3.46). CONCLUSIONS Factors associated with time, geography, age, race and ethnicity, sex, and parental history appear to influence the inception of ARE among children and adolescents.
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Affiliation(s)
| | - Holly Schuh
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Izzuddin M Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Inc, Boston, Mass
| | | | - Jeffrey Blossom
- Harvard University Center for Geographic Analysis, Cambridge, Mass
| | - Carrie Breton
- Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Carlos A Camargo
- Department of Epidemiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Glorisa Canino
- University of Puerto Rico Behavioral Sciences Research Institute, San Juan, Puerto Rico
| | | | | | - José F Cordero
- University of Georgia College of Public Health, Athens, Ga
| | - Dana M Dabelea
- University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Assiamira Ferrara
- Division of Research, Kaiser Permanente Northern California, Oakland, Calif
| | - Rebecca C Fry
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - James E Gern
- University of Wisconsin School of Medicine and Public Heath, Madison, Wis
| | - Frank D Gilliland
- Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Diane R Gold
- Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Rima Habre
- Keck School of Medicine of University of Southern California, Los Angeles, Calif
| | - Marion E Hare
- University of Tennessee Health Science Center, Memphis, Tenn
| | | | - Tina Hartert
- Vanderbilt University School of Medicine, Nashville, Tenn
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Gurjit K Khurana Hershey
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Heath, Madison, Wis
| | | | - Jean M Kerver
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, Mich
| | | | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, NY
| | - Carmen J Marsit
- Rollins School of Public Health, Emory University, Atlanta, Ga
| | - Cindy McEvoy
- Oregon Health and Science University, Portland, Ore
| | - Eneida A Mendonça
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Paul E Moore
- Vanderbilt University School of Medicine, Nashville, Tenn
| | | | - Thomas G O'Connor
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Inc, Boston, Mass
| | | | | | | | - Patrick H Ryan
- University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne Marie Singh
- University of Wisconsin School of Medicine and Public Heath, Madison, Wis
| | | | | | | | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Mass
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4
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Morin A, Thompson EE, Helling BA, Shorey-Kendrick LE, Faber P, Gebretsadik T, Bacharier LB, Kattan M, O'Connor GT, Rivera-Spoljaric K, Wood RA, Barnes KC, Mathias RA, Altman MC, Hansen K, McEvoy CT, Spindel ER, Hartert T, Jackson DJ, Gern JE, McKennan CG, Ober C. A functional genomics pipeline to identify high-value asthma and allergy CpGs in the human methylome. J Allergy Clin Immunol 2023; 151:1609-1621. [PMID: 36754293 PMCID: PMC10859971 DOI: 10.1016/j.jaci.2022.12.828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/24/2022] [Accepted: 12/20/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND DNA methylation of cytosines at cytosine-phosphate-guanine (CpG) dinucleotides (CpGs) is a widespread epigenetic mark, but genome-wide variation has been relatively unexplored due to the limited representation of variable CpGs on commercial high-throughput arrays. OBJECTIVES To explore this hidden portion of the epigenome, this study combined whole-genome bisulfite sequencing with in silico evidence of gene regulatory regions to design a custom array of high-value CpGs. This study focused on airway epithelial cells from children with and without allergic asthma because these cells mediate the effects of inhaled microbes, pollution, and allergens on asthma and allergic disease risk. METHODS This study identified differentially methylated regions from whole-genome bisulfite sequencing in nasal epithelial cell DNA from a total of 39 children with and without allergic asthma of both European and African ancestries. This study selected CpGs from differentially methylated regions, previous allergy or asthma epigenome-wide association studies (EWAS), or genome-wide association study loci, and overlapped them with functional annotations for inclusion on a custom Asthma&Allergy array. This study used both the custom and EPIC arrays to perform EWAS of allergic sensitization (AS) in nasal epithelial cell DNA from children in the URECA (Urban Environment and Childhood Asthma) birth cohort and using the custom array in the INSPIRE [Infant Susceptibility to Pulmonary Infections and Asthma Following RSV Exposure] birth cohort. Each CpG on the arrays was assigned to its nearest gene and its promotor capture Hi-C interacting gene and performed expression quantitative trait methylation (eQTM) studies for both sets of genes. RESULTS Custom array CpGs were enriched for intermediate methylation levels compared to EPIC CpGs. Intermediate methylation CpGs were further enriched among those associated with AS and for eQTMs on both arrays. CONCLUSIONS This study revealed signature features of high-value CpGs and evidence for epigenetic regulation of genes at AS EWAS loci that are robust to race/ethnicity, ascertainment, age, and geography.
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Affiliation(s)
- Andréanne Morin
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | - Emma E Thompson
- Department of Human Genetics, University of Chicago, Chicago, Ill
| | | | - Lyndsey E Shorey-Kendrick
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore
| | - Pieter Faber
- Genomics Core, University of Chicago, Chicago, Ill
| | - Tebeb Gebretsadik
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Meyer Kattan
- Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - George T O'Connor
- Pulmonary Center, Boston University School of Medicine, Boston, Mass
| | | | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University, Baltimore, Md
| | | | | | - Matthew C Altman
- Systems Immunology Division, Benaroya Research Institute Systems, Seattle, Wash; Department of Medicine, University of Washington, Seattle, Wash
| | - Kasper Hansen
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md
| | - Cindy T McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, Ore
| | - Eliot R Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore
| | - Tina Hartert
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Chris G McKennan
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pa.
| | - Carole Ober
- Department of Human Genetics, University of Chicago, Chicago, Ill.
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5
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Tanis R, Calatroni A, Bacharier L, Little F, Sandel M, Rivera-Spoljaric K, Visness C, Togias A, Gergen P, Gern J, Ramratnam S, Lamm C, Wood R, Johnson M. Comparison of Rhinitis Phenotypes with the Development of Asthma by Age 10 in an Urban Birth Cohort. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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6
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Eapen A, Sitarik A, Biagini J, Jackson D, Joseph C, Kim H, Martin L, Rivera-Spoljaric K, Schauberger E, Wegienka G, Gern J, Singh AM. Longitudinal assessment of Allergic Outcomes and Atopic Dermatitis Phenotypes in The Children's Respiratory and Environmental Workgroup (CREW) Birth Cohort Consortium. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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7
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Afshan T, Kulkarni A, Smith J, Blackshere T, Tesson E, Hartert T, Rivera-Spoljaric K, Zoratti E, Joseph C, Gangnon R, Gern J, Singh AM. Examining virtual research recruitment and participant diversity in a multi-center birth cohort, Childhood Allergy and the NeOnatal Environment" (CANOE). J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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8
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Sitarik A, Biagini J, Eapen A, Jackson D, Joseph C, Kim H, Martin L, Rivera-Spoljaric K, Schauberger E, Wegienka G, Gern J, Singh AM. Longitudinal Characterization of Atopic Dermatitis Phenotypes in The Children's Respiratory and Environmental Workgroup (CREW) Birth Cohort Consortium. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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9
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Zoratti E, Wood R, O G, Pongracic J, Makhija M, Hershey GK, Sherenian M, Gill M, Gruchalla R, Chambliss J, Liu A, Kattan M, Busse P, Bacharier L, Rivera-Spoljaric K, Sheehan W, Jackson D, Gergen P, Togias A, Calatroni A, Visness C, Cho K, Sette A, Altman M, Busse W. The Effect of Subcutaneous German Cockroach Immunotherapy (SCIT) on Nasal Allergen Challenge (NAC) and Cockroach-specific Antibody Responses Among Urban Children and Adolescents. J Allergy Clin Immunol 2023. [DOI: 10.1016/j.jaci.2022.12.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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10
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Havens TN, Rosen DA, Rivera-Spoljaric K. Airway multidrug-resistant organisms in a population of tracheostomy and chronic ventilator-dependent children at a tertiary care pediatric hospital. Pediatr Pulmonol 2023; 58:26-34. [PMID: 36100968 DOI: 10.1002/ppul.26152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 08/16/2022] [Accepted: 09/01/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE/BACKGROUND Children with tracheostomies are at an increased risk of bacterial respiratory tract infections. Infections caused by multidrug-resistant organisms (MDROs) are more difficult to treat and can result in severe complications. This study aimed to investigate the risk factors and sequelae of MDRO positivity in tracheostomy and chronic ventilator-dependent children. METHODS We performed a retrospective chart review of 75 tracheostomy and chronic ventilator-dependent children at St. Louis Children's Hospital. Data on demographics, respiratory cultures, hospitalizations, emergency department (ED) visits, and antibiotic usage were collected. We determined the frequency of MDRO positivity and compared the number of hospitalizations, number of ED visits, and antibiotic usage in patients with and without MDRO-positive cultures. Patient clinical variables were analyzed before and after MDRO acquisition. RESULTS We found 75.7% (56/74) of our participants had an MDRO-positive culture, with methicillin-resistant Staphylococcus aureus (MRSA, n = 36, 64%) and Pseudomonas aeruginosa (n = 8, 14%) being the most commonly detected organisms. Participants with a greater number of annual nonpulmonary admissions (odds ratio [OR] = 1.99, 95% confidence interval [CI] (1.21-3.29), p = 0.008], inpatient antibiotic courses [OR = 1.27, 95% CI (1.07-1.50), p = 0.006], total antibiotic courses [OR = 1.26, 95% CI (1.08-1.48), p = 0.004], and chronic antibiotic use [OR = 2.31, 95% CI (1.12-4.74), p = 0.03] were at an increased risk for MDRO positivity. Those who were MDRO-positive had more pulmonary admissions following MDRO acquisition compared those who were MDRO-negative [p = 0.005] but not more antibiotic usage or ED visits. CONCLUSION Frequent antibiotic usage and hospitalizations increase the risk of MDRO acquisition in children with tracheostomies and ventilator-dependence. Further antibiotic stewardship may help prevent resistant infections in technology-dependent children.
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Affiliation(s)
- Tara N Havens
- Division of Pediatric Allergy and Pulmonary Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - David A Rosen
- Division of Pediatric Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri, USA.,Department of Molecular Microbiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Katherine Rivera-Spoljaric
- Division of Pediatric Allergy and Pulmonary Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
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11
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Hazan G, Orscheln RC, Kertz L, Rivera-Spoljaric K. A child with chronic cough and eosinophilia secondary to Strongyloides stercoralis infection. Pediatr Pulmonol 2022; 57:2562-2564. [PMID: 35778783 DOI: 10.1002/ppul.26048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 06/26/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Guy Hazan
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rachel C Orscheln
- Division of Pediatric Infectious Diseases, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lila Kertz
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katherine Rivera-Spoljaric
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
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12
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Jackson DJ, Bacharier LB, Gergen PJ, Gagalis L, Calatroni A, Wellford S, Gill MA, Stokes J, Liu AH, Gruchalla RS, Cohen RT, Makhija M, Khurana Hershey GK, O'Connor GT, Pongracic JA, Sherenian MG, Rivera-Spoljaric K, Zoratti EM, Teach SJ, Kattan M, Dutmer CM, Kim H, Lamm C, Sheehan WJ, Segnitz RM, Dill-McFarland KA, Visness CM, Becker PM, Gern JE, Sorkness CA, Busse WW, Altman MC. Mepolizumab for urban children with exacerbation-prone eosinophilic asthma in the USA (MUPPITS-2): a randomised, double-blind, placebo-controlled, parallel-group trial. Lancet 2022; 400:502-511. [PMID: 35964610 PMCID: PMC9623810 DOI: 10.1016/s0140-6736(22)01198-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Black and Hispanic children living in urban environments in the USA have an excess burden of morbidity and mortality from asthma. Therapies directed at the eosinophilic phenotype reduce asthma exacerbations in adults, but few data are available in children and diverse populations. Furthermore, the molecular mechanisms that underlie exacerbations either being prevented by, or persisting despite, immune-based therapies are not well understood. We aimed to determine whether mepolizumab, added to guidelines-based care, reduced the number of asthma exacerbations during a 52-week period compared with guidelines-based care alone. METHODS This is a randomised, double-blind, placebo-controlled, parallel-group trial done at nine urban medical centres in the USA. Children and adolescents aged 6-17 years, who lived in socioeconomically disadvantaged neighbourhoods and had exacerbation-prone asthma (defined as ≥two exacerbations in the previous year) and blood eosinophils of at least 150 cells per μL were randomly assigned 1:1 to mepolizumab (6-11 years: 40 mg; 12-17 years: 100 mg) or placebo injections once every 4 weeks, plus guideline-based care, for 52 weeks. Randomisation was done using a validated automated system. Participants, investigators, and the research staff who collected outcome measures remained masked to group assignments. The primary outcome was the number of asthma exacerbations that were treated with systemic corticosteroids during 52 weeks in the intention-to-treat population. The mechanisms of treatment response were assessed by study investigators using nasal transcriptomic modular analysis. Safety was assessed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT03292588. FINDINGS Between Nov 1, 2017, and Mar 12, 2020, we recruited 585 children and adolescents. We screened 390 individuals, of whom 335 met the inclusion criteria and were enrolled. 290 met the randomisation criteria, were randomly assigned to mepolizumab (n=146) or placebo (n=144), and were included in the intention-to-treat analysis. 248 completed the study. The mean number of asthma exacerbations within the 52-week study period was 0·96 (95% CI 0·78-1·17) with mepolizumab and 1·30 (1·08-1·57) with placebo (rate ratio 0·73; 0·56-0·96; p=0·027). Treatment-emergent adverse events occurred in 42 (29%) of 146 participants in the mepolizumab group versus 16 (11%) of 144 participants in the placebo group. No deaths were attributed to mepolizumab. INTERPRETATION Phenotype-directed therapy with mepolizumab in urban children with exacerbation-prone eosinophilic asthma reduced the number of exacerbations. FUNDING US National Institute of Allergy and Infectious Diseases and GlaxoSmithKline.
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Affiliation(s)
- Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - Lisa Gagalis
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | | | | | - Michelle A Gill
- Department of Pediatrics, Washington University, St Louis, MO, USA
| | - Jeffrey Stokes
- Department of Pediatrics, Washington University, St Louis, MO, USA
| | - Andrew H Liu
- Pediatric Pulmonary and Sleep Medicine, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Rebecca S Gruchalla
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robyn T Cohen
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Melanie Makhija
- Division of Allergy and Immunology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | | | - George T O'Connor
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Jacqueline A Pongracic
- Division of Allergy and Immunology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Michael G Sherenian
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Katherine Rivera-Spoljaric
- Department of Pediatrics, Washington University, St Louis, MO, USA; St Louis Children's Hospital, St Louis, MO, USA
| | - Edward M Zoratti
- Department of Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Stephen J Teach
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Meyer Kattan
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Cullen M Dutmer
- Pediatrics-Allergy and Immunology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, CO, USA
| | - Haejin Kim
- Department of Medicine, Henry Ford Health System, Detroit, MI, USA
| | - Carin Lamm
- Department of Pediatrics, New York Columbia University Medical Center, New York, NY, USA
| | - William J Sheehan
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - R Max Segnitz
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | | | - Patrice M Becker
- National Institute of Allergy and Infectious Diseases, Bethesda, MD, USA
| | - James E Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christine A Sorkness
- School of Pharmacy, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matthew C Altman
- Department of Medicine, University of Washington, Seattle, WA, USA; Benaroya Research Institute, Seattle, WA, USA
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Seibold MA, Moore CM, Everman JL, Williams BJM, Nolin JD, Fairbanks-Mahnke A, Plender EG, Patel BB, Arbes SJ, Bacharier LB, Bendixsen CG, Calatroni A, Camargo CA, Dupont WD, Furuta GT, Gebretsadik T, Gruchalla RS, Gupta RS, Khurana Hershey GK, Murrison LB, Jackson DJ, Johnson CC, Kattan M, Liu AH, Lussier SJ, O'Connor GT, Rivera-Spoljaric K, Phipatanakul W, Rothenberg ME, Seroogy CM, Teach SJ, Zoratti EM, Togias A, Fulkerson PC, Hartert TV. Risk factors for SARS-CoV-2 infection and transmission in households with children with asthma and allergy: A prospective surveillance study. J Allergy Clin Immunol 2022; 150:302-311. [PMID: 35660376 PMCID: PMC9155183 DOI: 10.1016/j.jaci.2022.05.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/04/2022] [Accepted: 05/12/2022] [Indexed: 10/26/2022]
Abstract
BACKGROUND Whether children and people with asthma and allergic diseases are at increased risk for severe acute respiratory syndrome virus 2 (SARS-CoV-2) infection is unknown. OBJECTIVE Our aims were to determine the incidence of SARS-CoV-2 infection in households with children and to also determine whether self-reported asthma and/or other allergic diseases are associated with infection and household transmission. METHODS For 6 months, biweekly nasal swabs and weekly surveys were conducted within 1394 households (N = 4142 participants) to identify incident SARS-CoV-2 infections from May 2020 to February 2021, which was the pandemic period largely before a vaccine and before the emergence of SARS-CoV-2 variants. Participant and household infection and household transmission probabilities were calculated by using time-to-event analyses, and factors associated with infection and transmission risk were determined by using regression analyses. RESULTS In all, 147 households (261 participants) tested positive for SARS-CoV-2. The household SARS-CoV-2 infection probability was 25.8%; the participant infection probability was similar for children (14.0% [95% CI = 8.0%-19.6%]), teenagers (12.1% [95% CI = 8.2%-15.9%]), and adults (14.0% [95% CI = 9.5%-18.4%]). Infections were symptomatic in 24.5% of children, 41.2% of teenagers, and 62.5% of adults. Self-reported doctor-diagnosed asthma was not a risk factor for infection (adjusted hazard ratio [aHR] = 1.04 [95% CI = 0.73-1.46]), nor was upper respiratory allergy or eczema. Self-reported doctor-diagnosed food allergy was associated with lower infection risk (aHR = 0.50 [95% CI = 0.32-0.81]); higher body mass index was associated with increased infection risk (aHR per 10-point increase = 1.09 [95% CI = 1.03-1.15]). The household secondary attack rate was 57.7%. Asthma was not associated with household transmission, but transmission was lower in households with food allergy (adjusted odds ratio = 0.43 [95% CI = 0.19-0.96]; P = .04). CONCLUSION Asthma does not increase the risk of SARS-CoV-2 infection. Food allergy is associated with lower infection risk, whereas body mass index is associated with increased infection risk. Understanding how these factors modify infection risk may offer new avenues for preventing infection.
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Affiliation(s)
- Max A Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo; Department of Pediatrics, National Jewish Health, Denver, Colo; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, Colo.
| | - Camille M Moore
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo; Department of Biomedical Research, National Jewish Health, Denver, Colo; Department of Biostatistics and Informatics, University of Colorado, Denver, Colo
| | - Jamie L Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | - Blake J M Williams
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | - James D Nolin
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | | | - Elizabeth G Plender
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | - Bhavika B Patel
- Center for Genes, Environment, and Health, National Jewish Health, Denver, Colo
| | | | - Leonard B Bacharier
- Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Agustin Calatroni
- Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | | | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado and Section of Pediatric Gastroenterology, Hepatology and Nutrition, Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colo
| | - Tebeb Gebretsadik
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Ruchi S Gupta
- Ann and Robert H. Lurie Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Ill
| | | | - Liza Bronner Murrison
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Daniel J Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | | | - Meyer Kattan
- Columbia University Medical Center, New York, NY
| | - Andrew H Liu
- Digestive Health Institute, Children's Hospital Colorado and Section of Pediatric Gastroenterology, Hepatology and Nutrition, Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colo; University of Colorado School of Medicine, Aurora, Colo
| | | | - George T O'Connor
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | | | | | - Marc E Rothenberg
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | | | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Rockville, Md
| | | | - Tina V Hartert
- Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt University Medical Center, Nashville, Tenn
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Fulkerson PC, Lussier SJ, Bendixsen CG, Castina SM, Gebretsadik T, Marlin JS, Russell PB, Seibold MA, Everman JL, Moore CM, Snyder BM, Thompson K, Tregoning GS, Wellford S, Arbes SJ, Bacharier LB, Calatroni A, Camargo CA, Dupont WD, Furuta GT, Gruchalla RS, Gupta RS, Hershey GK, Jackson DJ, Johnson CC, Kattan M, Liu AH, Murrison L, O’Connor GT, Phipatanakul W, Rivera-Spoljaric K, Rothenberg ME, Seroogy CM, Teach SJ, Zoratti EM, Togias A, Hartert TV. Human Epidemiology and RespOnse to SARS-CoV-2 (HEROS): Objectives, Design and Enrollment Results of a 12-City Remote Observational Surveillance Study of Households with Children using Direct-to-Participant Methods. medRxiv 2022:2022.07.09.22277457. [PMID: 35860216 PMCID: PMC9298141 DOI: 10.1101/2022.07.09.22277457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Human Epidemiology and Response to SARS-CoV-2 (HEROS) is a prospective multi-city 6-month incidence study which was conducted from May 2020-February 2021. The objectives were to identify risk factors for SARS-CoV-2 infection and household transmission among children and people with asthma and allergic diseases, and to use the host nasal transcriptome sampled longitudinally to understand infection risk and sequelae at the molecular level. To overcome challenges of clinical study implementation due to the coronavirus pandemic, this surveillance study used direct-to-participant methods to remotely enroll and prospectively follow eligible children who are participants in other NIH-funded pediatric research studies and their household members. Households participated in weekly surveys and biweekly nasal sampling regardless of symptoms. The aim of this report is to widely share the methods and study instruments and to describe the rationale, design, execution, logistics and characteristics of a large, observational, household-based, remote cohort study of SARS-CoV-2 infection and transmission in households with children. The study enrolled a total of 5,598 individuals, including 1,913 principal participants (children), 1,913 primary caregivers, 729 secondary caregivers and 1,043 other household children. This study was successfully implemented without necessitating any in-person research visits and provides an approach for rapid execution of clinical research.
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Affiliation(s)
| | | | - Casper G. Bendixsen
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI, USA
| | | | - Tebeb Gebretsadik
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica S. Marlin
- Vanderbilt Coordinating Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Patty B. Russell
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Max A. Seibold
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine; Aurora, CO, USA
| | - Jamie L. Everman
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
| | - Camille M. Moore
- Center for Genes, Environment, and Health, National Jewish Health, Denver, CO, USA
- Department of Biomedical Research, National Jewish Health; Denver, CO, USA
- Department of Biostatistics and Informatics, University of Colorado; Denver, CO, USA
| | - Brittney M. Snyder
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kathy Thompson
- National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - George S. Tregoning
- Vanderbilt Coordinating Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Leonard B. Bacharier
- Department of Medicine, Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - William D. Dupont
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Glenn T. Furuta
- Digestive Health Institute, Children’s Hospital Colorado and Section of Pediatric Gastroenterology, Hepatology and Nutrition, Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Ruchi S. Gupta
- Ann & Robert H. Lurie Hospital of Chicago & Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gurjit Khurana Hershey
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel J. Jackson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Meyer Kattan
- Columbia University Medical Center, New York, NY, USA
| | - Andrew H. Liu
- Breathing Institute, Children’s Hospital Colorado and Section of Pediatric Pulmonary & Sleep Medicine, University of Colorado School of Medicine, Aurora CO, USA
| | - Liza Murrison
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | | | - Marc E. Rothenberg
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Tina V. Hartert
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Asthma Research, Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Jackson D, Bacharier L, Gergen P, Gagalis L, Villarreal M, Gill M, Liu A, Gruchalla R, Cohen R, Makhija M, Hershey GK, Sherenian M, Rivera-Spoljaric K, Stokes J, Zoratti E, Teach S, Kattan M, Visness C, Becker P, Gern J, Sorkness C, Busse W, Altman M. Phenotype-directed Therapy with Mepolizumab for Urban Children with Exacerbation-Prone Asthma. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Afshan T, Kulkarni A, Blackshere T, Smith J, Tesson E, Hartert T, Rivera-Spoljaric K, Zoratti E, Joseph C, Gern J, Singh AM. Childhood Allergy and the NeOnatal Environment (CANOE) Research Protocol and Recruitment Redesign during the COVID-19 Pandemic. J Allergy Clin Immunol 2022. [PMCID: PMC8804465 DOI: 10.1016/j.jaci.2021.12.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Ramratnam S, Johnson M, Calatroni A, Bacharier L, Lamm C, Little F, Sandel M, Rivera-Spoljaric K, Wood R, Limkar A, Visness C, Togias A, Gergen P, Gern J. Associations between Early Life Environmental Exposures and Rhinitis Trajectories in an Urban Birth Cohort. J Allergy Clin Immunol 2022. [DOI: 10.1016/j.jaci.2021.12.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Stratakis N, Garcia E, Chandran A, Hsu T, Alshawabkeh A, Aris IM, Aschner JL, Breton C, Burbank A, Camargo CA, Carroll KN, Chen Z, Claud EC, Dabelea D, Dunlop AL, Elliott AJ, Ferrara A, Ganiban JM, Gern JE, Gold DR, Gower WA, Hertz-Picciotto I, Karagas MR, Karr CJ, Lester B, Leve LD, Litonjua AA, Ludena Y, McEvoy CT, Miller RL, Mueller NT, O’Connor TG, Oken E, O’Shea TM, Perera F, Stanford JB, Rivera-Spoljaric K, Rundle A, Trasande L, Wright RJ, Zhang Y, Zhu Y, Berhane K, Gilliland F, Chatzi L. The Role of Childhood Asthma in Obesity Development: A Nationwide US Multicohort Study. Epidemiology 2022; 33:131-140. [PMID: 34561347 PMCID: PMC8633057 DOI: 10.1097/ede.0000000000001421] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
RATIONALE Asthma and obesity often co-occur. It has been hypothesized that asthma may contribute to childhood obesity onset. OBJECTIVES To determine if childhood asthma is associated with incident obesity and examine the role of asthma medication in this association. METHODS We studied 8,716 children between ages 6 and 18.5 years who were nonobese at study entry participating in 18 US cohorts of the Environmental influences on Child Health Outcomes program (among 7,299 children with complete covariate data mean [SD] study entry age = 7.2 [1.6] years and follow up = 5.3 [3.1] years). MEASUREMENTS AND MAIN RESULTS We defined asthma based on caregiver report of provider diagnosis. Incident obesity was defined as the first documented body mass index ≥95th percentile for age and sex following asthma status ascertainment. Over the study period, 26% of children had an asthma diagnosis and 11% developed obesity. Cox proportional hazards models with sex-specific baseline hazards were fitted to assess the association of asthma diagnosis with obesity incidence. Children with asthma had a 23% (95% confidence intervals [CI] = 4, 44) higher risk for subsequently developing obesity compared with those without asthma. A novel mediation analysis was also conducted to decompose the total asthma effect on obesity into pathways mediated and not mediated by asthma medication use. Use of asthma medication attenuated the total estimated effect of asthma on obesity by 64% (excess hazard ratios = 0.64; 95% CI = -1.05, -0.23). CONCLUSIONS This nationwide study supports the hypothesis that childhood asthma is associated with later risk of obesity. Asthma medication may reduce this association and merits further investigation as a potential strategy for obesity prevention among children with asthma.
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Affiliation(s)
- Nikos Stratakis
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erika Garcia
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Aruna Chandran
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Tingju Hsu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Akram Alshawabkeh
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA
| | - Izzuddin M. Aris
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA
| | - Judy L. Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley NJ and the Albert Einstein College of Medicine, Bronx, NY
| | - Carrie Breton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Allison Burbank
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Carlos A. Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kecia N. Carroll
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Zhanghua Chen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Erika C. Claud
- Departments of Pediatrics and Medicine, The University of Chicago, Chicago, IL
| | - Dana Dabelea
- University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Anne L. Dunlop
- Nell Hodgson Woodruff School of Nursing and Department of Family & Preventive Medicine, Emory University, Atlanta, GA
| | | | | | - Jody M. Ganiban
- Department of Psychology The George Washington University, Washington, DC
| | - James E. Gern
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Diane R Gold
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States; Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - William A. Gower
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Catherine J. Karr
- Department of Pediatrics & Environmental and Occupational Health Sciences, University of Washington, WA
| | - Barry Lester
- Department of Psychiatry and Human Behavior and Department of Pediatrics, Brown Alpert Medical School and Women and Infants Hospital, Providence, RI
| | - Leslie D. Leve
- Department of Education, University of Oregon, Eugene, OR
| | - Augusto A. Litonjua
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY
| | - Yunin Ludena
- University of California, Davis, School of Medicine, CA
| | - Cindy T. McEvoy
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | - Rachel L. Miller
- Division of Clinical Immunology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Noel T. Mueller
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Thomas G. O’Connor
- Departments of Psychiatry, Psychology, Neuroscience and Obstetrics and Gynecology, University of Rochester, NY
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston MA
| | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Frederica Perera
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Joseph B. Stanford
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT
| | - Katherine Rivera-Spoljaric
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of PediatricsSt. Louis Children’s Hospital, Washington University School of Medicine St. Louis, MO
| | - Andrew Rundle
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY
| | - Leonardo Trasande
- Departments of Pediatrics, Environmental Medicine and Population Health, New York University School of Medicine, NY
| | - Rosalind J. Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yue Zhang
- Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Yeyi Zhu
- Kaiser Permanente Northern California Division of Research
| | - Kiros Berhane
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Frank Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Lida Chatzi
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
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Lovinsky-Desir S, Lussier SJ, Calatroni A, Gergen PJ, Rivera-Spoljaric K, Bacharier LB, De A, O'Connor GT, Sandel MT, Wood RA, Arteaga-Solis E, Gern JE, Kattan M. Trajectories of adiposity indicators and association with asthma and lung function in urban minority children. J Allergy Clin Immunol 2021; 148:1219-1226.e7. [PMID: 34166677 PMCID: PMC8578316 DOI: 10.1016/j.jaci.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/29/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A relationship between adiposity and asthma has been described in some cohort studies, but little is known about trajectories of adiposity throughout early childhood among children at high risk for developing asthma in urban United States cities. Moreover, early life trajectories of adipokines that have metabolic and immunologic properties have not been comprehensively investigated. OBJECTIVE Our objective was to characterize trajectories of adiposity in a longitudinal birth cohort of predominately Black and Latinx children (n = 418) using several different repeated measures including body mass index (BMI) z score, bioimpedance analysis, leptin, and adiponectin in the first 10 years of life. METHODS In a longitudinal birth cohort of predominately Black and Latinx children, we used repeated annual measures of BMI, bioimpedance analysis (ie, percentage of body fat), leptin, and adiponectin to create trajectories across the first 10 years of life. Across those trajectories, we compared asthma diagnosis and multiple lung function outcomes, including spirometry, impulse oscillometry, and methacholine response. RESULTS Three trajectories were observed for BMI z score, bioimpedance analysis, and leptin and 2 for adiponectin. There was no association between trajectories of BMI, percentage of body fat, leptin, or adipokine and asthma diagnosis or lung function (P > .05). CONCLUSIONS Trajectories of adiposity were not associated with asthma or lung function in children at high risk for developing asthma. Risk factors related to geography as well as social and demographic factors unique to specific populations could explain the lack of association and should be considered in obesity and asthma studies.
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Affiliation(s)
- Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY.
| | | | | | - Peter J Gergen
- National Institute of Allergy and Infectious Diseases, Rockville, Md
| | - Katherine Rivera-Spoljaric
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Leonard B Bacharier
- Department of Pediatrics, Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo
| | - Aliva De
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - George T O'Connor
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Megan T Sandel
- Department of Medicine, Boston University School of Medicine, Boston, Mass
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University Medical Center, Baltimore, Md
| | - Emilio Arteaga-Solis
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
| | - James E Gern
- Department of Pediatrics, University of Wisconsin-Madison, Madison, Wis
| | - Meyer Kattan
- Division of Pediatric Pulmonology, Columbia University Irving Medical Center, Vagelos College of Physicians and Surgeons, New York, NY
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Reedy N, Beigelman A, Bacharier LB, Garbutt J, Rivera-Spoljaric K. Food-Specific IgE Testing in Children: Current Practices Among Primary Care Pediatricians and a Web-Based Educational Intervention. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sterni LM, Collaco JM, Baker CD, Carroll JL, Sharma GD, Brozek JL, Finder JD, Ackerman VL, Arens R, Boroughs DS, Carter J, Daigle KL, Dougherty J, Gozal D, Kevill K, Kravitz RM, Kriseman T, MacLusky I, Rivera-Spoljaric K, Tori AJ, Ferkol T, Halbower AC. An Official American Thoracic Society Clinical Practice Guideline: Pediatric Chronic Home Invasive Ventilation. Am J Respir Crit Care Med 2016; 193:e16-35. [PMID: 27082538 DOI: 10.1164/rccm.201602-0276st] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Children with chronic invasive ventilator dependence living at home are a diverse group of children with special health care needs. Medical oversight, equipment management, and community resources vary widely. There are no clinical practice guidelines available to health care professionals for the safe hospital discharge and home management of these complex children. PURPOSE To develop evidence-based clinical practice guidelines for the hospital discharge and home/community management of children requiring chronic invasive ventilation. METHODS The Pediatric Assembly of the American Thoracic Society assembled an interdisciplinary workgroup with expertise in the care of children requiring chronic invasive ventilation. The experts developed four questions of clinical importance and used an evidence-based strategy to identify relevant medical evidence. Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was used to formulate and grade recommendations. RESULTS Clinical practice recommendations for the management of children with chronic ventilator dependence at home are provided, and the evidence supporting each recommendation is discussed. CONCLUSIONS Collaborative generalist and subspecialist comanagement is the Medical Home model most likely to be successful for the care of children requiring chronic invasive ventilation. Standardized hospital discharge criteria are suggested. An awake, trained caregiver should be present at all times, and at least two family caregivers should be trained specifically for the child's care. Standardized equipment for monitoring, emergency preparedness, and airway clearance are outlined. The recommendations presented are based on the current evidence and expert opinion and will require an update as new evidence and/or technologies become available.
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Chuen-im P, Marwan S, Carter J, Kemp J, Rivera-Spoljaric K. Heterozygous 24-polyalanine repeats in the PHOX2B gene with different manifestations across three generations. Pediatr Pulmonol 2014; 49:E13-6. [PMID: 23460419 DOI: 10.1002/ppul.22731] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 10/26/2012] [Indexed: 11/10/2022]
Abstract
Congenital central hypoventilation syndrome (CCHS) is an uncommon genetic disorder that is characterized by alveolar hypoventilation and autonomic dysregulation. More than 90% of the patients are heterozygous for polyalanine repeat expansion mutations in the paired-like homeobox 2b (PHOX2B) gene. The normal genotype has a 20-polyalanine sequence whereas expanded alleles are usually 25-33. Heterozygous 24-polyalanine repeat expansion mutation in the PHOX2B gene has rarely been reported. We report three consecutive generations harboring heterozygous 24-polyalanine repeats in the PHOX2B gene with manifestations ranging from apparently asymptomatic to alveolar hypoventilation and apnea requiring mechanical ventilation. The 3-year-old proband developed cor pulmonale and central hypoventilation following an upper respiratory tract infection. Our findings add to the accumulating evidence that the 24-polyalanine repeat in the PHOX2B is a disease-causing mutation. In addition, a high index of suspicion and careful monitoring after anesthesia, sedation, or respiratory illnesses should be exercised when evaluating asymptomatic family members with this genotype.
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Affiliation(s)
- Piyaporn Chuen-im
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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Newton LP, Osei-Akosa Y, Strunk RC, Krauss M, Bacharier LB, Garbutt JM, Rivera-Spoljaric K. Nonrespiratory symptoms before loss of asthma control in children. J Allergy Clin Immunol Pract 2013; 1:304-6.e1-2. [PMID: 24565492 DOI: 10.1016/j.jaip.2013.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 01/17/2013] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
Affiliation(s)
| | - Yvette Osei-Akosa
- Department of Pediatric Allergy and Pulmonary, Washington University School of Medicine, St. Louis, Mo
| | - Robert C Strunk
- Department of Pediatric Allergy and Pulmonary, Washington University School of Medicine, St. Louis, Mo
| | - Melissa Krauss
- Department of Biostatistics, Washington University School of Medicine, St. Louis, Mo
| | - Leonard B Bacharier
- Department of Pediatric Allergy and Pulmonary, Washington University School of Medicine, St. Louis, Mo
| | - Jane M Garbutt
- Department of Pediatric Allergy and Pulmonary, Washington University School of Medicine, St. Louis, Mo
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Chuen-im P, Smyth MD, Segura B, Ferkol T, Rivera-Spoljaric K. Recurrent pleural effusion without intrathoracic migration of ventriculoperitoneal shunt catheter: a case report. Pediatr Pulmonol 2012; 47:91-5. [PMID: 22170808 DOI: 10.1002/ppul.21510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 06/23/2011] [Indexed: 11/07/2022]
Abstract
Pleural effusion is a rare complication of ventriculoperitoneal (VP) shunting, usually due to the migration of the VP shunt catheter into the thorax. Herein we report a neurologically disadvantaged child with a lobar holoprosencephaly and hydrocephalus, initially treated with a VP shunt, who years later developed recurrent right-sided pleural effusion ultimately confirmed to be a cerebrospinal fluid (CSF) hydrothorax without intra-thoracic migration of the distal shunt catheter. Thoracentesis was compatible with a transudative effusion. Given the presence of a persistent pleural effusion, beta-2 transferrin concentrations were measured, which yielded a positive result. Plain radiographs and head computed tomography (CT) showed a normally positioned, functional VP shunt. A spine CT myelogram to look for a spinal dural-thoracic CSF fistula was negative. A radionuclide CSF shunt study demonstrated normal functioning VP shunt with radiotracer accumulation within the peritoneum, with subsequent tracer rapidly accumulating in the right hemithorax. Video-assisted thoracoscopic (VATS) exploration with drainage of the pleural effusion and pleurodesis was then performed. No diaphragmatic defect or shunt tubing within the thorax was found and the procedure failed to resolve the effusion. The patient's recurrent effusion was ultimately resolved with intracranial endoscopic choroid plexus coagulation to decrease CSF output.
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Affiliation(s)
- Piyaporn Chuen-im
- Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri 63110, USA.
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Rivera-Spoljaric K, Jaenicke M, Sridhar S, Krauss MJ, Garbutt JM, Bacharier LB, Strunk RC. Caregivers report a wide variety of early signs and symptoms of impending asthma exacerbations that are not different between preschool and school-aged children. J Allergy Clin Immunol 2011; 128:1109-11.e1-5. [PMID: 21906791 DOI: 10.1016/j.jaci.2011.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 06/20/2011] [Accepted: 06/28/2011] [Indexed: 11/28/2022]
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Garbutt J, Highstein G, Nelson KA, Rivera-Spoljaric K, Strunk R. Detection and home management of worsening asthma symptoms. Ann Allergy Asthma Immunol 2010; 103:469-73. [PMID: 20084839 DOI: 10.1016/s1081-1206(10)60262-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Asthma guidelines recommend early home treatment of exacerbations. However, home treatment is often suboptimal and delayed. OBJECTIVES To describe antecedent symptoms and signs of asthma exacerbations noticed by parents and to learn when and how parents intensify asthma treatment. METHODS Parents of children 2 to 12 years old with asthma exacerbations that required urgent care in the past 12 months completed telephone questionnaires. Where multiple responses were possible, percentages may sum to more than 100%. RESULTS One hundred one parents were enrolled and interviewed; 94% were the children's mothers. Seventy percent of the children were black, and 64% had Medicaid insurance. Parents reported multiple antecedent symptoms and signs (median number per child, 3; range, 1-6), including respiratory symptoms (79%), allergy or cold symptoms (43%), behavioral changes (24%), and other nonspecific symptoms (29%). Twenty-three parents reported late respiratory symptoms, such as gasping for breath and using accessory muscles to breath, as the earliest antecedent signs. Treatment was most often intensified when the parent noticed cough (55%), shortness of breath (54%), and wheeze (25%) and included adding albuterol (92%), an oral corticosteroid (17%), an inhaled corticosteroid (8%), or other nonasthma medications (16%). CONCLUSIONS Although parents described antecedent symptoms and signs of impending asthma exacerbations that they consistently noticed in their children, many waited for lower respiratory signs to be present before intensifying treatment. Oral corticosteroids were used infrequently. Interventions to improve the ability of parents and children to accurately recognize worsening symptoms and initiate timely, effective treatment are needed.
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Affiliation(s)
- Jane Garbutt
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 63110, USA.
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Rivera-Spoljaric K, Jaenicke M, Garbutt J, Bacharier L, Strunk R. Are There Characteristics That Determine Which Type of Early Signs and Symptoms of Asthma a Patient Will Have? J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Newton L, Strunk R, Bacharier L, Garbutt J, Rivera-Spoljaric K. Background Variability During a Well Period of Parent-Identified Respiratory and Non-Respiratory Signs and Symptoms in Children with Asthma. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Rivera-Spoljaric K, Chinchilli VM, Camera LJ, Zeiger RS, Paul IM, Phillips BR, Taussig LM, Strunk RC, Bacharier LB. Signs and symptoms that precede wheezing in children with a pattern of moderate-to-severe intermittent wheezing. J Pediatr 2009; 154:877-81.e4. [PMID: 19324370 PMCID: PMC3086348 DOI: 10.1016/j.jpeds.2008.12.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 09/23/2008] [Accepted: 12/10/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To examine parent-reported signs and symptoms as antecedents of wheezing in preschool children with previous moderate to severe wheezing episodes, and to determine the predictive capacity of these symptom patterns for wheezing events. STUDY DESIGN Parents (n = 238) of children age 12 to 59 months with moderate-to-severe intermittent wheezing enrolled in a year-long clinical trial completed surveys that captured signs and symptoms at the start of a respiratory tract illness (RTI). Sensitivity, specificity, negative predictive value, and positive predictive value (PPV) for each symptom leading to wheezing during that RTI were calculated. RESULTS The most commonly reported first symptom categories during the first RTI were "nose symptoms" (41%), "significant cough" (29%), and "insignificant cough" (13%). The most reliable predictor of subsequent wheezing was significant cough, which had a specificity of 78% and a PPV of 74% for predicting wheezing. CONCLUSIONS Significant cough is the most reliable antecedent of wheezing during an RTI. It may be useful to consider individualized symptom patterns as a component of management plans intended to minimize wheezing episodes.
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