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Rugila DF, Oliveira JM, Machado FVC, Correia NS, Puzzi VC, Passos NFP, Freitas PD, Pitta F, Carvalho CRF, Furlanetto KC. Fat mass to fat-free mass ratio and its associations with clinical characteristics in asthma. Heart Lung 2022; 56:154-160. [PMID: 35908350 DOI: 10.1016/j.hrtlng.2022.07.006] [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] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Fat mass to fat-free mass ratio (FM/FFM) assesses the combined effect of the balance between fat mass and fat-free mass. AIMS to evaluate the associations beetween FM/FFM and clinical outcomes in asthma and to compare clinical characteristics between individuals with higher and lower FM/FFM. METHODS 128 participants with asthma underwent anthropometric, spirometry and bioelectrical impedance assessments. Physical activity in daily life (PADL) was assessed by the Actigraph for 7 days. Daily dose of inhaled medication, steps of pharmacological treatment, Asthma Control Questionnaire, Asthma Quality of Life Questionnaire and Hospital Anxiety and Depression Scale were also assessed. Participants were classified into two groups according to the 50th percentile of reference values for FM/FFM. RESULTS Individuals with higher FM/FFM (n=75) used higher daily doses of inhaled corticosteroids, had worse lung function and fewer steps/day when compared to those with lower FM/FFM (n=53) (P≤0.021). Associations were found between absolute values of FM/FFM with lung function (FEV1 and FVC [liters]): R2=0.207 and 0.364;P<0.0001), and between the categories of lower or higher FM/FFM with steps of medication treatment (Cramer's V=0.218;P=0.016) and level of PADL (Cramer's V=0.236;P=0.009). The highest FM/FFM was a determining factor of physical inactivity (OR: 3.21;95%CI:1.17-8.78) and highest steps of pharmacological treatment (OR: 8.89;95%CI:1.23-64.08). CONCLUSION Higher FM/FFM is significantly associated with worse clinical characteristics in individuals with asthma, such as higher doses of inhaled corticosteroids, worse lung function and fewer steps/day. Moreover, higher FM/FFM is a determining factor of physical inactivity and the highest steps of pharmacological treatment for asthma.
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Key Words
- ACQ, Asthma Control Questionnaire
- AQLQ, Asthma Quality of Life Questionnaire
- Asthma
- BMI, Body mass index
- Body composition
- Drug therapy
- FEV(1), Forced expiratory volume in the first second
- FEV(1)/FVC, Forced expiratory volume in the first second to forced vital capacity ratio
- FFM, Fat-free mass
- FM, Fat mass
- FM/FFM, Fat mass to fat-free mass ratio
- FVC, Forced vital capacity
- GINA, Global Initiative for Asthma
- HADS, Hospital Anxiety and Depression Scale
- Motor activity
- PADL, Physical Activity in Daily Life
- Respiratory function tests
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Affiliation(s)
- Diery Fernandes Rugila
- Postgraduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Paraná, Brazil; Department of Physical Therapy, Laboratory of Research in Respiratory Physiotherapy (LFIP), State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - Joice Mara Oliveira
- Postgraduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Paraná, Brazil; Department of Physical Therapy, Laboratory of Research in Respiratory Physiotherapy (LFIP), State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - Felipe Vilaça Cavallari Machado
- Department of Physical Therapy, Laboratory of Research in Respiratory Physiotherapy (LFIP), State University of Londrina (UEL), Londrina, Paraná, Brazil; Department of Research and Development, CIRO+, Horn, The Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Natielly Soares Correia
- Postgraduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Paraná, Brazil; Department of Physical Therapy, Laboratory of Research in Respiratory Physiotherapy (LFIP), State University of Londrina (UEL), Londrina, Paraná, Brazil
| | - Vitória Cavalheiro Puzzi
- Postgraduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Paraná, Brazil; Department of Physical Therapy, Laboratory of Research in Respiratory Physiotherapy (LFIP), State University of Londrina (UEL), Londrina, Paraná, Brazil
| | | | - Patrícia Duarte Freitas
- Department of Physical Therapy, School of Medicine, University of Sao Paulo (USP), Sao Paulo, Brazil
| | - Fabio Pitta
- Department of Physical Therapy, Laboratory of Research in Respiratory Physiotherapy (LFIP), State University of Londrina (UEL), Londrina, Paraná, Brazil
| | | | - Karina Couto Furlanetto
- Postgraduate Program in Rehabilitation Sciences, Pitágoras-Unopar University (UNOPAR), Londrina, Paraná, Brazil; Department of Physical Therapy, Laboratory of Research in Respiratory Physiotherapy (LFIP), State University of Londrina (UEL), Londrina, Paraná, Brazil.
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Ravindra K, Goyal A, Mor S. Does airborne pollen influence COVID-19 outbreak? Sustain Cities Soc 2021; 70:102887. [PMID: 33816082 PMCID: PMC7999829 DOI: 10.1016/j.scs.2021.102887] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 05/09/2023]
Abstract
The fast spread of SARS-CoV-2 presented a worldwide challenge to public health, economy, and educational system, affecting wellbeing of human society. With high transmission rates, there are increasing evidences of COVID-19 spread via bioaerosols from an infected person. The current review was conducted to examine airborne pollen impact on COVID-19 transmission and to identify the major gaps for post-pandemic research. The study used all key terms to identify revenant literature and observation were collated for the current research. Based on existing literature, there is a potential association between pollen bioaerosols and COVID-19. There are few studies focusing the impact of airborne pollen on SARS-CoV-2, which could be useful to advance future research. Allergic rhinitis and asthma patients were found to have pre-modified immune activation, which could help to provide protection against COVID-19. However, does airborne pollen acts as a potent carrier for SARS-CoV-2 transport, dispersal and its proliferation still require multidisciplinary research. Further, a clear conclusion cannot be drawn due to limited evidence and hence more research is needed to show how pollen bioaerosols could affect virus survivals. The small but growing literature review focuses on searching for every possible answer to provide additional security layers to overcome near future corona-like infectious diseases.
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Key Words
- AAAAI, American Academy of Allergy, Asthma & Immunology
- ACE-2, angiotensin-converting enzyme 2
- ARDS, acute respiratory distress syndrome
- Airborne pollen
- Allergic rhinitis
- Asthma
- Bioaerosols
- CCDC, Chinese Centre for Disease Control and Prevention
- CDC, Centers for Disease Control and Prevention
- CESM, Community Earth System Model
- CMAQ, Community Multiscale Air Quality
- COPD, chronic obstructive pulmonary diseases
- COVID-19
- ERS, European Respiratory Society
- FLI, flu-like illnesses
- GINA, Global Initiative for Asthma
- H1N1, Influenza A virus subtype H1N1
- H5N1, avian influenza virus
- IgE, Immunoglobulin E
- LDT, long-distance transport
- MERS, Middle East respiratory syndrome
- NHC, National Health Commission
- RSV, Respiratory Syncytial Virus infection
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus-2
- STaMPS, Simulator of Timing and Magnitude of Pollen Season
- Virus
- WAO, World Allergy Organisation
- WHO, World Health Organization
- WRF, Weather Research Forecasting
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Affiliation(s)
- Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Akshi Goyal
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India
| | - Suman Mor
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India
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Florido-López JF, Andreu-Balaguer C, Escudero C, Seoane-Rodríguez M, Hernández M, Navarro-Seisdedos LÁ, Torrecillas-Toro M, Anton-Girones M, Herrero-Lifona L, Brugaletta D, Macías J, Pineda R, Lara MÁ, López-Caballero J, Rojas MJ. Effectiveness and safety of a glutaraldehyde-modified, L-tyrosine-adsorbed and monophosphoryl lipid A-Adjuvanted allergen immunotherapy in patients with allergic asthma sensitized to olive pollen: A retrospective, controlled real-world study. World Allergy Organ J 2020; 13:100487. [PMID: 33376572 PMCID: PMC7750691 DOI: 10.1016/j.waojou.2020.100487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 01/20/2023] Open
Abstract
Background Allergy to olive pollen is one of the primary causes of allergic asthma in Spain. Even though allergen immunotherapy (AIT) has shown clinical benefits in patients sensitized to different allergens, studies in asthmatic patients sensitized to olive pollen are insufficient. Objective To assess the effectiveness and safety of an ultra-short course of AIT with an L-tyrosine-adsorbed and monophosphoryl lipid A-adjuvanted olive pollen and olive/grass pollen extract (Pollinex Quattro®) in patients with allergic asthma in the real-world setting. Methods Retrospective, controlled study including patients with asthma, with and without allergic rhinitis, caused by sensitization to olive pollen from 11 centers in Spain. Patients received out-of-season (October–March) treatment with AIT in addition to their pharmacological treatment (active group) or pharmacological treatment (control group). Effectiveness variables, including unscheduled visits to the healthcare center, emergency room admissions, symptoms of asthma and rhinitis (following GEMA and ARIA classifications, respectively), and use of medication to treat asthma and rhinitis during the subsequent pollen season were compared between treatment groups. Results Of 131 study patients, 42 were treated with their usual asthma medication (control group) and 89 were treated with AIT (active group), either Pollinex Quattro® 100% olive pollen (n = 43, 48.3%) or 50% olive pollen/50% grass pollen (n = 46, 51.7%). Patients’ demographic and clinical characteristics were similar between groups. The mean (SD) number of unscheduled visits to a healthcare center and emergency room admissions due to allergy symptoms was 2.19 (1.40) and 0.43 (0.63) in the control group, and 1.09 (1.25) and 0.11 (0.51) in the active group (P = 0.001 and P = 0.006, respectively). Severity and control of asthma symptoms remained unchanged (P = 0.347 and P = 0.179, respectively), rhinitis type improved (P = 0.025), and severity remained unchanged in the active compared to the control group. The use of short-acting beta-agonists and inhaled corticosteroids to treat asthma symptoms decreased in the active vs. the control group (P = 0.001 and P = 0.031, respectively). Twelve (13.5%) and two (2.2%) patients in the active group experienced local adverse reactions (edema, swelling, erythema, hives, pruritus, and heat), and systemic adverse reactions (hypertensive crisis and low-grade fever) to AIT, respectively; none was serious. Conclusion AIT with Pollinex Quattro® specific for olive pollen and olive/grass pollens resulted in reduced visits to the healthcare center and emergency room and the use of asthma medication during the pollen season, indicating that this treatment was safe and effective in treating asthma in patients sensitized to these pollens.
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Key Words
- AAAAI, American Academy of Allergy, Asthma & Immunology
- AIT, allergen immunotherapy
- ARIA, Allergic Rhinitis and its Impact on Asthma
- ARs, adverse reactions
- Allergen immunotherapy
- Allergic asthma
- Allergic rhinitis
- Allergoid
- EAACI, European Academy of Allergy and Clinical Immunology
- GEMA, “Guía Española para el Manejo del Asma” (Spanish Guidelines for Asthma Management)
- GINA, Global Initiative for Asthma
- LABAs, long-acting beta-2 agonists
- LTRAs, leukotriene receptor antagonists
- MCT, microcrystalline tyrosine
- MPL, monophosphoryl lipid A
- Microcrystalline tyrosine
- Monophosphoryl lipid A
- Olive pollen
- SABAs, short-acting beta-agonists
- SCIT, subcutaneous immunotherapy
- Subcutaneous immunotherapy
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Affiliation(s)
| | | | - Carmelo Escudero
- Department of Allergy, Hospital Infantil Universitario Niño Jesús, IIS-P, FibHNJ. Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Maria Ángeles Lara
- Hospital Clínico Universitario (Parque Tecnológico de La Salud). Granada, Spain
| | | | - Maria José Rojas
- Hospital Clínico Universitario (Parque Tecnológico de La Salud). Granada, Spain
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Abdullah B, Kandiah R, Hassan NFHN, Ismail AF, Mohammad ZW, Wang DY. Assessment of perception, attitude, and practice of primary care practitioners towards allergic rhinitis practice guidelines: Development and validation of a new questionnaire. World Allergy Organ J 2020; 13:100482. [PMID: 33294114 PMCID: PMC7689322 DOI: 10.1016/j.waojou.2020.100482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Primary care practitioners (PCPs), being the front liners, play an important role in treating allergic rhinitis (AR). As there is no proper tool to assess their perception, attitude, and practice in utilizing the guidelines, we aimed to develop and validate a new questionnaire for such purpose. METHODS The development phase consists of both literature and expert panel review. The validation phase consists of content validity, face validity, and construct validity. Cronbach's alpha was used to verify internal consistency. The development phase produced a questionnaire with 3 domains: perception, attitude, and practice consisting of 60 items (PAP-PCP questionnaire). Item response theory analysis for perception demonstrated the difficulty and discrimination values were acceptable except for 3 items. Exploratory factor analysis for attitude and practice domains showed the psychometric properties were good except for 3 items in practice domain. Experts judgement was used to decide on the final selection of questionnaire which consists of 59 items. RESULTS The final validated questionnaire has 3 domains with 59 items. All domains had Cronbach's alpha above 0.65 which was reliable. 302 physicians completed the questionnaire. 98% PCPs diagnosed AR based on clinical history. Although, majority agree AR guidelines is useful (67%), they had difficulty in using it to classify AR (54.9%) and determine AR severity (73.9%). Oral anti-histamines (first and second generation) were the most prescribed (>75%) followed by intranasal corticosteroids (59%) and combined intranasal corticosteroid and oral anti-histamine (51%). Majority agreed that treatment efficacy (81.8%), adverse effects (83.8%), fear of adverse effects (73.5%), route of administration (69.4%), dosing frequency (72.5%), taste (64.6%) and cost (73.5%) affect treatment compliance. CONCLUSIONS The newly developed and validated questionnaire is a promising instrument in understanding the treatment gap in AR. Although further testing and refinement are needed, it provides an initial means for evaluating knowledge and understanding of PCPs in treating AR.
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Key Words
- 2-PL IRT, Two-parameter logistic item response theory
- ARIA, Allergic Rhinitis and its Impact on Asthma
- Allergic rhinitis guidelines
- Attitude
- CVI, Content Validity Index
- EAR, Allergic rhinitis
- EFA, exploratory factor analysis
- FVI, Face Validity Index
- GINA, Global Initiative for Asthma
- IgE, immunoglobulin
- KMO, Kaiser-Meyer-Olkin test
- ORL, Otorhinolaryngologist
- PCPs, Primary care practitioners
- Perception
- Practice
- Primary care practitioners
- S-CVI/Ave, Scale-level CVI of averaging calculation method
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Affiliation(s)
- Baharudin Abdullah
- Department of Otorhinolaryngology- Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Ramaprabah Kandiah
- Department of Otorhinolaryngology- Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nik Fariza Husna Nik Hassan
- Department of Otorhinolaryngology- Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Filza Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
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5
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Canonica GW, Blasi F, Paggiaro P, Senna G, Passalacqua G, Spanevello A, Aliberti S, Bagnasco D, Bonavia M, Bonini M, Brussino L, Bucca C, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Carpagnano GE, Caruso C, Centanni S, Conte ME, Corsico AG, Cosmi L, Costantino MT, Crimi N, D’Alò S, D'Amato M, Del Giacco S, Farsi A, Favero E, Foschino Barbaro MP, Guarnieri G, Guida G, Latorre M, Lo Cicero S, Lombardi C, Macchia L, Mazza F, Menzella F, Milanese M, Montagni M, Montuschi P, Nucera E, Parente R, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ricciardolo FL, Richeldi L, Ridolo E, Rolla G, Santus P, Scichilone N, Spadaro G, Vianello A, Viviano V, Yacoub MR, Zappa MC, Heffler E. Oral CorticoSteroid sparing with biologics in severe asthma: A remark of the Severe Asthma Network in Italy ( SANI). World Allergy Organ J 2020; 13:100464. [PMID: 32999699 PMCID: PMC7509464 DOI: 10.1016/j.waojou.2020.100464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022] Open
Abstract
According to the data derived from several national and international registries, including SANI (Severe Asthma Network Italy), and considering the strong impact that frequent or regular use of oral corticosteroid has on quality of life (QoL) of severe asthmatics, as well as on the costs for managing corticosteroid-related diseases, oral corticosteroid sparing up to withdrawal should be considered a primary outcome in the management of severe asthma. New biologics have clearly demonstrated that this effect is possible, with concomitant reduction in the rate of exacerbations and in symptom control. Then, there is no reason for using so frequently oral corticosteroid before having explored all alternatives currently available for a large part of severe asthmatics.
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Key Words
- Biologics
- CRSwNP, chronic rhinosinusitis with nasal polyposis
- EMA, European Medicines Agency
- FDA, Food & Drug Administration
- FEV1, forced expiratory volume in the 1st second
- GINA, Global Initiative for Asthma
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- ISAR, International Severe Asthma Registry
- OCSs, Oral CorticoSteroids
- Oral corticosteroids
- RW, Real World
- Real-life
- Registr
- SA, severe asthma
- SANI, Severe Asthma Network in Italy
- SARP, Severe Asthma Research Program
- SHARP, Severe Heterogeneous Asthma Research collaboration, Patient-centred
- Severe asthma
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Gianenrico Senna
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Stefano Aliberti
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Luisa Brussino
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Caterina Bucca
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Maria F. Caiaffa
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Gianna Camiciottoli
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
| | - Marco Caminati
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanna E. Carpagnano
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria E. Conte
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
| | - Angelo G. Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria T. Costantino
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
| | - Nunzio Crimi
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
| | - Simona D’Alò
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
| | - Maria D'Amato
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Alessandro Farsi
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
| | - Elisabetta Favero
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
| | - Maria P. Foschino Barbaro
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | | | - Carlo Lombardi
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Francesco Menzella
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
| | - Manlio Milanese
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
| | | | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Nucera
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Parente
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
| | - Vincenzo Patella
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Fabio L.M. Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Italy
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Pierachille Santus
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Giuseppe Spadaro
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Vittorio Viviano
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
| | - Mona R. Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria C. Zappa
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - SANI (Severe Asthma Network Italy)
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
- University of Insubria, ICS Maugeri, IRCCS, Varese, Italy
- Respiratory Rehabilitation, ASL3, Genoa, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
- Department of Pneumology, Niguarda Hospital, Milan, Italy
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
- UOC Allergology Department, Piacenza, Italy
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
- Department of Medicine and Surgery, University of Parma, Italy
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
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Larenas-Linnemann D, Rodríguez-Pérez N, Luna-Pech JA, Rodríguez-González M, Blandón-Vijil MV, Del-Río-Navarro BE, Costa-Domínguez MDC, Navarrete-Rodríguez EM, Macouzet-Sánchez C, Ortega-Martell JA, Pozo-Beltrán CF, Estrada-Cardona A, Arias-Cruz A, Rodríguez Galván KG, Brito-Díaz H, Canseco-Raymundo MDR, Castelán-Chávez EE, Escalante-Domínguez AJ, Gálvez-Romero JL, Gómez-Vera J, González-Díaz SN, Guerrero-Núñez MGB, Hernández-Colín DD, Macías-Weinmann A, Mendoza-Hernández DA, Meneses-Sánchez NA, Mogica-Martínez MD, Moncayo-Coello CV, Montiel-Herrera JM, O'Farril-Romanillos PM, Onuma-Takane E, Ortega-Cisneros M, Rangel-Garza L, Stone-Aguilar H, Torres-Lozano C, Venegas-Montoya E, Wakida-Kusunoki G, Partida-Gaytán A, López-García AI, Macías-Robles AP, Ambriz-Moreno MDJ, Azamar-Jácome AA, Beltrán-De Paz CY, Caballero-López C, Fernández de Córdova-Aguirre JC, Fernández-Soto JR, Lozano-Sáenz JS, Oyoqui-Flores JJ, Osorio-Escamilla RE, Ramírez-Jiménez F, Rivero-Yeverino D, Martínez Infante E, Medina-Ávalos MA. Compromising between European and US allergen immunotherapy schools: Discussions from GUIMIT, the Mexican immunotherapy guidelines. World Allergy Organ J 2020; 13:100444. [PMID: 32884611 PMCID: PMC7451623 DOI: 10.1016/j.waojou.2020.100444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 11/16/2022] Open
Abstract
Background Allergen immunotherapy (AIT) has a longstanding history and still remains the only disease-changing treatment for allergic rhinitis and asthma. Over the years 2 different schools have developed their strategies: the United States (US) and the European. Allergen extracts available in these regions are adapted to local practice. In other parts of the world, extracts from both regions and local ones are commercialized, as in Mexico. Here, local experts developed a national AIT guideline (GUIMIT 2019) searching for compromises between both schools. Methods Using ADAPTE methodology for transculturizing guidelines and AGREE-II for evaluating guideline quality, GUIMIT selected 3 high-quality Main Reference Guidelines (MRGs): the European Academy of Allergy, Asthma and Immunology (EAACI) guideines, the S2k guideline of various German-speaking medical societies (2014), and the US Practice Parameters on Allergen Immunotherapy 2011. We formulated clinical questions and based responses on the fused evidence available in the MRGs, combined with local possibilities, patient's preference, and costs. We came across several issues on which the MRGs disagreed. These are presented here along with arguments of GUIMIT members to resolve them. GUIMIT (for a complete English version, Supplementary data) concluded the following. Results Related to the diagnosis of IgE-mediated respiratory allergy, apart from skin prick testing complementary tests (challenges, in vitro testing and molecular such as species-specific allergens) might be useful in selected cases to inform AIT composition. AIT is indicated in allergic rhinitis and suggested in allergic asthma (once controlled) and IgE-mediated atopic dermatitis. Concerning the correct subcutaneous AIT dose for compounding vials according to the US school: dosing tables and formula are given; up to 4 non-related allergens can be mixed, refraining from mixing high with low protease extracts. When using European extracts: the manufacturer's indications should be followed; in multi-allergic patients 2 simultaneous injections can be given (100% consensus); mixing is discouraged. In Mexico only allergoid tablets are available; based on doses used in all sublingual immunotherapy (SLIT) publications referenced in MRGs, GUIMIT suggests a probable effective dose related to subcutaneous immunotherapy (SCIT) might be: 50-200% of the monthly SCIT dose given daily, maximum mixing 4 allergens. Also, a table with practical suggestions on non-evidence-existing issues, developed with a simplified Delphi method, is added. Finally, dissemination and implementation of guidelines is briefly discussed, explaining how we used online tools for this in Mexico. Conclusions Countries where European and American AIT extracts are available should adjust AIT according to which school is followed.
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Key Words
- AGREE-II, Appraisal of Guidelines for Research & Evaluation Instrument
- AIT, Allergen immunotherapy
- Allergen extract
- Allergen immunotherapy
- Asthma and Immunology, DBPC
- CMICA, Colegio Mexicano de Inmunología Clínica y Alergia
- COMPEDIA, Colegio Mexicano de Pediatras Especialistas in Inmunología Clínica y Alergia
- EAACI, European Academy of Allergy
- FASIT, Future of the Allergists and Specific Immunotherapy
- GIN, Guidelines International Network
- GINA, Global Initiative for Asthma
- GP, grass pollen
- GRADE, grading of recommendations assessment development and evaluation
- GUIMIT, by its Spanish initials of Guía Mexicana de Inmunoterapia
- Guideline
- HDM, house dust mite
- Ig, immunoglobulin
- MRG, main reference guidelines
- PICO, Patient-Intervention-Comparator-Outcome
- SCIT, subcutaneous allergen immunotherapy
- SLIT, sublingual allergen immunotherapy
- Subcutaneous immunotherapy
- Sublingual immunotherapy
- US, United States of North America
- double-blind, placebo controlled
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Affiliation(s)
- Désirée Larenas-Linnemann
- Médica Sur, Clinical Foundation and Hospital, Mexico City, Mexico
- Corresponding author. Médica Sur, Fundación clínica y hospital, Puente de piedra 150, T2Toriello Guerra, Tlalpan, 14050, Ciudad de México, Mexico
| | | | - Jorge A. Luna-Pech
- Departamento de Disciplinas Filosóficas, Metodológicas e Instrumentales (CUCS), Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | | | | | | | - Carlos Macouzet-Sánchez
- State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
| | | | | | | | - Alfredo Arias-Cruz
- State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
| | | | | | | | | | | | | | - Javier Gómez-Vera
- Institute of Security and Social Services of State Workers, López Mateos Regional Hospital, Mexico City, Mexico
| | - Sandra Nora González-Díaz
- State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
| | | | | | - Alejandra Macías-Weinmann
- State University of Nuevo León, School of Medicine and University Hospital “Dr. José Eleuterio González”, Monterrey, Nuevo León, Mexico
| | | | - Néstor Alejandro Meneses-Sánchez
- Centro Médico Nacional Siglo Xxi. Unidad Médica De Alta Especialidad. Hospital De Pediatria Dr. Silvestre Frenk Freund., Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | - Edna Venegas-Montoya
- Mexican Social Security Institute, High Specialty Medical Unit 25, Department of Clinical Immunology and Allergy, Monterrey, Nuevo León, Mexico
| | | | | | | | - Ana Paola Macías-Robles
- Instituto Mexicano del Seguro Social, Centro Medico Nacional de Occidente Unidad de Alta Especialidad Hospital de Pediatria, Guadalajara, Jalisco, Mexico
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Krishna MT, Mahesh PA, Vedanthan P, Moitra S, Mehta V, Christopher DJ. An appraisal of allergic disorders in India and an urgent call for action. World Allergy Organ J 2020; 13:100446. [PMID: 32774662 PMCID: PMC7398972 DOI: 10.1016/j.waojou.2020.100446] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/12/2020] [Accepted: 06/26/2020] [Indexed: 01/22/2023] Open
Abstract
India is the second most populous country in the world with a population of nearly 1.3 billion, comprising 20% of the global population. There are an estimated 37.5 million cases of asthma in India, and recent studies have reported a rise in prevalence of allergic rhinitis and asthma. Overall, 40-50% of paediatric asthma cases in India are uncontrolled or severe. Treatment of allergic rhinitis and asthma is sub-optimal in a significant proportion of cases due to multiple factors relating to unaffordability to buy medications, low national gross domestic product, religious beliefs, myths and stigma regarding chronic ailment, illiteracy, lack of allergy specialists, and lack of access to allergen-specific immunotherapy for allergic rhinitis and biologics for severe asthma. High quality allergen extracts for skin tests and adrenaline auto-injectors are currently not available in India. Higher postgraduate specialist training programmes in Allergy and Immunology are also not available. Another major challenge for the vast majority of the Indian population is an unacceptably high level of exposure to particulate matter (PM)2.5 generated from traffic pollution and use of fossil fuel and biomass fuel and burning of incense sticks and mosquito coils. This review provides an overview of the burden of allergic disorders in India. It appraises current evidence and justifies an urgent need for a strategic multipronged approach to enhance quality of care for allergic disorders. This may include creating an infrastructure for education and training of healthcare professionals and patients and involving regulatory authorities for making essential treatments accessible at subsidised prices. It calls for research into better phenotypic characterisation of allergic disorders, as evidence generated from high income western countries are not directly applicable to India, due to important confounders such as ethnicity, air pollution, high rates of parasitic infestation, and other infections.
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Key Words
- A&I, Allergy and Immunology
- AB-NHPS, Ayushman Bharath National Health Protection Scheme
- ABPA, Allergic Bronchopulmonary Aspergillosis
- AD, Atopic Dermatitis
- BTS, British Thoracic Society
- CME, Continuing Medical Education
- COPD, Chronic Obstructive Pulmonary Disease
- DALY, Disability Associated Life Years
- DBPCFC, Double Blind Placebo Controlled Food Challenge
- ELISA, Enzyme Linked Immunosorbent Assay
- ETS, Environmental Tobacco Smoke
- GDP, Gross Domestic Product
- GINA, Global Initiative for Asthma
- ICAAI, Indian College of Allergy Asthma and Applied Immunology
- IHDS, Indian Human Development Survey
- INR, Indian Rupees
- ISAAC, International Study of Asthma and Allergies in Childhood
- NMBA, Neuromuscular blocking agents
- PAFs, Population Attributable Factors
- SAFS, Severe Asthma and Fungal Sensitisation
- SCIT, Subcutaneous Injection Immunotherapy
- SLIT, Sublingual Immunotherapy
- SPT, Skin Prick Test
- USA, United States of America
- USD, United States Dollars
- WHO, World Health Organization
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Affiliation(s)
- Mamidipudi Thirumala Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust and Institute of Immunology & Immunotherapy & Institute of Clinical Sciences, University of Birmingham, UK
- Corresponding author. Department of Allergy and Immunology, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK.
| | | | - Pudupakkam Vedanthan
- Department of Medicine, Division of Allergy and Immunology, The University of Colorado, Aurora, CO, USA
| | - Saibal Moitra
- Department of Allergy and Immunology, Apollo Gleneagles Hospital, Kolkota, West Bengal, India
| | - Vinay Mehta
- Allergy, Asthma and Immunology Associates, Lincoln, NE, USA
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Kwon N, Pizzichini E, Bansal AT, Albers FC, Barnes N, Rile JH, Lima-Matos A, Viera Ponte E, Cruz AA. Factors that affect blood eosinophil counts in a non-asthmatic population: Post hoc analysis of data from Brazil. World Allergy Organ J 2020; 13:100119. [PMID: 32435326 DOI: 10.1016/j.waojou.2020.100119] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/17/2020] [Accepted: 04/13/2020] [Indexed: 12/16/2022] Open
Abstract
Background Improved understanding of the normal range of blood eosinophil counts (BEC) and conditions that influence them in non-asthmatic individuals should allow more accurate estimation of the threshold at which eosinophilic disease should be considered, diagnosed, and treated. This analysis investigated the impact of atopy, smoking, and parasitic infection on BEC. Methods This was a post hoc analysis of non-asthmatic subjects from a case-control study (CONEP 450/10) conducted at the Program for Control of Asthma in Bahia (ProAR). Participant BECs were measured at baseline; correlations between predefined risk factors and BEC were assessed via univariate and stratified analysis. Results Of the 454 participants included, 3% were helminth parasite-positive, 18% were non-helminth parasite-positive; and 450 had BEC data. The median (interquartile range [IQR]) BEC was 152 (96, 252) cells/μL. Any positive skin prick test, elevated total immunoglobulin E, allergic rhinitis, and being a current smoker were all individually associated with higher BEC (p < 0.05) compared with BEC in participants without these factors, but having a non-helminthic parasitic infection was not. Participants with all 4 risk factors that were associated with higher BEC had a median (IQR) BEC of 192 cells/μL (94, 416) versus 106 cells/μL (70, 164) for those with no risk factors. Conclusions In non-asthmatic subjects, atopy, allergic rhinitis, and current smoking status were associated with higher BEC compared with subjects without these factors, but BEC values were well below the threshold commonly accepted as normal. Therefore, BEC should be interpreted in the context of an individual's medical conditions and other BEC-influencing factors.
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Key Words
- AR, allergic rhinitis
- Atopy
- BEC, blood eosinophil counts
- BMI, body mass index
- Biomarker
- COPD, chronic obstructive pulmonary disease
- EGPA, eosinophilic granulomatosis with polyangiitis
- Eosinophil
- FEV1, forced expiratory volume in 1s
- GINA, Global Initiative for Asthma
- IL, interleukin
- IQR, interquartile range
- IgE, immunoglobulin E
- Normal range
- Parasite
- ProAR, Program for Control of Asthma in Bahia
- SPT, skin prick test
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Morais-Almeida M, Aguiar R, Martin B, Ansotegui IJ, Ebisawa M, Arruda LK, Caminati M, Canonica GW, Carr T, Chupp G, Corren J, Dávila I, Park HS, Hanania NA, Rosenwasser L, Sánchez-Borges M, Virchow JC, Yáñez A, Bernstein JA, Caraballo L, Chang YS, Chikhladze M, Fiocchi A, González-Diaz SN, Tanno LK, Levin M, Ortega-Martell JA, Passalacqua G, Peden DB, Rouadi PW, Sublett JL, Wong GWK, Bleecker ER. COVID-19, asthma, and biological therapies: What we need to know. World Allergy Organ J 2020; 13:100126. [PMID: 32426090 PMCID: PMC7229954 DOI: 10.1016/j.waojou.2020.100126] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022] Open
Abstract
Managing patients with severe asthma during the coronavirus pandemic and COVID-19 is a challenge. Authorities and physicians are still learning how COVID-19 affects people with underlying diseases, and severe asthma is not an exception. Unless relevant data emerge that change our understanding of the relative safety of medications indicated in patients with asthma during this pandemic, clinicians must follow the recommendations of current evidence-based guidelines for preventing loss of control and exacerbations. Also, with the absence of data that would indicate any potential harm, current advice is to continue the administration of biological therapies during the COVID-19 pandemic in patients with asthma for whom such therapies are clearly indicated and have been effective. For patients with severe asthma infected by SARS-CoV-2, the decision to maintain or postpone biological therapy until the patient recovers should be a case-by-case based decision supported by a multidisciplinary team. A registry of cases of COVID-19 in patients with severe asthma, including those treated with biologics, will help to address a clinical challenge in which we have more questions than answers.
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Key Words
- AAAAI, American Academy of Allergy, Asthma and Immunology
- ACAAI, American College of Allergy, Asthma and Immunology
- ACE2, Angiotensin-converting enzyme 2
- ADCC, Antibody-Dependent Cell-mediated Cytotoxicity
- AEs, Adverse events
- Asthma
- BTS, British Thoracic Society
- Biologics
- COVID-19
- COVID-19, Coronavirus Disease 2019
- DNA, Deoxyribonucleic acid
- EBM, Evidence Based Medicine
- ELF, European Lung Foundation
- ERS, European Respiratory Society
- FDA, Food and Drug Administration
- GINA, Global Initiative for Asthma
- GSK, Glaxo Smith Kline
- ICS, inhaled corticosteroids
- ICU, Intensive Care Unit
- IL13, Interleukin 13
- IL4, Interleukin 4
- IL5, Interleukin 5
- IL5Ra, Interleukin 5 alfa receptor
- IL5r, Interleukin 5 receptor
- IL6, Interleukin 6
- IgE, Immunoglobulin E
- NHLBI, National Heart, Lung, and Blood Institute
- OCS, Oral corticosteroids
- PDGFRA, Platelet-Derived Growth Factor Receptor A
- PROSE study, Preventative Omalizumab or Step-up therapy for fall Exacerbations study
- Pandemic
- RCTs, Randomized Controlled Trials
- SAEs, Serious Adverse Events
- SARP, Severe Asthma Research Programme
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SC, Subcutaneous
- SIAAIC, Italian Society of Allergy, Asthma and Clinical Immunology
- Severe
- T2, Type 2 inflammation
- TMPRSS2, Transmembrane Protease Serine 2 Enzyme
- Treatment
- USA, United States of America
- mAb, Monoclonal antibody
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Affiliation(s)
| | - Rita Aguiar
- Allergy Centre, CUF Descobertas Hospital, Lisbon, Portugal
| | | | | | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagwa, Japan
| | - L Karla Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marco Caminati
- Department of Internal Medicine, University of Verona, Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital IRCCS, Milano, Italy
| | - Tara Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Geoffrey Chupp
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Corren
- David Geffen School of Medicine, University of California at Los Angelas (UCLA), Los Angeles, CA, USA
| | - Ignacio Dávila
- University Hospital, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - J Christian Virchow
- Department of Pneumology/Intensive Care Medicine, Universitätsmedizin, Rostock, Germany
| | - Anahí Yáñez
- INAER-Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Jonathan A Bernstein
- University of Cincinnati, College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Manana Chikhladze
- Medical Faculty at Akaki Tsereteli State University, KuTaisi, Tskaltubo, Georgia
| | | | | | - Luciana Kase Tanno
- Division of Allergy, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Michael Levin
- Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | | | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - David B Peden
- Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
| | - James L Sublett
- Pediatric Allergy & Immunology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Gary W K Wong
- Department of Paediatrics, Chinese University of Hong Kong, Hong Kong
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, AZ, USA
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Kanemitsu Y, Suzuki M, Fukumitsu K, Asano T, Takeda N, Nakamura Y, Ozawa Y, Masaki A, Ono J, Kurokawa R, Yap J, Nishiyama H, Fukuda S, Ohkubo H, Maeno K, Ito Y, Oguri T, Izuhara K, Takemura M, Niimi A. A novel pathophysiologic link between upper and lower airways in patients with chronic rhinosinusitis: Association of sputum periostin levels with upper airway inflammation and olfactory function. World Allergy Organ J 2020; 13:100094. [PMID: 32015784 PMCID: PMC6992843 DOI: 10.1016/j.waojou.2019.100094] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/07/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023] Open
Abstract
Background Chronic rhinosinusitis (CRS) and asthma are collectively called unified airway diseases. Periostin has been implicated in the pathophysiologic link of these conditions but only by serum measurements. We sought to investigate sputum levels of periostin and their association with upper airway inflammation and olfactory function in CRS patients. Methods We prospectively recruited 56 CRS patients who underwent endoscopic sinus surgery (20 with and 36 without comorbid asthma), and 28 healthy controls between October 2015 and December 2017. Lower and upper airway indices such as sputum periostin levels and eosinophil and neutrophil counts, exhaled fractional nitric oxide (FeNO) levels, and olfactory function were evaluated in the three groups. Radiological severity of CT images and tissue eosinophilia of surgical specimens were also assessed in the CRS patients. Results Sputum periostin levels were highest, and olfactory function was most impaired, in the CRS patients with comorbid asthma, followed by those without asthma and controls in this order. CRS with asthma group showed higher sputum eosinophils and FeNO levels than the other two groups, while CRS patients without asthma showed significantly higher neutrophils in sputum than the other two groups. When confined to CRS patients, olfactory dysfunction was correlated with sputum eosinophil counts. Eosinophil counts of nasal polyps showed a significant positive correlation with sputum periostin and FeNO levels. Radiological severity of CRS was correlated with sputum eosinophil counts and FeNO levels. Conclusions Periostin levels and inflammatory cells such as eosinophils and neutrophils in the lower airways are increased in patients with CRS, suggesting the presence of mutual interactions between upper and lower airways even if asthma does not coexist. Olfactory dysfunction and eosinophilic nasal polyps may be potential indicators of Th2-driven inflammation in the lower airways. Trial registration This study was registered on the UMIN Clinical Trials Registry (Registry ID UMIN000018672).
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Key Words
- AHR, airway hyperresponsiveness
- ATS, American Thoracic Society
- Asthma
- COPD, chronic obstructive pulmonary disease
- CRS, chronic rhinosinusitis
- CRSsNP, CRS without nasal polyps
- CRSwNP, CRS with nasal polyps
- CT, computed tomography
- Chronic rhinosinusitis
- ERS, European Respiratory Society
- ESS, endoscopic sinus surgery
- Eosinophils
- FeNO, fractional nitric oxides
- Fractional exhaled nitric oxides
- GINA, Global Initiative for Asthma
- HPF, high-power field
- IL, interleukin
- LMS, Lund-Mackay score
- NPs, nasal polyps
- Olfactory dysfunction
- Periostin
- SNOT-22, Sinonasal Outcome Test-22
- Tukey Kramer HSD, Tukey Kramer honestly significant difference
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Affiliation(s)
- Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Corresponding author. 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya-City, Japan.
| | - Motohiko Suzuki
- Department of Otorhinolaryngology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takamitsu Asano
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Norihisa Takeda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshihisa Nakamura
- Department of Otorhinolaryngology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshiyuki Ozawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ayako Masaki
- Department of Pathology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Junya Ono
- Shino-Test Corporation, Sagamihara, Japan
| | - Ryota Kurokawa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Jennifer Yap
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hirono Nishiyama
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Fukuda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kenji Izuhara
- The Division of Medical Biochemistry, Department of Biomolecular Sciences, Saga Medical School, Saga, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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11
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Koshak A, Koshak E, Heinrich M. Medicinal benefits of Nigella sativa in bronchial asthma: A literature review. Saudi Pharm J 2017; 25:1130-1136. [PMID: 30166900 PMCID: PMC6111118 DOI: 10.1016/j.jsps.2017.07.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/09/2017] [Indexed: 02/06/2023] Open
Abstract
Nigella sativa L. (NS) seeds, known as black seed, is a spice and a traditional herbal medicine used in various diseases including bronchial asthma. This review aimed to assess the studies supporting the medicinal use of NS in asthma and to highlight future research priorities. Various medical databases were searched for the effects of NS and its active secondary metabolites in asthma inflammation and outcomes. There were fourteen preclinical studies describing multiple effects of NS in animal or cellular models of asthma including bronchodilation, anti-histaminic, anti-inflammatory, anti-leukotrienes and immunomodulatory effects. Furthermore, seven clinical studies showed improvements in different asthma outcomes including symptoms, pulmonary function and laboratory parameters. However, often these studies are small and used ill-defined preparations. In conclusion, NS could be therapeutically beneficial in alleviating airway inflammation and the control of asthma symptoms, but the evidence remains scanty and is often based on poorly characterised preparations. Accordingly, well-designed large clinical studies using chemically well characterised NS preparation are required.
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Key Words
- ACT, Asthma Control Test
- Asthma
- Black seed
- Clinical studies
- FEV1, forced expiratory volume in one second
- FeNO, fractional exhaled nitric oxide
- GINA, Global Initiative for Asthma
- IL, Interleukin
- IgE, Immunoglobulin E
- NS, Nigella sativa L.
- Nigella sativa
- RDBCT, Randomised Double-Blinded Clinical Trial
- RDBPCT, Randomised Double-Blinded Placebo-Controlled Clinical Trial
- RSBPCT, Randomised Single-Blinded Placebo-Controlled Clinical Trial
- Th1, Type 1 T helper (Th1) cells
- Th2, Type 2 T helper (Th2) cells
- Traditional medicine
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Affiliation(s)
- Abdulrahman Koshak
- Research Cluster Biodiversity and Medicines, UCL School of Pharmacy, University College London, London, UK.,Department of Natural Products & Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Emad Koshak
- Allergy and Clinical Immunology Division, Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Michael Heinrich
- Research Cluster Biodiversity and Medicines, UCL School of Pharmacy, University College London, London, UK
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