Atopy and cause-specific mortality

Total IgE levels are associated with mortality risk partially mediated by vitamin status: A nationally representative population-based study

BACKGROUND AND AIMS

Elevated total IgE levels are traditionally associated with allergic conditions; however, their potential role as biomarker for mortality risk beyond allergic diseases has not been extensively explored. Recent studies have suggested that IgE is associated with cardiovascular (CV) disease. We aimed to investigate the association between total IgE levels and the risk of all-cause and cause-specific mortality, as well as to explore the potential mediating role of vitamin status in these associations.

METHODS AND RESULTS

The association between IgE and mortality risk was examined in the National Health and Examination Survey 2005-2006. Weighted multivariable Cox proportional hazards model was employed. We further performed restricted cubic spline analysis to assess dose-response relationships and conducted mediation analysis to explore the influence of vitamins on IgE-related mortality risk. Individuals in the highest total IgE quantile (>107.0 kU/L) exhibited a 32 % increased risk of all-cause mortality (95 % CI: 1.07-1.64) and a 98 % elevated risk of CV mortality (95 % CI: 1.28-3.07) compared to the lowest quantile (<14.5 kU/L). Heterogeneity exists in the dose-response relationship and threshold effects among individuals with and without allergic diseases. Vitamin deficiency is associated with elevated total IgE levels, and vitamins mediated the relationship of the IgE-related all-cause mortality with the proportion of mediation ranging from 4.68 to 12.71 %.

CONCLUSIONS

Our findings introduce a novel dimension to the understanding of IgE as a biomarker for mortality beyond its traditional role in allergic diseases, challenging the current paradigm that elevated IgE levels without overt allergic symptoms are benign.

The impact of maternal anxiety during pregnancy on children's eczema and allergic rhinitis: The Ma'anshan birth cohort study

OBJECTIVE

The objective of this study was to investigate the associations between maternal exposure to anxiety during pregnancy and the susceptibility of offspring to eczema and allergic rhinitis and the possibility of sensitivity periods and cumulative effects.

METHODS

The study's sample consisted of 3160 mother-child pairs from the Ma'anshan Birth Cohort Study. Maternal anxiety was repeatedly measured in the 1st, 2nd, and 3rd trimesters of pregnancy using the Chinese version of the Pregnancy-Related Anxiety Scale. Information regarding children's eczema and allergic rhinitis diagnoses was collected through parental reports at 12, 24, 36 and 48 months of age. Binary logistic regression models were used for statistical analysis and corrected for multiple comparisons using the false discovery rate (FDR) method.

RESULTS

Children whose mothers experienced anxiety throughout pregnancy had the highest odds of developing total eczema (aOR 1.45, 95% CI 1.02-2.07) and total allergic rhinitis (aOR 1.67, 95% CI 1.17-2.37) between the ages of 6 and 48 months. The higher the trajectory of the maternal anxiety scores throughout pregnancy, the higher the odds of total eczema (aOR 1.65, 95% CI 1.14-2.40) and allergic rhinitis (aOR 1.84, 95% CI 1.28-2.66) in their offspring. The association between maternal anxiety and children's eczema was mainly concentrated in the first 24 months, whereas the association with allergic rhinitis was mainly concentrated in the 36-48 months.

CONCLUSION

Maternal anxiety during any trimester of pregnancy, especially with a consistently high trajectory of anxiety scores, was associated with higher odds of children's eczema and allergic rhinitis.

The Diagnosis and Management of Allergic Reactions Caused by Chinese Materia Medica

Traditional Chinese medicines (TCM) have been used in China for thousands of years. Although TCM has been generally perceived to be safe, adverse reactions to Chinese materia medica (CMM) have been reported. Most of the adverse reactions are allergic in nature, but other mechanisms may play a role. This review focuses on the mechanism and clinical presentation of these allergic reactions. Allergic reactions can occur as a result of the active and inactive ingredients of CMM. Impurities and chemicals generated during the production process can also lead to allergic or adverse reactions. Environmental factors such as temperature, humidity, and light can cause changes in the allergenicity of drugs. Human error in formulating CMM drugs also contributes to adverse drug reactions. The management of allergic reactions to CMM includes taking a good history, avoidance of medications in the same class as those which caused prior reactions, the proper training of staff, adherence to manufacturer guidelines and expiration dates, evaluation of benefit and risk balance, and the formulation of a risk management strategy for the use of CMM. A small test dose of a considered drug before using, improvements in drug purification technology, and proper storage and clinical administration help reduce allergic reactions due to CMM.

Allergy-Related Diseases and Risk of Breast Cancer: The Role of Skewed Immune System on This Association

Background

The role of allergy in breast cancer (BC) development remains inconclusive. A comprehensive review article is required to present and discuss all findings on this topic and to clarify the association between allergic disorders and the risk of BC.

Objective

We aimed to explain the association between atopy, different types of allergic disorders, and the risk of BC. Moreover, we explored the immunological mechanism behind this association.

Methods

We electronically reviewed publications in PubMed from 1979 to 2018 relating to atopy, allergy, asthma, atopic dermatitis, allergic rhinitis, food allergy, drug allergy, immunoglobulin E (IgE) or prick test, and BC.

Results

Most of the identified studies demonstrated nonsignificant results. However, the pattern of the results indicated an increased risk of BC in individuals with a history of allergies. The majority of studies reported higher prevalence of atopic dermatitis and allergic rhinitis among individuals with BC compared to the control groups. Similarity, most of the studies revealed an increased risk of BC among people with a positive history of atopic using IgE specific or prick test. However, a null association was reported in most of the asthmatic studies, and controversial results were detected in the individuals with history of food and drug allergies.

Conclusion

The majority of findings were not statistically significant. Moreover, bias and other methodological problems are the major issues, which make it challenging to compare the findings of different studies and reach a strong conclusive result. However, the pattern of the results from most studies indicated that allergic diseases might be associated with an increased risk of BC. Skewed immune system toward T-helper 2 might have an important role in this association.

Association of allergic rhinitis, coronary heart disease, cerebrovascular disease, and all-cause mortality

BACKGROUND

Inflammation is implicated in atherosclerotic cardiovascular disease. Allergic diseases also involve a systemic inflammatory state, which may potentiate cardiovascular disease.

OBJECTIVE

To examine the association of allergic rhinitis, coronary heart disease (CHD), cerebrovascular disease (CVD), and all-cause mortality.

METHODS

We conducted a retrospective, population-based, matched cohort study comparing the incidence of CHD, CVD, and all-cause mortality from January 1, 1999, through December 31, 2012, in patients with International Classification of Disease, Ninth Revision, documented allergic rhinitis matched 1:1 by age, sex, and ethnicity to a reference cohort without allergic rhinitis within Kaiser Permanente Southern California. Fully adjusted hazard ratios (HRs) were calculated. Further analyses for those with positive environmental allergen specific IgE (sIgE) test results within the allergic rhinitis cohort were also performed.

RESULTS

Patients with physician-diagnosed allergic rhinitis (N = 110, 207 in matched cohort) had significantly lower risk for myocardial infarction (HR, 0.63; 95% confidence interval [CI], 0.59-0.67; P < .001), all CHD (HR, 0.81; 95% CI, 0.78-0.84; P < .001), CVD (HR, 0.67; 95% CI, 0.64-0.70; P < .001), and all-cause mortality (HR, 0.42; 95% CI, 0.40-0.43; P < .001). The results were similar after excluding patients with asthma. Patients with positive sIgE test result also had a decreased risk of all CHD (relative risk [RR], 0.87; 95% CI, 0.79-0.95; P = .003) but no association with cerebrovascular events (RR, 0.89; 95% CI, 0.77-1.02; P = .10) and all-cause mortality (RR, 1.16; 95% CI, 1.00-1.34; P = .06).

CONCLUSION

We found that the presence of allergic rhinitis was associated with decreased CHD, CVD, and all-cause mortality. This decreased risk was more pronounced after excluding patients with asthma. Patients with positive sIgE test results also had decreased risk of CHD.

IgE sensitization to inhalant allergens and the risk of airway infection and disease: A population-based study

BACKGROUND

Immunoglobulin E (IgE) sensitization, which is the propensity to develop IgE antibodies against common environmental allergens, is associated with a lymphocyte T-helper type 2 (Th2) skewed immune response and a high risk of allergic respiratory disease. Little is known about whether IgE sensitization confers an increased risk of respiratory infections in adults. We investigated the association between IgE sensitization and the incidence of acute airway infections, other infections and chronic lower airway disease events as recorded in nation-wide registries.

METHODS

We included 14,849 persons from five population-based studies with measurements of serum specific IgE positivity against inhalant allergens. Participants were followed by linkage to Danish national registries (median follow-up time 11.3 years). The study-specific relative risks were estimated by Cox regression analysis, meta-analysed, and expressed as hazard ratios, HRs (95% confidence intervals, CIs).

RESULTS

The relative risks for IgE sensitized vs. non-sensitized were: for pneumonia (HR = 1.20, 95% CI: 1.01, 1.41), other acute airway infection (HR = 0.86, 95% CI: 0.60, 1.22), infection (HR = 1.06, 95% CI: 0.90, 1.24), asthma (HR = 2.26, 95% CI: 1.79, 2.86), and other chronic lower airway disease (HR = 1.31, 95% CI: 1.08, 1.58). In never smokers, the higher risk of pneumonia (HR = 1.73, 95% CI: 1.23, 2.44) and asthma (HR = 3.17, 95% CI: 2.10, 4.76) among IgE sensitized was more pronounced.

CONCLUSIONS

IgE sensitization was associated with a higher risk of asthma, other chronic lower airway diseases, and pneumonia. However, the association between IgE sensitization and pneumonia may be explained by undiagnosed asthma causing the pneumonia. Further studies are needed for confirmation.

Developments in the field of allergy in 2014 through the eyes of Clinical and Experimental Allergy

The pathogenesis of asthma continues to be a major topic of interest to our authors with reviews and original papers on the role of viruses, mechanisms of inflammation, biomarkers, and phenotypes of asthma being major topics. A number of papers described new treatments for asthma focusing on blocking the Th2 response reflecting the fact that two decades of work in this area is finally bearing fruit. The pathogenesis of chronic rhinosinusitis is a growing area of interest, but there has been less on the genetics of airways disease than in previous years possibly reflecting the degree of rigour (and therefore a smaller body of work), with which these sorts of studies are now being undertaken. There continues to be a wide range of papers dealing with mechanisms of allergic disease ranging from clinical-based studies to basic research and the use of in vivo animal models especially mice. As before, mechanisms and new approaches to immunotherapy are common themes. Several were published in the allergens section investigating modification of allergens to increase their effectiveness and reduce the risk of adverse events. Risk factors for allergic disease was a common theme in the epidemiology section and food allergy a common theme in clinical allergy with papers on the development of protocols to induce tolerance and attempts to find biomarkers to distinguish sensitization from allergic disease. This was another exciting year for the editors, and we hope the readers of the journal.

Association between cancer and allergies

Background

The prevalence of allergies and the incidence of cancer are both increasing worldwide. It has been hypothesized that atopy may affect the risk of some cancers.

Methods

In this study, 1525 patients (754 women and 771 men with a mean age of 52.7 ± 11.9 years) with different types of cancer were examined for the presence of allergies. Allergies were confirmed based on retrospective analysis of allergy diagnostic procedures in patients previously diagnosed with cancer. All patients were also analyzed for bronchial asthma and allergic rhinitis according to relevant guidelines. A control group of patients without cancer diagnoses was used for comparison.

Results

Patients with cancer had significantly fewer IgE-mediated allergic diseases than the control population. For the oncological group compared to the non-cancer patients, the odds ratios (ORs) for allergic rhinitis, atopic dermatitis, and bronchial asthma were 0.67 (95 % CI 0.52–0.81), 0.89 (95 % CI 0.78–0.99), and 1.03 (95 % CI 0.91–1.13), respectively. The mean serum concentrations of total IgE were significantly lower in the study population of patients with cancer than in the patients in the control group (45.98 ± 14.9 vs. 83.2 ± 40.1 IU/l; p < 0.05). There were no significant correlations between the type of cancer diagnosed and the form of allergy.

Conclusion

Our results indicate that the overall incidence of allergies, particularly allergic rhinitis, was lower in patients with some types of cancer. Further studies are needed to confirm our findings.

Investigating the association between allergen-specific immunoglobulin E, cancer risk and survival

Prior findings linking allergy and cancer have been inconsistent, which may be driven by diverse assessment methods. We used serum specific immunoglobulin E (IgE) against common inhalant allergens that was assessed prior to cancer diagnosis in studying this association. We selected 8,727 Swedish men and women who had measurements of serum allergen-specific IgE and total IgE between 1992 and 1996. Multivariable Cox regression using age as a timescale was performed to assess the associations of IgE sensitization, defined by any levels of serum specific IgE ≥35 kU/L, with risk of overall and specific cancers. A test for trend was performed by assigning scores derived from allergen-specific IgE levels at baseline as an ordinal scale. Kaplan-Meier curves and log-rank test were used to assess cancer survival by IgE sensitization status. During a mean follow-up of 16 year, 689 persons were diagnosed with cancer. We found an inverse association between IgE sensitization and cancer risk, with a hazard ratio (HR) of 0.83 and 95% confidence intervals (CI) of 0.70-0.99. A similar trend was seen with specific IgE scores overall (Ptrend = 0.007) and in women (Ptrend = 0.01). Although IgE sensitization was not associated with risk of common site-specific cancers, serum specific IgE scores were inversely associated with melanoma risk in men and women combined, and with risk of female breast and gynecological cancers combined. No association with survival was observed. The association between circulating IgE levels and incident cancer may point toward a role of T-helper 2 (TH2)-biased response in development of some cancers.

[New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases]

The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients.

Lifestyle-Related Factors and Atopy in Seven Danish Population-Based Studies from Different Time Periods

BACKGROUND

The prevalence of allergic respiratory disease tends to increase in populations that adopt the so-called Westernized lifestyle. We investigated the association between atopy and several possible lifestyle-related factors in seven Danish population-based studies.

METHODS

A total of 20048 persons participated in the seven studies. We used logistic regression to analyse the associations between possible determinants and atopy defined as serum specific IgE or skin prick test positivity against inhalant allergens. Associations were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs). In addition, individual participant data meta-analyses were performed.

RESULTS

Atopy was significantly associated with younger age (OR per 1 year increase in age: 0.97; 95% CI: 0.97, 0.98); male sex (OR for males versus females: 1.34; 95% CI: 1.24, 1.45), heavy drinking (OR for heavy drinkers versus light drinkers: 1.15; 95% CI: 1.04, 1.27), never smoking (OR for current versus never smokers: 0.73; 95% CI: 0.67, 0.80), and higher educational level (OR for educated versus uneducated: 1.27; 95% CI: 1.15, 1.41). Atopy was not associated with blood pressure, serum total cholesterol, physical activity or body mass except in women only, where we found a positive association (OR for obese vs. normal weight: 1.18; 95% CI: 1.00, 1.39) with ptrend = 0.032.

CONCLUSIONS

Of interest for preventive purposes, we found that atopy was associated with some of the reversible lifestyle-related factors that characterize a Westernized lifestyle.

Pollinosis and all-cause mortality among middle-aged and elderly Japanese: a population-based cohort study

BACKGROUND

Having an allergic disease may have health implications beyond those more commonly associated with allergy given that previous epidemiological studies have suggested that both atopy and allergy are linked to mortality. More viable immune functioning among the elderly, as indicated by the presence of an allergic disease, might therefore be associated with differences in all-cause mortality.

OBJECTIVE

Using data from a Japanese cohort, this study examined whether having pollinosis (a form of allergic rhinitis) in a follow-up survey could predict all-cause and cause-specific mortality.

METHODS

Data came from the Komo-Ise cohort, which at its 1993 baseline recruited residents aged 40-69 years from two areas in Gunma prefecture, Japan. The current study used information on pollinosis that was obtained from the follow-up survey in 2000. Mortality and migration data were obtained throughout the follow-up period up to December 2008. Proportional hazard models were used to examine the relation between pollinosis and mortality.

RESULTS

At the 2000 follow-up survey, 12% (1088 of 8796) of respondents reported that they had pollinosis symptoms in the past 12 months. During the 76 186 person-years of follow-up, 748 died from all causes. Among these, there were 37 external, 208 cardiovascular, 74 respiratory, and 329 neoplasm deaths. After adjusting for potential confounders, pollinosis was associated with significantly lower all-cause [hazard ratio 0.57 (95% confidence interval = 0.38-0.87)] and neoplasms mortality [hazard ratio 0.48 (95% confidence interval = 0.26-0.92)].

CONCLUSIONS AND CLINICAL RELEVANCE

Having an allergic disease (pollinosis) at an older age may be indicative of more viable immune functioning and be protective against certain causes of death. Further research is needed to determine the possible mechanisms underlying the association between pollinosis and mortality.