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Ali M, Nair P, Capretta A, Brennan JD. In-vitro Clinical Diagnostics using RNA-Cleaving DNAzymes. Chembiochem 2024; 25:e202400085. [PMID: 38574237 DOI: 10.1002/cbic.202400085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/06/2024]
Abstract
Over the last three decades, significant advancements have been made in the development of biosensors and bioassays that use RNA-cleaving DNAzymes (RCDs) as molecular recognition elements. While early examples of RCDs were primarily responsive to metal ions, the past decade has seen numerous RCDs reported for more clinically relevant targets such as bacteria, cancer cells, small metabolites, and protein biomarkers. Over the past 5 years several RCD-based biosensors have also been evaluated using either spiked biological matrixes or patient samples, including blood, serum, saliva, nasal mucus, sputum, urine, and faeces, which is a critical step toward regulatory approval and commercialization of such sensors. In this review, an overview of the methods used to generate RCDs and the properties of key RCDs that have been utilized for in vitro testing is first provided. Examples of RCD-based assays and sensors that have been used to test either spiked biological samples or patient samples are then presented, highlighting assay performance in different biological matrixes. A summary of current prospects and challenges for development of in vitro diagnostic tests incorporating RCDs and an overview of future directions of the field is also provided.
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Affiliation(s)
- Monsur Ali
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Parameswaran Nair
- Division of Respirology, McMaster University, and, Firestone Institute of Respiratory Health at St. Joseph's Health Care, Hamilton, ON, L8N 4A6, Canada
| | - Alfredo Capretta
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - John D Brennan
- Biointerfaces Institute, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
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2
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Jesenak M, Diamant Z, Simon D, Tufvesson E, Seys SF, Mukherjee M, Lacy P, Vijverberg S, Slisz T, Sediva A, Simon HU, Striz I, Plevkova J, Schwarze J, Kosturiak R, Alexis NE, Untersmayr E, Vasakova MK, Knol E, Koenderman L. Eosinophils-from cradle to grave: An EAACI task force paper on new molecular insights and clinical functions of eosinophils and the clinical effects of targeted eosinophil depletion. Allergy 2023; 78:3077-3102. [PMID: 37702095 DOI: 10.1111/all.15884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/14/2023]
Abstract
Over the past years, eosinophils have become a focus of scientific interest, especially in the context of their recently uncovered functions (e.g. antiviral, anti-inflammatory, regulatory). These versatile cells display both beneficial and detrimental activities under various physiological and pathological conditions. Eosinophils are involved in the pathogenesis of many diseases which can be classified into primary (clonal) and secondary (reactive) disorders and idiopathic (hyper)eosinophilic syndromes. Depending on the biological specimen, the eosinophil count in different body compartments may serve as a biomarker reflecting the underlying pathophysiology and/or activity of distinct diseases and as a therapy-driving (predictive) and monitoring tool. Personalized selection of an appropriate therapeutic strategy directly or indirectly targeting the increased number and/or activity of eosinophils should be based on the understanding of eosinophil homeostasis including their interactions with other immune and non-immune cells within different body compartments. Hence, restoring as well as maintaining homeostasis within an individual's eosinophil pool is a goal of both specific and non-specific eosinophil-targeting therapies. Despite the overall favourable safety profile of the currently available anti-eosinophil biologics, the effect of eosinophil depletion should be monitored from the perspective of possible unwanted consequences.
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Affiliation(s)
- Milos Jesenak
- Department of Clinical Immunology and Allergology, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
- Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
| | - Zuzana Diamant
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
- Department Microbiology Immunology & Transplantation, KU Leuven, Catholic University of Leuven, Leuven, Belgium
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Dagmar Simon
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ellen Tufvesson
- Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund University, Lund, Sweden
| | - Sven F Seys
- Laboratory of Clinical Immunology, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Manali Mukherjee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- The Firestone Institute for Respiratory Health, Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Paige Lacy
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Susanne Vijverberg
- Amsterdam UMC Location University of Amsterdam, Pulmonary Diseases, Amsterdam, The Netherlands
| | - Tomas Slisz
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Anna Sediva
- Department of Immunology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
- Institute of Biochemistry, Brandenburg Medical School, Neuruppin, Germany
| | - Ilja Striz
- Department of Clinical and Transplant Immunology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jana Plevkova
- Department of Pathophysiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic
| | - Jurgen Schwarze
- Child Life and Health and Centre for Inflammation Research, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Radovan Kosturiak
- Department of Paediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovak Republic
- Outpatient Clinic for Clinical Immunology and Allergology, Nitra, Slovak Republic
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, Department of Paediatrics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Martina Koziar Vasakova
- Department of Respiratory Medicine, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Edward Knol
- Department Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leo Koenderman
- Department Center of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department Pulmonary Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
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Ali MM, Mukherjee M, Radford K, Patel Z, Capretta A, Nair P, Brennan JD. A Rapid Sputum-based Lateral Flow Assay for Airway Eosinophilia using an RNA-cleaving DNAzyme Selected for Eosinophil Peroxidase. Angew Chem Int Ed Engl 2023; 62:e202307451. [PMID: 37477970 DOI: 10.1002/anie.202307451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023]
Abstract
The first protein-binding allosteric RNA-cleaving DNAzyme (RCD) obtained by direct in vitro selection against eosinophil peroxidase (EPX), a validated marker for airway eosinophilia, is described. The RCD has nanomolar affinity for EPX, shows high selectivity against related peroxidases and other eosinophil proteins, and is resistant to degradation by mammalian nucleases. An optimized RCD was used to develop both fluorescence and lateral flow assays, which were evaluated using 38 minimally processed patient sputum samples (23 non-eosinophilic, 15 eosinophilic), producing a clinical sensitivity of 100 % and specificity of 96 %. This RCD-based lateral flow assay should allow for rapid evaluation of airway eosinophilia as an aid for guiding asthma therapy.
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Affiliation(s)
- M Monsur Ali
- Biointerfaces Institute, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Manali Mukherjee
- Division of Respirology, McMaster University, Firestone Institute of Respiratory Health at St. Joseph's Health Care, L8N 4A6, Hamilton, ON, Canada
| | - Katherine Radford
- Division of Respirology, McMaster University, Firestone Institute of Respiratory Health at St. Joseph's Health Care, L8N 4A6, Hamilton, ON, Canada
| | - Zil Patel
- Division of Respirology, McMaster University, Firestone Institute of Respiratory Health at St. Joseph's Health Care, L8N 4A6, Hamilton, ON, Canada
| | - Alfredo Capretta
- Biointerfaces Institute, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Parameswaran Nair
- Division of Respirology, McMaster University, Firestone Institute of Respiratory Health at St. Joseph's Health Care, L8N 4A6, Hamilton, ON, Canada
| | - John D Brennan
- Biointerfaces Institute, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
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Abstract
INTRODUCTION The numerous links between allergic rhinitis and asthma have been extensively explored in the last two decades, gaining great concern within the scientific community. These two conditions frequently coexist in the same patient and share numerous pathogenetic and pathophysiological mechanisms. AREAS COVERED We reviewed major pathophysiological, epidemiological, and clinical links between allergic rhinitis and asthma. We also provided a comprehensive discussion of allergic rhinitis treatment according to current guidelines, with a particular focus on the relevance of allergic rhinitis therapies in patients with comorbid asthma. EXPERT OPINION We believe that there are several unmet needs for our patients, however, there are promising advances forecasted for the future. Although allergic rhinitis is a recognized risk factor for asthma, a proper asthma detection and prevention plan in allergic rhinitis patients is not available. Allergen immunotherapy (AIT) represents a promising preventive strategy and may deserve an earlier positioning in allergic rhinitis management. A multidisciplinary approach should characterize the journey of patients with respiratory allergies, with an adequate referral to specialized Allergy/Asthma centers. Molecular Allergy Diagnosis may provide support for optimal AIT use. Finally, a possible evolution of biological treatment can be envisaged, mainly if biosimilars decrease such therapies' costs.
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Latorre M, Bacci E, Seccia V, Bartoli ML, Cardini C, Cianchetti S, Cristofani L, Di Franco A, Miccoli M, Puxeddu I, Celi A, Paggiaro P. Upper and lower airway inflammation in severe asthmatics: a guide for a precision biologic treatment. Ther Adv Respir Dis 2020; 14:1753466620965151. [PMID: 33263506 PMCID: PMC7716065 DOI: 10.1177/1753466620965151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background and aims: Severe asthma may require the prescription of one of the biologic drugs currently available, using surrogate markers of airway inflammation (serum IgE levels and allergic sensitization for anti-IgE, or blood eosinophils for anti-IL5/IL5R). Our objective: to assess upper and lower airway inflammation in severe asthmatics divided according to the eligibility criteria for one of the target biologic treatments. Methods: We selected 91 severe asthmatics, uncontrolled despite high-dose ICS-LABA, and followed for >6 months with optimization of asthma treatment. Patients underwent clinical, functional and biological assessment, including induced sputum and nasal cytology. They were then clustered according to the eligibility criteria for omalizumab or mepolizumab/benralizumab. Results: Four clusters were selected: A (eligible for omalizumab, n = 23), AB (both omalizumab and mepolizumab, n = 26), B (mepolizumab, n = 22) and C (non-eligible for both omalizumab and mepolizumab, n = 20). There was no difference among clusters for asthma control (Asthma Control Test and Asthma Control Questionnaire 7), pre-bronchodilator forced expiratory volume in 1 s, serum IgE and fractional exhaled nitric oxide levels. Sputum eosinophils were numerically higher in clusters AB and B, in agreement with the higher levels of blood eosinophils. Allergic rhinitis was more frequent in clusters A and AB, while chronic rhinosinusitis with nasal polyps prevalence increased progressively from A to C. Eosinophils in nasal cytology were higher in clusters AB, B and C. Conclusion: Eosinophilic upper and lower airway inflammation is present in the large majority of severe asthmatics, independently from the prescription criteria for the currently available biologics, and might suggest the use of anti-IL5/IL5R or anti IL4/13 also in patients without blood eosinophilia. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Manuela Latorre
- Pulmonary Unit, Nuovo Ospedale Apuano, UO Pneumologia, Via Enrico Mattei 21, Massa, Italy.,Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Elena Bacci
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | | | - Maria Laura Bartoli
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Cristina Cardini
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Silvana Cianchetti
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | | | - Antonella Di Franco
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Toscana, Italy
| | - Ilaria Puxeddu
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Toscana, Italy
| | - Alessandro Celi
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Toscana, Italy
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Yoon KH, Kim K, Yoon JS, Kim HH. The diagnostic usefulness and correlation of nasal eosinophil count and percentage in children with rhinitis. ALLERGY ASTHMA & RESPIRATORY DISEASE 2020. [DOI: 10.4168/aard.2020.8.1.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kyou Hyun Yoon
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyunghoon Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Seo Yoon
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Seoul, Korea
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Marino MJ, Garcia JO, Zarka MA, Lal D. Inflammatory cell predominance and patterns in chronic rhinosinusitis with and without nasal polyposis patients. Laryngoscope Investig Otolaryngol 2019; 4:573-577. [PMID: 31890873 PMCID: PMC6929577 DOI: 10.1002/lio2.328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/23/2019] [Accepted: 10/30/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES There is interest in identifying chronic rhinosinusitis (CRS) endotypes that align pathophysiology with clinical observation and outcomes. CRS with polyps (CRSwNP) has classically been studied with reference to tissue eosinophilia, but the role of other cellular infiltrates remains uncharacterized. No particular tissue prognosticators have been described for CRS without nasal polyps (CRSsNP). Predominance of leukocytes seen in surgical tissue may be useful for differentiating CRS subtypes, severity of inflammation, and outcomes. METHODS Structured histopathology reports were examined for 277 patients undergoing endoscopic sinus surgery for CRSwNP (n = 115), CRSsNP (n = 141), and recurrent acute rhinosinusitis (RARS, n = 21). Inflammatory predominance was examined for associations with nasal polyposis, asthma, allergic rhinitis, aspirin exacerbated respiratory disease (AERD), immune deficiency, preoperative Lund-Mackay score, and outcome (SNOT-22 score change). RESULTS In order of frequency, the prevalence of predominant inflammatory patterns accounting for 93.5% of CRS patients were: lymphoplasmocytic (n = 111), lymphocytic (n = 74), eosinophilic (n = 50), and lymphoplasmocytic with eosinophilic (n = 24). Eosinophilic predominance was 97.4% specific for nasal polyps (95% confidence interval [CI], 93.4%-99.3%), although sensitivity was 43.4% (95% CI, 33.8%-53.4%). The absence of eosinophilic predominance was 100% sensitive for RARS (95% CI, 82.4%-100%), however specificity was 30.8% (95% CI 25.1%-37.1%). There were no significant differences in preoperative SNOT-22 scores or change postoperatively. CONCLUSIONS Eosinophilic inflammatory predominance was predictive for nasal polyps and against RARS. Nevertheless, the majority of CRSwNP patients had a different inflammatory predominance, demonstrating heterogeneity in CRS, even among patients with nasal polyps. Symptomatic outcomes were not associated with inflammatory predominance through 12 months follow up. LEVEL OF EVIDENCE 4.
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Affiliation(s)
| | - J. Omar Garcia
- Department of OtorhinolaryngologyMayo ClinicPhoenixArizona
| | | | - Devyani Lal
- Department of OtorhinolaryngologyMayo ClinicPhoenixArizona
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8
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Ardura-Garcia C, Arias E, Hurtado P, Bonnett LJ, Sandoval C, Maldonado A, Workman LJ, Platts-Mills TAE, Cooper PJ, Blakey JD. Predictors of severe asthma attack re-attendance in Ecuadorian children: a cohort study. Eur Respir J 2019; 54:13993003.02419-2018. [PMID: 31515399 PMCID: PMC6860994 DOI: 10.1183/13993003.02419-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/11/2019] [Indexed: 01/23/2023]
Abstract
Asthma is a common cause of emergency care attendance in low- and middle-income countries (LMICs). While few prospective studies of predictors for emergency care attendance have been undertaken in high-income countries, none have been performed in a LMIC. We followed a cohort of 5–15-year-old children treated for asthma attacks in emergency rooms of public health facilities in Esmeraldas City, Ecuador. We collected blood and nasal wash samples, and performed spirometry and exhaled nitric oxide fraction measurements. We explored potential predictors for recurrence of severe asthma attacks requiring emergency care over 6 months’ follow-up. We recruited 283 children of whom 264 (93%) were followed-up for ≥6 months or until their next asthma attack. Almost half (46%) had a subsequent severe asthma attack requiring emergency care. Predictors of recurrence in adjusted analyses were (adjusted OR, 95% CI) younger age (0.87, 0.79–0.96 per year), previous asthma diagnosis (2.2, 1.2–3.9), number of parenteral corticosteroid courses in previous year (1.3, 1.1–1.5), food triggers (2.0, 1.1–3.6) and eczema diagnosis (4.2, 1.02–17.6). A parsimonious Cox regression model included the first three predictors plus urban residence as a protective factor (adjusted hazard ratio 0.69, 95% CI 0.50–0.95). Laboratory and lung function tests did not predict recurrence. Factors independently associated with recurrent emergency attendance for asthma attacks were identified in a low-resource LMIC setting. This study suggests that a simple risk-assessment tool could potentially be created for emergency rooms in similar settings to identify higher-risk children on whom limited resources might be better focused. Among children in a low-resource setting in Latin America, younger age, an established asthma diagnosis and history of severe asthma attacks in the previous year were associated with recurrence of severe asthma attacks, irrespective of biomarkershttp://bit.ly/2TBzJcP
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Affiliation(s)
- Cristina Ardura-Garcia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland .,Liverpool School of Tropical Medicine, Liverpool, UK
| | - Erick Arias
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Paola Hurtado
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Laura J Bonnett
- Dept of Biostatistics, University of Liverpool, Liverpool, UK
| | - Carlos Sandoval
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador
| | - Augusto Maldonado
- Colegio de Ciencias de la Salud, Universidad San Francsico de Quito, Quito, Ecuador
| | - Lisa J Workman
- Asthma and Allergic Diseases Center, University of Virginia, Charlottesville, VA, USA
| | | | - Philip J Cooper
- Fundación Ecuatoriana Para Investigación en Salud, Quito, Ecuador.,Facultad de Ciencias Medicas, de la Salud y la Vida, Universidad Internacional del Ecuador, Quito, Ecuador.,Institute of Infection and Immunity, St George's University of London, London, UK.,Both authors contributed equally
| | - John D Blakey
- Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, Curtin University, Perth, Australia.,Both authors contributed equally
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Choi Y, Jeon H, Yang EA, Yoon JS, Kim HH. Nasal eosinophilia and eosinophil peroxidase in children and adolescents with rhinitis. KOREAN JOURNAL OF PEDIATRICS 2019; 62:353-359. [PMID: 31096743 PMCID: PMC6753315 DOI: 10.3345/kjp.2019.00318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/24/2019] [Indexed: 01/21/2023]
Abstract
Background Researchers have shown that eosinophil peroxidase (EPO) is a relatively accurate marker of eosinophilia and eosinophil activity. However, its use as a marker of eosinophilic inflammation in nasal secretions is limited because the diagnostic cutoff values of EPO for use as a one-time test for allergic diseases such as allergic rhinitis have not been established. Purpose To identify the correlation between nasal eosinophil count and EPO in children and adolescents with rhinitis. Methods We recruited patients <18 years of age with rhinitis for more than 2 weeks or more than 2 episodes a year whose nasal eosinophil and EPO were measured at a single allergy clinic. The eosinophil percentage was calculated by dividing the eosinophil count by the number of total cells under light microscopy at ×1,000 magnification. EPO and protein were measured from nasal secretions. We retrospectively analyzed the correlation between nasal eosinophils and protein-corrected EPO (EPO/protein) value. Results Of the 67 patients enrolled, 41 were male (61.2%); the mean age was 8.2±4.0 years. The median nasal eosinophil count was 1 and percentage was 1%. The median protein-corrected EPO value was 12.5 ng/μg (range, 0–31 ng/μg). There was a statistically significant correlation between eosinophil count and percentage (P<0.001). However, the eosinophil percentage and EPO did not correlate. The eosinophil count and EPO had a statistically significant correlation (P =0.01). The EPO cutoff value examined for nasal eosinophil counts of 2, 5, 10, and 20 was 17.57 ng/μg regardless of the reference count. The largest area under the curve value was obtained when the receiver operating characteristic curve was drawn using the eosinophil count of 2. Conclusion Nasal eosinophil count was significantly associated with protein-corrected EPO.
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Affiliation(s)
- Yeonu Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Haeun Jeon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Ae Yang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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10
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Longo G, Conversano E, Panontin E, Ventura G, Ventura A. Nonatopic persistent asthma in children, a missed phenotype of asthma? J Allergy Clin Immunol 2017; 140:1212-1213. [PMID: 28780971 DOI: 10.1016/j.jaci.2017.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/30/2017] [Indexed: 11/25/2022]
Affiliation(s)
| | | | | | - Giovanna Ventura
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Alessandro Ventura
- Univerisity of Trieste, Trieste, Italy; Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
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11
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Ricciardolo FLM, Sorbello V, Folino A, Gallo F, Massaglia GM, Favatà G, Conticello S, Vallese D, Gani F, Malerba M, Folkerts G, Rolla G, Profita M, Mauad T, Di Stefano A, Ciprandi G. Identification of IL-17F/frequent exacerbator endotype in asthma. J Allergy Clin Immunol 2016; 140:395-406. [PMID: 27931975 DOI: 10.1016/j.jaci.2016.10.034] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 10/17/2016] [Accepted: 10/27/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Severe asthma might be associated with overexpression of Th17 cytokines, which induce neutrophil recruitment via neutrophil-mobilizing cytokines in airways. OBJECTIVE To study IL-17-related cytokines in nasal/bronchial biopsies from controls and mild asthmatics (MAs) to severe asthmatics (SAs) in relation to exacerbation rate. METHODS Inflammatory cells and IL-17A+, IL-17F+, IL-21+, IL-22+, and IL-23+ cells were examined by immunohistochemistry in cryostat sections of bronchial/nasal biopsies obtained from 33 SAs (21 frequent exacerbators [FEs]), 31 MAs (3 FEs), and 14 controls. IL-17F protein was also measured by ELISA in bronchial/nasal lysates and by immunohistochemistry in bronchial tissue obtained from subjects who died because of fatal asthma. Immunofluorescence/confocal microscopy was used for IL-17F colocalization. RESULTS Higher number (P < .05) of neutrophils, IL-17A+, IL-17F+, and IL-21+ cells in bronchial biopsies and higher numbers (P < .01) of IL-17F+ and IL-21+ cells in nasal biopsies were observed in SAs compared with MAs. Bronchial IL-17F+ cells correlated with bronchial neutrophils (r = 0.54), exacerbation rate (r = 0.41), and FEV1 (r = -0.46). Nasal IL-17F+ cells correlated with bronchial IL-17F (r = 0.35), exacerbation rate (r = 0.47), and FEV1 (r = -0.61). FEs showed increased number of bronchial neutrophils/eosinophils/CD4+/CD8+ cells and bronchial/nasal IL-17F+ cells. Receiver operating characteristic curve analysis evidenced predictive cutoff values of bronchial neutrophils and nasal/bronchial IL-17F for discriminating between asthmatics and controls, between MAs and SAs and between FEs and non-FEs. IL-17F protein increased in bronchial/nasal lysates of SAs and FEs and in bronchial tissue of fatal asthma. IL-17F colocalized in CD4+/CD8+ cells. CONCLUSIONS IL-17-related cytokines expression was amplified in bronchial/nasal mucosa of neutrophilic asthma prone to exacerbation, suggesting a pathogenic role of IL-17F in FEs.
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Affiliation(s)
- Fabio L M Ricciardolo
- Department of Clinical and Biological Sciences, Azienda Ospedaliera Universitaria (AOU) San Luigi Hospital, University of Torino, Torino, Italy.
| | - Valentina Sorbello
- Department of Clinical and Biological Sciences, Azienda Ospedaliera Universitaria (AOU) San Luigi Hospital, University of Torino, Torino, Italy
| | - Anna Folino
- Department of Clinical and Biological Sciences, Azienda Ospedaliera Universitaria (AOU) San Luigi Hospital, University of Torino, Torino, Italy
| | - Fabio Gallo
- Health Science Department, University of Genova, Genova, Italy
| | | | - Gabriella Favatà
- Division of Ear, Nose, and Throat, AOU San Luigi Hospital, Torino, Italy
| | | | - Davide Vallese
- Pulmonary Division, Fondazione S. Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Novara, Italy
| | - Federica Gani
- Division of Respiratory Disease, AOU San Luigi Hospital, Torino, Italy
| | - Mario Malerba
- Department of Internal Medicine, University of Brescia, Brescia, Italy
| | - Gert Folkerts
- Department of Pharmacology and Pathophysiology, Utrecht Institute for Pharmaceutical Sciences, University of Utrecht, Utrecht, The Netherlands
| | - Giovanni Rolla
- Allergologia ed Immunologia Clinica, Ospedale Ordine Mauriziano "Umberto I," University of Torino, Torino, Italy
| | - Mirella Profita
- Institute of Biomedicine and Molecular Immunology, Italian National Research Council, Palermo, Italy
| | - Thais Mauad
- Department of Pathology, Sao Paulo University Medical School, São Paulo, Brazil
| | - Antonino Di Stefano
- Pulmonary Division, Fondazione S. Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Novara, Italy
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12
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de Farias CF, Amorim MMF, Dracoulakis M, Caetano LB, Santoro IL, Fernandes ALG. Nasal lavage, blood or sputum: Which is best for phenotyping asthma? Respirology 2016; 22:671-677. [PMID: 27899011 DOI: 10.1111/resp.12958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/12/2016] [Accepted: 09/13/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Determination of asthma phenotypes, particularly inflammatory phenotypes, helps guide treatment and management of this heterogeneous disease. Induced sputum cytology has been the gold standard for determination of inflammatory phenotypes, but sputum induction is fairly invasive and technically challenging. Blood and nasal lavage cytology have been suggested as substitutes, but have not been fully verified. The aim of this study is to determine the accuracy of blood and nasal lavage cytometry as indicators of inflammatory phenotypes in asthma. METHODS Clinical evaluation, Asthma Control Questionnaire (ACQ) and spirometry were performed for 121 adult asthma patients, and blood, nasal lavage and induced sputum samples were taken. Eosinophils and neutrophils were counted in three samples from each subject. Inflammatory phenotypes (eosinophilic, neutrophilic, mixed and paucicellular) and cells counts were analysed using Venn diagram and receiver operating characteristic (ROC) curve, respectively. RESULTS ACQ score, spirometry and bronchodilator response did not differ among subjects with different inflammatory phenotypes. Inflammatory phenotypes defined by nasal lavage cytometry were in better concordance than those defined by blood cell counts with phenotypes determined by sputum cytology, and were significantly correlated with sputum phenotypes. For eosinophilia, nasal lavage cytology showed better accuracy than blood cytology (area under the curve (AUC): 0.89 vs 0.65). For all phenotypes, sensitivity and positive and negative predictive power were higher for nasal lavage cytometry than for blood. Blood cell counts gave a high level of false positives for all inflammatory phenotypes. CONCLUSION We recommend nasal lavage cytology over blood cell count as a substitute for sputum cytology to identify inflammatory phenotypes in asthma.
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Affiliation(s)
- Camyla F de Farias
- Asthma Research Group Respiratory Division, Escola Paulista de Medicina, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Maria M F Amorim
- Asthma Research Group Respiratory Division, Escola Paulista de Medicina, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Michel Dracoulakis
- Asthma Research Group Respiratory Division, Escola Paulista de Medicina, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Lilian B Caetano
- Asthma Research Group Respiratory Division, Escola Paulista de Medicina, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Ilka L Santoro
- Asthma Research Group Respiratory Division, Escola Paulista de Medicina, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
| | - Ana L G Fernandes
- Asthma Research Group Respiratory Division, Escola Paulista de Medicina, Federal University of São Paulo, Hospital São Paulo, São Paulo, Brazil
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13
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Rank MA, Ochkur SI, Lewis JC, Teaford HG, Wesselius LJ, Helmers RA, Lee NA, Nair P, Lee JJ. Nasal and pharyngeal eosinophil peroxidase levels in adults with poorly controlled asthma correlate with sputum eosinophilia. Allergy 2016; 71:567-70. [PMID: 26645423 DOI: 10.1111/all.12817] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
Abstract
The objective of the study was to compare nasal, pharyngeal, and sputum eosinophil peroxidase (EPX) levels with induced sputum eosinophil percentage in 10 adults with poorly controlled asthma and 10 normal controls. EPX was measured using an ELISA and normalized for grams of protein for nasal and pharynx specimens and for mL-gram of protein for sputum. Sputum EPX levels were statistically different between asthma and control subjects (P = 0.024). EPX levels measured in the nasal and pharyngeal swab samples derived from the same patients were also different between asthma and control subjects, each displaying a high degree of significance (P = 0.002). Spearman's correlation coefficients for nasal EPX and pharyngeal EPX levels compared to induced sputum eosinophil percentage were 0.81 (P = 0.0007) and 0.78 (P = 0.0017), respectively. Thus, there is a strong association in a given patient between both nasal and pharyngeal EPX levels and the eosinophil percentage of induced sputum.
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Affiliation(s)
- M. A. Rank
- Division of Allergy, Asthma, Clinical Immunology, Department of Internal Medicine; Mayo Clinic
| | - S. I. Ochkur
- Division of Pulmonary Medicine, Department of Biochemistry and Molecular Biology; Mayo Clinic
| | - J. C. Lewis
- Division of Allergy, Asthma, Clinical Immunology, Department of Internal Medicine; Mayo Clinic
| | - H. G. Teaford
- Division of Allergy, Asthma, Clinical Immunology, Department of Internal Medicine; Mayo Clinic
| | - L. J. Wesselius
- Division of Pulmonary Medicine, Department of Biochemistry and Molecular Biology; Mayo Clinic
| | - R. A. Helmers
- Division of Pulmonary Medicine, Department of Critical Care; Mayo Clinic
| | - N. A. Lee
- Division of Hematology and Oncology, Department of Biochemistry and Molecular Biology; Mayo Clinic
| | - P. Nair
- Department of Medicine; St. Joseph's Healthcare & McMaster University; Hamilton ON Canada
| | - J. J. Lee
- Division of Pulmonary Medicine, Department of Biochemistry and Molecular Biology; Mayo Clinic
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14
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Amorim MM, Fernandes PBL, Caetano LB, Dracoulakis S, Santoro IL, Fernandes ALG. Nasal lavage is better than blood count in predicting sputum eosinophilia. Clin Exp Allergy 2016; 45:1006-1008. [PMID: 25675973 DOI: 10.1111/cea.12512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M M Amorim
- Escola Paulista de Medicina/Universidade Federal de São Paulo, São Paulo, Brazil
| | - P B L Fernandes
- Escola Paulista de Medicina/Universidade Federal de São Paulo, São Paulo, Brazil
| | - L B Caetano
- Escola Paulista de Medicina/Universidade Federal de São Paulo, São Paulo, Brazil
| | - S Dracoulakis
- Escola Paulista de Medicina/Universidade Federal de São Paulo, São Paulo, Brazil
| | - I L Santoro
- Escola Paulista de Medicina/Universidade Federal de São Paulo, São Paulo, Brazil
| | - A L G Fernandes
- Escola Paulista de Medicina/Universidade Federal de São Paulo, São Paulo, Brazil
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Codispoti CD, Bernstein DI, Levin L, Reponen T, Ryan PH, Biagini Myers JM, Villareal M, Burkle J, Lummus Z, Lockey JE, Khurana Hershey GK, LeMasters GK. Early-life mold and tree sensitivity is associated with allergic eosinophilic rhinitis at 4 years of age. Ann Allergy Asthma Immunol 2015; 114:193-198.e4. [PMID: 25744905 DOI: 10.1016/j.anai.2014.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 12/10/2014] [Accepted: 12/12/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nasal eosinophils are a biomarker for allergic rhinitis (AR) and are associated with increased symptom severity. OBJECTIVE To identify predictors of allergic eosinophilic rhinitis (AER) in early childhood in children at higher risk for chronic allergic respiratory disorders. METHODS In the Cincinnati Childhood Allergy and Air Pollution Study, infants born to aeroallergen-sensitized and symptomatic parents were examined and underwent skin prick testing (SPT) annually to 15 aeroallergens from 1 to 4 years of age. Wheal circumferences were traced and scanned and areas were determined by computer planimetry. At 4 years, AER was defined as (1) at least 1 positive aeroallergen SPT result, (2) presence of sneezing and runny nose without a cold or influenza, and (3) nasal eosinophilia of at least 5%. Wheal areas at 1 to 3 years were analyzed for an association with AER compared with children without AR. RESULTS At 4 years, 487 children completed rhinitis health histories, SPT, and nasal sampling. Ninety-nine children (22.8%) had AR. Thirty-eight children had AER (8.8% of total sample and 38.4% of AR sample, respectively). At 3 years, for every 1-mm(2) increase in Penicillium species (adjusted odds ratio 1.18, 95% confidence interval 1.06-1.32, P = .002) and maple (adjusted odds ratio 1.07, 95% confidence interval 1.01-1.13, P = .02), wheal area significantly increased the risk of AER at 4 years of age. CONCLUSION Allergic eosinophilic rhinitis was identified in 8.8% of children at 4 years of age. Age 3 years was the earliest that aeroallergen SPT wheal areas were predictive of AER. Skin testing at 3 years identifies children at risk for an AR phenotype with nasal eosinophilia.
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Affiliation(s)
- Christopher D Codispoti
- Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio; Division of Immunology and Microbiology, Rush University Medical Center, Chicago, Illinois.
| | - David I Bernstein
- Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Linda Levin
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Tiina Reponen
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Patrick H Ryan
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio; Division of Asthma Research, Children's Hospital Medical Center, Rush University Medical Center, Chicago, Illinois
| | | | - Manuel Villareal
- Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jeff Burkle
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Zana Lummus
- Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio
| | - James E Lockey
- Department of Internal Medicine, Divisions of Immunology/Allergy and Pulmonary Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Children's Hospital Medical Center, Rush University Medical Center, Chicago, Illinois
| | - Grace K LeMasters
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
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16
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Suojalehto H, Kinaret P, Kilpeläinen M, Toskala E, Ahonen N, Wolff H, Alenius H, Puustinen A. Level of Fatty Acid Binding Protein 5 (FABP5) Is Increased in Sputum of Allergic Asthmatics and Links to Airway Remodeling and Inflammation. PLoS One 2015; 10:e0127003. [PMID: 26020772 PMCID: PMC4447257 DOI: 10.1371/journal.pone.0127003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 04/09/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The inflammatory processes in the upper and lower airways in allergic rhinitis and asthma are similar. Induced sputum and nasal lavage fluid provide a non-invasive way to examine proteins involved in airway inflammation in these conditions. OBJECTIVES We conducted proteomic analyses of sputum and nasal lavage fluid samples to reveal differences in protein abundances and compositions between the asthma and rhinitis patients and to investigate potential underlying mechanisms. METHODS Induced sputum and nasal lavage fluid samples were collected from 172 subjects with 1) allergic rhinitis, 2) asthma combined with allergic rhinitis, 3) nonallergic rhinitis and 4) healthy controls. Proteome changes in 21 sputum samples were analysed with two-dimensional difference gel electrophoresis (2D-DIGE), and the found differentially regulated proteins identified with mass spectrometry. Immunological validation of identified proteins in the sputum and nasal lavage fluid samples was performed with Western blot and ELISA. RESULTS Altogether 31 different proteins were identified in the sputum proteome analysis, most of these were found also in the nasal lavage fluid. Fatty acid binding protein 5 (FABP5) was up-regulated in the sputum of asthmatics. Immunological validation in the whole study population confirmed the higher abundance levels of FABP5 in asthmatic subjects in both the sputum and nasal lavage fluid samples. In addition, the vascular endothelial growth factor (VEGF) level was increased in the nasal lavage fluid of asthmatics and there were positive correlations between FABP5 and VEGF levels (r=0.660, p<0.001) and concentrations of FABP5 and cysteinyl leukotriene (CysLT) (r=0.535, p<0.001) in the nasal lavage fluid. CONCLUSIONS FABP5 may contribute to the airway remodeling and inflammation in asthma by fine-tuning the levels of CysLTs, which induce VEGF production.
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Affiliation(s)
- Hille Suojalehto
- Occupational Medicine Team, Finnish Institute of Occupational Health, Helsinki, Finland
- * E-mail:
| | - Pia Kinaret
- Unit of Systems Toxicology, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Maritta Kilpeläinen
- Department of Pulmonary Diseases and Allergology, University of Turku, Turku, Finland
| | - Elina Toskala
- Department of Otolaryngology- Head and Neck Surgery, Temple University, Philadelphia, United States of America
| | - Niina Ahonen
- Unit of Systems Toxicology, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Henrik Wolff
- Unit of Systems Toxicology, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Harri Alenius
- Unit of Systems Toxicology, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Anne Puustinen
- Unit of Systems Toxicology, Finnish Institute of Occupational Health, Helsinki, Finland
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17
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Di Cara G, Carelli A, Latini A, Panfili E, Bizzarri I, Ciprandi G, Buttafava S, Frati F, Verrotti A. Severity of allergic rhinitis and asthma development in children. World Allergy Organ J 2015; 8:13. [PMID: 26023322 PMCID: PMC4439609 DOI: 10.1186/s40413-015-0061-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/06/2015] [Indexed: 11/23/2022] Open
Abstract
Allergic rhinitis (AR) is a relevant risk factor for the development of asthma in children. We recruited a cohort of 104 children with AR and re-evaluated them after 5 years. We considered the ARIA classification. All patients, who had moderate to severe persistent AR at baseline, developed asthma symptoms. These results strongly indicate that the severity of AR may be an important factor that increases the risk of asthma development in children.
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Affiliation(s)
- Giuseppe Di Cara
- Institute of Pediatrics, Department of Surgical and Biomedical specialty, Perugia, Italy
| | - Alessia Carelli
- Institute of Pediatrics, Department of Surgical and Biomedical specialty, Perugia, Italy
| | - Arianna Latini
- Institute of Pediatrics, Department of Surgical and Biomedical specialty, Perugia, Italy
| | - Elisa Panfili
- Institute of Pediatrics, Department of Surgical and Biomedical specialty, Perugia, Italy
| | - Ilaria Bizzarri
- Institute of Pediatrics, Department of Surgical and Biomedical specialty, Perugia, Italy
| | - Giorgio Ciprandi
- Medicine Department, IRCCS-A.O.U. San Martino, Viale Benedetto XV 6, 16132 Genoa, Italy
| | - Serena Buttafava
- Medical and Scientific Department, Stallergenes Italy, Milan, Italy
| | - Franco Frati
- Medical and Scientific Department, Stallergenes Italy, Milan, Italy
| | - Alberto Verrotti
- Institute of Pediatrics, Department of Surgical and Biomedical specialty, Perugia, Italy
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18
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Di Cara G, Marcucci F, Palomba A, Milioni M, Pecoraro L, Ciprandi G, Buttafava S, Frati F, Verrotti A. Exhaled nitric oxide in children with allergic rhinitis: a potential biomarker of asthma development. Pediatr Allergy Immunol 2015; 26:85-7. [PMID: 25511873 DOI: 10.1111/pai.12326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Giuseppe Di Cara
- Department of Surgical and Biomedical Specialty, Institute of Pediatrics, Perugia, Italy
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19
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Sorbello V, Ciprandi G, Di Stefano A, Massaglia GM, Favatà G, Conticello S, Malerba M, Folkerts G, Profita M, Rolla G, Ricciardolo FLM. Nasal IL-17F is related to bronchial IL-17F/neutrophilia and exacerbations in stable atopic severe asthma. Allergy 2015; 70:236-40. [PMID: 25394579 DOI: 10.1111/all.12547] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2014] [Indexed: 01/09/2023]
Abstract
Severe asthma (SA) is associated with neutrophil recruitment and T helper (TH )17 chemokine overexpression in bronchial biopsies. We aimed to evaluate IL-17A and IL-17F expression in nasal/bronchial lamina propria of atopic mild-to-severe asthmatics and controls in relation to neutrophilia and asthma exacerbations. Cryostat sections of nasal/bronchial biopsies obtained from 14 SA and 14 mild asthma (MA) stable atopic patients with rhinitis, and seven healthy controls were analyzed by immunohistochemistry for neutrophils, IL-17A and IL-17F expression. Atopic SA showed an increase in asthma exacerbations number, IL-17F and IL-17A expression in nasal/bronchial lamina propria compared to MA and controls, and a higher expression of bronchial neutrophils in SA compared to MA and controls. In all asthmatics, significant relationships were found between bronchial IL-17F and neutrophils/FEV1 , nasal IL-17F and bronchial neutrophil/IL-17 markers and between the latter and exacerbations, suggesting that nasal IL-17F might be informative on bronchial IL17-driven neutrophilia in atopic SA.
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Affiliation(s)
- V. Sorbello
- Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | | | - A. Di Stefano
- Laboratorio di Citoimmunopatologia dell'Apparato Cardio Respiratorio; Fondazione Salvatore Maugeri; IRCCS; Veruno Novara Italy
| | - G. M. Massaglia
- Division of Respiratory Disease; San Luigi Hospital; Orbassano Italy
| | - G. Favatà
- Division of Ear, Nose and Throat; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - S. Conticello
- Division of Ear, Nose and Throat; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - M. Malerba
- Department of Internal Medicine; University of Brescia; Brescia Italy
| | - G. Folkerts
- Department of Pharmacology and Pathophysiology; Utrecht Institute for Pharmaceutical Sciences; University of Utrecht; Utrecht The Netherlands
| | - M. Profita
- Istituto di Biomedicina e Immunologia Molecolare; CNR; Palermo Italy
| | - G. Rolla
- Allergologia ed Immunologia Clinica; Ospedale Ordine Mauriziano ‘Umberto I’; University of Torino; Torino Italy
| | - F. L. M. Ricciardolo
- Department of Clinical and Biological Sciences; University of Torino; Torino Italy
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20
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Fernandes ALG, Amorim MM, Caetano LB, Dracoulakis S, Araruna AAR, Faresin SM, Santoro IL. Bronchodilator response as a hallmark of uncontrolled asthma: a randomised clinical trial. J Asthma 2014; 51:405-10. [PMID: 24404797 DOI: 10.3109/02770903.2013.878845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The goal of this study is to determine whether bronchodilator (BD) response can be used as a reliable measure of asthma control by analyzing the effects of a short course of oral corticosteroids (OC) or placebo (P) on spirometry, sputum cytology and BD response in controlled asthma patients scoring less than 1.5 on the ACQ5. METHODS Seventy patients with moderate to severe asthma who were undergoing combination therapy and were considered to be controlled based on ACQ5 scores, but who exhibited persistent positive BD response, were randomly assigned to two groups, one receiving OC and the other P. Patients were evaluated before and after 2 weeks of treatment. Intervention response (comparison of FEV(1) before and after OC or P treatment) was used as a measure of intervention efficacy, with values equal to or greater than 200 mL considered positive. RESULTS Patients who received OC showed significant improvement in FEV(1), and no longer exhibited a positive BD response. Those in the P group showed no change. In addition, sputum eosinophil counts significantly decreased in the OC group. CONCLUSIONS BD response can be used as a reliable measure of asthma control. This study suggests that ACQ5 scores alone are not sufficient to fully assess asthma control, and that BD response should be included as an essential measurement in any algorithm of asthma control evaluation.
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Affiliation(s)
- Ana Luisa Godoy Fernandes
- Respiratory Division, Universidade Federal de São Paulo/Escola Paulista de Medicina , São Paulo-SP , Brasil
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21
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Nasal polyposis: an inflammatory condition requiring effective anti-inflammatory treatment. Curr Opin Otolaryngol Head Neck Surg 2013; 21:23-30. [PMID: 23172039 DOI: 10.1097/moo.0b013e32835bc3f9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE OF REVIEW Recent literature in chronic rhinosinusitis with nasal polyps (CRSwNP) has focussed on inflammatory mechanisms underlying the disease. Endotyping the histopathological features of the disease, rather than simple clinical phenotypes, reflects a change in our understanding of the disease and approach to management. This is paralleled by renewed evidence for the need for wide postsurgical access and topical anti-inflammatory therapy. RECENT FINDINGS Recent research into patterns of dysfunction in innate immunity suggests a crucial role of respiratory epithelium in mediating the inflammatory response. Elevated interleukins, IL-25 and IL-33, from sinus mucosa in CRSwNP and their interaction via innate lymphoid cells may represent the link between the host-environment interface and T-helper 2 dominated inflammation that characterizes CRSwNP. While thorough immunological profiling of CRSwNP is not routinely available, classification of CRS as eosinophilic (ECRS) or noneosinophilic is practical and correlates with disease severity and prognosis. The practice and utility of endoscopic sinus surgery to create a single neosinus for topical corticosteroid delivery is a logical conclusion founded on the inflammatory basis of CRSwNP/ECRS. SUMMARY There is mounting evidence for CRSwNP as a predominantly inflammatory disease. Even simple histopathological classification on the basis of degrees of tissue eosinophilia reflects the underlying pathogenic mechanisms with diagnostic and prognostic implications. Optimal treatment involves topical anti-inflammatory therapy delivered locally via a wide, postsurgical corridor.
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22
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Feldman RE, Lam AC, Sadow PM, Bleier BS. P-glycoprotein is a marker of tissue eosinophilia and radiographic inflammation in chronic rhinosinusitis without nasal polyps. Int Forum Allergy Rhinol 2013; 3:684-7. [PMID: 23677641 DOI: 10.1002/alr.21176] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 03/29/2013] [Accepted: 04/09/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND P-glycoprotein (P-gp) is a membrane-bound efflux pump that is upregulated in chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and participates in epithelial cytokine secretion. Eosinophilic CRS (ECRS) shares a similar cytokine profile with CRSwNP and is associated with significant inflammation and poor surgical outcomes. The goal of this study is to determine if P-gp expression is associated with degree of eosinophilia and severity of radiographic inflammation in patients with CRS without polyps (CRSsNP). METHODS An institutional review board (IRB)-approved study using sinus tissue in 39 steroid-naive patients with CRS. P-gp expression was calculated using quantitative fluorescent immunohistochemistry (Q-FIHC) to generate an epithelial to background staining ratio. Patients were stratified into low and high epithelial expression groups (<3 and ≥3, respectively). Average eosinophils per high powered field (hpf) and Lund-Mackay scores were calculated and compared with P-gp staining ratios using a 2-tailed Student t test. RESULTS Among the 39 patients, 7 (17.95%) had high P-gp expression ratios (mean ± SD, 4.86 ± 1.33) while 32 (82.05%) had low expression ratios (1.91 ± 0.45). The number of eosinophils/hpf were significantly greater in the high P-gp expression group as compared to the low expression group (62.38 ± 83.69 vs 5.11 ± 10.12, p = 0.0003). The Lund-Mackay scores were significantly greater in the high P-gp expression group as compared to the low expression group (11.86 ± 2.79 vs 6.84 ± 4.19, p = 0.005). CONCLUSION P-gp is known to be overexpressed in CRSwNP. This study suggests that among patients with CRSsNP, P-gp is similarly overexpressed in those with high tissue eosinophilia and correlates with severity of radiographic inflammation.
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Affiliation(s)
- Rachel E Feldman
- Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA
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23
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Ciprandi G, Tosca MA, Capasso M. High exhaled nitric oxide levels may predict bronchial reversibility in allergic children with asthma or rhinitis. J Asthma 2012; 50:33-8. [PMID: 23157515 DOI: 10.3109/02770903.2012.740119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Allergic asthma and rhinitis may be associated. Airway inflammation is shared by both disorders. The measure of the fractional concentration of exhaled nitric oxide (FeNO) may be considered as a surrogate marker for airway inflammation, mainly in allergic patients. Reversibility to bronchodilation (BD) testing is a functional characteristic of asthma. OBJECTIVE The aim of this study was to evaluate whether FeNO may predict reversibility to BD in a pediatric cohort of allergic subjects with asthma (180) or rhinitis (150). METHODS Lung function (including forced expiratory volume at the first second (FEV(1)), forced volume capacity (FVC), forced expiratory flow at 25-75% of volume capacity (FEF (25-75))), FeNO measurement, and BD testing were performed in all children. RESULTS Lung function, FeNO, and sensitization type were significantly different in the two groups. A strong correlation was found between FeNO and ΔFEV(1) after BD. Two main predictors of reversibility were FeNO values >34 ppb [Odds RatioAdj (ORAdj) = 1.9] and sensitization to perennial allergens (ORAdj = 1.7). CONCLUSIONS This study provided evidence that FeNO was strongly related with the response to BD testing and could predict bronchial reversibility in children with allergic rhinitis or asthma. Therefore, a simple FeNO measurement could suggest relevant information about bronchial reversibility.
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Affiliation(s)
- Giorgio Ciprandi
- IRCCS-Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
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24
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Moscato G, Pala G, Barnig C, Blay F, Del Giacco SR, Folletti I, Heffler E, Maestrelli P, Pauli G, Perfetti L, Quirce S, Sastre J, Siracusa A, Walusiak-Skorupa J, Wjik RG. EAACI consensus statement for investigation of work-related asthma in non-specialized centres. Allergy 2012; 67:491-501. [PMID: 22257175 DOI: 10.1111/j.1398-9995.2011.02784.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2011] [Indexed: 11/28/2022]
Abstract
Work-related asthma (WRA) is a relevant problem in several countries, is cause of disability and socioeconomic consequences for both the patient and the society and is probably still underdiagnosed. A correct diagnosis is extremely important to reduce or limit the consequences of the disease. This consensus document was prepared by a EAACI Task Force consisting of an expert panel of allergologists, pneumologists and occupational physicians from different European countries. This document is not intended to address in detail the full diagnostic work-up of WRA, nor to be a formal evidence-based guideline. It is written to provide an operative protocol to allergologists and physicians dealing with asthma useful for identifying the subjects suspected of having WRA to address them to in-depth investigations in a specialized centre. No evidence-based system could be used because of the low grade of evidence of published studies in this area, and instead, 'key messages' or 'suggestions' are provided based on consensus of the expert panel members.
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Affiliation(s)
- G. Moscato
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - G. Pala
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - C. Barnig
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - F. Blay
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - S. R. Del Giacco
- Department of Medical Sciences ‘M. Aresu’; University of Cagliari; Cagliari; Italy
| | - I. Folletti
- Department of Clinical and Experimental Medicine; Occupational Allergy Unit; Terni Hospital; University of Perugia; Perugia; Italy
| | - E. Heffler
- Allergy and Clinical Immunology; University of Torino; ASO Mauriziano ‘Umberto I’; Torino; Italy
| | - P. Maestrelli
- Department of Environmental Medicine and Public Health; University of Padova; Padova; Italy
| | - G. Pauli
- Division of Asthma and Allergy; Department of Chest Diseases; University Hospital Strasbourg; Strasbourg; France
| | - L. Perfetti
- Allergy and Immunology Unit; Fondazione ‘Salvatore Maugeri’; Institute of Care and Research; Scientific Institute of Pavia; Pavia; Italy
| | - S. Quirce
- Department of Allergy; Hospital La Paz-IdiPAZ and CIBER de Enfermedades Respiratorias CIBERES; Madrid; Spain
| | - J. Sastre
- CIBER de Enfermedades Respiratorias; Ciberes and Department of Allergy; Fundación Jiménez Díaz; Madrid; Spain
| | - A. Siracusa
- Department of Clinical an Experimental Medicine; University of Perugia; Perugia; Italy
| | - J. Walusiak-Skorupa
- Department of Occupational Diseases; Nofer Institute of Occupational Medicine; Lodz; Poland
| | - R. Gerth Wjik
- Section of Allergology; Department of Internal Medicine; Erasmus MC; Rotterdam; the Netherlands
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Snidvongs K, Lam M, Sacks R, Earls P, Kalish L, Phillips PS, Pratt E, Harvey RJ. Structured histopathology profiling of chronic rhinosinusitis in routine practice. Int Forum Allergy Rhinol 2012; 2:376-85. [PMID: 22419386 DOI: 10.1002/alr.21032] [Citation(s) in RCA: 147] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 10/06/2011] [Accepted: 01/05/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND Tissue eosinophilia in chronic rhinosinusitis (CRS) is a marker of inflammatory disorders recalcitrant to surgical intervention. Eosinophilic chronic rhinosinusitis (ECRS) is traditionally associated with asthma, polyps, aspirin sensitivity, high serum eosinophilia, and elevated immunoglobulin E (IgE). However, patients with ECRS may not present with these associations and there is a need to establish other surrogate markers. The objective of the study was to determine the associations between the histopathology, serology, and clinical characteristics in CRS patients. METHODS A cross-sectional study was undertaken of CRS patients undergoing surgery. Tissue eosinophilia and other pathological features were compared to traditional surrogate features of ECRS, as well as to symptoms, and to radiologic and endoscopic scores. RESULTS A total of 51 patients were assessed (47% female, mean age 46.6 ± 4.1 years). High tissue eosinophilia (>10 per high-power field [HPF]) was more prominent in polyps (84%) (χ(2) = 25.76; p < 0.01) but was also seen in nonpolyp patients (19%). Asthma was not associated with high tissue eosinophilia (p = 0.60), with 43% of nonasthmatics demonstrating high tissue eosinophilia. Serum eosinophilia predicted high tissue eosinophilia at >0.30 × 10(9)/L or 4.4% of leukocytes (sensitivity 52%, specificity 87%, receiver operating characteristic [ROC] p = 0.001), with low negative predictive value. Serum IgE was nonpredictive (p = 0.08). CONCLUSION The diagnosis of ECRS has unique prognostic implications. Traditional features of the ECRS phenotype are not necessarily reliable markers for the presence of tissue eosinophilia. Serum eosinophilia may be a good surrogate marker of tissue eosinophilia but of limited use. The routine use of structured histopathology reporting in CRS is suggested, to allow for the diagnosis of ECRS and to identify other prognostic markers.
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Affiliation(s)
- Kornkiat Snidvongs
- Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
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Abstract
PURPOSE Asthma is a chronic disorder of the airways involving inflammation and airway hyper-reactivity. Clinical diagnosis and monitoring of asthma must incorporate the immunological, biochemical, and histological changes of a chronic disorder, while recognizing acute phenotypic changes in order to optimally tailor therapeutics to each individual. RECENT FINDINGS Articles published within the previous 18 months are summarized in this article in order to present an up to date review of the latest findings regarding the monitoring of asthma. The articles encompass a wide array of specialties from basic research and histology to clinical medicine as well as community medicine and nursing. SUMMARY Exciting new advancements in the monitoring of asthma continue to unfold. Potentially new diagnostic and monitoring tools are highlighted in this study. Continued investigations may enable a select few methodologies to reach clinical utility in the ongoing monitoring and treatment of patients with asthma.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2011; 19:58-65. [PMID: 21233627 DOI: 10.1097/moo.0b013e32834344aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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