1
|
Roberto G, Barberi S, Marseglia GL, Licari A. What's new in pediatric asthma and rhinitis phenotypes and endotypes? Curr Opin Allergy Clin Immunol 2024; 24:73-78. [PMID: 38295125 DOI: 10.1097/aci.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
PURPOSE OF REVIEW This review explores the evolving landscape of pediatric asthma and rhinitis, focusing on identifying and characterizing different subtypes. RECENT FINDINGS Childhood asthma and rhinitis are prevalent respiratory conditions frequently occurring together. To address the need for a precise definition of these diseases, an unbiased and comprehensive phenotyping approach has been undertaken with hypothesis-free analysis of extensive datasets to uncover new relationships among clinical, environmental, and biological characteristics. On the other hand, the concept of endotype is elaborate and multifaceted, representing distinct pathophysiological mechanisms underlying the clinical presentation and requires the identification of reliable biomarkers. The recognition of multiple inflammatory endotypes underscores the need for in-depth characterization, which could revolutionize the treatment landscape. SUMMARY Comprehending phenotypes and endotypes is crucial for customizing effective and personalized management approaches for children with asthma and rhinitis. More precise and efficient care can be administered through recognition and detailed characterization, ultimately enhancing patients' quality of life.
Collapse
Affiliation(s)
- Giulia Roberto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Salvatore Barberi
- Pediatric Unit, Rho and Garbagnate Milanese Hospital, ASST-Rhodense, Milan, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia
| |
Collapse
|
2
|
Trybus E, Trybus W, Król T. Cytological Study of Topical Effect of Azelastine Hydrochloride on the Nasal Mucous Membrane Cells in Various Nasal Rhinitis Types. Cells 2023; 12:2697. [PMID: 38067125 PMCID: PMC10706206 DOI: 10.3390/cells12232697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/03/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
Previous reports on the benefits of using local therapy with azelastine in rhinitis focus on the assessment of clinical symptoms and the analysis of nasal lavage for the presence of inflammatory cells and the expression of adhesion molecules. Little attention has been paid to studies assessing the effect of azelastine on individual cytotypes of the nasal mucosa, especially epithelial cells, also in the context of inducing morphological changes. The aim of this study was the cytological analysis of swabs taken from the surface of the nasal mucosa of patients with allergic rhinitis (AR) and nonallergic/vasomotor rhinitis (NAR/VMR) who were subjected to 4 weeks of therapy with azelastine and then comparing the obtained results with the pre-treatment condition. The technique of obtaining materials for cytoanalysis included sampling, staining of smears, microscopic analysis, and preparation of cytograms. Our studies confirmed the therapeutic benefits of azelastine in both study groups. Significant changes were demonstrated, confirming the regeneration of ciliated cells and the induction of autophagy and apoptosis in epithelial cells. Such changes indicate new mechanisms of action of azelastine, which play a significant role in restoring homeostasis in the nasal mucosa. The presented research also results in a detailed description of cytological changes in both studied rhinitis types, which complements the knowledge regarding prognostic indicators.
Collapse
Affiliation(s)
- Ewa Trybus
- Department of Medical Biology, Jan Kochanowski University of Kielce, Uniwersytecka 7, 25-406 Kielce, Poland;
| | - Wojciech Trybus
- Department of Medical Biology, Jan Kochanowski University of Kielce, Uniwersytecka 7, 25-406 Kielce, Poland;
| | | |
Collapse
|
3
|
Xu SY, Lv HQ, Zeng CL, Peng YJ. Prevalence and bidirectional association between rhinitis and urticaria: A systematic review and meta-analysis. Allergy Asthma Proc 2023; 44:402-412. [PMID: 37919842 DOI: 10.2500/aap.2023.44.230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
Background: Rhinitis, allergic rhinitis in particular, and urticaria are both common diseases globally. However, there is controversy with regard to the correlation between rhinitis and urticaria. Objective: To examine the accurate association between rhinitis and urticaria. Methods: Three medical literature data bases were searched from data base inception until January 11, 2022. The prevalence and association between rhinitis and urticaria were estimated by meta-analysis. Quality assessment was performed by using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% confidence intervals (CI) and pooled prevalence were calculated by using random-effects models. Results: Urticaria prevalence in patients with rhinitis was 17.6% (95% CI, 13.2%-21.9%). The pooled prevalence of rhinitis was 31.3% (95% CI, 24.2%-38.4%) in patients with urticaria, and rhinitis prevalence in patients with acute urticaria and chronic urticaria was 31.6% (95% CI, 7.4%-55.8%) and 28.7% (95% CI, 20.4%-36.9%), respectively. Rhinitis occurrence was significantly associated with urticaria (OR 2.67 [95% CI, 2.625-2.715]). Urticaria and rhinitis were diagnosed based on different criteria, possibly resulting in a potential error of misclassification. Conclusion: Rhinitis and urticaria were significantly correlated. Physicians should be cognizant with regard to this relationship and address nasal or skin symptoms in patients.
Collapse
|
4
|
Nieto A, El-Sayed ZA, Gómez RM, Hossny E, Jiu-Yao W, Kalayci Ö, Morais-Almeida M, Phipatanakul W, Pitrez PM, Pozo Beltrán CF, Xepapadaki P, Papadopoulos NG. Unanswered questions on the use of biologics in pediatric asthma. World Allergy Organ J 2023; 16:100837. [PMID: 38020283 PMCID: PMC10656246 DOI: 10.1016/j.waojou.2023.100837] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/13/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
The emergence of biologic therapies for the management of asthma has been a revolutionary change in our capacity to manage this disease. Since the launch of omalizumab, several other biologics have been marketed or are close to being marketed, suggesting that a plethora of monoclonal antibodies can be expected in the coming years. This will facilitate the transition to the paradigm of personalized medicine, but on the other hand will decisively further complicate the choice of the most appropriate treatment, in the absence of reliable enough biological markers. For these reasons, along with the relatively short time of use with these treatments, there are recurrently arising questions for which there are not even moderately documented answers, and for which the only solution must be based, with all reservations, on the combination of indirect evidence and expertise. In this paper, we attempt to address such questions, providing relevant commentaries and considering the whole width of the evidence base.
Collapse
Affiliation(s)
- Antonio Nieto
- Pediatric Pulmonology & Allergy Unit. Health Research Institute. Children's Hospital La Fe, Valencia, Spain
| | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Wang Jiu-Yao
- Research Center of Allergy, Immunology, and Microbiome (A.I.M.). China Medical University Children's Hospital, Taichung, Taiwan
| | - Ömer Kalayci
- Pediatric Allergy and Asthma, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Mário Morais-Almeida
- Allergy Center, CUF Descobertas Hospital, CUF Academic and Research Medical Center, Lisbon, Portugal
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Paulo Marcio Pitrez
- School of Medicine, Pediatric Pulmonary Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | | | | | - Nikolaos G. Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Division of Infection, Inflammation & Respiratory Medicine, The University of Manchester, Manchester, UK
| |
Collapse
|
5
|
Diniz AF, Ribeiro JA, Lira GV, Sarinho ES. Allergic Rhinitis in Preschoolers: A Systematic Review of Diagnostics. Am J Rhinol Allergy 2023; 37:360-368. [PMID: 36740859 DOI: 10.1177/19458924221149267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most studies that seek to analyze the prevalence of allergic rhinitis do not include preschool children and the diagnosis in this age group is difficult. OBJECTIVE Identify complementary tests to the diagnosis of allergic rhinitis in preschool children and verify if there is scientific robustness to propose a diagnostic algorithm for this condition in this age group. METHODS Systematic review of the literature in four databases: SCIELO, PubMed/MEDLINE, LILACS and SCOPUS. Each article was initially chosen by title, abstract and by the keywords "allergic rhinitis," "diagnosis" and "preschool." Those articles selected entered the complete reading and data extraction phase. The study was registered in the International Prospective Register of Systematic Reviews under number CRD42020207053. RESULTS Fourteen articles were suitable for analysis. In the assessment using Quality Assessment of Diagnostic Accuracy Studies - 2, all studies had at least one domain considered "high risk" or "undetermined risk." Seven reports of nasal cytology, seven of specific IgE, four of immediate hypersensitivity skin test, one of nasal nitric oxide, three of total IgE and one of urinary leukotriene E4 were found. Eight articles evaluated more than one diagnostic test. CONCLUSION There are no defined criteria for the diagnosis of allergic rhinitis in preschool children. Nasal cytology, serum specific IgE and immediate hypersensitivity skin test were the most used tests. A reliable diagnostic criterion in this age group is necessary so that in the future it is possible to propose a diagnostic algorithm for allergic rhinitis in preschool children.
Collapse
Affiliation(s)
- Alana F Diniz
- 28116Federal University of Pernambuco, Recife, Brasil
| | | | | | | |
Collapse
|
6
|
Tenero L, Vaia R, Ferrante G, Maule M, Venditto L, Piacentini G, Senna G, Caminati M. Diagnosis and Management of Allergic Rhinitis in Asthmatic Children. J Asthma Allergy 2023; 16:45-57. [PMID: 36636703 PMCID: PMC9829985 DOI: 10.2147/jaa.s281439] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 09/01/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Allergic rhinitis (AR) is a common upper airways inflammatory condition especially in paediatric population; its burden potentially impacts on quality of life, quality of sleep and daily performance, which can be difficult to perceive but not less relevant in the middle-long term. The present review aims to provide an updated overview on AR epidemiology, diagnosis and with a special focus on its connections with bronchial asthma. In fact, when considering asthmatic pediatric population, AR is probably the most important risk factor for asthma onset and the most impactful extra-bronchial determinant of asthma control. Under this perspective, allergen immunotherapy (AIT) should always be considered in the light of a precision medicine approach. In fact, AIT does represent a unique opportunity to specifically interfere with AR immunological background, improve both AR and bronchial asthma control and prevent allergic disease evolution. Verifying the patient's eligibility to that option should be considered as a priority for every physician managing children suffering from AR, especially when associated with bronchial asthma.
Collapse
Affiliation(s)
- Laura Tenero
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Rachele Vaia
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Matteo Maule
- Department of Medicine, University of Verona, Verona, Italy
| | - Laura Venditto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Pediatric Clinic, University of Verona, Verona, Italy
| | - Gianenrico Senna
- Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy,Department of Medicine, University of Verona, Verona, Italy
| | - Marco Caminati
- Department of Medicine, University of Verona, Verona, Italy,Correspondence: Marco Caminati, Department of Medicine, University of Verona, Piazzala L.A. Scuro, 10, Verona, 37134, Italy, Email
| |
Collapse
|
7
|
Trybus E, Król T, Trybus W. The Multidirectional Effect of Azelastine Hydrochloride on Cervical Cancer Cells. Int J Mol Sci 2022; 23:5890. [PMID: 35682572 DOI: 10.3390/ijms23115890] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
A major cause of cancer cell resistance to chemotherapeutics is the blocking of apoptosis and induction of autophagy in the context of cell adaptation and survival. Therefore, new compounds are being sought, also among drugs that are commonly used in other therapies. Due to the involvement of histamine in the regulation of processes occurring during the development of many types of cancer, antihistamines are now receiving special attention. Our study concerned the identification of new mechanisms of action of azelastine hydrochloride, used in antiallergic treatment. The study was performed on HeLa cells treated with different concentrations of azelastine (15-90 µM). Cell cycle, level of autophagy (LC3 protein activity) and apoptosis (annexin V assay), activity of caspase 3/7, anti-apoptotic protein of Bcl-2 family, ROS concentration, measurement of mitochondrial membrane potential (Δψm), and level of phosphorylated H2A.X in response to DSB were evaluated by cytometric method. Cellular changes were also demonstrated at the level of transmission electron microscopy and optical and fluorescence microscopy. Lysosomal enzyme activities-cathepsin D and L and cell viability (MTT assay) were assessed spectrophotometrically. Results: Azelastine in concentrations of 15-25 µM induced degradation processes, vacuolization, increase in cathepsin D and L activity, and LC3 protein activation. By increasing ROS, it also caused DNA damage and blocked cells in the S phase of the cell cycle. At the concentrations of 45-90 µM, azelastine clearly promoted apoptosis by activation of caspase 3/7 and inactivation of Bcl-2 protein. Fragmentation of cell nucleus was confirmed by DAPI staining. Changes were also found in the endoplasmic reticulum and mitochondria, whose damage was confirmed by staining with rhodamine 123 and in the MTT test. Azelastine decreased the mitotic index and induced mitotic catastrophe. Studies demonstrated the multidirectional effects of azelastine on HeLa cells, including anti-proliferative, cytotoxic, autophagic, and apoptotic properties, which were the predominant mechanism of death. The revealed novel properties of azelastine may be practically used in anti-cancer therapy in the future.
Collapse
|
8
|
Xie S, Fan R, Tang Q, Cai X, Zhang H, Wang F, Xie S, Gao K, Zhang J, Xie Z, Jiang W. Identification of Robust Biomarkers for Early Predicting Efficacy of Subcutaneous Immunotherapy in Children With House Dust Mite-Induced Allergic Rhinitis by Multiple Cytokine Profiling. Front Immunol 2022; 12:805404. [PMID: 35095890 PMCID: PMC8789884 DOI: 10.3389/fimmu.2021.805404] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 10/30/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background Subcutaneous immunotherapy (SCIT) is an effective treatment for children with allergic rhinitis (AR), but its efficacy fluctuates among patients. There are no reliable candidate biomarkers for monitoring and predicting the response to SCIT. The present study aims to identify novel biomarkers for early predicting the efficacy of SCIT in pediatric AR patients based on multiple cytokine profiling. Methods We prospectively recruited 72 children with house dust mite (HDM)-induced AR who were assigned to receive SCIT. The serum samples were collected and multiple cytokine profiling was conducted by Luminex assay at baseline. All patients were followed-up for 1 year and then categorized into effective and ineffective group based on their efficacy, and levels of 48 selected cytokines were tested and compared between the two groups. The potential cytokines were further validated by enzyme-linked immunosorbent assay (ELISA) in a cohort with 54 responders and 26 non-responders. Results Sixty-nine of 72 children completed one-year follow-up schedule with 46 included in effective group and 23 in ineffective group. The results of multiple cytokine profiling showed that 15 cytokines (eotaxin, G-CSF, GM-CSF, IFN-γ, IL-12(p40), IL-13, IL-15, IL-16, IL-4, MIF, MIP-1α, RANTES, SCF, SDF-1α and VEGF) were dysregulated between effective and ineffective group (all P < 0.05). Unadjusted and adjusted multivariate analysis models highlighted that serum eotaxin, IFN-γ, IL-4 and MIF levels closely associated with the efficacy of SCIT in pediatric HDM-induced AR patients. In addition, receiver operating characteristic (ROC) curves revealed potential values of these four biomarkers in predicting the response to SCIT. Further ELISA validation results in the cohort of 80 pediatric patients demonstrated that serum eotaxin and IL-4 levels were elevated in responders while IFN-γ levels decreased in responders (all P < 0.05). ROC curves demonstrated that serum IL-4 exhibited more reliable accuracy in predicting SCIT efficacy than eotaxin and IFN-γ. Conclusion Our discover–validation study suggested that cytokines including IL-4, eotaxin and IFN- γ may serve as robust biomarkers for early predicting response of SCIT in children with HDM-induced AR. These results strengthen the evidence that cytokines were associated with the response of SCIT and contributed to understand its underlying therapeutic mechanisms.
Collapse
Affiliation(s)
- Shaobing Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Ruohao Fan
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Qingping Tang
- Department of Rehabilitation, Brain Hospital of Hunan Province, Hunan University of Chinese Medicine, Changsha, China
| | - Xiao Cai
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Hua Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Fengjun Wang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Shumin Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Kelei Gao
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Junyi Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Zhihai Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Weihong Jiang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, China.,Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| |
Collapse
|
9
|
Masuda S, Nagao M, Usui S, Nogami K, Tohda Y, Fujisawa T. Development of allergic rhinitis in early life: A prospective cohort study in high-risk infants. Pediatr Allergy Immunol 2022; 33:e13733. [PMID: 35212053 DOI: 10.1111/pai.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Allergic rhinitis (AR) is the most common allergic disease in children. The development process of AR in early childhood, however, is not well understood. We prospectively investigated the process in regard to not only the nasal symptoms and sensitization but also the nasal cytology, in relation to recurrent wheeze in a high-risk cohort. METHODS Infants under 2 years of age with atopic dermatitis (AD) and/or food allergy (FA) symptoms were recruited and followed prospectively for 2 years. The phenotype of perennial AR was classified based on the presence/absence of (1) persistent nasal symptoms, (2) nasal eosinophils, and (3) HDM sensitization, the most common allergen for perennial AR in Japan. AR-like phenotypes were defined as positive for at least two of those three categories. High-risk recurrent wheezer was diagnosed based on the Japanese guidelines and Global Initiative for Asthma. Cox proportional hazards regression analyses for high-risk recurrent wheeze and the AR-like phenotype, adjusting for known covariate risk factors for asthma. RESULTS A total of 299 children were enrolled, and 237 subjects (78%) completed the 2-year observation. The prevalence of eosinophilia in nasal secretions increased from 18.5% to 69.9%, while HDM-specific IgE ≥ 0.35 kUA /L increased from 30.6% to 74.8%. AR-like phenotypes increased from 18.4% to 65.0%. The AR-like phenotype at 2 years was associated with development of high-risk recurrent wheezer (HR 2.062; 95% CI 1.005-4.796). CONCLUSIONS The prevalence of an HDM-related AR-like phenotype was markedly increased during infancy in infants with AD/FA and was associated with high-risk recurrent wheezer.
Collapse
Affiliation(s)
- Sawako Masuda
- Department of Otorhinolaryngology and Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Mizuho Nagao
- Department of Pediatrics and Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Satoko Usui
- Department of Otorhinolaryngology and Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Kazutaka Nogami
- Department of Pediatrics and Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University, Faculty of Medicine, Osaka-Sayama, Japan
| | - Takao Fujisawa
- Department of Pediatrics and Allergy Center, National Hospital Organization Mie National Hospital, Tsu, Japan
| | | |
Collapse
|
10
|
Ronco L, Folino A, Goia M, Crida B, Esposito I, Bignamini E. Do not forget asthma comorbidities in pediatric severe asthma! Front Pediatr 2022; 10:932366. [PMID: 35967579 PMCID: PMC9372496 DOI: 10.3389/fped.2022.932366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Asthma is the most common chronic respiratory disease in childhood. The long-term goals in managing asthma aim to control symptoms and prevent exacerbations, as well as to reduce side effects of therapy and mortality disease-related. Most of patients have mild to moderate asthma and respond well to standard therapies. However, a minor proportion of children with asthma has severe disease that remains uncontrolled despite optimal adherence to prescribed therapy and treatment of contributory factors, including trigger exposures and comorbidities, which can mimic or worsen asthma and contribute to exacerbations and poor quality of life. Evaluation of comorbidities is fundamental to optimize the management of the disease in a subgroup of patients with poor responder asthma. The overall aim of this article is to describe characteristics of main pediatric severe asthma comorbidities reported in literature, giving clinicians tools to recognize and manage properly these conditions.
Collapse
Affiliation(s)
- Lucia Ronco
- Department of Pediatric Science, School of Medicine, University of Turin, Turin, Italy
| | - Anna Folino
- Department of Surgical Science, University of Turin, Turin, Italy
| | - Manuela Goia
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| | - Benedetta Crida
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| | - Irene Esposito
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| | - Elisabetta Bignamini
- Pediatric Pulmonology Unit, Regina Margherita Children Hospital, AOU Cittá Della Salute e Della Scienza, Turin, Italy
| |
Collapse
|
11
|
Zhang Y, Zhu K, Xia C, Chen J, Yu C, Gao T, Yan J, Zhang H, Ren X. Multiple-Cytokine Profiling: A Novel Method for Early Prediction of the Efficacy of Sublingual Immunotherapy in Allergic Rhinitis Patients. J Inflamm Res 2022; 15:603-612. [PMID: 35115808 PMCID: PMC8803612 DOI: 10.2147/jir.s350003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/04/2022] [Indexed: 12/26/2022] Open
Abstract
Background Methods Results Conclusion
Collapse
Affiliation(s)
- Yanni Zhang
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Kang Zhu
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Cui Xia
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jingguo Chen
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Chao Yu
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Tianxi Gao
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jing Yan
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Huihui Zhang
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xiaoyong Ren
- Department of Otolaryngology-Head and Neck Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Correspondence: Xiaoyong Ren, Email
| |
Collapse
|
12
|
Malizia V, Cilluffo G, Fasola S, Ferrante G, Landi M, Montalbano L, Licari A, La Grutta S. Endotyping allergic rhinitis in children: A machine learning approach. Pediatr Allergy Immunol 2022; 33 Suppl 27:18-21. [PMID: 35080305 PMCID: PMC9546471 DOI: 10.1111/pai.13620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/24/2021] [Accepted: 08/06/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The diversity of allergic rhinitis (AR) phenotypes is particularly evident in childhood, suggesting the need to analyze and identify new approaches to capture such clinical heterogeneity. Nasal cytology (NC) is a very useful diagnostic tool for identifying and quantifying nasal inflammation. Data-driven approaches such as latent class analysis (LCA) assign subjects to classes based on their characteristics. We hypothesized that LCA based on NC, including the assessment of neutrophils, eosinophils, and mast cells, may be helpful for identifying AR endotypes in children. METHODS A total of 168 children were enrolled. Sociodemographic characteristics and detailed medical history were obtained from their parents. All children performed NC and skin prick tests. LCA was applied for identifying AR endotypes based on NC, using the R package poLCA. All the statistical analyses were performed using R 4.0.5 software. Statistical significance was set at p ≤ .05. RESULTS LCA identified two classes: Class 1 (n = 126, 75%): higher frequency of children with moderate/large number of neutrophils (31.45%); almost all the children in this class had no mast cells (91.27%) and Class 2 (n = 42, 25%): higher frequency of children with moderate/large number of eosinophils (45.24%) and moderate/large number of mast cells (50%). CONCLUSIONS The present study used a machine learning approach for endotyping childhood AR, which may contribute to improve the diagnostic accuracy and to deliver personalized health care in the context of precision medicine.
Collapse
Affiliation(s)
- Velia Malizia
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giovanna Cilluffo
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Salvatore Fasola
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Massimo Landi
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy.,Pediatric National Healthcare System, Turin, Italy
| | - Laura Montalbano
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| | - Amelia Licari
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Department of Clinical, Chirurgical, Diagnostic and Pediatric Science, University of Pavia, Pavia, Italy
| | - Stefania La Grutta
- Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy
| |
Collapse
|
13
|
Prieto A, Rondón C, Eguiluz-Gracia I, Muñoz C, Testera-Montes A, Bogas G, Nuñez Cuadros E, Campo P, Torres MJ. Systematic evaluation of allergic phenotypes of rhinitis in children and adolescents. Pediatr Allergy Immunol 2021; 32:953-962. [PMID: 33598969 DOI: 10.1111/pai.13474] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Three allergic phenotypes of rhinitis have been described in adults: allergic rhinitis (AR), local allergic rhinitis (LAR), and dual allergic rhinitis (DAR, coexistence of AR and LAR). Nevertheless, most centers follow a diagnostic approach only based on skin prick test and serum allergen-specific IgE (collectively called atopy tests, AT). This approach prevents the recognition of LAR and DAR, the diagnosis of which requires a nasal allergen challenge (NAC). Here, we investigate the existence of LAR and DAR phenotypes in children and adolescents, and the misdiagnosis rate associated with a work-up exclusively based on AT. METHODS Clinical data were obtained during physician-conducted interviews, and AT and NAC were systematically performed in 5- to 18-year-old patients with chronic rhinitis. The misdiagnosis rate was defined as the proportion of cases where AT and NAC results were discordant. RESULTS A total of 173 patients (mean age 15.1 years, 39.9% male) completed the study. AR (positive AT and NAC), LAR (negative AT and positive NAC), DAR (positive AT and NAC for some allergens and negative AT and positive NAC for other allergens), and non-allergic rhinitis (negative NAC) were diagnosed in 45.7%, 24.9%, 11.6%, and 17.9% of individuals, respectively. The clinical profile was comparable among allergic phenotypes, but allergic patients had a significantly earlier rhinitis onset, higher conjunctivitis prevalence, and more severe disease than NAR individuals. A diagnostic work-up exclusively based on AT misclassified 37.6% of patients. CONCLUSIONS LAR and DAR represent relevant differential diagnosis in pediatric rhinitis. NAC increases the diagnostic accuracy of clinical algorithms for rhinitis in children and adolescents.
Collapse
Affiliation(s)
- Ana Prieto
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Carmen Rondón
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Ibon Eguiluz-Gracia
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Candelaria Muñoz
- Pediatrics Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Almudena Testera-Montes
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain.,Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain
| | - Gador Bogas
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | | | - Paloma Campo
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain
| | - Maria J Torres
- Allergy Unit, Hospital Regional Universitario de Malaga, Instituto de Investigación Biomédica de Málaga-IBIMA and ARADyAL, Malaga, Spain.,Department of Medicine and Dermatology, Universidad de Malaga, Malaga, Spain.,Laboratory for Nanostructures for the Diagnosis and Treatment of Allergic Diseases, Andalusian Center for Nanomedicine and Biotechnology (BIONAND), Malaga, Spain
| |
Collapse
|
14
|
Eigenmann P. Comments on nitric oxide in children with asthma, low-dose oral immunotherapy for cow's milk allergy, and SARS-Cov-2 testing in school children. Pediatr Allergy Immunol 2021; 32:631-634. [PMID: 33932041 PMCID: PMC8207058 DOI: 10.1111/pai.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
| |
Collapse
|