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Pérez Chacón G, Fathima P, Jones M, Estcourt MJ, Gidding HF, Moore HC, Richmond PC, Snelling T. Infant Whole-Cell Versus Acellular Pertussis Vaccination in 1997 to 1999 and Risk of Childhood Hospitalization for Food-Induced Anaphylaxis: Linked Administrative Databases Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:670-680. [PMID: 38182097 DOI: 10.1016/j.jaip.2023.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Evidence suggests that children who had received an initial priming dose of whole-cell pertussis (wP) vaccine, rather than acellular pertussis (aP) vaccine, had a lower risk of developing IgE-mediated food allergy, the most common cause of anaphylaxis-related hospital presentations of childhood. OBJECTIVE To assess the association between wP versus aP vaccination in infancy and subsequent hospital presentations for anaphylaxis. METHODS This study was preregistered under PMID 34874968. Perinatal records for a cohort of New South Wales-born children (1997-1999) receiving their first dose of pertussis-containing vaccine before age 4 months were probabilistically linked to hospital and immunization records. We used adjusted Cox models to estimate hazard ratios (aHRs) and 95% CIs for anaphylaxis-coded hospitalizations. RESULTS There were 218,093 New South Wales-born children who received a first dose of wP or aP before age 4 months. Among these children, 86 experienced at least one hospitalization for food-induced anaphylaxis at age 5-15 years (range of events per patient, one to three). The person-time of follow-up was 1,476,969 years, and 665,519 years for children vaccinated with wP as a first dose (wP-1 children) and aP as a first dose (aP-1 children), respectively. The incidence rates for first hospitalization for food anaphylaxis were 3.5 (95% CI, 2.6-4.6) and 5.1 (95% CI, 3.5-7.1) per 100,000 child-years among wP-1 children and aP-1 children, respectively (aHR for wP vs aP = 0.47; 95% CI, 0.26-0.83). For first admission for venom anaphylaxis, the incidence rate was 4.9 (95% CI, 3.9-6.2) per 100,000 child-years among wP-1 children and 5.1 (95% CI, 3.5-7.1) per 100,000 child-years among aP-1 children (aHR for wP vs aP = 0.92; 95% CI, 0.53-1.60), and for all-cause anaphylaxis, the incidence rate was 10.6 (95% CI, 9.0-12.4) per 100,000 child-years among wP-1 children and 12.8 (95% CI, 10.2-15.8) per 100,000 child-years among aP-1 children (aHR for wP vs aP = 0.92; 95% CI, 0.53-1.60). CONCLUSION Vaccination with wP in infancy was associated with a lower risk of hospitalizations for food-induced anaphylaxis (and therefore severe IgE-mediated food allergy) occurring in childhood.
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Affiliation(s)
- Gladymar Pérez Chacón
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Parveen Fathima
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Jones
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Marie J Estcourt
- Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Heather F Gidding
- Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia; Women and Babies Health Research, Kolling Institute, Northern Sydney Local Health District, Sydney, New South Wales, Australia; National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Children's Hospital at Westmead, Sydney, New South Wales, Australia; School of Public Health and Community Medicine, University of New South Wales Medicine, Sydney, New South Wales, Australia
| | - Hannah C Moore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia
| | - Peter C Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Division of Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Tom Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia; Faculty of Health Science, Curtin School of Population Health, Curtin University, Bentley, Western Australia, Australia; Health and Clinical Analytics, School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
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Schuler CL, Kercsmar C, Mansour M, McDowell KM, Huang G, Hossain MM, Robinette ED, Beck AF. Identifying asthma-related risks during hospitalization using the child asthma risk assessment tool. J Asthma 2023; 60:2189-2197. [PMID: 37345884 DOI: 10.1080/02770903.2023.2228897] [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: 04/20/2023] [Accepted: 06/20/2023] [Indexed: 06/23/2023]
Abstract
Objective: The Child Asthma Risk Assessment Tool (CARAT) identifies risk factors for asthma morbidity. We hypothesized that CARAT-identified risk factors (using a CARAT adapted for inpatient use) would be associated with future healthcare utilization and would identify areas for intervention.Methods: We reviewed CARAT data collected during pediatric asthma admissions from 2010-2015, assessing for risk factors in environmental, medical, and social domains and providing prompts for inpatient (specialist consultation or social services engagement) and post-discharge interventions (home care visit or home environmental assessment). Confirmatory factor analysis identified groups of CARAT-identified risk factors with similar effects on healthcare utilization (latent factors). Structural equation models then evaluated relationships between latent factors and future utilization.Results: There were 2731 unique patients admitted for asthma exacerbations; 1015 (37%) had complete CARAT assessments and were included in analyses. Those with incomplete CARAT assessments were more often younger and privately-insured. CARAT-identified risk factors across domains were common in children hospitalized for exacerbations. Risks in the environmental domain were most common. Inpatient asthma consults by pulmonologists or allergists and home care referrals were the most frequent interventions indicated (62%, 628/1015, and 50%, 510/1015, respectively). Two latent factors were positively associated with healthcare utilization in the year after index stay - social stressors and known/suspected allergies (both p < 0.05). Stratified analyses analyzing data just from those children with prior healthcare utilization also indicated known/suspected allergies to be positively associated with future utilization.Conclusions: Inpatient interventions to address social stressors and allergic profiles may be warranted to reduce subsequent asthma morbidity.
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Affiliation(s)
- Christine L Schuler
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carolyn Kercsmar
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Mona Mansour
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Karen M McDowell
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Guixia Huang
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Md Monir Hossain
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eric D Robinette
- Division of Infectious Disease, Akron Children's Hospital, Akron, OH, USA
| | - Andrew F Beck
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Balz K, Kaushik A, Cemic F, Sampath V, Heger V, Renz H, Nadeau K, Skevaki C. Cross-reactive MHC class I T cell epitopes may dictate heterologous immune responses between respiratory viruses and food allergens. Sci Rep 2023; 13:14874. [PMID: 37684288 PMCID: PMC10491592 DOI: 10.1038/s41598-023-41187-1] [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: 03/06/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
Respiratory virus infections play a major role in asthma, while there is a close correlation between asthma and food allergy. We hypothesized that T cell-mediated heterologous immunity may induce asthma symptoms among sensitized individuals and used two independent in silico pipelines for the identification of cross-reactive virus- and food allergen- derived T cell epitopes, considering individual peptide sequence similarity, MHC binding affinity and immunogenicity. We assessed the proteomes of human rhinovirus (RV1b), respiratory syncytial virus (RSVA2) and influenza-strains contained in the seasonal quadrivalent influenza vaccine 2019/2020 (QIV 2019/2020), as well as SARS-CoV-2 for human HLA alleles, in addition to more than 200 most common food allergen protein sequences. All resulting allergen-derived peptide candidates were subjected to an elaborate scoring system considering multiple criteria, including clinical relevance. In both bioinformatics approaches, we found that shortlisted peptide pairs that are potentially binding to MHC class II molecules scored up to 10 × lower compared to MHC class I candidate epitopes. For MHC class I food allergen epitopes, several potentially cross-reactive peptides from shrimp, kiwi, apple, soybean and chicken were identified. The shortlisted set of peptide pairs may be implicated in heterologous immune responses and translated to peptide immunization strategies with immunomodulatory properties.
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Affiliation(s)
- Kathrin Balz
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), 35043, Marburg, Germany
| | - Abhinav Kaushik
- Division of Pulmonary, Allergy and Critical Care Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, 94040, USA
- Departmental of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Franz Cemic
- Department of Computer Science, TH Mittelhessen, University of Applied Sciences Gießen, 35390, Giessen, Germany
| | - Vanitha Sampath
- Division of Pulmonary, Allergy and Critical Care Medicine, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, CA, 94040, USA
| | - Vanessa Heger
- Department of Computer Science, TH Mittelhessen, University of Applied Sciences Gießen, 35390, Giessen, Germany
| | - Harald Renz
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), 35043, Marburg, Germany
| | - Kari Nadeau
- Departmental of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, German Center for Lung Research (DZL), 35043, Marburg, Germany.
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Dölle-Bierke S, Höfer V, Francuzik W, Näher AF, Bilo MB, Cichocka-Jarosz E, Lopes de Oliveira LC, Fernandez-Rivas M, García BE, Hartmann K, Jappe U, Köhli A, Lange L, Maris I, Mustakov TB, Nemat K, Ott H, Papadopoulos NG, Pföhler C, Ruëff F, Sabouraud-Leclerc D, Spindler T, Stock P, Treudler R, Vogelberg C, Wagner N, Worm M. Food-Induced Anaphylaxis: Data From the European Anaphylaxis Registry. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2069-2079.e7. [PMID: 36990430 DOI: 10.1016/j.jaip.2023.03.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/22/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Food is one of the most common elicitors of anaphylaxis, with an increasing incidence over recent years. OBJECTIVES To characterize elicitor-specific phenotypes and identify factors enhancing the risk or severity of food-induced anaphylaxis (FIA). METHODS We analyzed data from the European Anaphylaxis Registry applying an age- and sex-matched analysis of associations (Cramer's V) for single food triggers and calculated odds ratios (ORs) for severe FIA. RESULTS We identified 3,427 cases of confirmed FIA showing an age-dependent elicitor ranking (for children: peanut, cow's milk, cashew, and hen's egg; and for adults: wheat flour, shellfish, hazelnut, and soy). The age- and sex-matched analysis revealed defined symptom patterns for wheat and cashew. Wheat-induced anaphylaxis was more frequently associated with cardiovascular symptoms (75.7%; Cramer's V = 0.28) and cashew-induced anaphylaxis with gastrointestinal symptoms (73.9%; Cramer's V = 0.20). Furthermore, concomitant atopic dermatitis was slightly associated with anaphylaxis to hen's egg (Cramer's V = 0.19) and exercise was strongly associated with anaphylaxis to wheat (Cramer's V = 0.56). Additional factors influencing the severity were alcohol intake in wheat anaphylaxis (OR = 3.23; CI, 1.31-8.83) and exercise in peanut anaphylaxis (OR = 1.78; CI, 1.09-2.95). CONCLUSIONS Our data show that FIA is age-dependent. In adults, the range of elicitors inducing FIA is broader. For some elicitors, the severity of FIA seems to be related to the elicitor. These data require confirmation in future studies considering a clear differentiation between augmentation and risk factors in FIA.
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Affiliation(s)
- Sabine Dölle-Bierke
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Veronika Höfer
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Wojciech Francuzik
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany
| | - Anatol-Fiete Näher
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Division of Information and Research Data Management, Robert Koch Institute, Berlin, Germany
| | - Maria Beatrice Bilo
- Department of Clinical and Molecular Sciences, Università, Politecnica delle Marche, Ancona, Italy; Department of Internal Medicine/Allergy Unit, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Ewa Cichocka-Jarosz
- Department of Pediatrics, Pulmonology-Allergology-Dermatology Clinic, Jagiellonian University Medical College, Krakow, Poland
| | - Lucila C Lopes de Oliveira
- Division of Allergy, Clinical Immunology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | | | - Blanca E García
- Allergology Service. Hospital Universitario de Navarra. Pamplona, Spain
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel and University of Basel, Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Uta Jappe
- Division of Clinical and Molecular Allergology, Research Center Borstel, Airway Research Center North, German Center for Lung Research, Borstel, Germany; Interdisciplinary Outpatient Clinic, Department of Pneumology, University of Lübeck, Lübeck, Germany
| | - Alice Köhli
- Division of Allergology, University Children's Hospital Zurich, Zürich, Switzerland; Division of Paediatric Allergology, Department of Pediatrics, Children's Hospital Lucerne, Lucerne, Switzerland
| | - Lars Lange
- Department of Pediatrics, GFO-Kliniken Bonn, St Marien-Hospital, Bonn, Germany
| | - Ioana Maris
- Department of Paediatrics and Child Health, University College Cork/Bon Secours Hospital Cork, Cork, Ireland
| | | | - Katja Nemat
- Pediatric Pulmonology and Allergology, Kinderzentrum Dresden-Friedrichstadt, Dresden, Germany; University Allergy Center Dresden, University Hospital Dresden, Dresden, Germany
| | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | | | - Claudia Pföhler
- Saarland University Medical Center, Department of Dermatology, Homburg/Saar, Germany
| | - Franziska Ruëff
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Munich, Germany
| | | | | | | | - Regina Treudler
- Department of Dermatology, Venerology, and Allergology, University Leipzig Medical Faculty, Leipzig Interdisciplinary Allergy Centre-CAC, Leipzig, Germany
| | - Christian Vogelberg
- Division of Pediatric Pneumology and Allergology, Department of Pediatrics, Universitätsklinikum Carl Gustav Carus an der TU Dresden, Dresden, Germany
| | - Nicola Wagner
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology, Venerology and Allergy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany.
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Petek T, Lajhar M, Krašovec B, Homšak M, Kavalar M, Korošec P, Koren B, Tomazin M, Hojnik T, Berce V. Risk Factors for Anaphylaxis in Children Allergic to Peanuts. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1037. [PMID: 37374241 PMCID: PMC10300811 DOI: 10.3390/medicina59061037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/21/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: A peanut allergy is the most common single cause of anaphylaxis in children. The risk factors for anaphylaxis in children with a peanut allergy are not well defined. Therefore, we aimed to identify epidemiological, clinical, and laboratory characteristics of children with a peanut allergy that may predict the severity of the allergic reaction and anaphylaxis. Materials and Methods: We conducted a cross-sectional study and included 94 children with a peanut allergy. Allergy testing was performed, including skin prick testing and the determination of specific IgE levels to peanuts and their Ara h2 component. In case of discordance between patient history and allergy testing, an oral food challenge with peanuts was performed. Results: Anaphylaxis and moderate and mild reactions to peanuts occurred in 33 (35.1%), 30 (31.9%), and 31 (33.0%) patients, respectively. The severity of the allergic reaction was only weakly correlated (p = 0.04) with the amount of peanuts consumed. The median number of allergic reactions to peanuts was 2 in children with anaphylaxis compared to 1 in other patients (p = 0.04). The median level of specific IgE to Ara h2 was 5.3 IU/mL in children with anaphylaxis compared to 0.6 IU/mL and 10.3 IU/mL in children with mild and moderate peanut allergies (p = 0.06). The optimal cutoff for distinguishing between anaphylaxis and a less severe allergic reaction to peanuts was a specific IgE Ara h2 level of 0.92 IU/mL with 90% sensitivity and 47.5% specificity for predicting anaphylaxis (p = 0.04). Conclusions: Epidemiological and clinical characteristics of the patient cannot predict the severity of the allergic reaction to peanuts in children. Even standard allergy testing, including component diagnostics, is a relatively poor predictor of the severity of an allergic reaction to peanuts. Therefore, more accurate predictive models, including new diagnostic tools, are needed to reduce the need for oral food challenge in most patients.
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Affiliation(s)
- Tadej Petek
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (T.P.); (B.K.); (M.T.); (T.H.)
| | - Mija Lajhar
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (M.L.); (B.K.)
| | - Blažka Krašovec
- Faculty of Medicine, University of Maribor, Taborska ulica 8, 2000 Maribor, Slovenia; (M.L.); (B.K.)
| | - Matjaž Homšak
- Pediatric Outpatient Clinic, Maistrova ulica 22, 2230 Lenart v Slovenskih Goricah, Slovenia;
| | - Maja Kavalar
- Pediatric Allergy Outpatient Clinic, Lavričeva ulica 1, 2000 Maribor, Slovenia;
| | - Peter Korošec
- Laboratory for Clinical Immunology and Molecular Genetics, University Clinic of Respiratory and Allergic Diseases Golnik, 4204 Golnik, Slovenia;
| | - Brigita Koren
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (T.P.); (B.K.); (M.T.); (T.H.)
| | - Maja Tomazin
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (T.P.); (B.K.); (M.T.); (T.H.)
| | - Tina Hojnik
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (T.P.); (B.K.); (M.T.); (T.H.)
| | - Vojko Berce
- Department of Paediatrics, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia; (T.P.); (B.K.); (M.T.); (T.H.)
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Ma RX, Hu JQ, Fu W, Zhong J, Cao C, Wang CC, Qi SQ, Zhang XL, Liu GH, Gao YD. Intermittent fasting protects against food allergy in a murine model via regulating gut microbiota. Front Immunol 2023; 14:1167562. [PMID: 37228621 PMCID: PMC10205017 DOI: 10.3389/fimmu.2023.1167562] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Background The prevalence of food allergy (FA) is increasing. Decreases in the diversity of gut microbiota may contribute to the pathogenesis of FA by regulating IgE production of B cells. Intermittent fasting (IF) is a popular diet with the potential to regulate glucose metabolism, boosting immune memory and optimizing gut microbiota. The potential effect of long-term IF on the prevention and treatment of FA is still unknown. Methods Two IF protocols (16 h fasting/8 h feeding and 24 h fasting/24 h feeding) were conducted on mice for 56 days, while the control mice were free to intake food (free diet group, FrD). To construct the FA model, all mice were sensitized and intragastrical challenged with ovalbumin (OVA) during the second half of IF (day 28 to day 56). Rectal temperature reduction and diarrhea were recorded to evaluate the symptoms of FA. Levels of serum IgE, IgG1, Th1/Th2 cytokines, mRNA expression of spleen T cell related transcriptional factors, and cytokines were examined. H&E, immunofluorescence, and toluidine blue staining were used to assess the structural changes of ileum villi. The composition and abundance of gut microbiota were analyzed by 16srRNA sequencing in cecum feces. Results The diarrhea score and rectal temperature reduction were lower in the two fasting groups compared to the FrD groups. Fasting was associated with lower levels of serum OVA-sIgE, OVA-sIgG1, interleukin (IL)-4 and IL-5, and mRNA expression of IL-4, IL-5, and IL-10 in the spleen. While no significant association was observed in interferon (IFN)-γ, tumor necrosis factor (TNF)-α, IL-6, IL-2 levels. Less mast cell infiltration in ileum was observed in the 16h/8h fasting group compared to the FrD group. ZO-1 expression in the ileum of the two fasting groups was higher in IF mice. The 24h/24h fasting reshaped the gut microbiota, with a higher abundance of Alistipes and Rikenellaceae strains compared to the other groups. Conclusion In an OVA-induced mice FA model, long-term IF may attenuate FA by reducing Th2 inflammation, maintaining the integrity of the intestinal epithelial barrier, and preventing gut dysbiosis.
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Affiliation(s)
- Ru-xue Ma
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jia-qian Hu
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei Fu
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jian Zhong
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Can Cao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Chang-chang Wang
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Shi-quan Qi
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiao-Lian Zhang
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Department of Immunology, School of Basic Medical Sciences, Wuhan University, Wuhan, China
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
| | - Guang-hui Liu
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ya-dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
- Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, China
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Vlastos IM, Kalentakis Z, Doulaptsi M, Karatzanis A, Prokopakis EP. Multimorbidities in Allergic Rhinitis-Current Evidence from Epidemiological Studies, Treatment Trials, and Molecular Data. Curr Allergy Asthma Rep 2023; 23:133-140. [PMID: 36692819 DOI: 10.1007/s11882-022-01063-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW Given that allergic rhinitis (AR) commonly coexists with other diseases, the present narrative review attempts a brief presentation of current theories on multimorbidities in relation to phenotypes, genotypes, age, and treatment responses with the term "multimorbidities" indicating the uncertainty regarding the primary defect, organ, or pathophysiologic mechanism involved. RECENT FINDINGS Though age-related manifestations allow for the generation of several hypotheses on AR's specific mechanisms, the various theories regarding the initiation or the aggravation of atopic disorders have yet to be proved. Multimorbid AR seems to have a different genetic basis from "stand-alone" AR as well a more severe phenotype. Most studies on the treatment of AR and its multimorbidities focus on allergen immunotherapy, which improves the atopic symptoms and may play a preventive role in the onset of new allergen sensitizations. The use of biological factors may also have a beneficial effect, even though it has currently been approved only for some comorbidities of AR, such as asthma. Employing the use of phenotypes and genotypes concerning multimorbidity broadens current knowledge, but further research is needed to develop diagnostic, stratificational, and predictive algorithms for single and multimorbid allergic diseases (Fig. 1). The real-time data obtained by mobile apps and the new insights on the pathophysiology of AR and its comorbidities will permit both timed preventive measures and better individualized and effective antiallergic treatment. Fig. 1 Current concepts and future trends in diagnosis and management of multimorbid allergic rhinitis.
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Affiliation(s)
- Ioannis M Vlastos
- Department of Otorhinolaryngology, Evangelismos Hospital, Ipsilantou 45-47, Athens, 106 76, Greece.
| | | | - Maria Doulaptsi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Greece
| | - Alexander Karatzanis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Greece
| | - Emmanuel P Prokopakis
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Greece
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Asthma and Anaphylaxis—interconnected entities. CURRENT TREATMENT OPTIONS IN ALLERGY 2022. [DOI: 10.1007/s40521-022-00324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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9
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Namjou B, Lape M, Malolepsza E, DeVore SB, Weirauch MT, Dikilitas O, Jarvik GP, Kiryluk K, Kullo IJ, Liu C, Luo Y, Satterfield BA, Smoller JW, Walunas TL, Connolly J, Sleiman P, Mersha TB, Mentch FD, Hakonarson H, Prows CA, Biagini JM, Khurana Hershey GK, Martin LJ, Kottyan L. Multiancestral polygenic risk score for pediatric asthma. J Allergy Clin Immunol 2022; 150:1086-1096. [PMID: 35595084 PMCID: PMC9643615 DOI: 10.1016/j.jaci.2022.03.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/07/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Asthma is the most common chronic condition in children and the third leading cause of hospitalization in pediatrics. The genome-wide association study catalog reports 140 studies with genome-wide significance. A polygenic risk score (PRS) with predictive value across ancestries has not been evaluated for this important trait. OBJECTIVES This study aimed to train and validate a PRS relying on genetic determinants for asthma to provide predictions for disease occurrence in pediatric cohorts of diverse ancestries. METHODS This study applied a Bayesian regression framework method using the Trans-National Asthma Genetic Consortium genome-wide association study summary statistics to derive a multiancestral PRS score, used one Electronic Medical Records and Genomics (eMERGE) cohort as a training set, used a second independent eMERGE cohort to validate the score, and used the UK Biobank data to replicate the findings. A phenome-wide association study was performed using the PRS to identify shared genetic etiology with other phenotypes. RESULTS The multiancestral asthma PRS was associated with asthma in the 2 pediatric validation datasets. Overall, the multiancestral asthma PRS has an area under the curve (AUC) of 0.70 (95% CI, 0.69-0.72) in the pediatric validation 1 and AUC of 0.66 (0.65-0.66) in the pediatric validation 2 datasets. We found significant discrimination across pediatric subcohorts of European (AUC, 95% CI, 0.60 and 0.66), African (AUC, 95% CI, 0.61 and 0.66), admixed American (AUC, 0.64 and 0.70), Southeast Asian (AUC, 0.65), and East Asian (AUC, 0.73) ancestry. Pediatric participants with the top 5% PRS had 2.80 to 5.82 increased odds of asthma compared to the bottom 5% across the training, validation 1, and validation 2 cohorts when adjusted for ancestry. Phenome-wide association study analysis confirmed the strong association of the identified PRS with asthma (odds ratio, 2.71, PFDR = 3.71 × 10-65) and related phenotypes. CONCLUSIONS A multiancestral PRS for asthma based on Bayesian posterior genomic effect sizes identifies increased odds of pediatric asthma.
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Affiliation(s)
- Bahram Namjou
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
| | - Michael Lape
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Edyta Malolepsza
- Broad Institute of Massachusetts Institute of Technology and Harvard University, Cambridge, Massachusetts 02142
| | - Stanley B. DeVore
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Matthew T. Weirauch
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Division of Developmental Biology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Ozan Dikilitas
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Gail P. Jarvik
- Departments of Medicine (Division of Medical Genetics) and Genome Sciences, University of Washington Medical Center, Seattle, Washington 98195
| | - Krzysztof Kiryluk
- Department of Medicine, Division of Nephrology, College of Physicians and Surgeons, Columbia University, New York, New York 10032
| | - Iftikhar J. Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota 55905
| | - Cong Liu
- Department of Biomedical Informatics, Columbia University, New York, New York 10032
| | - Yuan Luo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | | | - Jordan W. Smoller
- Psychiatric and Neurodevelopmental Genetics Unit, Center for Human Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts 02142
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02115
| | - Theresa L. Walunas
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611
| | - John Connolly
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, Pennsylvania 19104
| | - Patrick Sleiman
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, Pennsylvania 19104
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Tesfaye B. Mersha
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Frank D Mentch
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, Pennsylvania 19104
| | - Hakon Hakonarson
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, Pennsylvania 19104
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Cynthia A. Prows
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Patient Services, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Jocelyn M. Biagini
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Gurjit K. Khurana Hershey
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Division of Allergy & Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Lisa J. Martin
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - Leah Kottyan
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio 45229
- Division of Allergy & Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229
| | - The eMERGE Network
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892
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The Role of Systems Biology in Deciphering Asthma Heterogeneity. LIFE (BASEL, SWITZERLAND) 2022; 12:life12101562. [PMID: 36294997 PMCID: PMC9605413 DOI: 10.3390/life12101562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/17/2022]
Abstract
Asthma is one of the most common and lifelong and chronic inflammatory diseases characterized by inflammation, bronchial hyperresponsiveness, and airway obstruction episodes. It is a heterogeneous disease of varying and overlapping phenotypes with many confounding factors playing a role in disease susceptibility and management. Such multifactorial disorders will benefit from using systems biology as a strategy to elucidate molecular insights from complex, quantitative, massive clinical, and biological data that will help to understand the underlying disease mechanism, early detection, and treatment planning. Systems biology is an approach that uses the comprehensive understanding of living systems through bioinformatics, mathematical, and computational techniques to model diverse high-throughput molecular, cellular, and the physiologic profiling of healthy and diseased populations to define biological processes. The use of systems biology has helped understand and enrich our knowledge of asthma heterogeneity and molecular basis; however, such methods have their limitations. The translational benefits of these studies are few, and it is recommended to reanalyze the different studies and omics in conjugation with one another which may help understand the reasons for this variation and help overcome the limitations of understanding the heterogeneity in asthma pathology. In this review, we aim to show the different factors that play a role in asthma heterogeneity and how systems biology may aid in understanding and deciphering the molecular basis of asthma.
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11
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Porat D, Dukhno O, Vainer E, Cvijić S, Dahan A. Antiallergic Treatment of Bariatric Patients: Potentially Hampered Solubility/Dissolution and Bioavailability of Loratadine, but Not Desloratadine, Post-Bariatric Surgery. Mol Pharm 2022; 19:2922-2936. [PMID: 35759355 DOI: 10.1021/acs.molpharmaceut.2c00292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Gastrointestinal anatomical/physiological changes after bariatric surgery influence variables affecting the fate of drugs after ingestion, and medication management of these patients requires a thorough and complex mechanistic analysis. The aim of this research was to study whether loratadine/desloratadine antiallergic treatment of bariatric patients is at risk of being ineffective due to impaired solubility/dissolution. The pH-dependent solubility of loratadine/desloratadine was studied in vitro, as well as ex vivo, in gastric content aspirated from patients before versus after bariatric surgery. Then, a biorelevant dissolution method was developed to simulate the gastric conditions after sleeve gastrectomy (SG) or one-anastomosis gastric bypass (OAGB), accounting for key variables (intragastric volume, pH, and contractility), and the dissolution of loratadine/desloratadine was studied pre- versus post-surgery. Dissolution was also studied after tablet crushing or syrup ingestion, as these actions are recommended after bariatric surgery. Finally, these experimental data were implemented in a newly developed physiologically based pharmacokinetic (PBPK) model to simulate loratadine/desloratadine PK profiles pre- versus post-surgery. For both drugs, pH-dependent solubility was demonstrated, with decreased solubility at higher pH; over the pH range 1-7, loratadine solubility decreased ∼2000-fold, and desloratadine decreased ∼120-fold. Ex vivo solubility in aspirated human gastric fluid pre- versus post-surgery was in good agreement with these in vitro results and revealed that while desloratadine solubility still allows complete dissolution post-surgery, loratadine solubility post-surgery is much lower than the threshold required for the complete dissolution of the drug dose. Indeed, severely hampered loratadine dissolution was revealed, dropping from 100% pre-surgery to only 3 and 1% post-SG and post-OAGB, respectively. Tablet crushing did not increase loratadine dissolution in any post-bariatric condition, nor did loratadine syrup in post-OAGB (pH 7) media, while in post-laparoscopic SG conditions (pH 5), the syrup provided partial improvement of up to 40% dissolution. Desloratadine exhibited quick and complete dissolution across all pre-/post-surgery conditions. PBPK simulations revealed pronounced impaired absorption of loratadine post-surgery, with 84-88% decreased Cmax, 28-36% decreased Fa, and 24-31% decreased overall bioavailability, depending on the type of bariatric procedure. Desloratadine absorption remained unchanged post-surgery. We propose that desloratadine should be preferred over loratadine in bariatric patients, and as loratadine is an over-the-counter medication, antiallergic therapy after bariatric surgery requires special attention by patients and clinicians alike. This mechanistic approach that reveals potential post-surgery complexity, and at the same time provides adequate substitutions, may contribute to better pharmacotherapy and overall patient care after bariatric surgery.
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Affiliation(s)
- Daniel Porat
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Oleg Dukhno
- Department of Surgery B, Soroka University Medical Center, Beer-Sheva 8410101, Israel
| | - Ella Vainer
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
| | - Sandra Cvijić
- Department of Pharmaceutical Technology and Cosmetology, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450, 11221 Belgrade, Serbia
| | - Arik Dahan
- Department of Clinical Pharmacology, School of Pharmacy, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 8410501, Israel
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The modifiable biopsychosocial drivers of psychological distress for adolescents with asthma: Implications for Clinical Care. Paediatr Respir Rev 2022; 41:68-72. [PMID: 34531130 DOI: 10.1016/j.prrv.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Overwhelming distress exceeds the capacity of healthy coping strategies to feel better using healthy coping strategies alone, resulting in the use of unhealthy coping strategies. Unhealthy coping strategies may exacerbate asthma symptoms and asthma can contribute to overwhelming distress. This study aimed to review the modifiable drivers of overwhelming distress in adolescents with asthma. METHODS The biopsychosocial drivers of psychological distress for adolescents with asthma were explored within the domains of the modifiable biopsychosocial model of health and wellbeing. RESULTS Asthma in adolescents is associated with problems in the domains of environment, developmental outcomes, sense of belonging, health behaviours, coping, and treatment of illness. CONCLUSIONS The relationship between asthma and psychological distress highlights the need for holistic treatment of asthma. Further research is needed to establish causation between variables and to investigate whether interventions that address either asthma symptoms or biopsychosocial drivers of distress can improve both factors.
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13
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Self-reported asthma prevalence and management in adults in France in 2018: ASTHMAPOP survey. Respir Med Res 2021; 80:100864. [PMID: 34773824 DOI: 10.1016/j.resmer.2021.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 08/26/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a paucity of epidemiological data on asthma classified by disease severity in France. The ASTHMAPOP cross-sectional study aimed to review the prevalence and current management of asthma in people aged ≥18 years in France. METHODS A self-administered questionnaire was mailed to 19 676 people representative of the French population in age, gender, region, and socio-economic status. Asthma was classified by treatment steps per the 2017 Global Initiative for Asthma (GINA) report, according to prescribed treatments. Analyses were mostly descriptive. RESULTS The questionnaire return rate was 81.7% (n = 16 083), and 15 587 questionnaires were analyzed. The prevalence of lifetime asthma was 12.8% (95% confidence interval (CI):12.3-13.3%; n = 1 989) in 2018. The prevalence of current asthma (i.e., 12 months before the survey) was 6.4% (95% CI: 6.0-6.8%; n = 993); most of these respondents (95.3% [n = 946]) were receiving asthma treatment, and 49.4% (n = 491) were treated for mild asthma (GINA step 1 or 2). Of people with current asthma, 47.6% reported ≥1 asthma exacerbation in the past 12 months-defined as episodes (several days) during which symptoms (cough, sputum, and dyspnea) were worse than usual; 14.3% had ≥1 emergency visit, and 3.1% had ≥1 hospitalization due to asthma. Of those taking continuous asthma controller medications who answered all Morisky Medication Adherence Scale questions (n = 501), 46.4% were adherent (score=4) to their treatment regimen. Based on the 6-item Asthma Control Questionnaire scores, asthma was partially controlled or uncontrolled in 47.7% of 969 people. CONCLUSIONS The prevalence of asthma in France has remained stable since 2006, but levels of asthma control and treatment adherence continue to be relatively poor. Asthma management in France requires improvement.
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Cattaneo C, Mameli C, D'Auria E, Zuccotti G, Pagliarini E. The Influence of Common Noncommunicable Diseases on Chemosensory Perception and Clinical Implications in Children and Adolescents. Adv Nutr 2021; 13:234-247. [PMID: 34535793 PMCID: PMC8803496 DOI: 10.1093/advances/nmab100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/06/2023] Open
Abstract
An increased incidence of noninfectious chronic diseases, such as obesity, diabetes, and allergies, has been noted in the last century, especially in the last 2 to 3 generations. Evidence suggested that the interrelation among these chronic conditions in pediatric age (e.g., children and adolescents aged 4-16 y) is complex and still unknown, reinforcing the interest of pediatricians in these diseases. Of interest is the need to better understand the link between these pathologies and sensory perception, since the chemical senses of taste and smell, together with chemesthesis, are reported to have a role in food choices and may provide a novel target for intervention in the treatment of these pathologies. This review aims to explore the current evidence on the link between these chronic conditions and chemosensory perception (i.e., taste and smell). In addition, the putative role that chemosensory perception may have on food choices and eating behavior of children and adolescents affected by these diseases are highlighted. Furthermore, the review addresses the unexplored issues that need to be investigated in this area. The literature data search suggested that no clear relation between taste and smell perception and the aforementioned diseases in young population yet exists. However, some possible trends have been highlighted in the adult population, in whom the duration of disease might have affected the relation. There is a need for further, high-quality, hypothesis-led research, with robust measures of taste and smell functions as the primary outcomes, to strengthen or deny this evidence.
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Affiliation(s)
| | - Chiara Mameli
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Enza D'Auria
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - Ella Pagliarini
- Sensory and Consumer Science Lab (SCS_Lab), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
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15
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Dietert RR. Microbiome First Medicine in Health and Safety. Biomedicines 2021; 9:biomedicines9091099. [PMID: 34572284 PMCID: PMC8468398 DOI: 10.3390/biomedicines9091099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023] Open
Abstract
Microbiome First Medicine is a suggested 21st century healthcare paradigm that prioritizes the entire human, the human superorganism, beginning with the microbiome. To date, much of medicine has protected and treated patients as if they were a single species. This has resulted in unintended damage to the microbiome and an epidemic of chronic disorders [e.g., noncommunicable diseases and conditions (NCDs)]. Along with NCDs came loss of colonization resistance, increased susceptibility to infectious diseases, and increasing multimorbidity and polypharmacy over the life course. To move toward sustainable healthcare, the human microbiome needs to be front and center. This paper presents microbiome-human physiology from the view of systems biology regulation. It also details the ongoing NCD epidemic including the role of existing drugs and other factors that damage the human microbiome. Examples are provided for two entryway NCDs, asthma and obesity, regarding their extensive network of comorbid NCDs. Finally, the challenges of ensuring safety for the microbiome are detailed. Under Microbiome-First Medicine and considering the importance of keystone bacteria and critical windows of development, changes in even a few microbiota-prioritized medical decisions could make a significant difference in health across the life course.
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Affiliation(s)
- Rodney R Dietert
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY 14853, USA
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16
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Meadows JA, Yu S, Hass SL, Guerin A, Latremouille-Viau D, Tilles SA. Health-care resource utilization associated with peanut allergy management under allergen avoidance among commercially insured individuals. Allergy Asthma Proc 2021; 42:333-342. [PMID: 34187625 DOI: 10.2500/aap.2021.42.210047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Until recently, the standard approach to care for individuals with peanut allergy (PA) was limited to allergen avoidance and treatment of reactions with emergency medicines. Objectives: To assess health-care resource utilization (HRU) and costs associated with PA management under allergen avoidance and to identify risk factors associated with peanut reactions that resulted in inpatient (IP) and/or emergency department (ED) visits. Methods: Privately insured individuals with PA diagnosis codes were identified from a large U.S. administrative claims data base (January 1, 1999, to March 31, 2017). PA-related HRU, indicated by a PA diagnosis and/or diagnostic procedure codes and by epinephrine autoinjectors (EAI) prescription fills in medical and pharmacy claims, respectively, and all-cause costs were described per patient-year (PPY). Risk factors associated with peanut reactions in an IP and/or ED setting were identified by using a multivariable logistic regression model. Results: A total of 86,483 patient-years from 14,136 individuals with PA were included. At the patient-year level, 28.1% were ages 0-3 years, 43.6% were ages 4-11 years, 13.7% were ages 12-17 years, and 14.5% were ages ≥ 18 years; 35.6% had PA-related outpatient visits; 50.6% had EAI fills; and 2.4% had PA-related IP and/or ED visits PPY. Younger individuals had more PA-related outpatient visits and EAI fills, with peak intensive use at ages 4-11 years. The proportion of individuals with PA-related IP and/or ED visits was highest among those aged ≥ 18 years. Mean all-cause costs were $3084 PPY; individuals with PA-related IP and/or ED visits incurred $8902 PPY ($17,451 for those with one or more IP visits). Risk factors associated with peanut reactions that resulted in IP and/or ED visits included young adults (odds ratio [OR] 3.19 [95% confidence interval {CI}, 2.66-3.83]), previous peanut reaction(s) (OR 1.66 [95% CI, 1.23-2.24]), asthma (OR 1.33 [95% CI, 1.18-1.51]), and male sex (OR 1.14 [95% CI, 1.01-1.28]). Conclusion: Individuals with PA and under allergen avoidance had significant HRU that varied across all age groups, with more PA-related outpatient visits during preschool and/or school age and PA-related urgent care among adults. Individuals with previous peanut reaction(s), asthma, and males had a higher risk of peanut reactions that resulted in IP and/or ED visits.
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Affiliation(s)
- J. Allen Meadows
- From the Alabama College of Osteopathic Medicine, Montgomery, Alabama
| | - Shengsheng Yu
- Aimmune Therapeutics, a Nestle Health Science company, Brisbane, California
| | | | | | | | - Stephen A. Tilles
- Aimmune Therapeutics, a Nestle Health Science company, Brisbane, California
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Barros SÉDL, Rocha CDS, de Moura MSB, Barcelos MP, da Silva CHTDP, Hage-Melim LIDS. Potential beneficial effects of kefir and its postbiotic, kefiran, on child food allergy. Food Funct 2021; 12:3770-3786. [PMID: 33977950 DOI: 10.1039/d0fo03182h] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Food allergies are known as the public health problem, affecting people of all age groups, but more commonly in babies and children, with consequences for nutritional status and quality of life. The increase in the consumption of healthy foods has consequently led to an increased demand for functional foods with specific health benefits. Thus, the pharmaceutical industry's interest in natural products has grown every time and is therefore considered as an alternative to synthetic drugs. Kefir has been outstanding for several years as promising in the manufacture of various pharmaceutical products, due to its nutritional and therapeutic properties for the treatment of many diseases. Currently, a wide variety of new functional foods are appearing on the market, representing an important segment. Postbiotics, for example, has stood out for being a product with action similar to probiotics, without offering side effects. The kefiran is the postbiotic from kefir that promotes potential beneficial effects on food allergy from the intestinal microbiome to the immune system. In this context, it is necessary to know the main promoting component of this functional effect. This review compiles the benefits that kefir, and especially its postbiotic, kefiran, can bring to food allergy. In addition, it serve as a subsidy for studies on the development of innovative nutraceutical products, including the use of kefiran as an alternative therapy in food allergy.
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Affiliation(s)
- Susy Érika de Lima Barros
- Laboratory of Pharmaceutical and Medicinal Chemistry (PharMedChem), Federal University of Amapá, Macapá, Brazil.
| | - Caique Dos Santos Rocha
- Laboratory of Pharmaceutical and Medicinal Chemistry (PharMedChem), Federal University of Amapá, Macapá, Brazil.
| | | | - Mariana Pegrucci Barcelos
- Computational Laboratory of Pharmaceutical Chemistry, School of Pharmaceutical Science of Riberão Preto, Univerisity of São Paulo, Ribeirão Preto, Brazil
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Blaiss MS, Meadows JA, Yu S, Robison DR, Hass SL, Norrett KE, Guerin A, Latremouille-Viau D, Tilles SA. Economic burden of peanut allergy in pediatric patients with evidence of reactions to peanuts in the United States. J Manag Care Spec Pharm 2021; 27:516-527. [PMID: 33470880 PMCID: PMC10394212 DOI: 10.18553/jmcp.2021.20389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: The economic burden of food allergy is large; however, costs specific to individuals with peanut allergy experiencing reactions to peanuts remain to be evaluated. As the prevalence of peanut allergy continues to increase in children, a better understanding of the cost of care is warranted. OBJECTIVE: To assess the cost of care of peanut allergy among privately insured and Medicaid-insured pediatric patients in the United States. METHODS: This retrospective matched-cohort study included patients aged 4-17 years from the Optum Health Care Solutions and Medicaid Claims databases (January 1, 2007-March 31, 2017). Patients were classified into 2 cohorts: peanut allergy (with peanut allergy diagnosis codes and reactions triggering health care resource utilization [HRU]) and peanut allergy-free (no peanut allergy diagnosis codes in claims). Peanut allergy patients were matched 1:10 to peanut allergy-free patients based on baseline covariates. Comorbidities including anxiety and depression, HRU, and direct health care costs were compared between cohorts and reported for both perspectives separately. RESULTS: Compared with peanut allergy-free patients (n = 30,840 privately insured; n = 12,450 Medicaid), peanut allergy patients (n = 3,084 privately insured; n = 1,245 Medicaid) had higher prevalence of asthma, atopic dermatitis/eczema, other food allergies, allergic rhinitis, depression, and anxiety (all P < 0.01). Peanut allergy patients had higher HRU per patient per year (PPPY), including 90% more emergency department visits among both privately insured and Medicaid patients (P < 0.01) and higher direct health care costs PPPY, with incremental costs of $2,247 total or $1,712 excluding asthma-related costs for privately insured patients and $2,845 total or $1,844 excluding asthma-related costs for Medicaid patients (all P < 0.01). CONCLUSIONS: Pediatric patients in the United States with peanut allergy and reactions triggering HRU had significantly higher comorbidity burdens, HRU, and direct health care costs, regardless of asthma-related costs, versus those without peanut allergy. DISCLOSURES: This study was funded by Aimmune Therapeutics, a Nestlé Health Science company. The study sponsor was involved in several aspects of the research including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication. Yu and Tilles are employees of Aimmune Therapeutics, a Nestlé Health Science company. Robison and Norrett were employees of Aimmune Therapeutics at the time this study was conducted. Blaiss, Meadows, and Hass provided paid consulting services to Aimmune Therapeutics. Guerin and Latremouille-Viau are employees of Analysis Group, a consulting company that provided paid consulting services to Aimmune Therapeutics. Parts of the results were presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting held March 25-28, 2019, in San Diego, CA, and at the ISPOR Annual Meeting held May 18-22, 2019, in New Orleans, LA.
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Affiliation(s)
| | | | - Shengsheng Yu
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA
| | - Dan R Robison
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA
| | | | - Kevin E Norrett
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA
| | | | | | - Stephen A Tilles
- Aimmune Therapeutics, a Nestlé Health Science company, Brisbane, CA
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Althumiri NA, Basyouni MH, AlMousa N, AlJuwaysim MF, BinDhim NF, Alqahtani SA. Prevalence of Self-Reported Food Allergies and Their Association with Other Health Conditions among Adults in Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E347. [PMID: 33466448 PMCID: PMC7796440 DOI: 10.3390/ijerph18010347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 02/08/2023]
Abstract
Food allergies are a potentially life-threatening health issue, and few studies have determined their prevalence throughout Saudi Arabia. The main objective of our study was to estimate the prevalence and distribution of self-reported food allergies, and explore their association with other health conditions among adults in Saudi Arabia. This study was a nationwide cross-sectional survey conducted via phone interviews in June 2020. A proportional quota-sampling technique was used to obtain equal distributions of participants by age and gender across the 13 regions of Saudi Arabia. Self-reported food allergy, height, weight, health conditions, mental health status, and demographic variables were collected. Of the 6239 participants contacted, 4709 (75.48%) participants responded and completed the interview. Furthermore, 50.1% of the participants were female, with a mean age of 36.4 ± 13.5 years (18-90 years). The prevalence of food allergies was 19.7%. The most self-reported food allergies were egg, shellfish and shrimp, and peanuts, with a prevalence of 3.7%, 3.1%, and 3.0%, respectively. There was an association between the presence of food allergies and reported bariatric surgery, asthma, colon disease, and being at risk of depression. Bariatric surgery was significantly associated with lower likelihood of self-reported allergy (OR 1.69, 95% CI 1.22-2.34, p = 0.002). This study revealed, for the first time, a high prevalence of self-reported food allergies among adults in Saudi Arabia in a large nationwide sample, and food allergy association with bariatric surgery, asthma, colon disease, and being at risk of depression. This information is valuable for clinicians and policymakers, particularly in terms of food allergen labeling.
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Affiliation(s)
- Nora A. Althumiri
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.F.B.)
| | - Mada H. Basyouni
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.F.B.)
- Ministry of Health, Riyadh 11176, Saudi Arabia
| | - Norah AlMousa
- Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia;
| | | | - Nasser F. BinDhim
- Sharik Association for Health Research, Riyadh 13326, Saudi Arabia; (M.H.B.); (N.F.B.)
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
- Saudi Food and Drug Authority, Riyadh 13513, Saudi Arabia
| | - Saleh A. Alqahtani
- Liver Transplant Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia;
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD 21218, USA
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Abdallah AM, Osman NS, Mohammad HA, Metwalley KA, Embaby M, ElMelegy TT. Food sensitization in preschool Egyptian children with recurrent wheezing. Pediatr Res 2020; 88:580-586. [PMID: 32485730 DOI: 10.1038/s41390-020-0960-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/27/2020] [Accepted: 04/24/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Food allergy is common in children with prevalence up to 10%. We assessed the clinico-laboratory characteristics and frequency of food sensitization to the commonly consumed food among upper Egyptian preschool children with recurrent wheezy chest. METHODS This cross-sectional descriptive study was conducted on 100 preschool children with recurrent wheezy chest recruited from Emergency, Allergy, and Pulmonology units, Assiut University Children's Hospital, Egypt. All enrolled patients were subjected to history taking, through examination, chest X-ray, skin prick testing (SPT), and lab investigations. RESULTS Family history of allergy was found in 66 patients, while history of other allergies was reported in 47 patients. History of food allergy was positive in 47% of the studied patients, and 28 patients had positive reaction by SPT. Sensitization to fish, milk, egg, and wheat was found in 15, 8, 5, and 4 patients, respectively. Eighteen out of the 28 patients who were sensitized by SPT gave positive history of food allergy, while ten patients had no suggestive history; also, history suggestive of food allergy was negative in 35.7% of sensitized patients versus 61.1% of non-sensitized patients. CONCLUSIONS Food sensitization is common in preschool Egyptian children with recurrent wheezing. IMPACT Food sensitization is common in children with prevalence up to 10%, and in atopic children up to 30%. Sensitization to fish was the most common type of sensitization observed among preschool children with recurrent wheezing, followed by milk, eggs, and wheat, respectively. SPT aided by history is a good screening tool to determine whether patients need to avoid some foods that can cause allergy in order to help in controlling their symptoms.
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Affiliation(s)
| | - Naglaa S Osman
- Pediatric Department, Faculty of Medicine, Assiut University, 71526, Assiut, Egypt
| | - Hanaa A Mohammad
- Pediatric Department, Faculty of Medicine, Assiut University, 71526, Assiut, Egypt
| | - Kotb A Metwalley
- Pediatric Department, Faculty of Medicine, Assiut University, 71526, Assiut, Egypt
| | - Mostafa Embaby
- Pediatric Department, Faculty of Medicine, Assiut University, 71526, Assiut, Egypt
| | - Tarek T ElMelegy
- Clinical Pathology Department, Faculty of Medicine, Assiut University, 71526, Assiut, Egypt
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21
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Impact of comorbid conditions on asthmatic adults and children. NPJ Prim Care Respir Med 2020; 30:36. [PMID: 32820164 PMCID: PMC7441401 DOI: 10.1038/s41533-020-00194-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
Comorbid conditions (comorbidities) can complicate the diagnosis and management of asthma. In different age groups, comorbid conditions can present varying challenges, including diagnostic confusion due to mimicking asthma symptoms, exacerbation of asthma symptoms, therapy for comorbid conditions affecting asthma or therapy for asthma affecting these conditions. This review aims to summarise some common comorbid conditions with asthma, such as rhinitis, vocal cord dysfunction, gastro-oesophageal reflux, psychiatric disorders, obesity and obstructive sleep apnoea, and discuss their prevalence, symptoms, diagnosis and treatment, highlighting any differences in how they impact children and adults. Overall, there is a lack of data on the impact of treating comorbid conditions on asthma outcomes and further studies are needed to guide age-appropriate asthma management in the presence of these conditions.
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Abstract
PURPOSE OF REVIEW Both asthma and anaphylaxis are recognized noncommunicable hypersensitivity conditions, which should be correctly diagnosed and treated/controlled in order to decrease avoidable deaths. Nevertheless, their association is not completely clear. We here propose to review the current and new evidence-based data of asthma and anaphylaxis in the view of the new knowledge in the field that can support the quality practice and empower allergists and health professionals in treating symptoms and preventing death. RECENT FINDINGS Hypersensitivity life-threatening conditions, such as anaphylaxis and asthma can coexist, mimic or worse each other. Asthma itself is not a strong predictor of more severe anaphylaxis. However, poor asthma control associated with more severe anaphylaxis reactions in all ages. In children, asthma is associated with the severity and recurrences of anaphylactic reactions. SUMMARY Although recent data point for the association between asthma and anaphylaxis, we still do not have harmonized evidence to confirm if we are dealing with two independent comorbidities one worsening each other. However, as far as this review is covering two relevant public health problems in the field of allergy, it is mandatory put in place decisions supporting recommendations to better manage the affected patients and reduce the risk.General strategies should include regular notification of this association, optimization of the classification and coding for anaphylaxis and asthma (new ICD 11 allergy codes) in order to harmonize epidemiological stratified data, early diagnosis of asthma in childhood, regular investigation of asthma in cases of anaphylaxis and optimization of the asthma control and lung function for all patients with indication to provocation tests, desensitization or allergen immunotherapy regardless to the trigger. Implementation of these strategies will involve national and international support for ongoing efforts in relationship with networks of centres of excellence to provide personalized management for the most at-risk patients and prevent death.
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Foradori DM, Sampayo EM, Fanny SA, Namireddy MK, Kumar AM, Lo HY. Improving Influenza Vaccination in Hospitalized Children With Asthma. Pediatrics 2020; 145:peds.2019-1735. [PMID: 32107285 DOI: 10.1542/peds.2019-1735] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Children with asthma are at increased risk of complications from influenza; hospitalization represents an important opportunity for vaccination. We aimed to increase the influenza vaccination rate among eligible hospitalized patients with asthma on the pediatric hospital medicine (PHM) service from 13% to 80% over a 4-year period. METHODS Serial Plan-Do-Study-Act cycles were implemented to improve influenza vaccination rates among children admitted with status asthmaticus and included modifications to the electronic health record (EHR) and provider and family education. Success of the initial PHM pilot led to the development of a hospital-wide vaccination tracking tool and an institutional, nurse-driven vaccine protocol by a multidisciplinary team. Our primary outcome metric was the inpatient influenza vaccination rate among PHM patients admitted with status asthmaticus. Process measures included documentation of influenza vaccination status and use of the EHR asthma order set and a history and physical template. The balance measure was adverse vaccine reaction within 24 hours. Data analysis was performed by using statistical process control charts. RESULTS The inpatient influenza vaccination rate increased from 13% to 57% over 4 years; special cause variation was achieved. Overall, 50% of eligible patients were vaccinated during asthma hospitalization in the postintervention period. Documentation of influenza vaccination status significantly increased from 51% to 96%, and asthma history and physical and order set use also improved. No adverse vaccine reactions were documented. CONCLUSIONS A bundle of interventions, including EHR modifications, provider and family education, hospital-wide tracking, and a nurse-driven vaccine protocol, increased influenza vaccination rates among eligible children hospitalized with status asthmaticus.
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Affiliation(s)
- Dana M Foradori
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Esther M Sampayo
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - S Aya Fanny
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Meera K Namireddy
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Anjali M Kumar
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Huay-Ying Lo
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Crestani E, Harb H, Charbonnier LM, Leirer J, Motsinger-Reif A, Rachid R, Phipatanakul W, Kaddurah-Daouk R, Chatila TA. Untargeted metabolomic profiling identifies disease-specific signatures in food allergy and asthma. J Allergy Clin Immunol 2020; 145:897-906. [PMID: 31669435 PMCID: PMC7062570 DOI: 10.1016/j.jaci.2019.10.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/10/2019] [Accepted: 10/01/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Food allergy (FA) affects an increasing proportion of children for reasons that remain obscure. Novel disease biomarkers and curative treatment options are strongly needed. OBJECTIVE We sought to apply untargeted metabolomic profiling to identify pathogenic mechanisms and candidate disease biomarkers in patients with FA. METHODS Mass spectrometry-based untargeted metabolomic profiling was performed on serum samples of children with either FA alone, asthma alone, or both FA and asthma, as well as healthy pediatric control subjects. RESULTS In this pilot study patients with FA exhibited a disease-specific metabolomic signature compared with both control subjects and asthmatic patients. In particular, FA was uniquely associated with a marked decrease in sphingolipid levels, as well as levels of a number of other lipid metabolites, in the face of normal frequencies of circulating natural killer T cells. Specific comparison of patients with FA and asthmatic patients revealed differences in the microbiota-sensitive aromatic amino acid and secondary bile acid metabolism. Children with both FA and asthma exhibited a metabolomic profile that aligned with that of FA alone but not asthma. Among children with FA, the history of severe systemic reactions and the presence of multiple FAs were associated with changes in levels of tryptophan metabolites, eicosanoids, plasmalogens, and fatty acids. CONCLUSIONS Children with FA have a disease-specific metabolomic profile that is informative of disease mechanisms and severity and that dominates in the presence of asthma. Lower levels of sphingolipids and ceramides and other metabolomic alterations observed in children with FA might reflect the interplay between an altered microbiota and immune cell subsets in the gut.
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Affiliation(s)
- Elena Crestani
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Hani Harb
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Louis-Marie Charbonnier
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Jonathan Leirer
- Bioinformatics Research Center, Department of Statistics, North Carolina State University, Raleigh, NC
| | - Alison Motsinger-Reif
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC
| | - Rima Rachid
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Rima Kaddurah-Daouk
- Department of Psychiatry and Behavioral Sciences and the Duke Institute for Brain Sciences, Duke University, Durham, NC
| | - Talal A Chatila
- Division of Immunology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Mass.
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Brough HA, Caubet JC, Mazon A, Haddad D, Bergmann MM, Wassenberg J, Panetta V, Gourgey R, Radulovic S, Nieto M, Santos AF, Nieto A, Lack G, Eigenmann PA. Defining challenge-proven coexistent nut and sesame seed allergy: A prospective multicenter European study. J Allergy Clin Immunol 2019; 145:1231-1239. [PMID: 31866098 DOI: 10.1016/j.jaci.2019.09.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 09/04/2019] [Accepted: 09/26/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Peanut, tree nut, and sesame allergies are responsible for most life-threatening food-induced allergic reactions. Rates of coexistent allergy between these foods have been from mostly retrospective studies that include only a limited number of tree nuts or were not based on oral food challenges. OBJECTIVE The Pronuts study is a multicenter European study (London, Geneva, and Valencia) assessing the challenge-proven rate of coexistent peanut, tree nut, and/or sesame seed allergy. METHODS Children aged 0 to 16 years with at least 1 confirmed nut or sesame seed allergy underwent sequential diagnostic food challenges to all other nuts and sesame seed. RESULTS Overall, the rate of coexistent peanut, tree nut, and sesame seed allergy was 60.7% (n = 74/122; 95% CI, 51.4% to 69.4%). Peanut allergy was more common in London, cashew and pistachio nut allergies were more common in Geneva, and walnut and pecan allergies were more common in Valencia. Strong correlations were found between cashew-pistachio, walnut-pecan, and walnut-pecan-hazelnut-macadamia clusters. Age (>36 months) and center (Valencia > Geneva > London) were associated with an increased odds of multiple nut allergies. By pursuing the diagnostic protocol to demonstrate tolerance to other nuts, participants were able to introduce a median of 9 nuts. CONCLUSION We found a higher rate of coexistent nut and sesame seed allergies than previously reported. Performing sequential food challenges was labor intensive and could result in severe allergic reactions; however, it reduced dietary restrictions. Age was a significant predictor of multiple nut allergies, and thus the secondary spread of nut allergies occurred in older children.
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Affiliation(s)
- Helen A Brough
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom; Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom; Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom.
| | - Jean-Christoph Caubet
- Department of Pediatrics Gynecology and Obstetrics, Medical School of the University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Angel Mazon
- Unit of Pediatric Allergy and Pneumology, Children's Hospital La Fe, Institute of Health Research La Fe, Valencia, Spain
| | - Diab Haddad
- St Peter's Hospital, Chertsey, United Kingdom
| | - Marcel M Bergmann
- Department of Pediatrics Gynecology and Obstetrics, Medical School of the University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
| | - Jacqueline Wassenberg
- Unit of Pediatric Allergy and Rheumatology, Department of Pediatrics, University Hospital of Lausanne, Switzerland
| | - Valentina Panetta
- L'altrastatistica srl, Consultancy & Training, Biostatistics Office, Rome, Italy
| | - Rosalynd Gourgey
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom; Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom; Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Suzana Radulovic
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom; Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom; Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Maria Nieto
- Unit of Pediatric Allergy and Pneumology, Children's Hospital La Fe, Institute of Health Research La Fe, Valencia, Spain
| | - Alexandra F Santos
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom; Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom; Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom; Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Antonio Nieto
- Unit of Pediatric Allergy and Pneumology, Children's Hospital La Fe, Institute of Health Research La Fe, Valencia, Spain
| | - Gideon Lack
- Paediatric Allergy Group, Department of Women and Children's Health, King's College London, London, United Kingdom; Paediatric Allergy Group, Peter Gorer Dept of Immunobiology, School of Immunology & Microbial Sciences, King's College London, Guys' Hospital, London, United Kingdom; Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, United Kingdom
| | - Philippe A Eigenmann
- Department of Pediatrics Gynecology and Obstetrics, Medical School of the University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
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Roberts G, Almqvist C, Boyle R, Crane J, Hogan SP, Marsland B, Saglani S, Woodfolk JA. Developments in the field of allergy in 2017 through the eyes of Clinical and Experimental Allergy. Clin Exp Allergy 2019; 48:1606-1621. [PMID: 30489681 DOI: 10.1111/cea.13318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In this article, we described the development in the field of allergy as described by Clinical and Experimental Allergy in 2017. Experimental models of allergic disease, basic mechanisms, clinical mechanisms, allergens, asthma and rhinitis and clinical allergy are all covered.
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Affiliation(s)
- G Roberts
- Faculty of Medicine, Clinical and Experimental Sciences and Human Development and Health, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - R Boyle
- Department of Paediatrics, Imperial College London, London, UK
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Mary H Weiser Food Allergy Center, Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - B Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, Victoria, Australia
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - J A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia
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Diet and Food Allergy as Risk Factors for Asthma in the Arabian Gulf Region: Current Evidence and Future Research Needs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203852. [PMID: 31614710 PMCID: PMC6843839 DOI: 10.3390/ijerph16203852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 09/30/2019] [Accepted: 10/10/2019] [Indexed: 12/13/2022]
Abstract
Asthma is a chronic respiratory disease which is associated with higher levels of systemic inflammation. The causes of asthma remain poorly understood. Unhealthy diet and food allergy are potential risk factors for developing asthma. The prevalence of asthma in the Arabian Gulf region (AGR), and Kuwait, Saudi Arabia and Qatar in particular, is higher than in other Eastern Mediterranean countries. In the AGR, diets tend to be of low nutritional value due to high levels of total energy, cholesterol, sodium, added sugars and saturated fat, and low levels of fiber, fruit and vegetables. A few studies that include children and adults in the AGR have suggested a potential link between unhealthy diets/specific food allergens and increased risk of asthma, however, the association of food allergy with asthma is still a controversial issue. The aim of this commentary is to consider the evidence from the AGR regarding the effects of diet/food allergy on asthma risk that may be used to make recommendations for future research.
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Greenshields S. Anaphylaxis in children and young people. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:1187-1189. [PMID: 31597053 DOI: 10.12968/bjon.2019.28.18.1187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Sarah Greenshields
- Lecturer in Children and Young People's Nursing, Northumbria University, Newcastle upon Tyne
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29
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Blazowski L, Majak P, Kurzawa R, Kuna P, Jerzynska J. Food allergy endotype with high risk of severe anaphylaxis in children-Monosensitization to cashew 2S albumin Ana o 3. Allergy 2019; 74:1945-1955. [PMID: 31131460 DOI: 10.1111/all.13810] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/30/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Food allergy in children can be life-threatening. Component-resolved diagnostics approach to food anaphylaxis is rarely assessed in children. The aim of the study was to identify the food allergen components as the triggers responsible for severe anaphylaxis, with regard to characteristics and associated risks, among children in a large, population-based setting. METHODS Two hundred and seventy-one children who were hospitalized due to systemic allergic reaction (SAR) and food anaphylaxis were recruited. Medical history was assessed, and culprit allergen source and anaphylaxis severity grade were established. Specific IgE to 112 allergen components using multiplex ImmunoCAP ISAC immunoassay and specific IgE to hazelnut, Cor a 14, and cashew, Ana o 3, using singleplex ImmunoCAP immunoassay were determined. RESULTS We analyzed data from 237 SAR/anaphylaxis in 237 children. Trigger at allergen component level was defined for every episode. The most common triggers of SAR/anaphylaxis were seeds (50.6%), among them, the storage proteins. Anaphylaxis triggered by Ana o 3, 2S albumin from cashews (aOR = 15.0; 95% CI: 3.27 to 73.47); Tri a 19 from wheat (aOR = 9.93; 95% CI: 1.73 to 56.97); and Cor a 9 from hazelnut (aOR = 6.53; 95% CI: 1.16 to 36.72) had the worst clinical presentation including cardiovascular and severe respiratory symptoms (grade IV-V vs I-III in Cox scale). Thirteen out of 237 (5.5%) SAR/anaphylaxis patients were triggered by Ana o 3. Almost 82% of patients with severe Ana o 3 anaphylaxis were sensitized only to this component and had no concomitant food sensitization. CONCLUSION Monosensitization to Ana o 3 is, irrespective of other parameters, connected with high risk of severe anaphylaxis.
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Affiliation(s)
- Lukasz Blazowski
- Department of Allergology National Research Institute of Tuberculosis and Lung Diseases Rabka‐Zdroj Poland
- Faculty of Medicine University of Rzeszow Rzeszow Poland
- Pediatric and Allergology Department Specialist Hospital Jaslo Poland
| | - Pawel Majak
- Department of Internal Medicine, Asthma and Allergy Medical University of Lodz Lodz Poland
| | - Ryszard Kurzawa
- Department of Allergology National Research Institute of Tuberculosis and Lung Diseases Rabka‐Zdroj Poland
- Institute of Health Science, Podhale State College of Applied Sciences Nowy Targ Poland
| | - Piotr Kuna
- Department of Internal Medicine, Asthma and Allergy Medical University of Lodz Lodz Poland
| | - Joanna Jerzynska
- Department of Pediatrics and Allergy Medical University of Lodz Lodz Poland
- Copernicus Memorial Hospital Lodz Poland
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30
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Hachim MY, Hachim IY, Elemam NM, Hamoudi RA. Toxicogenomic analysis of publicly available transcriptomic data can predict food, drugs, and chemical-induced asthma. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:181-199. [PMID: 31692590 PMCID: PMC6717055 DOI: 10.2147/pgpm.s217535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/30/2019] [Indexed: 02/04/2023]
Abstract
Background : With the increasing incidence of asthma, more attention is focused on the diverse and complex nutritional and environmental triggers of asthma exacerbations. Currently, there are no established risk assessment tools to evaluate asthma triggering potentials of most of the nutritional and environmental triggers encountered by asthmatic patients. Purpose The objective of this study is to devise a reliable workflow, capable of estimating the toxicogenomic effect of such factors on key player genes in asthma pathogenesis. Methods Gene expression extracted from publicly available datasets of asthmatic bronchial epithelium were subjected to a comprehensive analysis of differential gene expression to identify significant genes involved in asthma development and progression. The identified genes were subjected to Gene Set Enrichment Analysis using a total of 31,826 gene sets related to chemical, toxins, and drugs to identify common agents that share similar asthma-related targets genes and signaling pathways. Results Our analysis identified 225 differentially expressed genes between severe asthmatic and healthy bronchial epithelium. Gene Set Enrichment Analysis of the identified genes showed that they are involved in response to toxic substances and organic cyclic compounds and are targeted by 41 specific diets, plants products, and plants related toxins (eg adenine, arachidonic acid, baicalein, caffeic acid, corilagin, curcumin, ellagic acid, luteolin, microcystin-RR, phytoestrogens, protoporphyrin IX, purpurogallin, rottlerin, and salazinic acid). Moreover, the identified chemicals share interesting inflammation-related pathways like NF-κB. Conclusion Our analysis was able to explain and predict the toxicity in terms of stimulating the differentially expressed genes between severe asthmatic and healthy epithelium. Such an approach can pave the way to generate a cost-effective and reliable source for asthma-specific toxigenic reports thus allowing the asthmatic patients, physicians, and medical researchers to be aware of the potential triggering factors with fatal consequences.
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Affiliation(s)
- Mahmood Yaseen Hachim
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Ibrahim Yaseen Hachim
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Noha M Elemam
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Rifat A Hamoudi
- Sharjah Institute for Medical Research, University of Sharjah, Sharjah 27272, United Arab Emirates.,Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, United Arab Emirates.,Division of Surgery and Interventional Science, University College London, London, UK
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Ziyab AH. Prevalence of food allergy among schoolchildren in Kuwait and its association with the coexistence and severity of asthma, rhinitis, and eczema: A cross-sectional study. World Allergy Organ J 2019; 12:100024. [PMID: 30976380 PMCID: PMC6441753 DOI: 10.1016/j.waojou.2019.100024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/25/2018] [Accepted: 03/11/2019] [Indexed: 11/09/2022] Open
Abstract
Background Food allergy (FA) is a common public health problem that affects both children and adults. Empirical knowledge of the burden of FA in Kuwait is limited. This study sought to estimate the prevalence of FA among schoolchildren in Kuwait and assess associations between FA and the coexistence and severity of asthma, rhinitis, and eczema. Methods Schoolchildren aged 11–14 years (n = 3,864) were enrolled in a cross-sectional study. Parents completed questionnaires regarding their children's early life exposures and clinical history of FA and allergic diseases. Study-defined FA was ascertained by a convincing clinical history. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated. Results The 12-month prevalence of study-defined FA was estimated to be 4.1% (154/3,738), with more girls being affected than boys (aPR = 1.44, 95% CI: 1.04–1.99). Egg (2.7%), fish (1.6%), shellfish (1.3%), peanut (1.3%), and tree nut (1.2%) were the most reported offending food allergens. Underweight and adiposity, cesarean section delivery, exposure to household dogs during infancy, and parental history of doctor-diagnosed FA were associated with an increased prevalence of study-defined FA. However, later birth order was associated with a reduced prevalence of study-defined FA. The prevalence of eczema only was higher in children with study-defined FA than in those without study-defined FA (aPR = 3.49, 95% CI: 2.37–5.14). In contrast, this association was not pronounced for children who had asthma only (aPR = 1.56, 95% CI: 0.94–2.57) or rhinitis only (aPR = 1.40, 95% CI: 0.86–2.28). Study-defined FA was associated with a 9.20-fold (95% CI: 4.50–18.78) higher prevalence of coexisting asthma, rhinitis, and eczema. Moreover, study-defined FA was associated with increased severity of symptoms of asthma, rhinitis, and eczema. Conclusions FA affects a considerable proportion of schoolchildren in Kuwait, and the most reported offending food allergens are similar to those reported in Western countries. Study-defined FA was associated with the coexistence and increased severity of asthma, rhinitis, and eczema, indicating that FA may link the comanifestations of allergic diseases and contribute to their chronicity and severity.
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Affiliation(s)
- Ali H Ziyab
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait
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32
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Pouessel G, Turner PJ, Worm M, Cardona V, Deschildre A, Beaudouin E, Renaudin JM, Demoly P, Tanno LK. Food-induced fatal anaphylaxis: From epidemiological data to general prevention strategies. Clin Exp Allergy 2018; 48:1584-1593. [PMID: 30288817 DOI: 10.1111/cea.13287] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Anaphylaxis hospitalizations are increasing in many countries, in particular for medication and food triggers in young children. Food-related anaphylaxis remains an uncommon cause of death, but a significant proportion of these are preventable. AIM To review published epidemiological data relating to food-induced anaphylaxis and potential risk factors of fatal and/or near-fatal anaphylaxis cases, in order to provide strategies to reduce the risk of severe adverse outcomes in food anaphylaxis. METHODS We identified 32 published studies available in MEDLINE (1966-2017), EMBASE (1980-2017), CINAHL (1982-2017), using known terms and synonyms suggested by librarians and allergy specialists. RESULTS Young adults with a history of asthma, previously known food allergy particularly to peanut/tree nuts are at higher risk of fatal anaphylaxis reactions. In some countries, cow's milk and seafood/fish are also becoming common triggers of fatal reactions. Delayed adrenaline injection is associated with fatal outcomes, but timely adrenaline alone may be insufficient. There is still a lack of evidence regarding the real impact of these risk factors and co-factors (medications and/or alcohol consumption, physical activities, and mast cell disorders). CONCLUSIONS General strategies should include optimization of the classification and coding for anaphylaxis (new ICD 11 anaphylaxis codes), dissemination of international recommendations on the treatment of anaphylaxis, improvement of the prevention in food and catering areas, and dissemination of specific policies for allergic children in schools. Implementation of these strategies will involve national and international support for ongoing local efforts in relationship with networks of centres of excellence to provide personalized management (which might include immunotherapy) for the most at-risk patients.
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Affiliation(s)
- Guillaume Pouessel
- Department of Pediatrics, Children's Hospital, Roubaix, France.,Pediatric Pulmonology and Allergy Department, Pôle enfant, Hôpital Jeanne de Flandre, CHRU de Lille and Université Nord de France, Lille, France.,Allergy Vigilance Network, Vandoeuvre les Nancy, France
| | - Paul J Turner
- Section of Paediatrics, Imperial College London, London, UK.,Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Margitta Worm
- Department of Dermatology and Allergology, Charite -Universitätsmedizin, Berlin, Berlin, Germany
| | - Victòria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Spanish Allergy Research Network ARADyal, Madrid, Spain
| | - Antoine Deschildre
- Pediatric Pulmonology and Allergy Department, Pôle enfant, Hôpital Jeanne de Flandre, CHRU de Lille and Université Nord de France, Lille, France.,Allergy Vigilance Network, Vandoeuvre les Nancy, France
| | - Etienne Beaudouin
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Allergology and Clinical Immunology Unit, CHR Metz-Thionville, Mercy Hospital, France
| | - Jean-Marie Renaudin
- Allergy Vigilance Network, Vandoeuvre les Nancy, France.,Pediatric Allergy Care Unit University Hospital, Vandoeuvre les Nancy, France
| | - Pascal Demoly
- University Hospital of Montpellier, Montpellier, France.,INSERM, IPLESP, Equipe EPAR, Sorbonne Université, Paris, France
| | - Luciana K Tanno
- University Hospital of Montpellier, Montpellier, France.,INSERM, IPLESP, Equipe EPAR, Sorbonne Université, Paris, France.,Hospital Sírio Libanês, São Paulo, Brazil
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Jimenez-Rodriguez TW, Garcia-Neuer M, Alenazy LA, Castells M. Anaphylaxis in the 21st century: phenotypes, endotypes, and biomarkers. J Asthma Allergy 2018; 11:121-142. [PMID: 29950872 PMCID: PMC6016596 DOI: 10.2147/jaa.s159411] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Anaphylaxis is the most serious of all allergic reactions and can be fatal. The diagnosis is frequently delayed, and misdiagnosis often occurs with asthma or urticaria. Biomarkers such as tryptase are not routinely checked, and appropriate treatment with epinephrine is not administered in a majority of cases, increasing the risk of poor outcomes. The objective of this review is to provide a better understanding of the pathophysiology of anaphylaxis with a description of phenotypes, endotypes, and biomarkers available in both the clinical and research settings. Expanding knowledge with regard to the presentation, causes, and triggers for anaphylaxis among health care providers will improve its diagnosis and management, increase patient safety, and decrease morbidity and mortality.
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Affiliation(s)
- Teodorikez Wilfox Jimenez-Rodriguez
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Allergy Section, Alicante General University Hospital, Alicante, Spain
- PhD Program in Public Health, Medical and Surgical Sciences, Miguel Hernandez University, Alicante, Spain
| | - Marlene Garcia-Neuer
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Leila A Alenazy
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mariana Castells
- Division of Rheumatology, Immunology and Allergy, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Application of precision medicine to the treatment of anaphylaxis. Curr Opin Allergy Clin Immunol 2018; 18:190-197. [DOI: 10.1097/aci.0000000000000435] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Food Allergy Is an Important Risk Factor for Childhood Asthma, Irrespective of Whether It Resolves. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:1336-1341.e3. [PMID: 29153880 DOI: 10.1016/j.jaip.2017.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/04/2017] [Accepted: 10/10/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND The risk of developing asthma in those with early food allergy is unknown, particularly when early life food allergy has resolved. OBJECTIVE To understand whether challenge-proven food allergy in infancy increases the risk of asthma at age 4 years, using data from a population-based cohort. METHODS A total of 5,276 12-month-old infants were recruited using a population-based sampling frame. Infants underwent skin prick test to egg, peanut, and sesame and those with a detectable skin prick test result had oral food challenges. At age 4 years, food challenges were repeated to determine persistence or resolution of food allergy. The association between food allergy and doctor-diagnosed asthma was examined using binomial regression in 2,789 participants. RESULTS Children with food allergy at age 1 year had an increased risk of asthma (1 food allergy: relative risk [RR], 1.69; 95% CI, 1.29-2.21; 2 or more food allergies: RR, 2.76; 95% CI, 1.94-3.92). The risk of asthma was highest in children with food allergy and coexistent eczema in infancy (RR, 2.87; 95% CI, 2.22-3.70). Transient food allergy and persistent food allergy were both associated with an increased risk of asthma (transient egg allergy: RR, 1.92; 95% CI, 1.46-2.51; persistent egg allergy: RR, 2.60; 95% CI, 1.76-3.85). CONCLUSIONS Asthma at age 4 years is twice as common in those with challenge-proven food allergy at age 1 year, irrespective of whether the food allergy subsequently resolves. Children with 2 or more food allergies and those with coexistent eczema were almost 3 times as likely to develop asthma compared with those with no food allergies.
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