1
|
Mendenhall E, Hogan MB, Nudelman M, Preston DL, Weese H, Muckleroy G, Needens J, Addicott K, Haas JD, Roybal A, Miller D, Cottrell J, Massey C, Govindaswami B. Examination of cord blood at birth in women with SARS-CoV-2 exposure and/or vaccination during pregnancy and relationship to fetal complete blood count, cortisol, ferritin, vitamin D, and CRP. Front Pediatr 2023; 11:1092561. [PMID: 37009290 PMCID: PMC10060546 DOI: 10.3389/fped.2023.1092561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/27/2023] [Indexed: 04/04/2023] Open
Abstract
Background SARS-CoV-2 is known to manifest a robust innate immune response. However, little is known about inflammatory influences from maternal SARS-CoV-2 infection or maternal mRNA vaccination upon the fetus. In addition, it is unknown if Vitamin D deficiency influences fetal homeostasis or if an anti-inflammatory mechanism to the development of possible innate cytokines or acute phase reactants by the maternal/fetal dyad, in the form of cortisol elevations, occur. In addition, effects on Complete Blood Count (CBC) are not known. Objective To evaluate the neonatal acute phase reactants and anti-inflammatory responses after maternal SARS-CoV-2 disease or mRNA vaccination. Methods Samples and medical records reviews from mother/baby dyads (n = 97) were collected consecutively, and were categorized into 4 groups; no SARS-CoV-2 or vaccination exposure (Control), Vaccinated mothers, maternal SARS-CoV-2 disease positive/IgG titer positive fetal blood, and maternal SARS-CoV-2 positive/IgG titer negative fetal blood. SARS-CoV-2 IgG/IgM/IgA titers, CBC, CRP, ferritin, cortisol, and Vitamin D were obtained to examine the possible development of an innate immune response and possible anti-inflammatory response. Student's t-test, Wilcoxon rank-sum, and Chi-squared with Bonferroni corrections were used to compare groups. Multiple imputations were performed for missing data. Results Cortisol was higher in babies of both mothers who were vaccinated (p = 0.001) and SARS-CoV-2 positive/IgG positive (p = 0.009) as compared to the control group suggesting an attempt to maintain homeostasis in these groups. Measurements of ferritin, CRP, and vitamin D did not reach statistical significance. CBC showed no variation, except for the mean platelet volume (MPV), which was elevated in babies whose mothers were vaccinated (p = 0.003) and SARS-CoV-2 positive/IgG positive (p = 0.007) as compared to the control group. Conclusion Acute phase reactant elevations were not noted in our neonates. Vitamin D levels were unchanged from homeostatic levels. Cord blood at birth, showed Cortisol and MPV higher in vaccinated and SARS-CoV-2 IgG positive mother/baby dyads as compared to the Control group, indicating that possible anti-inflammatory response was generated. The implication of possible inflammatory events and subsequent cortisol and/or MPV elevation effects upon the fetus after SARS-CoV-2 disease or vaccination is unknown and merits further investigation.
Collapse
Affiliation(s)
- Eric Mendenhall
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
- Correspondence: Eric Mendenhall
| | - Mary Beth Hogan
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Matthew Nudelman
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Deborah L. Preston
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Hayley Weese
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Garrett Muckleroy
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Jordan Needens
- Department of Obstetrics and Gynecology, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Katherine Addicott
- Department of Obstetrics and Gynecology, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Jessica Dailey Haas
- Department of Neonatology, Hoops Family Children’s Hospital at Cabell Huntington Hospital, Huntington, WV, United States
| | - Ashlee Roybal
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Dustin Miller
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Jesse Cottrell
- Department of Obstetrics and Gynecology, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
| | - Cynthia Massey
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
- Department of Neonatology, Hoops Family Children’s Hospital at Cabell Huntington Hospital, Huntington, WV, United States
| | - Balaji Govindaswami
- Department of Pediatrics, Marshall University, Joan C Edwards School of Medicine, Huntington, WV, United States
- Department of Neonatology, Hoops Family Children’s Hospital at Cabell Huntington Hospital, Huntington, WV, United States
| |
Collapse
|
2
|
Hogan MB, Zhao W. High SABA Using and Poor Asthma Control: Blaming Poor Adherence or Missing the Phenotype? The Journal of Allergy and Clinical Immunology: In Practice 2022; 10:2084-2085. [PMID: 35961733 DOI: 10.1016/j.jaip.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
|
3
|
Shepherd MW, Hogan MB, Hayes R, Flesher S, Gillette C. Spacer microbial contamination and asthma outcomes: case series. J Asthma 2021; 59:755-756. [PMID: 33380230 DOI: 10.1080/02770903.2020.1870128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The primary method of drug delivery to treat asthma is through pressurized metered dose inhalers (pMDI). Asthma guidelines recommend that providers prescribe a spacer for all patients using pMDI. The objective of this study was to examine whether microbial contamination of spacer devices is associated with poor asthma outcomes. METHODS This was a cross-sectional, single-center case series of seven pediatric patients with persistent asthma who had previously been prescribed a spacer. Spacers were swabbed with sterile cotton and samples assessed for bacterial/fungal growth. Parents completed a questionnaire including Asthma Control Test (ACT) and asthma control was assessed by an Allergist/Immunologist physician. RESULTS Two (n = 2) children's parent-completed ACT score indicated poorly controlled asthma and three (n = 3) patients were noted to be poorly controlled by the physician. All but one caregiver reported cleaning the spacer with most reporting (n = 5) that they cleaned their child's spacer monthly and one (n = 1) reporting cleaning it every two weeks. One spacer had detected Candida albicans. There was not a statistically significant association between ACT score and microbial growth (p > 0.05). CONCLUSION Most spacers in a pediatric sample were not contaminated, despite lack of consistent cleaning, as recommended by spacer manufacturers. Providers and pharmacists should discuss proper cleaning of spacers with caregivers of pediatric patients.
Collapse
Affiliation(s)
- Meagan W Shepherd
- Department of Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Mary Beth Hogan
- Department of Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Rebecca Hayes
- Department of Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Susan Flesher
- Department of Pediatrics, Marshall University Joan C. Edwards School of Medicine, Huntington, WV, USA
| | - Chris Gillette
- Wake Forest School of Medicine, Physician Assistant Studies, Winston-Salem, NC, USA
| |
Collapse
|
4
|
Israel E, Hogan MB. Personalizing Precision Medicine. J Allergy Clin Immunol Pract 2021; 8:1614-1615. [PMID: 32389277 DOI: 10.1016/j.jaip.2020.01.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Elliot Israel
- Harvard Medical School, Pulmonary and Critical Care and Allergy & Immunology Divisions, Brigham & Women's Hospital, Boston, Mass
| | - Mary Beth Hogan
- Department of Pediatrics, Joan C. Edwards School of Medicine, Marshall University, Huntington, WVa.
| |
Collapse
|
5
|
Johnson H, Anderson J, Moonie S, Gutierrez K, Hogan MB. Factors and cost associated with atopic dermatitis in Nevada. Postgrad Med 2020; 132:629-635. [DOI: 10.1080/00325481.2020.1764263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hadley Johnson
- School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Julia Anderson
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Sheniz Moonie
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Karen Gutierrez
- School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Mary Beth Hogan
- Joan C. Edwards School of Medicine, Department of Pediatrics, Marshall University, Huntington, WV, USA
| |
Collapse
|
6
|
Oliver ET, Hogan MB. Eliminating Low-Value Medical Care in Chronic Spontaneous Urticaria. J Allergy Clin Immunol Pract 2020; 8:2370-2371. [PMID: 32620436 DOI: 10.1016/j.jaip.2020.04.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Eric T Oliver
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
| | - Mary Beth Hogan
- Section of Allergy/Immunology, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
| |
Collapse
|
7
|
Hogan RB, Hogan MB. After a Decade of Marketing Gastroenterology Practices, Has Anything Changed? Clin Gastroenterol Hepatol 2020; 18:1658-1662. [PMID: 32217153 DOI: 10.1016/j.cgh.2020.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - Mary Beth Hogan
- Healthcare Administration, University College, Fayetteville State University, Fayetteville, North Carolina
| |
Collapse
|
8
|
Anderson J, Moonie S, Hogan MB, Scherr R, Allenback G. Eosinophilic esophagitis: comorbidities and atopic disease in Nevada. Dis Esophagus 2020; 33:5734965. [PMID: 32052023 DOI: 10.1093/dote/doz105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/30/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022]
Abstract
Eosinophilic esophagitis (EoE) is a rare, immune-mediated illness. We aimed to examine the comorbidities and sensitization patterns associated with an EoE diagnosis in Nevada. The study goal was two-fold: to determine the most common EoE comorbidities and sequela in the state of Nevada using healthcare utilization records across all settings and to determine the most common food and aeroallergens in histologically positive EoE pediatric patients using clinical sensitization data. Esophageal obstruction/stricture was the most frequently reported diagnosis in adults with EoE (29.5%). Among pediatrics, the highest ranking comorbidities included asthma (13.4%); diseases of the stomach, duodenum, and intestine (7.26%); allergies (7.01%); and gastroesophageal reflux disease (GERD) (3.69%). Additionally, the top sensitizations reported in histologically positive EoE patients were largely pollen related (82.9%). Atopic disease and specifically food allergens are commonly reported as comorbid conditions with EoE in the literature. However, our clinical pediatric data set from this study revealed that aeroallergen sensitizations far exceeded that of food allergens (82.9% aero-positive vs. 17.1% dood positive). The high presence of esophageal stricture/obstruction in adults could be indicative of late diagnosis; in addition, the aeroallergen sensitization in children could suggest different clinical management techniques necessary may be needed for this disease. Education among healthcare providers regarding the presence of aeroallergen sensitization in this population may result in earlier diagnoses and help reduce morbidity and the cost from this disease.
Collapse
Affiliation(s)
- Julia Anderson
- School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Sheniz Moonie
- School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Mary Beth Hogan
- Department of Pediatrics, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Rebecca Scherr
- School of Medicine, University of Nevada, Las Vegas, NV, USA
| | - Gayle Allenback
- School of Medicine, University of Nevada, Las Vegas, NV, USA
| |
Collapse
|
9
|
Anderson J, Moonie S, Hogan MB, Scherr R, Labus B, Word J. Cost of chronic inflammatory disease: The impact of eosinophilic esophagitis in Nevada. J Dig Dis 2020; 21:12-19. [PMID: 31755642 DOI: 10.1111/1751-2980.12832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/17/2019] [Accepted: 11/18/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The cost of treating the rare eosinophilic esophagitis (EoE) disease and its impact on patients' quality of life have not been well documented in the literature. This study seeks to fill this gap by comparing the cost of EoE with other well-known inflammatory diseases, including Crohn's disease (CD) and celiac disease (CeD). METHODS A Mann-Whitney U test and multiple logistic regression were used to examine the cost of EoE in the state of Nevada across all hospital settings and its impact on quality of life compared with CD and CeD. RESULTS Several factors were associated with the overall cost of EoE in Nevada, including patients' age, sex and region (P < 0.001). EoE was significantly more expensive to treat in the pediatric group ($4001 EoE; $985 CD; $856 CeD), among men ($2532 EoE; $1500 CD; $1724 CeD), among those residing in the southern region of Nevada ($4501 EoE; $2538 CD; $1888 CeD), and among patients seeking medical care from outpatient clinics ($3298 EoE; $741 CD; $1686 CeD) (P < 0.001). Age, sex, region and hospital setting were all associated with having a positive EoE record compared with CeD or CD (P < 0.001). CONCLUSIONS Data from this study indicate that the EoE burden is significantly higher in cost for certain demographics and regions compared with CD and CeD in the state of Nevada, specifically among pediatric and male patients. These differences suggest that clinicians may encounter similar issues when treating EoE.
Collapse
Affiliation(s)
- Julia Anderson
- School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Sheniz Moonie
- School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Mary Beth Hogan
- Department of Pediatrics, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, USA
| | - Rebecca Scherr
- School of Medicine, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Brian Labus
- School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Jessica Word
- Department of Urban Affairs, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| |
Collapse
|
10
|
Anderson J, Moonie S, Hogan MB, Labus B. A description of eosinophilic esophagitis in the Southwestern state of Nevada. Postgrad Med 2019; 132:251-255. [PMID: 31674262 DOI: 10.1080/00325481.2019.1687192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Eosinophilic esophagitis (EoE) is a rare immune-mediated esophageal disorder that has been documented worldwide. Prior to this study, eosinophilic esophagitis had not been described in the Southwestern state of Nevada. Records containing positive eosinophilic esophagitis diagnosis codes were extracted from a large hospital utilization database and yielded over 2,000 records over 5 years (2013-2017). METHODS Descriptive statistics were used to identify the overall population demography. Logistic regression was used to determine the factors associated with an eosinophilic esophagitis event in Nevada. RESULTS Males were 2.93 times more likely (95% CI: 2.53, 3.41; p < 0.001) to have had an eosinophilic esophagitis event when compared to females. Older age was also significant; for each additional year in age the odds of having an eosinophilic esophagitis visit increased by 30% (95% CI: 1.28, 1.31; p < 0.001). Finally, individuals living in the Northern region had 1.95 higher odds of an eosinophilic esophagitis event than their Southern counterparts (OR = 1.95, 95% CI: 1.68, 2.26; p < 0.001). CONCLUSIONS The climate in Nevada makes this study novel, as the climate is unlike other studies reporting EoE disease prevalence. Previous atopic studies in Nevada report that warmer, drier weather leads to increased atopic illness and perennial pollen, which ultimately may be contributing to the higher than expected number of EoE records identified. Given the well-documented relationship between EoE and atopy, Nevada may be a susceptible region for this condition and an ideal location for future studies.
Collapse
Affiliation(s)
- Julia Anderson
- School of Public Health, University of Nevada , Las Vegas, NV, USA
| | - Sheniz Moonie
- School of Public Health, University of Nevada , Las Vegas, NV, USA
| | - Mary Beth Hogan
- Department of Pediatrics, Joan C. Edwards School of Medicine, Marshall University , Huntington, WV, USA
| | - Brian Labus
- School of Public Health, University of Nevada , Las Vegas, NV, USA
| |
Collapse
|
11
|
Moonie S, Hogan MB. Challenges for the Clinician: Physical Activity Among Severe Asthmatic Patients with Comorbid Obesity. J Allergy Clin Immunol Pract 2019; 6:823-824. [PMID: 29747985 DOI: 10.1016/j.jaip.2017.11.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 12/20/2022]
|
12
|
Jarjour NN, Hogan MB. A Systematic Approach to Evaluating Difficult to Control Asthma: A Little Goes a Long Way. J Allergy Clin Immunol Pract 2019; 5:965-966. [PMID: 28689845 DOI: 10.1016/j.jaip.2017.03.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 03/01/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Nizar N Jarjour
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
| | - Mary Beth Hogan
- Department of Pediatrics University of Nevada, Las Vegas School of Medicine, Las Vegas, Nev
| |
Collapse
|
13
|
Pangonis S, Dugan M, Beth Hogan M, Patrizi S. Cryptococcal Meningoencephalitis Complicated by Subdural Empyema in an 8-Year-Old Girl With Neonatal-Onset Multisystem Inflammatory Disease Syndrome: A Rare Sequela. J Pediatric Infect Dis Soc 2018; 7:e47-e51. [PMID: 28992083 DOI: 10.1093/jpids/pix069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/01/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Scott Pangonis
- Department of Pediatrics, University of Nevada, Las Vegas School of Medicine
| | - Mark Dugan
- Department of Pediatric Critical Care, University Medical Center of Southern Nevada, Children's Hospital of Nevada, Las Vegas
| | - Mary Beth Hogan
- Department of Pediatric Allergy/Immunology, University of Las Vegas, Las Vegas
| | - Sara Patrizi
- Touro University Osteopathic College of Medicine, Henderson, Nevada
| |
Collapse
|
14
|
Lucas JA, Moonie S, Hogan MB, Evans WN. Efficacy of an exercise intervention among children with comorbid asthma and obesity. Public Health 2018; 159:123-128. [PMID: 29571538 DOI: 10.1016/j.puhe.2018.02.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 02/12/2018] [Accepted: 02/14/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Children with comorbid asthma and obesity present with more severe and harder-to-control disease than asthmatic children at healthy weight. Weight loss has been shown to improve asthma symptoms, yet physical activity may be difficult due to exercise-induced bronchospasm. Children with asthma have lower exercise rates than non-asthmatics. The objective of this study was to retrospectively evaluate attrition rates and program outcome measures (Body Mass Index [BMI] and maximum oxygen consumption [VO2max]) among asthmatic and non-asthmatic participants. STUDY DESIGN Clinical data were collected from the Healthy Hearts Program, a 12-week nutrition and activity intervention program for children who are overweight, obese, or at risk for heart disease and other conditions, and used for the study. METHODS Intervention data and demographics were obtained from medical records at the Children's Heart Center Nevada. Descriptive statistics, paired t-tests, Cox regression analysis, and analysis of covariance were conducted. RESULTS The mean age of this population (N = 232) was 11 years; 54% were male, 64% were Hispanic, and 37% had asthma. Median time in the program was 9 weeks, and 58% of the population completed the program. Unadjusted analyses showed significant BMI decreases in asthmatic (P = 0.002) and non-asthmatic (P = 0.001) participants and increases in cardiorespiratory function for asthmatic males and females (P = 0.003, P = 0.004) and non-asthmatic males and females (P < 0.001 for both). Asthmatic and non-asthmatic children both had improved exercise intensity (P = 0.033, P < 0.001). CONCLUSIONS This program is both beneficial and practical for obese children with asthma for losing weight and improving cardiorespiratory function.
Collapse
Affiliation(s)
- J A Lucas
- School of Community Health Sciences, University of Nevada, Las Vegas, 4505 Maryland Parkway Box 453064, Las Vegas, NV 89154-3064, USA.
| | - S Moonie
- School of Community Health Sciences, University of Nevada, Las Vegas, 4505 Maryland Parkway Box 453064, Las Vegas, NV 89154-3064, USA.
| | - M B Hogan
- University of Nevada School of Medicine, Department of Pediatrics, 1524 Pinto Lane, 3rd Floor, Las Vegas, NV 89106, USA.
| | - W N Evans
- Children's Heart Center Nevada, Department of Pediatric Cardiology, Sunrise Hospital and Medical Center, 3006 S. Maryland Parkway, Suite 690, Las Vegas, NV 89109, USA.
| |
Collapse
|
15
|
Duncan CL, Walker HA, Brabson L, Williford DN, Hynes L, Hogan MB. Developing pictorial asthma action plans to promote self-management and health in rural youth with asthma: A qualitative study. J Asthma 2017; 55:915-923. [PMID: 28933570 DOI: 10.1080/02770903.2017.1371743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Asthma action plans (AAPs) provide asthma management instructions to families; however, AAPs typically are written at a 7th-9th grade reading level, making them less useful in lower literacy families. There is a need to develop simpler AAP formats and content to optimize their utility across all families, including those who are rural and may be at a risk for literacy concerns. Because using pictures can simplify and enhance health education, our study's aim was to develop a pictorial AAP through a series of focus groups with key stakeholders - youth with asthma, caregivers, and physicians. METHODS Fourteen caregiver/youth dyads and four physicians participated in separate focus groups where their preferences for pictorial AAP structure and content were obtained. Focus groups were audio recorded, transcribed, coded with ATLAS.ti, and analyzed for themes. RESULTS Youth and their caregivers prefer that the AAPs include simple, cartoon-like pictures customized to the patient. Physicians emphasized AAP's capability to display pictures of controller medication given its importance in preventing asthma exacerbations. A stoplight format, currently used in most written AAPs, received positive reviews. Specific suggestions for pictures showing symptoms, medications, and how to take medication were suggested. Words and short phrases accompanying the pictures were thought to add clarity. CONCLUSIONS Key stakeholders viewed pictorial AAPs as positive and potentially effective alternatives to standard written AAPs. It is expected that low literacy youth and caregivers would more easily understand a pictorial AAP presentation, which should facilitate better medication adherence and asthma outcomes in these children.
Collapse
Affiliation(s)
- Christina L Duncan
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Heather A Walker
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Laurel Brabson
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Desireé N Williford
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Lisa Hynes
- a Department of Psychology , West Virginia University , Morgantown , WV , USA
| | - Mary Beth Hogan
- b University of Nevada-Las Vegas , Reno School of Medicine , Reno , NV , USA
| |
Collapse
|
16
|
Bhoopalan SV, Chawla V, Hogan MB, Wilson NW, Das SU. Bullous Skin Manifestations of Mycoplasma pneumoniae Infection: A Case Series. J Investig Med High Impact Case Rep 2017; 5:2324709617727759. [PMID: 28959692 PMCID: PMC5593211 DOI: 10.1177/2324709617727759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/26/2017] [Accepted: 07/16/2017] [Indexed: 12/02/2022] Open
Abstract
Bullous skin lesions are uncommon in children. While it is well known that Mycoplasma infections are associated with papular skin manifestations, bullous skin lesions are not commonly reported. Mycoplasma pneumoniae is a very common bacterial pathogen causing respiratory tract infection in children and adults. We report 2 children with serology-confirmed Mycoplasma infection who were hospitalized for blistering skin lesions. Both of our patients responded well to corticosteroids and one of them required intravenous immunoglobulin. The aim of this case report is to raise awareness that Mycoplasma pneumoniae infection can present with bullous skin lesions, and to briefly review the pathophysiology, diagnosis, and management of the skin manifestation of Mycoplasma infection.
Collapse
Affiliation(s)
| | - Vonita Chawla
- University of Nevada, Las Vegas Campus, Las Vegas, NV, USA
| | | | - Nevin W Wilson
- University of Nevada, Las Vegas Campus, Las Vegas, NV, USA
| | - Samrat U Das
- University of Nevada, Las Vegas Campus, Las Vegas, NV, USA
| |
Collapse
|
17
|
Lemons AR, Hogan MB, Gault RA, Holland K, Sobek E, Olsen-Wilson KA, Park Y, Park JH, Gu JK, Kashon ML, Green BJ. Microbial rRNA sequencing analysis of evaporative cooler indoor environments located in the Great Basin Desert region of the United States. Environ Sci Process Impacts 2017; 19:101-110. [PMID: 28091681 PMCID: PMC5450635 DOI: 10.1039/c6em00413j] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Recent studies conducted in the Great Basin Desert region of the United States have shown that skin test reactivity to fungal and dust mite allergens are increased in children with asthma or allergy living in homes with evaporative coolers (EC). The objective of this study was to determine if the increased humidity previously reported in EC homes leads to varying microbial populations compared to homes with air conditioners (AC). Children with physician-diagnosed allergic rhinitis living in EC or AC environments were recruited into the study. Air samples were collected from the child's bedroom for genomic DNA extraction and metagenomic analysis of bacteria and fungi using the Illumina MiSeq sequencing platform. The analysis of bacterial populations revealed no major differences between EC and AC sampling environments. The fungal populations observed in EC homes differed from AC homes. The most prevalent species discovered in AC environments belonged to the genera Cryptococcus (20%) and Aspergillus (20%). In contrast, the most common fungi identified in EC homes belonged to the order Pleosporales and included Alternaria alternata (32%) and Phoma spp. (22%). The variations in fungal populations provide preliminary evidence of the microbial burden children may be exposed to within EC environments in this region.
Collapse
Affiliation(s)
- Angela R Lemons
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road, Morgantown, WV 26505, USA.
| | - Mary Beth Hogan
- Department of Pediatrics, Pediatrics Center, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Ruth A Gault
- Department of Microbiology and Immunology, Center for Molecular Medicine, University of Nevada School of Medicine, Reno, NV, USA
| | - Kathleen Holland
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Kimberly A Olsen-Wilson
- Department of Pediatrics, Center for Molecular Medicine, University of Nevada School of Medicine, Reno, NV, USA
| | - Yeonmi Park
- Field Studies Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Ju-Hyeong Park
- Field Studies Branch, Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Ja Kook Gu
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Michael L Kashon
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Brett J Green
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Road, Morgantown, WV 26505, USA.
| |
Collapse
|
18
|
Abstract
OBJECTIVE The majority of pediatric asthma is atopic, but whether pediatric obese asthma is atopic is indeterminate in the literature. In Nevada, children become sensitized to aeroallergens, a risk factor for asthma, at young ages. Additionally, Nevada children have high rates of obesity. Our objective is to determine whether elevated body mass index (BMI) is associated with asthma severity, allergen sensitization, and polysensitization. METHODS Medical records from a pediatric allergy clinic provided BMI percentile, physician-diagnosed asthma severity, skin prick test data, and sociodemographics such as age, race, sex, and insurance status from asthmatic patients. Descriptive statistics and binary and multinomial logistic regression were conducted. RESULTS In this population (N = 125) aged 1-16, 61% were male, 65% were white, and 74% had private health insurance. Sixty-five percent of children were under/healthy weight and 29% were overweight/obese. Asthma symptoms were moderate in 66% of the population, and severe in 18%. Nearly 85% of this population was atopic, and 82% were polysensitized. Sensitization and polysensitization occurred in all weight categories. Asthma severity and elevated BMI were not associated significantly. Overweight/obese children (≥85th percentile) had lower odds of allergen sensitization (adjusted odds ratio 0.26, 95% CI = 0.85-0.78, p = 0.016) and polysensitization (adjusted odds ratio 0.30, 95% CI = 0.11-0.85, p = 0.023) than healthy weight children (<85th percentile). CONCLUSION Although overweight children did show allergen sensitization, those who were overweight had lower odds of allergen sensitization and lower odds of polysensitization, as compared to normal weight asthmatic children. Elevated BMI was not a significant predictor of asthma severity.
Collapse
Affiliation(s)
- Jennifer A Lucas
- a School of Community Health Sciences, University of Nevada , Las Vegas, Las Vegas , Nevada , USA
| | - Sheniz Moonie
- a School of Community Health Sciences, University of Nevada , Las Vegas, Las Vegas , Nevada , USA
| | - Kimberly Olsen-Wilson
- b University of Nevada School of Medicine , Department of Pediatrics , Las Vegas , Nevada , USA
| | - Mary Beth Hogan
- b University of Nevada School of Medicine , Department of Pediatrics , Las Vegas , Nevada , USA
| |
Collapse
|
19
|
Hogan MB, Allenback GL, Chawla V, Mehta N, Plunkett G, Wilson NW. Sensitization to a nonnative plant without exposure is a marker of panallergen sensitization. The Journal of Allergy and Clinical Immunology: In Practice 2016; 4:982-983.e1. [DOI: 10.1016/j.jaip.2016.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 02/24/2016] [Accepted: 02/29/2016] [Indexed: 11/28/2022]
|
20
|
Chawla V, Hogan MB, Moonie S, Fenwick GL, Hooft A, Wilson NW. Parental perception of efficacy of antihistamines for pruritus in pediatric atopic dermatitis. Allergy Asthma Proc 2016; 37:157-63. [PMID: 26932173 DOI: 10.2500/aap.2016.37.3927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Clinicians have previously prescribed antihistamines for relief of atopic dermatitis (AD) associated pruritus. The use of antihistamines in AD has recently received less emphasis from newly published practice parameters that currently only recommend short-term, intermittent use of first-generation antihistamines to induce sleep in patients with AD. OBJECTIVE Our study aimed to determine parents' perception of the usefulness of antihistamines in reducing their child's itch due to AD. METHODS A 12-question survey was mailed to parents of patients who were attending a pediatric allergy clinic. Patients with physician-diagnosed AD who had a clinic visit in the past 3 years were included. Questions included the following: time since AD diagnosis, itching frequency, impact on sleep, frequency and relief provided from using antihistamines, and comparison of antihistamines to other antipruritus treatments. RESULTS Sixty-three percent of parents surveyed responded that antihistamines were helpful in the management of their child's AD, and only 5% did not find any itch relief. The majority of the responders were parents of younger patients (ages, 2-10 years) with immunoglobulin E sensitization and AD for more than a year. Eighty-five parents (68.5%) reported no interruption of sleep due to itching, and, among them, an almost equal number were currently solely using either a first- or second-generation antihistamine. The more antihistamines were perceived as relieving itching, the more they were used (ρ = 0.209, p = 0.025) and provided more relief than other products (ρ = -0.336, p < 0.001). When compared, parents ranked antihistamines to be as helpful as topical corticosteroids. CONCLUSION Parents of pediatric patients with AD found that antihistamines were an important part of AD management.
Collapse
Affiliation(s)
- Vonita Chawla
- Section of Allergy and Immunology, Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | | | | | | | | | | |
Collapse
|
21
|
Hogan MB, Chawla V, Scherr R, Allenback G, Wonnaparhown A, Wilson NW. Aeroallergen, Food and Panallergen Sensitization Patterns in Eosinophilic Esophagitis Patients. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
22
|
Duncan CL, Hogan MB, Tien KJ, Graves MM, Chorney JM, Zettler MD, Koven L, Wilson NW, Dinakar C, Portnoy J. Efficacy of a parent-youth teamwork intervention to promote adherence in pediatric asthma. J Pediatr Psychol 2012; 38:617-28. [PMID: 23248342 DOI: 10.1093/jpepsy/jss123] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine whether a parent-youth teamwork intervention improved medication adherence and related outcomes among youth with asthma. METHODS We used a randomized clinical trial with 48 youth (aged 9-15 years) assigned to 1 of 3 groups: Teamwork Intervention (TI), Asthma Education (AE), or Standard Care (SC). Treatment occurred across 2 months, with a 3-month follow-up assessment. Adherence to inhaled corticosteroids was assessed via the MDILog-II. Parent-adolescent conflict, asthma functional severity, and spirometry assessments were obtained pre-treatment, post-treatment, and on follow-up. Mixed linear model analysis was used to evaluate group and time effects for outcome measures. RESULTS TI group had significantly higher adherence and lower functional severity scores than AE or SC conditions, and lower parent-reported conflict and a trend for higher spirometry values compared with the SC group. CONCLUSIONS Results suggest support for the efficacy of TI for improving medication adherence as youth acquire more responsibility for their asthma management.
Collapse
Affiliation(s)
- Christina L Duncan
- Department of Psychology, West Virginia University, Morgantown, WV 26506-6040, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Wilson NW, Hogan MB, Harper CB, Peele K, Budhecha S, Loffredo V, Wong V. Sinusitis and chronic cough in children. J Asthma Allergy 2012; 5:27-32. [PMID: 22923996 PMCID: PMC3422815 DOI: 10.2147/jaa.s31874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Indexed: 11/23/2022] Open
Abstract
Background: Chronic cough in children is a common problem, and sinusitis is a common etiology. The diagnosis of sinusitis is often clinical, but confirmation is thought to require a CT scan due to the difficulty of interpreting a Water’s view sinus X-ray. Objectives: The purposes of the study were (1) to examine the frequency of an abnormal sinus X-ray in children with a chronic cough of more than 4 weeks duration; (2) to compare the interpretation of the sinus film between allergy/pulmonary clinicians and radiologists; and (3) to correlate symptoms with X-ray results. Methods: A chart review of 2- to 18-year-old patients with coughing exceeding 4 weeks was performed. Data was collected for patients who had received a Water’s view sinus film as part of their evaluation. Exam, X-ray results, and clinical outcomes were categorized and statistical analyses performed. Results: A total of 86 patients were included. Clinicians found that 65% of the children had positive Water’s view films, compared with the radiologist’s reading of 62% (non significant). Significant associations between post-tussive emesis (P = 0.01) and purulence (P = 0.03) were noted with a positive film. Positive sinus X-ray was highly associated with all findings except wheeze when present together (P < 0.001). Conclusion: Sinus abnormalities on X-ray are associated with prolonged cough in 65% of children. The Water’s view sinus film is a clinically useful screening tool for clinicians in the workup of chronic cough. Certain physical findings and clinical complaints, when present concurrently, correlate with the X-ray results.
Collapse
Affiliation(s)
- Nevin W Wilson
- University of Nevada School of Medicine, Department of Pediatrics, Section of Allergy, Immunology and Pulmonology, Reno, NV, USA
| | | | | | | | | | | | | |
Collapse
|
24
|
Spaulding SA, Devine KA, Duncan CL, Wilson NW, Hogan MB. Electronic monitoring and feedback to improve adherence in pediatric asthma. J Pediatr Psychol 2011; 37:64-74. [PMID: 21852340 DOI: 10.1093/jpepsy/jsr059] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of electronic monitoring and feedback to improve adherence in children taking daily asthma controller medications. METHOD Five patients with asthma and considered nonadherent participated. Inhalers were electronically monitored with the MDILogII(TM) device, and feedback was given by medical staff. Using a nonconcurrent multiple-baseline design, patients and their parents received bimonthly feedback regarding medication use. Following treatment, feedback was withdrawn and effects of monitoring alone were observed. RESULTS Three participants showed improvements in adherence following treatment, with more notable increases when baseline adherence was low. Improvements in the inhaler technique occurred for all patients. Some patients demonstrated improvements in lung functioning and functional severity. When feedback was withdrawn, adherence decreased for some participants, but technique improvements maintained. CONCLUSIONS Results support the use of objective monitoring devices for assessing pediatric asthma patients' adherence and indicate that feedback from medical staff may improve and maintain medication adherence for some patients.
Collapse
Affiliation(s)
- Scott A Spaulding
- Department of Psychology, West Virginia University, Morgantown, WV 26506, USA
| | | | | | | | | |
Collapse
|
25
|
Prasad C, Hogan MB, Peele K, Wilson NW. Effect of evaporative coolers on skin test reactivity to dust mites and molds in a desert environment. Allergy Asthma Proc 2009; 30:624-7. [PMID: 20031008 DOI: 10.2500/aap.2009.30.3290] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Dust mites and molds are usually not found in arid environments and have a lower prevalence in desert areas. Evaporative (swamp) coolers increase indoor humidity significantly. The purpose of this study is to determine whether evaporative coolers affect the skin test rate to dust mites and molds in patients. Patients with asthma or allergic rhinitis who were undergoing skin testing for molds, indoor allergens, grasses, weeds, and trees were asked about presence of central, window, and evaporative cooler air conditioning in their home. All were tested using the prick technique with controls. One hundred ninety patients between 1 and 42 years (mean, 5.4 years) were evaluated. Fifty-nine (31%) had an evaporative cooler in their home. Twenty-five (42%) of those with evaporative coolers had a positive skin test to at least one mold compared with 26 (19%) without coolers (chi-square, 10.5; p = 0.001). Twenty (34%) of those with evaporative coolers had a positive skin test to dust mites compared with 23 (17.5%) without coolers (chi-square, 6.2; p = 0.013). Children < or = 6 years of age had the greatest skin test prevalence (chi-square, 4.3; p = 0.03). In the desert, children in homes using evaporative coolers are significantly more likely to have positive skin tests to molds or mites. This appears to be because of humidity caused by these devices. Patients with asthma in homes with evaporative coolers should be counseled about the risk for mold and dust-mite allergy. Humidity monitoring, cooler maintenance, and filter changes should be discussed.
Collapse
Affiliation(s)
- Chaithra Prasad
- Department of Pediatrics, Section of Allergy, Immunology, and Pulmonology, University of Nevada School of Medicine, Reno, Nevada, USA
| | | | | | | |
Collapse
|
26
|
Hogan MB, Piktel D, Hubbs AF, McPherson LE, Landreth KS. Asthma progression to airway remodeling and bone marrow eosinophil responses in genetically distinct strains of mice. Ann Allergy Asthma Immunol 2009; 101:619-25. [PMID: 19119706 DOI: 10.1016/s1081-1206(10)60225-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient factors that cause long-term airway remodeling are largely unidentified. This suggests that genetic differences may determine which asthmatic patients develop airway remodeling. A murine model with repeated allergen exposure leading to peribronchial fibrosis in complement factor 5 (C5)-deficient A/J mice has been used to study asthma progression. No studies have addressed the systemic effects of allergen sensitization or chronic allergen exposure on bone marrow eosinophilopoiesis in this mouse strain. OBJECTIVE To investigate bone marrow eosinophil responses during acute sensitization and chronic allergen exposure using genetically distinct mouse strains differing in persistent airway reactivity and remodeling. METHODS The C5-sufficient BALB/c and C5-deficient A/J mice were repetitively exposed to intranasal ovalbumin for 12 weeks. Subsequently, the mice were evaluated for airway eosinophilia, mucus-containing goblet cells, and peribronchial fibrosis. Both strains of mice were also acutely sensitized to ovalbumin. Bone marrow eosinophil progenitor cells and mature eosinophils were enumerated. RESULTS BALB/c and A/J mice have similar bone marrow responses after acute allergen exposure, with elevations in bone marrow eosinophil progenitor cell and eosinophil numbers. After chronic allergen exposure, only C5-deficient A/J mice that developed peribronchial fibrosis exhibited bone marrow eosinophilia. BALB/c mice lacked peribronchial fibrosis and extinguished accelerated eosinophil production after long-term allergen challenge. CONCLUSIONS Chronic airway remodeling after repeated allergen exposure in genetically different mice correlated with differences in long-term bone marrow eosinophilopoiesis. Preventing asthma from progressing to chronic airway remodeling with fibrosis may involve identifying genetically determined influences on bone marrow responses to chronic allergen exposure.
Collapse
Affiliation(s)
- Mary Beth Hogan
- Department of Pediatrics, University of Nevada School of Medicine, Reno, Nevada 89503, USA.
| | | | | | | | | |
Collapse
|
27
|
Abstract
Otitis media is one of the most common childhood infections and may result from a variety of underlying problems. Suspicion of immunodeficiency should increase when ear infections are frequent; suppurative; unresponsive to antibiotics; caused by unusual organisms; or seen in the context of other frequent infections, severe eczema, or failure to thrive. Humoral immune deficiencies, particularly with an inability to make antibody to encapsulated organisms, are the immunodeficiencies most likely to cause increased otitis media. Immune system evaluation should concentrate on humoral immunodeficiency disorders, but the presenting history and physical findings also should be considered when designing the work-up. Treating the underlying immune deficiency is usually necessary to adequately control the ear infections.
Collapse
Affiliation(s)
- Nevin W Wilson
- Department of Pediatrics, Section of Allergy, Immunology, and Pulmonology, University of Nevada School of Medicine, 343 Elm Street, Suite 201, Reno, NV 89503, USA.
| | | |
Collapse
|
28
|
Piazza-Waggoner C, Adams CD, Muchant D, Wilson NW, Hogan MB. Coping and Adjustment in Children With Primary Immunodeficiency Disorders and Kidney Diseases: The Role of Illness Severity. Children's Health Care 2008. [DOI: 10.1080/02739610802151555] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
29
|
Beezhold DH, Green BJ, Blachere FM, Schmechel D, Weissman DN, Velickoff D, Hogan MB, Wilson NW. Prevalence of allergic sensitization to indoor fungi in West Virginia. Allergy Asthma Proc 2008; 29:29-34. [PMID: 18302835 DOI: 10.2500/aap2008.29.3076] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Exposure to indoor fungi is of growing concern in residential and occupational environments in the United States. The purpose of this study was to determine the prevalence of sensitization to common indoor fungal species in an atopic population. We evaluated 102 patients (73 female and 29 male patients) for immunoglobulin E (IgE) reactivity to a panel of skin-prick test (SPT) reagents used for routine allergy testing. Patients also were tested for six additional fungi that are common indoor contaminants. All patients had symptoms consistent with allergic rhinitis or asthma. The presence of specific IgE against the fungal species was determined using immunoblotting. Of the 102 eligible patients, 68% had at least one positive skin test. The most prevalent positive SPTs were to dust mites, cats, vernal grass, and short ragweed. Overall, 21/102 (21%) patients with asthma or allergic rhinitis were skin test positive to at least one fungal extract. Of the patients with a positive SPT to fungi, 12/21 (58%) showed sensitivity to one or more of the newly tested species; most notably Trichoderma viride (8%), Chaetomium globosum (7%), Paecilomyces variotii (7%), and Acremonium strictum (6%). Immunoblotting revealed specific IgE against a number of protein bands belonging to these fungal species. The prevalence of fungal sensitization was common, particularly for indoor fungal contaminants that are not routinely included in SPT panels. Cross-reactivity with other fungi may partially explain our results; however, skin testing for these indoor fungi may provide useful diagnostic information.
Collapse
Affiliation(s)
- Donald H. Beezhold
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Brett J. Green
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Francoise M. Blachere
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Detlef Schmechel
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - David N. Weissman
- Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Deborah Velickoff
- Department of Pediatrics, Allergy and Immunology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Mary Beth Hogan
- Department of Pediatrics, Allergy and Immunology, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Nevin W. Wilson
- Department of Pediatrics, Allergy and Immunology, West Virginia University School of Medicine, Morgantown, West Virginia
| |
Collapse
|
30
|
Abstract
It is commonly believed that young children are incapable of pollen sensitization; therefore, skin testing usually is not performed to these allergens. The purpose of this study was to identify the frequency of positive skin tests to outdoor allergens among younger children who have asthma. Patients who have asthma, aged 6 months to 10 years, were evaluated for pollen sensitization over a 10-year period. Skin-prick testing was performed to relevant individual aeroallergens including trees, grasses, and weeds. Testing for perennial indoor allergens such as dust mites, cats, dogs, cockroaches, and molds was performed also. A total of 687 children with asthma were evaluated. No child <12 months old was sensitized to pollens. Children between 12 and 24 months of age had a 29% incidence of pollen sensitization. Three-year-old children were as likely to be skin test positive to pollen as an indoor allergen. Notably, 49% of 3- and 4-year olds were sensitized to outdoor allergens. Primary sensitizing pollens in this age group were short ragweed, box elder, and June grass. In this population, pollen sensitization was not related to tobacco or wood smoke exposure. Although it is widely believed that young children with asthma are most commonly allergic to indoor allergens, almost 40% of our 1- to 3-year old children with asthma showed IgE-mediated sensitivity to outdoor allergens. Pediatric allergists should consider performing skin-prick testing to their local common aeroallergens in young children with asthma and seasonal symptoms.
Collapse
Affiliation(s)
- Paul R. Ogershok
- Section of Allergy and Immunology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Daniel J. Warner
- Section of Allergy and Immunology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Mary Beth Hogan
- Section of Allergy and Immunology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Nevin W. Wilson
- Section of Allergy and Immunology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia
| |
Collapse
|
31
|
Abstract
BACKGROUND Common variable immunodeficiency (CVID) may present at any age but usually presents during adulthood. OBJECTIVE To study the presentation and associated medical conditions found in pediatric patients with CVID. METHODS A medical record review of patients diagnosed as having CVID before the age of 18 years was performed at a tertiary care immunology clinic from 1992 to 2005. Inclusion criteria consisted of presentation with recurrent infections and decrease in 2 of 3 immunoglobulin isotypes (IgG, IgA, IgM) 2 SDs below the age-specific range, with a poor or absent response to immunization. There had to be no other identifiable predisposing cause of the immunodeficiency. RESULTS A total of 12 patients were identified. The mean age at presentation was 8 years. All patients had low IgG levels with poor functional antibody responses. The most common presenting infections were sinusitis (75%), otitis media (67%), and pneumonia (58%). Bronchiectasis was seen in 3 children. One patient presented with chronic diarrhea due to Giardia. Two patients presented with failure to thrive. Asthma was seen in 10 patients (83%) but was usually diagnosed after the initial presentation. Autoimmune disorders were seen, including 1 patient with idiopathic thrombocytopenia and 2 with neutropenia. Other disorders encountered were growth hormone deficiency, hypothyroidism, end-stage renal disease, and sarcoma. CONCLUSIONS CVID is a difficult diagnosis in the pediatric population because of an unpredictable presentation. Autoimmune disease, growth hormone deficiency, renal disease, and cancer were noted in our population. A high incidence of asthma also may be associated with pediatric CVID.
Collapse
Affiliation(s)
- Paul R Ogershok
- Section of Allergy and Immunology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia 26506-9214, USA
| | | | | | | | | |
Collapse
|
32
|
Piazza-Waggoner C, Adams CD, Muchant D, Wilson N, Hogan MB. Children With Primary Immunodeficiency Disorders: Family Functioning, Coping Strategies, and Behavioral Functioning. Children's Health Care 2006. [DOI: 10.1207/s15326888chc3503_1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
33
|
Piazza-Waggoner C, Adams CD, Cottrell L, Taylor BK, Wilson NW, Hogan MB. Child and caregiver psychosocial functioning in pediatric immunodeficiency disorders. Ann Allergy Asthma Immunol 2006; 96:298-303. [PMID: 16498851 DOI: 10.1016/s1081-1206(10)61239-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children with chronic illness have been found to be at an increased risk of behavioral and emotional difficulties. To date, children with pediatric immunodeficiency disorders (PIDDs) and their families have not been the focus of extensive published psychosocial research. OBJECTIVE To determine if children with PIDDs and their caregivers have altered psychosocial function and whether the severity of the PIDD was associated with such difficulties. METHODS Twenty children with PIDDs and 20 children with asthma were recruited for this study. Children and their caregivers completed various psychosocial questionnaire forms. Responses were compared with normative data for the appropriate measure and with other variables. RESULTS Higher frequencies of children with PIDDs were found to have a number of elevated psychosocial concerns when contrasted with normative data, particularly from parent report. These concerns included depression, anxiety, somatization, social withdrawal, and social skills. The severity of the PIDDs was significantly associated with a number of behavioral adjustment issues, including receiving psychiatric diagnoses and special education services. Although children with PIDDs had significantly more psychiatric diagnoses than did asthmatic children, these groups did not differ significantly on questionnaire scores regarding child or caregiver psychosocial adjustment. CONCLUSIONS Children with PIDDs have significant behavioral problems. Children receiving intravenous immunoglobulin or immunomodulatory treatments were reported to have more problems than children not receiving them. This study highlights the need for further research in psychosocial functioning of children with PIDDs in an effort to develop interventions to promote their overall adjustment.
Collapse
Affiliation(s)
- Carrie Piazza-Waggoner
- Division of Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
| | | | | | | | | | | |
Collapse
|
34
|
DeMore M, Adams C, Wilson N, Hogan MB. Parenting Stress, Difficult Child Behavior, and Use of Routines in Relation to Adherence in Pediatric Asthma. Children's Health Care 2005. [DOI: 10.1207/s15326888chc3404_1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
35
|
Smith TS, Hogan MB, Welch JE, Corder WT, Wilson NW. Modern prevalence of insect sensitization in rural asthma and allergic rhinitis patients. Allergy Asthma Proc 2005; 26:356-60. [PMID: 16450569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Inhalant allergy to insects other than cockroaches and dust mites was described in the 1950s, but little attention has been paid to these findings. Sensitization rates for many allergens have increased since then. In this rural population, we describe the current prevalence of sensitization to commonly found insects. We evaluated 200 patients (38 adults and 162 children), for immunoglobulin E (IgE)-mediated sensitization to the caddis fly, mayfly, moth, carpenter ant, and housefly using the prick technique and commercially available whole-body extracts. All had symptoms consistent with asthma and/or allergic rhinitis. They also were tested to indoor and outdoor aeroantigens. Of the 200 patients, 60 patients (30%) tested positive to at least one of the five insects. The most prevalent positive skin test was to the mayfly (37/60), followed by the housefly (36/60), caddis fly (27/60), moth (14/60), and ant (10/60). Of the 60 patients positive for insects, 35 patients (58%) also tested positive to at least one species of mite, 36 patients (60%) tested positive to the cockroach. Twelve of the 60 patients (20%) with positive insect testing did not react to either cockroaches or mites. In our patients, the immunoglobulin E-mediated sensitization rate to insects excluding cockroaches is 30%. Many patients also were sensitized to mites and/or cockroaches. These insects are all present in the indoor/outdoor environment of this rural population. Cross-reactivity with mites and cockroaches (insect panallergy) may partially explain our results. The presence of skin test sensitivity in the absence of cockroach or mite allergy suggests possible true insect sensitization.
Collapse
Affiliation(s)
- Tamara S Smith
- Section of Allergy and Immunology, Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | | | | | | | | |
Collapse
|
36
|
Welch JE, Hogan MB, Wilson NW. Ten-year experience using a plastic, disposable curette for the diagnosis of primary ciliary dyskinesia. Ann Allergy Asthma Immunol 2004; 93:189-92. [PMID: 15328681 DOI: 10.1016/s1081-1206(10)61474-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) results in impaired mucociliary clearance. Patients with this disorder develop chronic sinopulmonary disease with recurrent sinusitis, otitis media, nasal polyposis, pneumonia, and, ultimately, bronchiectasis. Other associated findings of dysfunctional ciliary activity include situs inversus, dextrocardia, and infertility. OBJECTIVE To describe our 10-year experience using a small, plastic, disposable curette to perform a screening procedure for cilia function and to collect samples for electron microscopy. METHODS In the past 10 years, we screened infants and children with severe chronic sinusitis and other chronic recurrent upper respiratory tract problems for PCD by using a plastic, disposable curette to collect tissue samples from the nasal mucosa. Samples were placed in sterile saline and examined under light microscopy for the presence of cilia. Failure to note ciliary movement prompted another examination 1 month later. If no functional cilia were noted at the follow-up examination, a specimen was obtained and sent for electron microscopy. RESULTS We identified 7 patients with PCD; 2 had situs inversus totalis. Average age at diagnosis was 3 years. The most common symptom at presentation was frequent upper respiratory tract infections with severe otitis media (7 patients) and sinusitis (5 patients). Recurrent pneumonia was present in 6 patients. Dynein arm deficiency was the most common electron microscopic diagnosis. CONCLUSIONS Evaluating children for PCD by using a plastic, disposable curette is a relatively simple procedure that could be used by allergists in practice. Primary ciliary dyskinesia occurs frequently enough that physicians should consider it as part of the differential diagnosis in evaluating children with recurrent, severe sinopulmonary infections.
Collapse
Affiliation(s)
- Jon E Welch
- Section of Pediatric Allergy and Immunology, Department of Pediatrics, West Virginia University, School of Medicine, Morgantown, West Virginia 26506-9214, USA
| | | | | |
Collapse
|
37
|
Abstract
Eosinophilic inflammation plays a key role in tissue damage that characterizes asthma. Eosinophils are produced in bone marrow and recent observations in both mice and humans suggest that allergen exposure results in increased output of eosinophils from hemopoietic tissue in individuals with asthma. However, specific mechanisms that alter eosinophilopoiesis in this disease are poorly understood. The current study used a well-characterized murine animal model of asthma to evaluate alterations of eosinophil and eosinophil progenitor cells (CFU-eo) in mice during initial sensitization to allergen and to determine whether observed changes in either cell population were regulated by T lymphocytes. Following the first intranasal installation of OVA, we observed sequential temporal elevation of eosinophils in bone marrow, blood, and lung. In immunocompetent BALB/c mice, elevation of bone marrow eosinophils was accompanied by transient depletion of CFU-eo in that tissue. CFU-eo rebounded to elevated numbers before returning to normal baseline values following intranasal OVA exposure. In T cell-deficient BALB/c nude (BALB/c(nu/nu)) mice, CFU-eo were markedly elevated following allergen sensitization, in the absence of bone marrow or peripheral blood eosinophilia. These data suggest that eosinophilia of asthma results from alterations in two distinct hemopoietic regulatory mechanisms. Elevation of eosinophil progenitor cells in the bone marrow is T cell independent and likely results from altered bone marrow stromal cell function. Differentiation of eosinophil progenitor cells and phenotypic eosinophilia is T cell dependent and does not occur in athymic nude mice exposed to intranasal allergen.
Collapse
Affiliation(s)
- Mary Beth Hogan
- Department of Pediatrics, West Virginia University School of Medicine, PO Box 9214, Morgantown, WV 26506, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Joseph KE, Adams CD, Cottrell L, Hogan MB, Wilson NW. Providing dust mite-proof covers improves adherence to dust mite control measures in children with mite allergy and asthma. Ann Allergy Asthma Immunol 2003; 90:550-3. [PMID: 12775137 DOI: 10.1016/s1081-1206(10)61849-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The most critical dust mite avoidance technique for asthmatic children with mite allergy is the use of dust mite-proof bedding covers. Adherence to allergen control measures is poor due to cost. The purpose of this study was to determine whether giving families mite-proof bedding encasings at the time of the diagnosis with mite allergy would improve adherence at a home visit 2 months later. METHODS Parents of children (mean age 7.7 years) with asthma and positive skin tests for dust mite were assigned either to an intervention group, which received dust mite covers upon enrollment or a comparison group, which did not. Both groups were instructed in dust mite control measures by a medical provider and told to invest in the covers as part of standard care. Two months after enrollment, parent report and observational measures from each family were obtained during a home visit. RESULTS The group provided allergen encasings was found to be significantly more likely to have used the casings at the home visit, t(22) = 2.77, P < 0.05. There were no differences between groups in adherence to other mite control strategies. Parenting stress was significantly related to poorer mite control compliance. The most common reason reported for nonadherence to control measures was cost. CONCLUSIONS Providing mite bedding encasings at the time of diagnosis significantly increases compliance at a 2-month home visit. Medicaid and insurance companies should be encouraged to pay for casings as a cost effective measure to improve asthma care in children with mite allergy.
Collapse
Affiliation(s)
- Karen E Joseph
- West Virginia University, Department of Psychology, Morgantown, West Virginia 26506-9214, USA
| | | | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND Mice are a common finding in the indoor environment of many homes. In a recent study, 18% of children with asthma from an inner-city environment were reported to be allergic to mouse allergen. OBJECTIVE To determine the frequency of skin test reactivity among asthmatic children in a rural environment. METHODS We consecutively evaluated 209 (82 female, 127 male) children between the ages of 5 months and 19 years with asthma for mouse allergy. A careful environmental history was obtained on all children. Children older than 3 years of age were skin tested to mouse allergen and other indoor/outdoor inhalant allergens. Children younger than 3 years were skin tested to mouse and indoor allergens. RESULTS Thirty-three percent of parents reported seeing mice in their homes. Overall, 25 of 209 (12%) children with asthma were skin test-positive for mouse. For children 3 years or younger, 6 of 52 were skin test-positive for mouse (12%). There was no correlation among socioeconomic status, skin test reactivity, and the presence of mice in the home. Children with multiple skin test reactions were more likely to be reactive to mouse (P < 0.01). Mice seen in the home did not correlate with positive mouse skin tests. CONCLUSIONS The frequency of skin test reactivity to mouse allergen in asthmatic children from rural areas appears slightly less than that in children from inner-city environments. However, a frequency of 12% suggests that skin testing for this allergen provides useful information for environmental control measures in the home.
Collapse
Affiliation(s)
- Jon E Welch
- The Section of Pediatric Allergy and Immunology, Department of Pediatrics, West Virginia University, School of Medicine, Morgantown, West Virginia 26506-9214, USA
| | | | | |
Collapse
|
40
|
Abstract
Understanding the role of inflammation in childhood asthma has led to major changes in the approach to management of this disease. Based on the guidelines from the NIH, inhaled long-term control medications that target the underlying inflammatory processes in asthma are now recommended as the mainstay of drug treatment. Long-term control medications are recommended for all children who have asthma symptoms that occur more frequently than twice weekly or nocturnal symptoms more than twice monthly. Environmental control measures to decrease allergen exposure are important, as is attention to sinusitis and GER. The main impediment to improved asthma care is poor patient compliance. Many patients do not understand the role and importance of prophylactic medications in asthma treatment. Further, inconvenient dosing regimens, difficulties with metered-dose inhalers, and fear of potential side effects have all contributed to poor patient compliance. Increased efforts at patient education are needed to improve adherence to asthma plans. These efforts at improving patient compliance, along with improved physician adherence to the guidelines from the NIH, are needed to decrease the morbidity and mortality of childhood asthma.
Collapse
Affiliation(s)
- Mary Beth Hogan
- Section of Pediatric Allergy and Immunology, Department of Pediatrics, Robert C. Byrd Health Science Center, West Virginia University, Morgantown, WV 26506-9214, USA
| | | |
Collapse
|
41
|
Lopez Granados E, Porpiglia AS, Hogan MB, Matamoros N, Krasovec S, Pignata C, Smith C, Hammarstrom L, Bjorkander J, Belohradsky BH, Casariego GF, Garcia Rodriguez M, Conley ME. Clinical and molecular analysis of patients with defects in μ heavy chain gene. J Clin Invest 2002. [DOI: 10.1172/jci0215658] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
42
|
Lopez Granados E, Porpiglia AS, Hogan MB, Matamoros N, Krasovec S, Pignata C, Smith CIE, Hammarstrom L, Bjorkander J, Belohradsky BH, Casariego GF, Garcia Rodriguez MC, Conley ME. Clinical and molecular analysis of patients with defects in micro heavy chain gene. J Clin Invest 2002; 110:1029-35. [PMID: 12370281 PMCID: PMC151150 DOI: 10.1172/jci15658] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Autosomal recessive disorders of B cell development are rare and heterogeneous. To determine the proportion of affected patients who have defects in the micro heavy chain (IGHM) gene, we used single-stranded conformational polymorphism analysis to screen genomic DNA from 40 unrelated patients with early onset infections, profound hypogammaglobulinemia, and absent B cells. All of the patients were genotypically normal in BTK, the gene that underlies X-linked agammaglobulinemia. Eight different mutations in the micro heavy chain were identified in 19 members of 12 unrelated families. Four of the mutations were large deletions that removed more than 40 kb of DNA in the IGHM locus. In six of the 12 families, the affected patients had an identical single base pair substitution, a G-->A, at the -1 position of the alternative splice site. Immunoglobulin haplotype analysis showed that this mutation occurred on at least three different haplotypes, indicating that this is a hot spot for mutations. Compared with patients with mutations in Btk, patients with defects in the micro heavy chain had an earlier onset of disease and more complications. Our study indicates that at least 20-30% of patients with autosomal recessive defects in B cell development have mutations in the micro heavy chain.
Collapse
Affiliation(s)
- Eduardo Lopez Granados
- Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee 38101, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Hogan MB, Weissman DN, Zhuang ZZ, Landreth KS. Bone marrow CFU-eosinophil (CFU-eo) production in a murine asthma model. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)82047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
44
|
Joseph KE, Adams CD, Epperly-Cottrell L, Walker K, Hogan MB, Wilson NW. Providing mattress and pillow covers improves adherance to dust mite control measures in mite allergic children with asthma. J Allergy Clin Immunol 2002. [DOI: 10.1016/s0091-6749(02)82254-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
45
|
Adams CD, Brestan EV, Ruggiero KJ, Hogan MB, Wilson NW, Shigaki CL, Sherman JM. Asthma Questionnaire: Psychometric Properties and Clinical Utility in Pediatric Asthma. Children's Health Care 2001. [DOI: 10.1207/s15326888chc3004_01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
46
|
Rajakumar K, Hogan MB, Wilson NW. Failure to thrive and two weeks of persistent vomiting in an 11-month-old infant. Ann Allergy Asthma Immunol 2000; 85:349-52. [PMID: 11101173 DOI: 10.1016/s1081-1206(10)62544-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Rajakumar
- Department of Pediatrics, West Virginia University, School of Medicine, Morgantown 26506-9214, USA
| | | | | |
Collapse
|
47
|
|
48
|
Abstract
BACKGROUND Eosinophil infiltration of bronchial tissue is a hallmark of asthma. Recruitment of eosinophils into pulmonary tissue is dependent on the presence of IL-5. In addition, IL-5 plays a significant role in the differentiation, proliferation, and maturation of eosinophil progenitor cells in the bone marrow before recruitment into the lung. The contribution of bone marrow eosinophil production to eosinophilia associated with asthma is poorly understood. OBJECTIVE The aims of this study were to determine whether bone marrow stromal cells produce IL-5 and to determine whether IL-5 production by stromal cells is upregulated by IL-1, an inflammatory cytokine associated with asthma. METHODS IL-5 messenger (m)RNA from bone marrow stromal cells was amplified by RT-PCR and sequenced. Stromal cells were lysed, and IL-5 protein production was measured by ELISA. Upregulation of stromal cell IL-5 transcription, translation, and functional effect on eosinophil differentiation was evaluated after stimulation with recombinant IL-1alpha and IL-1beta and compared with untreated cells. RESULTS Bone marrow stromal cells transcribe and translate IL-5. The nucleotide sequence of IL-5 mRNA from stromal cells was identical to that previously reported for murine T cells. IL-5 mRNA abundance in stromal cells increased with increasing cell confluence in culture. IL-5 mRNA and protein levels were upregulated by exposure of stromal cells to the inflammatory cytokines IL-1alpha and IL-1beta. Exposure of stromal cells to IL-1 resulted in increased eosinophil differentiation in coculture experiments with nonadherent bone marrow cells. CONCLUSION The production of IL-5 mRNA and protein by bone marrow stromal cells is a novel finding that has implications for both normal eosinophilopoiesis and development of the accelerated eosinophil production associated with asthma.
Collapse
Affiliation(s)
- M B Hogan
- Departments of Pediatrics and Microbiology and Immunology, West Virginia University School of Medicine, Morgantown
| | | | | |
Collapse
|
49
|
Abstract
BACKGROUND Infantile asthma is commonly thought to be caused by viral respiratory infections and exposure to second-hand cigarette smoke. Allergy has not been felt to be a major cause of infantile asthma and infants and small children are not commonly skin tested. OBJECTIVE To determine the frequency of skin test reactivity in asthmatic children less than 3 years of age. METHODS We evaluated 196 (50 female/146 male) children with infantile asthma for allergy. Infantile asthma was defined as three or more episodes of wheezing in a child less than 3 years of age. A careful environmental history was obtained on all children. All were skin tested to alternaria, cat, dog, cockroach, and house dust mites (HDM) extracts using the prick technique with the Greer Dermapik. RESULTS Forty-five percent of the infants and children tested had at least one positive skin test. 51/196 (26%) of the children were skin test positive to cockroach, 17.3% to HDM, 13.8% to cat, 6.6% to alternaria, and 6.1% positive to dog. For the 49 children who were less than 1 year of age, 28.5% were positive to cockroach, 10.2% to HDM, 10.2% to cats, 4% to alternaria, and 0% to dog. CONCLUSIONS Allergy to cockroach and other indoor allergens may be a significant contributor to infantile asthma in a rural setting. Skin testing children with infantile asthma may provide useful information for institution of environmental controls measures in the child's home.
Collapse
Affiliation(s)
- N W Wilson
- Department of Pediatrics, West Virginia University, School of Medicine, Morgantown 26506-9214, USA
| | | | | |
Collapse
|
50
|
Abstract
A 15-year-old girl developed end-stage renal disease requiring renal transplantation. Posttransplantation immunosuppression therapy consisted of antithymocyte globulin, glucocorticosteroids, cyclosporine A, and azathioprine. The patient's clinical course after transplantation was complicated by several episodes of graft rejection, chronic anemia, oral candidiasis, and numerous infections of the sinopulmonary tract that were recalcitrant to antibiotics and surgical intervention. An immunologic evaluation showed marked immune abnormalities beyond that expected by the transplant immunosuppression. Examination of serum samples taken before the transplant confirmed a diagnosis of common variable immunodeficiency. The difficulties of managing posttransplantation immunosuppression in a patient with a primary immunodeficiency are discussed. Patients with end-stage renal disease and a history of recurrent sinopulmonary infections may require immunologic screening before renal transplantation.
Collapse
Affiliation(s)
- M B Hogan
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, WV 26506-9214, USA
| | | | | |
Collapse
|