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Berdyshev E, Kim J, Kim BE, Goleva E, Lyubchenko T, Bronova I, Bronoff AS, Xiao O, Jang S, Shin S, Song J, Kim J, Kim S, Park B, Kim K, Choi SJ, Oh SY, Ahn K, Leung DYM. Skin biomarkers predict the development of food allergy in early life. J Allergy Clin Immunol 2024; 153:1456-1463.e4. [PMID: 38442771 PMCID: PMC11070305 DOI: 10.1016/j.jaci.2024.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/03/2024] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Food allergy (FA) often occurs in early childhood with and without atopic dermatitis (AD). FA can be severe and even fatal. For primary prevention, it is important to find early biomarkers to predict the future onset of FA before any clinical manifestations. OBJECTIVE Our aim was to find early predictors of future onset of FA in the stratum corneum (SC). METHODS Skin tape strips were collected from the forearm of newborns (n = 129) at age 2 months, before any signs of clinical FA or AD. Children were clinically monitored until they reached age 2 years to confirm the presence or absence of FA and AD. Skin tape strips were subjected to lipidomic analyses by liquid chromatography-tandem mass spectrometry and cytokine determination by Meso Scale Discovery U-Plex assay. RESULTS Overall, 9 of 129 infants (7.0%) developed FA alone and 9 of 129 infants (7.0%) developed FA concomitantly with AD. In the stratum corneum of children with future FA and concomitant AD and FA, absolute amounts of unsaturated (N24:1)(C18-sphingosine)ceramide and (N26:1)(C18-sphingosine)ceramide and their relative percentages within the molecular group were increased compared with the amounts and percentages in healthy children, with P values ranging from less than .01 to less than .05 according to ANOVA. The children with future AD had normal levels of these molecules. IL-33 level was upregulated in those infants with future FA but not in those with future AD, whereas thymic stromal lymphopoietin was upregulated in those with future AD but not in those with future FA. Logistic regression analysis revealed strong FA predicting power for the combination of dysregulated lipids and cytokines, with an odds ratio reaching 101.4 (95% CI = 5.4-1910.6). CONCLUSION Noninvasive skin tape strip analysis at age 2 months can identify infants at risk of FA in the future.
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Affiliation(s)
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea
| | - Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | | | - Irina Bronova
- Department of Medicine, National Jewish Health, Denver, Colo
| | | | - Olivia Xiao
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Sehun Jang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sanghee Shin
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
| | - Jeongmin Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiwon Kim
- Department of Pediatrics, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Sukyung Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boram Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea; Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea; Department of Data Convergence & Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea.
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Lacouture ME, Goleva E, Shah N, Rotemberg V, Kraehenbuehl L, Ketosugbo KF, Merghoub T, Maier T, Bang A, Gu S, Salvador T, Moy AP, Lyubchenko T, Xiao O, Hall CF, Berdyshev E, Crooks J, Weight R, Kern JA, Leung DYM. Immunologic Profiling of Immune-Related Cutaneous Adverse Events with Checkpoint Inhibitors Reveals Polarized Actionable Pathways. Clin Cancer Res 2024:743211. [PMID: 38652814 DOI: 10.1158/1078-0432.ccr-23-3431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/29/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Immune-related cutaneous adverse events (ircAEs) occur in ≥50% of patients treated with checkpoint inhibitors (CPI), but mechanisms are poorly understood. EXPERIMENTAL DESIGN Phenotyping/biomarker analyses were conducted in 200 patients on CPIs (139 with ircAEs, 61 without, control) to characterize their clinical presentation and immunologic endotypes. Cytokines were evaluated in skin biopsies, skin tape strip (STS) extracts and plasma using real-time PCR and Meso Scale Discovery multiplex cytokine assays. RESULTS Eight ircAE phenotypes were identified: pruritus (26%), maculopapular rash (MPR; 21%), eczema (19%), lichenoid (11%), urticaria (8%), psoriasiform (6%), vitiligo (5%), and bullous dermatitis (4%). All phenotypes showed skin lymphocyte and eosinophil infiltrates. Skin biopsy PCR revealed the highest increase in IFN-gamma mRNA in patients with lichenoid (p<0.0001) and psoriasiform dermatitis (p<0.01) as compared to patients without ircAEs, while the highest IL-13 mRNA levels were detected in the eczema (p<0.0001, compared to control). IL-17A mRNA was selectively increased in psoriasiform (p<0.001), lichenoid (p<0.0001), bullous dermatitis (p<0.05) and MPR (p<0.001), compared to control. Distinct cytokine profiles were confirmed in STS and plasma. Analysis determined increased skin/plasma IL-4 cytokine in pruritus, skin IL-13 in eczema, plasma IL-5 and IL-31 in eczema and urticaria, and mixed-cytokine pathways in MPR. Broad inhibition via corticosteroids or type 2-cytokine targeted inhibition resulted in clinical benefit in these ircAEs. In contrast, significant skin upregulation of type 1/type 17 pathways was found in psoriasiform, lichenoid, bullous dermatitis, and type 1 activation in vitiligo. CONCLUSIONS Distinct immunologic ircAE endotypes suggest actionable targets for precision medicine-based interventions.
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Affiliation(s)
| | - Elena Goleva
- National Jewish Health, Denver, CO, United States
| | - Neil Shah
- Memorial Sloan Kettering Cancer Center, United States
| | | | | | | | | | - Tara Maier
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Alexander Bang
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Stephanie Gu
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Trina Salvador
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Andrea P Moy
- Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Olivia Xiao
- National Jewish Health, Denver, Colorado, United States
| | | | | | | | - Ryan Weight
- The Melanoma and Skin Cancer Institute, United States
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Marshall HF, Leung DYM, Lack G, Sindher S, Ciaccio CE, Chan S, Nadeau KC, Brough HA. Topical steroid withdrawal and atopic dermatitis. Ann Allergy Asthma Immunol 2024; 132:423-425. [PMID: 38142858 DOI: 10.1016/j.anai.2023.12.022] [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] [Received: 10/13/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Hannah F Marshall
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Gideon Lack
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Sayantani Sindher
- Department of Medicine and Sean N. Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Christina E Ciaccio
- Departments of Pediatrics and Medicine, The University of Chicago, Chicago, Illinois
| | - Susan Chan
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Kari C Nadeau
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Helen A Brough
- Children's Allergy Service, Evelina London, Guy's and St Thomas', National Health Service Foundation Trust, London, United Kingdom; Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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Kim BE, Hui-Beckman JW, Nevid MZ, Goleva E, Leung DYM. Air pollutants contribute to epithelial barrier dysfunction and allergic diseases. Ann Allergy Asthma Immunol 2024; 132:433-439. [PMID: 38006973 DOI: 10.1016/j.anai.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/27/2023]
Abstract
Air pollution is a global problem associated with various health conditions, causing elevated rates of morbidity and mortality. Major sources of air pollutants include industrial emissions, traffic-related pollutants, and household biomass combustion, in addition to indoor pollutants from chemicals and tobacco. Various types of air pollutants originate from both human activities and natural sources. These include particulate matter, pollen, greenhouse gases, and other harmful gases. Air pollution is linked to allergic diseases, including atopic dermatitis, allergic rhinitis, allergic conjunctivitis, food allergy, and bronchial asthma. These pollutants lead to epithelial barrier dysfunction, dysbiosis, and immune dysregulation. In addition, climate change and global warming may contribute to the exacerbation and the development of allergic diseases related to air pollutants. Epigenetic changes associated with air pollutants have also been connected to the onset of allergic diseases. Furthermore, these changes can be passed down through subsequent generations, causing a higher prevalence of allergic diseases in offspring. Modulation of the aryl hydrocarbon receptor could be a valuable strategy for alleviating air pollutant-induced epidermal barrier dysfunction and atopic dermatitis. A more effective approach to preventing allergic diseases triggered by air pollutants is to reduce exposure to them. Implementing public policies aimed at safeguarding individuals from air pollutant exposure may prove to be the most efficient solution. A pressing need exists for global policy initiatives that prioritize efforts to reduce the production of air pollutants.
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Affiliation(s)
- Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | | | | | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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Sung M, Leung DYM, Kim BE. How does pollution worsen allergies? Ann Allergy Asthma Immunol 2024; 132:407-408. [PMID: 38569749 DOI: 10.1016/j.anai.2024.02.005] [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] [Received: 02/05/2024] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Myongsoon Sung
- Department of Pediatrics, National Jewish Health, Denver, Colorado; Department of Pediatrics, Soonchunhyang University Gumi Hospital, Gumi, Republic of Korea
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | - Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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Wood RA, Togias A, Sicherer SH, Shreffler WG, Kim EH, Jones SM, Leung DYM, Vickery BP, Bird JA, Spergel JM, Iqbal A, Olsson J, Ligueros-Saylan M, Uddin A, Calatroni A, Huckabee CM, Rogers NH, Yovetich N, Dantzer J, Mudd K, Wang J, Groetch M, Pyle D, Keet CA, Kulis M, Sindher SB, Long A, Scurlock AM, Lanser BJ, Lee T, Parrish C, Brown-Whitehorn T, Spergel AKR, Veri M, Hamrah SD, Brittain E, Poyser J, Wheatley LM, Chinthrajah RS. Omalizumab for the Treatment of Multiple Food Allergies. N Engl J Med 2024; 390:889-899. [PMID: 38407394 DOI: 10.1056/nejmoa2312382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Food allergies are common and are associated with substantial morbidity; the only approved treatment is oral immunotherapy for peanut allergy. METHODS In this trial, we assessed whether omalizumab, a monoclonal anti-IgE antibody, would be effective and safe as monotherapy in patients with multiple food allergies. Persons 1 to 55 years of age who were allergic to peanuts and at least two other trial-specified foods (cashew, milk, egg, walnut, wheat, and hazelnut) were screened. Inclusion required a reaction to a food challenge of 100 mg or less of peanut protein and 300 mg or less of the two other foods. Participants were randomly assigned, in a 2:1 ratio, to receive omalizumab or placebo administered subcutaneously (with the dose based on weight and IgE levels) every 2 to 4 weeks for 16 to 20 weeks, after which the challenges were repeated. The primary end point was ingestion of peanut protein in a single dose of 600 mg or more without dose-limiting symptoms. The three key secondary end points were the consumption of cashew, of milk, and of egg in single doses of at least 1000 mg each without dose-limiting symptoms. The first 60 participants (59 of whom were children or adolescents) who completed this first stage were enrolled in a 24-week open-label extension. RESULTS Of the 462 persons who were screened, 180 underwent randomization. The analysis population consisted of the 177 children and adolescents (1 to 17 years of age). A total of 79 of the 118 participants (67%) receiving omalizumab met the primary end-point criteria, as compared with 4 of the 59 participants (7%) receiving placebo (P<0.001). Results for the key secondary end points were consistent with those of the primary end point (cashew, 41% vs. 3%; milk, 66% vs. 10%; egg, 67% vs. 0%; P<0.001 for all comparisons). Safety end points did not differ between the groups, aside from more injection-site reactions in the omalizumab group. CONCLUSIONS In persons as young as 1 year of age with multiple food allergies, omalizumab treatment for 16 weeks was superior to placebo in increasing the reaction threshold for peanut and other common food allergens. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT03881696.).
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Affiliation(s)
- Robert A Wood
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Alkis Togias
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Scott H Sicherer
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Wayne G Shreffler
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Edwin H Kim
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Stacie M Jones
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Donald Y M Leung
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Brian P Vickery
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - J Andrew Bird
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Jonathan M Spergel
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Ahmar Iqbal
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Julie Olsson
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Monica Ligueros-Saylan
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Alkaz Uddin
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Agustin Calatroni
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Charmaine Marquis Huckabee
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Nicole H Rogers
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Nancy Yovetich
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Jennifer Dantzer
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Kim Mudd
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Julie Wang
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Marion Groetch
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - David Pyle
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Corinne A Keet
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Michael Kulis
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Sayantani B Sindher
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Andrew Long
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Amy M Scurlock
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Bruce J Lanser
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Tricia Lee
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Christopher Parrish
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Terri Brown-Whitehorn
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Amanda K Rudman Spergel
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Maria Veri
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Sanaz Daneshfar Hamrah
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Erica Brittain
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Julian Poyser
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - Lisa M Wheatley
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
| | - R Sharon Chinthrajah
- From the Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore (R.A.W., J.D., K.M.), and the National Institutes of Health (National Institutes of Allergy and Infectious Diseases), Bethesda (A.T., A.K.R.S., M.V., S.D.H., E.B., J.P., L.M.W.) - both in Maryland; the Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York (S.H.S., J.W., M.G.); the Division of Pediatric Allergy and Immunology and Food Allergy Center, Massachusetts General Hospital, Boston (W.G.S., D.P.); the University of North Carolina School of Medicine (E.H.K., C.A.K., M.K.) and Rho (A.C., C.M.H., N.H.R., N.Y.) - both in Chapel Hill; the University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock (S.M.J., A.M.S.); National Jewish Health, Denver (D.Y.M.L., B.J.L.); Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta (B.P.V., T.L.); the Department of Pediatrics, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas (J.A.B., C.P.); the Division of Allergy and Immunology, Department of Pediatrics at Perelman School of Medicine at University of Pennsylvania, Philadelphia (J.M.S., T.B.-W.); Genentech-Roche, South San Francisco (A.I., J.O.), and Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto (S.B.S., A.L., R.S.C.) - both in California; and Novartis Pharmaceuticals, East Hanover, NJ (M.L.-S., A.U.)
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Leung DYM. The 80th anniversary of atopic dermatitis in the Annals of Allergy. Ann Allergy Asthma Immunol 2024; 132:261-262. [PMID: 38432782 DOI: 10.1016/j.anai.2023.03.019] [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] [Received: 03/16/2023] [Accepted: 03/19/2023] [Indexed: 03/05/2024]
Affiliation(s)
- Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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8
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Leung DYM, Facheris P, Veverka KA, Cevikbas F, Guttman-Yassky E. Targeting type 2 immune activation beyond atopic dermatitis. Ann Allergy Asthma Immunol 2024; 132:121-123. [PMID: 37442541 DOI: 10.1016/j.anai.2023.06.028] [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] [Received: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Affiliation(s)
- Donald Y M Leung
- Pediatric Allergy and Clinical Immunology, Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | - Paola Facheris
- Department of Dermatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Rozzano, Milan, Italy
| | | | | | - Emma Guttman-Yassky
- Dermatology and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, New York
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9
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Spergel J, Borish L, Grayson MH, Greenhawt MJ, Leung DYM, Levi-Schaffer F, Lieberman JA, Moore-Clingenpeel M, Nowak-Wegrzyn A, Oppenheimer J, Shaker MS, Shulenberger K, Stukus DR. For allergists, the solution is never violence! Ann Allergy Asthma Immunol 2024; 132:117-118. [PMID: 37863191 DOI: 10.1016/j.anai.2023.10.012] [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] [Received: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Jonathan Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Larry Borish
- Asthma and Allergic Disease Center, Departments of Medicine and Microbiology, University of Virginia Health System, Charlottesville, Virginia
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Francesca Levi-Schaffer
- Pharmacology and Experimental Therapeutics Unit, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, The Hebrew University of Jerusalem, Ein Kerem Campus, Jerusalem, Israel
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee; Division of Pulmonology, Allergy and Immunology, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee
| | | | - Anna Nowak-Wegrzyn
- Department of Pediatrics, New York University Grossman School of Medicine and Hassenfeld Children's Hospital New York, New York
| | - John Oppenheimer
- Pulmonary and Allergy Associates, Summit, New Jersey; The University of Medicine and Dentistry of New Jersey Rutgers, Newark, New Jersey
| | - Marcus S Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Pediatrics and Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Kurt Shulenberger
- Annals of Allergy, Asthma, and Immunology Editorial Office, Nationwide Children's Hospital, Columbus, Ohio
| | - David R Stukus
- Asthma and Allergic Disease Center, Departments of Medicine and Microbiology, University of Virginia Health System, Charlottesville, Virginia
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10
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Leung DYM. Evolving atopic dermatitis toward precision medicine. Ann Allergy Asthma Immunol 2024; 132:107-108. [PMID: 38309944 DOI: 10.1016/j.anai.2023.11.022] [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] [Received: 11/21/2023] [Accepted: 11/21/2023] [Indexed: 02/05/2024]
Affiliation(s)
- Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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11
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Marques-Mejias A, Bartha I, Ciaccio CE, Chinthrajah RS, Chan S, Hershey GKK, Hui-Beckman JW, Kost L, Lack G, Layhadi JA, Leung DYM, Marshall HF, Nadeau KC, Radulovic S, Rajcoomar R, Shamji MH, Sindher S, Brough HA. Skin as the target for allergy prevention and treatment. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00001-2. [PMID: 38253125 DOI: 10.1016/j.anai.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/27/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
The fact that genetic and environmental factors could trigger disruption of the epithelial barrier and subsequently initiate a TH2 inflammatory cascade conversely proposes that protecting the same barrier and promoting adequate interactions with other organs, such as the gut, may be crucial for lowering the risk and preventing atopic diseases, particularly, food allergies. In this review, we provide an overview of structural characteristics that support the epithelial barrier hypothesis in patients with atopic dermatitis, including the most relevant filaggrin gene mutations, the recent discovery of the role of the transient receptor potential vanilloid 1, and the role involvement of the microbiome in healthy and damaged skin. We present experimental and human studies that support the mechanisms of allergen penetration, particularly the dual allergen exposure and the outside-in, inside-out, and outside-inside-outside hypotheses. We discuss classic skin-targeted therapies for food allergy prevention, including moisturizers, steroids, and topical calcineurin inhibitors, along with pioneering trials proposed to change their current use (Prevention of Allergy via Cutaneous Intervention and Stopping Eczema and ALlergy). We provide an overview of the novel therapies that enhance the skin barrier, such as probiotics and prebiotics topical application, read-through drugs, direct and indirect FLG replacement, and interleukin and janus kinases inhibitors. Last, we discuss the newer strategies for preventing and treating food allergies in the form of epicutaneous immunotherapy and the experimental use of single-dose of adeno-associated virus vector gene immunotherapy.
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Affiliation(s)
- Andreina Marques-Mejias
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Irene Bartha
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Christina E Ciaccio
- Department of Pediatrics, The University of Chicago, Chicago, Illinois; Department of Medicine, The University of Chicago, Chicago, Illinois
| | - R Sharon Chinthrajah
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Susan Chan
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Laurie Kost
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Gideon Lack
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Janice A Layhadi
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Hannah F Marshall
- Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
| | - Kari C Nadeau
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Suzana Radulovic
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Reena Rajcoomar
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Sayantani Sindher
- Department of Medicine, and Sean N Parker Center for Allergy and Asthma Research, Stanford University, Palo Alto, California
| | - Helen A Brough
- Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Children's Allergy Service, Evelina London, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom; Peter Gorer Department of Immunobiology, School of Immunology & Microbial Sciences, King's College London, London, United Kingdom.
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12
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Nicolàs LSDS, Czarnowicki T, Akdis M, Pujol RM, Lozano-Ojalvo D, Leung DYM, Guttman-Yassky E, Santamaria-Babí LF. CLA+ memory T cells in atopic dermatitis: CLA+ T cells and atopic dermatitis. Allergy 2024; 79:15-25. [PMID: 37439317 DOI: 10.1111/all.15816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
Circulating skin-homing cutaneous lymphocyte-associated antigen (CLA)+ T cells constitute a small subset of human memory T cells involved in several aspects of atopic dermatitis: Staphylococcus aureus related mechanisms, the abnormal Th2 immune response, biomarkers, clinical aspects of the patients, pruritus, and the mechanism of action of targeted therapies. Superantigens, IL-13, IL-31, pruritus, CCL17 and early effects on dupilumab-treated patients have in common that they are associated with the CLA+ T cell mechanisms in atopic dermatitis patients. The function of CLA+ T cells corresponds with the role of T cells belonging to the skin-associated lymphoid tissue and could be a reason why they reflect different mechanisms of atopic dermatitis and many other T cell mediated skin diseases. The goal of this review is to gather all this translational information of atopic dermatitis pathology.
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Affiliation(s)
- Lídia Sans-de San Nicolàs
- Immunologia Translacional, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona (UB), Parc Científic de Barcelona (PCB), Barcelona, Spain
| | - Tali Czarnowicki
- Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos-Wolfgang, Switzerland
| | - Ramon M Pujol
- Departament de Dermatologia, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Daniel Lozano-Ojalvo
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Luis F Santamaria-Babí
- Immunologia Translacional, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona (UB), Parc Científic de Barcelona (PCB), Barcelona, Spain
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13
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Schlievert PM, Nelson JD, Kilgore SH, Radoshevich L, Klingelhutz AJ, Leung DYM. Purification, characterization, and cloning of a novel pro-inflammatory secreted protein from Staphylococcus aureus. Microbiol Spectr 2023; 11:e0289823. [PMID: 37937984 PMCID: PMC10715055 DOI: 10.1128/spectrum.02898-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/09/2023] [Indexed: 11/09/2023] Open
Abstract
IMPORTANCE Staphylococcus aureus causes a myriad of human diseases, ranging from relatively mild soft tissue infections to highly fatal pneumonia, sepsis, and toxic shock syndrome. The organisms primarily cause diseases across mucosal and skin barriers. In order to facilitate penetration of barriers, S. aureus causes harmful inflammation by inducing chemokines from epithelial cells. We report the cloning and characterization of a novel secreted S. aureus protein that induces chemokine production from epithelial cells as its major demonstrable function. This secreted protein possibly helps S. aureus and its secreted proteins to penetrate host barriers.
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Affiliation(s)
- Patrick M. Schlievert
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jacob D. Nelson
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Samuel H. Kilgore
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Lilliana Radoshevich
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Aloysius J. Klingelhutz
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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Hui-Beckman JW, Leung DYM. Physical influences on the skin barrier and pathogenesis of allergy. Curr Opin Pediatr 2023; 35:656-662. [PMID: 37650580 DOI: 10.1097/mop.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW As the incidence of allergic conditions has increased in recent decades, the effects of climate change have been implicated. There is also increased knowledge on the effects of other physical influences, such as scratching and Staphylococcus aureus . The skin barrier is the first line of defense to the external environment, so understanding the ways that these factors influence skin barrier dysfunction is important. RECENT FINDINGS Although the impact on environmental exposures has been well studied in asthma and other allergic disorders, there is now more literature on the effects of temperature, air pollution, and detergents on the skin barrier. Factors that cause skin barrier dysfunction include extreme temperatures, air pollution (including greenhouse gases and particulate matter), wildfire smoke, pollen, scratching, S. aureus, and detergents. SUMMARY Understanding the ways that external insults affect the skin barrier is important to further understand the mechanisms in order to inform the medical community on treatment and prevention measures for atopic conditions.
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15
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Chun Y, Grishin A, Rose R, Zhao W, Arditi Z, Zhang L, Wood RA, Burks AW, Jones SM, Leung DYM, Jones DR, Sampson HA, Sicherer SH, Bunyavanich S. Longitudinal dynamics of the gut microbiome and metabolome in peanut allergy development. J Allergy Clin Immunol 2023; 152:1569-1580. [PMID: 37619819 DOI: 10.1016/j.jaci.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Rising rates of peanut allergy (PA) motivate investigations of its development to inform prevention and therapy. Microbiota and the metabolites they produce shape food allergy risk. OBJECTIVE We sought to gain insight into gut microbiome and metabolome dynamics in the development of PA. METHODS We performed a longitudinal, integrative study of the gut microbiome and metabolome of infants with allergy risk factors but no PA from a multicenter cohort followed through mid-childhood. We performed 16S rRNA sequencing, short chain fatty acid measurements, and global metabolome profiling of fecal samples at infancy and at mid-childhood. RESULTS In this longitudinal, multicenter sample (n = 122), 28.7% of infants developed PA by mid-childhood (mean age 9 years). Lower infant gut microbiome diversity was associated with PA development (P = .014). Temporal changes in the relative abundance of specific microbiota and gut metabolite levels significantly differed in children who developed PA. PA-bound children had different abundance trajectories of Clostridium sensu stricto 1 sp (false discovery rate (FDR) = 0.015) and Bifidobacterium sp (FDR = 0.033), with butyrate (FDR = 0.045) and isovalerate (FDR = 0.036) decreasing over time. Metabolites associated with PA development clustered within the histidine metabolism pathway. Positive correlations between microbiota, butyrate, and isovalerate and negative correlations with histamine marked the PA-free network. CONCLUSION The temporal dynamics of the gut microbiome and metabolome in early childhood are distinct for children who develop PA. These findings inform our thinking on the mechanisms underlying and strategies for potentially preventing PA.
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Affiliation(s)
- Yoojin Chun
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Grishin
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rebecca Rose
- Metabolomics Core, New York University, New York, NY
| | - William Zhao
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Zoe Arditi
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lingdi Zhang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University, Baltimore, Md
| | - A Wesley Burks
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Stacie M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Ark
| | | | - Drew R Jones
- Metabolomics Core, New York University, New York, NY
| | - Hugh A Sampson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Scott H Sicherer
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Supinda Bunyavanich
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
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16
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Hui-Beckman JW, Goleva E, Leung DYM, Kim BE. The impact of temperature on the skin barrier and atopic dermatitis. Ann Allergy Asthma Immunol 2023; 131:713-719. [PMID: 37595740 DOI: 10.1016/j.anai.2023.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/20/2023]
Abstract
Climate change is a global threat to public health and causes or worsens various diseases including atopic dermatitis (AD), allergic, infectious, cardiovascular diseases, physical injuries, and mental disorders. The incidence of allergy, such as AD, has increased over the past several decades, and environmental factors such as climate change have been implicated as a potential mechanism. A substantial amount of literature has been published on the impact of climate factors, including cold and hot temperatures, on the skin barrier and AD. Studies in several countries have found a greater incidence of AD in children born in the colder seasons of fall and winter. The effect of cold and warm temperatures on itch, skin flares, increased outpatient visits, skin barrier dysfunction, development of AD, and asthma exacerbations have been reported. Understanding mechanisms by which changes in temperature influence allergies is critical to the development of measures for the prevention and treatment of allergic disorders, such as AD and asthma. Low and high temperatures induce the production of proinflammatory cytokines and lipid mediators such as interleukin-1β, thymic stromal lymphopoietin, and prostaglandin E2, and cause itch and flares by activation of TRPVs such as TRPV1, TRPV3, and TRPV4. TRPV antagonists may attenuate temperature-mediated itch, skin barrier dysfunction, and exacerbation of AD.
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Affiliation(s)
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | - Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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17
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Simpson EL, Schlievert PM, Yoshida T, Lussier S, Boguniewicz M, Hata T, Fuxench Z, De Benedetto A, Ong PY, Ko J, Calatroni A, Rudman Spergel AK, Plaut M, Quataert SA, Kilgore SH, Peterson L, Gill AL, David G, Mosmann T, Gill SR, Leung DYM, Beck LA. Rapid reduction in Staphylococcus aureus in atopic dermatitis subjects following dupilumab treatment. J Allergy Clin Immunol 2023; 152:1179-1195. [PMID: 37315812 PMCID: PMC10716365 DOI: 10.1016/j.jaci.2023.05.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is an inflammatory disorder characterized by dominant type 2 inflammation leading to chronic pruritic skin lesions, allergic comorbidities, and Staphylococcus aureus skin colonization and infections. S aureus is thought to play a role in AD severity. OBJECTIVES This study characterized the changes in the host-microbial interface in subjects with AD following type 2 blockade with dupilumab. METHODS Participants (n = 71) with moderate-severe AD were enrolled in a randomized (dupilumab vs placebo; 2:1), double-blind study at Atopic Dermatitis Research Network centers. Bioassays were performed at multiple time points: S aureus and virulence factor quantification, 16s ribosomal RNA microbiome, serum biomarkers, skin transcriptomic analyses, and peripheral blood T-cell phenotyping. RESULTS At baseline, 100% of participants were S aureus colonized on the skin surface. Dupilumab treatment resulted in significant reductions in S aureus after only 3 days (compared to placebo), which was 11 days before clinical improvement. Participants with the greatest S aureus reductions had the best clinical outcomes, and these reductions correlated with reductions in serum CCL17 and disease severity. Reductions (10-fold) in S aureus cytotoxins (day 7), perturbations in TH17-cell subsets (day 14), and increased expression of genes relevant for IL-17, neutrophil, and complement pathways (day 7) were also observed. CONCLUSIONS Blockade of IL-4 and IL-13 signaling, very rapidly (day 3) reduces S aureus abundance in subjects with AD, and this reduction correlates with reductions in the type 2 biomarker, CCL17, and measures of AD severity (excluding itch). Immunoprofiling and/or transcriptomics suggest a role for TH17 cells, neutrophils, and complement activation as potential mechanisms to explain these findings.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, Ore
| | | | - Takeshi Yoshida
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | | | - Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo
| | - Tissa Hata
- Department of Dermatology, University of California, San Diego, Calif
| | - Zelma Fuxench
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pa
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Peck Y Ong
- Department of Pediatrics, University Southern California, Los Angeles, Calif
| | - Justin Ko
- Department of Dermatology, Stanford University, Stanford, Calif
| | | | - Amanda K Rudman Spergel
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Marshall Plaut
- Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Sally A Quataert
- Center for Vaccine Biology and Immunology, University of Rochester Medical Center, Rochester, NY
| | - Samuel H Kilgore
- Department of Microbiology and Immunology, University of Iowa, Iowa City, Iowa
| | - Liam Peterson
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Ann L Gill
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY
| | | | - Tim Mosmann
- Center for Vaccine Biology and Immunology, University of Rochester Medical Center, Rochester, NY
| | - Steven R Gill
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY
| | - Donald Y M Leung
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo.
| | - Lisa A Beck
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY.
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18
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Moran MC, Klose A, Yoshida T, De Benedetto A, Schneider LC, Ong PY, Simpson EL, Leung DYM, Miller BL, Seplaki CL, Beck LA. History of S. aureus Skin Infection Significantly Associates with History of Eczema Herpeticum in Patients with Atopic Dermatitis. Dermatol Ther (Heidelb) 2023; 13:2417-2429. [PMID: 37615834 PMCID: PMC10539263 DOI: 10.1007/s13555-023-00996-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 07/28/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION Patients with atopic dermatitis (AD) are uniquely susceptible to a number of serious viral skin complications, including eczema herpeticum (EH), caused by herpes simplex virus. This study explored the associations between biomarkers of epithelial barrier dysfunction, type 2 immunity, Staphylococcus aureus infection, and S. aureus-specific immunoglobulin responses in a cohort of AD subjects with and without a history of EH (EH+ and EH-, respectively). METHODS A total of 112 subjects with AD (56 EH+, 56 EH-), matched by age and AD severity, were selected from a registry of over 3000 AD subjects. Logistic regression was used to test the association between history of S. aureus skin infection and history of EH, while controlling for a number of confounders. RESULTS Compared to those without a history of S. aureus skin infection, subjects with a history of S. aureus skin infection were found to have more than sixfold increased odds of having a history of EH (6.60, 95% confidence interval [CI]: 2.00-21.83), after adjusting for history of other viral skin infections (molluscum contagiosum virus, human papillomavirus), serum total IgE, and IgG against the S. aureus virulence factor SElX. CONCLUSIONS These findings indicate an important relationship between S. aureus skin infections and EH.
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Affiliation(s)
- Mary C Moran
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Alanna Klose
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Takeshi Yoshida
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lynda C Schneider
- Division of Allergy-Immunology, Department of Pediatrics, Boston Children's Hospital-Harvard Medical School, Boston, MA, USA
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles-University of Southern California, Los Angeles, CA, USA
| | - Eric L Simpson
- Department of Dermatology, Oregon Health and Science University, Portland, OR, USA
| | - Donald Y M Leung
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health-University of Colorado School of Medicine, Denver, CO, USA
| | - Benjamin L Miller
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher L Seplaki
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, NY, USA.
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Schlievert PM, Gaitán AV, Kilgore SH, Roe AL, Maukonen J, Lehtoranta L, Leung DYM, Marsman DS. Inhibition of Toxic Shock Syndrome-Associated Staphylococcus aureus by Probiotic Lactobacilli. Microbiol Spectr 2023; 11:e0173523. [PMID: 37404182 PMCID: PMC10434015 DOI: 10.1128/spectrum.01735-23] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
Staphylococcus aureus is a human pathogen with many infections originating on mucosal surfaces. One common group of S. aureus is the USA200 (CC30) clonal group, which produces toxic shock syndrome toxin-1 (TSST-1). Many USA200 infections occur on mucosal surfaces, particularly in the vagina and gastrointestinal tract. This allows these organisms to cause cases of menstrual TSS and enterocolitis. The current study examined the ability of two lactobacilli, Lactobacillus acidophilus strain LA-14 and Lacticaseibacillus rhamnosus strain HN001, for their ability to inhibit the growth of TSST-1 positive S. aureus, the production of TSST-1, and the ability of TSST-1 to induce pro-inflammatory chemokines from human vaginal epithelial cells (HVECs). In competition growth experiments, L. rhamnosus did not affect the growth of TSS S. aureus but did inhibit the production of TSST-1; this effect was partially due to acidification of the growth medium. L. acidophilus was both bactericidal and prevented the production of TSST-1 by S. aureus. This effect appeared to be partially due to acidification of the growth medium, production of H2O2, and production of other antibacterial molecules. When both organisms were incubated with S. aureus, the effect of L. acidophilus LA-14 dominated. In in vitro experiments with HVECs, neither lactobacillus induced significant production of the chemokine interleukin-8, whereas TSST-1 did induce production of the chemokine. When the lactobacilli were incubated with HVECs in the presence of TSST-1, the lactobacilli reduced chemokine production. These data suggest that these two bacteria in probiotics could reduce the incidence of menstrual and enterocolitis-associated TSS. IMPORTANCE Toxic shock syndrome (TSS) Staphylococcus aureus commonly colonize mucosal surfaces, giving them the ability to cause TSS through the action of TSS toxin-1 (TSST-1). This study examined the ability of two probiotic lactobacilli to inhibit S. aureus growth and TSST-1 production, and the reduction of pro-inflammatory chemokine production by TSST-1. Lacticaseibacillus rhamnosus strain HN001 inhibited TSST-1 production due to acid production but did not affect S. aureus growth. Lactobacillus acidophilus strain LA-14 was bactericidal against S. aureus, partially due to acid and H2O2 production, and consequently also inhibited TSST-1 production. Neither lactobacillus induced the production of pro-inflammatory chemokines by human vaginal epithelial cells, and both inhibited chemokine production by TSST-1. These data suggest that the two probiotics could reduce the incidence of mucosa-associated TSS, including menstrual TSS and cases originating as enterocolitis.
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Affiliation(s)
- Patrick M. Schlievert
- Department of Microbiology and Immunology, University of Iowa; Carver College of Medicine, Iowa City, Iowa, USA
| | | | - Samuel H. Kilgore
- Department of Microbiology and Immunology, University of Iowa; Carver College of Medicine, Iowa City, Iowa, USA
| | - Amy L. Roe
- The Procter & Gamble Company, Cincinnati, Ohio, USA
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20
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Simpson EL, De Benedetto A, Boguniewicz M, Ong PY, Lussier S, Villarreal M, Schneider LC, Paller AS, Guttman-Yassky E, Hanifin JM, Spergel JM, Barnes KC, David G, Austin B, Leung DYM, Beck LA. Phenotypic and Endotypic Determinants of Atopic Dermatitis Severity From the Atopic Dermatitis Research Network (ADRN) Registry. J Allergy Clin Immunol Pract 2023; 11:2504-2515. [PMID: 37182563 PMCID: PMC10524351 DOI: 10.1016/j.jaip.2023.04.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/07/2023] [Accepted: 04/28/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin condition with a highly variable clinical phenotype. OBJECTIVE This study aimed to identify historical and clinical features and biomarkers associated with AD severity. METHODS A US registry of extensively phenotyped AD participants (aged 0.73-80 years) were enrolled at 9 academic centers. Information on family and personal medical history, examination, skin swabs (culture), and serum biomarkers was collected to evaluate their association with AD severity. RESULTS Participants with AD (N = 2862) whose disease was categorized as mild (11.6%), moderate (58.0%), or severe (30.4%) based on Rajka-Langeland scoring were enrolled. The trend test, when adjusting for gender, race, and age, demonstrated that severity was strongly (P ≤ .04) associated with a personal/family history of allergic disorders, history of alopecia, exposure to passive smoke, ocular herpes infection, skin bacterial and viral infections, and history of arrhythmia. Features observed more frequently (P ≤ .002), as a function of severity, included skin infections (impetigo, human papillomavirus, and molluscum contagiosum virus), Staphylococcus aureus colonization, excoriations, hyperlinear palms, ichthyosis, blepharitis, conjunctivitis, ectropion, and wheezing. Serum IgE, allergen and food (≤6 years) Phadiatop, and eosinophilia were strongly linked to severity (P < .001). CONCLUSIONS In a diverse US AD population, severity was associated with a history of atopic disorders, skin and extracutaneous bacterial and viral infections (by history and physical examination), higher IgE, eosinophilia and allergen sensitization, atopic skin manifestations (ie, excoriation, hyperlinear palms, and ichthyosis), and atopic ocular features (ie, blepharitis, conjunctivitis, and ectropion) as well as asthma findings (ie, wheezing). Data from our prospective registry significantly advance our understanding of AD phenotypes and endotypes, which is critical to achieve optimal management.
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Affiliation(s)
- Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Ore
| | - Anna De Benedetto
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Mark Boguniewicz
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Department of Pediatrics, Children's Hospital Los Angeles, University Southern California, Los Angeles, Calif
| | | | | | - Lynda C Schneider
- Division of Allergy and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jon M Hanifin
- Department of Dermatology, Oregon Health & Science University, Portland, Ore
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Kathleen C Barnes
- Department of Medicine and Epidemiology, University of Colorado Anschutz Medical Campus, Denver, Colo
| | | | | | - Donald Y M Leung
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health and University of Colorado School of Medicine, Denver, Colo
| | - Lisa A Beck
- Department of Dermatology, Medicine and Pathology, University of Rochester Medical Center, Rochester, NY.
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21
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Yang B, Wilkie H, Das M, Timilshina M, Bainter W, Woods B, Daya M, Boorgula MP, Mathias RA, Lai P, Petty CR, Weller E, Harb H, Chatila TA, Leung DYM, Beck LA, Simpson EL, Hata TR, Barnes KC, Phipatanakul W, Leyva-Castillo JM, Geha RS. The IL-4Rα Q576R polymorphism is associated with increased severity of atopic dermatitis and exaggerates allergic skin inflammation in mice. J Allergy Clin Immunol 2023; 151:1296-1306.e7. [PMID: 36690254 PMCID: PMC10164706 DOI: 10.1016/j.jaci.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/02/2022] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is characterized by TH2-dominated skin inflammation and systemic response to cutaneously encountered antigens. The TH2 cytokines IL-4 and IL-13 play a critical role in the pathogenesis of AD. The Q576->R576 polymorphism in the IL-4 receptor alpha (IL-4Rα) chain common to IL-4 and IL-13 receptors alters IL-4 signaling and is associated with asthma severity. OBJECTIVE We sought to investigate whether the IL-4Rα R576 polymorphism is associated with AD severity and exaggerates allergic skin inflammation in mice. METHODS Nighttime itching interfering with sleep, Rajka-Langeland, and Eczema Area and Severity Index scores were used to assess AD severity. Allergic skin inflammation following epicutaneous sensitization of mice 1 or 2 IL-4Rα R576 alleles (QR and RR) and IL-4Rα Q576 (QQ) controls was assessed by flow cytometric analysis of cells and quantitative RT-PCR analysis of cytokines in skin. RESULTS The frequency of nighttime itching in 190 asthmatic inner-city children with AD, as well as Rajka-Langeland and Eczema Area and Severity Index scores in 1116 White patients with AD enrolled in the Atopic Dermatitis Research Network, was higher in subjects with the IL-4Rα R576 polymorphism compared with those without, with statistical significance for the Rajka-Langeland score. Following epicutaneous sensitization of mice with ovalbumin or house dust mite, skin infiltration by CD4+ cells and eosinophils, cutaneous expression of Il4 and Il13, transepidermal water loss, antigen-specific IgE antibody levels, and IL-13 secretion by antigen-stimulated splenocytes were significantly higher in RR and QR mice compared with QQ controls. Bone marrow radiation chimeras demonstrated that both hematopoietic cells and stromal cells contribute to the mutants' exaggerated allergic skin inflammation. CONCLUSIONS The IL-4Rα R576 polymorphism predisposes to more severe AD and increases allergic skin inflammation in mice.
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Affiliation(s)
- Barbara Yang
- Division of Immunology and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Hazel Wilkie
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Mrinmoy Das
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | | | - Wayne Bainter
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Brian Woods
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Michelle Daya
- University of Colorado Anschutz Medical Campus, Aurora, Colo
| | | | | | - Peggy Lai
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, Mass
| | - Carter R Petty
- ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Mass
| | - Edie Weller
- ICCTR Biostatistics and Research Design Center, Boston Children's Hospital, Boston, Mass
| | - Hani Harb
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | - Talal A Chatila
- Division of Immunology, Boston Children's Hospital, Boston, Mass
| | | | - Lisa A Beck
- Departments of Dermatology, Medicine, and Pathology, University of Rochester School of Medicine, Rochester, NY
| | - Eric L Simpson
- Department of Dermatology, Oregon Health & Science University, Portland, Ore
| | - Tissa R Hata
- Department of Dermatology, University of California, San Diego, Calif
| | | | | | | | - Raif S Geha
- Division of Immunology, Boston Children's Hospital, Boston, Mass.
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22
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Leung DYM, Bissonnette R, Kreimer S, Berdyshev E, Bafna S, Lyubchenko T, Richers BN, Garcia S, Ramirez-Gama M, Hall CF, Xiao O, Taylor P, Boguniewicz M, Levit NA, Agueusop I, Zhang A, Goleva E. Dupilumab inhibits vascular leakage of blood proteins into atopic dermatitis skin. J Allergy Clin Immunol Pract 2023; 11:1421-1428. [PMID: 36958520 DOI: 10.1016/j.jaip.2023.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) skin lesions are associated with oozing, bleeding, and erythema. This suggests AD is associated with vascular changes. Dupilumab is an antibody to the alpha-subunit of interleukin (IL) 4 receptor that demonstrates strong efficacy in the treatment of AD. IL-4 is known to reduce the permeability barrier function of vascular endothelium. OBJECTIVE To examine the effects of dupilumab on vascular barrier function in AD skin. METHODS Using proteomic analysis, we evaluated the plasma protein composition in skin tapes of lesional and non-lesional skin of adults and adolescents with moderate-to-severe AD over the course of a 16-week treatment with dupilumab and compared those to matched healthy subjects. RESULTS At baseline, 115 plasma proteins were detected in AD skin and globally increased (1.5-fold or greater) compared to healthy skin. Functionally, these proteins included immunoglobulins, proteins involved in the coagulation process, enzymes, protease inhibitors, transport proteins, acute-phase proteins, complement proteins, and other pleiotropic proteins. Noteworthy, fibrinogens, fibronectin, and heme-binding proteins haptoglobin and hemopexin were among the top proteins originating from plasma and were increased in AD lesional versus healthy skin at baseline (p<0.0001). Dupilumab treatment resulted in significantly reduced levels of plasma proteins in AD skin (p<0.0001), with the majority dropping to levels seen in healthy skin or no longer detectable at week 16. CONCLUSIONS Inhibition of IL-4/IL-13 action by dupilumab significantly reduces the efflux of plasma proteins into AD skin. Several of these proteins, such as fibrinogens and fibronectin, are known to enhance Staphylococcus aureuscolonization and are associated with AD skin severity.
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Affiliation(s)
| | | | - Simion Kreimer
- Advanced Clinical Biosystems Institute, Smidt Heart institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | | | | | | | | | | | | | | | | | | | - Noah A Levit
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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23
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Lozano-Ojalvo D, Tyler SR, Aranda CJ, Wang J, Sicherer S, Sampson HA, Wood RA, Burks AW, Jones SM, Leung DYM, de Lafaille MC, Berin MC. Allergen recognition by specific effector Th2 cells enables IL-2-dependent activation of regulatory T-cell responses in humans. Allergy 2023; 78:697-713. [PMID: 36089900 PMCID: PMC10111618 DOI: 10.1111/all.15512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/11/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022]
Abstract
Type 2 allergen-specific T cells are essential for the induction and maintenance of allergies to foods, and Tregs specific for these allergens are assumed to be involved in their resolution. However, it has not been convincingly demonstrated whether allergen-specific Treg responses are responsible for the generation of oral tolerance in humans. We observed that sustained food allergen exposure in the form of oral immunotherapy resulted in increased frequency of Tregs only in individuals with lasting clinical tolerance. We sought to identify regulatory components of the CD4+ T-cell response to food allergens by studying their functional activation over time in vitro and in vivo. Two subsets of Tregs expressing CD137 or CD25/OX40 were identified with a delayed kinetics of activation compared with clonally enriched pathogenic effector Th2 cells. Treg activation was dependent on IL-2 derived from effector T cells. In vivo exposure to peanut in the form of an oral food challenge of allergic subjects induced a delayed and persistent activation of Tregs after initiation of the allergen-specific Th2 response. The novel finding of our work is that a sustained wave of Treg activation is induced by the release of IL-2 from Th2 effector cells, with the implication that therapeutic administration of IL-2 could improve current OIT approaches.
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Affiliation(s)
- Daniel Lozano-Ojalvo
- Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, Precision Immunology Institute, New York, New York, USA
| | - Scott R Tyler
- Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Carlos J Aranda
- Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, Precision Immunology Institute, New York, New York, USA
| | - Julie Wang
- Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York, USA
| | - Scott Sicherer
- Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York, USA
| | - Hugh A Sampson
- Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, Precision Immunology Institute, New York, New York, USA
| | - Robert A Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Wesley Burks
- Department of Medicine and Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Stacie M Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Maria Curotto de Lafaille
- Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, Precision Immunology Institute, New York, New York, USA
| | - M Cecilia Berin
- Icahn School of Medicine at Mount Sinai, Jaffe Food Allergy Institute, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, Precision Immunology Institute, New York, New York, USA
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24
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Kim J, Kim BE, Goleva E, Berdyshev E, Bae J, Kim S, Kim HY, Lee UH, Kim MS, Jung M, Kim H, Lee J, Leung DYM, Ahn K. Alterations of Epidermal Lipid Profiles and Skin Microbiome in Children With Atopic Dermatitis. Allergy Asthma Immunol Res 2023; 15:186-200. [PMID: 37021505 PMCID: PMC10079518 DOI: 10.4168/aair.2023.15.2.186] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/22/2022] [Accepted: 10/17/2022] [Indexed: 04/07/2023]
Abstract
PURPOSE We aimed to investigate epidermal lipid profiles and their association with skin microbiome compositions in children with atopic dermatitis (AD). METHODS Specimens were obtained by skin tape stripping from 27 children with AD and 18 healthy subjects matched for age and sex. Proteins and lipids of stratum corneum samples from nonlesional and lesional skin of AD patients and normal subjects were quantified by liquid chromatography tandem mass spectrometry. Skin microbiome profiles were analyzed using bacterial 16S rRNA sequencing. RESULTS Ceramides with nonhydroxy fatty acids (FAs) and C18 sphingosine as their sphingoid base (C18-NS-CERs) N-acylated with C16, C18 and C22 FAs, sphingomyelin (SM) N-acylated with C18 FAs, and lysophosphatidylcholine (LPC) with C16 FAs were increased in AD lesional skin compared to those in AD nonlesional skin and that of control subjects (all P < 0.01). SMs N-acylated with C16 FAs were increased in AD lesional skin compared to control subjects (P < 0.05). The ratio of NS-CERs with long-chain fatty acids (LCFAs) to short-chain fatty acids (SCFAs) (C24-32:C14-22), the ratio of LPC with LCFAs to SCFAs (C24-30:C16-22) as well as the ratio of total esterified omega-hydroxy ceramides to total NS-CERs were negatively correlated with transepidermal water loss (rho coefficients = -0.738, -0.528, and -0.489, respectively; all P < 0.001). The proportions of Firmicutes and Staphylococcus were positively correlated to SCFAs including NS ceramides (C14-22), SMs (C17-18), and LPCs (C16), while the proportions of Actinobacteria, Proteobacteria, Bacteroidetes, Corynebacterium, Enhydrobacteria, and Micrococcus were negatively correlated to these SCFAs. CONCLUSIONS Our results suggest that pediatric AD skin shows aberrant lipid profiles, and these alterations are associated with skin microbial dysbiosis and cutaneous barrier dysfunction.
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Affiliation(s)
- Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea
| | - Byung Eui Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Evgeny Berdyshev
- Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Jaewoong Bae
- R&D Institute, BioEleven Co., Ltd., Seoul, Korea
| | - Seokjin Kim
- R&D Institute, BioEleven Co., Ltd., Seoul, Korea
| | - Hye-Young Kim
- Department of Pediatrics, Medical Research Institute of Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Un Ha Lee
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Myoung Shin Kim
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Minyoung Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Hyunmi Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, CO, USA.
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea.
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25
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Berdyshev E, Kim J, Kim BE, Goleva E, Lyubchenko T, Bronova I, Bronoff AS, Xiao O, Kim J, Kim S, Kwon M, Lee S, Seo YJ, Kim K, Choi SJ, Oh SY, Kim SH, Yu SY, Hwang SY, Ahn K, Leung DYM. Stratum corneum lipid and cytokine biomarkers at age 2 months predict the future onset of atopic dermatitis. J Allergy Clin Immunol 2023; 151:1307-1316. [PMID: 36828081 DOI: 10.1016/j.jaci.2023.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) commonly occurs in children and can progress into severe phenotypes or atopic march, causing significant impairment in quality of life. It is important to find early biomarkers of future onset of AD before any clinical manifestations. OBJECTIVE We sought to find early predictors of future onset of AD in skin stratum corneum (SC). METHODS Skin tape strips were collected from the forearm of newborns (n = 111) with and without family history of atopic diseases at the age of 2 months before any signs of clinical AD. Children were clinically monitored until they reached age 2 years to ensure the presence or absence of AD. Skin tape strips were subjected to lipidomic analyses by the liquid chromatography electrospray ionization tandem mass spectrometry and cytokine determination by Meso Scale Discovery U-Plex assay. RESULTS Overall, 22 of 74 (29.7%) and 5 of 37 (13.5%) infants developed AD in the risk group and the control group, respectively. In the SC of future AD children, protein-bound ceramides were decreased (P < .001), whereas unsaturated sphingomyelin species (P < .0001) and "short-chain" nonhydroxy fatty acid sphingosine and alpha-hydroxy fatty acid sphingosine ceramides were elevated (P < .01 and .05, respectively) as compared with healthy children. Thymic stromal lymphopoietin and IL-13 levels were increased in the SC of future AD subjects (by 74.5% and 78.3%, P = .0022 and P < .0001, respectively). Multivariable logistic regression analysis revealed strong AD predicting power of the combination of family history, type 2 cytokines, and dysregulated lipids, with an odds ratio reaching 54.0 (95% CI, 9.2-317.5). CONCLUSIONS Noninvasive skin tape strip analysis at age 2 months can identify asymptomatic children at risk of future AD development with a high probability.
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Affiliation(s)
| | - Jihyun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea
| | - Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | | | - Irina Bronova
- Department of Medicine, National Jewish Health, Denver, Colo
| | | | - Olivia Xiao
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Jiwon Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea
| | - Sukyung Kim
- Department of Pediatrics, Hallym University Dongtan Sacred Heart Hospital, Hallym University School of Medicine, Hwasung, Korea
| | - Mijeong Kwon
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sungjoo Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea
| | - Yu Jeong Seo
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Korea; Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea; Department of Data Convergence & Future Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Suk-Joo Choi
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Young Oh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hwan Kim
- Department of Molecular and Life Science, Hanyang University, Ansan, Korea
| | - So Yeon Yu
- Department of Molecular and Life Science, Hanyang University, Ansan, Korea
| | - Seung Yong Hwang
- Department of Molecular and Life Science, Hanyang University, Ansan, Korea
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology, Seoul, Korea.
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Schlievert PM, Kilgore SH, Beck LA, Yoshida T, Klingelhutz AJ, Leung DYM. Host Cationic Antimicrobial Molecules Inhibit S. aureus Exotoxin Production. mSphere 2023; 8:e0057622. [PMID: 36598227 PMCID: PMC9942567 DOI: 10.1128/msphere.00576-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/02/2022] [Indexed: 01/05/2023] Open
Abstract
Innate immune molecules, including antimicrobial peptides (for example, defensins) and lysozyme, function to delay or prevent bacterial infections. These molecules are commonly found on mucosal and skin surfaces. Staphylococcus aureus is a common pathogen and causes millions of infections annually. It is well known that innate immune molecules, such as defensins and lysozyme, either poorly inhibit or do not inhibit the growth of S. aureus. Our current studies show that the α-defensin human neutrophil α-defensin-1 (HNP-1) and lysozyme inhibit exotoxin production, both hemolysins and superantigens, which are required for S. aureus infection. HNP-1 inhibited exotoxin production at concentrations as low as 0.001 μg/mL. Lysozyme inhibited exotoxin production at 0.05 to 0.5 μg/mL. Both HNP-1 and lysozyme functioned through at least one two-component system (SrrA/B). The β-defensin human β-defensin 1 (HBD-1) inhibited hemolysin but not superantigen production. The cation chelator S100A8/A9 (calprotectin), compared to EDTA, was tested for the ability to inhibit exotoxin production. EDTA at high concentrations inhibited exotoxin production; these were the same concentrations that interfered with staphylococcal growth. S100A8/A9 at the highest concentration tested (10 μg/mL) had no effect on S. aureus growth but enhanced exotoxin production. Lower concentrations had no effect on growth or exotoxin production. Lysostaphin is regularly used to lyse S. aureus. The lytic concentrations of lysostaphin were the only concentrations that also inhibited growth and exotoxin production. Our studies demonstrate that a major activity of innate defensin peptides and lysozyme is inhibition of staphylococcal exotoxin production but not inhibition of growth. IMPORTANCE Staphylococcus aureus causes large numbers of both relatively benign and serious human infections, which are mediated in large part by the organisms' secreted exotoxins. Since 1921, it has been known that lysozyme and, as shown later in the 1900s, other innate immune peptides, including human neutrophil α-defensin-1 (HNP-1) and human β-defensin 1 (HBD-1), are either not antistaphylococcal or are only weakly inhibitory to growth. Our study confirms those findings but, importantly, shows that at subgrowth inhibitory concentrations, these positively charged innate immune peptides inhibit exotoxin production, including both hemolysins and the superantigen toxic shock syndrome toxin-1. The data show that the principal activity of innate immune peptides in the host is likely to be inhibition of exotoxin production required for staphylococcal mucosal or skin colonization rather than growth inhibition.
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Affiliation(s)
- Patrick M. Schlievert
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Samuel H. Kilgore
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Lisa A. Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Takeshi Yoshida
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Aloysius J. Klingelhutz
- Department of Microbiology and Immunology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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van den Bogaard EH, Elias PM, Goleva E, Berdyshev E, Smits JPH, Danby SG, Cork M, Leung DYM. Targeting skin barrier function in atopic dermatitis. J Allergy Clin Immunol Pract 2023; 11:1335-1346. [PMID: 36805053 DOI: 10.1016/j.jaip.2023.02.005] [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] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/22/2023]
Abstract
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in the general population. Skin barrier dysfunction is the central abnormality leading to AD. The cause of skin barrier dysfunction is complex and rooted in genetic mutations, interactions between the immune pathway activation and epithelial cells, altered host defense mechanisms, as well as environmental influences that cause epithelial cell activation and release of alarmins (such as thymic stromal lymphopoietin) which can activate the type 2 immune pathway, including generation of IL-4 and IL-13, which induces defects in the skin barrier and increased allergic inflammation. These inflammatory pathways are further influenced by environmental factors including the microbiome (especially Staphylococcus aureus), air pollution, stress, and other factors. As such, AD is a syndrome involving multiple phenotypes, all of which have in common skin barrier dysfunction as a key contributing factor. Understanding mechanisms leading to skin barrier dysfunction in AD is pointing to the development of new topical and systemic treatments in AD that helps keep skin borders secure and effectively treat the disease.
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Affiliation(s)
- Ellen H van den Bogaard
- Department of Dermatology, Radboud Institute for Molecular Life Science, Radboud university medical center, Nijmegen, The Netherlands
| | - Peter M Elias
- Department of Dermatology, University of California San Francisco and VA Medical Center, San Francisco, CA 94143
| | - Elena Goleva
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, National Jewish Health, Denver, CO 80206
| | - Evgeny Berdyshev
- Department of Pulmonology, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO 80206
| | - Jos P H Smits
- Department of Dermatology, Radboud Institute for Molecular Life Science, Radboud university medical center, Nijmegen, The Netherlands
| | - Simon G Danby
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School at The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX
| | - Michael Cork
- Department of Infection, Immunity and Cardiovascular Disease, The Medical School at The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX
| | - Donald Y M Leung
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, National Jewish Health, Denver, CO 80206.
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Kim J, Kim BE, Berdyshev E, Bronova I, Bin L, Bae J, Kim S, Kim HY, Lee UH, Kim MS, Kim H, Lee J, Hall CF, Hui-Beckman J, Chang Y, Bronoff AS, Hwang D, Lee HY, Goleva E, Ahn K, Leung DYM. Staphylococcus aureus causes aberrant epidermal lipid composition and skin barrier dysfunction. Allergy 2023; 78:1292-1306. [PMID: 36609802 DOI: 10.1111/all.15640] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Staphylococcus (S) aureus colonization is known to cause skin barrier disruption in atopic dermatitis (AD) patients. However, it has not been studied how S. aureus induces aberrant epidermal lipid composition and skin barrier dysfunction. METHODS Skin tape strips (STS) and swabs were obtained from 24 children with AD (6.0 ± 4.4 years) and 16 healthy children (7.0 ± 4.5 years). Lipidomic analysis of STS samples was performed by mass spectrometry. Skin levels of methicillin-sensitive and methicillin-resistant S. aureus (MSSA and MRSA) were evaluated. The effects of MSSA and MRSA were evaluated in primary human keratinocytes (HEKs) and organotypic skin cultures. RESULTS AD and organotypic skin colonized with MRSA significantly increased the proportion of lipid species with nonhydroxy fatty acid sphingosine ceramide with palmitic acid ([N-16:0 NS-CER], sphingomyelins [16:0-18:0 SM]), and lysophosphatidylcholines [16:0-18:0 LPC], but significantly reduced the proportion of corresponding very long-chain fatty acids (VLCFAs) species (C22-28) compared to the skin without S. aureus colonization. Significantly increased transepidermal water loss (TEWL) was found in MRSA-colonized AD skin. S. aureus indirectly through interleukin (IL)-1β, tumor necrosis factor (TNF)-α, IL-6, and IL-33 inhibited expression of fatty acid elongase enzymes (ELOVL3 and ELOVL4) in HEKs. ELOVL inhibition was more pronounced by MRSA and resulted in TEWL increase in organotypic skin. CONCLUSION Aberrant skin lipid profiles and barrier dysfunction are associated with S. aureus colonization in AD patients. These effects are attributed to the inhibition of ELOVLs by S. aureus-induced IL-1β, TNF-α, IL-6, and IL-33 seen in keratinocyte models and are more prominent in MRSA than MSSA.
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Affiliation(s)
- Jihyun Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.,Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Eui Kim
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA.,Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Evgeny Berdyshev
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Irina Bronova
- Department of Medicine, National Jewish Health, Denver, Colorado, USA
| | - Lianghua Bin
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Jaewoong Bae
- R&D Institute, BioEleven Co., Ltd., Seoul, Korea
| | - Seokjin Kim
- R&D Institute, BioEleven Co., Ltd., Seoul, Korea
| | - Hye-Young Kim
- Department of Pediatrics, Medical Research Institute of Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Un Ha Lee
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Myoung Shin Kim
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyunmi Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jinyoung Lee
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Clifton F Hall
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | | | - Yunhee Chang
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Korea
| | | | - Dasom Hwang
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Korea
| | - Hae-Young Lee
- Department of Biomedical Laboratory Science, College of Health Sciences, Yonsei University, Wonju, Korea
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
| | - Kangmo Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado, USA
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29
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Nevid MZ, Leung DYM, Crooks JL, Lanser BJ. The diagnostic challenge of sesame allergy: A review of sesame oral food challenges in a pediatric clinic. Ann Allergy Asthma Immunol 2023; 130:118-119. [PMID: 36596610 DOI: 10.1016/j.anai.2022.10.015] [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] [Received: 10/20/2022] [Accepted: 10/20/2022] [Indexed: 01/02/2023]
Affiliation(s)
- Michael Z Nevid
- Division of Allergy and Clinical Immunology, Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Division of Allergy and Clinical Immunology, Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | - James L Crooks
- Division of Biostatistics and Bioinformatics, Department of Immunology and Genomic Medicine, National Jewish Health, Denver, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Bruce J Lanser
- Division of Allergy and Clinical Immunology, Department of Pediatrics, National Jewish Health, Denver, Colorado
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30
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Spergel JM, Leung DYM. Topical steroid withdrawal syndrome: Should we worry? Ann Allergy Asthma Immunol 2023; 130:8. [PMID: 36596614 DOI: 10.1016/j.anai.2022.09.005] [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] [Received: 08/26/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 01/02/2023]
Affiliation(s)
- Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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31
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Leung DYM, Paller AS, Zaenglein AL, Tom WL, Ong PY, Venturanza ME, Kuligowski ME, Li Q, Gong X, Lee MS. Safety, pharmacokinetics, and efficacy of ruxolitinib cream in children and adolescents with atopic dermatitis. Ann Allergy Asthma Immunol 2022; 130:500-507.e3. [PMID: 36586583 DOI: 10.1016/j.anai.2022.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Therapies for children with atopic dermatitis (AD) have safety and tolerability concerns that may limit long-term use. Ruxolitinib cream, a Janus kinase (JAK) inhibitor, is effective and well tolerated in adolescents and adults with AD. OBJECTIVE To analyze the safety and tolerability of ruxolitinib cream in pediatric patients. Pharmacokinetics and efficacy were also evaluated in this phase 1 study (NCT03257644). METHODS Patients aged 2 to 17 years with AD (affected body surface area 8%-20%; Investigator's Global Assessment score ≥2) were enrolled stepwise in 6 age-descending, strength-increasing cohorts to apply 0.5%, 0.75%, or 1.5% ruxolitinib cream twice daily for 28 days. Safety, pharmacokinetics, and efficacy were analyzed at baseline, week 2 (day 10), and week 4 (day 29). RESULTS Among 71 patients, 44 (62.0%) had a baseline Investigator's Global Assessment score of 3; median (range) body surface area affected at baseline was 12.2% (1.7%-20.4%). Ruxolitinib cream was well tolerated, with 4 patients (5.6%) experiencing treatment-related adverse events (all grades 1/2). No clinically meaningful changes in mean chemistry or hematology values were observed, and no consistent pattern of change in bone biomarkers was detected. Mean plasma ruxolitinib levels within each cohort (range, 23.1-97.9 nM) were well below the half-maximal inhibitory concentration for thrombopoietin phosphorylation of STAT3 (281 nM). All cohorts experienced improvements in exploratory efficacy end points. CONCLUSION Ruxolitinib cream was well tolerated in pediatric patients with AD, with no effect on blood counts or bone biomarkers. Mean plasma concentration was low. Efficacy was consistent with data from previous studies in adolescents and adults. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03257644.
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Affiliation(s)
| | - Amy S Paller
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Wynnis L Tom
- University of California, San Diego and Rady Children's Hospital, San Diego, California
| | - Peck Y Ong
- Children's Hospital Los Angeles, Los Angeles, California
| | | | | | - Qian Li
- Incyte Corporation, Wilmington, Delaware
| | | | - Mark S Lee
- Progressive Clinical Research, San Antonio, Texas
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32
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Liu EG, Zhang B, Martin V, Anthonypillai J, Kraft M, Grishin A, Grishina G, Catanzaro JR, Chinthrajah S, Sindher T, Manohar M, Quake AZ, Nadeau K, Burks AW, Kim EH, Kulis MD, Henning AK, Jones SM, Leung DYM, Sicherer SH, Wood RA, Yuan Q, Shreffler W, Sampson H, Shabanova V, Eisenbarth SC. Food-specific immunoglobulin A does not correlate with natural tolerance to peanut or egg allergens. Sci Transl Med 2022; 14:eabq0599. [PMID: 36383680 PMCID: PMC10219469 DOI: 10.1126/scitranslmed.abq0599] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ImmunoglobulinA (IgA) is the predominant antibody isotype in the gut, where it regulates commensal flora and neutralizes toxins and pathogens. The function of food-specific IgA in the gut is unknown but is presumed to protect from food allergy. Specifically, it has been hypothesized that food-specific IgA binds ingested allergens and promotes tolerance by immune exclusion; however, the evidence to support this hypothesis is indirect and mixed. Although it is known that healthy adults have peanut-specific IgA in the gut, it is unclear whether children also have gut peanut-specific IgA. We found in a cohort of non-food-allergic infants (n = 112) that there is detectable stool peanut-specific IgA that is similar to adult quantities of gut peanut-specific IgA. To investigate whether this peanut-specific IgA is associated with peanut tolerance, we examined a separate cohort of atopic children (n = 441) and found that gut peanut-specific IgA does not predict protection from development of future peanut allergy in infants nor does it correlate with concurrent oral tolerance of peanut in older children. We observed higher plasma peanut-specific IgA in those with peanut allergy. Similarly, egg white-specific IgA was detectable in infant stools and did not predict egg tolerance or outgrowth of egg allergy. Bead-based epitope assay analysis of gut peanut-specific IgA revealed similar epitope specificity between children with peanut allergy and those without; however, gut peanut-specific IgA and plasma peanut-specific IgE had different epitope specificities. These findings call into question the presumed protective role of food-specific IgA in food allergy.
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Affiliation(s)
- Elise G. Liu
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Biyan Zhang
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Singapore Immunology Network, Agency for Science, Technology, and Research, Singapore 138648, Singapore
| | - Victoria Martin
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street, Boston, MA 02114, USA
- Food Allergy Science Initiative, Broad Institute, Cambridge, MA 02142, USA
| | - John Anthonypillai
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Magdalena Kraft
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Alexander Grishin
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Galina Grishina
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jason R. Catanzaro
- Section of Pulmonology, Allergy, Immunology, and Sleep Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Sharon Chinthrajah
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Tina Sindher
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Monali Manohar
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Antonia Zoe Quake
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Stanford, CA 94040, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, Stanford University, Stanford, CA 94305, USA
| | - A. Wesley Burks
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Edwin H. Kim
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | - Michael D. Kulis
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
| | | | - Stacie M. Jones
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, Little Rock, AR 72205, USA
| | - Donald Y. M. Leung
- Department of Pediatrics, Division of Pediatric Allergy-Immunology, National Jewish Health, Denver, CO 80206, USA
| | - Scott H. Sicherer
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Robert A. Wood
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Qian Yuan
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street, Boston, MA 02114, USA
- Food Allergy Science Initiative, Broad Institute, Cambridge, MA 02142, USA
- Pediatrics at Newton Wellesley, Newton, MA 02462, USA
| | - Wayne Shreffler
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Food Allergy Center, Massachusetts General Hospital, MGH Professional Office Building, Suite 530, 275 Cambridge Street, Boston, MA 02114, USA
- Food Allergy Science Initiative, Broad Institute, Cambridge, MA 02142, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hugh Sampson
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Veronika Shabanova
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Stephanie C. Eisenbarth
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT 06519, USA
- Department of Medicine, Section of Rheumatology, Allergy, and Immunology, Yale University School of Medicine, New Haven, CT 06519, USA
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Berdyshev E, Goleva E, Bissonnette R, Bronova I, Bronoff AS, Richers BN, Garcia S, Ramirez-Gama M, Taylor P, Praestgaard A, Agueusop I, Jurvilliers P, Boguniewicz M, Levit NA, Rossi AB, Zhang A, Leung DYM. Dupilumab significantly improves skin barrier function in patients with moderate-to-severe atopic dermatitis. Allergy 2022; 77:3388-3397. [PMID: 35815904 DOI: 10.1111/all.15432] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is characterized by abnormal skin lipids that are largely driven by hyperactivated type 2 immune responses. The antibody to the α-subunit of interleukin (IL)-4 receptor, dupilumab, was recently approved to treat AD and demonstrated strong efficacy. However, the role of dupilumab therapy in the regulation of skin barrier structure and function has not been fully explored. METHODS We have evaluated the content of lipids and transepidermal water loss (TEWL) in lesional and non-lesional skin of adults and adolescents with moderate-to-severe AD over the course of 16-week treatment with dupilumab and compared those values with that of matched healthy volunteers. RESULTS Dupilumab treatment provided a significant decrease in TEWL in AD lesions, lowering it almost to the levels seen in the skin of healthy subjects. Blocking IL-4/IL-13 signaling with dupilumab normalized lipid composition (decreased levels of ceramides with non-hydroxy fatty acids and C18-sphingosine and increased the level of esterified omega-hydroxy fatty acid-containing ceramides) and increased ceramide chain length in lesional as well as non-lesional stratum corneum of AD patients. Partial changes for these parameters were already observed after 2 weeks, with a full response achieved after 8 weeks of dupilumab treatment. CONCLUSIONS Inhibition of IL-4/IL-13 signaling by dupilumab allows restoration of skin lipid composition and barrier function in patients with moderate-to-severe AD.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Noah A Levit
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
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Huffaker MF, Kanchan K, Bahnson HT, Ruczinski I, Shankar G, Leung DYM, Baloh C, Du Toit G, Lack G, Nepom GT, Mathias RA. Epidermal Differentiation Complex Genetic Variation in Atopic Dermatitis and Peanut Allergy. J Allergy Clin Immunol 2022; 151:1137-1142.e4. [PMID: 36403663 DOI: 10.1016/j.jaci.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Deleterious variation in the epidermal differentiation complex (EDC) on chromosome 1 is a well-known genetic determinant of atopic dermatitis (AD) and has been associated with risk of peanut allergy (PA) in population-based studies. OBJECTIVE Our aim was to determine the effect of genetic variation in the EDC on AD trajectory and risk of PA in early life. METHODS Genome sequencing was used to measure genetic variation in the EDC in the Learning Early about Peanut Allergy (LEAP) study participants. Association tests were done to identify gene- and variant-level predicted deleterious variation associated with AD severity by using the Scoring Atopic Dermatitis (SCORAD) tool (n = 559) at baseline and each follow-up visit, as well as PA and food allergy in peanut avoiders (n = 275). Predicted deleterious variants included missense variants that were frameshift insertions, frameshift deletions, stop-gain mutations, or stop-loss mutations. Associations between variant load, SCORAD score, and PA were tested by using linear and generalized linear regression models. RESULTS The genes FLG, FLG2, HRNR, and TCHH1 harbored the most predicted deleterious variation (30, 6, 3, and 1 variant, respectively). FLG variants were associated with SCORAD score at all time points; 4 variants (R1798X, R501X, S126X, and S761fs) drove the association with SCORAD score at each time point, and higher variant load was associated with greater AD severity over time. There was an association between these variants and PA, which remained significant independent of baseline AD severity (odds ratio = 2.63 [95% CI = 1.11-6.01] [P = .02]). CONCLUSIONS Variation in FLG predicted to be deleterious is associated with AD severity at baseline and longitudinally and has an association with PA independent of baseline severity.
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Affiliation(s)
| | - Kanika Kanchan
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, Baltimore, Md
| | - Henry T Bahnson
- Immune Tolerance Network, Seattle, Wash; Benaroya Research Institute at Virginia Mason, Seattle, Wash
| | - Ingo Ruczinski
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md
| | - Gautam Shankar
- Division of Allergy and Clinical Immunology, Department of Medicine, School of Medicine, Baltimore, Md
| | - Donald Y M Leung
- Division of Pediatric Allergy and Immunology, National Jewish Health, Denver, Colo
| | - Carolyn Baloh
- Immune Tolerance Network, San Francisco, Calif; Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass
| | - George Du Toit
- Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London, and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gideon Lack
- Department of Pediatric Allergy, Division of Asthma, Allergy and Lung Biology, King's College London, and Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gerald T Nepom
- Immune Tolerance Network, Seattle, Wash; Benaroya Research Institute at Virginia Mason, Seattle, Wash
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35
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Rabinovitch N, Nevid M, Lomas C, Covar R, Levy H, Leung DYM. Reversible peripheral airway obstruction and lung hyperinflation in children presenting with dyspnea and exercise intolerance after COVID-19 infection. The Journal of Allergy and Clinical Immunology: In Practice 2022; 10:2748-2749.e1. [PMID: 36184531 PMCID: PMC9520121 DOI: 10.1016/j.jaip.2022.07.038] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nathan Rabinovitch
- Department of Pediatrics, Division of Allergy and Immunology, National Jewish Health, Denver, Colo.
| | - Michael Nevid
- Department of Pediatrics, Division of Allergy and Immunology, National Jewish Health, Denver, Colo
| | - Chad Lomas
- Department of Pediatrics, Division of Allergy and Immunology, National Jewish Health, Denver, Colo
| | - Ronina Covar
- Department of Pediatrics, Division of Allergy and Immunology, National Jewish Health, Denver, Colo
| | - Hara Levy
- Department of Pediatrics, Division of Pulmonary Medicine, the University of Wisconsin-Madison, Madison, Wis
| | - Donald Y M Leung
- Department of Pediatrics, Division of Allergy and Immunology, National Jewish Health, Denver, Colo
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36
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Leung DYM, Ong PY. Dupilumab nonresponders in atopic dermatitis. Ann Allergy Asthma Immunol 2022; 129:267-268. [PMID: 35988971 DOI: 10.1016/j.anai.2022.05.029] [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] [Received: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 10/15/2022]
Affiliation(s)
| | - Peck Y Ong
- Division of Clinical Immunology and Allergy, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California.
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Berdyshev E, Goleva E, Bronova I, Bronoff AS, Streib JE, Vang KA, Richers BN, Taylor P, Beck L, Villarreal M, Johnson K, David G, Slifka MK, Hanifin J, Leung DYM. Signaling sphingolipids are biomarkers for atopic dermatitis prone to disseminated viral infections. J Allergy Clin Immunol 2022; 150:640-648. [PMID: 35304160 PMCID: PMC9463085 DOI: 10.1016/j.jaci.2022.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Life-threatening viral diseases such as eczema herpeticum (EH) and eczema vaccinatum (EV) occur in <5% of individuals with atopic dermatitis (AD). The diagnosis of AD, however, excludes all individuals with AD from smallpox vaccination. OBJECTIVES We sought to identify circulatory and skin lipid biomarkers associated with EH and EV. METHODS Stratum corneum and plasma samples from 15 subjects with AD and a history of EH, 13 age- and gender-matched subjects with AD and without EH history, and 13 healthy nonatopic (NA) controls were analyzed by liquid chromatography tandem mass spectrometry for sphingolipid content. Sphingosine-1-phosphate (S1P) and ceramide levels were validated in plasma samples from the Atopic Dermatitis Vaccinia Network/Atopic Dermatitis Research Network repository (12 NA, 12 AD, 23 EH) and plasma from 7 subjects with EV and 7 matched subjects with AD. S1P lyase was downregulated in human primary keratinocytes to evaluate its effect on herpes simplex virus 1 (HSV-1) replication in vitro. RESULTS The stratum corneum of patients with EH demonstrated significantly higher levels of free sphingoid bases than those in patients who were NA, indicating enhanced sphingolipid turnover in keratinocytes (P < .05). Plasma from 2 independent cohorts of patients with EH had a significantly increased S1P/ceramide ratio in subjects with EH versus those with AD and or who were NA (P < .01). The S1P level in plasma from subjects with EV was twice the level in plasma from subjects with AD (mean = 1,533 vs 732 pmol/mL; P < .001). Downregulation of S1P lyase expression with silencing RNA led to an increased S1P level and doubled HSV-1 titer in keratinocytes. CONCLUSIONS Our data point to long-term abnormalities in the S1P signaling system as a biomarker for previous disseminated viral diseases and a potential treatment target in recurring infections.
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Affiliation(s)
- Evgeny Berdyshev
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Irina Bronova
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colo
| | | | - Joanne E Streib
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Kathryn A Vang
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | | | - Patricia Taylor
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | - Lisa Beck
- Department of Dermatology, Medicine and Pathology, University of Rochester Medical Center, Rochester, NY
| | | | | | | | - Mark K Slifka
- Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore
| | - Jon Hanifin
- Department of Dermatology, Oregon Health and Science University, Portland, Ore
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Kuo AM, Kraehenbuehl L, King S, Leung DYM, Goleva E, Moy AP, Lacouture ME, Shah NJ, Faleck DM. Contribution of the Skin-Gut Axis to Immune-Related Adverse Events with Multi-System Involvement. Cancers (Basel) 2022; 14:cancers14122995. [PMID: 35740660 PMCID: PMC9221505 DOI: 10.3390/cancers14122995] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Increasing numbers of cancer patients are treated with immunotherapy that activates their immune systems to control or even eliminate tumors. However, a substantial proportion of patients experience adverse events mediated by the unleashed immune system. The skin is one of the most frequently affected organs, with toxicities typically manifesting as distinct types of rashes. The gastrointestinal (GI) tract is also commonly affected, with a wide spectrum of symptom manifestations that can range from self-limited diarrhea to life-threatening colitis. Here we present the relationship between skin and GI adverse events among cancer patients receiving treatment with immune checkpoint blockade, which has not been well-studied. Abstract Immune-related adverse events (irAEs) frequently complicate treatment with immune checkpoint blockade (ICB) targeting CTLA-4, PD-1, and PD-L1, which are commonly used to treat solid and hematologic malignancies. The skin and gastrointestinal (GI) tract are most frequently affected by irAEs. While extensive efforts to further characterize organ-specific adverse events have contributed to the understanding and management of individual toxicities, investigations into the relationship between multi-organ toxicities have been limited. Therefore, we aimed to conduct a characterization of irAEs occurring in both the skin and gut. A retrospective analysis of two cohorts of patients treated with ICB at Memorial Sloan Kettering Cancer Center was conducted, including a cohort of patients with cutaneous irAEs (ircAEs) confirmed by dermatologists (n = 152) and a cohort of patients with biopsy-proven immune-related colitis (n = 246). Among both cohorts, 15% (61/398) of patients developed both skin and GI irAEs, of which 72% (44/61) patients had ircAEs preceding GI irAEs (p = 0.00013). Our study suggests that in the subset of patients who develop both ircAEs and GI irAEs, ircAEs are likely to occur first. Further prospective studies with larger sample sizes are needed to validate our findings, to assess the overall incidence of co-incident irAEs, and to determine whether ircAEs are predictors of other irAEs. This analysis highlights the development of multi-system dermatologic and gastrointestinal irAEs and underscores the importance of oncologists, gastroenterologists, and dermatologists confronted with an ircAE to remain alert for additional irAEs.
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Affiliation(s)
- Alyce M. Kuo
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (A.M.K.); (M.E.L.)
| | - Lukas Kraehenbuehl
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (A.M.K.); (M.E.L.)
- Ludwig Collaborative and Swim Across America Laboratory, Parker Institute for Cancer Immunotherapy, Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
- Correspondence: or
| | - Stephanie King
- Gastroenterology, Hepatology & Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.K.); (D.M.F.)
| | - Donald Y. M. Leung
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health Hospital, Denver, CO 80206, USA; (D.Y.M.L.); (E.G.)
| | - Elena Goleva
- Division of Allergy-Immunology, Department of Pediatrics, National Jewish Health Hospital, Denver, CO 80206, USA; (D.Y.M.L.); (E.G.)
| | - Andrea P. Moy
- Dermatopathology Service, Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Mario E. Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA; (A.M.K.); (M.E.L.)
| | - Neil J. Shah
- Genitourinary Solid Tumor Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - David M. Faleck
- Gastroenterology, Hepatology & Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (S.K.); (D.M.F.)
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Wang EA, Leung DYM. Allergens and atopic dermatitis. Ann Allergy Asthma Immunol 2022; 128:624-625. [PMID: 35017082 DOI: 10.1016/j.anai.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/29/2021] [Accepted: 01/01/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Evelyn A Wang
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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40
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Grayson MH, Borish L, Castells MC, Greenhawt MJ, Leung DYM, Lieberman JA, Marshall GD, Nowak-Wegrzyn A, Oppenheimer J, Shaker MS, Shulenberger K, Spergel J, Stukus DR. Annals editors on the war in Ukraine. Ann Allergy Asthma Immunol 2022; 128:619-620. [PMID: 35342018 DOI: 10.1016/j.anai.2022.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, Ohio; Annals of Allergy, Asthma, and Immunology Editorial Office, Nationwide Children's Hospital, Columbus, Ohio.
| | - Larry Borish
- Asthma and Allergic Disease Center, Departments of Medicine and Microbiology, University of Virginia Health System, Charlottesville, Virginia
| | - Mariana C Castells
- Division of Allergy and Clinical Immunology. Department of Medicine, Brigham and Women's Hospital and Harvard Medical School. Boston, Massachusetts
| | - Matthew J Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado-University of Colorado School of Medicine, Aurora, Colorado
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee; Division of Pulmonology, Allergy, and Immunology, Department of Pediatrics, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Gailen D Marshall
- Division of Allergy, Asthma and Clinical Immunology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, New York University Grossman School of Medicine, New York, New York; Department of Pediatrics, Hassenfeld Children's Hospital, New York, New York
| | - John Oppenheimer
- Pulmonary and Allergy Associates, Summit, New Jersey; The University of Medicine and Dentistry of New Jersey Rutgers, Newark, New Jersey
| | - Marcus S Shaker
- Section of Allergy and Clinical Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Pediatrics, Medicine, and Community and Family Medicine, Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Kurt Shulenberger
- Annals of Allergy, Asthma, and Immunology Editorial Office, Nationwide Children's Hospital, Columbus, Ohio
| | - Jonathan Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital-The Ohio State University College of Medicine, Columbus, Ohio
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41
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Leung DYM. Targeting the skin in atopic dermatitis. Ann Allergy Asthma Immunol 2022; 128:481-482. [PMID: 35489797 DOI: 10.1016/j.anai.2022.01.044] [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] [Received: 01/20/2022] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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Leung DYM, Paller AS, Guttman-Yassky E. New therapies for atopic dermatitis: How will they impact skin care? Ann Allergy Asthma Immunol 2022; 128:344-345. [PMID: 35093553 DOI: 10.1016/j.anai.2022.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
| | - Amy S Paller
- Department of Dermatology, Northwestern University, Chicago, Illinois
| | - Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
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Affiliation(s)
- John Oppenheimer
- New Jersey Medical School, University of Medicine and Dentistry of New Jersey (UMDNJ), Newark, New Jersey.
| | - Donald Y M Leung
- Department of Pediatrics, Division of Allergy and Immunology, National Jewish Health, Denver, Colorado
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Brough HA, Lanser BJ, Sindher SB, Teng JMC, Leung DYM, Venter C, Chan SM, Santos AF, Bahnson HT, Guttman‐Yassky E, Gupta RS, Lack G, Ciaccio CE, Sampath V, Nadeau KC, Nagler CR. Early intervention and prevention of allergic diseases. Allergy 2022; 77:416-441. [PMID: 34255344 DOI: 10.1111/all.15006] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022]
Abstract
Food allergy (FA) is now one of the most common chronic diseases of childhood often lasting throughout life and leading to significant worldwide healthcare burden. The precise mechanisms responsible for the development of this inflammatory condition are largely unknown; however, a multifactorial aetiology involving both environmental and genetic contributions is well accepted. A precise understanding of the pathogenesis of FA is an essential first step to developing comprehensive prevention strategies that could mitigate this epidemic. As it is frequently preceded by atopic dermatitis and can be prevented by early antigen introduction, the development of FA is likely facilitated by the improper initial presentation of antigen to the developing immune system. Primary oral exposure of antigens allowing for presentation via a well-developed mucosal immune system, rather than through a disrupted skin epidermal barrier, is essential to prevent FA. In this review, we present the data supporting the necessity of (1) an intact epidermal barrier to prevent epicutaneous antigen presentation, (2) the presence of specific commensal bacteria to maintain an intact mucosal immune system and (3) maternal/infant diet diversity, including vitamins and minerals, and appropriately timed allergenic food introduction to prevent FA.
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Affiliation(s)
- Helen A. Brough
- Department Women and Children’s Health (Pediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’s NHS Foundation Trust London UK
| | - Bruce Joshua Lanser
- Division of Pediatric Allergy‐Immunology Department of Pediatrics National Jewish Health Denver CO USA
| | - Sayantani B. Sindher
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
- Division of Pulmonary and Critical Care Medicine Department of Medicine Stanford University Stanford CA USA
- Division of Allergy, Immunology and Rheumatology Department of Medicine Stanford University Stanford CA USA
| | - Joyce M. C. Teng
- Department of Dermatology Lucile Packard Children's Hospital at the Stanford University School of Medicine Palo Alto CA USA
| | - Donald Y. M. Leung
- Division of Pediatric Allergy‐Immunology Department of Pediatrics National Jewish Health Denver CO USA
| | - Carina Venter
- Section of Allergy & Immunology School of Medicine University of Colorado DenverChildren's Hospital Colorado Aurora CO USA
| | - Susan M. Chan
- Department Women and Children’s Health (Pediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’s NHS Foundation Trust London UK
| | - Alexandra F. Santos
- Department Women and Children’s Health (Pediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’s NHS Foundation Trust London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Henry T. Bahnson
- Benaroya Research Institute and Immune Tolerance Network Seattle WA USA
| | - Emma Guttman‐Yassky
- Department of Dermatology and the Immunology Institute Icahn School of Medicine at Mount Sinai New York NY USA
- Laboratory for Investigative Dermatology The Rockefeller University New York NY USA
| | - Ruchi S. Gupta
- Center for Food Allergy and Asthma Research Northwestern University Feinberg School of Medicine Chicago IL USA
- Ann & Robert H. Lurie Children's Hospital of Chicago Chicago IL USA
| | - Gideon Lack
- Department Women and Children’s Health (Pediatric Allergy) School of Life Course Sciences Faculty of Life Sciences and Medicine King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Evelina Children’s Hospital Guy’s and St. Thomas’s NHS Foundation Trust London UK
| | | | - Vanitha Sampath
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
| | - Kari C. Nadeau
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University Stanford University Stanford CA USA
- Division of Pulmonary and Critical Care Medicine Department of Medicine Stanford University Stanford CA USA
- Division of Allergy, Immunology and Rheumatology Department of Medicine Stanford University Stanford CA USA
| | - Cathryn R. Nagler
- Department of Pathology and Pritzker School of Molecular Engineering University of Chicago Chicago IL USA
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Suprun M, Sicherer SH, Wood RA, Jones SM, Leung DYM, Burks AW, Dunkin D, Witmer M, Grishina G, Getts R, Suárez-Fariñas M, Sampson HA. Mapping Sequential IgE-Binding Epitopes on Major and Minor Egg Allergens. Int Arch Allergy Immunol 2021; 183:249-261. [PMID: 34818647 DOI: 10.1159/000519618] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Molecular studies of hen's egg allergens help define allergic phenotypes, with IgE to sequential (linear) epitopes on the ovomucoid (OVM) protein associated with a persistent disease. Epitope profiles of other egg allergens are largely unknown. The objective of this study was to construct an epitope library spanning across 7 allergens and further evaluate sequential epitope-specific (ses-)IgE and ses-IgG4 among baked-egg reactive or tolerant children. METHODS A Bead-Based Epitope Assay was used to identify informative IgE epitopes from 15-mer overlapping peptides covering the entire OVM and ovalbumin (OVA) proteins in 38 egg allergic children. An amalgamation of 12 B-cell epitope prediction tools was developed using experimentally identified epitopes. This ensemble was used to predict epitopes from ovotransferrin, lysozyme, serum albumin, vitellogenin-II fragment, and vitellogenin-1 precursor. Ses-IgE and ses-IgG4 repertoires of 135 egg allergic children (82 reactive to baked-egg, the remaining 52 tolerant), 46 atopic controls, and 11 healthy subjects were compared. RESULTS 183 peptides from OVM and OVA were screened and used to create an aggregate algorithm, improving predictions of 12 individual tools. A final library of 65 sequential epitopes from 7 proteins was constructed. Egg allergic children had higher ses-IgE and lower ses-IgG4 to predominantly OVM epitopes than both atopic and healthy controls. Baked-egg reactive children had similar ses-IgG4 but greater ses-IgE than tolerant group. A combination of OVA-sIgE with ses-IgEs to OVM-023 and OVA-028 was the best predictor of reactive phenotype. CONCLUSION We have created a comprehensive epitope library and showed that ses-IgE is a potential biomarker of baked-egg reactivity.
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Affiliation(s)
- Maria Suprun
- Icahn School of Medicine at Mount Sinai, New York, New York, USA,
| | - Scott H Sicherer
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stacie M Jones
- University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | | | - A Wesley Burks
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - David Dunkin
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Galina Grishina
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Hugh A Sampson
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Affiliation(s)
- John J Oppenheimer
- Department of Internal Medicine, New Jersey Medical School, Newark, New Jersey; Pulmonary and Allergy Associates, Morristown, New Jersey.
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47
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Hui-Beckman J, Leung DYM, Goleva E. Hand hygiene impact on the skin barrier in health care workers and individuals with atopic dermatitis. Ann Allergy Asthma Immunol 2021; 128:108-110. [PMID: 34400312 PMCID: PMC8363178 DOI: 10.1016/j.anai.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 11/05/2022]
Affiliation(s)
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Elena Goleva
- Department of Pediatrics, National Jewish Health, Denver, Colorado
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Bin L, Malley C, Taylor P, Preethi Boorgula M, Chavan S, Daya M, Mathias M, Shankar G, Rafaels N, Vergara C, Potee J, Campbell M, Hanifin JM, Simpson E, Schneider LC, Gallo RL, Hata T, Paller AS, De Benedetto A, Beck LA, Ong PY, Guttman‐Yassky E, Richers B, Baraghoshi D, Ruczinski I, Barnes KC, Leung DYM, Mathias RA. Whole genome sequencing identifies novel genetic mutations in patients with eczema herpeticum. Allergy 2021; 76:2510-2523. [PMID: 33548076 DOI: 10.1111/all.14762] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Eczema herpeticum (EH) is a rare complication of atopic dermatitis (AD) caused by disseminated herpes simplex virus (HSV) infection. The role of rare and/or deleterious genetic variants in disease etiology is largely unknown. This study aimed to identify genes that harbor damaging genetic variants associated with HSV infection in AD with a history of recurrent eczema herpeticum (ADEH+). METHODS Whole genome sequencing (WGS) was performed on 49 recurrent ADEH+ (≥3 EH episodes), 491 AD without a history of eczema herpeticum (ADEH-) and 237 non-atopic control (NA) subjects. Variants were annotated, and a gene-based approach (SKAT-O) was used to identify genes harboring damaging genetic variants associated with ADEH+. Genes identified through WGS were studied for effects on HSV responses and keratinocyte differentiation. RESULTS Eight genes were identified in the comparison of recurrent ADEH+to ADEH-and NA subjects: SIDT2, CLEC7A, GSTZ1, TPSG1, SP110, RBBP8NL, TRIM15, and FRMD3. Silencing SIDT2 and RBBP8NL in normal human primary keratinocytes (NHPKs) led to significantly increased HSV-1 replication. SIDT2-silenced NHPKs had decreased gene expression of IFNk and IL1b in response to HSV-1 infection. RBBP8NL-silenced NHPKs had decreased gene expression of IFNk, but increased IL1b. Additionally, silencing SIDT2 and RBBP8NL also inhibited gene expression of keratinocyte differentiation markers keratin 10 (KRT10) and loricrin (LOR). CONCLUSION SIDT2 and RBBP8NL participate in keratinocyte's response to HSV-1 infection. SIDT2 and RBBP8NL also regulate expression of keratinocyte differentiation genes of KRT10 and LOR.
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Affiliation(s)
- Lianghua Bin
- Department of Pediatrics National Jewish Health Denver CO USA
| | - Claire Malley
- Division of Allergy and Clinical Immunology Johns Hopkins University Baltimore MD USA
| | - Patricia Taylor
- Department of Pediatrics National Jewish Health Denver CO USA
| | | | - Sameer Chavan
- Department of Medicine University of Colorado Aurora CO USA
| | - Michelle Daya
- Department of Medicine University of Colorado Aurora CO USA
| | - Malaika Mathias
- Division of Allergy and Clinical Immunology Johns Hopkins University Baltimore MD USA
| | - Gautam Shankar
- Division of Allergy and Clinical Immunology Johns Hopkins University Baltimore MD USA
| | | | | | | | | | | | - Eric Simpson
- Oregon Health & Science University Portland OR USA
| | | | - Richard L. Gallo
- Department of Dermatology University of California San Diego CA USA
| | - Tissa Hata
- Department of Dermatology University of California San Diego CA USA
| | - Amy S. Paller
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | | | - Lisa A. Beck
- University of Rochester Medical Center Rochester NY USA
| | - Peck Y. Ong
- Children’s Hospital Los Angeles University of Southern California Los Angeles CA USA
| | | | | | | | - Ingo Ruczinski
- Department of Biostatistics Bloomberg School of Public Health Johns Hopkins University Baltimore MD USA
| | | | | | - Rasika A. Mathias
- Division of Allergy and Clinical Immunology Johns Hopkins University Baltimore MD USA
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Hui-Beckman J, Leung DYM. The importance of considering mental health in the management of atopic dermatitis across the lifespan. Ann Allergy Asthma Immunol 2021; 127:159-160. [PMID: 34348850 DOI: 10.1016/j.anai.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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Leung DYM. Immune-related cutaneous adverse events: A new opportunity for allergists and clinical immunologists. Ann Allergy Asthma Immunol 2021; 126:607. [PMID: 34049668 DOI: 10.1016/j.anai.2020.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 10/21/2022]
Affiliation(s)
- Donald Y M Leung
- Department of Pediatrics, National Jewish Health, Denver, Colorado.
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