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Böck A, Urner K, Eckert JK, Salvermoser M, Laubhahn K, Kunze S, Kumbrink J, Hoeppner MP, Kalkbrenner K, Kreimeier S, Beyer K, Hamelmann E, Kabesch M, Depner M, Hansen G, Riedler J, Roponen M, Schmausser-Hechfellner E, Barnig C, Divaret-Chauveau A, Karvonen AM, Pekkanen J, Frei R, Roduit C, Lauener R, Schaub B. An integrated molecular risk score early in life for subsequent childhood asthma risk. Clin Exp Allergy 2024; 54:314-328. [PMID: 38556721 DOI: 10.1111/cea.14475] [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: 08/30/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Numerous children present with early wheeze symptoms, yet solely a subgroup develops childhood asthma. Early identification of children at risk is key for clinical monitoring, timely patient-tailored treatment, and preventing chronic, severe sequelae. For early prediction of childhood asthma, we aimed to define an integrated risk score combining established risk factors with genome-wide molecular markers at birth, complemented by subsequent clinical symptoms/diagnoses (wheezing, atopic dermatitis, food allergy). METHODS Three longitudinal birth cohorts (PAULINA/PAULCHEN, n = 190 + 93 = 283, PASTURE, n = 1133) were used to predict childhood asthma (age 5-11) including epidemiological characteristics and molecular markers: genotype, DNA methylation and mRNA expression (RNASeq/NanoString). Apparent (ap) and optimism-corrected (oc) performance (AUC/R2) was assessed leveraging evidence from independent studies (Naïve-Bayes approach) combined with high-dimensional logistic regression models (LASSO). RESULTS Asthma prediction with epidemiological characteristics at birth (maternal asthma, sex, farm environment) yielded an ocAUC = 0.65. Inclusion of molecular markers as predictors resulted in an improvement in apparent prediction performance, however, for optimism-corrected performance only a moderate increase was observed (upto ocAUC = 0.68). The greatest discriminate power was reached by adding the first symptoms/diagnosis (up to ocAUC = 0.76; increase of 0.08, p = .002). Longitudinal analysis of selected mRNA expression in PASTURE (cord blood, 1, 4.5, 6 years) showed that expression at age six had the strongest association with asthma and correlation of genes getting larger over time (r = .59, p < .001, 4.5-6 years). CONCLUSION Applying epidemiological predictors alone showed moderate predictive abilities. Molecular markers from birth modestly improved prediction. Allergic symptoms/diagnoses enhanced the power of prediction, which is important for clinical practice and for the design of future studies with molecular markers.
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Affiliation(s)
- Andreas Böck
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
| | - Kathrin Urner
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
| | - Jana Kristin Eckert
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
| | - Michael Salvermoser
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
| | - Kristina Laubhahn
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center - Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
| | - Sonja Kunze
- Research Unit of Molecular Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Jörg Kumbrink
- Institute of Pathology, Medical Faculty, LMU Munich, Munich, Germany
| | - Marc P Hoeppner
- Institute of Clinical Molecular Biology, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Kathrin Kalkbrenner
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
| | - Simone Kreimeier
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kirsten Beyer
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Eckard Hamelmann
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
- Department for Pediatrics, Children's Center Bethel, University Hospital OWL, Bielefeld University, Bielefeld, Germany
| | - Michael Kabesch
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
- University Children's Hospital Regensburg (KUNO), St. Hedwig's Hospital of the Order of St. John and the University of Regensburg, Regensburg, Germany
| | - Martin Depner
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Gesine Hansen
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
- Excellence Cluster Resolving Infection Susceptibility RESIST (EXC 2155), Deutsche Forschungsgemeinschaft, Hannover Medical School, Hannover, Germany
| | | | - Marjut Roponen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Elisabeth Schmausser-Hechfellner
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health, Neuherberg, Germany
| | - Cindy Barnig
- Department of Respiratory Disease, University Hospital, Besanҫon, France
- INSERM, EFS BFC, LabEx LipSTIC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Univ. Bourgogne Franche-Comté, Besançon, France
| | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France
- EA3450 Development, Adaptation and Handicap (devah), Pediatric Allergy Department, University of Lorraine, Nancy, France
- UMR/CNRS 6249 Chrono-environment, University of Franche Comté, Besançon, France
| | - Anne M Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Juha Pekkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Remo Frei
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Division of Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Caroline Roduit
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Division of Respiratory Medicine and Allergology, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
- Children's Hospital, University of Zürich, Zürich, Switzerland
| | - Roger Lauener
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Bianca Schaub
- Pediatric Allergology, Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
- Member of the CHildhood Allergy and Tolerance Consortium (CHAMP), LMU Munich, Munich, Germany
- Comprehensive Pneumology Center - Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany
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2
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Lommatzsch M, Criée CP, de Jong CCM, Gappa M, Geßner C, Gerstlauer M, Hämäläinen N, Haidl P, Hamelmann E, Horak F, Idzko M, Ignatov A, Koczulla AR, Korn S, Köhler M, Lex C, Meister J, Milger-Kneidinger K, Nowak D, Nothacker M, Pfaar O, Pohl W, Preisser AM, Rabe KF, Riedler J, Schmidt O, Schreiber J, Schuster A, Schuhmann M, Spindler T, Taube C, Christian Virchow J, Vogelberg C, Vogelmeier CF, Wantke F, Windisch W, Worth H, Zacharasiewicz A, Buhl R. [Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.]. Pneumologie 2023; 77:e3. [PMID: 38513695 DOI: 10.1055/a-2284-8593] [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] [Indexed: 03/23/2024]
Affiliation(s)
- Marek Lommatzsch
- Zentrum für Innere Medizin, Abt. für Pneumologie, Universitätsmedizin Rostock
| | | | - Carmen C M de Jong
- Abteilung für pädiatrische Pneumologie, Abteilung für Pädiatrie, Inselspital, Universitätsspital Bern
| | - Monika Gappa
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus Düsseldorf
| | | | | | | | - Peter Haidl
- Abteilung für Pneumologie II, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - Eckard Hamelmann
- Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Bielefeld
| | | | - Marco Idzko
- Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien
| | - Atanas Ignatov
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum Magdeburg
| | - Andreas Rembert Koczulla
- Schön-Klinik Berchtesgadener Land, Berchtesgaden
- Klinik für Innere Medizin Schwerpunkt Pneumologie, Universitätsklinikum Marburg
| | - Stephanie Korn
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
| | - Michael Köhler
- Deutsche Patientenliga Atemwegserkrankungen, Gau-Bickelheim
| | - Christiane Lex
- Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen
| | - Jochen Meister
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Aue
| | | | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V
| | - Oliver Pfaar
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Sektion für Rhinologie und Allergie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg
| | - Wolfgang Pohl
- Gesundheitszentrum Althietzing, Karl Landsteiner Institut für klinische und experimentelle Pneumologie, Wien
| | - Alexandra M Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus F Rabe
- Pneumologie, LungenClinic Großhansdorf, UKSH Kiel
| | - Josef Riedler
- Abteilung für Kinder- und Jugendmedizin, Kardinal Schwarzenberg Klinikum Schwarzach
| | | | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg
| | - Antje Schuster
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf
| | | | | | - Christian Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik
| | | | - Christian Vogelberg
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Wolfram Windisch
- Lungenklinik Köln-Merheim, Lehrstuhl für Pneumologie, Universität Witten/Herdecke
| | - Heinrich Worth
- Pneumologische & Kardiologische Gemeinschaftspraxis, Fürth
| | | | - Roland Buhl
- Klinik für Pneumologie, Zentrum für Thoraxerkrankungen, Universitätsmedizin Mainz
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3
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Lommatzsch M, Criée CP, de Jong CCM, Gappa M, Geßner C, Gerstlauer M, Hämäläinen N, Haidl P, Hamelmann E, Horak F, Idzko M, Ignatov A, Koczulla AR, Korn S, Köhler M, Lex C, Meister J, Milger-Kneidinger K, Nowak D, Nothacker M, Pfaar O, Pohl W, Preisser AM, Rabe KF, Riedler J, Schmidt O, Schreiber J, Schuster A, Schuhmann M, Spindler T, Taube C, Christian Virchow J, Vogelberg C, Vogelmeier CF, Wantke F, Windisch W, Worth H, Zacharasiewicz A, Buhl R. [Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023 - published by the German Respiratory Society (DGP) e. V.]. Pneumologie 2023; 77:461-543. [PMID: 37406667 DOI: 10.1055/a-2070-2135] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma. Of note, this guideline is the first worldwide to announce symptom prevention and asthma remission as the ultimate goals of asthma treatment, which can be achieved by using individually tailored, disease-modifying anti-asthmatic drugs such as inhaled steroids, allergen immunotherapy or biologics. In addition, the central role of the treatment of comorbidities is emphasized. Finally, the document addresses several challenges in asthma management, including asthma treatment during pregnancy, treatment of severe asthma or the diagnosis and treatment of work-related asthma.
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Affiliation(s)
- Marek Lommatzsch
- Zentrum für Innere Medizin, Abt. für Pneumologie, Universitätsmedizin Rostock
| | | | - Carmen C M de Jong
- Abteilung für pädiatrische Pneumologie, Abteilung für Pädiatrie, Inselspital, Universitätsspital Bern
| | - Monika Gappa
- Klinik für Kinder und Jugendliche, Evangelisches Krankenhaus Düsseldorf
| | | | | | | | - Peter Haidl
- Abteilung für Pneumologie II, Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - Eckard Hamelmann
- Kinder- und Jugendmedizin, Evangelisches Klinikum Bethel, Bielefeld
| | | | - Marco Idzko
- Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien
| | - Atanas Ignatov
- Universitätsklinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum Magdeburg
| | - Andreas Rembert Koczulla
- Schön-Klinik Berchtesgadener Land, Berchtesgaden
- Klinik für Innere Medizin Schwerpunkt Pneumologie, Universitätsklinikum Marburg
| | - Stephanie Korn
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg
| | - Michael Köhler
- Deutsche Patientenliga Atemwegserkrankungen, Gau-Bickelheim
| | - Christiane Lex
- Klinik für Kinder- und Jugendmedizin, Universitätsmedizin Göttingen
| | - Jochen Meister
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Aue
| | | | - Dennis Nowak
- Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V
| | - Oliver Pfaar
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Sektion für Rhinologie und Allergie, Universitätsklinikum Marburg, Philipps-Universität Marburg, Marburg
| | - Wolfgang Pohl
- Gesundheitszentrum Althietzing, Karl Landsteiner Institut für klinische und experimentelle Pneumologie, Wien
| | - Alexandra M Preisser
- Zentralinstitut für Arbeitsmedizin und Maritime Medizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus F Rabe
- Pneumologie, LungenClinic Großhansdorf, UKSH Kiel
| | - Josef Riedler
- Abteilung für Kinder- und Jugendmedizin, Kardinal Schwarzenberg Klinikum Schwarzach
| | | | - Jens Schreiber
- Universitätsklinik für Pneumologie, Universitätsklinikum Magdeburg
| | - Antje Schuster
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf
| | | | | | - Christian Taube
- Klinik für Pneumologie, Universitätsmedizin Essen-Ruhrlandklinik
| | | | - Christian Vogelberg
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | | | | | - Wolfram Windisch
- Lungenklinik Köln-Merheim, Lehrstuhl für Pneumologie, Universität Witten/Herdecke
| | - Heinrich Worth
- Pneumologische & Kardiologische Gemeinschaftspraxis, Fürth
| | | | - Roland Buhl
- Klinik für Pneumologie, Zentrum für Thoraxerkrankungen, Universitätsmedizin Mainz
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Pechlivanis S, Depner M, Kirjavainen PV, Roduit C, Täubel M, Frei R, Skevaki C, Hose A, Barnig C, Schmausser-Hechfellner E, Ege MJ, Schaub B, Divaret-Chauveau A, Lauener R, Karvonen AM, Pekkanen J, Riedler J, Illi S, von Mutius E. Continuous Rather Than Solely Early Farm Exposure Protects From Hay Fever Development. J Allergy Clin Immunol Pract 2023; 11:591-601. [PMID: 36356926 PMCID: PMC9907754 DOI: 10.1016/j.jaip.2022.10.035] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND An important window of opportunity for early-life exposures has been proposed for the development of atopic eczema and asthma. OBJECTIVE However, it is unknown whether hay fever with a peak incidence around late school age to adolescence is similarly determined very early in life. METHODS In the Protection against Allergy-Study in Rural Environments (PASTURE) birth cohort potentially relevant exposures such as farm milk consumption and exposure to animal sheds were assessed at multiple time points from infancy to age 10.5 years and classified by repeated measure latent class analyses (n = 769). Fecal samples at ages 2 and 12 months were sequenced by 16S rRNA. Hay fever was defined by parent-reported symptoms and/or physician's diagnosis of hay fever in the last 12 months using questionnaires at 10.5 years. RESULTS Farm children had half the risk of hay fever at 10.5 years (adjusted odds ratio [aOR] 0.50; 95% CI 0.31-0.79) than that of nonfarm children. Whereas early life events such as gut microbiome richness at 12 months (aOR 0.66; 95% CI 0.46-0.96) and exposure to animal sheds in the first 3 years of life (aOR 0.26; 95% CI 0.06-1.15) were determinants of hay fever, the continuous consumption of farm milk from infancy up to school age was necessary to exert the protective effect (aOR 0.35; 95% CI 0.17-0.72). CONCLUSIONS While early life events determine the risk of subsequent hay fever, continuous exposure is necessary to achieve protection. These findings argue against the notion that only early life exposures set long-lasting trajectories.
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Affiliation(s)
- Sonali Pechlivanis
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Martin Depner
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Pirkka V. Kirjavainen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Caroline Roduit
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland,Children's Hospital, University of Zurich, Zurich, Switzerland,Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Martin Täubel
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Remo Frei
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland,Division of Respiratory Medicine, Department of Paediatrics, Inselspital, University of Bern, Bern, Switzerland
| | - Chrysanthi Skevaki
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center (UGMLC), Philipps University Marburg, Marburg, Germany,Member of the German Center for Lung Research, Gießen, Germany
| | - Alexander Hose
- Dr. von Hauner Children’s Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Cindy Barnig
- Institut national de la santé et de la recherche médicale, Établissement français du sang Bourgogne-Franche-Comté, LabEx LipSTIC, Unité Mixte de recherche 1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, Univ. Bourgogne Franche-Comté, Besançon, France,Department of Chest Disease, University Hospital of Besançon, Besançon, France
| | - Elisabeth Schmausser-Hechfellner
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Markus J. Ege
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany,Member of the German Center for Lung Research, Gießen, Germany,Dr. von Hauner Children’s Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Bianca Schaub
- Member of the German Center for Lung Research, Gießen, Germany,Dr. von Hauner Children’s Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, Children’s Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, Nancy, France,UMR 6249 Chrono-environment, Centre National de la Recherche Scientifique and University of Franche-Comté, Besançon, France,EA3450 Development, Adaptation and Handicap, University of Lorraine, Nancy, France
| | - Roger Lauener
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland,Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Anne M. Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Juha Pekkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland,Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Sabina Illi
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Erika von Mutius
- Institute of Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany,Member of the German Center for Lung Research, Gießen, Germany,Dr. von Hauner Children’s Hospital, Ludwig Maximilians University Munich, Munich, Germany
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5
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Thürmann L, Klös M, Mackowiak SD, Bieg M, Bauer T, Ishaque N, Messingschlager M, Herrmann C, Röder S, Bauer M, Schäuble S, Faessler E, Hahn U, Weichenhan D, Mücke O, Plass C, Borte M, von Mutius E, Stangl GI, Lauener R, Karvonen AM, Divaret-Chauveau A, Riedler J, Heinrich J, Standl M, von Berg A, Schaaf B, Herberth G, Kabesch M, Eils R, Trump S, Lehmann I. Global hypomethylation in childhood asthma identified by genome-wide DNA-methylation sequencing preferentially affects enhancer regions. Allergy 2023. [PMID: 36704932 DOI: 10.1111/all.15658] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Childhood asthma is a result of a complex interaction of genetic and environmental components causing epigenetic and immune dysregulation, airway inflammation and impaired lung function. Although different microarray based EWAS studies have been conducted, the impact of epigenetic regulation in asthma development is still widely unknown. We have therefore applied unbiased whole genome bisulfite sequencing (WGBS) to characterize global DNA-methylation profiles of asthmatic children compared to healthy controls. METHODS Peripheral blood samples of 40 asthmatic and 42 control children aged 5-15 years from three birth cohorts were sequenced together with paired cord blood samples. Identified differentially methylated regions (DMRs) were categorized in genotype-associated, cell-type-dependent, or prenatally primed. Network analysis and subsequent natural language processing of DMR-associated genes was complemented by targeted analysis of functional translation of epigenetic regulation on the transcriptional and protein level. RESULTS In total, 158 DMRs were identified in asthmatic children compared to controls of which 37% were related to the eosinophil content. A global hypomethylation was identified affecting predominantly enhancer regions and regulating key immune genes such as IL4, IL5RA, and EPX. These DMRs were confirmed in n = 267 samples and could be linked to aberrant gene expression. Out of the 158 DMRs identified in the established phenotype, 56 were perturbed already at birth and linked, at least in part, to prenatal influences such as tobacco smoke exposure or phthalate exposure. CONCLUSION This is the first epigenetic study based on whole genome sequencing to identify marked dysregulation of enhancer regions as a hallmark of childhood asthma.
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Affiliation(s)
- Loreen Thürmann
- Associated Member of the German Center for Lung Research, Unit for Molecular Epidemiology, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Klös
- Associated Member of the German Center for Lung Research, Unit for Molecular Epidemiology, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian D Mackowiak
- Associated Member of the German Center for Lung Research, Center for Digital Health, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Matthias Bieg
- Associated Member of the German Center for Lung Research, Center for Digital Health, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Bauer
- German Cancer Research Center (DKFZ), Division of Theoretical Bioinformatics and Heidelberg Center for Personalized Oncology (DKFZ-HIPO), Heidelberg, Germany
| | - Naveed Ishaque
- Associated Member of the German Center for Lung Research, Center for Digital Health, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marey Messingschlager
- Associated Member of the German Center for Lung Research, Unit for Molecular Epidemiology, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carl Herrmann
- Health Data Science Unit, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Röder
- Department of Environmental Immunology, Helmholtz Centre for Environmental Research (UFZ), Leipzig, Germany
| | - Mario Bauer
- Department of Environmental Immunology, Helmholtz Centre for Environmental Research (UFZ), Leipzig, Germany
| | - Sascha Schäuble
- Friedrich-Schiller-University Jena, Jena University Language & Information Engineering (JULIE) Lab, Jena, Germany.,Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Systems Biology and Bioinformatics Unit, Jena, Germany
| | - Erik Faessler
- Friedrich-Schiller-University Jena, Jena University Language & Information Engineering (JULIE) Lab, Jena, Germany
| | - Udo Hahn
- Friedrich-Schiller-University Jena, Jena University Language & Information Engineering (JULIE) Lab, Jena, Germany
| | - Dieter Weichenhan
- Division of Cancer Epigenetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oliver Mücke
- Division of Cancer Epigenetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christoph Plass
- Division of Cancer Epigenetics, German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Center for Lung Research (DZL), Heidelberg, Munich, Germany
| | - Michael Borte
- Children's Hospital, Municipal Hospital "St. Georg", Leipzig, Germany
| | - Erika von Mutius
- German Center for Lung Research (DZL), Heidelberg, Munich, Germany.,Dr. von Hauner Children's Hospital, Ludwig Maximilian University Munich, Munich, Germany.,Helmholtz Zentrum München-German Research Center for Environmental Health, Institute for Asthma and Allergy Prevention, Neuherberg, Germany
| | - Gabriele I Stangl
- Martin Luther University Halle-Wittenberg, Institute of Agricultural and Nutritional Sciences, Halle (Saale), Germany
| | - Roger Lauener
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Anne M Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France.,UMR 6249 Chrono-Environment, Centre National de la Recherche Scientifique and University of Franche-Comté, Besançon, France.,EA3450 Development, Adaptation and Handicap, University of Lorraine, Nancy, France
| | | | - Joachim Heinrich
- German Center for Lung Research (DZL), Heidelberg, Munich, Germany.,Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Marie Standl
- German Center for Lung Research (DZL), Heidelberg, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany
| | - Andrea von Berg
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Wesel, Germany
| | - Beate Schaaf
- Pediatric Outpatient Department, Bad Honnef, Germany
| | - Gunda Herberth
- Department of Environmental Immunology, Helmholtz Centre for Environmental Research (UFZ), Leipzig, Germany
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany
| | - Roland Eils
- Associated Member of the German Center for Lung Research, Center for Digital Health, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Health Data Science Unit, Heidelberg University Hospital, Heidelberg, Germany.,German Center for Lung Research (DZL), Heidelberg, Munich, Germany
| | - Saskia Trump
- Associated Member of the German Center for Lung Research, Unit for Molecular Epidemiology, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Irina Lehmann
- Associated Member of the German Center for Lung Research, Unit for Molecular Epidemiology, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Center for Lung Research (DZL), Heidelberg, Munich, Germany
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6
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Divaret‐Chauveau A, Mauny F, Hose A, Depner M, Dalphin M, Kaulek V, Barnig C, Schaub B, Schmausser‐Hechfellner E, Renz H, Riedler J, Pekkanen J, Karvonen AM, Täubel M, Lauener R, Roduit C, Vuitton DA, von Mutius E, Demoulin‐Alexikova S, Kirjavainen P, Roponen M, Laurent L, Theodorou J, Böck A, Pechlivanis S, Ege M, Genuneit J, Illi S, Kabesch M, Pfefferle P, Frei R. Trajectories of cough without a cold in early childhood and associations with atopic diseases. Clin Exp Allergy 2022; 53:429-442. [PMID: 36453463 DOI: 10.1111/cea.14257] [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: 08/01/2022] [Revised: 11/06/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Although children can frequently experience a cough that affects their quality of life, few epidemiological studies have explored cough without a cold during childhood. OBJECTIVES The objective of the study was to describe the latent class trajectories of cough from one to 10 years old and analyse their association with wheezing, atopy and allergic diseases. METHODS Questions about cough, wheeze and allergic diseases were asked at 1, 1.5, 2, 3, 4, 5, 6 and 10 years of age in the European prospective cohort of Protection against Allergy: STUdy in Rural Environment (PASTURE). Specific IgE assays were performed at 10 years of age. Questions regarding a cough without a cold were used to build a latent class model of cough over time. RESULTS Among the 961 children included in the study, apart from the never/infrequent trajectory (59.9%), eight trajectories of cough without a cold were identified: five grouped acute transient classes (24.1%), moderate transient (6.8%), late persistent (4.8%) and early persistent (4.4%). Compared with the never/infrequent trajectory, the other trajectories were significantly associated with wheezing, asthma and allergic rhinitis. For asthma, the strongest association was with the early persistent trajectory (ORa = 31.00 [14.03-68.51]), which was inversely associated with farm environment (ORa = 0.39 [0.19-0.77]) and had a high prevalence of cough triggers and unremitting wheeze. Late and early persistent trajectories were also associated with food allergy. Atopic sensitization was only associated with the late persistent trajectory. CONCLUSION Late and early persistent coughs without a cold are positively associated with atopic respiratory diseases and food allergy. Children having recurrent cough without a cold with night cough and triggers would benefit from an asthma and allergy assessment. Growing up on a farm is associated with reduced early persistent cough.
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Affiliation(s)
- Amandine Divaret‐Chauveau
- Paediatric Allergy Department University Hospital of Nancy Vandoeuvre‐les‐Nancy France
- EA3450 Développement Adaptation et Handicap (DevAH) University of Lorraine Nancy France
- UMR 6249 Chrono‐environment, CNRS and University of Franche‐Comté Besançon France
| | - Frederic Mauny
- UMR 6249 Chrono‐environment, CNRS and University of Franche‐Comté Besançon France
- Unité de Méthodologie en Recherche Clinique, Épidémiologie et Santé Publique CIC Inserm 143, University Hospital of Besançon Besançon France
| | - Alexander Hose
- Department of Paediatric Allergology, Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany
| | - Martin Depner
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg Germany
| | | | - Vincent Kaulek
- Respiratory Diseases Department University Hospital of Besançon Besançon France
| | - Cindy Barnig
- Respiratory Diseases Department University Hospital of Besançon Besançon France
- INSERM, EFS BFC, LabEx LipSTIC, UMR1098, Interactions Hôte‐Greffon‐Tumeur, Ingénierie Cellulaire et Génique Bourgogne Franche‐Comté University Besançon France
| | - Bianca Schaub
- Department of Paediatric Allergology, Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany
- Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Centre for Lung Research Neuherberg Germany
| | - Elisabeth Schmausser‐Hechfellner
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg Germany
| | - Harald Renz
- Institute for Medicine Laboratory, Pathobiochemistry and Molecular Diagnostics Philipps‐University Marburg Marburg Germany
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergology Sechenov University Moscow Russia
| | | | - Juha Pekkanen
- Department of Health Security Finnish Institute for Health and Welfare Kuopio Finland
- Department of Public Health University of Helsinki Helsinki Finland
| | - Anne M. Karvonen
- Department of Health Security Finnish Institute for Health and Welfare Kuopio Finland
| | - Martin Täubel
- Department of Health Security Finnish Institute for Health and Welfare Kuopio Finland
| | - Roger Lauener
- Christine Kühne Centre for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Children's Hospital of Eastern Switzerland St Gallen Switzerland
| | - Caroline Roduit
- Christine Kühne Centre for Allergy Research and Education (CK‐CARE) Davos Switzerland
- University Children's Hospital Zurich Zurich Switzerland
| | | | - Erika von Mutius
- Department of Paediatric Allergology, Dr von Hauner Children's Hospital Ludwig Maximilian University of Munich Munich Germany
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Centre for Environmental Health Neuherberg Germany
- Comprehensive Pneumology Center Munich (CPC‐M), Member of the German Centre for Lung Research Neuherberg Germany
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7
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Taft DH, Lewis ZT, Nguyen N, Ho S, Masarweh C, Dunne-Castagna V, Tancredi DJ, Huda MN, Stephensen CB, Hinde K, von Mutius E, Kirjavainen PV, Dalphin JC, Lauener R, Riedler J, Smilowitz JT, German JB, Morrow AL, Mills DA. Bifidobacterium Species Colonization in Infancy: A Global Cross-Sectional Comparison by Population History of Breastfeeding. Nutrients 2022; 14:nu14071423. [PMID: 35406036 PMCID: PMC9003546 DOI: 10.3390/nu14071423] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/16/2022] Open
Abstract
Bifidobacterium species are beneficial and dominant members of the breastfed infant gut microbiome; however, their health benefits are partially species-dependent. Here, we characterize the species and subspecies of Bifidobacterium in breastfed infants around the world to consider the potential impact of a historic dietary shift on the disappearance of B. longum subsp. infantis in some populations. Across populations, three distinct patterns of Bifidobacterium colonization emerged: (1) The dominance of Bifidobacterium longum subspecies infantis, (2) prevalent Bifidobacterium of multiple species, and (3) the frequent absence of any Bifidobacterium. These patterns appear related to a country’s history of breastfeeding, with infants in countries with historically high rates of long-duration breastfeeding more likely to be colonized by B. longum subspecies infantis compared with infants in countries with histories of shorter-duration breastfeeding. In addition, the timing of infant colonization with B. longum subsp. infantis is consistent with horizontal transmission of this subspecies, rather than the vertical transmission previously reported for other Bifidobacterium species. These findings highlight the need to consider historical and cultural influences on the prevalence of gut commensals and the need to understand epidemiological transmission patterns of Bifidobacterium and other major commensals.
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Affiliation(s)
- Diana H. Taft
- Department of Food Science and Technology, University of California Davis, Davis, CA 95616, USA; (D.H.T.); (Z.T.L.); (N.N.); (S.H.); (C.M.); (V.D.-C.); (J.T.S.); (J.B.G.)
- Foods for Health Institute, University of California Davis, Davis, CA 95616, USA
| | - Zachery T. Lewis
- Department of Food Science and Technology, University of California Davis, Davis, CA 95616, USA; (D.H.T.); (Z.T.L.); (N.N.); (S.H.); (C.M.); (V.D.-C.); (J.T.S.); (J.B.G.)
| | - Nhu Nguyen
- Department of Food Science and Technology, University of California Davis, Davis, CA 95616, USA; (D.H.T.); (Z.T.L.); (N.N.); (S.H.); (C.M.); (V.D.-C.); (J.T.S.); (J.B.G.)
| | - Steve Ho
- Department of Food Science and Technology, University of California Davis, Davis, CA 95616, USA; (D.H.T.); (Z.T.L.); (N.N.); (S.H.); (C.M.); (V.D.-C.); (J.T.S.); (J.B.G.)
| | - Chad Masarweh
- Department of Food Science and Technology, University of California Davis, Davis, CA 95616, USA; (D.H.T.); (Z.T.L.); (N.N.); (S.H.); (C.M.); (V.D.-C.); (J.T.S.); (J.B.G.)
| | - Vanessa Dunne-Castagna
- Department of Food Science and Technology, University of California Davis, Davis, CA 95616, USA; (D.H.T.); (Z.T.L.); (N.N.); (S.H.); (C.M.); (V.D.-C.); (J.T.S.); (J.B.G.)
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California Davis School of Medicine, Sacramento, CA 95817, USA;
| | - M. Nazmul Huda
- US Department of Agriculture, Western Human Nutrition Research Center, Davis, CA 95616, USA; (M.N.H.); (C.B.S.)
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA
| | - Charles B. Stephensen
- US Department of Agriculture, Western Human Nutrition Research Center, Davis, CA 95616, USA; (M.N.H.); (C.B.S.)
- Department of Nutrition, University of California Davis, Davis, CA 95616, USA
| | - Katie Hinde
- Center for Evolution and Medicine, School of Human Evolution and Social Change, Arizona State University, Tempe, AZ 85281, USA;
| | - Erika von Mutius
- Dr. von Hauner Children’s Hospital, Ludwig Maximilian University, 80337 Munich, Germany;
- Institute for Asthma and Allergy Prevention, Helmholtz Centre Munich, 85764 Neuherberg, Germany
| | - Pirkka V. Kirjavainen
- Environment Health Unit, National Institute for Health and Welfare, 70210 Kuopio, Finland;
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland
| | - Jean-Charles Dalphin
- Department of Respiratory Disease, UMR/CNRS 6249 Chrono-Environment, University Hospital of Besançon, F-25000 Besançon, France;
| | - Roger Lauener
- Christine Kühne-Center for Allergy Research and Education, 7265 Davos, Switzerland;
- Children’s Hospital of Eastern Switzerland, 9000 St. Gallen, Switzerland
| | - Josef Riedler
- Children’s Hospital Schwarzach, 5620 Schwarzach, Austria;
| | - Jennifer T. Smilowitz
- Department of Food Science and Technology, University of California Davis, Davis, CA 95616, USA; (D.H.T.); (Z.T.L.); (N.N.); (S.H.); (C.M.); (V.D.-C.); (J.T.S.); (J.B.G.)
- Foods for Health Institute, University of California Davis, Davis, CA 95616, USA
| | - J. Bruce German
- Department of Food Science and Technology, University of California Davis, Davis, CA 95616, USA; (D.H.T.); (Z.T.L.); (N.N.); (S.H.); (C.M.); (V.D.-C.); (J.T.S.); (J.B.G.)
- Foods for Health Institute, University of California Davis, Davis, CA 95616, USA
| | - Ardythe L. Morrow
- Department of Environmental and Public Health Sciences, University of Cincinnati, Cincinnati, OH 45221, USA
- Correspondence: (A.L.M.); (D.A.M.); Tel.: +1-513-558-0809 (A.L.M.); +1-530-754-7821 (D.A.M.)
| | - David A. Mills
- Department of Food Science and Technology, University of California Davis, Davis, CA 95616, USA; (D.H.T.); (Z.T.L.); (N.N.); (S.H.); (C.M.); (V.D.-C.); (J.T.S.); (J.B.G.)
- Department of Viticulture and Enology, University of California Davis, Davis, CA 95616, USA
- Correspondence: (A.L.M.); (D.A.M.); Tel.: +1-513-558-0809 (A.L.M.); +1-530-754-7821 (D.A.M.)
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8
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Illi S, Depner M, Pfefferle PI, Renz H, Roduit C, Taft DH, Kalanetra KM, Mills DA, Farquharson FM, Louis P, Schmausser-Hechfellner E, Divaret-Chauveau A, Lauener R, Karvonen AM, Pekkanen J, Kirjavainen PV, Roponen M, Riedler J, Kabesch M, Schaub B, von Mutius E. Immune Responsiveness to LPS Determines Risk of Childhood Wheeze and Asthma in 17q21 Risk Allele Carriers. Am J Respir Crit Care Med 2021; 205:641-650. [PMID: 34919021 DOI: 10.1164/rccm.202106-1458oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In murine models microbial exposures induce protection from experimental allergic asthma through innate immunity. Our aim was to assess the association of early life innate immunity with the development of asthma in children at risk. METHODS In the PASTURE farm birth cohort innate, Th2, Th1 and Th17 cytokine expression at age 1 year was measured after stimulation of PBMCs with lipopolysaccharide (LPS) in N=445 children. Children at risk of asthma were defined based on single-nucleotide polymorphisms at the 17q21 asthma gene locus. Specifically, we used the SNP rs7216389 in the GSDMB gene. Wheeze in the 1st year of life was assessed by weekly diaries and asthma by questionnaire at age 6 years. RESULTS Not all cytokines were detectable in all children after LPS-stimulation. When classifying detectability of cytokines by latent class analysis, carrying the 17q21 risk allele rs7216389 was associated with risk of wheeze only in the class with the lowest level of LPS-induced activation, odds ratio (OR)=1.89, 95%-CI 1.13-3.16, p=0.015. In contrast, in children with high cytokine activation after LPS-stimulation no association of the 17q21 risk allele with wheeze (OR=0.63, 95%-CI 0.29-1.40, p=0.258, p=0.034 for interaction) or school age asthma was observed. In these children consumption of unprocessed cow's milk was associated with higher cytokine activation (OR=3.37, 95%-CI 1.56-7.30, p=0.002), which was in part mediated by the gut microbiome. CONCLUSIONS These findings suggest that within the 17q21 genotype asthma risk can be mitigated by activated immune responses after innate stimulation, which is partly mediated by a gut-immune axis.
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Affiliation(s)
- Sabina Illi
- Helmholtz Zentrum Munchen Deutsches Forschungszentrum fur Gesundheit und Umwelt, 9150, Institute of Asthma and Allergy Prevention, Neuherberg, Germany.,German Center for Lung Research, 542891, Giessen, Germany;
| | - Martin Depner
- Helmholtz Zentrum Munchen Deutsches Forschungszentrum fur Umwelt und Gesundheit, 9150, Institute of Asthma and Allergy Prevention, Neuherberg, Germany
| | - Petra Ina Pfefferle
- Philipps-Universität Marburg Fachbereich Medizin, 98594, Comprehensive Biobank Marburg CBBM, Marburg, Germany.,German Center for Lung Research, 542891, Giessen, Germany
| | - Harald Renz
- Philipps-Universität Marburg, 9377, Institute of Laboratory Medicine, Marburg, Germany.,Sechenov University, 68477, Department of Clinical Immunology and Allergology, Laboratory of Immunopathology, Moskva, Russian Federation.,German Center for Lung Research, 542891, Giessen, Germany
| | - Caroline Roduit
- University of Zurich, Children's Hospital, Zurich, Switzerland.,Christine Kühne Center for Allergy Research and Education (CK-CARE) , Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Diana Hazard Taft
- University of California Davis, 8789, Department of Food Science & Technology, Davis, California, United States
| | - Karen M Kalanetra
- University of California Davis, 8789, Department of Food Science & Technology, Davis, California, United States
| | - David A Mills
- University of California Davis, 8789, Department of Food Science & Technology, Davis, California, United States
| | - Freda M Farquharson
- University of Aberdeen, 1019, The Rowett Institute, Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - Petra Louis
- University of Aberdeen, 1019, The Rowett Institute, Aberdeen, United Kingdom of Great Britain and Northern Ireland
| | - Elisabeth Schmausser-Hechfellner
- Helmholtz Zentrum München Deutsches Forschungszentrum für Gesundheit und Umwelt, 9150, Institute of Asthma and Allergy Prevention, Neuherberg, Germany
| | - Amandine Divaret-Chauveau
- Burgundy Franche-Comté University, 439716, UMR 6249 Chrono-environment , Besancon, France.,University of Lorraine, 137665, EA3450 Développement Adaptation et Handicap (DevAH) , Nancy, France.,University Hospital Centre Nancy, 26920, Pediatric Allergy Department, Nancy, France
| | - Roger Lauener
- Children's Hospital of Eastern Switzerland, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.,Christine Kühne Center for Allergy Research and Education (CK-CARE) , Davos, Switzerland
| | - Anne M Karvonen
- Finnish Institute for Health and Welfare, 3837, Department of Health Security, Helsinki, Finland
| | - Juha Pekkanen
- University of Helsinki, Department of Public Health, Helsinki, Finland.,Finnish Institute for Health and Welfare, 3837, Department of Health Security, Helsinki, Finland
| | - Pirkka V Kirjavainen
- Finnish Institute for Health and Welfare, 3837, Department of Health Security, Kuopio, Finland.,University of Eastern Finland, 163043, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Marjut Roponen
- University of Eastern Finland, 163043, Department of Environmental and Biological Sciences, Kuopio, Finland
| | - Josef Riedler
- Children's Hospital Schwarzach, Children's Hospital Schwarzach, Schwarzach, Austria
| | - Michael Kabesch
- University Children's Hospital Regensburg (KUNO), Department of Pediatric Pneumology and Allergy, Campus St. Hedwig, Regensburg, Germany
| | - Bianca Schaub
- Ludwig-Maximilians-Universitat Munchen, 9183, Dr. von Hauner Children's Hospital, Munchen, Germany.,German Center for Lung Research, 542891, Giessen, Germany
| | - Erika von Mutius
- Helmholtz Zentrum Munchen Deutsches Forschungszentrum fur Gesundheit und Umwelt, 9150, Institute of Asthma and Allergy Prevention, Neuherberg, Germany.,Ludwig-Maximilians-Universitat Munchen, 9183, Dr. von Hauner Children's Hospital, München, Germany.,German Center for Lung Research, 542891, Giessen, Germany
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9
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Stampfli M, Frei R, Divaret-Chauveau A, Schmausser-Hechfellner E, Karvonen AM, Pekkanen J, Riedler J, Schaub B, von Mutius E, Lauener R, Roduit C. Inverse associations between food diversity in the second year of life and allergic diseases. Ann Allergy Asthma Immunol 2021; 128:39-45. [PMID: 34648974 DOI: 10.1016/j.anai.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The influence of diet in early childhood on later allergic diseases is currently a highly debated research topic. We and others have suggested that an increased diet diversity in the first year of life has a protective effect on the development of allergic diseases. OBJECTIVE This follow-up study aimed to investigate associations between diet in the second year of life and later allergic diseases. METHODS A total of 1014 children from rural areas in 5 European countries (the Protection against Allergy: Study in Rural Environments or PASTURE birth cohort) were included. Information on feeding practices in their second year of life and allergic diseases were collected up to age 6 years. Multivariate logistic regressions were performed with different models considering reverse causality, such as excluding children with a positive sensitization to egg and those with a positive sensitization to cow's milk at the age of 1 year. RESULTS An increased food diversity score during the second year of life was negatively associated with the development of asthma. Consumption of dairy products and eggs in the second year of life found an inverse association with reported allergic outcomes. Consumption of butter was strongly associated with protection against asthma and food sensitization. Egg was inversely associated with atopic dermatitis (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.04-0.77). Yogurt and cow's milk were inversely associated with food allergy (OR for yogurt, 0.05; 95% CI, 0.01-0.55; OR for cow's milk, 0.31; 95% CI, 0.11-0.89). CONCLUSION Increased food diversity in the second year of life is inversely associated with the development of asthma, and consumption of dairy products might have a protective effect on allergic diseases.
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Affiliation(s)
- Martha Stampfli
- Department of Immunology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Remo Frei
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland; Division of Respiratory Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, University Hospital of Nancy, Nancy, France; EA3450 Développement Adaptation et Handicap (DevAH), University of Lorraine, Nancy, France; Unité de Mixte de Recherche (UMR) 6249 Chrono-environment, Centre National De La Recherche Scientifique (CNRS) and University of Franche-Comté, Besançon, France
| | - Elisabeth Schmausser-Hechfellner
- Helmholtz Zentrum München-German Research Center for Environmental Health, Institute for Asthma and Allergy Prevention, Neuherberg, Germany
| | - Anne M Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Juha Pekkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Josef Riedler
- Children's Hospital Schwarzach, Kardinal Schwarzenbergplatz 1, Schwarzach, Austria; Teaching Hospital of Paracelsus Medical Private University Salzburg, Salzburg, Austria
| | - Bianca Schaub
- Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - Erika von Mutius
- Helmholtz Zentrum München-German Research Center for Environmental Health, Institute for Asthma and Allergy Prevention, Neuherberg, Germany; Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Munich, Germany
| | - Roger Lauener
- Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland; Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Caroline Roduit
- Department of Immunology, University Children's Hospital Zurich, Zurich, Switzerland; Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland; Children's Hospital of Eastern Switzerland, St Gallen, Switzerland.
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10
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Pechlivanis S, Depner M, Pekkanen J, Roduit C, Riedler J, Divaret-Chauveau A, Lauener R, Karvonen AM, Roponen M, Schaub B, Schmausser-Hechfellner E, Loss G, Kirjavainen PV, Mills D, Renz H, Pfefferle PI, Illi S, Von Mutius E. Protection from childhood hay fever in farm environment. Epidemiology 2021. [DOI: 10.1183/13993003.congress-2021.pa631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Markowicz M, Schötta AM, Penatzer F, Matscheko C, Stanek G, Stockinger H, Riedler J. Isolation of Francisella tularensis from Skin Ulcer after a Tick Bite, Austria, 2020. Microorganisms 2021; 9:microorganisms9071407. [PMID: 34209915 PMCID: PMC8304467 DOI: 10.3390/microorganisms9071407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022] Open
Abstract
Ulceroglandular tularemia is caused by the transmission of Francisella tularensis by arthropods to a human host. We report a case of tick-borne tularemia in Austria which was followed by an abscess formation in a lymph node, making drainage necessary. F. tularensis subsp. holarctica was identified by PCR and multilocus sequence typing.
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Affiliation(s)
- Mateusz Markowicz
- Center for Pathophysiology, Infectiology and Immunology, Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria; (A.-M.S.); (G.S.); (H.S.)
- Correspondence: ; Tel.: +043-1-40160-33023
| | - Anna-Margarita Schötta
- Center for Pathophysiology, Infectiology and Immunology, Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria; (A.-M.S.); (G.S.); (H.S.)
| | - Freya Penatzer
- Kardinal Schwarzenberg Klinikum, Kardinal Schwarzenbergplatz 1, A-5620 Schwarzach, Austria; (F.P.); (C.M.); (J.R.)
| | - Christoph Matscheko
- Kardinal Schwarzenberg Klinikum, Kardinal Schwarzenbergplatz 1, A-5620 Schwarzach, Austria; (F.P.); (C.M.); (J.R.)
| | - Gerold Stanek
- Center for Pathophysiology, Infectiology and Immunology, Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria; (A.-M.S.); (G.S.); (H.S.)
| | - Hannes Stockinger
- Center for Pathophysiology, Infectiology and Immunology, Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, A-1090 Vienna, Austria; (A.-M.S.); (G.S.); (H.S.)
| | - Josef Riedler
- Kardinal Schwarzenberg Klinikum, Kardinal Schwarzenbergplatz 1, A-5620 Schwarzach, Austria; (F.P.); (C.M.); (J.R.)
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12
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Hose AJ, Pagani G, Karvonen AM, Kirjavainen PV, Roduit C, Genuneit J, Schmaußer-Hechfellner E, Depner M, Frei R, Lauener R, Riedler J, Schaub B, Fuchs O, von Mutius E, Divaret-Chauveau A, Pekkanen J, Ege MJ. Excessive Unbalanced Meat Consumption in the First Year of Life Increases Asthma Risk in the PASTURE and LUKAS2 Birth Cohorts. Front Immunol 2021; 12:651709. [PMID: 33986744 PMCID: PMC8111016 DOI: 10.3389/fimmu.2021.651709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
A higher diversity of food items introduced in the first year of life has been inversely related to subsequent development of asthma. In the current analysis, we applied latent class analysis (LCA) to systematically assess feeding patterns and to relate them to asthma risk at school age. PASTURE (N=1133) and LUKAS2 (N=228) are prospective birth cohort studies designed to evaluate protective and risk factors for atopic diseases, including dietary patterns. Feeding practices were reported by parents in monthly diaries between the 4th and 12th month of life. For 17 common food items parents indicated frequency of feeding during the last 4 weeks in 4 categories. The resulting 153 ordinal variables were entered in a LCA. The intestinal microbiome was assessed at the age of 12 months by 16S rRNA sequencing. Data on feeding practice with at least one reported time point was available in 1042 of the 1133 recruited children. Best LCA model fit was achieved by the 4-class solution. One class showed an elevated risk of asthma at age 6 as compared to the other classes (adjusted odds ratio (aOR): 8.47, 95% CI 2.52–28.56, p = 0.001) and was characterized by daily meat consumption and rare consumption of milk and yoghurt. A refined LCA restricted to meat, milk, and yoghurt confirmed the asthma risk effect of a particular class in PASTURE and independently in LUKAS2, which we thus termed unbalanced meat consumption (UMC). The effect of UMC was particularly strong for non-atopic asthma and asthma irrespectively of early bronchitis (aOR: 17.0, 95% CI 5.2–56.1, p < 0.001). UMC fostered growth of iron scavenging bacteria such as Acinetobacter (aOR: 1.28, 95% CI 1.00-1.63, p = 0.048), which was also related to asthma (aOR: 1.55, 95% CI 1.18-2.03, p = 0.001). When reconstructing bacterial metabolic pathways from 16S rRNA sequencing data, biosynthesis of siderophore group nonribosomal peptides emerged as top hit (aOR: 1.58, 95% CI 1.13-2.19, p = 0.007). By a data-driven approach we found a pattern of overly meat consumption at the expense of other protein sources to confer risk of asthma. Microbiome analysis of fecal samples pointed towards overgrowth of iron-dependent bacteria and bacterial iron metabolism as a potential explanation.
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Affiliation(s)
- Alexander J Hose
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Giulia Pagani
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Anne M Karvonen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Pirkka V Kirjavainen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Caroline Roduit
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.,Department of Immunology, Children's Hospital, University of Zürich, Zürich, Switzerland.,Department of Allergology, Childrens Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,Pediatric Epidemiology, Department of Pediatrics, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Schmaußer-Hechfellner
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Martin Depner
- Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Remo Frei
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.,Pediatric Pulmonology, Bern University Hospital, Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Roger Lauener
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.,Department of Allergology, Childrens Hospital of Eastern Switzerland, St. Gallen, Switzerland.,Department of Allergology, University of Zurich, Zurich, Switzerland.,School of Medicine, University of St Gallen, St Gallen, Switzerland
| | - Josef Riedler
- Department of Pediatric and Adolescent Medicine, Children's Hospital, Schwarzach, Austria
| | - Bianca Schaub
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,Comprehensive Pneumology Center (CPCM), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Oliver Fuchs
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics, University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Erika von Mutius
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,Institute for Asthma and Allergy Prevention, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Comprehensive Pneumology Center (CPCM), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, Children's Hospital, University Hospital of Nancy, Vandoeuvre les Nancy, France.,EA 3450 DevAH, Faculty of Medecine, University of Lorraine, Vandoeuvre les Nancy, France.,Department of Respiratory Disease, UMR/CNRS 6249 Chrono-environnement, University Hospital of Besançon, Besançon, France
| | - Juha Pekkanen
- Department of Health Security, Finnish Institute for Health and Welfare, Kuopio, Finland.,Department of Public Health, University of Helsinki, University of Helsinki, Helsinki, Finland
| | - Markus J Ege
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,Comprehensive Pneumology Center (CPCM), Member of the German Center for Lung Research (DZL), Munich, Germany
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13
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Buhl R, Bals R, Baur X, Berdel D, Criée CP, Gappa M, Gillissen A, Greulich T, Haidl P, Hamelmann E, Horak F, Kardos P, Kenn K, Klimek L, Korn S, Magnussen H, Nowak D, Pfaar O, Rabe KF, Riedler J, Ritz T, Schultz K, Schuster A, Spindler T, Taube C, Vogelmeier C, von Leupoldt A, Wantke F, Wildhaber J, Worth H, Zacharasiewicz A, Lommatzsch M. [Guideline for the Diagnosis and Treatment of Asthma - Addendum 2020 - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. Pneumologie 2021; 75:191-200. [PMID: 33728628 DOI: 10.1055/a-1352-0296] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The present addendum of the guideline for the diagnosis and treatment of asthma (2017) complements new insights into the diagnosis and management of asthma as well as for the newly approved drugs for the treatment of asthma. Current, evidence-based recommendations on diagnostic and therapeutic approaches are presented for children and adolescents as well as for adults with asthma.
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Affiliation(s)
- R Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Pneumologie, III. Medizinische Klinik, Mainz
| | - R Bals
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin V, Homburg/Saar
| | - X Baur
- Haut- und Lasercentrum, Standort Berlin, Berlin
| | | | - C-P Criée
- Evangelisches Krankenhaus Göttingen Weende, Abteilung für Pneumologie, Bovenden-Lenglern
| | - M Gappa
- Evangelisches Krankenhaus Düsseldorf, Klinik für Kinder und Jugendmedizin, Düsseldorf
| | - A Gillissen
- Klinikum Am Steinenberg, Ermstalklinik, Medizinische Klinik III/Innere Medizin und Pneumologie, Reutlingen-Bad Urach
| | - T Greulich
- Universitätsklinikum Gießen und Marburg, Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Marburg
| | - P Haidl
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie II, Schmallenberg
| | - E Hamelmann
- Universitäts-Klinikum OWL, Universität Bielefeld, Kinderzentrum Bethel, Bielefeld
| | - F Horak
- Allergiezentrum Wien West, Wien
| | - P Kardos
- Lungenpraxis an der Klinik Maingau vom Roten Kreuz, Frankfurt am Main
| | - K Kenn
- Philips Universität Marburg, Lehrstuhl für pneumologische Rehabilitation, Marburg
| | - L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - S Korn
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Pneumologie, III. Medizinische Klinik, Mainz
| | - H Magnussen
- Pneumologisches Forschungsinstitut an der LungenClinic Grosshansdorf GmbH, Großhansdorf
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - O Pfaar
- Klinik für Hals-, Nasen-und Ohrenheilkunde, Sektion Rhinologie und Allergologie, Universitätsklinikum Gießen und Marburg GmbH, Philipps-Universität Marburg, Marburg
| | - K F Rabe
- LungenClinic Grosshansdorf GmbH, Abteilung für Pneumologie, Großhansdorf
| | - J Riedler
- Kardinal Schwarzenberg Klinikum, Kinder- und Jugendmedizin, Schwarzach im Pongau, Österreich
| | - T Ritz
- Southern Methodist University, Department of Psychology, Dallas, USA
| | - K Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, Bad Reichenhall
| | - A Schuster
- Universitätsklinikum Düsseldorf, Zentrum für Kinder- und Jugendmedizin, Düsseldorf
| | - T Spindler
- Hochgebirgsklinik Davos, Abteilung für Kinder und Jugendliche, Davos, Schweiz
| | - C Taube
- Universitätsmedizin Essen, Ruhrlandklinik, Klinik für Pneumologie, Essen
| | - C Vogelmeier
- Universitätsklinikum Gießen und Marburg, Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Marburg
| | - A von Leupoldt
- University of Leuven, Health Psychology, Leuven, Belgien
| | - F Wantke
- Floridsdorfer Allergiezentrum, Wien, Österreich
| | - J Wildhaber
- HFR Freiburg, Kantonsspital, Klinik für Pädiatrie, Freiburg, Schweiz
| | - H Worth
- Facharztzentrum Fürth, Fürth
| | - A Zacharasiewicz
- Klinikum Ottakring, Wilhelminenspital, Lehrkrankenhaus der Medizinischen Universität Wien, Abteilung für Kinder- und Jugendheilkunde, Wien, Österreich
| | - M Lommatzsch
- Universitätsmedizin Rostock, Abteilung für Pneumologie, Rostock
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14
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Zeyda M, Schanzer A, Basek P, Bauer V, Eber E, Ellemunter H, Kallinger M, Riedler J, Thir C, Wadlegger F, Zacharasiewicz A, Renner S. Cystic Fibrosis Newborn Screening in Austria Using PAP and the Numeric Product of PAP and IRT Concentrations as Second-Tier Parameters. Diagnostics (Basel) 2021; 11:diagnostics11020299. [PMID: 33668470 PMCID: PMC7918494 DOI: 10.3390/diagnostics11020299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/21/2022] Open
Abstract
In Austria, newborns have been screened for cystic fibrosis (CF) by analyzing immunoreactive trypsinogen (IRT) from dried blood spots (DBS)s for nearly 20 years. Recently, pancreatitis-associated protein (PAP) analysis was introduced as a second-tier test with the aim of reducing recalls for second DBS cards while keeping sensitivity high. For 28 months, when IRT was elevated (65–130 ng/mL), PAP was measured from the first DBS (n = 198,927) with a two-step cut-off applied. For the last 12 months of the observation period (n = 85,421), an additional IRT×PAP cut-off was introduced. If PAP or IRT×PAP were above cut-off, a second card was analyzed for IRT and in case of elevated values identified as screen-positive. Above 130 ng/mL IRT in the first DBS, newborns were classified as screen-positive. IRT analysis of first DBS resulted in 1961 (1%) tests for PAP. In the first 16 months, 26 of 93 screen-positive were confirmed to have CF. Two false-negatives have been reported (sensitivity = 92.8%). Importantly, less than 30% of families compared to the previous IRT-IRT screening scheme had to be contacted causing distress. Adding IRT×PAP caused a marginally increased number of second cards and sweat tests to be requested during this period (15 and 3, respectively) compared to the initial IRT-PAP scheme. One case of confirmed CF was found due to IRT×PAP, demonstrating an increase in sensitivity. Thus, the relatively simple and economical algorithm presented here performs effectively and may be a useful model for inclusion of CF into NBS panels or modification of existing schemes.
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Affiliation(s)
- Maximilian Zeyda
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.S.); (S.R.)
- Correspondence:
| | - Andrea Schanzer
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.S.); (S.R.)
| | - Pavel Basek
- University Clinic for Paediatric and Adolescent Medicine, University Hospital Salzburg, 5020 Salzburg, Austria;
| | - Vera Bauer
- Department of Pediatrics and Adolescent Medicine, Klinikum Wels-Grieskirchen, 4600 Wels, Austria;
| | - Ernst Eber
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Helmut Ellemunter
- Department of Child and Adolescent Health, Division of Cardiology, Pulmonology, Allergology, and Cystic Fibrosis, Cystic Fibrosis Centre, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Margit Kallinger
- PEK Hospital Steyr Department of Pediatrics and Adolescent Medicine, 4400 Steyr, Austria;
| | - Josef Riedler
- Department of Pediatrics and Adolescent Medicine, Kardinal Schwarzenberg Hospital Schwarzach, 5620 Schwarzach, Austria;
| | - Christina Thir
- Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, 4040 Linz, Austria;
| | - Franz Wadlegger
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Hopital Klagenfurt am Wörthersee, 9020 Klagenfurt am Wörthersee, Austria;
| | - Angela Zacharasiewicz
- Department of Pediatrics and Adolescent Medicine, Klinikum Ottakring, Wilhelminenspital, Teaching Hospital of the University of Vienna, 1010 Vienna, Austria;
| | - Sabine Renner
- Clinical Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, 1090 Vienna, Austria; (A.S.); (S.R.)
- Associated National Center in the European Reference Network for Rare Respiratory Diseases, ERN-LUNG Coordinating Center, University Hospital Frankfurt, 60596 Frankfurt am Main, Germany
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15
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Rose MA, Barker M, Liese J, Adams O, Ankermann T, Baumann U, Brinkmann F, Bruns R, Dahlheim M, Ewig S, Forster J, Hofmann G, Kemen C, Lück C, Nadal D, Nüßlein T, Regamey N, Riedler J, Schmidt S, Schwerk N, Seidenberg J, Tenenbaum T, Trapp S, van der Linden M. [Guidelines for the Management of Community Acquired Pneumonia in Children and Adolescents (Pediatric Community Acquired Pneumonia, pCAP) - Issued under the Responsibility of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Pulmonology (GPP)]. Pneumologie 2020; 74:515-544. [PMID: 32823360 DOI: 10.1055/a-1139-5132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation > 92 % can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48 - 72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.
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Affiliation(s)
- M A Rose
- Fachbereich Medizin, Johann-Wolfgang-Goethe-Universität Frankfurt/Main und Zentrum für Kinder- und Jugendmedizin, Klinikum St. Georg Leipzig
| | - M Barker
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Emil von Behring, Berlin
| | - J Liese
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg
| | - O Adams
- Institut für Virologie, Universitätsklinikum Düsseldorf
| | - T Ankermann
- Klinik für Kinder- und Jugendmedizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - U Baumann
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - F Brinkmann
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ruhr-Universität Bochum
| | - R Bruns
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - M Dahlheim
- Praxis für Kinderpneumologie und Allergologie, Mannheim
| | - S Ewig
- Kliniken für Pneumologie und Infektiologie, Thoraxzentrum Ruhrgebiet, Bochum/Herne
| | - J Forster
- Kinderabteilung St. Hedwig, St. Josefskrankenhaus , Freiburg und Merzhausen
| | | | - C Kemen
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - C Lück
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden
| | - D Nadal
- Kinderspital Zürich, Schweiz
| | - T Nüßlein
- Klinik für Kinder- und Jugendmedizin, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - N Regamey
- Pädiatrische Pneumologie, Kinderspital Luzern, Schweiz
| | - J Riedler
- Kinder- und Jugendmedizin, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Österreich
| | - S Schmidt
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - N Schwerk
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - J Seidenberg
- Klinik für pädiatrische Pneumologie und Allergologie, Neonatologie, Intensivmedizin und Kinderkardiologie, Klinikum Oldenburg
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim
| | | | - M van der Linden
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen
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16
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Brick T, Hose A, Wawretzka K, von Mutius E, Roduit C, Lauener R, Riedler J, Karvonen AM, Pekkanen J, Divaret-Chauveau A, Dalphin JC, Ege MJ. Parents know it best: Prediction of asthma and lung function by parental perception of early wheezing episodes. Pediatr Allergy Immunol 2019; 30:795-802. [PMID: 31441979 DOI: 10.1111/pai.13118] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/29/2019] [Accepted: 08/14/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Childhood asthma is often preceded by early wheeze. Usually, wheezing episodes are recorded retrospectively, which may induce recall bias. AIMS AND OBJECTIVES The aim of this study was to investigate true-positive recall of parent-reported wheeze at 1 year of age, its determinants, and its implications for asthma and lung function at 6 years of age. METHODS The PASTURE (Protection Against Allergy-Study in Rural Environments) study followed 880 children from rural areas in 5 European countries from birth to age 6 years. Wheeze symptoms in the first year were asked weekly. At age 6, parent-reported asthma diagnosis was ascertained and lung function measurements were conducted. Correct parental recall of wheeze episodes at the end of the first year was assessed for associations with lung function, asthma, and the asthma risk locus on chromosome 17q21. RESULTS Parents correctly recalled wheeze after the first year in 54% of wheezers. This true-positive recall was determined by number of episodes, timing of the last wheeze episode, and parental asthma. Independently from these determinants, true-positive recall predicted asthma at age 6 years (odds ratio 4.54, 95% confidence interval (CI) [1.75-14.16]) and impaired lung function (β = -0.62, 95% CI [-1.12; -0.13], P-value = .02). Associations were stronger in children with asthma risk SNPs on chromosome 17q21. CONCLUSION Correct parental recall of wheezing episodes may reflect clinical relevance of early wheeze and its impact on subsequent asthma and lung function impairment. Questions tailored to parental perception of wheezing episodes may further enhance asthma prediction.
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Affiliation(s)
- Tabea Brick
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Alexander Hose
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Katharina Wawretzka
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Institute for Asthma and Allergy Prevention, Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Munich, Germany.,Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
| | - Caroline Roduit
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Roger Lauener
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | | | - Anne M Karvonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Juha Pekkanen
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Amandine Divaret-Chauveau
- UMR/CNRS 6249 Chrono-Environment, University of Bourgogne Franche Comté, Besanҫon, France.,Pediatric Allergy Department, University Hospital of Nancy, Nancy, France.,EA3450 DevAH-Department of Physiology, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Jean-Charles Dalphin
- UMR/CNRS 6249 Chrono-Environment, University of Bourgogne Franche Comté, Besanҫon, France.,Department of Respiratory Disease, University Hospital of Besanҫon, Besanҫon, France
| | - Markus J Ege
- Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Munich, Germany.,Member of the German Center for Lung Research, Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany
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17
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Krusche J, Twardziok M, Rehbach K, Böck A, Tsang MS, Schröder PC, Kumbrink J, Kirchner T, Xing Y, Riedler J, Dalphin JC, Pekkanen J, Lauener R, Roponen M, Li J, Wong CK, Wong GWK, Schaub B. TNF-α-induced protein 3 is a key player in childhood asthma development and environment-mediated protection. J Allergy Clin Immunol 2019; 144:1684-1696.e12. [PMID: 31381928 DOI: 10.1016/j.jaci.2019.07.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Childhood asthma prevalence is significantly greater in urban areas compared with rural/farm environments. Murine studies have shown that TNF-α-induced protein 3 (TNFAIP3; A20), an anti-inflammatory regulator of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signaling, mediates environmentally induced asthma protection. OBJECTIVE We aimed to determine the role of TNFAIP3 for asthma development in childhood and the immunomodulatory effects of environmental factors. METHODS In a representative selection of 250 of 2168 children from 2 prospective birth cohorts and 2 cross-sectional studies, we analyzed blood cells of healthy and asthmatic children from urban and rural/farm environments from Europe and China. PBMCs were stimulated ex vivo with dust from "asthma-protective" farms or LPS. NF-κB signaling-related gene and protein expression was assessed in PBMCs and multiplex gene expression assays (NanoString Technologies) in isolated dendritic cells of schoolchildren and in cord blood mononuclear cells from newborns. RESULTS Anti-inflammatory TNFAIP3 gene and protein expression was consistently decreased, whereas proinflammatory Toll-like receptor 4 expression was increased in urban asthmatic patients (P < .05), reflecting their increased inflammatory status. Ex vivo farm dust or LPS stimulation restored TNFAIP3 expression to healthy levels in asthmatic patients and shifted NF-κB signaling-associated gene expression toward an anti-inflammatory state (P < .001). Farm/rural children had lower expression, indicating tolerance induction by continuous environmental exposure. Newborns with asthma at school age had reduced TNFAIP3 expression at birth, suggesting TNFAIP3 as a possible biomarker predicting subsequent asthma. CONCLUSION Our data indicate TNFAIP3 as a key regulator during childhood asthma development and its environmentally mediated protection. Because environmental dust exposure conferred the anti-inflammatory effects, it might represent a promising future agent for asthma prevention and treatment.
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Affiliation(s)
- Johanna Krusche
- Pediatric Allergology, Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany; Member of the German Center for Lung Research-DZL, LMU Munich, Munich, Germany
| | - Monika Twardziok
- Pediatric Allergology, Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Rehbach
- Pediatric Allergology, Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Andreas Böck
- Pediatric Allergology, Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Miranda S Tsang
- Institute of Chinese Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Paul C Schröder
- Pediatric Allergology, Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Jörg Kumbrink
- Institute of Pathology, Medical Faculty, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Thomas Kirchner
- Institute of Pathology, Medical Faculty, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Yuhan Xing
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China
| | - Josef Riedler
- Children's Hospital Schwarzach, Schwarzach, Austria, Teaching Hospital of Paracelsus Medical Private University Salzburg, Salzburg, Austria
| | - Jean-Charles Dalphin
- University Hospital of Besançon, UMR CNRS 6249 Chrono-Environment, University of Franche-Comté, Besançon, France
| | - Juha Pekkanen
- Department of Health Security, National Institute for Health and Welfare (THL), Kuopio, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Roger Lauener
- Children's Hospital of Eastern Switzerland, St Gallen, Switzerland; University of Zurich, Zurich, Switzerland; School of Medicine, University of St Gallen, St Gallen, Switzerland; Christine Kühne-Center for Allergy Care and Education, CK-CARE, Davos, Switzerland
| | - Marjut Roponen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jing Li
- Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Department of Allergy and Clinical Immunology, Guangzhou, China
| | - Chun K Wong
- Department of Chemical Pathology, Chinese University of Hong Kong, Shatin, NT, Hong Kong, China
| | - Gary W K Wong
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong, China.
| | - Bianca Schaub
- Pediatric Allergology, Department of Pediatrics, Dr von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany; Member of the German Center for Lung Research-DZL, LMU Munich, Munich, Germany.
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18
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Kiechl‐Kohlendorfer U, Simma B, Urlesberger B, Maurer‐Fellbaum U, Wald M, Wald M, Weissensteiner M, Ehringer‐Schetitska D, Berger A, Kurz H, Bernert G, Frischer T, Minkov M, Zwiauer K, Salzer H, Falger J, Jaros Z, Peter Wagentristl H, Bruckne R, Birnbacher R, Kaulfersch W, Wiesinger‐Eidenberger G, Riedler J. Low mortality and short-term morbidity in very preterm infants in Austria 2011-2016. Acta Paediatr 2019; 108:1419-1426. [PMID: 30817025 PMCID: PMC6767187 DOI: 10.1111/apa.14767] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/24/2019] [Accepted: 02/26/2019] [Indexed: 01/03/2023]
Abstract
AIM The current study determined survival, short-term neonatal morbidity and predictors for death or adverse outcome of very preterm infants in Austria. METHODS This population-based cohort study included 5197 very preterm infants (53.3% boys) born between 2011 and 2016 recruited from the Austrian Preterm Outcome Registry. Main outcome measures were gestational age-related mortality and major short-term morbidities. RESULTS Overall, survival rate of all live-born infants included was 91.6% and ranged from 47.1% and 73.4% among those born at 23 and 24 weeks of gestation to 84.9% and 88.2% among infants born at 25 and 26 weeks to more than 90.0% among those with a gestational age of 27 weeks or more. The overall prevalence of chronic lung disease, necrotising enterocolitis requiring surgery, intraventricular haemorrhage Grades 3-4, and retinopathy of prematurity Grades 3-5 was 10.0%, 2.1%, 5.5%, and 3.6%, respectively. Low gestational age, low birth weight, missing or incomplete course of antenatal steroids, male sex, and multiple births were significant risk predictors for death or adverse short-term outcome. CONCLUSION In this national cohort study, overall survival rates were high and short-term morbidity rate was low.
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Affiliation(s)
- U Kiechl‐Kohlendorfer
- Department of Paediatrics II (Neonatology) Medical University of Innsbruck Innsbruck Austria
| | - B Simma
- Department of Paediatrics Academic Teaching Hospital Landeskrankenhaus Feldkirch Feldkirch Austria
| | - B Urlesberger
- Department of Paediatrics Division of Neonatology Medical University of Graz Graz Austria
| | - U Maurer‐Fellbaum
- Department of Paediatrics Division of Neonatology Medical University of Graz Graz Austria
| | - M Wald
- Division of Neonatology Paracelsus Medical University Salzburg Salzburg Austria
| | - M Wald
- Department of Paediatrics Klinikum Wels‐Grieskirchen Wels Austria
| | - M Weissensteiner
- Department of Paediatrics Kepler University Hospital Linz Austria
| | | | - A Berger
- Department of Paediatrics and Adolescent Medicine Division of Neonatology Paediatric Intensive Care and Neuropaediatrics Medical University of Vienna Vienna Austria
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19
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Taft D, Ho S, Tancredi D, Stephensen C, Hinde K, Mutius EV, Kirjavainen P, Dalphin JC, Lauener R, Riedler J, Morrow A, Lewis Z, Mills D. Population Duration of Breastfeeding and Prevalence of Bifidobacterium Longum Subspecies Infantis (OR01-01-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz040.or01-01-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Lack of microbiota accessible carbohydrates (MAC) can drive gut commensal extinctions. Infant formula lacks the MAC found in breastmilk, human milk oligosaccharides (HMOs). As a result, a switch from breastmilk feeding (high MAC) to formula (low MAC) may drive extinctions of infant gut commensals.
Methods
The prevalence of Bifidobacterium longum subsp. infantis, a bacterium that efficiently consumes HMOs, was compared in cohorts from Austria, Bangladesh, Finland, Gambia, Germany, Switzerland, and United States. Scientific literature reports that both Bangladesh and Gambia have long duration breastfeeding without a history of prevalent formula use; Bangladesh has a mean duration of breastfeeding of 31.9 months and Gambia has a median duration of breastfeeding >18 months. This contrasts with European countries and the US, who all have median duration of breastfeeding <12 months and had a nadir in breastfeeding rates in the 1960 s. Deterministic epidemiological models of B. infantis prevalence were created for each country to explore the potential effect of changing duration of breastfeeding on the prevalence of B. infantis.
Results
The highest prevalence of infant colonization with B. longum subsp. infantis was observed in countries without a history of disrupted breastfeeding patterns, Bangladesh and Gambia (80% and 91% colonization prevalence, respectively). The remaining countries had a prevalence of infant colonization with B. infantis ranging from 0.7% to 14%. The majority of infants in the European countries had gut communities dominated by Bifidobacterium (>50% relative abundance Bifidobacterium) despite the low frequency of colonization with B. infantis. The R0 of B. infantis transmission varied by country.
Conclusions
The prevalence of infant colonization with B. infantis may be sensitive to breastfeeding duration in populations. Our data supports the concept that lack of MAC drives commensal extinctions, and suggests that deliberate intervention may be needed to restore B. infantis, a bacteria that benefits infant health. More studies are needed, particularly to determine whether species of Bifidobacterium other than B. infantis are sensitive to breastfeeding duration, and to understand the impact of different types of Bifidobacterium on infant health.
Funding Sources
NIH awards F32HD093185 (DHT), AT007079 (DAM), and AT008759 (DAM).
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Affiliation(s)
| | | | | | | | | | | | - Pirkka Kirjavainen
- Department of Environment Health, National Institute for Health and Welfare
| | | | | | | | - Ardythe Morrow
- University of Cincinnati College of Medicine/Dept of Environmental Health
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20
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Metzler S, Frei R, Schmaußer-Hechfellner E, von Mutius E, Pekkanen J, Karvonen AM, Kirjavainen PV, Dalphin JC, Divaret-Chauveau A, Riedler J, Lauener R, Roduit C. Association between antibiotic treatment during pregnancy and infancy and the development of allergic diseases. Pediatr Allergy Immunol 2019; 30:423-433. [PMID: 30734960 DOI: 10.1111/pai.13039] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Allergies are a serious public health issue, and prevalences are rising worldwide. The role of antibiotics in the development of allergies has repeatedly been discussed, as results remain inconsistent. The aim of this study was to investigate the association between pre- and post-natal antibiotic exposure and subsequent development of allergies (atopic dermatitis, food allergy, asthma, atopic sensitization and allergic rhinitis). METHODS A total of 1080 children who participated in a European birth cohort study (PASTURE) were included in this analysis. Data on antibiotic exposure during pregnancy and/or first year of life and allergic diseases were collected by questionnaires from pregnancy up to 6 years of age and analysed by performing logistic regressions. To take into account reverse causation, we included models, where children with diagnosis or symptoms of the respective disease in the first year of life were excluded. RESULTS Antibiotic exposure in utero was significantly and positively associated with atopic dermatitis and food allergy. The strongest effect was on diseases with onset within the first year of life (for atopic dermatitis: aOR 1.66, 95% CI 1.11-2.48 and for food allergy: aOR 3.01, 95% CI 1.22-7.47). Antibiotics in the first year of life were positively associated with atopic dermatitis up to 4 years (aOR 2.73, 95% CI 1.66-4.49) and also suggested a dose-response relationship. A tendency was observed with asthma between 3 and 6 years (aOR 1.65, 95% CI 0.95-2.86). CONCLUSIONS Our findings show positive associations between exposure to antibiotics and allergies, mainly atopic dermatitis and food allergy within the first year of life, after prenatal exposure, and atopic dermatitis and asthma after post-natal exposure to antibiotics in children born in rural settings.
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Affiliation(s)
- Stefanie Metzler
- University of Zurich, Zurich, Switzerland.,Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Remo Frei
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.,Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Elisabeth Schmaußer-Hechfellner
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute for Asthma and Allergy Prevention, Neuherberg, Germany
| | - Erika von Mutius
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute for Asthma and Allergy Prevention, Neuherberg, Germany.,Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany.,CPC-M, German Center for Lung Research, Munich, Germany
| | - Juha Pekkanen
- Environment Health Unit, National Institute for Health and Welfare, Kuopio, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anne M Karvonen
- Environment Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Pirkka V Kirjavainen
- Environment Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Jean-Charles Dalphin
- Department of Respiratory Disease, UMR/CNRS 6249 Chrono-environment, University Hospital, University of Besançon, Besançon, France
| | - Amandine Divaret-Chauveau
- Pediatric Allergy Department, University Hospital of Nancy, Nancy, France.,EA3450 Développement Adaptation et Handicap (DevAH), University of Lorraine, Nancy, France.,UMR 6249 Chrono-environment, CNRS and University of Franche-Comté, Besançon, France
| | - Josef Riedler
- Children's Hospital Schwarzach, Schwarzach, Austria.,Teaching Hospital of Paracelsus Medical Private University Salzburg, Salzburg, Austria
| | - Roger Lauener
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.,Children's Hospital St Gallen, St Gallen, Switzerland
| | - Caroline Roduit
- Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.,Children's Hospital St Gallen, St Gallen, Switzerland.,University Children's Hospital Zurich, Zurich, Switzerland
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21
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Roduit C, Frei R, Ferstl R, Loeliger S, Westermann P, Rhyner C, Schiavi E, Barcik W, Rodriguez‐Perez N, Wawrzyniak M, Chassard C, Lacroix C, Schmausser‐Hechfellner E, Depner M, Mutius E, Braun‐Fahrländer C, Karvonen AM, Kirjavainen PV, Pekkanen J, Dalphin J, Riedler J, Akdis C, Lauener R, O'Mahony L, Hyvärinen A, Remes S, Roponen M, Chauveau A, Dalphin ML, Kaulek V, Ege M, Genuneit J, Illi S, Kabesch M, Schaub B, Pfefferle P, Doekes G. High levels of butyrate and propionate in early life are associated with protection against atopy. Allergy 2019; 74:799-809. [PMID: 30390309 DOI: 10.1111/all.13660] [Citation(s) in RCA: 272] [Impact Index Per Article: 54.4] [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: 06/19/2018] [Revised: 08/30/2018] [Accepted: 10/02/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Dietary changes are suggested to play a role in the increasing prevalence of allergic diseases and asthma. Short-chain fatty acids (SCFAs) are metabolites present in certain foods and are produced by microbes in the gut following fermentation of fibers. SCFAs have been shown to have anti-inflammatory properties in animal models. Our objective was to investigate the potential role of SCFAs in the prevention of allergy and asthma. METHODS We analyzed SCFA levels by high-performance liquid chromatography (HPLC) in fecal samples from 301 one-year-old children from a birth cohort and examined their association with early life exposures, especially diet, and allergy and asthma later in life. Data on exposures and allergic diseases were collected by questionnaires. In addition, we treated mice with SCFAs to examine their effect on allergic airway inflammation. RESULTS Significant associations between the levels of SCFAs and the infant's diet were identified. Children with the highest levels of butyrate and propionate (≥95th percentile) in feces at the age of one year had significantly less atopic sensitization and were less likely to have asthma between 3 and 6 years. Children with the highest levels of butyrate were also less likely to have a reported diagnosis of food allergy or allergic rhinitis. Oral administration of SCFAs to mice significantly reduced the severity of allergic airway inflammation. CONCLUSION Our results suggest that strategies to increase SCFA levels could be a new dietary preventive option for allergic diseases in children.
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Affiliation(s)
- Caroline Roduit
- University Children's Hospital Zurich Zurich Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Children's Hospital St Gallen St Gallen Switzerland
| | - Remo Frei
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Ruth Ferstl
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Susanne Loeliger
- University Children's Hospital Zurich Zurich Switzerland
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
| | - Patrick Westermann
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Claudio Rhyner
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Elisa Schiavi
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Weronika Barcik
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Noelia Rodriguez‐Perez
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Marcin Wawrzyniak
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | | | - Christophe Lacroix
- Department of Health Sciences and Technology ETH‐Zurich Zurich Switzerland
| | - Elisabeth Schmausser‐Hechfellner
- Institute for Asthma and Allergy Prevention Helmholtz Zentrum Munich German Research Center for Environmental Health Munich Germany
| | - Martin Depner
- Institute for Asthma and Allergy Prevention Helmholtz Zentrum Munich German Research Center for Environmental Health Munich Germany
| | - Erika Mutius
- Institute for Asthma and Allergy Prevention Helmholtz Zentrum Munich German Research Center for Environmental Health Munich Germany
- Dr von Hauner Children's Hospital of Ludwig Maximilian University of Munich Comprehensive Pneumology Center Munich (CPC‐M) Munich Germany
| | | | - Anne M. Karvonen
- Department of Health Security National Institute for Health and Welfare Kuopio Finland
| | - Pirkka V. Kirjavainen
- Department of Health Security National Institute for Health and Welfare Kuopio Finland
- Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio Finland
| | - Juha Pekkanen
- Department of Health Security National Institute for Health and Welfare Kuopio Finland
- Department of Public Health University of Helsinki Helsinki Finland
| | - Jean‐Charles Dalphin
- Department of Respiratory Disease University of Besançon UMR/CNRS 6249 Chrono‐environment University Hospital Besançon France
| | | | - Cezmi Akdis
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
| | - Roger Lauener
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Children's Hospital St Gallen St Gallen Switzerland
| | - Liam O'Mahony
- Christine Kühne‐Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Departments of Medicine and Microbiology APC Microbiome Ireland National University of Ireland Cork Ireland
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22
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Nicklaus S, Divaret‐Chauveau A, Chardon M, Roduit C, Kaulek V, Ksiazek E, Dalphin M, Karvonen AM, Kirjavainen P, Pekkanen J, Lauener R, Schmausser‐Hechfellner E, Renz H, Braun‐Fahrländer C, Riedler J, Vuitton DA, Mutius EV, Dalphin J. The protective effect of cheese consumption at 18 months on allergic diseases in the first 6 years. Allergy 2019; 74:788-798. [PMID: 30368847 DOI: 10.1111/all.13650] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 04/04/2018] [Revised: 09/19/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effect of exposure to microorganisms on allergic diseases has been well studied. The protective effect of early food diversity against allergic diseases was previously shown in the PASTURE cohort study. The consumption of cheese, a food potentially rich in microbial diversity, deserves further examination. We aimed to evaluate whether cheese consumption is associated with allergic diseases. METHODS In the PASTURE study (birth cohort in 5 European countries), data on feeding practices, environmental factors, and allergic diseases were collected by questionnaires from birth to 6 years (N = 931). Cheese consumption at 18 months of age was quantified in terms of frequency and diversity (ie, number of consumed types among 6 types: hard pressed, semipressed, soft, blue, fresh cheese, and cheese from the farm). Multiple logistic regressions were performed to evaluate the effect of cheese consumption on atopic dermatitis (AD), food allergy (FA), allergic rhinitis, asthma, and atopic sensitization at 6 years after adjustment for confounders of atopy. RESULTS Cheese consumption (vs. nonconsumption) had a significant protective effect on AD (OR = 0.51 [0.29-0.90], P = 0.02) and FA (OR = 0.32, [0.15-0.71], P = 0.004), but no effect on atopic sensitization, allergic rhinitis, and asthma at 6 years. This effect on AD and FA may be related to the diversity of consumed cheeses (OR = 0.64 [0.48-0.85] per cheese type, P = 0.002; OR = 0.55 [0.33-0.92], P = 0.02, respectively). CONCLUSION Although reverse causality cannot totally be ruled out, cheese diversity at 18 months had a protective effect against AD and FA at 6 years in addition to the protective effect of diversity of other foods.
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Affiliation(s)
- Sophie Nicklaus
- Centre des Sciences du Goût et de l'Alimentation AgroSup Dijon, CNRS INRA Université Bourgogne Franche‐Comté Dijon France
| | - Amandine Divaret‐Chauveau
- Pediatrics Department University Hospital of Besançon Besançon France
- Pediatric Allergy Department University Hospital of Nancy Nancy France
| | - Marie‐Laure Chardon
- University Hospital of Besançon, Respiratory Disease Besançon France
- Hospital of Haute‐Saône, Respiratory disease Vesoul France
| | - Caroline Roduit
- Christine Kühne Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Children's Hospital University of Zürich Zürich Switzerland
| | - Vincent Kaulek
- University Hospital of Besançon, Respiratory Disease UMR6249 ChronoEnvironnement CNRS and Université Bourgogne Franche‐Comté Besançon France
| | - Eléa Ksiazek
- Centre des Sciences du Goût et de l'Alimentation AgroSup Dijon, CNRS INRA Université Bourgogne Franche‐Comté Dijon France
| | - Marie‐Laure Dalphin
- University Hospital of Besançon, Respiratory Disease UMR6249 ChronoEnvironnement CNRS and Université Bourgogne Franche‐Comté Besançon France
| | - Anne M. Karvonen
- Department of Health Security National Institute for Health and Welfare Kuopio Finland
| | - Pirkka Kirjavainen
- Department of Health Security National Institute for Health and Welfare Kuopio Finland
| | - Juha Pekkanen
- Department of Health Security National Institute for Health and Welfare Kuopio Finland
- Department of Public Health University of Helsinki Helsinki Finland
| | - Roger Lauener
- Christine Kühne Center for Allergy Research and Education (CK‐CARE) Davos Switzerland
- Children's Hospital of Eastern Switzerland St. Gallen Switzerland
| | | | - Harald Renz
- Department of Clinical Chemistry and Molecular Diagnostics Philipps University of Marburg Marburg Germany
| | | | - Josef Riedler
- Children's Hospital Schwarzach Schwarzach Austria
- Teaching Hospital of Paracelsus Medical Private University Salzburg Salzburg Austria
| | | | - Erika Von Mutius
- Dr. Von Hauner Children's Hospital Ludwig Maximilians University Munich Munich Germany
- Institute for Asthma and Allergy Prevention Helmholtz Centre Munich Neuherberg Germany
- German Center for Lung Research Munich Germany
| | - Jean‐Charles Dalphin
- University Hospital of Besançon, Respiratory Disease UMR6249 ChronoEnvironnement CNRS and Université Bourgogne Franche‐Comté Besançon France
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23
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Gorlanova O, Illi S, Toncheva AA, Usemann J, Latzin P, Kabesch M, Dalphin JC, Lauener R, Pekkanen JR, Von Mutius E, Riedler J, Kuehni CE, Röösli M, Frey U. Protective effects of breastfeeding on respiratory symptoms in infants with 17q21 asthma risk variants. Allergy 2018; 73:2388-2392. [PMID: 30030842 DOI: 10.1111/all.13568] [Citation(s) in RCA: 12] [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] [Indexed: 12/18/2022]
Affiliation(s)
- O. Gorlanova
- University Children's Hospital (UKBB); University of Basel; Basel Switzerland
| | - S. Illi
- Dr von Hauner Children's Hospital; Ludwig Maximilian University; Munich Germany
- Comprehensive Pneumology Center Munich (CPC-M); Munich Germany
- Member of the German Center for Lung Research; Munich Germany
| | - A. A. Toncheva
- Department of Pediatric Pneumology and Allergy; University Children's Hospital Regensburg (KUNO); Regensburg Germany
| | - J. Usemann
- University Children's Hospital (UKBB); University of Basel; Basel Switzerland
- Division of Respiratory Medicine; Department of Paediatrics, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - P. Latzin
- Division of Respiratory Medicine; Department of Paediatrics, Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - M. Kabesch
- Department of Pediatric Pneumology and Allergy; University Children's Hospital Regensburg (KUNO); Regensburg Germany
| | - J.-C. Dalphin
- Department of Respiratory Disease; UMR/CNRS 6249 Chrono-environment; University Hospital; University of Besançon; Besançon France
| | - R. Lauener
- Children's Hospital of Eastern Switzerland; St. Gallen Switzerland
- Christine Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - J. R. Pekkanen
- National Institute for Health and Welfare; Kuopio Finland
- Department of Public Health; University of Helsinki; Helsinki Finland
| | - E. Von Mutius
- Dr von Hauner Children's Hospital; Ludwig Maximilian University; Munich Germany
- Comprehensive Pneumology Center Munich (CPC-M); Munich Germany
- Member of the German Center for Lung Research; Munich Germany
| | - J. Riedler
- Children's Hospital Schwarzach; Teaching Hospital Paracelsus Private Medical University Salzburg; Salzburg Austria
| | - C. E. Kuehni
- Institute for Social and Preventive Medicine; University of Bern; Bern Switzerland
| | - M. Röösli
- Swiss Tropical and Public Health Institute Basel; Basel Switzerland
| | - U. Frey
- University Children's Hospital (UKBB); University of Basel; Basel Switzerland
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24
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Buhl R, Bals R, Baur X, Berdel D, Criée CP, Gappa M, Gillissen A, Greulich T, Haidl P, Hamelmann E, Kardos P, Kenn K, Klimek L, Korn S, Lommatzsch M, Magnussen H, Nicolai T, Nowak D, Pfaar O, Rabe KF, Riedler J, Ritz T, Schultz K, Schuster A, Spindler T, Taube C, Taube K, Vogelmeier C, von Leupoldt A, Wantke F, Weise S, Wildhaber J, Worth H, Zacharasiewicz A. [Guideline for the Diagnosis and Treatment of Asthma - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. Pneumologie 2018; 71:e3. [PMID: 30406626 DOI: 10.1055/a-0790-0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- R Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Pneumologie, III. Medizinische Klinik, Mainz
| | - R Bals
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin V, Homburg/Saar
| | - X Baur
- European Society for Environmental and Occupational Medicine, EOM, Berlin
| | | | - C-P Criée
- Evangelisches Krankenhaus Göttingen Weende, Abteilung für Pneumologie, Bovenden-Lenglern
| | - M Gappa
- Marien-Hospital gGmbH, Klinik für Kinder- und Jugendmedizin, Wesel
| | - A Gillissen
- Klinikum Am Steinenberg, Ermstalklinik, Medizinische Klinik III/Innere Medizin und Pneumologie, Reutlingen-Bad Urach
| | - T Greulich
- Universitätsklinikum Gießen und Marburg, Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Marburg
| | - P Haidl
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie II, Schmallenberg
| | - E Hamelmann
- Evangelisches Klinikum Bethel, Klinik für Kinder- und Jugendmedizin, Bielefeld
| | - P Kardos
- Lungenpraxis an der Klinik Maingau vom Roten Kreuz, Frankfurt am Main
| | - K Kenn
- Schön Klinik Berchtesgadener Land, Fachzentrum für Pneumologie, Schönau am Königssee, Philipps Universität Marburg, Standort Schönau
| | - L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - S Korn
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Pneumologie, III. Medizinische Klinik, Mainz
| | - M Lommatzsch
- Universitätsmedizin Rostock, Abteilung Pneumologie, Rostock
| | - H Magnussen
- Pneumologisches Forschungsinstitut an der LungenClinic Grosshansdorf GmbH, Großhansdorf
| | - T Nicolai
- Klinikum der Universität München, Kinderklinik und Kinderpoliklinik, LMU München
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - O Pfaar
- Zentrum für Rhinologie und Allergologie, Wiesbaden.,HNO-Universitätsklinik Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
| | - K F Rabe
- LungenClinic Grosshansdorf GmbH, Abteilung für Pneumologie, Großhansdorf
| | - J Riedler
- Kardinal Schwarzenberg Klinikum, Kinder- und Jugendmedizin, Schwarzach im Pongau, Österreich
| | - T Ritz
- Southern Methodist University, Department of Psychology, Dallas, USA
| | - K Schultz
- Klinik Bad Reichenhall, Fachbereich Pneumologie, Bad Reichenhall
| | - A Schuster
- Universitätsklinikum Düsseldorf, Zentrum für Kinder- und Jugendmedizin, Düsseldorf
| | - T Spindler
- Waldburg-Zeil Kliniken, Fachkliniken Wangen, Klinik für Pädiatrische Pneumologie und Allergologie, Rehabilitationsklinik für Kinder und Jugendliche, Wangen
| | - C Taube
- Universitätsmedizin Essen, Ruhrlandklinik, Klinik für Pneumologie, Essen
| | | | - C Vogelmeier
- Universitätsklinikum Gießen und Marburg, Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Marburg
| | - A von Leupoldt
- University of Leuven, Health Psychology, Leuven, Belgien
| | - F Wantke
- Floridsdorfer Allergiezentrum, Wien, Österreich
| | - S Weise
- Atem- und Physiotherapie Solln, München
| | - J Wildhaber
- HFR Freiburg, Kantonsspital, Klinik für Pädiatrie, Freiburg, Schweiz
| | - H Worth
- Facharztzentrum Fürth, Fürth
| | - A Zacharasiewicz
- Wilhelminenspital, Lehrkrankenhaus der Medizinischen Universität Wien, Abteilung für Kinder- und Jugendheilkunde, Wien, Österreich
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25
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Buhl R, Bals R, Baur X, Berdel D, Criée CP, Gappa M, Gillissen A, Greulich T, Haidl P, Hamelmann E, Kardos P, Kenn K, Klimek L, Korn S, Lommatzsch M, Magnussen H, Nicolai T, Nowak D, Pfaar O, Rabe KF, Riedler J, Ritz T, Schultz K, Schuster A, Spindler T, Taube C, Taube K, Vogelmeier C, von Leupold A, Wantke F, Weise S, Wildhaber J, Worth H, Zacharasiewicz A. [Guideline for the Diagnosis and Treatment of Asthma - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. Pneumologie 2018; 71:e2. [PMID: 29334688 DOI: 10.1055/s-0044-100881] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- R Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Pneumologie, III. Medizinische Klinik, Mainz
| | - R Bals
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin V, Homburg/Saar
| | - X Baur
- European Society for Environmental and Occupational Medicine, EOM, Berlin
| | | | - C-P Criée
- Evangelisches Krankenhaus Göttingen Weende, Abteilung für Pneumologie, Bovenden-Lenglern
| | - M Gappa
- Marien-Hospital gGmbH, Klinik für Kinder- und Jugendmedizin, Wesel
| | - A Gillissen
- Klinikum Am Steinenberg, Ermstalklinik, Medizinische Klinik III/Innere Medizin und Pneumologie, Reutlingen-Bad Urach
| | - T Greulich
- Universitätsklinikum Gießen und Marburg, Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Marburg
| | - P Haidl
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie II, Schmallenberg
| | - E Hamelmann
- Evangelisches Klinikum Bethel, Klinik für Kinder- und Jugendmedizin, Bielefeld
| | - P Kardos
- Lungenpraxis an der Klinik Maingau vom Roten Kreuz, Frankfurt am Main
| | - K Kenn
- Schön Klinik Berchtesgadener Land, Fachzentrum für Pneumologie, Schönau am Königssee, Philipps Universität Marburg, Standort Schönau
| | - L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - S Korn
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Pneumologie, III. Medizinische Klinik, Mainz
| | - M Lommatzsch
- Universitätsmedizin Rostock, Abteilung Pneumologie, Rostock
| | - H Magnussen
- Pneumologisches Forschungsinstitut an der LungenClinic Grosshansdorf GmbH, Großhansdorf
| | - T Nicolai
- Klinikum der Universität München, Kinderklinik und Kinderpoliklinik, LMU München
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - O Pfaar
- Zentrum für Rhinologie und Allergologie, Wiesbaden.,HNO-Universitätsklinik Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
| | - K F Rabe
- LungenClinic Grosshansdorf GmbH, Abteilung für Pneumologie, Großhansdorf
| | - J Riedler
- Kardinal Schwarzenberg Klinikum, Kinder- und Jugendmedizin, Schwarzach im Pongau, Österreich
| | - T Ritz
- Southern Methodist University, Department of Psychology, Dallas, USA
| | - K Schultz
- Klinik Bad Reichenhall, Fachbereich Pneumologie, Bad Reichenhall
| | - A Schuster
- Universitätsklinikum Düsseldorf, Zentrum für Kinder- und Jugendmedizin, Düsseldorf
| | - T Spindler
- Waldburg-Zeil Kliniken, Fachkliniken Wangen, Klinik für Pädiatrische Pneumologie und Allergologie, Rehabilitationsklinik für Kinder und Jugendliche, Wangen
| | - C Taube
- Universitätsmedizin Essen, Ruhrlandklinik, Klinik für Pneumologie, Essen
| | | | - C Vogelmeier
- Universitätsklinikum Gießen und Marburg, Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Marburg
| | - A von Leupold
- University of Leuven, Health Psychology, Leuven, Belgien
| | - F Wantke
- Floridsdorfer Allergiezentrum, Wien, Österreich
| | - S Weise
- Atem- und Physiotherapie Solln, München
| | - J Wildhaber
- HFR Freiburg, Kantonsspital, Klinik für Pädiatrie, Freiburg, Schweiz
| | - H Worth
- Facharztzentrum Fürth, Fürth
| | - A Zacharasiewicz
- Wilhelminenspital, Lehrkrankenhaus der Medizinischen Universität Wien, Abteilung für Kinder- und Jugendheilkunde, Wien, Österreich
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26
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Buhl R, Bals R, Baur X, Berdel D, Criée CP, Gappa M, Gillissen A, Greulich T, Haidl P, Hamelmann E, Kardos P, Kenn K, Klimek L, Korn S, Lommatzsch M, Magnussen H, Nicolai T, Nowak D, Pfaar O, Rabe KF, Riedler J, Ritz T, Schultz K, Schuster A, Spindler T, Taube C, Taube K, Vogelmeier C, von Leupoldt A, Wantke F, Weise S, Wildhaber J, Worth H, Zacharasiewicz A. [Guideline for the Diagnosis and Treatment of Asthma - Guideline of the German Respiratory Society and the German Atemwegsliga in Cooperation with the Paediatric Respiratory Society and the Austrian Society of Pneumology]. Pneumologie 2017; 71:849-919. [PMID: 29216678 DOI: 10.1055/s-0043-119504] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The present guideline is a new version and an update of the guideline for the diagnosis and treatment of asthma, which replaces the previous version for german speaking countries from the year 2006. The wealth of new data on the pathophysiology and the phenotypes of asthma, and the expanded spectrum of diagnostic and therapeutic options necessitated a new version and an update. This guideline presents the current, evidence-based recommendations for the diagnosis and treatment of asthma, for children and adolescents as well as for adults with asthma.
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Affiliation(s)
| | | | | | - R Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Pneumologie, III. Medizinische Klinik, Mainz
| | - R Bals
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin V, Homburg/Saar
| | - X Baur
- European Society for Environmental and Occupational Medicine, EOM, Berlin
| | | | - C-P Criée
- Evangelisches Krankenhaus Göttingen Weende, Abteilung für Pneumologie, Bovenden-Lenglern
| | - M Gappa
- Marien-Hospital gGmbH, Klinik für Kinder- und Jugendmedizin, Wesel
| | - A Gillissen
- Klinikum Am Steinenberg, Ermstalklinik, Medizinische Klinik III/Innere Medizin und Pneumologie, Reutlingen-Bad Urach
| | - T Greulich
- Universitätsklinikum Gießen und Marburg, Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Marburg
| | - P Haidl
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung Pneumologie II, Schmallenberg
| | - E Hamelmann
- Evangelisches Klinikum Bethel, Klinik für Kinder- und Jugendmedizin, Bielefeld
| | - P Kardos
- Lungenpraxis an der Klinik Maingau vom Roten Kreuz, Frankfurt am Main
| | - K Kenn
- Schön Klinik Berchtesgadener Land, Fachzentrum für Pneumologie, Schönau am Königssee, Philipps Universität Marburg, Standort Schönau
| | - L Klimek
- Zentrum für Rhinologie und Allergologie, Wiesbaden
| | - S Korn
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Schwerpunkt Pneumologie, III. Medizinische Klinik, Mainz
| | - M Lommatzsch
- Universitätsmedizin Rostock, Abteilung Pneumologie, Rostock
| | - H Magnussen
- Pneumologisches Forschungsinstitut an der LungenClinic Grosshansdorf GmbH, Großhansdorf
| | - T Nicolai
- Klinikum der Universität München, Kinderklinik und Kinderpoliklinik, LMU München
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München
| | - O Pfaar
- Zentrum für Rhinologie und Allergologie, Wiesbaden.,HNO-Universitätsklinik Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
| | - K F Rabe
- LungenClinic Grosshansdorf GmbH, Abteilung für Pneumologie, Großhansdorf
| | - J Riedler
- Kardinal Schwarzenberg Klinikum, Kinder- und Jugendmedizin, Schwarzach im Pongau, Österreich
| | - T Ritz
- Southern Methodist University, Department of Psychology, Dallas, USA
| | - K Schultz
- Klinik Bad Reichenhall, Fachbereich Pneumologie, Bad Reichenhall
| | - A Schuster
- Universitätsklinikum Düsseldorf, Zentrum für Kinder- und Jugendmedizin, Düsseldorf
| | - T Spindler
- Waldburg-Zeil Kliniken, Fachkliniken Wangen, Klinik für Pädiatrische Pneumologie und Allergologie, Rehabilitationsklinik für Kinder und Jugendliche, Wangen
| | - C Taube
- Universitätsmedizin Essen, Ruhrlandklinik, Klinik für Pneumologie, Essen
| | | | - C Vogelmeier
- Universitätsklinikum Gießen und Marburg, Klinik für Innere Medizin mit Schwerpunkt Pneumologie, Marburg
| | - A von Leupoldt
- University of Leuven, Health Psychology, Leuven, Belgien
| | - F Wantke
- Floridsdorfer Allergiezentrum, Wien, Österreich
| | - S Weise
- Atem- und Physiotherapie Solln, München
| | - J Wildhaber
- HFR Freiburg, Kantonsspital, Klinik für Pädiatrie, Freiburg, Schweiz
| | - H Worth
- Facharztzentrum Fürth, Fürth
| | - A Zacharasiewicz
- Wilhelminenspital, Lehrkrankenhaus der Medizinischen Universität Wien, Abteilung für Kinder- und Jugendheilkunde, Wien, Österreich
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27
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Twardziok M, Schröder PC, Krusche J, Casaca VI, Illi S, Böck A, Loss GJ, Kabesch M, Toncheva AA, Roduit C, Depner M, Genuneit J, Renz H, Roponen M, Weber J, Braun-Fahrländer C, Riedler J, Lauener R, Vuitton DA, Dalphin JC, Pekkanen J, von Mutius E, Schaub B, Hyvärinen A, Karvonen AM, Kirjavainen PV, Remes S, Kaulek V, Dalphin ML, Ege M, Pfefferle PI, Doekes G. Asthmatic farm children show increased CD3 +CD8 low T-cells compared to non-asthmatic farm children. Clin Immunol 2017; 183:285-292. [PMID: 28917722 DOI: 10.1016/j.clim.2017.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/28/2017] [Accepted: 09/12/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Monika Twardziok
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Paul C Schröder
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Johanna Krusche
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany; Member of German Center for Lung Research, DZL, LMU Munich, Germany
| | - Vera I Casaca
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Sabina Illi
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Andreas Böck
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Georg J Loss
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany; University of California, San Diego, School of Medicine, Department of Pediatrics, CA, USA
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany
| | - Antoaneta A Toncheva
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany
| | - Caroline Roduit
- Zurich University Children's Hospital, Zurich, Switzerland; Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland and Christine Kühne-Center for Allergy Research and Education, St. Gallen, Switzerland
| | - Martin Depner
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Harald Renz
- Institute of Laboratory Medicine, Philipps University Marburg, Marburg, Germany; Member of German Center for Lung Research, DZL, LMU Munich, Germany
| | - Marjut Roponen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Juliane Weber
- Bavarian Health and Food Safety Authority, Oberschleißheim, Germany
| | | | | | - Roger Lauener
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland and Christine Kühne-Center for Allergy Research and Education, St. Gallen, Switzerland
| | | | | | - Juha Pekkanen
- Department of Public health, University of Helsinki, Helsinki, Finland; Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Erika von Mutius
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany; Member of German Center for Lung Research, DZL, LMU Munich, Germany
| | - Bianca Schaub
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany; Member of German Center for Lung Research, DZL, LMU Munich, Germany.
| | | | - Anne Hyvärinen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Anne M Karvonen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Pirkka V Kirjavainen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Sami Remes
- Kuopio University Hospital, Department of Paediatrics, Kuopio, Finland
| | - Vincent Kaulek
- University Hospital of Besançon, University of Franche-Comté, Besançon, France
| | - Marie-Laure Dalphin
- University Hospital of Besançon, University of Franche-Comté, Besançon, France
| | - Markus Ege
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany; Member of German Center for Lung Research, DZL, LMU Munich, Germany
| | - Petra I Pfefferle
- Institute of Laboratory Medicine, Philipps University Marburg, Marburg, Germany; Member of German Center for Lung Research, DZL, LMU Munich, Germany
| | - Gert Doekes
- Utrecht University, Institut for Risk Assessment Sciences (IRAS), Devision of Environmental Epidemiology, Utrecht, Netherlands
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28
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Delgado-Eckert E, Fuchs O, Kumar N, Pekkanen J, Dalphin JC, Riedler J, Lauener R, Kabesch M, Kupczyk M, Dahlen SE, Mutius EV, Frey U. Functional phenotypes determined by fluctuation-based clustering of lung function measurements in healthy and asthmatic cohort participants. Thorax 2017; 73:107-115. [PMID: 28866644 DOI: 10.1136/thoraxjnl-2016-209919] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 07/11/2017] [Accepted: 07/31/2017] [Indexed: 11/03/2022]
Abstract
RATIONALE Asthma is characterised by inflammation and reversible airway obstruction. However, these features are not always closely related. Fluctuations of daily lung function contain information on asthma phenotypes, exacerbation risk and response to long-acting β-agonists. OBJECTIVES In search of subgroups of asthmatic participants with specific lung functional features, we developed and validated a novel clustering approach to asthma phenotyping, which exploits the information contained within the fluctuating behaviour of twice-daily lung function measurements. METHODS Forced expiratory volume during the first second (FEV1) and peak expiratory flow (PEF) were prospectively measured over 4 weeks in 696 healthy and asthmatic school children (Protection Against Allergy - Study in Rural Environments (PASTURE)/EFRAIM cohort), and over 1 year in 138 asthmatic adults with mild-to-moderate or severe asthma (Pan-European Longitudinal Assessment of Clinical Course and BIOmarkers in Severe Chronic AIRway Disease (BIOAIR) cohort). Using enrichment analysis, we explored whether the method identifies clinically meaningful, distinct clusters of participants with different lung functional fluctuation patterns. MEASUREMENTS AND MAIN RESULTS In the PASTURE/EFRAIM dataset, we found four distinct clusters. Two clusters were enriched in children with well-known clinical characteristics of asthma. In cluster 3, children from a farming environment predominated, whereas cluster 4 mainly consisted of healthy controls. About 79% of cluster 3 carried the asthma-risk allele rs7216389 of the 17q21 locus. In the BIOAIR dataset, we found two distinct clusters clearly discriminating between individuals with mild-to-moderate and severe asthma. CONCLUSIONS Our method identified dynamic functional asthma and healthy phenotypes, partly independent of atopy and inflammation but related to genetic markers on the 17q21 locus. The method can be used for disease phenotyping and possibly endotyping. It may identify participants with specific functional abnormalities, potentially needing a different therapeutic approach.
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Affiliation(s)
- Edgar Delgado-Eckert
- University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
- Endothelial Cell Biology Unit and Department of Applied Mathematics, School of Molecular & Cellular Biology, School of Mathematics, University of Leeds, Leeds, UK
| | - Oliver Fuchs
- Dr von Hauner Children's Hospital, Ludwig Maximilians University, Member of the German Center for Lung Research (DZL), Munchen, Germany
- Department of Paediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland
| | - Nitin Kumar
- University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
| | - Juha Pekkanen
- Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jean-Charles Dalphin
- Department of Respiratory Disease, University Hospital of Besançon, Besançon, France
| | | | - Roger Lauener
- Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy Campus St. Hedwig, KUNO Children's University Hospital, Regensburg, Germany
- Clinic for Pediatric Pneumology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Maciej Kupczyk
- Experimental Asthma and Allergy Research Unit, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Sven-Erik Dahlen
- Experimental Asthma and Allergy Research Unit, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig Maximilians University, Member of the German Center for Lung Research (DZL), Munchen, Germany
| | - Urs Frey
- University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
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29
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Chauveau A, Dalphin ML, Mauny F, Kaulek V, Schmausser-Hechfellner E, Renz H, Riedler J, Pekkanen J, Karvonen AM, Lauener R, Roduit C, Vuitton DA, von Mutius E, Dalphin JC. Skin prick tests and specific IgE in 10-year-old children: Agreement and association with allergic diseases. Allergy 2017; 72:1365-1373. [PMID: 28235151 DOI: 10.1111/all.13148] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Accurate assessment of atopic sensitization is pivotal to clinical practice and research. Skin prick test (SPT) and specific IgE (sIgE) are often used interchangeably. Some studies have suggested a disagreement between these two methods, and little is known about their association with allergic diseases. The aims of our study were to evaluate agreement between SPT and sIgE, and to compare their association with allergic diseases in 10-year-old children. METHODS Skin prick test, sIgE measurements, and assessment of allergic diseases were performed in children aged 10 years in the Protection against Allergy: STUdy in Rural Environments (PASTURE) cohort. The agreement between SPT and sIgE was assessed by Cohen's kappa coefficient with different cutoff values. RESULTS Skin prick tests and sIgE were performed in 529 children. The highest agreement (κ=.44) was found with a cutoff value of 3 and 5 mm for SPT, and 3.5 IU/mL for sIgE. The area under the curve (AUC) obtained with SPT was not significantly different from that obtained with sIgE. For asthma and hay fever, SPT (cutoff value at 3 mm) had a significantly higher specificity (P<.0001) than sIgE (cutoff value at 0.35 IU/mL) and the specificity was not different between both tests (P=.1088). CONCLUSION Skin prick test and sIgE display moderate agreement, but have a similar AUC for allergic diseases. At the cutoff value of 3 mm for SPT and 0.35 IU/mL for sIgE, SPT has a higher specificity for asthma and hay fever than sIgE without difference for sensitivity.
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Affiliation(s)
- A. Chauveau
- Pediatrics Department; University Hospital of Besançon; Besançon France
- Pediatric Allergy Department; University Hospital of Nancy; Nancy France
- UMR 6249 Chrono-Environment; CNRS and University of Franche-Comté; Besançon France
| | - M.-L. Dalphin
- Pediatrics Department; University Hospital of Besançon; Besançon France
| | - F. Mauny
- UMR 6249 Chrono-Environment; CNRS and University of Franche-Comté; Besançon France
- Clinical Methodology Center; University Hospital of Besançon; Besançon France
| | - V. Kaulek
- UMR 6249 Chrono-Environment; CNRS and University of Franche-Comté; Besançon France
- Respiratory Diseases Department; University Hospital of Besançon; Besançon France
| | | | - H. Renz
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics; Philipps University of Marburg; Marburg Germany
| | - J. Riedler
- Children's Hospital Schwarzach; Salzburg Austria
| | - J. Pekkanen
- Department of Health Protection; National Institute for Health and Welfare; Kuopio Finland
- Department of Public Health; University of Helsinki; Helsinki Finland
| | - A. M. Karvonen
- Department of Health Protection; National Institute for Health and Welfare; Kuopio Finland
| | - R. Lauener
- Christine Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
- Children's Hospital of Eastern Switzerland; St. Gallen Switzerland
| | - C. Roduit
- Christine Kühne Center for Allergy Research and Education (CK-CARE); Davos Switzerland
- University Children's Hospital Zurich; Zurich Switzerland
| | - D. A. Vuitton
- EA 3181; University of Franche-Comté; Besançon France
| | - E. von Mutius
- Dr. von Hauner Children's Hospital; Ludwig Maximilians University Munich; Munich Germany
- CPC-M; Member of the German Center for Lung Research; Giessen Germany
| | - J.-C. Dalphin
- UMR 6249 Chrono-Environment; CNRS and University of Franche-Comté; Besançon France
- Respiratory Diseases Department; University Hospital of Besançon; Besançon France
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30
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Roduit C, Frei R, Depner M, Karvonen AM, Renz H, Braun-Fahrländer C, Schmausser-Hechfellner E, Pekkanen J, Riedler J, Dalphin JC, von Mutius E, Lauener RP, Hyvärinen A, Kirjavainen P, Remes S, Roponen M, Dalphin ML, Kaulek V, Ege M, Genuneit J, Illi S, Kabesch M, Schaub B, Pfefferle PI, Doekes G. Phenotypes of Atopic Dermatitis Depending on the Timing of Onset and Progression in Childhood. JAMA Pediatr 2017; 171:655-662. [PMID: 28531273 PMCID: PMC5710337 DOI: 10.1001/jamapediatrics.2017.0556] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Atopic dermatitis is an inflammatory, pruritic skin disease that often occurs in early infancy with a chronic course. However, a specific description of subtypes of atopic dermatitis depending on the timing of onset and progression of the disease in childhood is lacking. OBJECTIVE To identify different phenotypes of atopic dermatitis using a definition based on symptoms before age 6 years and to determine whether some subtypes are more at risk for developing other allergic diseases. DESIGN, SETTING, AND PARTICIPANTS The Protection Against Allergy Study in Rural Environments (PASTURE) is a European birth cohort where pregnant women were recruited between August 2002 and March 2005 and divided in 2 groups dependent on whether they lived on a farm. Children from this cohort with data on atopic dermatitis from birth to 6 years of age were included. EXPOSURES Atopic dermatitis, defined as an itchy rash on typical locations from birth to 6 years. MAIN OUTCOMES AND MEASURES The latent class analysis was used to identify subtypes of atopic dermatitis in childhood based on the course of symptoms. Multivariable logistic regressions were used to analyze the association between atopic dermatitis phenotypes and other allergic diseases. RESULTS We included 1038 children; of these, 506 were girls. The latent class analysis model with the best fit to PASTURE data separated 4 phenotypes of atopic dermatitis in childhood: 2 early phenotypes with onset before age 2 years (early transient [n = 96; 9.2%] and early persistent [n = 67; 6.5%]), the late phenotype with onset at age 2 years or older (n = 50; 4.8%), and the never/infrequent phenotype (n = 825; 79.5%), defined as children with no atopic dermatitis. Children with both parents with history of allergies were 5 times more at risk to develop atopic dermatitis with an early-persistent phenotype compared with children with parents with no history of allergies. Both early phenotypes were strongly associated with food allergy. The risk of developing asthma was significantly increased among the early-persistent phenotype (adjusted odds ratio, 2.87; 95% CI, 1.31-6.31). The late phenotype was only positively associated with allergic rhinitis. CONCLUSIONS AND RELEVANCE Using latent class analysis, 4 phenotypes of atopic dermatitis were identified depending on the onset and course of the disease. The prevalence of asthma and food allergy by 6 years of age was strongly increased among children with early phenotypes (within age 2 years), especially with persistent symptoms. These findings are important for the development of strategies in allergy prevention.
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Affiliation(s)
- Caroline Roduit
- University Children’s Hospital, Zurich, Switzerland,Christine Kühne Center for Allergy Research and Education, Davos, Switzerland
| | - Remo Frei
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland,Swiss Institute of Allergy and Asthma Research, University of Zurich, Zurich, Switzerland
| | - Martin Depner
- Dr von Hauner Children’s Hospital, Ludwig Maximilian University, Munich, Germany
| | - Anne M. Karvonen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Harald Renz
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany
| | | | | | - Juha Pekkanen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Josef Riedler
- Children’s Hospital Schwarzach, Teaching Hospital Paracelsus Private Medical University Salzburg, Salzburg, Austria
| | - Jean-Charles Dalphin
- University of Besançon, Department of Respiratory Disease, Unités Mixtes de Recherche/Le Centre National de la Recherche Scientifique 6249 Chrono-environment, University Hospital, Besançon, France
| | - Erika von Mutius
- Dr von Hauner Children’s Hospital, Ludwig Maximilian University, Munich, Germany,Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | - Roger Pascal Lauener
- Christine Kühne Center for Allergy Research and Education, Davos, Switzerland,Children’s Hospital of Eastern Switzerland, St Gallen, Switzerland
| | | | - Anne Hyvärinen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | | | | | | | | | - Vincent Kaulek
- University of Besançon, Department of Respiratory Disease, Unités Mixtes de Recherche/Le Centre National de la Recherche Scientifique 6249 Chrono-environment, University Hospital, Besançon, France
| | - Markus Ege
- Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Sabina Illi
- Asthma and Allergy Research Group, University of Munich, Munich, Germany
| | - Micahel Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg, Regensburg, Germany
| | - Bianca Schaub
- Comprehensive Pneumology Center Munich, Member of the German Center for Lung Research, Munich, Germany
| | | | - Gert Doekes
- Utrecht University, Institue for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht, Germany
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Schröder PC, Illi S, Casaca VI, Lluis A, Böck A, Roduit C, Depner M, Frei R, Genuneit J, Pfefferle PI, Roponen M, Weber J, Braun-Fahrländer C, Riedler J, Dalphin J, Pekkanen J, Lauener R, von Mutius E, Schaub B. A switch in regulatory T cells through farm exposure during immune maturation in childhood. Allergy 2017; 72:604-615. [PMID: 27732759 DOI: 10.1111/all.13069] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Farm exposure protects against development of allergies early in life. At 4.5 years, protection against asthma by farm-milk exposure was partially mediated by regulatory T cells (Tregs). The aim of this study was to investigate the critical time window of the 'asthma-protective' farm effect via Tregs during childhood immune maturation. METHODS Tregs were assessed longitudinally at 4.5 and 6 years in 111 children (56 farm and 55 reference children) from the PASTURE/EFRAIM birth cohort (flow cytometry). Peripheral blood mononuclear cells were cultured unstimulated (U), with phorbol 12-myristate 13-acetate/ionomycin (PI) or lipopolysaccharide (LPS), and stained for Tregs (CD4+ CD25high FOXP3upper20% ). mRNA expression of Treg/Th1/Th2/Th17-associated cell markers was measured ex vivo. Suppressive capacity of Tregs on effector cells and cytokines was assessed. Detailed questionnaires assessing farm exposures and clinical phenotypes from birth until age 6 years were answered by the parents. RESULTS Treg percentage before and after stimulation and FOXP3mRNA expression ex vivo decreased from age 4.5 to 6 years (P(U,LPS) < 0.001; P(PI) = 0.051; P(FOXP3) < 0.001). High vs low farm-milk and animal-stable exposure was associated with decreased LPS-stimulated Treg percentage at age 6 years (P(LPS) = 0.045). Elevated LPS-stimulated-Treg percentage at age 6 was associated with increased risk of asthma (aOR = 11.29, CI: 0.96-132.28, P = 0.053). Tregs from asthmatics vs nonasthmatics suppressed IFN-γ (P = 0.015) and IL-9 (P = 0.023) less efficiently. mRNA expression of Th1/Th2/Th17-associated cell markers decreased between 4.5 and 6 years (P < 0.001). CONCLUSIONS Tregs at the age of 6 years were decreased with farm exposure and increased within asthmatics, opposite to age 4.5 years. This immunological switch defines a critical 'time window' for Treg-mediated asthma protection via environmental exposure before age 6 years.
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Affiliation(s)
- P. C. Schröder
- LMU Munich; University Children's Hospital; Munich Germany
| | - S. Illi
- LMU Munich; University Children's Hospital; Munich Germany
| | - V. I. Casaca
- LMU Munich; University Children's Hospital; Munich Germany
| | - A. Lluis
- National Jewish Health; Denver CO USA
| | - A. Böck
- LMU Munich; University Children's Hospital; Munich Germany
| | - C. Roduit
- Children's Hospital; University of Zürich; Zürich Switzerland
- Christine Kühne - Center for Allergy Research and Education (CK-CARE); Davos Switzerland
| | - M. Depner
- LMU Munich; University Children's Hospital; Munich Germany
| | - R. Frei
- Christine Kühne - Center for Allergy Research and Education (CK-CARE); Davos Switzerland
- Swiss Institute of Allergy and Asthma Research (SIAF); University of Zurich; Davos Switzerland
| | - J. Genuneit
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm Germany
| | - P. I. Pfefferle
- Comprehensive Biomaterial Bank Marburg CBBM; Fachbereich Medizin der Philipps Universität Marburg; Zentrum für Tumor und Immunbiologie ZTI; Marburg Germany
- Member of the German Centre for Lung Research (DZL); Munich Germany
| | - M. Roponen
- Department of Environmental Science; Inhalation Toxicology Laboratory; University of Eastern Finland; Kuopio Finland
| | - J. Weber
- LMU Munich; University Children's Hospital; Munich Germany
| | - C. Braun-Fahrländer
- Swiss Tropical and Public Health Institute; Basel Switzerland
- University of Basel; Basel Switzerland
| | - J. Riedler
- Children's Hospital Schwarzach; Schwarzach Austria
- Teaching Hospital of Paracelsus Medical Private University Salzburg; Salzburg Austria
| | - J.C. Dalphin
- Department of Respiratory Disease; University Hospital; University of Besançon; Besançon France
| | - J. Pekkanen
- Department of Health Protection; National Institute for Health and Welfare; Kuopio Finland
- Department of Public Health; University of Helsinki; Helsinki Finland
| | - R. Lauener
- Christine Kühne - Center for Allergy Research and Education (CK-CARE); Davos Switzerland
- Children's Hospital of Eastern Switzerland; St. Gallen Switzerland
| | - E. von Mutius
- LMU Munich; University Children's Hospital; Munich Germany
- Comprehensive Pneumology Centre Munich (CPC-M); German Centre for Lung Research (DZL); Munich Germany
| | - B. Schaub
- LMU Munich; University Children's Hospital; Munich Germany
- Comprehensive Pneumology Centre Munich (CPC-M); German Centre for Lung Research (DZL); Munich Germany
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32
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Frischer T, Eber E, Ellemunter H, Zacharasiewicz A, Kaluza I, Riedler J, Renner S. Cystic fibrosis in Austria. Wien Klin Wochenschr 2017; 129:527-532. [PMID: 28236043 DOI: 10.1007/s00508-017-1179-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
Registry data for patients with cystic fibrosis (CF) are increasingly used to evaluate the natural history, for benchmarking of therapy and in order to identify eligible patients for clinical studies. So far, no data on frequency and clinical status of CF patients have been available for Austria on a national level. We collected data of CF patients treated 2014 in Austrian CF outpatient clinics by means of a European CF registry and on an individual search basis. A total of 773 CF patients with a median age of 18.9 years (SD 11.8 years) were seen in 13 centers (18-151 patients/center). Homozygous F508del mutation being the most common genotype was observed in 48.8% of patients. Mean age at diagnosis was 27 days. In 59% of all patients FEV1% predicted (Forced Exspiratory Volume in 1 second) was <80% and in 20% <50%. An average FEV1 predicted decline per year of 1.9% was observed between 6-18 years of age. Colonisation with Pseudomonas aeruginosa ranged between 12% and 69% in adult patients and in 0-16% in children with CF. Burkholderia cepacia complex species were present in a total of 29 samples (3.8%). Insulin therapy for diabetes was given in 14.5%. Liver involvement was reported in 36.3%. A wide variation of prescribed CF therapy was observed between centers. Data on CF patients living in Austria are now available and form a basis for clinical benchmarking as well as analyses from a public health perspective.
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Affiliation(s)
- Thomas Frischer
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria.
| | - Ernst Eber
- Department of Pneumology and Allergology, University Children's Hospital of Graz, Graz, Austria
| | - Helmut Ellemunter
- Department of Pediatrics and Adolescent medicine, University Children's Hospital of Innsbruck, Innsbruck, Austria
| | - Angela Zacharasiewicz
- Department of Pediatrics and Adolescent Medicine, Wilhelminenspital, Montleartstraße 37, 1160, Vienna, Austria
| | - Ingrid Kaluza
- Department of Pneumology, Krankenhaus Hietzing, Vienna, Austria
| | - Josef Riedler
- Department of Pediatrics and Adolescent Medicine, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Austria
| | - Sabine Renner
- Department of Pneumology, Allergology and Endocrinology, University Children's Hospital of Vienna, Vienna, Austria
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33
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Bergroth E, Roponen M, Karvonen AM, Keski-Nisula L, Remes S, Riedler J, Roduit C, Dalphin JC, Kaulek V, Loss GJ, Lauener R, Hirvonen MR, Genuneit J, Schmaußer-Hechfellner E, Renz H, Pfefferle PI, Krauss-Etschmann S, Schaub B, von Mutius E, Pekkanen J. Enhanced T helper 1 and 2 cytokine responses at birth associate with lower risk of middle ear infections in infancy. Pediatr Allergy Immunol 2017; 28:53-59. [PMID: 27633913 DOI: 10.1111/pai.12658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Respiratory tract infections and their symptoms are frequent during early childhood, but their risk factors, including the effect of early immune regulation, are less known. The aim of the study was to analyze whether stimulated cord blood cytokine production is associated with the frequency of respiratory tract infection symptoms or infections during the first year of life. METHODS The study population consisted of children of mothers from farm or non-farm rural environment from Austria, Finland, Germany, and Switzerland who participated in a prospective birth cohort study (PASTURE: Protection against Allergy-Study in Rural Environments) (N = 550). Cord blood samples were stimulated with the combination of phorbol ester and ionomycin (P/I) for 24 h, and the production of IL-5, IL-10, TNF-α, and IFN-γ was determined using ELISA. Information about infectious morbidity was collected using weekly diaries. RESULTS P/I-stimulated production of IL-5 (adjusted risk ratio (aRR) for ≤median production, 0.37; 95% confidence interval (CI), 0.25-0.55, aRR for >median production, 0.41; 95% CI, 0.27-0.61 vs. production <detection limit) and IFN-γ (aRR for ≤median production, 0.62; 95% CI, 0.40-0.95, aRR for >median production, 0.39; 95% CI, 0.25-0.62 vs. production <detection limit) in cord blood were associated with lower number of weeks with reported middle ear infection. There was a tendency toward positive association with P/I-stimulated TNF-α production and middle ear infections. CONCLUSION Our results suggest that increased Th2- and Th1-associated cytokine responses at birth may provide protection from later middle ear infections.
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Affiliation(s)
- Eija Bergroth
- Department of Pediatrics, Central Hospital of Central Finland, Jyväskylä, Finland.,Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | - Marjut Roponen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Anne M Karvonen
- Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland
| | - Leea Keski-Nisula
- Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sami Remes
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland
| | | | - Caroline Roduit
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.,Children's Hospital, University of Zürich, Zürich, Switzerland
| | - Jean-Charles Dalphin
- Department of Respiratory Disease, University of Besançon, UMR/CNRS 6249 Chrono-Environment, University Hospital, Besançon, France
| | - Vincent Kaulek
- Department of Respiratory Disease, University of Besançon, UMR/CNRS 6249 Chrono-Environment, University Hospital, Besançon, France
| | - Georg J Loss
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Roger Lauener
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Maija-Riitta Hirvonen
- Department of Environmental and Biological Sciences, University of Eastern Finland, Kuopio, Finland
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Harald Renz
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany.,Member of the German Center for Lung Research, UGMLC, Marburg, Germany
| | - Petra I Pfefferle
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany.,Member of the German Center for Lung Research, UGMLC, Marburg, Germany.,Comprehensive Biomaterial Bank Marburg CBBM, Medical faculty, Philipps University of Marburg, Marburg, Germany
| | - Susanne Krauss-Etschmann
- Division of Experimental Asthma Research, Research Center Borstel, Leibniz-Center for Medicine and Biosciences, Member of the German Research Center for Lung Research, Borstel, Germany.,Institute for Experimental Medicine, Christian-Albrechts-Universitaet zu Kiel, Kiel, Germany
| | - Bianca Schaub
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,Member of the German Center for Lung Research, CPC-M, Munich, Germany
| | - Erika von Mutius
- Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,Member of the German Center for Lung Research, CPC-M, Munich, Germany
| | - Juha Pekkanen
- Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
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Schröder PC, Casaca VI, Illi S, Schieck M, Michel S, Böck A, Roduit C, Frei R, Lluis A, Genuneit J, Pfefferle P, Roponen M, Weber J, Braun-Fahrländer C, Riedler J, Lauener R, Vuitton DA, Dalphin JC, Pekkanen J, von Mutius E, Kabesch M, Schaub B. IL-33 polymorphisms are associated with increased risk of hay fever and reduced regulatory T cells in a birth cohort. Pediatr Allergy Immunol 2016; 27:687-695. [PMID: 27171815 DOI: 10.1111/pai.12597] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND IL-33 polymorphisms influence the susceptibility to asthma. IL-33 indirectly induces Th2-immune responses via dendritic cell activation, being important for development of atopic diseases. Furthermore, IL-33 upregulates regulatory T cells (Tregs), which are critical for healthy immune homeostasis. This study investigates associations between IL-33 polymorphisms during the development of childhood atopic diseases and underlying mechanisms including immune regulation of Tregs. METHODS Genotyping of IL-33-polymorphisms (rs928413, rs1342326) was performed by MALDI-TOF-MS in 880 of 1133 PASTURE/EFRAIM children. In 4.5-year-old German PASTURE/EFRAIM children (n = 99), CD4+ CD25high FOXP3+ Tregs were assessed by flow cytometry following 24-h incubation of PBMCs with PMA/ionomycin, LPS or without stimuli (U). SOCS3, IL1RL1, TLR4 mRNA expression and sST2 protein levels ex vivo were measured in PASTURE/EFRAIM children by real-time PCR or ELISA, respectively. Health outcomes (hay fever, asthma) were assessed by questionnaires at the age of 6 years. RESULTS rs928413 and rs1342326 were positively associated with hay fever (OR = 1.77, 95%CI = 1.02-3.08; OR = 1.79, 95%CI = 1.04-3.11) and CD4+ CD25high FOXP3+ Tregs (%) decreased in minor allele homozygotes/heterozygotes compared to major allele homozygotes (p(U) = 0.004; p(LPS) = 0.005; p(U) = 0.001; p(LPS) = 0.012). SOCS3 mRNA expression increased in minor allele homozygotes and heterozygotes compared with major allele homozygotes for both IL-33-polymorphisms (p(rs928413) = 0.032, p(rs1342326) = 0.019) and negatively correlated to Tregs. CONCLUSIONS IL-33-polymorphisms rs928413 and rs1342326 may account for an increased risk of hay fever with the age of 6 years. Lower Tregs and increased SOCS3 in combined heterozygotes and minor allele homozygotes may be relevant for hay fever development, pointing towards dysbalanced immune regulation and insufficient control of allergic inflammation.
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Affiliation(s)
| | - Vera I Casaca
- LMU Munich, University Children's Hospital, Munich, Germany
| | - Sabina Illi
- LMU Munich, University Children's Hospital, Munich, Germany
| | - Maximilian Schieck
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany.,Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Sven Michel
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany.,Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Andreas Böck
- LMU Munich, University Children's Hospital, Munich, Germany
| | - Caroline Roduit
- Children's Hospital, and Christine Kühne-Center for Allergy Research and Education, University of Zurich, Zurich, Switzerland
| | - Remo Frei
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.,Christine Kühne-Center for Allergy research and Education, Hochgebirgsklinik Davos-Wolfgang, Davos, Switzerland
| | | | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Petra Pfefferle
- Department of Clinical Chemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany
| | - Marjut Roponen
- Living Environment and Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Juliane Weber
- LMU Munich, University Children's Hospital, Munich, Germany
| | | | | | - Roger Lauener
- Christine Kühne-Center for Allergy research and Education, Hochgebirgsklinik Davos-Wolfgang, Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Dominique Angèle Vuitton
- University Hospital of Besançon, the Research Unit Health and Rural Environment, University of Franche-Comté, Besançon, France
| | - Jean-Charles Dalphin
- University Hospital of Besançon, the Research Unit Health and Rural Environment, University of Franche-Comté, Besançon, France
| | - Juha Pekkanen
- Living Environment and Health Unit, National Institute for Health and Welfare, Kuopio, Finland.,Department of Public health, University of Helsinki, Helsinki, Finland
| | | | - Michael Kabesch
- Department of Pediatric Pneumology and Allergy, University Children's Hospital Regensburg (KUNO), Regensburg, Germany.,Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Bianca Schaub
- LMU Munich, University Children's Hospital, Munich, Germany.
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Hose AJ, Depner M, Illi S, Lau S, Keil T, Wahn U, Fuchs O, Pfefferle PI, Schmaußer-Hechfellner E, Genuneit J, Lauener R, Karvonen AM, Roduit C, Dalphin JC, Riedler J, Pekkanen J, von Mutius E, Ege MJ, Zepp F, Wahn V, Schuster A, Bergmann RL, Bergmann KE, Reich A, Grabenhenrich L, Schaub B, Loss GJ, Renz H, Kabesch M, Roponen M, Hyvärinen A, Tiittanen P, Remes S, Braun-Fahrländer C, Frei R, Kaulek V, Dalphin ML, Doekes G, Blümer N, Frey U. Latent class analysis reveals clinically relevant atopy phenotypes in 2 birth cohorts. J Allergy Clin Immunol 2016; 139:1935-1945.e12. [PMID: 27771325 DOI: 10.1016/j.jaci.2016.08.046] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [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: 01/22/2016] [Revised: 08/11/2016] [Accepted: 08/22/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Phenotypes of childhood-onset asthma are characterized by distinct trajectories and functional features. For atopy, definition of phenotypes during childhood is less clear. OBJECTIVE We sought to define phenotypes of atopic sensitization over the first 6 years of life using a latent class analysis (LCA) integrating 3 dimensions of atopy: allergen specificity, time course, and levels of specific IgE (sIgE). METHODS Phenotypes were defined by means of LCA in 680 children of the Multizentrische Allergiestudie (MAS) and 766 children of the Protection against allergy: Study in Rural Environments (PASTURE) birth cohorts and compared with classical nondisjunctive definitions of seasonal, perennial, and food sensitization with respect to atopic diseases and lung function. Cytokine levels were measured in the PASTURE cohort. RESULTS The LCA classified predominantly by type and multiplicity of sensitization (food vs inhalant), allergen combinations, and sIgE levels. Latent classes were related to atopic disease manifestations with higher sensitivity and specificity than the classical definitions. LCA detected consistently in both cohorts a distinct group of children with severe atopy characterized by high seasonal sIgE levels and a strong propensity for asthma; hay fever; eczema; and impaired lung function, also in children without an established asthma diagnosis. Severe atopy was associated with an increased IL-5/IFN-γ ratio. A path analysis among sensitized children revealed that among all features of severe atopy, only excessive sIgE production early in life affected asthma risk. CONCLUSIONS LCA revealed a set of benign, symptomatic, and severe atopy phenotypes. The severe phenotype emerged as a latent condition with signs of a dysbalanced immune response. It determined high asthma risk through excessive sIgE production and directly affected impaired lung function.
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Affiliation(s)
| | - Martin Depner
- Dr von Hauner Children's Hospital, LMU Munich, Munich, Germany
| | - Sabina Illi
- Dr von Hauner Children's Hospital, LMU Munich, Munich, Germany
| | - Susanne Lau
- Department for Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
| | - Ulrich Wahn
- Department for Pediatric Pneumology and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Fuchs
- Dr von Hauner Children's Hospital, LMU Munich, and the Comprehensive Pneumology Center, Munich (CPC-M), Germany (Member of the German Center for Lung Research [DZL]), Munich, Germany; Division of Respiratory Medicine, Department of Pediatrics, Inselspital, University of Bern, Bern, Switzerland; University Children's Hospital (UKBB), University of Basel, Basel, Switzerland
| | - Petra Ina Pfefferle
- Comprehensive Biomaterial Bank Marburg CBBM, Fachbereich Medizin der Philipps Universität Marburg, Zentrum für Tumor und Immunbiologie ZTI Marburg (Member of the German Center for Lung Research), Marburg, Germany
| | | | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Roger Lauener
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland; Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Anne M Karvonen
- Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland
| | - Caroline Roduit
- Christine Kühne Center for Allergy Research and Education (CK-CARE), Davos, Switzerland; Children's Hospital, University of Zürich, Zürich, Switzerland
| | - Jean-Charles Dalphin
- Department of Respiratory Disease, University of Besançon, UMR/CNRS6249 Chrono-environment, University Hospital, Besançon, France
| | - Josef Riedler
- Children's Hospital Schwarzach, and the Teaching Hospital of Paracelsus Medical Private University Salzburg, Salzburg, Austria
| | - Juha Pekkanen
- Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Erika von Mutius
- Dr von Hauner Children's Hospital, LMU Munich, and the Comprehensive Pneumology Center, Munich (CPC-M), Germany (Member of the German Center for Lung Research [DZL]), Munich, Germany
| | - Markus J Ege
- Dr von Hauner Children's Hospital, LMU Munich, and the Comprehensive Pneumology Center, Munich (CPC-M), Germany (Member of the German Center for Lung Research [DZL]), Munich, Germany
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Loss GJ, Depner M, Hose AJ, Genuneit J, Karvonen AM, Hyvärinen A, Roduit C, Kabesch M, Lauener R, Pfefferle PI, Pekkanen J, Dalphin JC, Riedler J, Braun-Fahrländer C, von Mutius E, Ege MJ. The Early Development of Wheeze. Environmental Determinants and Genetic Susceptibility at 17q21. Am J Respir Crit Care Med 2016; 193:889-97. [PMID: 26575599 DOI: 10.1164/rccm.201507-1493oc] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Growing up on a farm protects from childhood asthma and early wheeze. Virus-triggered wheeze in infancy predicts asthma in individuals with a genetic asthma risk associated with chromosome 17q21. OBJECTIVES To test environmental determinants of infections and wheeze in the first year of life, potential modifications of these associations by 17q21, and the implications for different trajectories of wheeze. METHODS We followed 983 children in rural areas of Europe from birth until age 6 years. Symptoms of wheeze, rhinitis, fever, and environmental exposures were documented with weekly diaries during year 1. Asthma at age 6 was defined as ever having a reported doctor's diagnosis. Single-nucleotide polymorphisms related to ORMDL3 (rs8076131) and GSDMB (rs7216389, rs2290400) at 17q21 were genotyped. MEASUREMENTS AND MAIN RESULTS Early wheeze was positively associated with presence of older siblings among carriers of known asthma risk alleles at 17q21 (e.g., rs8076131) (adjusted odds ratio [aOR], 1.53; 95% confidence interval [CI], 1.16-2.01). Exposure to farm animal sheds was inversely related to wheeze (aOR, 0.44; 95% CI, 0.33-0.60). Both effects were similarly observed in children with transient wheeze up to age 3 years without subsequent development of asthma (aOR, 1.71 [95% CI, 1.09-2.67]; and aOR, 0.48 [95% CI, 0.30-0.76], respectively). CONCLUSIONS These findings suggest that the chromosome 17q21 locus relates to episodes of acute airway obstruction common to both transient wheeze and asthma. The previously identified asthma risk alleles are the ones susceptible to environmental influences. Thus, this gene-environment interaction reveals two faces of 17q21: The same genotype constitutes genetic risk and allows for environmental protection, thereby providing options for prospective prevention strategies.
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Affiliation(s)
- Georg J Loss
- 1 Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,2 Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Martin Depner
- 1 Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Alexander J Hose
- 1 Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany
| | - Jon Genuneit
- 3 Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Anne M Karvonen
- 4 Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland
| | - Anne Hyvärinen
- 4 Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland
| | - Caroline Roduit
- 5 Children's Hospital, University of Zürich, Zürich, Switzerland.,6 Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland
| | - Michael Kabesch
- 7 Department of Pediatric Pneumology and Allergy, KUNO Children's University Hospital Regensburg, Regensburg, Germany.,8 Clinic for Pediatric Pneumology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Roger Lauener
- 6 Christine Kühne-Center for Allergy Research and Education, Davos, Switzerland.,9 Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Petra Ina Pfefferle
- 10 Comprehensive Biomaterial Bank Marburg CBBM, Center for Tumor Biology and Immunology, Faculty of Medicine, Philipp University of Marburg, Marburg, Germany.,11 German Center for Lung Research, Giessen, Germany
| | - Juha Pekkanen
- 4 Department of Health Protection, National Institute for Health and Welfare, Kuopio, Finland.,12 Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jean-Charles Dalphin
- 13 Department of Respiratory Disease, University of Besançon, University Hospital, Besançon, France
| | - Josef Riedler
- 14 Children's Hospital Schwarzach, Schwarzach, Austria.,15 Teaching Hospital of Paracelsus Private Medical University of Salzburg, Salzburg, Austria
| | - Charlotte Braun-Fahrländer
- 16 Swiss Tropical and Public Health Institute, Basel, Switzerland.,17 University of Basel, Basel, Switzerland; and
| | - Erika von Mutius
- 1 Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,18 German Center for Lung Research, Comprehensive Pneumology Center Munich, Munich, Germany
| | - Markus J Ege
- 1 Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Munich, Germany.,18 German Center for Lung Research, Comprehensive Pneumology Center Munich, Munich, Germany
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Horak F, Doberer D, Eber E, Horak E, Pohl W, Riedler J, Szépfalusi Z, Wantke F, Zacharasiewicz A, Studnicka M. Diagnosis and management of asthma - Statement on the 2015 GINA Guidelines. Wien Klin Wochenschr 2016; 128:541-54. [PMID: 27370268 PMCID: PMC5010591 DOI: 10.1007/s00508-016-1019-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/12/2016] [Indexed: 11/06/2022]
Abstract
This statement was written by a group of pulmonologists and pediatric pulmonologists belonging to the corresponding professional associations ÖGP (Austrian Society for Pulmonology) and ÖGKJ (Austrian Society for pediatric and adolescent medicine) to provide a concise overview of the latest updates in the 2015 GINA Guidelines and to include aspects that are specific to Austria.
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Affiliation(s)
- Fritz Horak
- Allergy Center Vienna West, Hütteldorfertraße 46, 1150, Vienna, Austria.
| | - Daniel Doberer
- Wilhelminen Hospital, Department of Internal and Pulmonary Medicine, Teaching Hospital of the Medical University of Vienna, Montleartstraße 37, 1160, Vienna, Austria
| | - Ernst Eber
- Clinical Department of Pediatric Pulmonology and Allergology University Clinic for Pediatric and Adolescent Medicine, Graz University, Auenbruggerplatz 34/2, 8036, Graz, Austria
| | - Elisabeth Horak
- Pediatric Pulmonology/Allergology, Department of Pediatric and Adolescent Medicine Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Wolfgang Pohl
- Department of Respiratory and Lung Diseases, Hietzing Hospital, Karl Landsteiner Institute for Experimental and Clinical Pulmonology, Wolkersbergenstraße 1, 1130, Vienna, Austria
| | - Josef Riedler
- Department of Pediatric and Adolescent Medicine, Kardinal Schwarzenberg Hospital, Kardinal-Schwarzenbergstraße 2-6, 5620, Schwarzach, Austria
| | - Zsolt Szépfalusi
- Clin. Department for Pediatric Pulmonology, Allergology and Endocrinology, University Clinic for Pediatric and Adolescent Medicine, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Felix Wantke
- Floridsdorf Allergy Center, Franz Jonas Platz 8/6, 1210, Vienna, Austria
| | - Angela Zacharasiewicz
- Department of Pediatric and Adolescent Medicine, Wilhelminen Hospital, Montleartstr.37, 1160, Vienna, Austria
| | - Michael Studnicka
- University Clinic for Pulmonology, Hospital Salzburg, University Hospital of Paracelsus Private Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Roduit C, Frei R, Ferstl R, Loeliger S, Braun-Fahrländer C, Von Mutius E, Pekkanen J, Dalphin JC, Riedler J, Lauener R, O'Mahony L. Potential Role of Gut Microbial Metabolites in Allergy Prevention in Children. J Allergy Clin Immunol 2016. [DOI: 10.1016/j.jaci.2015.12.1206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brick T, Schober Y, Böcking C, Pekkanen J, Genuneit J, Loss G, Dalphin JC, Riedler J, Lauener R, Nockher WA, Renz H, Vaarala O, Braun-Fahrländer C, von Mutius E, Ege MJ, Pfefferle PI. ω-3 fatty acids contribute to the asthma-protective effect of unprocessed cow's milk. J Allergy Clin Immunol 2016; 137:1699-1706.e13. [PMID: 26792208 DOI: 10.1016/j.jaci.2015.10.042] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/18/2015] [Accepted: 10/08/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Living on a farm has repeatedly been shown to protect children from asthma and allergies. A major factor involved in this effect is consumption of unprocessed cow's milk obtained directly from a farm. However, this phenomenon has never been shown in a longitudinal design, and the responsible milk components are still unknown. OBJECTIVES We sought to assess the asthma-protective effect of unprocessed cow's milk consumption in a birth cohort and to determine whether the differences in the fatty acid (FA) composition of unprocessed farm milk and industrially processed milk contributed to this effect. METHODS The Protection Against Allergy-Study in Rural Environments (PASTURE) study followed 1133 children living in rural areas in 5 European countries from birth to age 6 years. In 934 children milk consumption was assessed by using yearly questionnaires, and samples of the "usually" consumed milk and serum samples of the children were collected at age 4 years. Doctor-diagnosed asthma was parent reported at age 6 years. In a nested case-control study of 35 asthmatic and 49 nonasthmatic children, 42 FAs were quantified in milk samples. RESULTS The risk of asthma at 6 years of age was reduced by previous consumption of unprocessed farm milk compared with shop milk (adjusted odds ratio for consumption at 4 years, 0.26; 95% CI, 0.10-0.67). Part of the effect was explained by the higher fat content of farm milk, particularly the higher levels of ω-3 polyunsaturated FAs (adjusted odds ratio, 0.29; 95% CI, 0.11-0.81). CONCLUSION Continuous farm milk consumption in childhood protects against asthma at school age partially by means of higher intake of ω-3 polyunsaturated FAs, which are precursors of anti-inflammatory mediators.
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Affiliation(s)
- Tabea Brick
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Yvonne Schober
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany
| | - Christian Böcking
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany
| | - Juha Pekkanen
- Department of Environmental Health, National Institute for Health and Welfare, and Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Georg Loss
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany; Department of Pediatrics, University of California, San Diego, La Jolla, Calif
| | - Jean-Charles Dalphin
- Department of Respiratory Disease, UMR/CNRS 6249 chrono-environment, University Hospital of Besançon, Besançon, France
| | | | - Roger Lauener
- Christine Kühne Center for Allergy Research and Education, Davos, and Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Wolfgang Andreas Nockher
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany
| | - Harald Renz
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany
| | - Outi Vaarala
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland
| | | | - Erika von Mutius
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research, Munich, Germany
| | - Markus Johannes Ege
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research, Munich, Germany.
| | - Petra Ina Pfefferle
- Institute for Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics, Philipps University of Marburg, Marburg, Germany; Comprehensive Biomaterial Bank Marburg, CBBMR, Medical Faculty, Philipps University of Marburg, Marburg, Germany
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Orivuori L, Mustonen K, de Goffau MC, Hakala S, Paasela M, Roduit C, Dalphin JC, Genuneit J, Lauener R, Riedler J, Weber J, von Mutius E, Pekkanen J, Harmsen HJM, Vaarala O. High level of fecal calprotectin at age 2 months as a marker of intestinal inflammation predicts atopic dermatitis and asthma by age 6. Clin Exp Allergy 2016; 45:928-939. [PMID: 25758537 DOI: 10.1111/cea.12522] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 01/05/2015] [Accepted: 01/16/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Gut microbiota and intestinal inflammation regulate the development of immune-mediated diseases, such as allergies. Fecal calprotectin is a biomarker of intestinal inflammation. OBJECTIVE We evaluated the association of early-age fecal calprotectin levels to the later development of allergic diseases in children from farming and non-farming environments and further studied the effect of gut microbiota on the fecal calprotectin levels. METHODS Fecal calprotectin was measured from 758 infants participating in the PASTURE study at the age of 2 months using the ELISA method. Serum-specific IgE levels were measured at 6 years of age. Data of environmental factors, doctor-diagnosed atopic dermatitis (AD) and asthma were collected by questionnaire. Multivariate logistic regression models were used for analysis. The composition of fecal microbiota was analysed in a subgroup of 120 infants with 16S rRNA pyrosequencing. The effect of Escherichia coli lipopolysaccharide (LPS) on in vitro monocyte IL-10 secretion was studied by flow cytometry. RESULTS The infants with high fecal calprotectin levels at 2 months, that is above the 90th percentile, had an increased risk of developing AD and asthma/asthmatic bronchitis by the age of 6 years (aOR 2.02 (1.06-3.85) and 2.41 (1.25-4.64), respectively). High fecal calprotectin levels correlated negatively with fecal Escherichia. LPS from E. coli stimulated production of IL-10 in monocytes. CONCLUSION AND CLINICAL RELEVANCE High degree intestinal inflammation at 2 months of age, detected as high fecal calprotectin, predicted asthma and AD by the age of 6 years and was linked to low abundance of fecal Escherichia. Impaired IL-10 activation due to the lack of colonization with E. coli could explain the intestinal inflammation associated high fecal calprotectin and later risk of asthma and AD. Our results have implications for the design of probiotic treatments and suggest that early intestinal colonization has long-term health effects.
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Affiliation(s)
- L Orivuori
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.,Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - K Mustonen
- Environmental Health Department, National Institute for Health and Welfare, Kuopio, Finland
| | - M C de Goffau
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S Hakala
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - M Paasela
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - C Roduit
- Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.,Children's Hospital, University of Zurich, Zurich, Switzerland
| | - J-C Dalphin
- The Department of Respiratory Disease, Université de Franche-Comté, UMR-CNRS Chrono-Environnement, University Hospital, Besançon, France
| | - J Genuneit
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - R Lauener
- Christine Kühne - Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - J Riedler
- Children and Young Adults' Medicine, Children's Hospital, Schwarzach, Austria
| | - J Weber
- Dr. von Hauner Children's Hospital of the Ludwig Maximilian University Munich, Munich, Germany
| | - E von Mutius
- Dr. von Hauner Children's Hospital of the Ludwig Maximilian University Munich, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Mölndal, Sweden
| | - J Pekkanen
- Environmental Health Department, National Institute for Health and Welfare, Kuopio, Finland
| | - H J M Harmsen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - O Vaarala
- Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland.,Respiratory, Inflammation and Autoimmunity, Innovative Medicine, AstraZeneca R & D, Mölndal, Sweden
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Grüber C, van Stuivenberg M, Mosca F, Moro G, Chirico G, Braegger CP, Riedler J, Yavuz Y, Boehm G, Wahn U. Immunoactive prebiotics transiently prevent occurrence of early atopic dermatitis among low-atopy-risk infants. J Allergy Clin Immunol 2015; 136:1696-1698.e1. [DOI: 10.1016/j.jaci.2015.07.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/09/2015] [Accepted: 07/28/2015] [Indexed: 12/14/2022]
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van Stuijvenberg M, Stam J, Grüber C, Mosca F, Arslanoglu S, Chirico G, Braegger CP, Riedler J, Boehm G, Sauer PJJ. Similar Occurrence of Febrile Episodes Reported in Non-Atopic Children at Three to Five Years of Age after Prebiotics Supplemented Infant Formula. PLoS One 2015; 10:e0129927. [PMID: 26076141 PMCID: PMC4468127 DOI: 10.1371/journal.pone.0129927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 05/04/2015] [Indexed: 12/20/2022] Open
Abstract
This is a follow up study of a multicenter randomised placebo-controlled trial in seven centres in five West European countries. The RCT assessed the effect of infant formula supplemented with a mixture of prebiotics (with neutral short-chain and long-chain oligosaccharides and pectin-derived acidic oligosaccharides) during infancy in term-born children (n=1130). In the follow-up study 672 children (60% of the study population) participated: 232 (56%) from the prebiotics group (PG), 243 (58%) from the control group (CG), and 197 (66%) from the non-randomised breast-fed group (BG). The primary outcome was the occurrence of febrile episodes at three to five years of age prospectively documented by the parents: in the PG 1.17 (interquartile range 0.50-2.08) episodes per year versus 1.20 (0.52-2.57) in the CG; and 1.48 (0.65-2.60) in the BG. This specific prebiotics mixture given during infancy in healthy non-atopic subjects does not decrease febrile episodes and therefore seems not to prevent infection between their third and fifth birthday.
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Affiliation(s)
- Margriet van Stuijvenberg
- Department of Paediatrics, Beatrix Children’s Hospital, UMC Groningen, Groningen, The Netherlands
- * E-mail:
| | - José Stam
- Department of Paediatrics, Beatrix Children’s Hospital, UMC Groningen, Groningen, The Netherlands
| | - Christoph Grüber
- Department of Pediatric Pulmonology and Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Fabio Mosca
- NICU, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Sertac Arslanoglu
- Centre for Infant Nutrition, Macedonio Melloni Hospital, Milan, Italy
| | | | - Christian P. Braegger
- Division of Pediatric Gastroenterology and Nutrition, University Children’s Hospital, Zürich, Switzerland
| | | | | | - Pieter J. J. Sauer
- Department of Paediatrics, Beatrix Children’s Hospital, UMC Groningen, Groningen, The Netherlands
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Zacharasiewicz A, Eber E, Riedler J, Frischer T. Evaluation und Therapie des chronischen Hustens bei Kindern. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-014-3305-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nicklaus S, Chauveau A, Roduit C, Chardon ML, Kaulek V, Dalphin ML, Pekannen J, Braun-Fahrländer C, Riedler J, Vuitton D, Von Mutiu E, Dalphin JC. O58: La diversité de consommation de fromages dans la petite enfance : un facteur protecteur des maladies allergiques ? NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70634-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Schieck M, Sharma V, Michel S, Toncheva AA, Worth L, Potaczek DP, Genuneit J, Kretschmer A, Depner M, Dalphin JC, Riedler J, Frei R, Pekkanen J, Tost J, Kabesch M. A polymorphism in the TH 2 locus control region is associated with changes in DNA methylation and gene expression. Allergy 2014; 69:1171-80. [PMID: 24866380 DOI: 10.1111/all.12450] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Genomewide association and epigenetic studies found a region within the RAD50 gene on chromosome 5q31 to be associated with total serum IgE levels and asthma. In mice, this region harbors a locus control region for nearby TH 2 cytokines, which is characterized by four Rad50 DNase I hypersensitive sites (RHS4-7). Among these, RHS7 seems to have the strongest impact on TH 2 differentiation. We investigated whether within the human homolog of RHS7, functional polymorphisms exist, which could affect DNA methylation or gene expression in the 5q31 locus and might have an influence on asthma status or IgE regulation. METHODS The human RHS7 region was fine mapped using 1000 genomes database information. In silico analysis and electrophoretic mobility shift assays were used to assess SNP function. Allele-specific effects on DNA methylation were evaluated in cord blood (n = 73) and at age of 4.5 years (n = 61) by pyrosequencing. Allele-specific effects on RAD50, IL4, and IL13 expression were analyzed in 100 subjects. Associations with asthma and IgE levels were investigated in the MAGICS/ISAAC II population (n = 1145). RESULTS Polymorphism rs2240032 in the RHS7 region is suggestive of allele-specific transcription factor binding, affects methylation of the IL13 promoter region and influences RAD50 and IL4 expression (lowest P = 0.0027). It is also associated with total serum IgE levels (P = 0.0227). CONCLUSION A functional relevant polymorphism in the TH 2 locus control region, equivalent to RHS7 in mice, affects DNA methylation and gene expression within 5q31 and influences total serum IgE on the population level.
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Affiliation(s)
- M Schieck
- Department of Pediatric Pneumology and Allergy, University Children`s Hospital Regensburg (KUNO), Regensburg, Germany; Department of Pediatric Pneumology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
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Orivuori L, Loss G, Roduit C, Dalphin JC, Depner M, Genuneit J, Lauener R, Pekkanen J, Pfefferle P, Riedler J, Roponen M, Weber J, von Mutius E, Braun-Fahrländer C, Vaarala O. Soluble immunoglobulin A in breast milk is inversely associated with atopic dermatitis at early age: the PASTURE cohort study. Clin Exp Allergy 2014; 44:102-12. [PMID: 24102779 DOI: 10.1111/cea.12199] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 09/05/2013] [Accepted: 09/15/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND The role of breastfeeding for the development of atopic diseases in childhood is contradictory. This might be due to differences in the composition of breast milk and levels of antimicrobial and anti-inflammatory components. OBJECTIVE The objective of this study was to examine whether levels of total immunoglobulin A (IgA) or transforming growth factor-β1 (TGF-β1) in breast milk were associated with the risk of developing atopic dermatitis (AD), atopic sensitization or asthma at early age taking breastfeeding duration into account. METHODS The birth cohort study PASTURE conducted in Finland, France, Germany and Switzerland provided 610 breast milk samples collected 2 months after delivery in which soluble IgA (sIgA) and TGF-β1 levels were measured by ELISA. Duration of breastfeeding was assessed using weekly food frequency diaries from month 3 to month 12. Data on environmental factors, AD and asthma were collected by questionnaires from pregnancy up to age 6. Atopic status was defined by specific IgE levels in blood collected at the ages of 4 and 6 years. Multivariate logistic regression models were used for statistical analysis. RESULTS Soluble IgA and TGF-β1 levels in breast milk differed between countries, and sIgA levels were associated with environmental factors related to microbial load, for example, contact to farm animals or cats during pregnancy, but not with raw milk consumption. sIgA levels were inversely associated with AD up to the of age 2 years (P-value for adjusted linear trend: 0.005), independent of breastfeeding duration. The dose of sIgA ingested in the first year of life was associated with reduced risk of AD up to the age of 2 (aOR, 95% CI: 0.74; 0.55-0.99) and 4 years (0.73; 0.55-0.96). No clear associations between sIgA and atopy or asthma up to age 6 were observed. TGF-β1 showed no consistent association with any investigated health outcome. CONCLUSION AND CLINICAL RELEVANCE IgA in breast milk might protect against the development of AD.
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Affiliation(s)
- L Orivuori
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
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Zacharasiewicz A, Eber E, Riedler J, Frischer T. Konsensuspapier zur Evaluation und Therapie des chronischen Hustens in der Pädiatrie. Wien Klin Wochenschr 2014; 126:439-50. [DOI: 10.1007/s00508-014-0554-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 04/13/2014] [Indexed: 01/11/2023]
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Orivuori L, Mustonen K, Roduit C, Braun-Fahrländer C, Dalphin JC, Genuneit J, Lauener R, Pfefferle P, Riedler J, Weber J, von Mutius E, Pekkanen J, Vaarala O. Immunoglobulin A and immunoglobulin G antibodies against β-lactoglobulin and gliadin at age 1 associate with immunoglobulin E sensitization at age 6. Pediatr Allergy Immunol 2014; 25:329-37. [PMID: 24953294 DOI: 10.1111/pai.12246] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Serum immunoglobulin A (IgA) and immunoglobulin G (IgG) antibodies against wheat gliadin and cow's milk β-lactoglobulin (BLG) are considered markers of gut permeability and inflammation which modulate the development of mucosal tolerance. Living on a farm has been shown to decrease allergies in children. Our aim was to study whether farm environment affected mucosal tolerance, immunoglobulin E (IgE) sensitization, or allergic diseases. METHODS The PASTURE birth cohort study was conducted in Finland, France, Germany, Austria, and Switzerland. At age 1, we measured serum IgA and IgG against wheat gliadin (N = 636) and cow's milk BLG (N = 639) using ELISA. Serum-specific IgE was measured at ages 1 and 6 (N = 459). Data on environmental factors and allergic diseases were collected by questionnaires. Discrete time hazard and multivariate logistic regression models were used for analyses. RESULTS Increased IgA or IgG antibodies against BLG at age 1 increased the risk of sensitization to at least one of the measured allergens or food allergens at age 6. Increased IgG against gliadin at age 1 increased the risk of sensitization to any, at least one inhalant, or at least one food allergen at age 6. Early exposure to cow's milk formula associated with increased IgA or IgG against BLG. No association with farming or clinical allergy was found. CONCLUSIONS Increased IgA or IgG against BLG or gliadin at age 1 was associated with IgE sensitization at age 6. We suggest that an enhanced antibody response to food antigens reflects mucosal tolerance aberrancies, e.g., altered microbiota and/or increased gut permeability, which is later seen as sensitization to allergens.
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Affiliation(s)
- Laura Orivuori
- Department of Vaccination and Immune Protection, National Institute for Health and Welfare, Helsinki, Finland
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50
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Depner M, Fuchs O, Genuneit J, Karvonen AM, Hyvärinen A, Kaulek V, Roduit C, Weber J, Schaub B, Lauener R, Kabesch M, Pfefferle PI, Frey U, Pekkanen J, Dalphin JC, Riedler J, Braun-Fahrländer C, von Mutius E, Ege MJ. Clinical and epidemiologic phenotypes of childhood asthma. Am J Respir Crit Care Med 2014; 189:129-38. [PMID: 24283801 DOI: 10.1164/rccm.201307-1198oc] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Clinical and epidemiologic approaches have identified two distinct sets of classifications for asthma and wheeze phenotypes. OBJECTIVES To compare epidemiologic phenotype definitions identified by latent class analysis (LCA) with clinical phenotypes based on patient histories, diagnostic work-up, and treatment responses. To relate phenotypes to genetic and environmental determinants as well as diagnostic and treatment-related parameters. METHODS LCA was performed in an international multicenter birth cohort based on yearly questions about current wheeze until age 6 years. Associations of wheeze classes and clinical phenotypes with asthma-related characteristics such as atopy, lung function, fraction of exhaled nitric oxide, and medication use were calculated using regression models. MEASUREMENTS AND MAIN RESULTS LCA identified five classes, which verified the clinically defined wheeze phenotypes with high sensitivity and specificity; the respective receiver operating characteristics curves displayed an area under the curve ranging from 84% (frequent wheeze) to 85% (asthma diagnosis) and 87% (unremitting wheeze) to 97% (recurrent unremitting wheeze). Recurrent unremitting wheeze was the most specific and unremitting wheeze at least once the most sensitive definition. The latter identified a subgroup of children with decreased lung function, increased genetic risk, and in utero smoke exposure (ODDS RATIO, 2.03; 95% CONFIDENCE INTERVAL, 1.12-3.68; P = 0.0191), but without established asthma diagnosis and treatment. CONCLUSIONS Clinical phenotypes were well supported by LCA analysis. The hypothesis-free LCA phenotypes were a useful reference for comparing clinical phenotypes. Thereby, we identified children with clinically conspicuous but undiagnosed disease. Because of their high area under the curve values, clinical phenotypes such as (recurrent) unremitting wheeze emerged as promising alternative asthma definitions for epidemiologic studies.
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Affiliation(s)
- Martin Depner
- 1 Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich, Member of the German Center for Lung Research (DZL), Munich, Germany
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