The latest medical research on Pediatric Allergy & Immunology
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Request AccessCurrent Review of Comorbidities in Chronic Rhinosinusitis.
Current Allergy and Asthma ReportsChronic rhinosinusitis (CRS) is a heterogenous disease with a significant impact on patient quality of life and a substantial economic burden. CRS is associated with several systemic inflammatory conditions. We provide an updated review of CRS comorbidities as a springboard for future comorbidity mapping and potential therapeutics.
The link between environmental allergies and CRS is most evident for central compartment atopic disease (CCAD) and allergic fungal rhinosinusitis (AFRS) subtypes but remains inconclusive for CRS overall. The association between asthma and CRS, reinforced by the unified airway theory, is evidenced by their response to similar biologic therapies. Another lower respiratory tract disease, COPD, has up to a 50% co-occurrence with CRS and warrants careful screening and treatment. Eosinophilic esophagitis and CRS share eosinophilic inflammation in different sites, meriting further research. Obesity not only presents physiological challenges but also correlates with a more severe subset of CRS. Diabetes mellitus is associated with CRSwNP, possibly secondary to therapeutics with steroids. Autoimmunity may contribute to nasal polyp formation through cytokines such as B-cell activating factor (BAFF), offering potential for future therapeutics. This review illustrates the need to employ a macroscopic approach in clinical decision making and treatment of CRS. Comorbidities may contribute to an overall proinflammatory state, magnify severity of symptoms, be a source of treatment resistance, and even an opportunity for future therapeutics.
Differential Clinical Significance of FENO200 and CANO in Asthma, Chronic Obstructive Pulmonary Disease (COPD), and Asthma-COPD Overlap (ACO).
Journal of Asthma and AllergyTo investigate the differential clinical significance of fractional concentration of exhaled nitric oxide measured at a flow rate of 200 mL/s (FENO200) and concentration of nitric oxide in alveolar (CANO) in asthma, chronic obstructive pulmonary disease (COPD) or asthma-COPD Overlap (ACO).
A total of 178 patients were included, with 82 patients in asthma group, 47 patients in COPD group and 49 patients in ACO group. Data for demographic data, spirometry and exhaled nitric oxide were collected for comparative analysis, correlation analysis and discriminant canonical analysis.
The values of FENO200 in asthma, COPD and ACO groups were 11.0(7.0-22.3), 8.0(6.0-11.0) and 9.0(6.5-19.5) ppb, respectively. In the asthma group, FENO200 exhibited negative correlations with FEV1/FVC, MMEF and MEF50. No significant correlation was observed between CANO and pulmonary function parameters. In the COPD group, both FENO200 and CANO showed negative correlation with pulmonary function parameters including FVC, FEV1, PEF, MMEF, MEF75, MEF50. In the ACO group, FENO200 demonstrated no significant correlation with pulmonary function parameters, while CANO was correlated with FEV1, PEF, MMEF and MEF50. In COPD group, ΔFEV1 in the bronchodilator test was correlated with FENO200. As for the ACO group, ΔFEV1 was correlated with CANO. In the discriminant canonical analysis, four parameters including gender, age, MEF75 and FENO50 discriminated between the three groups of asthma, COPD and ACO.
In asthma, COPD and ACO, FENO200 has demonstrated a robust correlation with CANO. Elevated FENO200 levels are predominantly indicative of pulmonary function impairment in asthma and COPD, whereas elevated CANO levels are mainly correlated with pulmonary function impairment in COPD and ACO. Compared with FENO200 and CANO, FENO50 may have a better discriminatory ability in distinguishing asthma, COPD and ACO.
Japanese Patients with Severe Asthma Identified as Responders to Omalizumab Treatment at 2 Years Based on the GETE Score Continued Treatment for an Extended Period.
Journal of Asthma and AllergyOmalizumab, the anti-IgE monoclonal antibody used to treat severe asthma, reduces asthma exacerbations, hospitalizations, and corticosteroid use. Although allergic asthma is a therapeutic target of omalizumab, omalizumab is not effective in all patients with severe allergic asthma and is not always available for long-term use. We retrospectively investigated factors related to long-term (≥2 years) use of omalizumab for severe asthma.
Of the 116 patients treated with omalizumab for severe asthma at our hospital between 2009 and 2017, 82 were included in this retrospective analysis. Thirty-four were excluded because of adverse events, financial difficulties, or hospital transfers. The number of asthma exacerbations, unscheduled visits, corticosteroid doses, asthma control test scores, pulmonary function test results, and fractional exhaled nitric oxide levels were evaluated.
The median age of the study population was 58 years, with 66% female and 26% taking regular oral corticosteroids. After 2 years of treatment, 52 responders were identified using the global evaluation of treatment effectiveness (GETE) score. Improvements in asthma control test scores, airflow limitation, exacerbations, and oral corticosteroid use were observed in the responders. Multivariate analysis revealed that a peripheral blood eosinophil count of ≥200 or a perennial antigen-specific IgE antibody positivity of ≥2 predicted a response at the 2-year mark. However, Kaplan-Meier analysis demonstrated that neither high eosinophil counts nor perennial antigen-specific IgE positivity influenced the prolongation of treatment beyond 2 years, and responders at 2 years underwent omalizumab treatment for a significantly longer period than non-responders (HR = 9.89, p < 0.001), with GETE at 2 years being the only predictor of long-term omalizumab use.
In this retrospective study the GETE after 2 years of omalizumab therapy emerged as the most meaningful predictor of the long-term effectiveness of omalizumab treatment in patients with severe asthma, highlighting the benefits of prolonged therapy in certain populations. These findings may guide future therapeutic strategies for severe asthma.
Disease Modification in Asthma: Are We on the Right Way? A Multidisciplinary Expert Delphi Consensus (MODIASTHMA Consensus).
Journal of Asthma and AllergyWith the advent of biological therapies, emerging concepts regarding establishing new targets in asthma management, such as disease modification, have entered the debate among the scientific community. The definitions that form the conceptual basis of this goal need to be agreed upon.
A multidisciplinary expert group was assembled as the steering committee. A systematic literature review was conducted to identify the scientific background for constructing appropriate definitions. Based on the literature review and the clinical experience of the experts, the committee built a list of statements that could be applied to establish the definition of disease modification in asthma. After that, a Delphi validation was performed to assess the appropriateness of the list of statements. The questionnaire included a total of 22 statements, divided into "Essential criteria for disease modification in asthma" (5 statements) and "Disease modification indicators and other considerations" (17 statements). Panelists used a 9-point Likert scale to measure agreement on each statement. The cut-off point for high consensus was defined as a minimum score of 7 and had to be reached by at least two-thirds of the experts.
A total of 192 asthma experts voted on statements anonymously. Of those, 104 (54%) were Pneumologists, 65 (34%) were allergologists, and 23 (12%) were Pediatricians. An interim analysis of round 1 data was performed. All statements reached consensus on the first round, with a median score above 7 in all cases.
In conclusion, in this Delphi study, a large number of experts in the management of severe asthma from different specialties agreed on the clinical-functional and pathophysiological aspects to be considered in order to try to achieve disease modification.
Allergic Diseases and T2DM:A Bidirectional Multivariable Mendelian Randomization Study and Mediation Analysis.
J AsthmaClinical studies involving observation have uncovered a mutual relationship between allergic disorders and diabetes, yet the precise causal link remains undetermined.
We conducted two-sample bidirectional Mendelian randomization analyses using single nucleotide polymorphisms (SNPs) associated with allergic conditions (asthma, allergic rhinitis, atopic dermatitis) from genome-wide studies and SNPs related to type 2 diabetes from FinnGen. Initially, we evaluated the causal link between allergic disorders and type 2 diabetes through a univariate Mendelian randomization study, incorporating inverse variance weighting, MR-Egger, and the weighted median estimator. To address potential confounding, we employed multivariate Mendelian randomization. Finally, we validated mediators influencing the correlation between asthma and type 2 diabetes.
The Inverse variance weighte method showed that asthma genetically increased the risk of type 2 diabetes (Asthma- type 2 diabetes: β(95%CI)=0.892(0.152~1.632), P = 0.018). Allergic rhinitis and type 2 diabetes exhibit a mutual protective effect: β(95% CI)=-1.333(-2.617 to -0.049), P = 0.042;type 2 diabetes - Allergic rhinitis: β(95%CI)=-0.002(-0.004 to -0.000), P = 0.018). The Multivariable Mendelian randomization study results showed that after after excluding confounding factors, asthma still demonstrates statistical significance in relation to type 2 diabetes. Through mediation analysis, it was discovered that lung function and the percentage of monocytes in leukocytes exert an inhibitory effect on the mediation between asthma and type 2 diabetes.
The Multivariable Mendelian randomization study indicates asthma as a risk factor for type 2 diabetes.Lung function, and the percentage of monocytes in leukocytes, play an inhibitory role in asthma and type 2 diabetes mediating effects.
Fast-Food Consumption and Asthma-Related Emergency Room Visits in California.
J AsthmaAsthma is common, affecting up to 8% of adults in the United States. Several studies have shown an association between poorer diet and asthma. Despite the prevalence of fast-food consumption in the Western diet, research examining fast food consumption and asthma is limited.
This study aimed to examine the association between fast food consumption and asthma-related emergency room visits among adults with asthma in California from 2011-2016.
This cross-sectional study focused on 11,561 adults with asthma in California. Publicly available data from the California Health Interview Survey was used. The independent variable included fast food consumption, and the dependent variable was emergency room visits due to asthma. This study used logistic regression models and controlled for sex, race, self-reported overall health, BMI, and current smoking status. Survey weights were applied to ensure the analysis represented the general population.
Consumption of fast food ≥3 times per week was associated with increased odds of emergency room visits for asthma among adults with asthma in California (unadjusted model: OR = 1.64 CI: 1.13-2.40, p = 0.01; adjusted model: ORadj =1.53, CI: 1.03-2.26, p = 0.03).
Our findings suggest that high consumption of fast food among adults with asthma may result in higher odds of asthma-related emergency room visits. Thus, decreasing fast food consumption may benefit adults with asthma by reducing emergency room visits.
Benralizumab: Effectiveness in Patients with Uncontrolled Severe Eosinophilic Asthma at 6 and 12 Months at a Third-Level Care Hospital. Capacity for ICS-LABA Therapy Reduction.
Journal of Asthma and AllergyAsthma is a health condition with worldwide relevance, evaluated based on the necessary treatment to control symptoms and exacerbations. Severe asthma is uncontrolled despite high doses of ICS-LABA and treatment for triggering factors. Severe eosinophilic asthma is characterized by an increase in eosinophils in the peripheral circulation, walls, and passages of the respiratory tract. Biologic treatments such as benralizumab have demonstrated effectiveness as aids in decreasing respiratory tract inflammation and improving the management of symptoms in patients living with asthma.
To assess the efficacy and safety of benralizumab as an add-on therapy for patients with severe, uncontrolled asthma and elevated blood eosinophil counts.
Observational, analytic and ambispective study in 21 patients diagnosed with severe eosinophilic asthma treated with benralizumab, to determine the treatment's effectiveness through the change in estimated respiratory function by spirometry through the forced expiratory volume in one second (FEV1) value, reduction in second controlling treatment, serum eosinophil reduction, change in the Asthma Control Test score and the Asthma Control Questionnaire test at 6 and 16 months of treatment.
An average difference of 241.43 mL (±461.43) in FEV1 at 6 months was found, as well as an average FeNO reduction of 49.8 ppm and eosinophil reduction of 612.78 cells at 12 months of treatment, additionally, CSI requirements were reduced in 95% of patients.
Benralizumab improved respiratory function as well as key biomarkers such as eosinophil count, exhaled nitric oxide fraction (FeNO), which reflected in a decreased requirement of inhaled corticosteroids and improved symptom control.
Minimizing Indoor Allergen Exposure: What Works?
Current Allergy and Asthma ReportsAllergic rhinitis and asthma morbidity has been linked to indoor allergen exposure. Common indoor allergens include dust mites, cats, dogs, rodents, and cockroaches. These allergens are ubiquitous and often difficult to remove from the home, making long-lasting reduction strategies difficult to achieve. Identifying strategies for reducing the presence of indoor allergens in homes could be utilized to decrease allergic disease burden, improve symptomology, reduce healthcare costs, and improve patients' quality of life.
Studies have yielded mixed results with regard to specific environmental control measures in reducing indoor allergen levels and in improving clinical outcomes of allergic disease. In this review, we assess the available evidence of the effectiveness of environmental control measures in reducing indoor allergens and the potential clinical impact of these measures.
IMPAIRED RESPIRATORY FUNCTIONS IN CHILDREN WITH CAT SENSITIZATION IN THE EARLY AGES OF CHILDHOOD.
J AsthmaTo evaluate the respiratory functions in children with cat sensitization accompanying allergic respiratory diseases and to compare these with those of healthy controls, as well as within themselves by classifying according to their diseases, domestic cat exposure, age groups'.
This prospective case-control study included 130 children aged 3-17 years with cat sensitization (CS group) accompanying respiratory allergic diseases and 70 age- and sex-matched healthy controls (HC group). The cases' demographic parameters were recorded, and respiratory functions were analyzed using IOS and spirometry.
At IOS evaluation, zR5, R5-20, Fres, and AX values were higher in children in the CS group compared to the HC group (p = 0.029, p = 0.008, p = 0.001, and p < 0.001, respectively), while zX5 and zX20 values were lower (p = 0.001 and p < 0.001). R5-20 and AX were higher in asthma compared to allergic rhinitis (p = 0.008, p = 0.015), but were insignificant compared to asthma and allergic rhinitis coexistent group (p > 0.05). R5-20, Fres, and AX were higher, and zX20 was lower in the pre-school age group (p < 0.001). No correlation was found between zFEV1, zFVC, zFEV1/FVC, zFEF25-75 and zR5 values in the CS group (p > 0.05).
Pulmonary resistance was higher and reactance was lower in the entire and peripheral airways in children with cat sensitization accompanying respiratory allergic diseases compared to the healthy controls. Peripheral airway resistance and reactance were more impaired in asthma group compared to allergic rhinitis. However, peripheral airway resistance and main airway reactance were more impaired in the pre-school age group than the older ones.
Skin Surface Lipid-RNA Profile Obtained from Patients with Severe Asthma After Benralizumab Treatment.
Journal of Asthma and AllergyExamining human coding and non-coding RNAs present in skin surface lipids (SSL-RNAs) offers a promising approach to understanding the physiological state of the skin. Benralizumab treatment can reduce exacerbations and improve symptom control and quality of life in patients with severe eosinophilic asthma. Although this treatment effectively depletes peripheral blood eosinophils, the impact of benralizumab on SSL-RNA remains completely unknown.
To investigate the effects of benralizumab treatment on SSL-RNA profiles in patients with severe asthma.
Skin samples were non-invasively collected from patients before and after one year of benralizumab treatment. Sixteen patients were enrolled, but the SSL-RNA analysis was only feasible for five patients due to collection challenges, mainly in female participants.
Following benralizumab treatment, asthma symptoms, exacerbation rates, and lung function parameters improved. Peripheral blood eosinophils were completely depleted and serum eotaxin-1 levels increased. SSL-RNA analysis revealed differential expression of 134 genes, with significant downregulation of immune-related pathways and genes associated with neutrophilic inflammation.
These findings suggest a suppression of both type 2 and non-type 2 inflammation in response to benralizumab treatment, with potential implications for asthma management. However, the limitations of the study include a small sample size and challenges in sebum collection, particularly among female participants. Although the noninvasive nature of this sampling method makes it attractive for both research and clinical applications, additional studies are needed to fully investigate the potential of SSL-RNA analysis as a noninvasive biomarker to assess treatment response in asthma.
Allergen Immunotherapy for a Year Can Effectively Reduce the Risk of Postoperative Recurrence of Adenoid Hypertrophy in Children with Concurrent Allergic Rhinitis (IMPROVEII).
Journal of Asthma and AllergyAdenoid hypertrophy (AH) and allergic rhinitis (AR) are common pediatric diseases, seriously affecting the quality of life and growth of children. The recurrence rate of AH is higher for patients with than for those without concurrent AR. Allergen specific immunotherapy (AIT) is the only effective therapy for modifying the course of allergic diseases. This study sought to investigate the efficacy of AIT in preventing AH recurrence in patients with AR who underwent adenoidectomy.
This study included 134 children aged 5-12 years with concurrent AH and AR. They were separated into the subcutaneous immunotherapy (SCIT) group treated with a double-mite allergen preparation or the non-AIT group treated symptomatically with only medications. The adenoid/nasopharyngeal ratio at one year after adenoidectomy was used to assess AH recurrence. The Obstructive Sleep Apnoea Questionnaire (OSA-18), Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), and Visual Analogue Scale (VAS) were used to assess the severity of the sleep disorders and AR.
This study included 62 and 72 children with concurrent AH and AR in the SCIT and non-AIT groups, respectively. The rate of recurrence in the SCIT group was significantly lower than that in the non-AIT group (4.84% vs.16.67%; P=0.030). The OSA-18, PRQLQ, and VAS scores were significantly lower for the SCIT than (P<0.001) for the non-AIT group after one year of treatment.
The findings suggest that AIT should be considered the preferred therapy for reducing postoperative recurrence of AH in children with concurrent AR following adenoidectomy, but further research is needed to confirm these findings in a larger population.
The Influence of Emphysema on Treatment Response to Biologic Therapy in Severe Asthma.
Journal of Asthma and AllergyPatients with severe asthma (SA) benefit from biologic therapy substantially. However, the impact of smoking-related comorbidities remains unclear due to the exclusion of patients with ≥10 pack-years from asthma studies. Our aim was to examine the effects of emphysema on biologic treatment response in SA in this retrospective cohort study.
Pulmonary emphysema was examined using computed tomography. Patients with SA were included and divided into two groups based on emphysema quantity (≥5% or <5%). They received either anti-IgE (22.1%), anti-IL-5-(receptor) (52.3%), or anti-IL-4/IL-13 (25.6%) biologic therapy. Treatment response was assessed after 7.8 ± 2.5 months based on acute exacerbations (AE), oral corticosteroid (OCS) therapy, Asthma Control Test (ACT), forced expiratory volume in 1 second (FEV1) and using the Biologics Asthma Response Score (BARS).
This study comprised 86 patients (mean age 56.1 ± 12.8 years; 54% female). Half (43, 50.0%) were never-smokers, half ex-smokers with an average of 26.9 ± 18.2 pack-years. Patients with ≥5% emphysema were more often ex-smokers (80% vs 41%, p=0.002), had poorer lung function (FEV1 median 1.3 [interquartile range: 1.0;1.6] vs 1.8[1-2;2.4] L, p=0.037), and more comorbid COPD (50% vs 21%, p=0.012). However, no significant differences were noted in treatment response regarding annualized AE rate (-2.5[-5;-1] vs -3.0[-5;-2] n/year, p=0.295) and OCS reduction (-4[-10;0] vs -5[-10;0] mg, p=0.691), ACT score (5[3;9] vs 4[0;9] points, p=0.579) or FEV1 improvement (0.03[-0.15;0.25] vs 0.23[-0.5;0.49] L, p=0.052), BARS (p=0.312), and remission rates (15.0% vs 19.7%, p=0.753).
In patients with severe asthma, those with comorbid emphysema show similar treatment response to biologic therapy. Therefore, suitable patients should not be denied biologics due to the presence of emphysema.