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Pediatric Pulmonology Jan 2021Epidemiologic studies have found low/absence of atopy in obese asthmatic children, but the association or lack thereof of atopy with disease morbidity, including...
INTRODUCTION
Epidemiologic studies have found low/absence of atopy in obese asthmatic children, but the association or lack thereof of atopy with disease morbidity, including pulmonary function, in obese asthma is not well understood. We sought to define the association of atopy with pulmonary function in overweight/obese minority children with asthma.
METHODS
In a retrospective chart review of 200 predominantly minority children evaluated at an academic Pediatric Asthma Center over 5 years, we compared the prevalence of atopy, defined as 1 positive skin prick test or serum-specific immunoglobulin E quantification to environmental allergens, and its association with pulmonary function in overweight/obese (body mass index [BMI] > 85th percentile) (n = 99) to healthy-weight children (BMI, 5th-85th percentile for age) (n = 101).
RESULTS
In a cohort comprised of 47.5% Hispanics and 39.5% African Americans, 81% of overweight/obese and 74% of healthy-weight children were atopic. While atopic healthy-weight children had lower percent-predicted forced expiratory volume in the first second (FEV ) (93 ± 13.6 vs 107% ± 33.2%, P = .03) and lower percent-predicted forced vital capacity (FVC) (93% ± 12.2% vs 104% ± 16.1%, P = .01) as compared to nonatopic children, atopy was not associated with FEV (P = .7) or FVC (P = .17) in overweight/obese children. Adjusting for demographic and clinical variables, atopy was found to be an independent predictor of FEV and FVC in healthy-weight (β = -2.4, P = .07 and β = -1.7, P = .04, respectively) but not in overweight/obese children (β = .6, P = .5 and β = .8, P = .3).
CONCLUSIONS
Atopy is associated with lower lung function in healthy-weight asthmatics but not in overweight/obese asthmatics, supporting the role of nonallergic mechanisms in disease burden in pediatric obesity-related asthma.
Topics: Adolescent; Black or African American; Allergens; Asthma; Body Mass Index; Child; Female; Forced Expiratory Volume; Hispanic or Latino; Humans; Hypersensitivity, Immediate; Immunoglobulin E; Lung; Male; Overweight; Pediatric Obesity; Respiratory Function Tests; Retrospective Studies; Skin Tests; Vital Capacity
PubMed: 32757362
DOI: 10.1002/ppul.25005 -
Current Opinion in Allergy and Clinical... Apr 2020Asthma is the most common chronic disease in pediatric age. Childhood-onset asthma, as opposed to adult-onset asthma, is typically characterized by a personal and often... (Review)
Review
PURPOSE OF REVIEW
Asthma is the most common chronic disease in pediatric age. Childhood-onset asthma, as opposed to adult-onset asthma, is typically characterized by a personal and often a family history of atopy and related markers of type 2-mediated inflammation. However, the interplay between atopy and asthma development is more complex than a linear dose-response relationship.
RECENT FINDINGS
Family and personal history of atopic diseases have been confirmed as major risk factors for asthma occurrence and persistence in children. Early life and multiple sensitizations to aeroallergens significantly increase the risk of asthma development in school age. Early life lower respiratory tract viral infections, especially caused by rhinovirus, also increase the susceptibility to atopic asthma in childhood. Human rhinovirus type C receptor CDHR3 polymorphisms have been shown to affect receptor epithelial expression, activation, and asthma development and exacerbation severity in children. Atopic sensitization and respiratory viral infections can synergistically enhance the susceptibility to asthma through multiple mechanisms, including the IgE-mediated inhibition of innate antiviral responses to rhinovirus. Emerging evidence shows that several nonatopic factors are also involved in the asthma pathogenesis in genetically predisposed individuals, including early life exposure to environmental factors, and lung and gut microbiome composition.
SUMMARY
The current review outlines recent data on the complex role of atopy in asthma pathogenesis and persistence, and addresses new research topics such as the role of epigenetics and the lung microbiome.
Topics: Allergens; Asthma; Cadherin Related Proteins; Cadherins; Child; Chronic Disease; Common Cold; Dose-Response Relationship, Immunologic; Environmental Exposure; Genetic Predisposition to Disease; Humans; Hypersensitivity, Immediate; Immunity, Innate; Immunoglobulin E; Intestinal Mucosa; Lung; Medical History Taking; Membrane Proteins; Microbiota; Polymorphism, Single Nucleotide; Respiratory Mucosa; Rhinovirus
PubMed: 31985546
DOI: 10.1097/ACI.0000000000000627 -
Allergologia Et Immunopathologia 2021Atopic dermatitis is a highly prevalent chronic disorder. Therapeutic education in diseases of this kind is essential in order to improve patient management and...
INTRODUCTION
Atopic dermatitis is a highly prevalent chronic disorder. Therapeutic education in diseases of this kind is essential in order to improve patient management and prognosis. A study was conducted regarding parent satisfaction following educational sessions in an Atopy School organized by a multidisciplinary team.
MATERIAL AND METHODS
E-mail surveys with variables scored by means of a Likert scale were administered among the parents participating in the workshops organized by the Atopy School. The educational program comprised four sessions with a duration of 4 hours.
RESULTS
Ninety-five percent of the parents were satisfied after participating in the workshops, and were of the opinion that the therapeutic education received was useful for improving control of the illness of their children. Likewise, 85% were satisfied or very satisfied with the help received in the sessions for control of the disease during flare-ups, and 90% considered the data and advice received in the sessions to be of use in improving quality of life of both the children and the family as a whole.
CONCLUSIONS
The Atopy School afforded caregiver empowerment, and the parents were satisfied and felt more secure in dealing with the disease of their children-thereby improving the prognosis and quality of life.
Topics: Caregivers; Child; Child, Preschool; Dermatitis, Atopic; Female; Health Knowledge, Attitudes, Practice; Humans; Infant; Infant, Newborn; Male; Parents; Patient Education as Topic; Prognosis; Program Evaluation; Quality of Life; Severity of Illness Index
PubMed: 33641287
DOI: 10.15586/aei.v49i2.47 -
Postepy Dermatologii I Alergologii Feb 2021Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. AD affects 10-20% of children worldwide and persists into adulthood in a minority of cases,... (Review)
Review
Atopic dermatitis (AD) is the most common chronic inflammatory skin disease. AD affects 10-20% of children worldwide and persists into adulthood in a minority of cases, affecting approximately 2-3% of the adult population, with an increased prevalence over the past decades in developed countries. Atopy is a genetic tendency to overproduce IgE class antibodies in response to common antigens found in the environment. Concurrence of different atopy such as allergic rhinitis or asthma in children with AD is estimated at 80%. AD is characterized by a vicious cycle of an allergic immune response. The emerging picture of the AD is a complex disorder with barrier dysfunction, immunological, genetic and environmental factors all playing key roles. Patients with severe or persistent disease and their families experience significant impairment in their quality of life, and in addition, AD places a heavy economic burden on society as a whole. Pathogenesis, the role of the epidermal barrier, mechanisms of cells apoptosis, the role of T cells and cytokines in AD are discussed in this article.
PubMed: 34408560
DOI: 10.5114/ada.2019.88394 -
Journal of Fungi (Basel, Switzerland) Apr 2020Fungi have many potential roles in paediatric asthma, predominantly by being a source of allergens (severe asthma with fungal sensitization, SAFS), and also directly... (Review)
Review
Fungi have many potential roles in paediatric asthma, predominantly by being a source of allergens (severe asthma with fungal sensitization, SAFS), and also directly damaging the epithelial barrier and underlying tissue by releasing proteolytic enzymes (fungal bronchitis). The umbrella term 'fungal asthma' is proposed for these manifestations. Allergic bronchopulmonary aspergillosis (ABPA) is not a feature of childhood asthma, for unclear reasons. Diagnostic criteria for SAFS are based on sensitivity to fungal allergen(s) demonstrated either by skin prick test or specific IgE. In children, there are no exclusion criteria on total IgE levels or IgG precipitins because of the rarity of ABPA. Diagnostic criteria for fungal bronchitis are much less well established. Data in adults and children suggest SAFS is associated with worse asthma control and greater susceptibility to asthma attacks than non-sensitized patients. The data on whether anti-fungal therapy is beneficial are conflicting. The pathophysiology of SAFS is unclear, but the epithelial alarmin interleukin-33 is implicated. However, whether individual fungi have different pathobiologies is unclear. There are many unanswered questions needing further research, including how fungi interact with other allergens, bacteria, and viruses, and what optimal therapy should be, including whether anti-neutrophilic strategies, such as macrolides, should be used. Considerable further research is needed to unravel the complex roles of different fungi in severe asthma.
PubMed: 32349347
DOI: 10.3390/jof6020055 -
Seminars in Immunology Sep 2023The rapid rise in atopy and asthma in industrialized nations has led to the identification of early life environmental factors that promote these conditions and spurred... (Review)
Review
The rapid rise in atopy and asthma in industrialized nations has led to the identification of early life environmental factors that promote these conditions and spurred research into how such exposures may mediate the trajectory to childhood disease development. Over the past decade, the human microbiome has emerged as a key determinant of human health. This is largely due to the increasing appreciation for the myriad of non-mutually exclusive mechanisms by which microbes tune and train host immunity. Microbiomes, particularly those in early life, are shaped by extrinsic and intrinsic factors, including many of the exposures known to influence allergy and asthma risk. This has led to the over-arching hypothesis that such exposures mediate their effect on childhood atopy and asthma by altering the functions and metabolic productivity of microbiomes that shape immune function during this critical developmental period. The capacity to study microbiomes at the genetic and molecular level in humans from the pre-natal period into childhood with well-defined clinical outcomes, offers an unprecedented opportunity to identify early-life and inter-generational determinants of atopy and asthma outcomes. Moreover, such studies provide an integrative microbiome research framework that can be applied to other chronic inflammatory conditions. This review attempts to capture key studies in the field that offer insights into the developmental origins of childhood atopy and asthma, providing novel insights into microbial mediators of maladaptive immunity and chronic inflammatory disease in childhood.
Topics: Humans; Asthma; Hypersensitivity; Microbiota
PubMed: 37379671
DOI: 10.1016/j.smim.2023.101795 -
The Journal of Allergy and Clinical... Nov 2021The concept of atopy was initially developed in the first quarter of the 20th century on the basis of clinical observations without any knowledge of pathogenic...
The concept of atopy was initially developed in the first quarter of the 20th century on the basis of clinical observations without any knowledge of pathogenic mechanisms. Atopy involves a collection of comorbidities that share pathogenic features, and atopic comorbidities affect outcomes of concomitant conditions rather than existing synchronously. The clinical importance of understanding the relationship of these conditions is necessary because the treatment of one condition influences the others, and the development of one leads to or precedes the development of another. Environmental influences and multigenetic predispositions result in complex relationships among the atopic conditions sharing a type 2 pathogenesis. The specialty of Allergy and Immunology is devoted to managing the comorbidities of atopy, and better understanding of their connections can improve patient care.
Topics: Asthma; Comorbidity; Humans; Hypersensitivity; Hypersensitivity, Immediate
PubMed: 34509674
DOI: 10.1016/j.jaip.2021.09.002 -
Annals of Allergy, Asthma & Immunology... Oct 2019To synthesize available data related to the complex associations among viral infections, atopy, and asthma. (Review)
Review
OBJECTIVE
To synthesize available data related to the complex associations among viral infections, atopy, and asthma.
DATA SOURCES
Key historical articles, articles highlighted in our recent review of most significant recent asthma advancements, and findings from several birth cohorts related to asthma and viral infections were reviewed. In addition, PubMed was searched for review articles and original research related to the associations between viral infection and asthma, using the search words asthma, viral infections, atopy, development of asthma, rhinovirus (RV), and respiratory syncytial virus (RSV).
STUDY SELECTIONS
Articles were selected based on novelty and relevance to our topic of interest, the role of asthma and viral infections, and possible mechanisms to explain the association.
RESULTS
There is a large body of evidence demonstrating a link between early viral infections (especially RV and RSV) and asthma inception and exacerbations. RV-induced wheezing is an important risk factor for asthma only when atopy is present, with much evidence supporting the idea that sensitization is a risk factor for early RV-induced wheezing, which in turn is a risk factor for asthma. RSV, on the other hand, is a more important risk factor for nonatopic asthma, with severe infections conferring greater risk.
CONCLUSION
There are important differences in the development of atopic and nonatopic asthma, with several proposed mechanisms explaining the association between viral infections and the development of asthma and asthma exacerbations. Understanding these complex associations is important for developing asthma prevention strategies and targeted asthma therapies.
Topics: Asthma; Child; Child, Preschool; Dendritic Cells; Humans; Neutrophils; Picornaviridae Infections; Respiratory Sounds; Respiratory Syncytial Virus Infections; Respiratory Syncytial Viruses; Rhinovirus; Symptom Flare Up
PubMed: 31276807
DOI: 10.1016/j.anai.2019.06.020 -
Current Allergy and Asthma Reports Aug 2023The prevalence and incidence of allergic disease have been rising in Westernized countries since the twentieth century. Increasingly, evidence suggests that damage to... (Review)
Review
PURPOSE OF REVIEW
The prevalence and incidence of allergic disease have been rising in Westernized countries since the twentieth century. Increasingly, evidence suggests that damage to the epithelium initiates and shapes innate and adaptive immune responses to external antigens. The objective of this review is to examine the role of detergents as a potential risk factor for developing allergic disease.
RECENT FINDINGS
Herein, we identify key sources of human detergent exposure. We summarize the evidence suggesting a possible role for detergents and related chemicals in initiating epithelial barrier dysfunction and allergic inflammation. We primarily focus on experimental models of atopic dermatitis, asthma, and eosinophilic esophagitis, which show compelling associations between allergic disease and detergent exposure. Mechanistic studies suggest that detergents disrupt epithelial barrier integrity through their effects on tight junction or adhesion molecules and promote inflammation through epithelial alarmin release. Environmental exposures that disrupt or damage the epithelium may account for the increasing rates of allergic disease in genetically susceptible individuals. Detergents and related chemical compounds represent possible modifiable risk factors for the development or exacerbation of atopy.
Topics: Humans; Detergents; Asthma; Dermatitis, Atopic; Inflammation; Eosinophilic Esophagitis
PubMed: 37233851
DOI: 10.1007/s11882-023-01094-x -
Der Hautarzt; Zeitschrift Fur... Oct 2019The pathogenesis of hand eczema is multifactorial. Exogenous factors such as skin irritation and contact sensitization contribute to this as well as an endogenous atopic... (Review)
Review
BACKGROUND
The pathogenesis of hand eczema is multifactorial. Exogenous factors such as skin irritation and contact sensitization contribute to this as well as an endogenous atopic predisposition.
OBJECTIVE
This article provides a review of the pathogenetic factors relevant to the development of hand eczema.
MATERIAL AND METHODS
An evaluation of the current literature on the pathogenesis of hand eczema was carried out.
RESULTS
Impairment of the epidermal barrier function plays an essential role for the development of hand eczema. The molecular biological basis and the possible significance of a genetic predisposition beyond atopy are not yet fully understood. Immunological processes involved in the pathogenesis of allergic contact dermatitis and atopic eczema are likely to play a role in the development of certain subtypes of hand eczema. This might contribute to an expansion of the therapeutic armamentarium for hand eczema in the future.
CONCLUSION
The exact understanding of the individual pathogenesis in single hand eczema patients is essential in order to provide specific advice on allergen avoidance, skin protection and basic treatment and to initiate appropriate therapeutic measures.
Topics: Allergens; Dermatitis, Allergic Contact; Dermatitis, Atopic; Eczema; Epidermis; Hand Dermatoses; Humans
PubMed: 31501971
DOI: 10.1007/s00105-019-04474-5