Allergy, Asthma and Immunology

September 6, 2014

Asthma in the elderly: a study of the role of vitamin D

Short report

Michele Columbo, Reynold A Panettieri and Albert S Rohr

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Allergy, Asthma & Clinical Immunology 2014, 10:48 doi:10.1186/1710-1492-10-48

Published: 5 September 2014

Abstract (provisional)

Background

Asthma in the elderly is poorly understood and vitamin D deficiency and insufficiency are very common in older individuals. We studied the role of vitamin D in elderly asthmatics.

Findings: Asthmatics subjects, age 65 and older, were followed every 4 weeks for 12 weeks in the late fall and winter. During the study period they took 2,000 I.U. vitamin D3 daily. Serum 25-Hydroxyvitamin D and calcium were measured at baseline and study end. Twenty nine percent of subjects were deficient and 50% insufficient in serum vitamin D at baseline. Serum vitamin D increased from 24.3 +/- 9.2 ng/ml (60.7 +/- 23 nmol/L) to 34 +/- 7.1 ng/ml (84.9 +/- 17.7 nmol/L) at the end of the study (p < 0.001), whereas calcium was unchanged. We found no significant association between vitamin D and subjects' demographics. Vitamin D was similar in men and women. There was no association between serum vitamin D and inhaled steroid dose. Vitamin D was significantly lower in subjects with uncontrolled asthma (Asthma Control Test, ACT -= 19) compared to the ones with well controlled symptoms (p - 0.05). In subjects with uncontrolled asthma at baseline, ACT scores increased significantly at the end of the study (p - 0.04), but not at 4 and 8 weeks. Spirometric values remained unchanged throughout the study.

Conclusions

Elderly asthmatics very commonly have vitamin D deficiency or insufficiency. Serum vitamin D levels were lower in subjects with uncontrolled asthma. In these subjects, vitamin D supplementation for 12 weeks led to improved ACT scores. Larger, randomized, placebo controlled studies are required to further evaluate whether vitamin D supplementation may improve asthma symptoms in this population.

Trial registration: ClinicalTrials.gov NCT01730976.

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The intestinal microbiome in early life: health and disease

Front. Immunol., 05 September 2014 | doi: 10.3389/fimmu.2014.00427

Marie-Claire Arrieta¹,

Leah T. Stiemsma²,

Nelly Amenyogbe²,

Eric M. Brown¹ and

Brett Finlay^1,3,4*

1Michael Smith Laboratories, University of British Columbia, Vancouver, BC, Canada
2Child and Family Research Institute, University of British Columbia, Vancouver, BC, Canada
3Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
4Department of Biochemistry and Molecular Biology, University of British Columbia, Vancouver, BC, Canada

Human microbial colonization begins at birth and continues to develop and modulate in species abundance for about 3 years, until the microbiota becomes adult-like. During the same time period, children experience significant developmental changes that influence their health status as well as their immune system. An ever-expanding number of articles associate several diseases with early-life imbalances of the gut microbiota, also referred to as gut microbial dysbiosis. Whether early-life dysbiosis precedes and plays a role in disease pathogenesis, or simply originates from the disease process itself is a question that is beginning to be answered in a few diseases, including IBD, obesity, and asthma. This review describes the gut microbiome structure and function during the formative first years of life, as well as the environmental factors that determine its composition. It also aims to discuss the recent advances in understanding the role of the early-life gut microbiota in the development of immune-mediated, metabolic, and neurological diseases. A greater understanding of how the early-life gut microbiota impacts our immune development could potentially lead to novel microbial-derived therapies that target disease prevention at an early age.

Full text

Regulation of intestinal health and disease by innate lymphoid cells

Int. Immunol. (2014) 26 (9): 501-507. doi: 10.1093/intimm/dxu052 First published online: May 12, 2014

Gregory F. Sonnenberg

Abstract

Innate lymphoid cells (ILCs) are a recently appreciated immune cell population that is constitutively found in the healthy mammalian gastrointestinal (GI) tract and associated lymphoid tissues. Translational studies have revealed that alterations in ILC populations are associated with GI disease in patients, such as inflammatory bowel disease, HIV infection and colon cancer, suggesting a potential role for ILCs in either maintaining intestinal health or promoting intestinal disease. Mouse models identified that ILCs have context-dependent protective and pathologic functions either during the steady state, or following infection, inflammation or tissue damage. This review will discuss the associations of altered intestinal ILCs with human GI diseases, and the functional consequences of targeting ILCs in mouse models. Collectively, our current understanding of ILCs suggests that the development of novel therapeutic strategies to modulate ILC responses will be of significant clinical value to prevent or treat human GI diseases.

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Japanese Guideline for Allergic Rhinitis 2014

REVIEW ARTICLE

doi:10.2332/allergolint.14-RAI-0768

Kimihiro Okubo, Yuichi Kurono, Shigeharu Fujieda, Satoshi Ogino, Eiichi Uchio, Hiroshi Odajima, Hiroshi Takenaka and Japanese Society of Allergology

ABSTRACT

Like asthma and atopic dermatitis, allergic rhinitis is an allergic disease, but of the three, it is the only type I allergic disease. Allergic rhinitis includes pollinosis, which is intractable and reduces quality of life (QOL) when it becomes severe. A guideline is needed to understand allergic rhinitis and to use this knowledge to develop a treatment plan. In Japan, the first guideline was prepared after a symposium held by the Japanese Society of Allergology in 1993. The current 7th edition was published in 2013, and is widely used today.

To incorporate evidence based medicine (EBM) introduced from abroad, the most recent collection of evidence/literature was supplemented to the Practical Guideline for the Management of Allergic Rhinitis in Japan 2013. The revised guideline includes assessment of diagnosis/treatment and prescriptions for children and pregnant women, for broad clinical applications. An evidence-based step-by-step strategy for treatment is also described. In addition, the QOL concept and cost benefit analyses are also addressed. Along with Allergic Rhinitis and its Impact of Asthma (ARIA), this guideline is widely used for various clinical purposes, such as measures for patients with sinusitis, childhood allergic rhinitis, oral allergy syndrome, and anaphylaxis and for pregnant women. A Q&A section regarding allergic rhinitis in Japan was added to the end of this guideline.

KEY WORDS:

allergen immunotherapy, mechanism, pharmacotherapy, pollinosis, surgery

Received: 28 April 2014.

Allergology International 2014; 63: 357-375 (Full text)

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September 4, 2014

Therapeutic uses of anti-interleukin-6 receptor antibody

Int. Immunol. (2014) doi: 10.1093/intimm/dxu081
First published online: August 20, 2014
Sujin Kang¹,²,
Toshio Tanaka¹,² and
Tadamitsu Kishimoto³

¹Department of Clinical Application of Biologics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita City,
Osaka 565-0871, Japan
²Department of Immunopathology, World Premier International Immunology Frontier Research Center, Osaka University,
3-1 Yamada-oka, Suita City, Osaka 565-0871, Japan
³Laboratory of Immune Regulation, World Premier International Immunology Frontier Research Center, Osaka University,
3-1 Yamada-oka, Suita City, Osaka 565-0871, Japan

Corresponding author: Tadamitsu Kishimoto Contact email: kishimoto@ifrec.osaka-u.ac.jp Laboratory of Immune Regulation,
World Premier International Immunology Frontier Research Center, Osaka University, 3-1 Yamada-oka, Suita City, Osaka 565-0871, Japan

Received July 13, 2014.

Abstract

Cytokine-targeted therapy has generated a paradigm shift in the treatment of several immune-mediated diseases. Interleukin 6 (IL-6), which was initially identified as a B cell stimulatory factor 2, is a prototypical cytokine with wide-ranging biological effects on immune cells such as B and T cells, hepatocytes, hematopoietic cells, vascular endothelial cells, and many others. IL-6 is thus crucially involved in the regulation of immune response, hematopoiesis, and inflammation. When infections and tissue injuries occur, IL-6 is promptly synthesized and performs a protective role in host defense against such stresses and traumas. However, excessive production of IL-6 during this emergent process induces potentially fatal complications, including systemic inflammatory response syndrome (SIRS), while dysregulated, persistently high expression of IL-6 causes the onset or development of various chronic immune-mediated disorders. For these reasons, IL-6 blockade was expected to become a novel therapeutic strategy for various diseases characterized by IL-6 overproduction. Indeed, worldwide clinical trials of tocilizumab, a humanized anti-IL-6 receptor monoclonal antibody, have successfully proved its outstanding efficacy against rheumatoid arthritis, juvenile idiopathic arthritis, and Castleman disease, leading to the approval of tocilizumab for the treatment of these diseases. Moreover, various reports regarding off-label use with tocilizumab strongly suggest that it will be widely applicable for acute severe complications such as SIRS and cytokine release syndrome and other refractory chronic immune-mediated diseases.

Key words

Anaphylaxis and cardiovascular diseases: a dangerous liaison

Current Opinion in Allergy & Clinical Immunology:

August 2014 - Volume 14 - Issue 4 - p 309-315

Triggiani, Massimo^a; Montagni, Marcello^b; Parente, Roberta^a; Ridolo, Erminia^b

Free Access

Article Outline

Author Information

^aDivision of Allergy and Clinical Immunology, University of Salerno, Salerno

^bDepartment of Clinical and Experimental Medicine, University of Parma, Italy

Correspondence to Massimo Triggiani, MD, Division of Allergy and Clinical Immunology, Department of Medicine, University of Salerno, Via Allende, 84081 Baronissi (Salerno), Italy. Tel: +39 081 965056; e-mail: mtriggiani@unisa.it

Abstract

Purpose of review

Anaphylaxis is a life-threatening event in which the cardiovascular system is responsible for the majority of clinical symptoms and for potentially fatal outcome. This review summarizes the most recent clinical and experimental data on cardiovascular involvement during anaphylaxis.

Recent findings

Great efforts have been made in the last few years to understand the pathophysiology of anaphylactic reaction and to provide better identification of risk factors for the development of this reaction. Coronary blood flow can be impaired during anaphylaxis, which may significantly contribute to an unfavourable outcome. Also, preexisting coronary artery disease is a negative prognostic factor for anaphylaxis. In addition, acute ischemic events, including angina and myocardial infarction, are currently considered as part of the clinical picture of anaphylaxis. Moreover, cardiac emergency can be the presenting clinical picture of mast cell-related disorders.

Summary

Both cardiovascular and allergic diseases are frequent among populations. A better understanding of the mechanisms leading to cardiac mast cell activation and the effects of mast cell mediators on cardiovascular system can help improve the prevention and treatment of anaphylaxis.

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Dietary exposures and allergy prevention in high-risk infants: a joint position statement of the Canadian Society of Allergy and Clinical Immunology and the Canadian Paediatric Society

Review

Edmond S Chan, Carl Cummings, Adelle Atkinson, Zave Chad, Marie-Josée Francoeur, Linda Kirste, Douglas Mack, Marie-Noël Primeau, Timothy K Vander Leek and Wade TA Watson

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Allergy, Asthma & Clinical Immunology 2014, 10:45 doi:10.1186/1710-1492-10-45

Published: 2 September 2014