September 10, 2014

Severe Asthma Phenotyping: The Applicability of Current Proposols in Daily Practice

Research Article

Volume 1 Issue 1 - 2014

Adile Berna Dursun1,2*, Ferda Oner Erkekol2 and Ozlem Kar Kurt2,3

1Department of Internal Medicine, Division of Immunology and Allergic Diseases, Recep Tayyip Erdogan University School of Medicine, Turkey
2Divison of Immunology and Allergic Diseases, Ataturk Chest Disease and Thoracic Surgery Trainig and Research Hospital, Turkey
3Department of Respiratory Medicine, Izzet Baysal University School of Medicine, Turkey

Received: August 12, 2014 | Published: August 21, 2014

*Corresponding author: Adile Berna Dursun, Department of Internal Medicine, Division of Immunology and Allergic Diseases, Recep Tayyip Erdogan University School of Medicine, Rize, Turkey, Tel: 905325874868; Email: @

Citation: Dursun AB, Erkekol FO, Kurt OK (2014) Severe Asthma Phenotyping: The Applicability of Current Proposols in Daily Practice. J Lung Pulm Respir Res 1(1): 00003. http://dx.doi.org/10.15406/jlprr.2014.01.00003

Abstract

Background: Severe asthma (SA) is also need to be phenotyping. We aimed to demonstrate the applicability of current definition and classification proposals in daily practice.
Methods: SA patients, according to WHO definition of treatment resistant SA, were enrolled from the allergy clinic. The SARP algorith define and WHO proposal were applied to the subjects independently by asthma experts. Demographic and clinical characteristics of the subjects were used for the comparison.
Results: Ninety-five (F/M: 68/27) patients with a mean age of 45.97± 9.44 years (range25-71) were enrolled. The patients were grouped as controlled treatment-resistant SA (56%) and uncontrolled treatment resistant SA group (44%). There was no statistically significant difference between the groups but aspirin hypersensitivity. 49% of patients was classified as exacerbators, 26% as fixed airway obstruction group and 23% as undefined (other 2%). Age and mold sensitivity was higher; FEV1/FVC and FEF25-75 were lower in exacerbation-prone SA. More than half of the patients were define clustered at 4 and 5 according to SARP proposol. Patients with fixed obstruction were only in the clusters 4 and 5.
Conclusion: Current phenotyping proposols failed to cover all SA patients. Thus, there is still need further investigations in order to explore validity and applicability of the phenotyping of SA.

Keywords: Adult asthma; Severe asthma; Phenotype; Cluster analysis; Refractory asthma; Difficult-to-treat asthma

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September 8, 2014

Component resolved diagnosis: when should it be used?

Clinical and Translational Allergy

Volume 4

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Component resolved diagnosis: when should it be used?

Olga Luengo and Victòria Cardona

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Abstract (provisional)

The knowledge on molecular allergy diagnosis is continuously evolving. It is now time for the clinician to integrate this knowledge and use it when needed to improve the accuracy of diagnosis and thus provide more precise therapeutic and avoidance measures. This review does not intend to comprehensively analyze all the available allergen molecules, but to provide some practical clues on use and interpretation of molecular allergy diagnosis. The potential role of component resolved diagnosis in circumstances such as the indication of allergen immunotherapy, pollen polysensitization, food allergy, latex allergy or anaphylaxis, is assessed. Interpreting the information provided by molecular allergy diagnosis needs a structured approach. It is necessary to evaluate single positivities and negativities, but also to appraise "the big picture" with perspective.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

September 6, 2014

Anti-Inflammatory Effect of IL-37b in Children with Allergic Rhinitis

Mediators of Inflammation
Volume 2014 (2014), Article ID 746846, 13 pages
http://dx.doi.org/10.1155/2014/746846

Research Article

Wenlong Liu,¹ Li Deng,¹ Yanqiu Chen,¹ Changzhi Sun,¹ Jie Wang,¹ Lifeng Zhou,¹ Huabin Li,² and Renzhong Luo¹

¹Department of Otolaryngology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical College, No. 9 Jinsui Road, Guangzhou 510623, China
²Department of Otolaryngology, Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China

Received 9 December 2013; Revised 4 July 2014; Accepted 14 July 2014; Published 11 August 2014

Academic Editor: Arkadiusz Orzechowski

Copyright © 2014 Wenlong Liu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background. Interleukin-37 (IL-37), a newly described member of IL-1family, functioned as a fundamental inhibitor of innate inflammatory and immune responses, especially its isoform IL-37b. Objective. This study was undertaken to evaluate the expression and regulation of IL-37b in children with allergic rhinitis (AR).Methods. Forty children with AR and twenty-five normal controls were included. The relationship between IL-37b and Th1/2 cytokines production in serum and nasal lavage was examined by enzyme-linked immunosorbent assay (ELISA). Peripheral blood mononuclear cells (PBMCs) were purified for in vitro regulation experiment of IL-37b. Intranasal mometasone furoate was given in AR children and IL-37b change after one-month treatment was detected using ELISA. Results. We observed significantly decreased IL-37b expression levels in both serum and nasal lavage compared to controls. IL-37b was negatively correlated with Th2 cytokines. Our results also showed that IL-37b downregulated Th2 cytokine expressed by PBMCs and this modulation was through mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K) pathway. We also found that intranasal mometasone furoate therapy can promote nasal IL-37b expression.Conclusion. IL-37b may be involved in Th2 cytokine regulation in AR and its expression was related to the efficacy of intranasal steroid therapy.

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

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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.

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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.

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September 10, 2014

Severe Asthma Phenotyping: The Applicability of Current Proposols in Daily Practice

Abstract

September 9, 2014

Dr. David Lang discusses urticaria (hives) and angioedema (swelling). Held on July 7, 2014.

Dr. Michael Foggs discusses the NHLBI guidelines for management of asthma. Held on July 11, 2014.

September 8, 2014