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A blog that publishes updates and open access scientific papers about allergy, asthma and immunology. Editor: Juan Carlos Ivancevich, MD. Specialist in Allergy & Immunology
February 20, 2013
Asthma in Mexican school-age children is not associated with passive smoking or obesity
Diagnosis of food allergies: the impact of oral food challenge testing
Educational & Teaching Material
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Allergies in Asia: are we facing an allergy epidemic?
Editorial
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February 15, 2013
Sputum mediator profiling and relationship to airway wall geometry imaging in severe asthma
Sputum mediator profiling and relationship to airway wall geometry imaging in severe asthma
Dhananjay Desai, Sumit Gupta, Salman Siddiqui, Amisha Singapuri, William Monteiro, James Entwisle, Sudha Visvanathan, Harsukh Parmar, Radhika Kajekar and Christopher C Brightling
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Respiratory Research 2013, 14:17 doi:10.1186/1465-9921-14-17
Published: 11 February 2013Abstract (provisional)
Background
Severe asthma is a heterogeneous disease and the relationship between airway inflammation and airway remodelling is poorly understood. We sought to define sputum mediator profiles in severe asthmatics categorised by CT-determined airway geometry and sputum differential cell counts.
Methods
In a single centre cross-sectional observational study we recruited 59 subjects with severe asthma that underwent sputum induction and thoracic CT. Quantitative CT analysis of the apical segment of the right upper lobe (RB1) was performed. Forty-one mediators in sputum samples were measured of which 21 mediators that were assessable in >50% of samples were included in the analyses.
Results
Independent of airway geometry, sputum MMP9 and IL-1beta were elevated in those groups with a high sputum neutrophil count while sputum ICAM was elevated in those subjects with a low sputum neutrophil count. In contrast, sputum CCL11, IL-1alpha and fibrinogen were different in groups stratified by both sputum neutrophil count and airway geometry. Sputum CCL11 concentration was elevated in subjects with a low sputum neutrophil count and high luminal and total RB1 area, whereas sputum IL1alpha was increased in subjects with a high sputum neutrophil count and low total RB1 area. Sputum fibrinogen was elevated in those subjects with RB1 luminal narrowing and in those subjects with neutrophilic inflammation without luminal narrowing.
Conclusions
We have demonstrated that sputum mediator profiling reveals a number of associations with airway geometry. Whether these findings reflect important biological phenotypes that might inform stratified medicine approaches requires further investigation.
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production. |
February 14, 2013
Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study
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Sao Paulo Medical Journal
Print version ISSN 1516-3180
Sao Paulo Med. J. vol.130 no.5 São Paulo 2012
http://dx.doi.org/10.1590/S1516-31802012000500005
ORIGINAL ARTICLE
Autoimmune thyroid disease as a risk factor for angioedema in patients with chronic idiopathic urticaria: a case-control study
Doença autoimune da tireoide como um fator de risco para angioedema em pacientes com urticária crônica idiopática: um estudo caso-controle
Ruy Felippe Brito Gonçalves MissakaI; Henrique Costa PenattiI; Maria Regina Cavariani SilvaresII; Célia Regina NogueiraIII; Gláucia Maria Ferreira da Silva MazetoIV
IUndergraduate Medical Student, Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
IIMD, PhD. Professor of Dermatology, Department of Dermatology and Radiotherapy, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
IIIMD, PhD. Professor of Endocrinology and Metabology, Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
IVMD, PhD. Professor of Endocrinology and Metabology, Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
IIMD, PhD. Professor of Dermatology, Department of Dermatology and Radiotherapy, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
IIIMD, PhD. Professor of Endocrinology and Metabology, Department of Internal Medicine, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
IVMD, PhD. Professor of Endocrinology and Metabology, Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (Unesp), Botucatu, São Paulo, Brazil
ABSTRACT
CONTEXT AND OBJECTIVE: An association between chronic idiopathic urticaria (CIU) and autoimmune thyroid disease (ATD) has been reported. However, there have not been any reports on whether ATD raises the risk of angioedema, which is a more severe clinical presentation of CIU. Thus, the aim of the present study was to evaluate whether the risk of angioedema is increased in patients with CIU and ATD.
DESIGN AND SETTING: Case-control study including 115 patients with CIU at a tertiary public institution.
METHODS: The patients were evaluated with regard to occurrence of angioedema and presence of ATD, hypothyroidism or hyperthyroidism.
RESULTS: Angioedema was detected in 70 patients (60.9%). There were 22 cases (19.1%) of ATD, 19 (16.5%) of hypothyroidism and nine (7.8%) of hyperthyroidism. The risk among patients with ATD was 16.2 times greater than among those without this thyroid abnormality (confidence interval, CI = 2.07-126.86). The odds ratio for hypothyroidism was 4.6 (CI = 1.00-21.54) and, for hyperthyroidism, 3.3 (CI = 0.38-28.36).
CONCLUSIONS: Patients with CIU and ATD presented greater risk of angioedema, which reinforces the idea that a relationship exists between this allergic condition and thyroid autoimmunity. This finding could imply that such patients require specifically directed therapy.
DESIGN AND SETTING: Case-control study including 115 patients with CIU at a tertiary public institution.
METHODS: The patients were evaluated with regard to occurrence of angioedema and presence of ATD, hypothyroidism or hyperthyroidism.
RESULTS: Angioedema was detected in 70 patients (60.9%). There were 22 cases (19.1%) of ATD, 19 (16.5%) of hypothyroidism and nine (7.8%) of hyperthyroidism. The risk among patients with ATD was 16.2 times greater than among those without this thyroid abnormality (confidence interval, CI = 2.07-126.86). The odds ratio for hypothyroidism was 4.6 (CI = 1.00-21.54) and, for hyperthyroidism, 3.3 (CI = 0.38-28.36).
CONCLUSIONS: Patients with CIU and ATD presented greater risk of angioedema, which reinforces the idea that a relationship exists between this allergic condition and thyroid autoimmunity. This finding could imply that such patients require specifically directed therapy.
Key words: Angioedema. Allergy and immunology. Autoimmunity. Hashimoto disease. Thyroiditis. Urticaria.
RESUMO
CONTEXTO E OBJETIVO: A associação de urticária crônica idiopática (UCI) com doença autoimune da tireoide (DAT) é relatada. Porém, não foram encontrados relatos se a DAT eleva o risco de angioedema, uma apresentação clínica mais grave da UCI. Assim, o objetivo do presente estudo foi avaliar se o risco de angioedema está aumentado em pacientes com UCI e DAT.
TIPO DE ESTUDO E LOCAL: Estudo caso-controle, incluindo 115 pacientes com UCI em uma instituição pública terciária.
MÉTODOS: Os pacientes foram avaliados quanto à ocorrência de angioedema e à presença de DAT, hiper ou hipotireoidismo.
RESULTADOS: Angioedema ocorreu em 70 pacientes (60,9%). Foram observados 22 (19,1%) casos de DAT, 19 (16,5%) de hipotireoidismo e 9 (7,8%) de hipertireoidismo. Os pacientes com DAT apresentaram risco 16,2 vezes maior de angioedema do que os sem a alteração tireoidiana (intervalo de confiança, IC = 2.07-126.86). Oodds ratio, para hipotireoidismo, foi de 4,6 (IC = 1.00-21.54) e para hipertireoidismo foi de 3,3 (IC = 0.38-28.36).
CONCLUSÕES: Pacientes com UCI e DAT apresentaram maior risco de angioedema, reforçando a ideia de existência de relação entre o quadro alérgico e autoimunidade tireoidiana. Este achado poderia implicar em um direcionamento terapêutico específico para tais pacientes.
TIPO DE ESTUDO E LOCAL: Estudo caso-controle, incluindo 115 pacientes com UCI em uma instituição pública terciária.
MÉTODOS: Os pacientes foram avaliados quanto à ocorrência de angioedema e à presença de DAT, hiper ou hipotireoidismo.
RESULTADOS: Angioedema ocorreu em 70 pacientes (60,9%). Foram observados 22 (19,1%) casos de DAT, 19 (16,5%) de hipotireoidismo e 9 (7,8%) de hipertireoidismo. Os pacientes com DAT apresentaram risco 16,2 vezes maior de angioedema do que os sem a alteração tireoidiana (intervalo de confiança, IC = 2.07-126.86). Oodds ratio, para hipotireoidismo, foi de 4,6 (IC = 1.00-21.54) e para hipertireoidismo foi de 3,3 (IC = 0.38-28.36).
CONCLUSÕES: Pacientes com UCI e DAT apresentaram maior risco de angioedema, reforçando a ideia de existência de relação entre o quadro alérgico e autoimunidade tireoidiana. Este achado poderia implicar em um direcionamento terapêutico específico para tais pacientes.
Palavras-chave: Angioedema. Alergia e imunologia. Auto-imunidade. Doença de Hashimoto. Tireoidite. Urticária.
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