Environmental interventions for mite-induced asthma: a journey between systematic reviews, contrasting evidence, and clinical practice

European Annals of Allergy and Clinical Immunology Vol 45, No 3 (2013) > Pingitore

Environmental interventions for mite-induced asthma: a journey between systematic reviews, contrasting evidence, and clinical practice

G. Pingitore, E. Pinter

Abstract

House dust mites (HDM) are one of the most important sources of indoor allergens worldwide.Exposure to high environmental levels of dust mite allergen is associated with anincreased risk of sensitization, asthma and deterioration of lung function. On the basis ofthese data, it would be logical to assume that asthmatic patients with mite allergy couldbenefit from a reduction of exposure to these allergens. Several environmental prophylacticactions against HDM, either physical or chemical have been tried, alone or in differentcombinations.However, a recent Cochrane Systematic Review did not detect specific clinicalbenefits from the use of prophylactic environmental measures in asthmatic patientssensitive to HDM and concluded that such measures can no longer be recommended asthey are ineffective.This paper presents the results of a web-based questionnaire, administeredto more than 200 Italian paediatricians, and shows that physicians' behaviour in reallife is very far from SR conclusions. It also summarizes the indications of the most authoritativeguidelines, highlighting some contrasting evidence and some significantweaknesses of the SR, that could make the final conclusions at least uncertain. In the lightof these findings, it seems that the recent Cochrane SR cannot be considered the definitivedocument on the uselessness of environmental prevention of mite-related asthma.

Keywords

House dust mites, avoidance, asthma

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RESEARCH ARTICLE

Temporal Asthma Patterns Using Repeated Questionnaires over 13 Years in a Large French Cohort of Women

• Margaux Sanchez mail,
 
• Jean Bousquet,
 
• Nicole Le Moual,
 
• Bénédicte Jacquemin,
 
• Françoise Clavel-Chapelon,
 
• Marc Humbert,
 
• Francine Kauffmann,
• Pascale Tubert-Bitter,
 
• Raphaëlle Varraso

• Abstract

  Variable expression is one aspect of the heterogeneity of asthma. We aimed to define a variable pattern, which is relevant in general health epidemiological cohorts. Our objectives were to assess whether: 1) asthma patterns defined using simple asthma questions through repeated measurements could reflect disease variability 2) these patterns may further be classified according to asthma severity/control. Among 70,428 French women, we used seven questionnaires (1992–2005) and a comprehensive reimbursement database (2004–2009) to define three reliable asthma patterns based on repeated positive answers to the ever asthma attack question: “never asthma” (n = 64,061); “inconsistent” (“yes” followed by “no”, n = 3,514); “consistent” (fully consistent positive answers, n = 2,853). The “Inconsistent” pattern was related to both long-term (childhood-onset asthma with remission in adulthood) and short-term (reported asthma attack in the last 12 months, associated with asthma medication) asthma variability, showing that repeated questions are relevant markers of the variable expression of asthma. Furthermore, in this pattern, the number of positive responses (1992–2005) predicted asthma drug consumption in subsequent years, a marker of disease severity. The “Inconsistent” pattern is a phenotype that may capture the variable expression of asthma. Repeated answers, even to a simple question, are too often neglected.

  Citation: Sanchez M, Bousquet J, Le Moual N, Jacquemin B, Clavel-Chapelon F, et al. (2013) Temporal Asthma Patterns Using Repeated Questionnaires over 13 Years in a Large French Cohort of Women. PLoS ONE 8(5): e65090. doi:10.1371/journal.pone.0065090

  • Abstract
  • Introduction
  • Materials and Methods
  • Results
  • Discussion
  • Supporting Information
  • Acknowledgments
  • Author Contributions
  • References

  • Reader Comments (0)
  • Figures

  Editor: Monica da Silva Nunes, Universidade Federal do Acre (Federal University of Acre), Brazil

  Received: December 4, 2012; Accepted: April 20, 2013; Published: May 31, 2013

  Copyright: © 2013 Sanchez et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

  Funding: The E3N study is supported by the Mutuelle Générale de l’Education Nationale (MGEN), the European Community, the French League against Cancer (LNCC), the Gustave Roussy Institute (IGR), the National Institute for Health and Medical Research (Inserm) and General Councils of France. The specific respiratory health survey in the E3N study was supported by the Fonds de dotation “Recherche en Santé Respiratoire”. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

  Competing interests: The authors have declared that no competing interests exist.

Heated Allergens and Induction of Tolerance in Food Allergic Children

Nutrients 2013, 5(6), 2028-2046; doi:10.3390/nu5062028

Heated Allergens and Induction of Tolerance in Food Allergic Children

Review

Merryn Netting ¹ , Maria Makrides ¹ , Michael Gold ² , Patrick Quinn ²  and Irmeli Penttila ^1,* 

¹ Women's and Children's Health Research Institute, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia² Children's Youth and Women's Health Network, University of Adelaide, 72 King William Road, North Adelaide, SA 5006, Australia

* Author to whom correspondence should be addressed.

Received: 28 March 2013; in revised form: 15 May 2013 / Accepted: 17 May 2013 / Published: 5 June 2013

(This article belongs to the Special Issue Nutrients and Immune Function)

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Abstract: Food allergies are one of the first manifestations of allergic disease and have been shown to significantly impact on general health perception, parental emotional distress and family activities. It is estimated that in the Western world, almost one in ten children have an IgE-mediated allergy. Cow’s milk and egg allergy are common childhood allergies. Until recently, children with food allergy were advised to avoid all dietary exposure to the allergen to which they were sensitive, in the thought that consumption would exacerbate their allergy. However, recent publications indicate that up to 70% of children with egg allergy can tolerate egg baked in a cake or muffin without apparent reaction. Likewise, up to 75% of children can tolerate baked goods containing cow’s milk, and these children demonstrate IgE and IgG4 profiles indicative of tolerance development. This article will review the current literature regarding the use of heated food allergens as immunotherapy for children with cow’s milk and egg allergy.

Keywords: egg; milk; allergy; heated allergens; tolerance; oral; immunotherapy

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Cite This Article

MDPI and ACS Style

Netting, M.; Makrides, M.; Gold, M.; Quinn, P.; Penttila, I. Heated Allergens and Induction of Tolerance in Food Allergic Children. Nutrients 2013, 5, 2028-2046.

AMA Style

Netting M, Makrides M, Gold M, Quinn P, Penttila I. Heated Allergens and Induction of Tolerance in Food Allergic Children. Nutrients. 2013; 5(6):2028-2046.

Chicago/Turabian Style

Netting, Merryn; Makrides, Maria; Gold, Michael; Quinn, Patrick; Penttila, Irmeli. 2013. "Heated Allergens and Induction of Tolerance in Food Allergic Children."Nutrients 5, no. 6: 2028-2046.

Toxocariasis in children attending a Public Health Service Pneumology Unit in Paraná State, Brazil

Rev. Inst. Med. trop. S. Paulo vol.55 no.3 São Paulo May/June 2013

http://dx.doi.org/10.1590/S0036-46652013000300009 

PARASITOLOGY

Toxocariasis in children attending a Public Health Service Pneumology Unit in Paraná State, Brazil

ABSTRACT

The enzyme-linked immunosorbent assay (ELISA) is the most widely used tool to detect anti-Toxocara IgG antibodies for both serodiagnostic and seroepidemiological surveys on human toxocariasis. In the last eight years a high prevalence of toxocariasis (32.2-56.0%) has been reported in children attending public health units from municipalities in the state of Paraná, Brazil. Therefore, the aim of this work was to compare the frequency found among the general child population with that of children attending a public pneumology service in Maringá, Paraná, Brazil and describe the laboratorial, clinical and epidemiological findings. The research was conducted at the Consórcio Público Intermunicipal de Saúde do Setentrião Paranaense (CISAMUSEP) from July 2009 to July 2010 among children aged between one and 15 years. From a total of 167 children studied, only 4.2% (7/167) tested positive for anti-Toxocara spp. IgG antibodies and presented mild eosinophilia (2/7), increased serum IgE levels (6/7) and a positive allergy test for mites (5/7). The presence of pets (dogs or cats) at home did not correlate with the seroprevalence. In conclusion, cases of toxocariasis involving the respiratory tract are rare in children attending a public health pneumology unit in the northwestern region of Paraná State, despite the high prevalence of this type of toxocariasis among the infantile population attending Basic Health Units in the same geographical area.

Keywords: Toxocara spp.; Children; Respiratory tract; Toxocariasis

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Phenotypes and endotypes of severe asthma in children

Korean J Pediatr > 2013 May;56(5) > Article

REVIEW ARTICLE

Korean J Pediatr 2013 May;56(5) :191-195. Published online 2012 December 28.

Phenotypes and endotypes of severe asthma in children Young Yoo Department of Pediatrics, Allergy Immunology Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea Corresponding Author: Young Yoo ,Tel: +82-2-920-5090, Fax: +82-2-922-7476, Email: yoolina@korea.ac.kr Copyright © 2013 by The Korean Pediatric Society Share :    ABSTRACT Severe childhood asthma is a complicated and heterogeneous disorder with distinct phenotypes. Children with severe asthma have more persistent symptoms despite receiving treatment, more atopy, greater airway obstruction, and more air trapping than those with mild-to-moderate asthma. They also have higher morbidity and substantial airflow limitations that persist throughout adulthood. Identification of the phenotype clusters and endotypes of severe asthma can allow further modulation of the natural history of severe asthma and may provide the pathophysiologic rationale for appropriate management strategies. Keywords: Severe asthma | Child | Phenotype | Endotype TOOLS   PDF Links   Full text via DOI   Download Citation   Supplementary Material   E-Mail

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RESEARCH ARTICLE

Galectin-9 Activates and Expands Human T-Helper 1 Cells

• Marloes J. M. Gooden equal contributor,
 
• Valerie R. Wiersma equal contributor,
 
• Douwe F. Samplonius,
 
• Jurjen Gerssen,
 
• Robert J. van Ginkel,
 
• Hans W. Nijman,
 
• Mitsuomi Hirashima,
• Toshiro Niki,
 
• Paul Eggleton ¶,
 
• Wijnand Helfrich ¶,
 
• Edwin Bremer 

Abstract

Galectin-9 (Gal-9) is known for induction of apoptosis in IFN-γ and IL-17 producing T-cells and amelioration of autoimmunity in murine models. On the other hand, Gal-9 induced IFN-γ positive T-cells in a sarcoma mouse model and in food allergy, suggesting that Gal-9 can have diametric effects on T-cell immunity. Here, we aimed to delineate the immunomodulatory effect of Gal-9 on human resting and ex vivo activated peripheral blood lymphocytes. Treatment of resting lymphocytes with low concentrations of Gal-9 (5–30 nM) induced apoptosis in ~60% of T-cells after 1 day, but activated the surviving T-cells. These viable T-cells started to expand after 4 days with up to 6 cell divisions by day 7 and an associated shift from naïve towards central memory and IFN-γ producing phenotype. In the presence of T-cell activation signals (anti-CD3/IL-2) Gal-9 did not induce T-cell expansion, but shifted the CD4/CD8 balance towards a CD4-dominated T-cell response. Thus, Gal-9 activates resting T-cells in the absence of typical T-cell activating signals and promotes their transition to a TH1/C1 phenotype. In the presence of T-cell activating signals T-cell immunity is directed towards a CD4-driven response by Gal-9. Thus, Gal-9 may specifically enhance reactive immunological memory.

Citation: Gooden MJM, Wiersma VR, Samplonius DF, Gerssen J, van Ginkel RJ, et al. (2013) Galectin-9 Activates and Expands Human T-Helper 1 Cells. PLoS ONE 8(5): e65616. doi:10.1371/journal.pone.0065616

• Abstract
• Introduction
• Materials and Methods
• Results
• Discussion
• Supporting Information
• Author Contributions
• References

• Reader Comments (0)
• Figures

Editor: Kjetil Tasken, University of Oslo, Norway

Received: February 19, 2013; Accepted: April 25, 2013; Published: May 31, 2013

Copyright: © 2013 Gooden et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was supported by Dutch Cancer Society grants RUG 2009-4355 (E.B.), RUG2009-4542/RUG2011-5206 (E.B/W.H.) and RUG2007-3784 (W.H.), the Netherlands Organization for Scientific Research (E.B.), the Melanoma Research Alliance (E.B.), the Alexander von Humboldt Foundation (E.B.) and the European Community’s Seventh Framework Programme (FP7/2007–2013) under grant agreement (grant number 215009) (P.E.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have the following interests: Drs. Niki and Hirashima are board members of GalPharma Co., Ltd. The authors have a product in development: stable-form galectin-9. Name of the patent: NOVEL MODIFIED GALECTIN 9 PROTEINS AND USE THEREOF. Patent numbers: EP1736541, JP4792390, US8268324. There are no further patents, products in development or marketed products to declare. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

¶ These authors also contributed equally to this work.

Assessment of asthma control: clinical, functional and inflammatory aspects

 Vol 45, No 3 (2013) > Leblanc

Assessment of asthma control: clinical, functional and inflammatory aspects

A. Leblanc, C. Botelho, A. Coimbra, et al.

Abstract

Background: Asthma is a complex disease with numerous markers of severity/activity.Clinical assessment, functional parameters and inflammation biomarkers are the mostused. A correlation between them is difficult, as each one evaluates a particular aspectof the disease. Objective and Methods: To explore the possible association betweenasthma control, pulmonary function and inflammation in patients with asthma, consecutiveasthmatics underwent simultaneous spirometry (measurement of FEV1), exhalednitric oxide (eNO) evaluation and Asthma Control Test (ACTTM) questionnaire.Results: The study included 232 asthmatics (mean age: 37.48 years; 78.4% female):43% had uncontrolled asthma (ACTTM≤19) with FEV1 mean values of83.3%±21.8; 48% partially controlled (ACTTM:20-24) with FEV1 of 87.6%±17;9% complete control (ACTTM=25) with FEV1 of 93.1±20.6. The relationACTTM/FEV1 and ACTTM/FEF25-75% was statistically significant (p=0.001and p=0.034, respectively). Among patients with eNO -35 ppb, 66% had FEV1 + 80%and 52% had ACTTM + 19. No association was found combining ACTTM/eNO orFEV1/eNO. A subgroup of 66 patients was evaluated twice. Conclusion: An associationwas found between ACTTM and spirometry, with higher ACTTM scores reflectingless bronchial obstruction. The authors advise a combined approach in asthmafollow-up, involving clinical aspects, functional parameters and inflammation biomarkers,although in some circumstances ACT could be a valid instrument to be usedalone to assess control.

Keywords

Asthma control; exhaled nitric oxide;FEV1; spirometry

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Eur Rev Med Pharmacol Sci 2013; 17 (10): 1419-1423

Vernal keratoconjunctivitis: atopy and autoimmunity

A.M. Zicari, M. Nebbioso, V. Lollobrigida, F. Bardanzellu, C. Celani, F. Occasi, A. Cesoni Marcelli, M. Duse

Department of Pediatrics, and Department of Sense Organs, Sapienza University of Rome, Rome, Italy. marcella.nebbioso@uniroma1.it

---

• OPHTHALMOLOGY

BACKGROUND: Vernal Keratoconjunctivitis (VKC) is a rare chronic ocular inflammatory disease and it mainly affects boys in the first decade of life. Although it is a self-limiting disease, patients may present many phases characterized by an exacerbation of inflammatory symptoms with a consequent decline of the quality of life.

PURPOSE: define the clinical and immunological profile of patients affected by VKC and investigate their familiar history of autoimmune disorders and their autoimmunity pattern.

PATIENTS AND METHODS: 28 children were enrolled (20 males, 71%) aged between 4 and 14 years of life affected by VKC. Family history of allergic and immunological diseases was collected for each patient. In particular, it was asked whether some components of their families were affected by Hashimoto’s thyroiditis, type I diabetes, psoriasis or rheumatoid arthritis and Systemic Lupus Erythematosus (SLE). All VKC children underwent a serological evaluation of anti-nuclear antibodies (ANA).

RESULTS: A family history of immunological disorders was found in 46% of patients, 28% of Hashimoto’s thyroiditis, 14% of type I diabetes, 14% of psoriasis, and 1 of Systemic Lupus Erythematosus. Furthermore, 35% of patients was ANA positive and they corresponded to patients with a higher ocular score and with the most important clinical symptoms.

CONCLUSIONS: the detection of ANA positivity and of a familiar history of autoimmune disorders in a high percentage of children with VKC may help us to better understand the association of this ocular inflammatory disease with systemic autoimmune disorders and atopic condition.
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