The Clinical Impact of Vitamin D in Children With Atopic Dermatitis

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|    Allergy Asthma Immunol Res. 2013 Jul;5(4):179-180. English. Published online 2013 June 26.  http://dx.doi.org/10.4168/aair.2013.5.4.179  Copyright © 2013 The Korean Academy of Asthma, Allergy and Clinical Immunology • The Korean Academy of Pediatric Allergy and Respiratory Disease The Clinical Impact of Vitamin D in Children With Atopic Dermatitis Jae-Won Oh Department of Pediatrics, Hanyang University College of Medicine, Guri, Korea.  Correspondence to: Jae-Won Oh, MD, PhD, Department of Pediatrics, Hanyang University College of Medicine, 153 Gyeongchun-ro, Guri 471-701, Korea. Tel: +82-31-560-2254; Fax: +82-31-552-9493; Email: jaewonoh@hanyang.ac.kr  Received May 27, 2013; Accepted May 27, 2013. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Dan Med J. 2013 Jul;60(7):B4687. Risk factors for developing atopic dermatitis. Carson CG. Source COPSAC (COpenhagen Prospective Studies on Asthma in Childhood), Gentofte University Hospital, Ledreborg Alle 34, 2820 Gentofte, Denmark. c_giwercman@hotmail.com. Abstract The aim of this thesis was to investigate possible risk factors affecting the development of AD. AD is a frequent disease among children and has a substantial impact on the lives of both the child and its family. A better understanding of the disease would enable better treatment, prevention and information to the families involved. Previous risk factor studies have been hampered by an unsuitable study design and/or difficulties in standardization when diagnosing AD, which limit their conclusions. In paper I, we conducted a traditional cross-sectional analysis testing 40 possible risk factors for developing AD at 3 years of age. Our data suggested a strong heredity of AD and confirmed the risk associated with the non-functional FLG allele mutations after adjustments for confounders. Besides this mother's dermatitis and father's allergic rhinitis were found to increase the risk of AD. Perinatal exposure to dog was the only environmental exposure that significantly reduced the disease manifestation, suggesting other, yet unknown environmental factors affecting the increasing prevalence of AD in children. Length at birth was shown to be inversely associated with the risk of later developing AD. This traditional risk factor analysis led to two borderline significant results: duration of exclusive breastfeeding and mother's alcohol intake during the 3rd trimester. Since these possible two risk factors could neither be rejected nor accepted, we decided to do two in-depth studies, further investigating these, using longitudinal data information and data analysis instead of the traditional cross-sectional approach (paper II & III). In paper II, we investigated the risk of developing AD and wheezy symptoms until age 2 years depending on duration of breastfeeding. We found an increased risk of AD, but a protective effect on wheezy disorders in infancy from exclusive breastfeeding. The effect of exclusive breastfeeding on the risk of development of AD was significant after adjustment for demographics, FLG variants R501X and 2282del4 status, parent's AD and pets at home (RR 2.09, 95% CI 1.15-3.80, p=0.016). In addition, there was a significant effect of duration of exclusive breastfeeding (p=0.043), as the relative risk of AD was increased in proportion to increased duration of breastfeeding. The risk associated with exclusive breastfeeding was not explained by the fatty acid composition of mother's milk, though a trend showed higher risk of AD if mother's milk had low concentrations of n-3 fatty acids. In paper III, we found that alcohol intake during pregnancy was associated with a significantly higher risk of developing AD in the offspring, with the effect persisting throughout the whole 7 years follow-up period (HR 1.44, 95% CI 1.05-1.99, p=0.024). The increased risk was still significant after confounder adjustment for mother's education, AD and smoking habits during the 3rd trimester. There was no association between alcohol intake during pregnancy and other atopic endpoints (wheeze episodes, asthma, allergic rhinitis, blood eosinophil count, total IgE, sensitization, cord blood IgE and nasal eosinophilia). However, the underlying explanation was not clear. The thesis is based on data collected as part of the ongoing COPSAC cohort. The cohort is a longitudinal, prospective birth cohort following 411 children born to mothers with asthma. This selection of high-risk children restricts the interpretation of the results and they cannot necessarily be expanded to apply to the general population. PMID:   23809981   [PubMed - in process]  Free full text DAN MED J 2013;60(7):B4687

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Seeking allergy when it hides: which are the best fitting tests?

Review

Seeking allergy when it hides: which are the best fitting tests?

Cristoforo Incorvaia, Nicola Fuiano and Giorgio W Canonica

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World Allergy Organization Journal 2013, 6:11 doi:10.1186/1939-4551-6-11

Published: 1 July 2013

Abstract (provisional)

In the common practice of respiratory allergy, the confirmation by IgE tests of the relationship between the occurrence and duration of symptoms and the exposure to specific inhalant allergens allows an aetiological diagnosis. However, to see patients with suggestive history but negative IgE tests is not rare, and this generally lead to a diagnosis of nonallergic rhinitis or asthma. In many cases, such diagnosis is wrong, because the patient may be revealed as allergic by using additional testing. This is true for local allergic rhinitis, characterized by an exclusive IgE production in the nasal mucosa, that may be correctly diagnosed by performing a nasal IgE measurement or a nasal provocation test with the suspected allergen (s). Another misleading issue is the role of T cell-mediated, delayed hypersensitivity in the pathophysiology of rhinitis and asthma. Recent studies showed that in patients with rhinitis or asthma and negative IgE tests, especially when there is a positive history for current or past atopic dermatitis, the clinical symptoms are actually driven by such mechanism, that may be detected by performing an atopy patch test (APT). The allergen source most frequently responsible for this kind of allergy is the house dust mite, but other allergens may also be involved. Thus, before delivering a diagnosis of nonallergic rhinitis or asthma in patients with negative result to common allergy testing, further tests are needed. To miss the diagnosis of allergy has obvious consequences in terms of management, including allergen avoidance, patient's education, and specific immunotherapy.

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The Journal of Allergy and Clinical Immunology: In Practice
Volume 1, Issue 3 , Pages 214-226, May 2013

Current and Future Directions in Pediatric Allergic Rhinitis

• Deborah Gentile, MD
, 
• Ashton Bartholow, BS
, 
• Erkka Valovirta, MD, PhD
, 
• Glenis Scadding, MD
, 
• David Skoner, MD

Received 8 January 2013; received in revised form 22 March 2013; accepted 23 March 2013.

• Abstract
• Full Text
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Article Outline

• Background
• Epidemiology
• Comorbidities and complications
• Pathophysiology
• Current treatment strategies
  • Allergen avoidance
  • Pharmacotherapy
    • Oral or intranasal antihistamines
    • Intranasal corticosteroids
    • Systemic corticosteroids
    • Leukotriene receptor antagonists
    • Intranasal anticholinergics
    • Intranasal decongestants
    • Intranasal cromolyn
    • Anti-IgE
  • Specific immunotherapy
    • Subcutaneous immunotherapy
    • Sublingual immunotherapy
  • Surgery
  • Partnership
• Future directions
  • Diagnosis
  • Guidelines
  • Potential effect of health care reform
  • New/future therapies
  • Influence of generics/OTC switches
• References
• Copyright

Background

Allergic rhinitis (AR) is a common pediatric problem that significantly affects sleep, learning, performance, and quality of life. In addition, it is associated with significant comorbidities and complications.

Objective

The aim was to provide an update on the epidemiology, comorbidities, pathophysiology, current treatment, and future direction of pediatric AR.

Methods

Literature reviews in each of these areas were conducted, and the results were incorporated.

Results

The prevalence of AR is increasing in the pediatric population and is associated with significant morbidity, comorbidities, and complications. The mainstay of current treatment strategies includes allergen avoidance, pharmacotherapy, and allergen specific immunotherapy.

Conclusions

In the future, diagnosis will be improved by microarrayed recombinant allergen testing and therapy will be expanded to include emerging treatments such as sublingual immunotherapy and combination products.

Key words: Allergic rhinitis, Pediatrics, Specific immunotherapy, Intranasal corticosteroids, Antihistamines, Leukotriene modifiers

Abbreviations used: ADHD, Attention deficit hyperactivity disorder, AH, Antihistamines, AR, Allergic rhinitis, CRD, Component-resolved diagnostics, DC, Dendritic cell, FDA, Food and Drug Administration, FEIA, Fluorescent enzyme immunoassay, HCP, Health care provider,ICS, Inhaled corticosteroid, INCS, Intranasal corticosteroids, OCS, Oral corticosteroids, OME, Otitis media with effusion, OR, Odds ratio,OSA, Obstructive sleep apnea, OTC, Over-the-counter, PAA, Pediatric Allergies in America, QoL, Quality of life, SCIT, Subcutaneous immunotherapy, SIT, Specific immunotherapy, SLIT, Sublingual immunotherapy, Treg, Regulatory T [cell]

Research article

The health economic impact of disease management programs for COPD: a systematic literature review and meta-analysis

Melinde RS Boland, Apostolos Tsiachristas, Annemarije L Kruis, Niels H Chavannes and Maureen PMH Rutten-van Mölken

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BMC Pulmonary Medicine 2013, 13:40 doi:10.1186/1471-2466-13-40

Published: 3 July 2013

Abstract (provisional)

Background

There is insufficient evidence of the cost-effectiveness of Chronic Obstructive Pulmonary Disease (COPD) Disease Management (COPD-DM) programs. The aim of this review is to evaluate the economic impact of COPD-DM programs and investigate the relation between the impact on healthcare costs and health outcomes. We also investigated the impact of patient-, intervention, and study-characteristics.

Methods

We conducted a systematic literature review to identify cost-effectiveness studies of COPD-DM. Where feasible, results were pooled using random-effects meta-analysis and explorative subgroup analyses were performed.

Results

Sixteen papers describing 11 studies were included (7 randomized control trials (RCT), 2 pre-post, 2 case--control). Meta-analysis showed that COPD-DM led to hospitalization savings of [euro sign]1060 (95% CI: [euro sign]2040 to [euro sign]80) per patient per year and savings in total healthcare utilization of [euro sign]898 (95% CI: [euro sign]1566 to [euro sign]231) (excl. operating costs). In these health economic studies small but positive results on health outcomes were found, such as the St Georges Respiratory Questionnaire (SGRQ) score, which decreased with 1.7 points (95% CI: 0.5-2.9). There was great variability in DM interventions-, study- and patient-characteristics. There were indications that DM showed greater savings in studies with: severe COPD patients, patients with a history of exacerbations, RCT study design, high methodological quality, few different professions involved in the program, and study setting outside Europe.

Conclusions

COPD-DM programs were found to have favourable effects on both health outcomes and costs, but there is considerable heterogeneity depending on patient-, intervention-, and study-characteristics.

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• Front Immunol
• v.4; 2013
• PMC3689036

Front Immunol. 2013; 4: 159.

Published online 2013 June 21. doi:  10.3389/fimmu.2013.00159

PMCID: PMC3689036

Natural Killer Cells in Asthma

Khalil Karimi1,2,* and Paul Forsythe2,3

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Abstract

The worldwide prevalence, morbidity, and mortality of asthma have dramatically increased over the last few decades and there is a clear need to identify new effective therapeutic and prophylactic strategies. Despite high numbers of NK cells in the lung and their ability to generate a variety of immunomodulatory mediators, the potential of NK cells as therapeutic targets in allergic airway disease has been largely overlooked. The fact that IgE, acting through FcγRIII, can activate NK cells resulting in cytokine/chemokine production implies that NK cells may contribute to IgE-mediated allergic responses. Indeed, current evidence suggests that NK cells can promote allergic airway responses during sensitization and ongoing inflammation. In animal models, increased NK cells are observed in the lung following antigen challenge and depletion of the cells before immunization inhibits allergic airway inflammation. Moreover, in asthmatics, NK cell phenotype is altered and may contribute to the promotion of a pro-inflammatory Th2-type environment. Conversely, driving NK cells toward an IFN-γ-secreting phenotype can reduce features of the allergic airway response in animal models. However, we have limited knowledge of the signals that drive the development of distinct subsets and functional phenotypes of NK cells in the lung and thus the role and therapeutic potential of NK cells in the allergic airway remains unclear. Here we review the potentially diverse role of NK cells in allergic airway disease, identify gaps in current knowledge, and discuss the potential of modulating NK cell function as a treatment strategy in asthma.

Keywords: natural killer cells, asthma, airway inflammation, asthma exacerbation, therapeutic potential of NK cells

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