Early molecular biomarkers predicting the evolution of allergic rhinitis and its comorbidities: A longitudinal multicenter study of a patient cohort
Francesca CiprianiSalvatore TripodiValentina PanettaSerena K. PernaEkaterina PotapovaArianna DondiRoberto BernardiniCarlo CaffarelliAntonella CasaniRosa CervoneL ChiniPasquale ComberiatiGiovanna De CastroMichele Miraglia del GiudiceIride Dello IaconoAndrea Di Rienzo BusincoMarcella GallucciArianna GiannettiCarla MastrorilliViviana MoscheseSimone PelosiIfigenia SfikaElena VarinValeria VillellaAnna Maria ZicariGiulia BrindisiGiampaolo RicciPaolo Maria Matricardi
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Abstract:
Pollen-related seasonal allergic rhinoconjunctivitis (SAR) is a very frequent pediatric disease in Westernized countries. Risk factors and disease phenotypes have been thoroughly examined in several cross-sectional studies. By contrast, only a few studies have examined disease evolution in patient cohorts. We investigated predictive biomarkers of disease evolution in a large cohort of children with SAR.During 2015-2017 (follow-up), we re-examined 401 patients from those enrolled in 2009-2011 (baseline) by the "Panallergens in Pediatrics" study, a large multicenter survey of Italian children with SAR. Information on clinical history (standard questionnaire, AllergyCARD®; TPS, Italy) and skin prick tests for inhalant and foods extracts (ALK-Abelló, Hørsholm, Denmark) was acquired as at baseline visit. Evolution in clinical and sensitization data of patients was analyzed over time, as well as their association with the main baseline characteristics and atopy risk factors.The average age of participants was 10.4 ± 3.4 years at baseline and 16.2 ± 3.6 years at follow-up. SAR persisted in 93.3% of patients at follow-up and became more frequently associated with asthma (from 36.7% at baseline to 48.6% at follow-up) and oral allergy syndrome (OAS, from 23.4% to 37.7%). Compared to baseline, the prevalence of skin sensitization to some pollens (Phleum pratense, Corylus avellana, Platanus acerifolia, Artemisia vulgaris) and vegetables (hazelnut, wheat, and apple) significantly decreased at follow-up. Earlier onset of SAR and polysensitization at baseline were associated with incident asthma at follow-up. The presence at baseline of serum IgE to the following allergen molecules was identified as biomarkers of clinical evolution: (a) Phl p 1, for persistence of SAR; (b) Phl p 5, for persistence of both rhinitis and asthma; (c) Pru p 3, for new onset of asthma; (d) Bet v 1, for persistence of OAS.Seasonal allergic rhinoconjunctivitis is clinically heterogeneous in its evolution from childhood to adolescence. The detection of serum IgE to specific molecules (Phl p 1, Phl p 5, Bet v 1, Pru p 3) may be useful as biomarkers to predict SAR persistence and future onset of comorbidities, such as asthma and/or OAS.Keywords:
Atopy
Aeroallergen
A number of scientific reports have been published on patch tests with protein allergens performed on patients with atopic eczema (AE). Evaluation of eczematous skin lesions with an atopy patch test (APT) can be used as a diagnostic tool in characterizing patients with aeroallergen- and food-triggered AE. Indications for testing with APT, choice of allergens (aeroallergens and foods), test materials and technique, including present knowledge on sensitivity and specificity, are reviewed on the basis of available literature. This position paper also points out the need for future research on the clinical use of the APT.
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Background: Bronchial asthma is a chronic respiratory problem characterized by a reversible hyper-responsive airway obstruction that is provoked by allergens, infections, or nonspecific triggers. The study aims to assess the coexistence of atopy and allergies among children with asthma.Methods: This single-center study was conducted at Mohamed El-Amin H. Hospital, Sudan. A free online sample size calculator was used. A specially designed form was used for data collection. Data were analyzed using the SPSS version 20.0.Results: A total of 300 participants were enrolled in the study, with a mean age of 7.46 ± 3.93 years. The male-to-female ratio was 1.3:1. A total of 215 (71.6%) children had a family history of asthma; atopy was allergic rhinitis in 108 (36%), eczema in 53 (17.7%), food allergy in 38 (14%), and allergic conjunctivitis in 29 (9.7%). A significant association was observed between male gender and family history of asthma, atopy, and coexisting personal history of atopy, P = 0.002, 0.004, and 0.001, respectively. All participants who had atopy had allergic rhinitis; 53 (49%) had atopic dermatitis, 29 (26.8%) had coexisting allergic conjunctivitis, and food allergies were found in 38 (35.2%) participants. Common food allergies found were eggplants, fish, cow milk, and banana. Atopy and allergies were common among those who were 6–10 years old, however, only allergic rhinitis was statistically significant with age (P = 0.021).Conclusion: Combined family history of asthma and atopy was common, few had atopy only, and fewer had neither family history nor atopy. Atopy found was allergic rhinitis, conjunctivitis, eczemas, and food allergy.
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Introduction: Studies on the association of birth by caesarean section and allergies have produced conflicting findings. Evidence on whether this relation may differ in those at risk of atopy is limited. Aim: To investigate the association of mode of delivery with asthma and atopic sensitization and the extend to which this effect is modified by family history of allergies Methods: Asthma outcomes were assessed cross-sectionally in 2216 children aged 8 using the ISAAC questionnaire whilst in a random subgroup of 746 skin prick tests to eleven allergens were also performed. Adjusted odds ratios of asthma and atopy by mode of delivery were estimated in multivariable logistic models. Results: After adjusting for potential confounders, children born by caesarean section as compared to vaginally had significantly higher odds of reporting ever having wheeze (OR 1.36, 95%CI 1.07-1.71), asthma diagnosis (OR 1.41, 95%CI 1.09-1.83) and atopic sensitization (OR 1.67, 95%CI 1.08-2.60). There was some evidence that family history of allergies may modify the effect of caesarean section delivery on atopy (p for effect modification=0.06) but not asthma. More specifically, children with a family history of allergies had double the odds of atopic sensitization if born by caesarean section (OR 2.34, 95%CI 1.20-4.54) whilst a non-significant association was observed in children without a family history of allergies (OR 1.27, 95%CI 0.69-2.36) Conclusion: Birth by caesarean section is associated with asthma and atopic sensitization in childhood. The association of caesarean delivery and atopy but not asthma is more pronounced in children with family history of allergies.
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Epidemiological studies have shown conflicting findings on the relationship between asthma, atopy, and intestinal helminth infections. There are no such studies from Angola; therefore, we aimed to evaluate the relationship between asthma, allergic diseases, atopy, and intestinal helminth infection in Angolan schoolchildren. We performed a cross-sectional study of schoolchildren between September and November 2017. Five schools (three urban, two rural) were randomly selected. Asthma, rhinoconjunctivitis, and eczema were defined by appropriate symptoms in the previous 12 months: atopy was defined by positive skin prick tests (SPT) or aeroallergen-specific IgE; intestinal helminths were detected by faecal sample microscopy. In total, 1023 children were evaluated (48.4% female; 57.6% aged 10–14 years; 60.5% urban). Asthma, rhinoconjunctivitis, or eczema were present in 9%, 6%, and 16% of the studies children, respectively. Only 8% of children had positive SPT, but 64% had positive sIgE. Additionally, 40% were infected with any intestinal helminth (A. lumbricoides 25.9%, T. trichiura 7.6%, and H. nana 6.3%). There were no consistent associations between intestinal helminth infections and asthma, allergic diseases, or atopy, except for A. lumbricoides, which was inversely associated with rhinoconjuctivitis and directly associated with aeroallergen-specific IgE. We concluded that, overall, intestinal helminth infections were not consistently associated with allergic symptoms or atopy. Future, preferably longitudinal, studies should collect more detailed information on helminth infections as part of clusters of environmental determinants of allergies.
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Two populations of schoolchildren, one living in an area where the predominant allergens are house dust mites and the other in an area where the predominant allergens are pollens, were studied to investigate in more detail the associations between atopy, bronchial hyperresponsiveness (BHR) and symptoms of asthma. The prevalence of atopy (39%) was the same in both towns but the prevalence of BHR was higher in the inland 'pollen' area (19% vs 15%). Atopic children had an increased risk of having BHR and, to a lesser extent, respiratory symptoms, diagnosed asthma and hay fever. The risk of BHR was further increased in children atopic to both pollens and house dust mites, and in children with a high index of atopy (derived from the number and size of the skin reactions to four allergen groups). In addition, the relationship between atopy and BHR was quantitative in that the severity of BHR increased with the severity of atopy. We conclude that there is not a direct causal relationship between atopy and BHR but there may be a common mechanism involved in their development. It appears that, within the atopic population, the type of allergen to which the individual is sensitized, the quantity of aeroallergen present in the environment and the degree of atopy, as measured by the number and size of the skin reactions, are all factors that may interact to increase the risk of BHR.
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The role of allergy in atopic dermatitis is controversial. The atopy patch test (APT) has been used to investigate the association between atopic dermatitis and aeroallergen allergy. To determine the proportion of patients with atopic dermatitis with positive patch tests to common local aeroallergens and to compare this to controls with and without respiratory atopy, we performed APT, skin-prick tests (SPT) and IgE radioallergosorbent tests (RAST) on 73 patients with atopic dermatitis and on 38 nonatopic controls (13 with and 25 without respiratory atopy). The allergens used were house dust mite, cat dander, Bermuda grass and German cockroach. Only the APT for house dust mite showed a significant difference between the two groups. APT for house dust mite correlated with the RAST test, while APT for cat fur correlated with the SPT. The APT may be useful to evaluate aeroallergens in atopic dermatitis, but further work is needed to make it more reliable.
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The complex pathomechanisms underlying skin lesions in atopic dermatitis (AD) result in variations of the clinical picture and frequent diagnostic difficulties. The purpose of this study was to evaluate the usefulness of atopy patch tests (APT) for aeroallergens in the diagnosis of AD. The study involved 115 adult patients with AD and 98 healthy volunteers (the control group). APTs for cat dander allergens, birch pollen, a mixture of house dust mite species and a mixture of 5 grass pollen allergens were applied for both groups. Positive reaction to at least one test allergen was found in 53.9% patients compared to 6.2% in the control group (p<0.001). The most frequent hypersensitivity (45.2%) observed was to house dust mite allergens. Polyvalent allergy to 2-4 allergens was found in 56.5% patients. The specificity of tests exceeded 75%, whereas the sensitivity varied from 18 to 66%.1. Atopy patch tests, which are characterised by considerable specificity, confirm the role of polyvalent contact hypersensitivity to aeroallergens in the development of atopic dermatitis. 2. Positive aeroallergen ATP results are observed in the majority of patients and can thus be regarded as an additional diagnostic criterion in atopic dermatitis.
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The serum of 50 surgical patients with a history of asthma, hay fever or allergy has been analysed for IgE levels and compared with a control group without such a history. The values in the 'normal' group largely fell within the accepted range (below 200 iu./ml). Those in the 'hypersensitive' group had a wide range extending to over 1000 iu./ml but many of those with low values in this group had contact dermatitis and similar minor allergies. However, analysis of cases studied shows that any patient with a history of atopy or allergy is at risk from Cremophor-containing intravenous anaesthetics.
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Atopy is defined as the genetic propensity to develop immunoglobulin E antibodies in response to exposure to allergens and assessed by skin prick test (SPT) responses to common allergens, which may contribute to the development of the clinical disorders (phenotype). Although it is generally agreed that atopy is an important risk factor for allergic diseases such as asthma, rhinitis, and eczema, the extent to which atopy accounts for these diseases is controversial. One hundred forty one children (up to 12 years) were skin prick tested to evaluate 16 foods common to the Malaysian diet and 4 common aeroallergens. Eighty-five percent of patients had positive SPT reactivity. The most commonly implicated aeroallergen and food allergen was house dust mite (HDM) and Prawn. Seventy percent had positive SPT reactivity results to HDM and 24.8% to prawns. Fifty five percent were positive to more than one allergen and 17.7% positive to single aeroallergen. The prevalence of atopy in children with history of eczema was 90%. The incidence of HDM and food allergy especially crabs and prawns, is significantly greater in Malaysian Children with rhinitis symptoms.
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