Helena Backman, Laxmi Bhatta, Linnea Hedman, Ben Brumpton, Iida Vähätalo, Paul G Lassmann-Klee, Bright I Nwaru, Linda Ekerljung, Steinar Krokstad, Sigrid Anna Aalberg Vikjord, Anne Lindberg, Hannu Kankaanranta, Eva Rönmark, Arnulf Langhammer
Background and Aim: The relationship between socioeconomic status (SES), asthma and mortality is complex and multifaceted, and it is not established if educational level modifies the association between asthma and mortality. The aim was to study the association between asthma and mortality in Sweden and Norway and to what extent educational level modifies this association. Participants and Methods: Within the Nordic EpiLung Study, > 56,000 individuals aged 30– 69 years participated in population-based surveys on asthma and associated risk factors in Sweden and Norway during 2005– 2007. Data on educational level and 10-year all-cause mortality were linked by national authorities. The fraction of mortality risk attributable to asthma was calculated, and Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for mortality related to asthma, stratified by educational level. Results: In total, 5.5% of all deaths was attributed to asthma. When adjusted for potential confounders, the HR for mortality related to asthma was 1.71 (95% CI 1.52– 1.93). Those with primary level of education had higher hazard of all-cause death related to asthma than those with tertiary level (HR 1.80, 95% CI 1.48– 2.18, vs HR 1.39, 95% CI 0.99– 1.95). Conclusion: Asthma was associated with an overall 71% increased all-cause mortality and 5.5% of deaths can be attributed to asthma. Educational levels modified the risk of mortality associated with asthma, with the highest risk among those with primary education.
Keywords: epidemiology, cohort, prognosis
背景和目的：社会经济地位（SES）、哮喘和死亡率之间的关系是复杂和多方面的，教育水平是否会改变哮喘和死亡率之间的关系尚未确定。研究的目的是了解瑞典和挪威哮喘与死亡率之间的关系，以及教育水平在多大程度上改变了这种关系：在北欧肺病研究（Nordic EpiLung Study）中，有5.6万名年龄在30-69岁之间的人参加了2005-2007年期间在瑞典和挪威进行的有关哮喘和相关风险因素的人口调查。有关教育水平和 10 年全因死亡率的数据由国家当局进行关联。我们计算了哮喘导致的死亡风险比例，并采用 Cox 回归估算了按教育水平分层的哮喘相关死亡率的危险比 (HR) 和 95% 置信区间 (95%CI)：在所有死亡病例中，共有5.5%的病例归因于哮喘。在对潜在的混杂因素进行调整后，与哮喘相关的死亡率为 1.71（95% CI 1.52-1.93）。与受过高等教育的人相比，受过初等教育的人因哮喘导致全因死亡的风险更高（HR 1.80，95% CI 1.48- 2.18；HR 1.39，95% CI 0.99- 1.95）：哮喘导致全因死亡率总体上升 71%，5.5% 的死亡可归因于哮喘。教育水平改变了与哮喘相关的死亡风险，小学文化程度者的风险最高。
{"title":"Level of Education Modifies Asthma Mortality in Norway and Sweden. The Nordic EpiLung Study","authors":"Helena Backman, Laxmi Bhatta, Linnea Hedman, Ben Brumpton, Iida Vähätalo, Paul G Lassmann-Klee, Bright I Nwaru, Linda Ekerljung, Steinar Krokstad, Sigrid Anna Aalberg Vikjord, Anne Lindberg, Hannu Kankaanranta, Eva Rönmark, Arnulf Langhammer","doi":"10.2147/jaa.s450103","DOIUrl":"https://doi.org/10.2147/jaa.s450103","url":null,"abstract":"<strong>Background and Aim:</strong> The relationship between socioeconomic status (SES), asthma and mortality is complex and multifaceted, and it is not established if educational level modifies the association between asthma and mortality. The aim was to study the association between asthma and mortality in Sweden and Norway and to what extent educational level modifies this association.<br/><strong>Participants and Methods:</strong> Within the Nordic EpiLung Study, > 56,000 individuals aged 30– 69 years participated in population-based surveys on asthma and associated risk factors in Sweden and Norway during 2005– 2007. Data on educational level and 10-year all-cause mortality were linked by national authorities. The fraction of mortality risk attributable to asthma was calculated, and Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for mortality related to asthma, stratified by educational level.<br/><strong>Results:</strong> In total, 5.5% of all deaths was attributed to asthma. When adjusted for potential confounders, the HR for mortality related to asthma was 1.71 (95% CI 1.52– 1.93). Those with primary level of education had higher hazard of all-cause death related to asthma than those with tertiary level (HR 1.80, 95% CI 1.48– 2.18, vs HR 1.39, 95% CI 0.99– 1.95).<br/><strong>Conclusion:</strong> Asthma was associated with an overall 71% increased all-cause mortality and 5.5% of deaths can be attributed to asthma. Educational levels modified the risk of mortality associated with asthma, with the highest risk among those with primary education.<br/><br/><strong>Keywords:</strong> epidemiology, cohort, prognosis<br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"43 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140155219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Early-onset asthma (EOA) and late-onset asthma (LOA) are two distinct phenotypes. Air pollution has been associated with an increase in poorer asthma outcomes. The objective of this study was to examine the effects of traffic-related air pollution (TRAP) on asthma outcomes in EOA and LOA patients. Methods: A cross-sectional study was conducted on 675 asthma patients (LOA: 415) recruited from a major medical center in Taiwan. The land-use regression (LUR) model was used to estimate the level of exposure to PM10, PM2.5, NO2, and O3 on an individual level. We investigated the association between TRAP and asthma outcomes in EOA and LOA patients, stratified by allergic sensitization status, using a regression approach. Results: An increase in PM10 was associated with younger age of onset, increased asthma duration, and decreased lung function in EOA patients (p< 0.05). An increase in PM10 was associated with older age of onset, and decreased asthma duration, eosinophil count, and Asthma Control Test (ACT) score in LOA patients. An increase in PM2.5 was associated with younger age of onset, increased asthma duration, decreased eosinophil count, and lung function in EOA patients (p< 0.05). An increase in PM2.5 was associated with decreased lung function and ACT score in LOA patients. An increase in NO2 was associated with increased eosinophil count and decreased lung function in EOA patients (p< 0.05). An increase in O3 was associated with decreased lung function in LOA patients (p< 0.05). In addition, associations of TRAP with age of onset and eosinophil counts were mainly observed in both EOA and LOA patients with allergic sensitization, and an association with ACT was mainly observed in LOA patients without allergic sensitization. Conclusion: The impact of TRAP on age of onset, eosinophil count, and lung function in EOA patients, and ACT in LOA patients, was affected by the status of allergic sensitization.
{"title":"Different Impacts of Traffic-Related Air Pollution on Early-Onset and Late-Onset Asthma","authors":"Ting-Yu Lin, Firdian Makrufardi, Nguyen Thanh Tung, Amja Manullang, Po-Jui Chang, Chun-Yu Lo, Tzu-Hsuan Chiu, Pi-Hung Tung, Chiung-Hung Lin, Horng-Chyuan Lin, Chun-Hua Wang, Shu-Min Lin","doi":"10.2147/jaa.s451725","DOIUrl":"https://doi.org/10.2147/jaa.s451725","url":null,"abstract":"<strong>Background:</strong> Early-onset asthma (EOA) and late-onset asthma (LOA) are two distinct phenotypes. Air pollution has been associated with an increase in poorer asthma outcomes. The objective of this study was to examine the effects of traffic-related air pollution (TRAP) on asthma outcomes in EOA and LOA patients.<br/><strong>Methods:</strong> A cross-sectional study was conducted on 675 asthma patients (LOA: 415) recruited from a major medical center in Taiwan. The land-use regression (LUR) model was used to estimate the level of exposure to PM<sub>10</sub>, PM<sub>2.5</sub>, NO<sub>2</sub>, and O<sub>3</sub> on an individual level. We investigated the association between TRAP and asthma outcomes in EOA and LOA patients, stratified by allergic sensitization status, using a regression approach.<br/><strong>Results:</strong> An increase in PM<sub>10</sub> was associated with younger age of onset, increased asthma duration, and decreased lung function in EOA patients (<em>p</em>< 0.05). An increase in PM<sub>10</sub> was associated with older age of onset, and decreased asthma duration, eosinophil count, and Asthma Control Test (ACT) score in LOA patients. An increase in PM<sub>2.5</sub> was associated with younger age of onset, increased asthma duration, decreased eosinophil count, and lung function in EOA patients (<em>p</em>< 0.05). An increase in PM<sub>2.5</sub> was associated with decreased lung function and ACT score in LOA patients. An increase in NO<sub>2</sub> was associated with increased eosinophil count and decreased lung function in EOA patients (<em>p</em>< 0.05). An increase in O<sub>3</sub> was associated with decreased lung function in LOA patients (<em>p</em>< 0.05). In addition, associations of TRAP with age of onset and eosinophil counts were mainly observed in both EOA and LOA patients with allergic sensitization, and an association with ACT was mainly observed in LOA patients without allergic sensitization.<br/><strong>Conclusion:</strong> The impact of TRAP on age of onset, eosinophil count, and lung function in EOA patients, and ACT in LOA patients, was affected by the status of allergic sensitization.<br/><br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"68 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140125152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Prognostic models hold great potential for predicting asthma exacerbations, providing opportunities for early intervention, and are a popular area of current research. However, it is unclear how models should be compared and contrasted, given their differences in both design and performance, particularly with a view to potential implementation in routine practice. This systematic review aimed to identify novel predictive models of asthma attacks in adults and compare differences in construction related to populations, outcome definitions, prediction time horizons, algorithms, validation, and performance estimation. Twenty-five studies were identified for comparison, with varying definitions of asthma attacks and prediction event time horizons ranging from 15 days to 30 months. The most commonly used algorithm was logistic regression (20/25 studies); however, none of the six which tested multiple algorithms identified it as highest performing algorithm. The effect of various study design characteristics on performance was evaluated in order to provide context to the limitations of highly performing models. Models used a variety of constructs, which affected both their performance and their viability for implementation in routine practice. Consultation with stakeholders is necessary to identify priorities for model refinement and to create a benchmark of acceptable performance for implementation in clinical practice.
{"title":"Primary Care Asthma Attack Prediction Models for Adults: A Systematic Review of Reported Methodologies and Outcomes","authors":"Lijun Ma, Holly Tibble","doi":"10.2147/jaa.s445450","DOIUrl":"https://doi.org/10.2147/jaa.s445450","url":null,"abstract":"<strong>Abstract:</strong> Prognostic models hold great potential for predicting asthma exacerbations, providing opportunities for early intervention, and are a popular area of current research. However, it is unclear how models should be compared and contrasted, given their differences in both design and performance, particularly with a view to potential implementation in routine practice. This systematic review aimed to identify novel predictive models of asthma attacks in adults and compare differences in construction related to populations, outcome definitions, prediction time horizons, algorithms, validation, and performance estimation. Twenty-five studies were identified for comparison, with varying definitions of asthma attacks and prediction event time horizons ranging from 15 days to 30 months. The most commonly used algorithm was logistic regression (20/25 studies); however, none of the six which tested multiple algorithms identified it as highest performing algorithm. The effect of various study design characteristics on performance was evaluated in order to provide context to the limitations of highly performing models. Models used a variety of constructs, which affected both their performance and their viability for implementation in routine practice. Consultation with stakeholders is necessary to identify priorities for model refinement and to create a benchmark of acceptable performance for implementation in clinical practice.<br/><br/><strong>Keywords:</strong> clinical decision support, machine learning, prediction modelling, asthma exacerbation, systematic review<br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"2010 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140129771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tu HK Trinh, Chi N Duong, Tu HT Pham, Hao DT Au, Loc T Tran, Cuong V Nguyen, Han BG Nguyen, Nguyen M Tran, Quy Q Phan, Thu NA Le, Nga Nguyen
Purpose: Increasing seafood consumption is associated with more frequent reports of food allergy. Little is known about seafood allergy (SFA) among adults in Vietnam. We investigated the characteristics of individuals with SFA and the risk factors for severe SFA. Patients and methods: A cross-sectional, web-based survey was conducted among individuals aged ≥ 18 years from universities in Ho Chi Minh City (Vietnam) between December 2021 and July 2022. The survey was based on a structured, validated questionnaire related to FA. Strict definitions of “convincing allergy” were used. Multivariate analysis was used to estimate the risk factors for severe SFA after adjusting for covariates. Data were analyzed using JASP (v.0.16.3) and SPSS (v.22.0). Results: Totally, 1038 out of 2137 (48.57%) individuals completed the questionnaire, of whom 285 (27.46%) had reported SFA. Convincing SFA accounted for 20.13% (209/1038) of the cases, with convincing shellfish allergy being more common than fish allergy. Participants with comorbid shellfish and fish allergy had higher prevalence of atopic dermatitis, peanut/nut allergy, other food allergy, and cutaneous and upper airway symptoms compared to participants with shellfish allergy (p < 0.05). The spectrum of reactive seafood was diverse and characterized by local species. The age of symptom onset was most commonly during late childhood and adolescence, with most reactions persisting into adulthood. A history of anaphylaxis, comorbid peanut, and tree nut allergy, and ≥ 3 allergens were associated with severe SFA. Conclusion: Features of causative, coexisting seafood allergy, and risk factors for severe SFA were demonstrated, which can provide a reference for future studies.
Keywords: seafood allergy, shellfish allergy, fish allergy, Vietnam
{"title":"Risk Factors for Severe Seafood Allergy Among Adults in an Urban City in Vietnam","authors":"Tu HK Trinh, Chi N Duong, Tu HT Pham, Hao DT Au, Loc T Tran, Cuong V Nguyen, Han BG Nguyen, Nguyen M Tran, Quy Q Phan, Thu NA Le, Nga Nguyen","doi":"10.2147/jaa.s448565","DOIUrl":"https://doi.org/10.2147/jaa.s448565","url":null,"abstract":"<strong>Purpose:</strong> Increasing seafood consumption is associated with more frequent reports of food allergy. Little is known about seafood allergy (SFA) among adults in Vietnam. We investigated the characteristics of individuals with SFA and the risk factors for severe SFA.<br/><strong>Patients and methods:</strong> A cross-sectional, web-based survey was conducted among individuals aged ≥ 18 years from universities in Ho Chi Minh City (Vietnam) between December 2021 and July 2022. The survey was based on a structured, validated questionnaire related to FA. Strict definitions of “convincing allergy” were used. Multivariate analysis was used to estimate the risk factors for severe SFA after adjusting for covariates. Data were analyzed using JASP (v.0.16.3) and SPSS (v.22.0).<br/><strong>Results:</strong> Totally, 1038 out of 2137 (48.57%) individuals completed the questionnaire, of whom 285 (27.46%) had reported SFA. Convincing SFA accounted for 20.13% (209/1038) of the cases, with convincing shellfish allergy being more common than fish allergy. Participants with comorbid shellfish and fish allergy had higher prevalence of atopic dermatitis, peanut/nut allergy, other food allergy, and cutaneous and upper airway symptoms compared to participants with shellfish allergy (p < 0.05). The spectrum of reactive seafood was diverse and characterized by local species. The age of symptom onset was most commonly during late childhood and adolescence, with most reactions persisting into adulthood. A history of anaphylaxis, comorbid peanut, and tree nut allergy, and ≥ 3 allergens were associated with severe SFA.<br/><strong>Conclusion:</strong> Features of causative, coexisting seafood allergy, and risk factors for severe SFA were demonstrated, which can provide a reference for future studies.<br/><br/><strong>Keywords:</strong> seafood allergy, shellfish allergy, fish allergy, Vietnam<br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"143 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140105568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract: Monosodium glutamate (MSG), a salt form of a non-essential amino acid, is widely used as a food additive, particularly in Asian cuisines, due to its unique flavor-enhancing qualities. Type I allergic reactions to MSG have not previously been reported. Our patient, a 21-year-old woman, was 14 years old when she first noticed swelling of her tongue (but no oral itching, diarrhea, or abdominal pain) after eating various snack foods. Current skin prick testing elicited a weak positive reaction to MSG. We then performed an oral challenge test during which our patient ingested potato snacks. Subsequent histology showed telangiectasia of the buccal mucosa, interstitial edema in the subepithelial submucosa, and mast cell infiltration. Oral mucosal challenge tests using sodium glutamate confirmed oral swelling in this patient. This report is the first to confirm a case of type 1 allergy to MSG by combining pathology findings with the results of challenge testing.
摘要：谷氨酸钠（味精）是一种非必需氨基酸的盐类，因其独特的增味作用而被广泛用作食品添加剂，尤其是在亚洲菜肴中。味精引起的 I 型过敏反应此前尚未见报道。我们的患者是一名 21 岁的女性，她在 14 岁时第一次发现自己在食用各种零食后舌头肿胀（但没有出现口腔瘙痒、腹泻或腹痛）。目前的皮肤点刺试验显示她对味精的反应呈弱阳性。随后，我们对患者进行了口腔挑战试验，患者在试验过程中吃了马铃薯零食。随后的组织学检查显示，患者的口腔黏膜出现毛细血管扩张，黏膜上皮下出现间质水肿，肥大细胞浸润。使用谷氨酸钠进行的口腔粘膜挑战试验证实了该患者的口腔肿胀。本报告是首例通过将病理学发现与挑战试验结果相结合来证实味精 1 型过敏的病例。关键词：食品添加剂、肥大细胞、谷氨酸钠、食物过敏
{"title":"A Case of Type I Food Allergy Induced by Monosodium Glutamate","authors":"Reeko Osada, Chiyako Oshikata, Yuichi Kurihara, Kosuke Terada, Yuka Kodama, Yuga Yamashita, Ryo Nakadegawa, Hinako Masumitsu, Yuto Motobayashi, Hirokazu Takayasu, Nami Masumoto, Saki Manabe, Yingyao Zhu, Ryo Tanaka, Takeshi Kaneko, Aya Sasaki, Naomi Tsurikisawa","doi":"10.2147/jaa.s451911","DOIUrl":"https://doi.org/10.2147/jaa.s451911","url":null,"abstract":"<strong>Abstract:</strong> Monosodium glutamate (MSG), a salt form of a non-essential amino acid, is widely used as a food additive, particularly in Asian cuisines, due to its unique flavor-enhancing qualities. Type I allergic reactions to MSG have not previously been reported. Our patient, a 21-year-old woman, was 14 years old when she first noticed swelling of her tongue (but no oral itching, diarrhea, or abdominal pain) after eating various snack foods. Current skin prick testing elicited a weak positive reaction to MSG. We then performed an oral challenge test during which our patient ingested potato snacks. Subsequent histology showed telangiectasia of the buccal mucosa, interstitial edema in the subepithelial submucosa, and mast cell infiltration. Oral mucosal challenge tests using sodium glutamate confirmed oral swelling in this patient. This report is the first to confirm a case of type 1 allergy to MSG by combining pathology findings with the results of challenge testing.<br/><br/><strong>Keywords:</strong> food additive, mast cell, monosodium glutamate, food allergy<br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"35 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140053649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Theresa W Guilbert, Alberto Tolcachier, Alessandro G Fiocchi, Constance H Katelaris, Wanda Phipatanakul, Philippe Begin, Inés de Mir, Arman Altincatal, Rebecca Gall, Olivier Ledanois, Amr Radwan, Juby A Jacob-Nara, Yamo Deniz, Paul J Rowe
Purpose: Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukins-4/-13, key and central drivers of type 2 inflammation in multiple diseases. This post hoc analysis of the Phase 3 LIBERTY ASTHMA VOYAGE study (NCT02948959) evaluated the efficacy of dupilumab in children aged 6 to 11 years with moderate-to-severe asthma with a type 2 inflammatory phenotype (blood eosinophil count ≥ 150 cells/μL or fractional exhaled nitric oxide [FeNO] ≥ 20 ppb) and a history of 1, 2, or ≥ 3 prior exacerbations. The impact of baseline type 2 biomarker levels on the efficacy of dupilumab in this population was also investigated. Patients and Methods: Patients were stratified by the number of exacerbations in the prior year (1, 2, or ≥ 3) and level of FeNO or blood eosinophil count at baseline. Endpoints included rate of severe exacerbations, percentage of non-exacerbators, and change from baseline in both lung function parameters (pre- and post-bronchodilator [BD] percent predicted forced expiratory volume in 1 s (ppFEV1) and ppFEV1/forced vital capacity [FVC] ratio) and Asthma Control Questionnaire 7 Interviewer-Administered (ACQ-7-IA) score. Results: A total of 350 patients were included in this analysis. Across patients with 1, 2, or ≥ 3 prior exacerbations and different levels of type 2 biomarkers, dupilumab reduced the risk of severe asthma exacerbations vs placebo by 53.0– 96.0% and improved both pre-BD ppFEV1 and pre-BD FEV1/FVC ratio at Week 52. Dupilumab led to significant reductions in ACQ-7-IA scores in all groups of patients by Week 52. Conclusion: In children with uncontrolled, moderate-to-severe asthma with a type 2 phenotype, dupilumab consistently reduced the risk of asthma exacerbations, improved lung function, and reduced ACQ-7-IA scores, regardless of exacerbation history.
Keywords: pediatric asthma, type 2 asthma, lung function, asthma control, biologics, anti-interleukin-4 and -13
{"title":"Impact of Exacerbation History on Dupilumab Efficacy in Children with Uncontrolled Moderate-to-Severe Asthma: LIBERTY ASTHMA VOYAGE Study","authors":"Theresa W Guilbert, Alberto Tolcachier, Alessandro G Fiocchi, Constance H Katelaris, Wanda Phipatanakul, Philippe Begin, Inés de Mir, Arman Altincatal, Rebecca Gall, Olivier Ledanois, Amr Radwan, Juby A Jacob-Nara, Yamo Deniz, Paul J Rowe","doi":"10.2147/jaa.s416292","DOIUrl":"https://doi.org/10.2147/jaa.s416292","url":null,"abstract":"<strong>Purpose:</strong> Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukins-4/-13, key and central drivers of type 2 inflammation in multiple diseases. This post hoc analysis of the Phase 3 LIBERTY ASTHMA VOYAGE study (NCT02948959) evaluated the efficacy of dupilumab in children aged 6 to 11 years with moderate-to-severe asthma with a type 2 inflammatory phenotype (blood eosinophil count ≥ 150 cells/μL or fractional exhaled nitric oxide [FeNO] ≥ 20 ppb) and a history of 1, 2, or ≥ 3 prior exacerbations. The impact of baseline type 2 biomarker levels on the efficacy of dupilumab in this population was also investigated.<br/><strong>Patients and Methods:</strong> Patients were stratified by the number of exacerbations in the prior year (1, 2, or ≥ 3) and level of FeNO or blood eosinophil count at baseline. Endpoints included rate of severe exacerbations, percentage of non-exacerbators, and change from baseline in both lung function parameters (pre- and post-bronchodilator [BD] percent predicted forced expiratory volume in 1 s (ppFEV<sub>1</sub>) and ppFEV<sub>1</sub>/forced vital capacity [FVC] ratio) and Asthma Control Questionnaire 7 Interviewer-Administered (ACQ-7-IA) score.<br/><strong>Results:</strong> A total of 350 patients were included in this analysis. Across patients with 1, 2, or ≥ 3 prior exacerbations and different levels of type 2 biomarkers, dupilumab reduced the risk of severe asthma exacerbations vs placebo by 53.0– 96.0% and improved both pre-BD ppFEV<sub>1</sub> and pre-BD FEV<sub>1</sub>/FVC ratio at Week 52. Dupilumab led to significant reductions in ACQ-7-IA scores in all groups of patients by Week 52.<br/><strong>Conclusion:</strong> In children with uncontrolled, moderate-to-severe asthma with a type 2 phenotype, dupilumab consistently reduced the risk of asthma exacerbations, improved lung function, and reduced ACQ-7-IA scores, regardless of exacerbation history. <br/><br/><strong>Keywords:</strong> pediatric asthma, type 2 asthma, lung function, asthma control, biologics, anti-interleukin-4 and -13<br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"47 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140025379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: This study aimed to determine indices to diagnose and predict eosinophilic chronic rhinosinusitis (ECRS) during the initial clinic visit. Patients and Methods: We retrospectively analyzed 116 patients with chronic rhinosinusitis who underwent endoscopic sinus surgery and were classified according to the postoperative pathological diagnosis. General data and various clinical indicators were analyzed, and indicators with statistically significant differences between groups were further incorporated into a multivariate logistic regression to establish a comprehensive prediction model. The receiver operating characteristic (ROC) curve was used to compare the two significant valuable single factors from previous studies, the difference in CT scores between the ethmoid sinus and the sum difference of the maxillary sinus (EM difference) and the absolute value of peripheral blood eosinophil (bEOS), with a comprehensive prediction model. Results: There were significant differences in history of allergic asthma (p < 0.001), visual analog scale (VAS) score (p=0.005), sino-nasal outcome test-22(SNOT-22) scale score (p=0.004), Lund-Mackay scale score (p=0.017), EM difference (p=0.002), percentage of bEOS (%)(p=0.001), and absolute value of bEOS (× 109/L) (p=0.000) between the two groups (p< 0.05). The history of allergic disease, VAS and bEOS were screened out and included in the comprehensive prediction model. The area under the curve (AUC) of the comprehensive prediction model (0.804)> the AUC of the absolute value of the bEOS (0.764)>the AUC of the EM difference (0.655). The AUC of the EM difference and the comprehensive prediction model were statistically different (P=0.025). There was no statistical difference between the absolute value of bEOS and the AUC of the comprehensive prediction model. Conclusion: The comprehensive prediction model covering the three aspects of allergic asthma history, VAS score, and bEOS count had the highest AUC compared to the other predictors and had good predictive power for the diagnosis of ECRS.
Keywords: eosinophilic chronic rhinosinusitis, non-eosinophilic chronic rhinosinusitis, prediction model, the difference of the CT scores between the ethmoid sinus and maxillary sinus, European position paper on rhinosinusitis and nasal polyps 2020
{"title":"Analysis of the Construction of a Predictive Model for Eosinophilic Chronic Rhinosinusitis","authors":"Shuo Wu, Jiahong Lao, Feitong Jian","doi":"10.2147/jaa.s450514","DOIUrl":"https://doi.org/10.2147/jaa.s450514","url":null,"abstract":"<strong>Purpose:</strong> This study aimed to determine indices to diagnose and predict eosinophilic chronic rhinosinusitis (ECRS) during the initial clinic visit.<br/><strong>Patients and Methods:</strong> We retrospectively analyzed 116 patients with chronic rhinosinusitis who underwent endoscopic sinus surgery and were classified according to the postoperative pathological diagnosis. General data and various clinical indicators were analyzed, and indicators with statistically significant differences between groups were further incorporated into a multivariate logistic regression to establish a comprehensive prediction model. The receiver operating characteristic (ROC) curve was used to compare the two significant valuable single factors from previous studies, the difference in CT scores between the ethmoid sinus and the sum difference of the maxillary sinus (EM difference) and the absolute value of peripheral blood eosinophil (bEOS), with a comprehensive prediction model.<br/><strong>Results:</strong> There were significant differences in history of allergic asthma (p < 0.001), visual analog scale (VAS) score (p=0.005), sino-nasal outcome test-22(SNOT-22) scale score (p=0.004), Lund-Mackay scale score (p=0.017), EM difference (p=0.002), percentage of bEOS (%)(p=0.001), and absolute value of bEOS (× 109/L) (p=0.000) between the two groups (p< 0.05). The history of allergic disease, VAS and bEOS were screened out and included in the comprehensive prediction model. The area under the curve (AUC) of the comprehensive prediction model (0.804)> the AUC of the absolute value of the bEOS (0.764)>the AUC of the EM difference (0.655). The AUC of the EM difference and the comprehensive prediction model were statistically different (P=0.025). There was no statistical difference between the absolute value of bEOS and the AUC of the comprehensive prediction model.<br/><strong>Conclusion:</strong> The comprehensive prediction model covering the three aspects of allergic asthma history, VAS score, and bEOS count had the highest AUC compared to the other predictors and had good predictive power for the diagnosis of ECRS.<br/><br/><strong>Keywords:</strong> eosinophilic chronic rhinosinusitis, non-eosinophilic chronic rhinosinusitis, prediction model, the difference of the CT scores between the ethmoid sinus and maxillary sinus, European position paper on rhinosinusitis and nasal polyps 2020<br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"42 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140004134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Henry J Kanarek, Drew Austin Saville Mutschelknaus
Abstract: Hereditary angioedema (HAE) is a rare genetic disorder characterized by potentially life-threatening episodes of swelling. Most HAE cases are caused by deficient (type I) or dysfunctional (type II) C1-esterase inhibitor (C1-INH) protein. However, some patients present with a subtype of HAE that is associated with normal plasma levels of functional C1-INH protein and complement component 4 (HAE-nC1INH). Treatment of HAE-nC1INH is driven by clinical experience as robust clinical trial data to inform treatment decisions are lacking in this population. This retrospective case series assessed clinical features and treatment outcomes in 15 patients with HAE-nC1INH who initiated long-term prophylaxis with oral berotralstat 150 mg once daily as part of their disease management pathway. Most patients were female (93%), with a median age of 49 years. All patients experienced abdominal swelling attacks. On average, patients tried a mean of 4 different treatments for their HAE, including berotralstat. Although most patients associated prophylactic and on-demand medications that target the bradykinin pathway with improvements in the frequency and/or severity of attacks, treatment outcomes varied considerably between patients, highlighting the importance of a personalized approach to disease management. In this case series, berotralstat was an effective prophylactic treatment option in most patients with HAE-nC1INH. Further studies are required to demonstrate the potential efficacy, safety, and impact on quality of life of currently approved HAE therapies in patients with HAE-nC1INH.
摘要：遗传性血管性水肿（HAE）是一种罕见的遗传性疾病，其特征是可能危及生命的肿胀发作。大多数 HAE 病例是由 C1-酯酶抑制剂（C1-INH）蛋白缺乏（I 型）或功能障碍（II 型）引起的。然而，有些患者的 HAE 亚型与血浆中正常水平的功能性 C1-INH 蛋白和补体成分 4（HAE-nC1INH）有关。对 HAE-nC1INH 的治疗主要依靠临床经验，因为这类患者缺乏可靠的临床试验数据作为治疗决策的依据。本回顾性系列病例评估了 15 例 HAE-nC1INH 患者的临床特征和治疗效果，这些患者在疾病管理过程中开始长期口服贝罗曲司他 150 毫克，每天一次。大多数患者为女性（93%），中位年龄为 49 岁。所有患者都经历过腹部肿胀发作。患者平均尝试过 4 种不同的 HAE 治疗方法，其中包括贝罗司他。虽然大多数患者在服用针对缓激肽通路的预防性药物和按需药物后，发作频率和/或严重程度有所改善，但不同患者的治疗效果差异很大，这凸显了个性化疾病管理方法的重要性。在本病例系列中，贝罗曲司他是大多数 HAE-nC1INH 患者的有效预防性治疗选择。关键词：遗传性血管性水肿；正常C1-酯酶抑制剂；预防；贝洛曲司他；拉那度单抗；血浆源性C1-酯酶抑制剂；终止治疗
{"title":"Clinical Experience with Berotralstat in Patients with Hereditary Angioedema with Normal C1-Esterase Inhibitor: A Commented Case Series","authors":"Henry J Kanarek, Drew Austin Saville Mutschelknaus","doi":"10.2147/jaa.s445893","DOIUrl":"https://doi.org/10.2147/jaa.s445893","url":null,"abstract":"<strong>Abstract:</strong> Hereditary angioedema (HAE) is a rare genetic disorder characterized by potentially life-threatening episodes of swelling. Most HAE cases are caused by deficient (type I) or dysfunctional (type II) C1-esterase inhibitor (C1-INH) protein. However, some patients present with a subtype of HAE that is associated with normal plasma levels of functional C1-INH protein and complement component 4 (HAE-nC1INH). Treatment of HAE-nC1INH is driven by clinical experience as robust clinical trial data to inform treatment decisions are lacking in this population. This retrospective case series assessed clinical features and treatment outcomes in 15 patients with HAE-nC1INH who initiated long-term prophylaxis with oral berotralstat 150 mg once daily as part of their disease management pathway. Most patients were female (93%), with a median age of 49 years. All patients experienced abdominal swelling attacks. On average, patients tried a mean of 4 different treatments for their HAE, including berotralstat. Although most patients associated prophylactic and on-demand medications that target the bradykinin pathway with improvements in the frequency and/or severity of attacks, treatment outcomes varied considerably between patients, highlighting the importance of a personalized approach to disease management. In this case series, berotralstat was an effective prophylactic treatment option in most patients with HAE-nC1INH. Further studies are required to demonstrate the potential efficacy, safety, and impact on quality of life of currently approved HAE therapies in patients with HAE-nC1INH.<br/><br/><strong>Keywords:</strong> hereditary angioedema, normal C1-esterase inhibitor, prophylaxis, berotralstat, lanadelumab, plasma-derived C1-esterase inhibitor, abortive therapy<br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"30 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139948886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Buket Başa Akdoğan, Ilkay Koca Kalkan, Gözde Köycü Buhari, Özlem Özdedeoğlu, Hale Ateş, Kurtuluş Aksu, Ferda Öner Erkekol
Objective: The best method and strategy for the diagnosis of asthma remains unclear, especially in patients with negative bronchodilator reversibility test (BDRT). In our study, we aimed to investigate the diagnostic yield of peak expiratory flow (PEF) variability for this patient group. Methods: A total of 50 patients with suspected asthma, all with negative BDR test, were included in the study. Demographic information and symptoms were recorded and PEF variability was monitored for 2 weeks. Metacolinbronchial provocation test (mBPT) was performed. Asthma was diagnosed when PEF variability ≥ 20% and/or positive mBPT was observed. Results: 30 of 50 patients were diagnosed with asthma. After 1 month, 17 patients were evaluated for treatment outcomes. The sensitivity and specificity of PEF variability for different cut-off values (≥ 20%, > 15% and > 10%) were 61.5– 83.3, 88.5– 62.5 and 100– 16.7, respectively. One of the most important findings of our study was the absence of variable airflow limitation or airway hyper reactivity in 39% patients with a previous diagnosis of asthma. Multiple logistic regression analysis revealed that a low baseline FEF25-75 value was an independent predictive factor for the diagnosis of asthma (p= 0.05). Conclusion: The most efficient diagnostic test for asthma is still unclear due to many factors. Our study is one of the few studies on this subject. Although current diagnostic recommendations generally recommend a PEF variability of 10% for the diagnosis of asthma, this threshold may not be appropriate for the BDR-negative patient group. Our results suggest using a threshold value of < 15% for PEF variability when excluding asthma and ≥ 20% when confirming the diagnosis of asthma in patients with clinically suspected but unproven reversibility. Furthermore, FEF25-75 is considered to be an important diagnostic parameter that should be included in diagnostic recommendations for asthma.
{"title":"What is the Best Way to Diagnose Possible Asthma Patients with Negative Bronchodilator Reversibility Tests?","authors":"Buket Başa Akdoğan, Ilkay Koca Kalkan, Gözde Köycü Buhari, Özlem Özdedeoğlu, Hale Ateş, Kurtuluş Aksu, Ferda Öner Erkekol","doi":"10.2147/jaa.s437756","DOIUrl":"https://doi.org/10.2147/jaa.s437756","url":null,"abstract":"<strong>Objective:</strong> The best method and strategy for the diagnosis of asthma remains unclear, especially in patients with negative bronchodilator reversibility test (BDRT). In our study, we aimed to investigate the diagnostic yield of peak expiratory flow (PEF) variability for this patient group.<br/><strong>Methods:</strong> A total of 50 patients with suspected asthma, all with negative BDR test, were included in the study. Demographic information and symptoms were recorded and PEF variability was monitored for 2 weeks. Metacolinbronchial provocation test (mBPT) was performed. Asthma was diagnosed when PEF variability ≥ 20% and/or positive mBPT was observed.<br/><strong>Results:</strong> 30 of 50 patients were diagnosed with asthma. After 1 month, 17 patients were evaluated for treatment outcomes. The sensitivity and specificity of PEF variability for different cut-off values (≥ 20%, > 15% and > 10%) were 61.5– 83.3, 88.5– 62.5 and 100– 16.7, respectively. One of the most important findings of our study was the absence of variable airflow limitation or airway hyper reactivity in 39% patients with a previous diagnosis of asthma. Multiple logistic regression analysis revealed that a low baseline FEF<sub>25-75</sub> value was an independent predictive factor for the diagnosis of asthma (p= 0.05).<br/><strong>Conclusion:</strong> The most efficient diagnostic test for asthma is still unclear due to many factors. Our study is one of the few studies on this subject. Although current diagnostic recommendations generally recommend a PEF variability of 10% for the diagnosis of asthma, this threshold may not be appropriate for the BDR-negative patient group. Our results suggest using a threshold value of < 15% for PEF variability when excluding asthma and ≥ 20% when confirming the diagnosis of asthma in patients with clinically suspected but unproven reversibility. Furthermore, FEF<sub>25-75</sub> is considered to be an important diagnostic parameter that should be included in diagnostic recommendations for asthma.<br/><br/><strong>Keywords:</strong> diagnosis of asthma, reversibility, peak expiratory flow (PEF) variability, bronchial challenge test, forced expiratory flow <sub>(25-75%)</sub><br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"2 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139919235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zhu Qin, Liangzhen Xie, Wentao Li, Chao Wang, Yan Li
Abstract: Allergy rhinitis (AR) is becoming more common and has serious medical and societal consequences. Sneezing, paroxysmal nasal blockage, nasal itching, mucosal edema, coughing, and rhinorrhea are symptoms of this type I allergic immunological illness. Immunoglobulin E-mediated inflammation is the cause of it. Because AR is prone to recurrent attacks, extended medication therapy may impair its effectiveness. In addition to negatively affecting the patients’ physical health, this can also negatively impact their mental health. During AR development, there are inflammatory and oxidative stress responses that are linked to problems in a number of signal transduction pathways. By using the terms “allergic rhinitis”, “traditional Chinese medicine”, “inflammation”, and “oxidative stress”, we screened for pertinent research published over the previous five years in databases like PubMed. We saw that NF-KB, TLR, IL-33/ST2, PI3K/AKT, MAPK, and Nrf2 are some of the most important inflammatory and oxidative stress pathways in AR. Studies have revealed that antioxidant and anti-inflammatory therapy reduced the risk of AR and was therapeutic; however, the impact of the therapy varies widely. The Chinese medical system places a high value on traditional Chinese medicine (TCM), which has been there for virtually all of China’s 5000-year history. By influencing signaling pathways related to inflammation and oxidative stress, Chinese herbal medicine and its constituent compounds have been shown to prevent allergic rhinitis. This review will focus on this evidence and provide references for clinical treatment and scientific research applications.
Keywords: allergic rhinitis, traditional Chinese medicine, inflammatory, oxidative stress, signaling pathways
摘要：过敏性鼻炎（AR）越来越常见，对医疗和社会造成了严重后果。打喷嚏、阵发性鼻塞、鼻痒、黏膜水肿、咳嗽和鼻出血是这种 I 型过敏性免疫疾病的症状。免疫球蛋白 E 介导的炎症是其病因。由于 AR 容易反复发作，长时间的药物治疗可能会影响其疗效。这不仅会对患者的身体健康造成负面影响，还会对他们的心理健康造成负面影响。在 AR 的发病过程中，会出现炎症和氧化应激反应，这些反应与一些信号转导途径的问题有关。通过使用 "过敏性鼻炎"、"中药"、"炎症 "和 "氧化应激 "等术语，我们在 PubMed 等数据库中筛选了过去五年发表的相关研究。我们发现，NF-KB、TLR、IL-33/ST2、PI3K/AKT、MAPK 和 Nrf2 是 AR 中最重要的炎症和氧化应激途径。研究表明，抗氧化和抗炎治疗可降低 AR 的风险，并具有治疗作用；但治疗效果却大相径庭。中国医学体系高度重视传统中医药，在中国五千年的历史中，传统中医药几乎一直存在。通过影响与炎症和氧化应激相关的信号通路，中药及其成分化合物已被证明可以预防过敏性鼻炎。关键词：过敏性鼻炎、中药、炎症、氧化应激、信号通路
{"title":"New Insights into Mechanisms Traditional Chinese Medicine for Allergic Rhinitis by Regulating Inflammatory and Oxidative Stress Pathways","authors":"Zhu Qin, Liangzhen Xie, Wentao Li, Chao Wang, Yan Li","doi":"10.2147/jaa.s444923","DOIUrl":"https://doi.org/10.2147/jaa.s444923","url":null,"abstract":"<strong>Abstract:</strong> Allergy rhinitis (AR) is becoming more common and has serious medical and societal consequences. Sneezing, paroxysmal nasal blockage, nasal itching, mucosal edema, coughing, and rhinorrhea are symptoms of this type I allergic immunological illness. Immunoglobulin E-mediated inflammation is the cause of it. Because AR is prone to recurrent attacks, extended medication therapy may impair its effectiveness. In addition to negatively affecting the patients’ physical health, this can also negatively impact their mental health. During AR development, there are inflammatory and oxidative stress responses that are linked to problems in a number of signal transduction pathways. By using the terms “allergic rhinitis”, “traditional Chinese medicine”, “inflammation”, and “oxidative stress”, we screened for pertinent research published over the previous five years in databases like PubMed. We saw that NF-KB, TLR, IL-33/ST2, PI3K/AKT, MAPK, and Nrf2 are some of the most important inflammatory and oxidative stress pathways in AR. Studies have revealed that antioxidant and anti-inflammatory therapy reduced the risk of AR and was therapeutic; however, the impact of the therapy varies widely. The Chinese medical system places a high value on traditional Chinese medicine (TCM), which has been there for virtually all of China’s 5000-year history. By influencing signaling pathways related to inflammation and oxidative stress, Chinese herbal medicine and its constituent compounds have been shown to prevent allergic rhinitis. This review will focus on this evidence and provide references for clinical treatment and scientific research applications.<br/><br/><strong>Keywords:</strong> allergic rhinitis, traditional Chinese medicine, inflammatory, oxidative stress, signaling pathways<br/>","PeriodicalId":15079,"journal":{"name":"Journal of Asthma and Allergy","volume":"52 1","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139919153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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