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Yavuz ST, Karakus CO, Custovic A, et al., 2021, Four subtypes of childhood allergic rhinitis identified by latent class analysis
<jats:p id="p1">Background: Childhood allergic rhinitis (AR) is clinically highlyheterogeneous. We aimed to identify distinct subgroups amongst childrenwith AR, and to ascertain their association with patterns of symptoms,allergic sensitization and concomitant physician-diagnosed asthma.Methods: We recruited 510 children with physician-diagnosed AR, of whom205 (40%) had asthma. Latent class analysis (LCA) was performed toidentify latent structure within the data set using 17 variables(allergic conjunctivitis, eczema, asthma, family history of asthma,family history of allergic rhinitis, skin sensitization to 8 commonallergens, tonsillectomy, adenoidectomy). Results: A four−class solutionwas selected as the optimal model based on statistical fit. We labeledAR latent classes as: (1) AR with grass mono-sensitization andconjunctivitis (n=361, 70.8%); (2) AR with house dust mitesensitization and asthma (n=75, 14.7%); (3) AR with pet and grasspolysensitization and conjunctivitis (n=35, 6.9%) and (4) AR amongchildren with tonsils and adenoids removed (n=39, 7.6%). Perennial ARwas significantly more common among children in Class 2 (OR 5.83, 95%CI3.42−9.94, p<0.001) and Class 3 (OR 2.88, 95%CI 1.36−6.13,p=0.006). Mild and intermittent AR symptoms were significantly morecommon in children in Class 3 compared to those in Class 1. AR was moresevere in Class 1, compared to other 3 classes, indicating that upperrespiratory symptoms are more severe among children with isolatedseasonal rhinitis, than in those with rhinitis and coexisting asthma.Conclusion: We have identified 4 phenotypes in school-age children withAR, which were associated with different patterns of clinical symptomsand comorbidities.</jats:p>
Bousquet J, Anto JM, Czarlewski W, et al., 2021, Cabbage and fermented vegetables: From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19, Allergy, Vol: 76, Pages: 735-750, ISSN: 0105-4538
Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT1 R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT1 R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.
Bousquet J, Jutel M, Akdis CA, et al., 2021, ARIA-EAACI statement on asthma and COVID-19 (June 2, 2020), Allergy, Vol: 76, Pages: 689-697, ISSN: 0105-4538
Holguin F, Cardet JC, Chung KF, et al., 2021, Management of severe asthma: A European Respiratory Society/American Thoracic Society guideline, Pulmonologiya, Vol: 31, Pages: 272-295, ISSN: 0869-0189
This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including metaanalyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force’s questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: • suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; • suggest using a blood eosinophil cut-point ≥150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma; • suggest considering specific eosinophil (≥260 μL−1) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; • suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4 – 5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; • suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; • suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These reco
Pearce N, Moirano G, Maule M, et al., 2021, Does death from Covid-19 arise from a multi-step process?, European Journal of Epidemiology, Vol: 36, Pages: 1-9, ISSN: 0393-2990
The Covid-19 death rate increases exponentially with age, and the main risk factors are having underlying conditions such as hypertension, diabetes, cardiovascular disease, severe chronic respiratory disease and cancer. These characteristics are consistent with the multi-step model of disease. We applied this model to Covid-19 case fatality rates (CFRs) from China, South Korea, Italy, Spain and Japan. In all countries we found that a plot of log(CFR) against log(age) was approximately linear with a slope of about 5. We also conducted similar analyses for selected other respiratory diseases. SARS showed a similar log–log age-pattern to that of Covid-19, albeit with a lower slope, whereas seasonal and pandemic influenza showed quite different age-patterns. Thus, death from Covid-19 and SARS appears to follow a distinct age-pattern, consistent with a multi-step model of disease that in the case of Covid-19 is probably defined by comorbidities and age producing immune-related susceptibility.
Makrinioti H, Custovic A, Hasegawa K, et al., 2021, The role of interferons in preschool wheeze, The Lancet Respiratory Medicine, Vol: 9, Pages: 9-11, ISSN: 2213-2600
Bousquet J, Anto JM, Bachert C, et al., 2021, ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice., Allergy, Vol: 76, Pages: 168-190, ISSN: 0105-4538
Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis.It strengthens the ARIA change management strategy in the prevention and managementof airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.
Ibrahimagic OC, Kunic S, Imamovic G, et al., 2021, OTHERS ARE TO BLAME (DISPLACEMENT IN PATIENTS WITH DRUG-RESISTANT EPILEPSY), Publisher: MEDICINSKA NAKLADA, Pages: S219-S219, ISSN: 0353-5053
Bousquet J, Cristol J-P, Czarlewski W, et al., 2020, Nrf2-interacting nutrients and COVID-19: time for research to develop adaptation strategies, Clinical and Translational Allergy, Vol: 10, Pages: 1-18, ISSN: 2045-7022
There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPARγ:Peroxisome proliferator-activated receptor, NFκB: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2α:Elongation initiation factor 2α). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT1R axis (AT1R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity.
Bousquet J, Anto JM, Iaccarino G, et al., 2020, Is diet partly responsible for differences in COVID-19 death rates between and within countries?, Clinical and Translational Allergy, Vol: 10, ISSN: 2045-7022
Reported COVID-19 deaths in Germany are relatively low as compared to many European countries. Among the several explanations proposed, an early and large testing of the population was put forward. Most current debates on COVID-19 focus on the differences among countries, but little attention has been given to regional differences and diet. The low-death rate European countries (e.g. Austria, Baltic States, Czech Republic, Finland, Norway, Poland, Slovakia) have used different quarantine and/or confinement times and methods and none have performed as many early tests as Germany. Among other factors that may be significant are the dietary habits. It seems that some foods largely used in these countries may reduce angiotensin-converting enzyme activity or are anti-oxidants. Among the many possible areas of research, it might be important to understand diet and angiotensin-converting enzyme-2 (ACE2) levels in populations with different COVID-19 death rates since dietary interventions may be of great benefit.
Huoman J, Haider S, Simpson A, et al., 2020, Circulating Chemokine Levels and the Development of Allergic Phenotypes from Infancy to Adolescence: A Population-Based Birth Cohort Study
<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background:</jats:bold> Chemokines are important mediators in immune cell recruitment, contributing to allergy development. However, extensive studies of chemokines in the circulation in relation to the presence and development of allergic diseases remain scarce.<jats:bold>Objective:</jats:bold> To investigate associations of circulating allergy-related chemokines with development of asthma and sensitisation cross-sectionally and longitudinally in a population-based cohort. <jats:bold>Methods:</jats:bold> The chemokines CCL17, CCL22, CXCL10, CXCL11 and CCL18 were measured in plasma samples from children in a population-based birth cohort. Samples were available from cord blood at birth (n=376) and age 1 (n=195) and 8 years (n=334). Cross-sectional and longitudinal association analyses were performed in relation to asthma and allergic sensitisation, as well as allergic phenotype clusters previously derived using machine learning in the same study population.<jats:bold>Results:</jats:bold> In children with asthma and/or allergic sensitisation, CCL18 levels at ages 1 and/or 8 were consistently elevated. In a longitudinal model which included information on asthma from 4 time-points (ages 5, 8, 11 and 16 years),<jats:italic> </jats:italic>we observed a significant association between increasing levels of CCL18 at age 1 year and a higher risk of asthma from early school age to adolescence (OR=2.9, 95% CI 1.1-7.6, p=0.028). We observed similar associations in longitudinal models for allergic sensitisation. Asthma later in life was preceded by increased CXCL10 levels after birth, and decreased CXCL11 levels at birth. <jats:bold>Conclusion:</jats:bold> Elevated CCL18 levels throughout childhood foreshadow the development of asthma and allergic sensitisation. The Th1-associated chemokines CXCL10 and CXCL11 were also associated
Papadopoulos NG, Mathioudakis AG, Custovic A, et al., 2020, Childhood asthma outcomes during the COVID-19 pandemic: Findings from the PeARL multi-national cohort
<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Importance</jats:title><jats:p>Importance: The interplay between COVID-19 pandemic and asthma in children is still unclear.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>We evaluated the impact of COVID-19 pandemic on childhood asthma outcomes.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>The PeARL multinational cohort included children with asthma and non-asthmatic controls recruited during the COVID-19 pandemic and compared current disease activity with data available from the previous year.</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>Pediatric outpatient clinics.</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>The study included 1,054 children with asthma and 505 non-asthmatic controls, aged between 4-18 years, from 25 pediatric departments, from 15 countries globally.</jats:p></jats:sec><jats:sec><jats:title>Exposures</jats:title><jats:p>COVID-19 pandemic first wave, starting from the date of the first fatality in the respective country.</jats:p></jats:sec><jats:sec><jats:title>Main outcomes and measures</jats:title><jats:p>We assessed the pandemic’s impact on the frequency of respiratory infections, emergency presentations and hospital admissions in asthmatic versus non-asthmatic participants, controlling for confounding factors including the pandemic’s duration and the frequency of such acute events during 2019. Using paired analyses, we evaluated the impact of the pandemic on the annualized frequency of asthma attacks and the previously mentioned acute events, asthma control, and pulmonary function in children with asthma, compared to their baseline
Bousquet J, Anto JM, Iaccarino G, et al., 2020, Is diet partly responsible for differences in COVID-19 death rates between and within countries? (vol 10, 16, 2020), Clinical and Translational Allergy, Vol: 10, Pages: 1-3, ISSN: 2045-7022
Vogelezang S, Bradfield JP, Ahluwalia TS, et al., 2020, Novel loci for childhood body mass index and shared heritability with adult cardiometabolic traits, PLoS Genetics, Vol: 16, Pages: 1-26, ISSN: 1553-7390
The genetic background of childhood body mass index (BMI), and the extent to which the well-known associations of childhood BMI with adult diseases are explained by shared genetic factors, are largely unknown. We performed a genome-wide association study meta-analysis of BMI in 61,111 children aged between 2 and 10 years. Twenty-five independent loci reached genome-wide significance in the combined discovery and replication analyses. Two of these, located near NEDD4L and SLC45A3, have not previously been reported in relation to either childhood or adult BMI. Positive genetic correlations of childhood BMI with birth weight and adult BMI, waist-to-hip ratio, diastolic blood pressure and type 2 diabetes were detected (Rg ranging from 0.11 to 0.76, P-values <0.002). A negative genetic correlation of childhood BMI with age at menarche was observed. Our results suggest that the biological processes underlying childhood BMI largely, but not completely, overlap with those underlying adult BMI. The well-known observational associations of BMI in childhood with cardio-metabolic diseases in adulthood may reflect partial genetic overlap, but in light of previous evidence, it is also likely that they are explained through phenotypic continuity of BMI from childhood into adulthood.
Roberts G, Fontanella S, Selby A, et al., 2020, Connectivity patterns between multiple allergen specific IgE antibodies and their association with severe asthma, Journal of Allergy and Clinical Immunology, Vol: 146, Pages: 821-830, ISSN: 0091-6749
BACKGROUND: Allergic sensitization is associated with severe asthma, but assessment of sensitization is not recommended by most guidelines. OBJECTIVE: We hypothesized that patterns of IgE responses to multiple allergenic proteins differ between sensitized participants with mild/moderate and severe asthma. METHODS: IgE to 112 allergenic molecules (components, c-sIgE) was measured using multiplex array among 509 adults and 140 school-age and 131 preschool children with asthma/wheeze from the Unbiased BIOmarkers for the PREDiction of respiratory diseases outcomes cohort, of whom 595 had severe disease. We applied clustering methods to identify co-occurrence patterns of components (component clusters) and patterns of sensitization among participants (sensitization clusters). Network analysis techniques explored the connectivity structure of c-sIgE, and differential network analysis looked for differences in c-sIgE interactions between severe and mild/moderate asthma. RESULTS: Four sensitization clusters were identified, but with no difference between disease severity groups. Similarly, component clusters were not associated with asthma severity. None of the c-sIgE were identified as associates of severe asthma. The key difference between school children and adults with mild/moderate compared with those with severe asthma was in the network of connections between c-sIgE. Participants with severe asthma had higher connectivity among components, but these connections were weaker. The mild/moderate network had fewer connections, but the connections were stronger. Connectivity between components with no structural homology tended to co-occur among participants with severe asthma. Results were independent from the different sample sizes of mild/moderate and severe groups. CONCLUSIONS: The patterns of interactions between IgE to multiple allergenic proteins are predictors of asthma severity among school children and adults with allergic asthma.
Bousquet J, Akdis CA, Jutel M, et al., 2020, Intranasal corticosteroids in allergic rhinitis in COVID-19 infected patients: An ARIA-EAACI statement, ALLERGY, Vol: 75, Pages: 2440-2444, ISSN: 0105-4538
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Custovic A, Custovic D, Kljaic Bukvic B, et al., 2020, Atopic phenotypes and their implication in the atopic march, Expert Review of Clinical Immunology, Vol: 16, Pages: 873-881, ISSN: 1744-666X
Eczema, allergic rhinitis, and asthma are traditionally considered atopic (or allergic) diseases. They are complex, multifactorial, and are caused by a variety of different mechanisms, which result in multiple heterogeneous clinical phenotypes. Atopic march is usually interpreted as the sequential development of symptoms from eczema in infancy, to asthma, and then allergic rhinitis. Areas covered: The authors reviewed the evidence on the multimorbidity of eczema, asthma, and rhinitis, and the implication of results of data-driven analyses on the concept framework of atopic march. A literature search was conducted in the PubMed and Web of Science for peer-reviewed articles published until July 2020. Application of Bayesian machine learning framework to rich phenotypic data from birth cohorts demonstrated that the postulated linear progression of symptoms (atopic march) does not capture the heterogeneity of allergic phenotypes. Expert opinion: Eczema, wheeze, and rhinitis co-exist more often than would be expected by chance, but their relationship can be best understood in a multimorbidity framework, rather than through atopic march sequence. The observation of their co-occurrence does not imply any specific relationship between them, and certainly not a progressive or causal one. It is unlikely that a sngle mechanism such as allergic sensitization underpins different multimorbidity manifestations.
Custovic A, 2020, "Asthma" or "Asthma Spectrum Disorder"?, Journal of Allergy and Clinical Immunology: In Practice, Vol: 8, Pages: 2628-2629, ISSN: 2213-2198
Papadopoulos NG, Custovic A, Deschildre A, et al., 2020, Impact of COVID-19 on pediatric asthma: practice adjustments and disease burden., Journal of Allergy and Clinical Immunology: In Practice, Vol: 8, Pages: 2592-2599.e3, ISSN: 2213-2198
BACKGROUND: It is unclear whether asthma may affect susceptibility or severity of coronavirus disease 2019 (COVID-19) in children and how pediatric asthma services worldwide have responded to the pandemic. OBJECTIVE: To describe the impact of the COVID-19 pandemic on pediatric asthma services and on disease burden in their patients. METHODS: An online survey was sent to members of the Pediatric Asthma in Real Life think tank and the World Allergy Organization Pediatric Asthma Committee. It included questions on service provision, disease burden, and the clinical course of confirmed cases of COVID-19 infection among children with asthma. RESULTS: Ninety-one respondents, caring for an estimated population of more than 133,000 children with asthma, completed the survey. COVID-19 significantly impacted pediatric asthma services: 39% ceased physical appointments, 47% stopped accepting new patients, and 75% limited patients' visits. Consultations were almost halved to a median of 20 (interquartile range, 10-25) patients per week. Virtual clinics and helplines were launched in most centers. Better than expected disease control was reported in 20% (10%-40%) of patients, whereas control was negatively affected in only 10% (7.5%-12.5%). Adherence also appeared to increase. Only 15 confirmed cases of COVID-19 were reported among the population; the estimated incidence is not apparently different from the reports of general pediatric cohorts. CONCLUSIONS: Children with asthma do not appear to be disproportionately affected by COVID-19. Outcomes may even have improved, possibly through increased adherence and/or reduced exposures. Clinical services have rapidly responded to the pandemic by limiting and replacing physical appointments with virtual encounters.
Custovic A, Tahirovic H, 2020, Asthma and allergies: from diagnosis-based approach towards personalised treatments, Acta Medica Academica, Vol: 49, Pages: 93-102, ISSN: 1840-1848
Soto-Martínez ME, Soto-Quiros ME, Custovic A, 2020, Childhood asthma: low and middle-income countries perspective, Acta Medica Academica, Vol: 49, Pages: 181-190, ISSN: 1840-1848
Our aim is to review current asthma epidemiology, achievements from the last 10 years, and persistent challenges of asthma management and control in low-middle income countries (LMICs). Despite global efforts, asthma continues to be an important public health problem worldwide, particularly in poorly resourced settings. Several epidemiological studies in the last decades have shown significant variability in the prevalence of asthma globally, but generally a marked increase in LMICs resulting in significant morbidity and mortality. Poverty, air pollution, climate change, exposure to indoor allergens, urbanization and diet are some of the factors that contribute to inadequate control and poor outcomes in developing countries. Although asthma guidelines have been developed to raise awareness and improve asthma diagnosis and treatment, problems with underdiagnosis and undertreatment are still common. In addition, important social, financial, cultural and healthcare barriers are common obstacles in LMICs in achieving control. Given the high burden of asthma in these countries, adaptation and implementation of national asthma guidelines tailored to local needs should be a public health priority. Governmental commitment, education, better health system infrastructure, access to care and effective asthma medications are the cornerstone of achieving success. CONCLUSION: Asthma poses significant challenges to LMICs. Whilst there are ongoing efforts in improving asthma diagnosis and decreasing asthma burden in LMICs; reasons for inadequate asthma control are also common and difficult to tackle. Improving asthma diagnosis, access to appropriate treatment and decreasing risk factors should be key goals to reduce asthma morbidity and mortality worldwide.
Holt PG, Strickland DH, Custovic A, 2020, Targeting maternal immune function during pregnancy for asthma prevention in offspring: Harnessing the "farm effect"?, Journal of Allergy and Clinical Immunology, Vol: 146, Pages: 270-272, ISSN: 0091-6749
Saglani S, Wisnivesky JP, Charokopos A, et al., 2020, Update in Asthma 2019, American Journal of Respiratory and Critical Care Medicine, Vol: 202, Pages: 184-192, ISSN: 1073-449X
In a recent review on childhood asthma, we proposed that knowledge gaps will only be addressed by integrating technological advances and human knowledge across diverse disciplines, with a patient at its center (1). So, how far have we come in turning “big data” into actionable information to address some of the most important questions in asthma today, including clinical and mechanistic insights about the architecture of asthma heterogeneity, to inform personalized treatments? In this Update focusing on publications in the American Thoracic Society journals, we review the progress made in 2019 on understanding asthma epidemiology and risk factors, mechanisms underpinning different disease subtypes, therapeutic options and prediction of treatment responses, and highlight areas for future research.
Bédard A, Antó JM, Fonseca JA, et al., 2020, Correlation between work impairment, scores of rhinitis severity and asthma using the MASK-air® App, Allergy, Vol: 75, Pages: 1672-1688, ISSN: 0105-4538
BACKGROUND: In allergic rhinitis, a relevant outcome providing information on the effectiveness of interventions is needed. In MASK-air (Mobile Airways Sentinel Network), a visual analogue scale (VAS) for work is used as a relevant outcome. This study aimed to assess the performance of the work VAS work by comparing VAS work with other VAS measurements and symptom-medication scores obtained concurrently. METHODS: All consecutive MASK-air users in 23 countries from 1 June 2016 to 31 October 2018 were included (14 189 users; 205 904 days). Geolocalized users self-assessed daily symptom control using the touchscreen functionality on their smart phone to click on VAS scores (ranging from 0 to 100) for overall symptoms (global), nose, eyes, asthma and work. Two symptom-medication scores were used: the modified EAACI CSMS score and the MASK control score for rhinitis. To assess data quality, the intra-individual response variability (IRV) index was calculated. RESULTS: A strong correlation was observed between VAS work and other VAS. The highest levels for correlation with VAS work and variance explained in VAS work were found with VAS global, followed by VAS nose, eye and asthma. In comparison with VAS global, the mCSMS and MASK control score showed a lower correlation with VAS work. Results are unlikely to be explained by a low quality of data arising from repeated VAS measures. CONCLUSIONS: VAS work correlates with other outcomes (VAS global, nose, eye and asthma) but less well with a symptom-medication score. VAS work should be considered as a potentially useful AR outcome in intervention studies.
Zuiani C, Custovic A, 2020, Update on house dust mite allergen avoidance measures for asthma, Current Allergy and Asthma Reports, Vol: 20, Pages: 1-8, ISSN: 1529-7322
Purpose of ReviewTo critically review the evidence in favor or against the use of house dust mite (HDM) allergen avoidance measures in patients with asthma.Recent FindingsSystematic reviews and meta-analyses suggested no positive effect of mite allergen avoidance strategies on asthma outcomes, resulting in a lack of consensus regarding the utility of these measures. However, such analyses have a number limitations and might not be the most adequate tool to evaluate current evidence and to derive clinical recommendations regarding mite allergen avoidance in asthmatic patients. We should not disproportionately rely on the results of meta-analyses and systematic reviews to inform clinical practice and asthma guidelines in this area. Recent high-quality evidence from randomized controlled trial in children confirmed that mite allergen–impermeable bed encasings reduce emergency hospital attendance with acute severe asthma exacerbations.SummaryUntil better evidence is available, we suggest that physicians should adopt a pragmatic approach to mite allergen avoidance and advise sensitized patients to implement a multifaceted set of measures to achieve as great a reduction in exposure as possible. Potential predictors of positive response (e.g., patient’s sensitization and exposure status) can pragmatically be evaluated using the size of skin test wheal or the titer of allergen-specific IgE. Finally, the intervention should be started as early as possible.
Pearce N, Moirano G, Maule M, et al., 2020, Is death from Covid-19 a multistep process?
<jats:title>ABSTRACT</jats:title><jats:p>Covid-19 death has a different relationship with age than is the case for other severe respiratory pathogens. The Covid-19 death rate increases exponentially with age, and the main risk factors are age itself, as well as having underlying conditions such as hypertension, diabetes, cardiovascular disease, severe chronic respiratory disease and cancer. Furthermore, the almost complete lack of deaths in children suggests that infection alone is not sufficient to cause death; rather, one must have gone through a number of changes, either as a result of undefined aspects of aging, or as a result of chronic disease. These characteristics of Covid-19 death are consistent with the multistep model of disease, a model which has primarily been used for cancer, and more recently for amyotrophic lateral sclerosis (ALS). We applied the multi-step model to data on Covid-19 case fatality rates (CFRs) from China, South Korea, Italy, Spain and Japan. In all countries we found that a plot of ln (CFR) against ln (age) was approximately linear with a slope of about 5. As a comparison, we also conducted similar analyses for selected other respiratory diseases. SARS showed a similar log-log age-pattern to that of Covid-19, albeit with a lower slope, whereas seasonal and pandemic influenza showed quite different age-patterns. Thus, death from Covid-19 and SARS appears to follow a distinct age-pattern, consistent with a multistep model of disease that in the case of Covid-19 is probably defined by comorbidities and age producing immune-related susceptibility. Identification of these steps would be potentially important for prevention and therapy for SARS-COV-2 infection.</jats:p>
Thyssen JP, Ahluwalia TS, Paternoster L, et al., 2020, Interaction between filaggrin mutations and neonatal cat exposure in atopic dermatitis, Allergy, Vol: 75, Pages: 1481-1485, ISSN: 0105-4538
Niespodziana K, Borochova K, Pazderova P, et al., 2020, Toward personalization of asthma treatment according to trigger factors, JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY, Vol: 145, Pages: 1529-1534, ISSN: 0091-6749
Asthma is a severe and chronic disabling disease affecting more than 300 million people worldwide. Although in the past few drugs for the treatment of asthma were available, new treatment options are currently emerging, which appear to be highly effective in certain subgroups of patients. Accordingly, there is a need for biomarkers that allow selection of patients for refined and personalized treatment strategies. Recently, serological chip tests based on microarrayed allergen molecules and peptides derived from the most common rhinovirus strains have been developed, which may discriminate 2 of the most common forms of asthma, that is, allergen- and virus-triggered asthma. In this perspective, we argue that classification of patients with asthma according to these common trigger factors may open new possibilities for personalized management of asthma.
Mathioudakis AG, Custovic A, Deschildre A, et al., 2020, Research priorities in pediatric asthma: results of a global survey of multiple stakeholder groups by the Pediatric Asthma in Real Life (PeARL) Think Tank, Journal of Allergy and Clinical Immunology: In Practice, Vol: 8, Pages: 1953-1960.e9, ISSN: 2213-2198
BACKGROUND: Pediatric asthma remains a public health challenge with enormous impact worldwide. OBJECTIVE: The aim of this study was to identify and prioritize unmet clinical needs in pediatric asthma, which could be used to guide future research and policy activities. METHODS: We first identified unmet needs through an open-question survey administered to international experts in pediatric asthma who were members of the Pediatric Asthma in Real Life Think Tank. Prioritization of topics was then achieved through a second, extensive survey with global reach, of multiple stakeholders (leading experts, researchers, clinicians, patients, policy makers, and the pharmaceutical industry). Differences across responder groups were compared. RESULTS: A total of 57 unmet clinical need topics identified by international experts were prioritized by 412 participants from 5 continents and 60 countries. Prevention of disease progression and prediction of future risk, including persistence into adulthood, emerged as the most urgent research questions. Stratified care, based on biomarkers, clinical phenotypes, the children's age, and demographics were also highly rated. The identification of minimum diagnostic criteria in different age groups, cultural perceptions of asthma, and best treatment by age group were priorities for responders from low-middle-income countries. There was good agreement across different stakeholder groups in all domains with some notable exceptions that highlight the importance of involving the whole range of stakeholders in formulation of recommendations. CONCLUSIONS: Different stakeholders agree in the majority of research and strategic (eg, prevention, personalized approach) priorities for pediatric asthma. Stakeholder diversity is crucial for highlighting divergent issues that future guidelines should consider.
Akar-Ghibril N, Casale T, Custovic A, et al., 2020, Allergic endotypes and phenotypes of asthma (vol 8, pg 429, 2020), Journal of Allergy and Clinical Immunology: In Practice, Vol: 8, Pages: 1779-1779, ISSN: 2213-2198
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