Childhood Allergic Asthma Is Not a Single Phenotype

Just, Jocelyne; Saint‐Pierre, Philippe; Gouvis-Echraghi, Rahelé; Laoudi, Yacine; Roufai, Layde; Momas, Isabelle; Annesi‐Maesano, Isabella

doi:10.1016/j.jpeds.2013.11.037

Cited by 71 publications

(52 citation statements)

References 26 publications

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“…The IL13 rs20541A allele was not related to the whole asthma group, which could indicate that this genotype would be characteristic of a true atopic asthma endotype. We demonstrated a dose-dependent association between sensitization and the presence of AR and/or AC symptoms in asthmatics, strengthening the previous reports that sensitization is not a dichotomous value [16,20]. …”

Section: Discussionsupporting

confidence: 89%

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Self-Reported Allergic Rhinitis and/or Allergic Conjunctivitis Associate with IL13 rs20541 Polymorphism in Finnish Adult Asthma Patients

Ådjers

Luukkainen

Pekkanen³

et al. 2017

Int Arch Allergy Immunol

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Background: Our aim was to observe factors associated with IL13 rs20541 polymorphism and other factors with or without allergic comorbidities such as subject-reported allergic rhinitis (AR) and/or allergic conjunctivitis (AC) symptoms in adult asthmatics. Methods: A population-based sample of Finnish adult asthma patients (n = 1,156) and matched controls (n = 1,792) filled in a questionnaire. Asthma was diagnosed based on a typical history of asthma symptoms and lung function tests. Skin prick tests with 17 aeroallergens and blood tests including analysis of interleukin 13 (IL13) rs20541 (G/A) genotypes were performed for a subsample (n = 193). Results: The proportion of asthmatics reporting AR was 61.9% and reporting AC was 40.7%. After adjustments, the presence of the IL13 rs20541A- allele (OR 3.06, 95% CI 1.42-6.58, p = 0.004) or multisensitization (adjusted OR 4.59, 95% CI 1.48-14.26, p = 0.008) was associated with AR/AC asthma. Nasal polyps and acetylsalicylic acid-exacerbated respiratory disease was also associated with AR/AC asthma. Conclusions: Adult AR/AC asthma could putatively be a phenotype, characterized by the presence of atopic and/or eosinophilic factors and a high prevalence of the IL13 rs20541A- allele. Studies on the mechanisms behind this and in other populations are needed.

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Section: Discussionsupporting

confidence: 89%

“…AR/AC did not associate with the severity of asthma. In accordance with this, variation exists in the severity of the atopic asthma phenotypes, depending on eosinophilia, female gender, and early multiple allergies [20,22]. …”

Section: Discussionmentioning

confidence: 99%

Self-Reported Allergic Rhinitis and/or Allergic Conjunctivitis Associate with IL13 rs20541 Polymorphism in Finnish Adult Asthma Patients

Ådjers

Luukkainen

Pekkanen³

et al. 2017

Int Arch Allergy Immunol

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“…Nearly all other studies have been restricted to populations of children with asthma [9,12,33,34]. In common with our study, others have found that respiratory symptoms [10], atopy [9,12,33,34], AHR [9,12] and airway inflammation [9,34] are distinguishing features of phenotypes. Hence, the findings of this study conducted during early and mid-childhood are consistent with previous cross-sectional studies conducted within this age range.…”

Section: Discussionsupporting

confidence: 88%

Change in the manifestations of asthma and asthma-related traits in childhood: a latent transition analysis

et al. 2015

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It is known that asthma is a heterogeneous entity whose manifestations vary with age. Our objective was to examine changes in the manifestation of asthma and asthma-related traits in childhood by defining empirically derived childhood asthma phenotypes and examining their transitions over time.To define the phenotypes we used data on respiratory symptoms, healthcare utilisation, medications, spirometry, airway hyperresponsiveness (AHR), exhaled nitric oxide concentration and atopy from a birth cohort recruited on the basis of having a first-degree relative with asthma. Data were acquired at ages 1.5-11.5 years and analysed using latent transition analysis.In a study population of 370 participants, we classified subjects into four phenotypes: 1) nonatopic, few symptoms ( prevalence range from 1.5 to 5 years: 52-60%), 2) atopic, few symptoms (3-21%), 3) nonatopic, asthma and rhinitis symptoms (13-35%), and 4) atopic, asthma and rhinitis symptoms (2-14%) in early childhood; and 1) nonatopic, no respiratory disease ( prevalence range from 8 to 11.5 years: 41-46%), 2) atopic, no respiratory disease (23-33%), 3) nonatopic, asthma symptoms, no AHR or airway inflammation (8-12%) and 4) atopic asthma (19%) in mid-childhood. Transitioning between phenotypes was common in early childhood, but less common in later childhood.This analysis represents the first attempt to incorporate longitudinal patterns of several manifestations of asthma into a single model to simultaneously define phenotypes and examine their transitions over time. It provides quantitative support for the view that asthma is a heterogeneous entity, and that some children with wheeze and other respiratory symptoms in early life progress to asthma in mid-childhood, while others become asymptomatic. @ERSpublications New objective childhood asthma phenotypes show transitioning between phenotypes is common in early not late childhood http://ow.ly/RT5qz

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“…For example, allergy testing (22) may allow for more sophisticated asthma phenotyping. Studies have identified asthma phenotypes, or clusters, that are potentially amenable to more tailored medical care (39,40). Indeed, medication changes or optimization, such as targeted addition of antihistamines, allergen-specific immunotherapy (23, 24), or omalizumab; or referrals for in-home exposure assessment and remediation have the potential to reduce future exacerbations and improve asthma control (25)(26)(27).…”

Section: Discussionmentioning

confidence: 99%

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

Beck¹,

Huang

Kercsmar

et al. 2015

Annals ATS

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Rationale: Allergen sensitization is associated with asthma morbidity. A better understanding of allergen sensitization patterns among children hospitalized for asthma could help clinicians tailor care more effectively. To our knowledge, however, sensitization profiles among children hospitalized for asthma are unknown.Objectives: We sought to describe allergen sensitization profiles and the distribution of self-reported in-home exposures among children hospitalized for asthma. We also sought to assess how sensitization profiles varied by sociodemographic and clinical factors.Methods: This population-based cohort study includes data for 478 children, aged 4-16 years, hospitalized for an asthma exacerbation. Predictors included child age, race, sex, insurance status, reported income, salivary cotinine, exposure to traffic-related air pollution, asthma and atopic history, and season of admission. Outcomes included serum IgE specific to Alternaria alternata/A. tenuis, Aspergillus fumigatus, American cockroach, mouse epithelium, dust mite (Dermatophagoides pteronyssinus and farinae), cat dander, and dog dander (deemed sensitive if IgE > 0.35). Self-reported adverse exposures included mold/mildew, water leaks, cockroaches, rodents, and cracks or holes in the walls or ceiling. Presence of carpeting and furry pets was also assessed.Measurements and Main Results: More than 50% of included patients were sensitized to each of Alternaria, Aspergillus, dust mite, cat dander, and dog dander; 28% were sensitized to cockroach and 18% to mouse. Roughly 68% were sensitized to three or more allergens with evidence of clustering. African American children, compared with white children, were more likely to be sensitized to Alternaria, Aspergillus, cockroach, and dust mite (all P , 0.01). White children were more likely to be sensitized to mouse, cat, and dog (all P , 0.01). Lower income was associated with cockroach sensitization whereas higher income was associated with dog and cat sensitization (all P , 0.01). Atopic history was associated with sensitization to three or more allergens (P , 0.01). Although 42% reported exposure to at least one adverse in-home exposure (and 72% to carpet, 51% to furry pets), only weak relationships were seen between reported exposures and sensitizations.Conclusions: Most children admitted to the hospital for asthma exacerbations are sensitized to multiple indoor allergens. Atopy on the inpatient unit serves as a potential target for improvement in chronic asthma management.

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Childhood Allergic Asthma Is Not a Single Phenotype

Cited by 71 publications

References 26 publications

Self-Reported Allergic Rhinitis and/or Allergic Conjunctivitis Associate with <b><i>IL13</i></b> rs20541 Polymorphism in Finnish Adult Asthma Patients

Self-Reported Allergic Rhinitis and/or Allergic Conjunctivitis Associate with <b><i>IL13</i></b> rs20541 Polymorphism in Finnish Adult Asthma Patients

Change in the manifestations of asthma and asthma-related traits in childhood: a latent transition analysis

Allergen Sensitization Profiles in a Population-Based Cohort of Children Hospitalized for Asthma

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