Environmental Improvements Brought by the Legal Interventions in the Homes of Poorly Controlled Inner-city Adult Asthmatic Patients: A Proof-of-Concept Study

O’Sullivan, Mary; Brandfield, Julie; Hoskote, Sumedh; Segal, Shiri N.; Chug, Luis; Modrykamien, Ariel; Eden, Edward

doi:10.3109/02770903.2012.724131

Cited by 51 publications

(30 citation statements)

References 30 publications

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“…In particular, Vitamin D3 has been shown to inhibit IL-17A production 47, 48 and as such, it may be beneficial in improving steroid responsiveness in fungal exposed patients who have elevated IL-17A levels. Our data provides mechanistic evidence to support the numerous epidemiologic studies, which have found that mold exposure is associated with increased development and severity of childhood and adult asthma 4–6, 9, 27, 49 . Thus, prevention and treatment strategies should include interventions to reduce exposure to mold.…”

Section: Discussionsupporting

confidence: 83%

β-Glucan exacerbates allergic asthma independent of fungal sensitization and promotes steroid-resistant T H 2/T H 17 responses

Zhang

Myers

Brandt

et al. 2017

Journal of Allergy and Clinical Immunology

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Background Allergic sensitization to fungi have been associated with asthma severity. As a result, it has been largely assumed that the contribution of fungi to allergic disease is mediated through their potent antigenicity. Objective We sought to determine the mechanism by which fungi impact asthma development and severity. Methods We integrated epidemiologic and experimental asthma models to explore the impact of fungal exposure on asthma development and severity. Results We report that fungal exposure enhances allergen-driven TH2 responses promoting severe allergic asthma. This effect is independent of fungal sensitization, and can be reconstituted with β-glucan and abrogated by neutralization of IL-17A. Further, this severe asthma is resistant to steroids and characterized by mixed TH2 and TH17 responses, including IL-13+IL17+CD4+ double-producing T-effector cells. Steroid resistance is dependent on fungal-induced TH17 responses as steroid sensitivity was restored in IL-17RC−/− mice. Similarly, in children with asthma, fungal exposure was associated with increased serum IL-17A and asthma severity. Conclusion Our data demonstrate that fungi are potent immunomodulators and have powerful effects on asthma independent of their potential to act as antigens. Further, our results provide strong rationale for combination treatment strategies targeting IL-17A for this subgroup of fungal-exposed difficult-to-treat asthmatics.

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Section: Discussionsupporting

confidence: 83%

β-Glucan exacerbates allergic asthma independent of fungal sensitization and promotes steroid-resistant T H 2/T H 17 responses

Zhang

Myers

Brandt

et al. 2017

Journal of Allergy and Clinical Immunology

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“…The Neighborhood Asthma Coalition and the Asthma Coach programs demonstrated that addressing topics that may appear to be unrelated to asthma, such as problems with landlords, domestic disputes, or community violence, led to reduced acute care visits and increased confidence in asthma management (45). The Medical Legal Partnership, which integrates legal assistance into patient care to remove barriers that impede health, was shown to reduce emergency room visits and hospitalizations and lessen asthma severity in inner-city adults with asthma (46). …”

Section: Discussionmentioning

confidence: 99%

Socioeconomic status and asthma control in African American youth in SAGE II

Thakur¹,

Martin²,

Castellanos³

et al. 2014

Journal of Asthma

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Objective African Americans are disproportionately burdened by asthma. We assessed the individual and joint contribution of socioeconomic status (SES) on asthma morbidity among African American youth. Methods We examined 686 African Americans (8–21 years) with asthma. To account for the joint effects of SES, a composite index was derived from maternal educational attainment, household income, and insurance status. Ordinal logistic regression was used to estimate the individual and joint effect of SES on asthma control. Models were adjusted for age, sex, controller medication use, in utero smoke exposure, family history of asthma, family history of rhinitis, breastfeeding, daycare attendance, and mold exposure. Results Participants were classified as Poorly Controlled Asthma (40.8%), Partially Controlled Asthma (29.7%), or Controlled Asthma (30.2%). Of the individual SES indicators, low income was the strongest predictor of poor asthma control. Children with low income had worse asthma control than those with higher income (OR 1.39; 95%CI 0.92–2.12). The SES index ranged from 4–9. SES was associated with 17% increased odds of poor asthma control with each decrease in the index (95%CI 1.05–1.32). The SES index was associated with asthma-related symptoms, nocturnal awakenings, limited activity, and missed school days. Conclusions The negative effects of SES were observed along the entire socioeconomic gradient, and the adverse asthma outcomes observed in African American youth were not limited to the very poor. We also found that the SES index may be a more consistent and useful predictor of poor asthma outcomes than each indicator alone.

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“…However, we believe that the detrimental exposure is more due to irritation than to allergic sensitization towards mold, especially in young children. In fact, it is well known that mold exposure promotes bacterial growth and the release of volatile organic compounds which enhance non-specific inflammation especially in severe asthmatic children [33], [34]. The increase of epithelial permeability could thus lead to sensitization to other aeroallergens [35].…”

Section: Discussionmentioning

confidence: 99%

Determinants of Allergic Rhinitis in Young Children with Asthma

et al. 2014

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BackgroundIn the preschool period, allergic rhinitis (AR) is infrequent and thus under-diagnosed. However, recent works have highlighted the occurrence of AR in toddlers although the causes of AR in this young population remain unknown. The objective of this study was to identify determinants of AR in young children with asthma.MethodsWe carried out a case-control study of 227 children with active asthma and enrolled in the Trousseau Asthma Program. AR and other allergic diseases (asthma, food allergy and eczema) were diagnosed by medical doctors using standardized questionnaires. Parental history of AR and asthma, biological markers of atopy (total IgE, blood eosinophilia, allergic sensitization towards food and aeroallergens) and environmental parameters were also collected.ResultsForty one of the children (18.1%) had AR. By univariate logistic regression analysis, AR was mainly associated with peanut sensitization (OR = 6.75; p = 0.002); food allergy (OR = 4.31; p = 0.026); mold exposure (OR = 3.81 p<0.01) and parental history of AR (OR = 1.42; p = 0.046). Due to the strong link between food allergy and peanut sensitization three models of multivariate logistic regression were performed and confirmed that AR is associated with peanut sensitization but also food allergy and mold exposure. A random forest analysis was also performed to explain AR. The results reinforced the logistic analysis that peanut sensitization and mold exposure were the principal determinants of AR.Conclusions & Clinical RelevanceThese results stress the importance of investigating AR in young children with asthma to potentially diagnose a particularly severe allergic asthmatic phenotype. Moreover, these data evoke the hypothesis that peanut could be an aeroallergen.

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Environmental Improvements Brought by the Legal Interventions in the Homes of Poorly Controlled Inner-city Adult Asthmatic Patients: A Proof-of-Concept Study

Abstract: Medical-legal collaboration is highly effective in improving the control of inner-city asthmatics by effecting improvements in the domestic environment.

Cited by 51 publications

References 30 publications

β-Glucan exacerbates allergic asthma independent of fungal sensitization and promotes steroid-resistant T H 2/T H 17 responses

β-Glucan exacerbates allergic asthma independent of fungal sensitization and promotes steroid-resistant T H 2/T H 17 responses

Socioeconomic status and asthma control in African American youth in SAGE II

Determinants of Allergic Rhinitis in Young Children with Asthma

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