Sex differences in hospital admissions from emergency departments in asthmatic adults: a population-based study

Baibergenova, Akerke; Thabane, Lehana; Akhtar–Danesh, Noori; Levine, Mitchell; Gafni, Amiram; Leeb, Kira

doi:10.1016/s1081-1206(10)61063-0

Cited by 47 publications

(38 citation statements)

References 39 publications

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“…One major challenge to estrogen-based therapeutics is maximizing cell specificity and minimizing unintended impact on reproductive function. Women are burdened with the highest incidence of allergy (65, 66) and autoimmune diseases (67–69). Generally speaking, women respond to infection and vaccination with increased antibody production compared to men and this reflects a predisposition to a Th2 bias in women compared to a Th1 bias in men (70–72).…”

Section: Discussionmentioning

confidence: 99%

Estrogen Signaling Contributes to Sex Differences in Macrophage Polarization during Asthma

Keselman

Fang

White

et al. 2017

The Journal of Immunology

127

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Allergic asthma is a chronic Th2 inflammation in the lungs that constricts the airways and presents as coughing and wheezing. Asthma mostly affects boys in childhood and women in adulthood, suggesting that shifts in sex hormones alter the course of the disease. Alveolar macrophages have emerged as major mediators of allergic lung inflammation in animal models as well as humans. Whether sex differences exist in macrophage polarization and the molecular mechanism(s) which drive differential responses are not well understood. We found that IL-4- stimulated bone marrow-derived and alveolar macrophages from female mice exhibited greater expression of M2 genes in vitro and after allergen challenge in vivo. Alveolar macrophages from female mice exhibited greater expression of the IL-4 receptor (IL-4R)-α and estrogen receptor (ER)-α compared to macrophages from male mice following allergen challenge. An ERα-specific agonist enhanced IL-4-induced M2 gene expression in macrophages from both sexes but more so in macrophages from female mice. Further, IL-4-stimulated macrophages from female mice exhibited more transcriptionally active histone modifications at M2 gene promoters than did macrophages from male mice. We found that supplementation of estrogen into ovariectomized female mice enhanced M2-polarization in vivo upon challenge with allergen and that macrophage-specific deletion of ERα impaired this M2-polarization. The effects of estrogen are long-lasting; bone marrow derived macrophages from ovariectomized mice implanted with estrogen exhibited enhanced IL-4-induced M2-gene expression compared to macrophages from placebo-implanted littermates. Taken together, our findings suggest that estrogen enhances IL-4-induced M2-gene expression and thereby contributes to sex differences observed in asthma.

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Section: Discussionmentioning

confidence: 99%

Estrogen Signaling Contributes to Sex Differences in Macrophage Polarization during Asthma

Keselman

Fang

White

et al. 2017

The Journal of Immunology

127

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“…Although analysis of patient asthma management characteristics was not possible using NHAMCS data, other studies have reported that whereas women who present with acute asthma are more likely to have ICSs, primary care, and health insurance than men, they are less likely than men to use their ICS daily if they have one, and stay longer when they are admitted to the hospital despite having less severe symptoms. [24][25][26] Biological, social, and disease management factors may influence sex differences in asthma epidemiology, although consensus is lacking and further exploration is warranted.…”

Section: Discussionmentioning

confidence: 99%

Improved overall trends but persistent racial disparities in emergency department visits for acute asthma, 1993-2005

Ginde

Espinola

Camargo

2008

Journal of Allergy and Clinical Immunology

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“…Asthma in women is associated with excess mortality risk (as compared with the general population) and women with asthma have been found to visit the emergency department for asthma more frequently than men [5]. Subsequent hospitalization rates for asthma reflect the difference in asthma prevalence and severity as observed between men and women [6].…”

Section: Introductionmentioning

confidence: 99%

Are there reasons why adult asthma is more common in females?

Melgert

Ray²,

Hylkema

et al. 2007

Curr Allergy Asthma Rep

161

118

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Many epidemiological studies suggest that women are at increased risk of developing adult-onset asthma and also suffer from more severe disease than men. These gender differences appear to be the product of biological sex differences as well as sociocultural and environmental differences. The biological sex differences include genetic, pulmonary, and immunological factors. There is compelling evidence that sex hormones are major determinants of at least these biological sex differences. This paper explores the current literature regarding effects of sex hormones on immune function, resident lung cells, and regulation of local processes in the lung to shed light on underlying mechanisms of gender differences in asthma. More research is needed to understand these mechanisms in order to improve treatment of women with asthma.

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Sex differences in hospital admissions from emergency departments in asthmatic adults: a population-based study

Cited by 47 publications

References 39 publications

Estrogen Signaling Contributes to Sex Differences in Macrophage Polarization during Asthma

Estrogen Signaling Contributes to Sex Differences in Macrophage Polarization during Asthma

Improved overall trends but persistent racial disparities in emergency department visits for acute asthma, 1993-2005

Are there reasons why adult asthma is more common in females?

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