BACKGROUND:Recently, clonidine has been increasingly utilized for the treatment of tic disorders in children rather than for hypertension in adults. The transdermal patch is a common route of administration. Allergic contact dermatitis caused by clonidine transdermal patch was reported in adults with hypertension but never in children with tic disorder. OBJECTIVE:We report on the first pediatric case developed allergic contact dermatitis within one to two weeks after using clonidine transdermal patch. METHODS:Patch test with clonidine and Chinese baseline series including adhesive components (ethyl acrylate, methyl methacrylate, and 2-hydroxyethyl methacrylate) from the adhesive layer of the transdermal patch were performed. RESULTS:We report the first pediatric case with allergic contact dermatitis due to clonidine transdermal patch confirmed by patch test. She presented with pruritic erythema, blistering, and rupture at the patch site, matching its size and shape. Patch test with clonidine hydrochloride elicited positive reactions (++ to +++), while tests for specific components from the adhesive layer, including ethyl acrylate, methyl methacrylate, and 2-hydroxyethyl methacrylate, were negative, thereby identifying clonidine as the primary allergen. CONCLUSIONS:This case highlights that although clonidine itself has weak sensitizing potential, the transdermal therapeutic system may increase the risk of clonidine-induced sensitization and make it become a potential trigger for allergic contact dermatitis in clonidine transdermal patch users.
BACKGROUND:Although penicillin allergy is frequently reported, the majority of labeled patients do not have confirmed hypersensitivity upon formal evaluation. The PEN-FAST clinical decision rule was developed to identify adults at low risk of true penicillin allergy; however, evidence supporting its performance in children remains limited. OBJECTIVE:To evaluate the diagnostic performance of the PEN-FAST score in a pediatric population with reported penicillin allergy. METHODS:We performed a retrospective cohort study including children younger than 18 years with a documented penicillin allergy label who underwent allergy evaluation at a tertiary referral center between January 2012 and February 2023. Children with suspected severe cutaneous adverse reactions (SCARs) or insufficient information to calculate the PEN-FAST score were excluded. Diagnostic evaluation included skin testing and/or drug provocation testing (DPT). Diagnostic performance of the PEN-FAST score was assessed by calculating sensitivity, specificity, predictive values, and the area under the receiver operating characteristic curve (AUC). RESULTS:Among 267 children included in the analysis, 19 (7.1%) had confirmed penicillin allergy. Using the original PEN-FAST cutoff of ≥ 3, the AUC was 0.62 (95%CI, 0.51-0.73), with sensitivity of 68.4%, specificity of 55.7%, positive predictive value of 10.6%, and negative predictive value of 95.8%. Exploratory analyses using alternative PEN-FAST score representations showed only minimal differences in discrimination. CONCLUSIONS:In this pediatric cohort, the PEN-FAST score demonstrated limited accuracy in distinguishing true penicillin allergy. These findings suggest that the adult-derived decision rule may require further refinement before routine application in children.
BACKGROUND:Evidence on the association between physical activity (PA) and allergic rhinitis (AR) remains inconsistent. While the prevalence of AR was high in Japan, no epidemiological study regarding this issue has been conducted. OBJECTIVE:This study examined the association between exercise habits including exercise partner and self-reported AR among Japanese young adults. METHODS:This cross-sectional study included 12,497 university students who underwent annual health checkups. Exercise habits were evaluated using a self-administered questionnaire on frequency (none, 1-2/month, 1-3/week, ≥ 4/week), intensity (none, light, moderate, intense), and exercise partner (no exercise, group, friends, alone). AR was defined as responding "Yes" to the question about self-reported AR. Multivariable logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs), controlling for age, sex, body mass index, smoking, and alcohol use. RESULTS:Of 12,497 participants (mean age 20.1 ± 3.1 years; 60.4% men), the prevalence of AR was 20.0% (n = 2,500). Compared with non-exercisers, high-frequency exercise (≥ 4/week) was independently and inversely associated with AR (adjusted OR = 0.83, 95%CI 0.72-0.96; p for trend = 0.008). Inverse associations between intense exercise (adjusted OR = 0.84, 95%CI 0.75-0.95), exercising with groups (adjusted OR = 0.83, 95%CI 0.72-0.94), and AR were also observed. CONCLUSIONS:Among Japanese young adults, frequent and intense exercise, particularly in organized settings, was independently and inversely associated with self-reported AR. These findings provide the first large-scale evidence from Japan suggesting an inverse association between habitual exercise and AR.
Background: Visual analog scale (VAS) correlates well with total nasal symptom score (TNSS) but negatively correlates with peak nasal inspiratory flow (PNIF) in adults with allergic rhinitis (AR). Small children may not rate VAS properly and parents usually help assess their child's symptoms. Data on the correlations among parent-assessed VAS (P-VAS), VAS, TNSS, and PNIF in children with AR was limited. Objective: To assess correlations among P-VAS, VAS, TNSS, and PNIF in children and adolescents with perennial AR (PAR). Methods: Patients with PAR aged 6-18 years and their parents were instructed to record daily VAS, TNSS, PNIF, and P-VAS in an electronic diary for 8 weeks. Results: 2387 records from 46 patients (56.5% male) were obtained. VAS and P-VAS showed a strong correlation (r(s )= 0.82, p < 0.001). Moderate correlations were found between VAS vs TNSS (r(s) = 0.53, p < 0.001) and between P-VAS vs TNSS (r(s) = 0.48, p < 0.001). There was a weak negative correlation between PNIF vs VAS, PNIF vs TNSS, and PNIF vs P-VAS (r(s) =-0.20, r(s )=-0.22, rs =-0.18, p < 0.001 respectively). In addition, a weak negative correlation was found between nasal congestion and PNIF (r(s )=-0.26, p < 0.001). The overall inter-rater agreement between VAS and TNSS was fair (Kappa = 0.37, p < 0.001). Higher inter-rater agreement was found in moderate-severe than in the mild PAR group (Kappa = 0.50 vs 0.17) and in adolescents than in the children group (Kappa = 0.44 vs 0.26). Conclusions: In small children, P-VAS was a reliable tool to assess nasal symptoms. Both subjective and objective measurements provided complementary information for symptom monitoring in patients with AR.
Background: Anaphylaxis is a life-threatening allergic reaction with rising incidence worldwide. Young children's limited ability to express symptoms adds unique diagnostic challenges. Objective: To study on anaphylaxis in children, including triggers, symptoms, treatment, atopic status impact, and adrenaline injection time intervals. Methods: In-patient medical records of children who were diagnosed with anaphylaxis during 2014-2021 were reviewed. Results: One hundred thirty-three anaphylaxis events were identified. Food (47%) was the most common trigger, followed by drugs (31%), blood components (17%), insects (3%), and idiopathic causes (2%). Ten cases of refractory anaphylaxis, 2 cases of biphasic reactions, and 1 case of persistent anaphylaxis were found. There were no reported fatalities. The most common presentations involved the skin (94%), followed by the respiratory (73%), gastrointestinal (47%), and cardiovascular (42%) systems. In atopic patients, wheezing was more prominent than in those without atopy (p-value = 0.017). In the non-atopic patients, there was a higher incidence of cardiovascular symptoms, particularly hypotension (p-value = 0.001), compared to individuals with atopy. Children under 5 years old with mild-moderate anaphylaxis required more time to reach the hospital (147.0 vs. 45.0 minutes, p = 0.033) and to receive adrenaline injections (35.0 vs. 9.0 minutes, p-value = 0.017) than those with severe anaphylaxis. Conclusion: Childhood anaphylaxis is prevalent. Children with mild-moderate anaphylaxis experienced delays in hospital visits and adrenaline administration. Education on allergies is needed to improve the identification and prompt response to anaphylactic reactions, especially in young children.
Background: Preclinical studies demonstrated anti-inflammatory effects of Zingiber montanum (J.K & ouml;nig) Link ex Dietr. (Phlai). However, its clinical effect on allergic rhinitis (AR) is not evident. Objective: We sought to assess the efficacy and safety of Phlai for treating AR. Methods: A phase 3, randomized, double-blind, placebo-controlled study was conducted. Patients with AR were randomized into three groups and received Phlai 100 mg or Phlai 200 mg or placebo once a day for four weeks. The primary outcome was a change in the reflective total five symptom score (rT5SS). The secondary outcomes were the change in the instantaneous total five symptom score (iT5SS), the reflective individual symptom scores (rhinorrhea, nasal congestion, sneezing, itchy nose, itchy eyes), Rhinoconjunctivitis Quality of Life-36 Questionnaire (RCQ-36) score, peak nasal inspiratory flow (PNIF), and adverse events. Results: Two hundred and sixty-two patients were enrolled. Compared with placebo, Phlai 100 mg improved rT5SS [adjusted mean difference (aMD)-0.62; 95%CI-1.22,-0.03; p = 0.039], rhinorrhea (aMD-0.19; 95%CI-0.37, 0.002; p = 0.048), itchy nose (aMD-0.24; 95%CI-0.43,-0.05; p = 0.011), and itchy eyes (aMD-0.19; 95%CI-0.36,-0.02; p = 0.033) at week 4. Nasal obstruction, sneezing, iT5SS, overall RCQ-36 score, PNIF did not reach statistical significance. Phlai 200 mg did not bring additional benefits compared to 100 mg. Adverse events were similar among groups. Conclusion: Phlai was safe. At four weeks, there were small improvements in rT5SS, together with the individual symptoms of rhinorrhea, itchy nose, and itchy eyes.
BACKGROUND:Allergic asthma in children significantly impacts quality of life, and immunotherapy, including subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT), has emerged as an effective treatment. However, their comparative immunological mechanisms remain unclear. OBJECTIVE:This study aimed to compare the effects of SCIT and SLIT on immune response in children with allergic asthma and to explore their underlying immunological mechanisms. METHODS:A total of 86 children aged 5-12 years with allergic asthma who visited Hangzhou Children's Hospital were prospectively enrolled and randomly assigned to three groups: inhaled corticosteroids (ICS) group (n = 30), SCIT group (n = 30), and SLIT group (n = 26). Clinical and immunological parameters-including Childhood Asthma Control Test (C-ACT) scores, forced expiratory volume in the first second percentage (FEV1%), Th17, Treg cells, and serum levels of IL-17, IL-9, IL-10-were assessed before treatment and after one year. RESULTS:After treatment, all three groups showed significant improvements in C-ACT scores and FEV1% compared to baseline (all p < 0.05). The SCIT and SLIT groups demonstrated greater improvements than the ICS group (all p < 0.05), with no significant differences between the SCIT and SLIT groups (p > 0.05). In terms of immune markers, significant differences were observed in all parameters before and after treatment in the SCIT and SLIT groups (all p < 0.05), while Treg levels in the ICS group remained unchanged (p > 0.05). No statistically significant differences in immune markers were found among the three groups post-treatment (all p >0.05). CONCLUSIONS:Both SCIT and SLIT, when combined with ICS, offer superior efficacy compared to ICS monotherapy. The comparable immunological changes observed in SCIT and SLIT suggest a shared mechanism of immune tolerance, potentially mediated through Treg cell induction.
BACKGROUND:Bullous systemic lupus erythematosus (BSLE) is a rare autoimmune blistering disorder occurring in association with systemic lupus erythematosus (SLE). Owing to its rarity, current knowledge remains limited, particularly in Southeast Asian populations. OBJECTIVE:This study retrospectively evaluated the clinical, histopathologic, immunofluorescence, and serologic features of BSLE, together with a review of the existing literature. METHODS:This review included patients diagnosed with BSLE at Siriraj Hospital, Mahidol University, between 2003 and 2024. RESULTS:Among 9,055 patients with cutaneous lupus erythematosus, 12 were identified as having BSLE (incidence 0.13%). The median age was 39.5 years with equal sex distribution. Most patients (75%) presented with BSLE at the time of SLE diagnosis, while others developed it later. Lesions appeared on sun-exposed and non-sun-exposed areas, mainly the extremities, and mucosal involvement occurred in 33.3%. Direct immunofluorescence most frequently demonstrated immunoglobulin (Ig) G deposition (91.7%), followed by complement 3 (83.3%), IgM (75%), and IgA (50%), typically with linear and/or granular deposition of IgG and C3 along the basement membrane zone. Antinuclear antibodies were present in all patients. Systemic involvement was common (75%), most frequently affecting the kidneys (66.7%), followed by hematologic abnormalities (58.3%). Owing to disease severity, most patients required treatment with systemic corticosteroids in combination with immunosuppressive agents rather than dapsone alone to achieve disease control. CONCLUSIONS:This study and literature review highlight that, although BSLE is an uncommon cutaneous manifestation of SLE, it is strongly associated with systemic involvement, particularly renal and hematologic disease, which often necessitates treatment with immunosuppressive agents.
BACKGROUND:Eosinophilic asthma is a severe phenotype in pediatrics, often refractory to conventional therapy. Biologic agents targeting Type 2 inflammatory pathway are increasingly used in children and adolescents. OBJECTIVE:To evaluate the efficacy and safety of omalizumab, mepolizumab, benralizumab, and dupilumab in pediatric eosinophilic asthma. METHODS:We systematically searched eight databases to March 31, 2025 (PROSPERO: CRD420251017602). Eligible studies were randomized controlled or controlled observational trials in patients 1≤8 years. Outcomes included lung function, asthma control, quality of life (QoL), and adverse events (AEs). RESULTS:Twenty-two studies (n = 2,468) were included. Biologics significantly improved predicted FEV1 (SMD = 0.97, 95%CI: 0.38-1.57), asthma control also improved (SMD = 2.84, 95%CI: 1.40-4.28), as did quality of life (SMD = 1.72, 95%CI: 0.39-3.05). Overall AEs were more frequent (OR 1.48, 95%CI 1.22-1.81), but serious AEs were rare and not increased. Evidence was strongest for omalizumab; data for other biologics remain limited. CONCLUSIONS:Biologic therapies are associated with improvements in clinical outcomes in children and adolescents with eosinophilic asthma, with an increased incidence of predominantly mild adverse events. However, the current evidence is largely driven by studies of omalizumab, and data for other biologics remain limited in pediatric populations. Further long-term and comparative studies are warranted to better define the efficacy and safety profiles of individual biologic agents.
BACKGROUND:The emergence of the SARS-CoV-2 Delta variant necessitated examining hybrid immunity (vaccination- plus-infection) to optimize boosting strategies. We analyzed the kinetics, magnitude, and durability of anti-spike receptor binding domain immunoglobulin G (Anti-sRBD IgG) following Delta infection. OBJECTIVE:This study analyzed the kinetics, magnitude, and long-term durability of anti-spike receptor binding domain immunoglobulin G (Anti-sRBD IgG) levels following Delta variant infection across individuals with diverse vaccination histories. METHODS:This observational cohort study monitored 161 patients with varying vaccination histories for up to 16 weeks post-infection. Responses were compared against SARS-CoV-2 naïve controls receiving a two-dose inactivated series plus a heterologous booster. Sub-analyses assessed post-infection booster immunogenicity. RESULTS:Prior vaccination significantly enhanced humoral responses. Patients with two prior doses achieved the highest median Anti-sRBD IgG peaks, surpassing vaccine-boosted naïve controls. While unvaccinated individuals exhibited delayed primary responses, hybrid immunity demonstrated superior durability with slower antibody decay than vaccine-only immunity. Crucially, while a post-infection booster effectively primed unvaccinated patients, early boosting in previously vaccinated individuals yielded minimal immunological gain. CONCLUSIONS:Prior vaccination significantly enhanced humoral responses. Patients with two prior doses achieved the highest median Anti-sRBD IgG peaks, surpassing vaccine-boosted naïve controls. While unvaccinated individuals exhibited delayed primary responses, hybrid immunity demonstrated superior durability with slower antibody decay than vaccine-only immunity. Crucially, while a post-infection booster effectively primed unvaccinated patients, early boosting in previously vaccinated individuals yielded minimal immunological gain.
BACKGROUND:Asthma is a heterogeneous disease with diverse and poorly defined phenotypes, especially in children. OBJECTIVE:We aimed to classify childhood asthma phenotypes using unsupervised cluster analysis based on type 2 (T2) biomarkers and to evaluate their clinical characteristics and outcomes. METHODS:We retrospectively analyzed 614 pediatric patients. Hierarchical clustering was performed using four variables: age, absolute eosinophil count (AEC), eosinophil cationic protein (ECP), and total immunoglobulin E (IgE). Clinical characteristics and two-year clinical outcomes were compared across clusters. The effect of age was examined using Analysis of Covariance (ANCOVA) and age-tertile subgroup analyses. RESULTS:Three distinct clusters were identified. Cluster 2, the T2-high asthma group (n = 157; median age: 8.0 years), was characterized by male predominance (69.4%), the highest levels of T2 biomarkers (AEC, ECP, IgE, FeNO; all P < 0.001), airway hyperresponsiveness (BDR, P = 0.024; PC20, P < 0.001), and reduced lung function (FEV1, P = 0.002). In contrast, Cluster 1 (n = 252; median age: 4.0 years) showed the highest exacerbation and steroid use rates but relatively low T2 biomarker levels. Cluster 3 (n = 205; median age: 12.0 years) had moderate T2 levels and the lowest exacerbation burden. After adjusting for age, Cluster 2 maintained 4-6 folds higher T2 biomarker levels compared to other clusters (all P <0.001). These cluster-specific differences were not observed in the age tertile subgroup analysis. CONCLUSIONS:The identified school-age T2-high cluster in childhood asthma exhibits distinct immunological and clinical phenotypes, characterized by high airway hyperresponsiveness, atopic features, and decreased lung function.
BACKGROUND:Dermatophagoides pteronyssinus and D. farinae are major indoor allergens. Raw materials derived from these house dust mites (HDMs) are used to produce allergen extracts. The stability of these materials is influenced by storage form and conditions, which can affect protein integrity. OBJECTIVE:To compare storage formats and conditions for maintaining physicochemical stability of HDM raw materials. METHODS:Pure mite bodies (PMBs), prepared in fresh frozen and lyophilized forms, were stored at -80°C, -20°C, and 25°C. Over a 12-month period, samples were assessed for total protein and major allergens (Der p 1 and Der f 1) using ELISA. Protein integrity was analyzed by SDS-PAGE. Accelerated stability testing at 25°C for up to 14 days was also performed. RESULTS:Storage at -80°C best preserved total protein and Group 1 allergen content over 12 months. At -20°C, moderate declines were observed, with D. farinae showing greater reductions than D. pteronyssinus. Lyophilized samples were generally more stable than fresh-frozen ones at -20C°. Accelerated testing at 25°C caused marked losses over 14 days. CONCLUSIONS:Ultra-low temperature storage (-80°C) remains optimal for preserving physicochemical stability of HDM raw materials. Lyophilization with -20°C storage is a promising, context-dependent option; however, in the absence of residual-moisture and immunological data, these findings should be interpreted as preliminary and limited to raw-material handling.
BACKGROUND:Asthma is a heterogeneous disease influenced by genetic and environmental factors. Type 2 (T2)-high asthma has been extensively studied; however, the pathophysiological mechanisms of T2-low asthma remain unclear. OBJECTIVE:The present study aimed to determine the clinical indices contributing to asthma exacerbation and identify the phenotypes of T2-low asthma. METHODS:We used data from the NHOM Asthma Study (N = 1925), a nationwide asthma cohort study conducted in Japan. T2-low asthma was defined by eosinophils < 150/μL and fractional exhaled nitric oxide levels < 25 ppb. The clinical indices associated with asthma exacerbation were identified using univariate and multivariate analyses. Hierarchical cluster analysis was performed to classify the phenotypes of T2-low asthma. RESULTS:Multivariate analysis revealed that younger age and comorbid allergic diseases contributed to the exacerbation of T2-low asthma. Four phenotypes were identified: Cluster 1 (n = 19, 7.8%, smoking-related T2-low asthma with preserved pulmonary function), Cluster 2 (n = 18, 7.4%, smoking-related T2-low asthma with low pulmonary function), Cluster 3 (n = 99, 40.7%, elderly, female-dominant, late-onset T2-low asthma), and Cluster 4 (n = 107, 44.0%, younger, female-dominant, comorbid with allergic disease T2-low asthma). Clusters 2 and 4 were prone to asthma exacerbation, indicating distinct allergen sensitization. CONCLUSIONS:These findings indicate that antigen-specific IgE profiles may reflect the phenotypic heterogeneity of T2-low asthma and could serve as potential biomarkers for identifying subgroups at increased risk of exacerbations.
BACKGROUND:Inhaled corticosteroids (ICS) represent an alternative treatment option to systemic corticosteroids (SCS) in the treatment of asthma and chronic obstructive pulmonary disease (COPD); however, detailed clinical guidance on the use of nebulized ICS, such as budesonide, in the management of asthma and COPD remains scarce. OBJECTIVE:To review the literature and develop Delphi consensus statements on the use of nebulized ICS for the management of asthma and COPD in adults. METHODS:An expert panel of 13 respiratory physicians, comprising pulmonologists (n = 9), allergists (n = 1), and emergency department consultants (n = 3) from tertiary medical centers in Thailand, undertook a Delphi procedure with the aim of developing evidence-based consensus statements on the use of nebulized ICS in patients with asthma and COPD. Panelists used a 5-point Likert scale to score their agreement with each statement. RESULTS:A total of 12 Delphi consensus statements pertaining to the use of nebulized ICS in the management of asthma and COPD in both acute and maintenance care were developed. The overall consensus of the panel across the 12 statements was very high (mean agreement score, 4.2-4.9/5). The panelists expressed strongest consensus agreement (84.6% strong agreement) with the following two statements: 1) inhalation devices are the cornerstone of drug delivery in patients with asthma and COPD, and 2) for adult asthma and COPD patients with severe exacerbations, nebulization is more suitable for drug delivery than a pMDI plus spacer. CONCLUSIONS:Nebulized budesonide is an effective and well tolerated treatment option for the management of asthma and COPD.
BACKGROUND:Previous studies have demonstrated that salbutamol administration via metered-dose inhaler with spacer (MDI-S) is as effective as using a jet nebulizer (NEB) for treating children experiencing asthma exacerbation. However, a paucity of research focuses on the direct medical costs associated with each mode of salbutamol administration for asthma exacerbation. OBJECTIVE:This study aims to compare the effectiveness and direct medical costs of salbutamol administration via MDI-S versus NEB. METHODS:A retrospective cohort study was conducted on the medical records of children under 18 years old presenting with mild to moderate asthma exacerbation. Clinical responses to salbutamol administration were assessed using the Ramathibodi Pediatrics Asthma Scores. The costs and clinical outcomes (i.e., Asthma score and hospitalization averted) were compared using the Incremental Cost-Effectiveness Ratio (ICER) from a hospital perspective. RESULTS:The study included 95 medical records from 72 children, with 33 records of MDI-S and 62 records of NEB. Both the MDI-S and NEB groups showed significant reductions in asthma scores post-treatment. Children with moderate asthma exacerbation treated with MDI-S had a lower hospitalization rate than those treated with NEB (20% vs 57.5%, p = 0.034). The cost-effectiveness analysis indicated that the MDI-S group incurred lower costs and was considered cost-saving compared to the NEB group, with an ICER of -4.60 US dollars per one-point improvement in asthma score and -20.07 US dollars per hospitalization averted. CONCLUSIONS:Salbutamol administration via MDI-S offers clinical effectiveness comparable to NEB and is more cost-effective.
BACKGROUND:The allergenic relevance of the living environment changes over the last decades is largely unknown. OBJECTIVE:We aimed to compare the factors associated with asthma and/or rhinitis between 2008 and 2018. METHODS:We assessed two nationally representative cross-sectional datasets in 2008 and 2018. Within the rigorous protocol, questionnaire and serum IgE measurement were conducted in 2322 and 2353 patients with allergic asthma (A) and/or rhinitis (R) respectively. Multivariate logistic regression analysis was used to examine the effect of different factors on sensitization. RESULTS:The prevalence of sensitization increased in rhinitis alone (A-R+, 63% in 2008 vs. 67.7% in 2018, P = 0.039) and asthma with rhinitis (A+R+, 70.6% vs. 75.1%, P = 0.014). The common factors for sensitization were male sex, using mattress and air conditioner, family history of rhinitis, building age > 30 years, and meat consumption. Compared with 2008, secondhand smoke was an additional risk factor for A+R- (odds ratio [OR] 2.17, 95% confidence interval [CI] 1.18-7.01) and A+R+ (OR 1.72, 95%CI 1.03-3.14), and the odds of farmland or forest for pollen and mold sensitization were higher in 2018 (OR 3.61, 95%CI 2.79-4.66, and OR 1.86, 95%CI 1.34-2.58). Eating fish was inversely associated with A-R+ (OR 0.68, 95%CI 0.52-0.91, P < 0.01), while older age also showed an inverse relationship with sensitization. The OR of age 25-44 years was higher in 2018. CONCLUSIONS:Repeated surveys showed variations in the factors affecting allergic asthma and/or rhinitis. The variable factors included age of 25-44 years, secondhand smoke, farmland, forest, and fish consumption.
BACKGROUND:Asthma are associated with the vitamin D axis. Genetic variations of VDBP, notably rs7041 and rs4588, influence circulating vitamin D levels. However, data on their link to asthma are inconsistent, and ethnic differences remain unclear. OBJECTIVE:We explored how genetic variations in VDBP affect vitamin D levels and susceptibility to asthma across diverse ethnic populations. METHODS:In our cross-ethnic study, we analyzed vitamin D levels and VDBP polymorphisms (rs7041 and rs4588) in Taiwanese, Mongolian, Lithuanian, and Latvian populations. Our study included 363 asthmatic subjects and 481 non-asthma controls. We performed genotyping for rs7041 and rs4588 and assessed serum concentrations of 25-hydroxyvitamin D [25(OH)D], examining the associations between VDBP polymorphisms, vitamin D levels, and asthma. RESULTS:The study found significant differences in vitamin D levels among ethnic groups. Non-asthmatic individuals from Taiwan had higher concentrations, while asthma subjects in both Taiwanese and Lithuanian populations showed lower levels compared to their non-asthma counterparts (both p-value < 0.001). VDBP polymorphisms were associated with asthma in the Latvian population, with the rs7041 GG vs. GT+TT showing an odds ratio (OR) of 1.72 (95% confidence interval (CI): 1.10-2.69, p = 0.016) and the rs4588 CC vs. CA+AA showing an OR of 1.88 (95%CI: 1.24-2.84, p = 0.003). However, this association was not observed in other populations. CONCLUSIONS:Our cross-ethnic study underscores the intricate relationship between VDBP genetic variations, vitamin D levels, and asthma vulnerability. The association of VDBP polymorphisms with asthma seems to differ among populations, emphasizing the importance of a nuanced comprehension of these connections.
BACKGROUND:Inhaled corticosteroids (ICS) are the first-line therapy for pediatric asthma. However, very few studies have developed simple tools for predicting treatment outcomes in pediatric asthma. OBJECTIVE:This study aimed to construct a predictive model for poor asthma control in children after 6 months of ICS therapy. METHODS:This retrospective study included children with asthma, aged 6-15 years, who received ICS with complete follow-up for 6 months. The potential factors associated with poor asthma control were also assessed. Poor control was considered if the child had partial or uncontrolled symptoms according to the Global Initiative for Asthma guidelines. RESULTS:Among the 165 eligible children, 33 (20%) had poor symptom control. The factors associated with poor control were a history of more than four exacerbations in the 12 months before ICS treatment (odds ratio [OR], 3.39 [1.06, 10.83]), the presence of moderate to severe allergic rhinitis symptoms at the 6-month follow-up visit (OR, 21.93 [2.97, 162.05]), and poor adherence to asthma medications (OR, 4.16 [1.32, 13.12]). By incorporating these factors, a model for predicting poorly controlled asthma was constructed and converted into a nomogram with a total score of 200, with prediction risk ranging from 0 to 100%. The area under the receiver operating characteristic curve of the developed model was 0.737, indicating a moderate performance level. CONCLUSIONS:We developed a predictive tool for poor asthma control. The model has a good discriminatory ability and is simple to use, which could facilitate the individualized management of children with asthma.
BACKGROUND:Non-allergic eosinophilic asthma (NAEA) is a distinct subtype of asthma. However, the immune mechanisms associated with NAEA are not yet clearly understood. OBJECTIVE:To gain further insight into the pathogenesis of NAEA. METHODS:The proportion of innate lymphoid cells (ILCs) in the blood of patients with allergic eosinophilic asthma (AEA) and NAEA was evaluated. Eosinophilic asthma was defined when fractional exhaled nitric oxide measured at diagnosis (before initiating anti-asthma medications) was greater than 50 ppb. We evaluated the genome-wide gene expression profiles in peripheral blood mononuclear cells obtained at enrollment (in a stable state). RESULTS:A total of 57 participants were enrolled (10 healthy controls, 23 patients with NAEA, and 24 patients with AEA). We found that the type 1 ILC (ILC1) proportion significantly decreased, but the type 2 ILC (ILC2) and type 3 ILC (ILC3) proportions significantly increased in the blood of both patients with NAEA and those with AEA compared with healthy controls. However, there were no significant differences in the ILC1~3 proportions between NAEA and AEA patients. We also identified distinct biological pathways in patients with NAEA (anti-viral pathway) or AEA (IL-4 and IL-13 signaling and neutrophil degranulation pathways) based on co-expressed gene modules showing significant correlations with the ILC proportions. CONCLUSION:ILC proportions in the blood did not differ between NAEA and AEA patients. However, different biological pathways were related to the ILC proportions in these patients. Our results provide further insight into eosinophilic airway inflammation in allergic and non-allergic patients.
BACKGROUND:The ISAAC phase III study in Korea found a higher incidence of wheezing illnesses among residents in basements or semi-basements. OBJECTIVE:This study investigates the link between living in banjihas (semi-basements) and airway resistance and Th2 airway inflammation in Korean children, compared to those on higher floors. METHODS:We assessed 575 fifth- and sixth-grade students (aged 10-12) in an inner-city area of South Korea. The study utilized impulse oscillometry to measure small and total airway resistance (Rrs20-5 and Rrs0, respectively) and Fractional Exhaled Nitric Oxide (FeNO) measurements to evaluate airway inflammation. We also considered a range of biological and environmental factors, including allergen sensitization, serum 25-hydroxyvitamin D levels, and urinary metabolites like VOCs, bisphenol, and triclosan. Participants were categorized by living floors: banjihas, first-fifth floors, and sixth floors or higher. RESULTS:Twenty-five children (4.3%) lived in banjihas, 311 (54.1%) on the first to fifth floor, and 239 (41.6%) on the sixth floor or above. Despite similar levels of allergen sensitization and urinary pollutant metabolite levels across all groups, banjiha dwellers showed significantly higher total airway resistance (adjusted &1: 0.633, 95%CI: 0.156, 1.109; P = 0.009) and a greater prevalence of elevated FeNO levels (> 35 ppb) (P = 0.033). These findings persisted after adjusting for critical factors like height, gender, BMI z-score, and birth conditions. CONCLUSION:Children in banjihas exhibit elevated airway resistance and FeNO levels independently of allergen sensitization or pollution exposure, underscoring the necessity for enhanced focus on their respiratory health in such living conditions.
