Atopic Conditions Research Articles

Effect of prenatal dog exposure on eczema development in early and late childhood

Eczema in early childhood, often the start of the atopic march, increases the likelihood of developing subsequent atopic conditions (food allergy, allergic asthma, and allergic rhinitis).1,2 Modifiable environmental risk factors, which are important to eczema pathogenesis, may represent potential interventions. Studies demonstrate the protective effects of domestic pets on eczema development.3,4 Previous reports focused on eczema in early childhood but did not address potential effects in late childhood.

S498 The Eosinophilic Esophagitis Patient With Multiple Atopic Conditions: Clinical Characteristics and Treatment Response to Topical Steroids

Introduction: Patients with eosinophilic esophagitis (EoE) commonly have other atopic conditions, but the impace of multipe allergic diseases is unknown. We aimed to determine whether EoE patients with multiple atopic conditions have differences in presentation or response to topical corticosteroid (tCS) treatment. Methods: This retrospective cohort study of the UNC EoE Clinicopathologic database assessed adults and children with a new diagnosis of EoE. Demographics, clinical characteristics, and procedural data were extracted. We calculated the total number of atopic comorbidities and defined a group with ≥2 atopic conditions (not including allergic rhinitis given its high prevalence in our region). For those with tCS treatment and follow-up endoscopy/biopsy, we assessed histologic response (< 15 eos/hpf), global symptom response, endoscopic response, EREFS, and an endoscopic severity score (ESS). Patients with and without multiple atopic conditions were compared at baseline, and also before and after treatment. Results: Of 1020 EoE patients with atopic disease information, 426 (42%) had no atopy, 235 (23%) had 1 atopic comorbidity, 211 (21%) had 2, 113 (11%) had 3, and 34 (3%) had 4. The mean age of EoE diagnosis varied by associated atopic condition (EoE in patients with eczema was diagnosed at 18.5 yrs, with food allergy at 24.5 yrs, asthma at 27 yrs, allergic rhinitis at 28 yrs). The 180 (18%) patients with ≥2 atopic diseases were younger (22 vs 31 yrs; p< 0.001) and had more vomiting, less abdominal pain, more exudates and edema on endoscopy, and higher peak eosinophil counts (73.4 vs 62.6; p=0.003). On multivariate analysis, younger age, lack of abdominal pain, exudates, and higher eosinophil counts were independently associated with multiple atopy. In 465 patients treated with tCS, there was no difference in histologic response in patients with and without multiple atopic conditions (Table), and response rates were between 56%-63% for patients with 0-4 concomitant atopic conditions. Conclusion: EoE patients commonly have multiple atopic diseases. At time of diagnosis, patients with ≥2 atopic diseases were younger, less likely to have abdominal pain, and more likely to have exudates on endoscopy and a higher eosinophil count on biopsy. However, there were no major differences in histologic treatment response to corticosteroids, though a non-response rate of ∼40% was seen regardless of atopic status.

S501 High Burden of Disease and Associated Costs for Eosinophilic Gastrointestinal Diseases: Results From an Online Patient-Centered Research Network

Introduction: Data regarding health care-related costs and the burden of disease for non-EoE eosinophilic gastrointestinal diseases (EGIDs) are lacking, particularly from the patient perspective. We aimed to determine the patient-reported health care burden of disease and costs related to care for non-EoE EGIDs. Methods: We performed a retrospective cohort study based in EGID Partners (egidpartners.org), an online patient-centered research network designed and launched in 2020 by patient advocacy groups (PAGs) and researchers. Subjects were recruited via informational emails, social media, directed messages through patient healthcare portals, webinars, and by physicians. Adult (≥18 years) EGID patients and caregivers of children < 18 years with EGIDs could join and complete surveys which included a burden of disease questionnaire. This instrument recorded patient-reported healthcare utilization over the prior year related to heath care visits and procedures, as well as out-of-pocket costs/payments. We calculated the median total costs and number of visits. Results: Of 58 non-EoE EGID patients with health care utilization data (mean (SD) age 29 (19) years; 69% female; 95% white; 88% with an atopic condition; mean (SD) 7.4 (9.9) years of symptoms prior to diagnosis), 13 had eosinophilic gastritis (EoG), 17 had eosinophilic enteritis (EoN), 6 had eosinophilic colitis (EoC), and 22 had multiple areas of overlap; additionally, 27 had esophageal involvement. The median number of health care visits over the prior year was 12 (IQR: 5-33; range 1-90), with a median of 5 outpatient doctor visits, 3 urgent care/ED visits or hospitalizations, and 2 endoscopy visits; results were similar for adult patient report (n=42) or caregiver report for pediatric patients (n=16) (Table). The annual median costs were $1000 (IQR: $100-$3570; range: 0-$100,400). Median costs for outpatient visits, testing, and medications were $250, $400, and $325, respectively. Costs were similar for adult patients and caregivers (Table). Conclusion: Patients with non-EoE EGIDs experience a high health care burden, with frequent health care encounters (median of 1 encounter/month) and substantial out-pocket costs (median of $1000/year). Both adult and pediatric providers must maintain awareness of the substantial burden in costs to EGID patients, including challenges for patients to manage their disease given these costs.

Significance of constitutional in atopic dermatitis

Atopic Dermatitis is an intermittent severely pruritic eczematous dermatitis with scaly erythematous patches, vesiculation, crusting and fissuring. It is a reaction pattern that presents with variable clinical and histological findings. It affects at least 20% of school children and 5-10 %of adults. It constitutes atopy, a condition of altered reactivity to common and mild environmental stimuli. Mainly affects the face and flexures of infants and childrens. In infants, eczema often starts on the face before spreading to the body.There is positive family history or past history of atopic conditions like asthma, etc.

Corticosteroid exposure and cumulative effects in patients with eczema: Results from a patient survey

BackgroundIndividuals with eczema may have substantial lifetime corticosteroid exposure, increasing the risk of corticosteroid-related side effects. ObjectiveTo conduct a patient survey evaluating corticosteroid exposure and its cumulative effects in individuals with eczema. MethodsThe multinational online survey was conducted between November 5, 2020, and January 11, 2021. Participants were aged 18 years or older and a patient (n = 1889) or a caregiver of a child (n = 271) diagnosed with having eczema by a medical professional. ResultsAll participants reported using corticosteroids. Average duration of topical corticosteroid (TCS) use was 15.3 years in adults and 3.6 years in children; 75% used TCS 1 to 2 times a day and 50% applied TCS 15 to 30 days/mo. Frequency and duration could not be determined by varying prescription TCS potencies. Oral corticosteroid use was reported by 36% of the participants (23% for eczema), with a lifetime average of 8.4 courses in adults and 8.1 courses in children. Corticosteroids for non-eczema atopic conditions were reported by 49% of the participants. In participants using TCS, 83% of adults and 64% of children experienced worsening symptoms over time. Development of new symptoms and conditions increased with a greater number of corticosteroid treatments and longer duration of TCS use but may have been owing to eczema progression. Symptoms consistent with topical steroid withdrawal syndrome after TCS discontinuation were reported by many participants. ConclusionReported substantial corticosteroid exposure throughout their lifetime eczema experience placed participants at risk of negative outcomes. Corticosteroids are a critical component of eczema treatment for many patients. However, careful corticosteroid prescribing practices and monitoring are needed to avoid side effects. When possible, corticosteroid-sparing strategies should be explored.

The Role of TGFβ and Other Cytokines in Regulating Mast Cell Functions in Allergic Inflammation.

Mast cells (MC) are a key effector cell in multiple types of immune responses, including atopic conditions. Allergic diseases have been steadily rising across the globe, creating a growing public health problem. IgE-mediated activation of MCs leads to the release of potent mediators that can have dire clinical consequences. Current therapeutic options to inhibit MC activation and degranulation are limited; thus, a better understanding of the mechanisms that regulate MC effector functions in allergic inflammation are necessary in order to develop effective treatment options with minimal side effects. Several cytokines have been identified that play multifaceted roles in regulating MC activation, including TGFβ, IL-10, and IL-33, and others that appear to serve primarily anti-inflammatory functions, including IL-35 and IL-37. Here, we review the literature examining cytokines that regulate MC-mediated allergic immune responses.

Pediatric eosinophilic esophagitis outcomes vary with co-morbid eczema and pollen food syndrome.

BackgroundEosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease characterized by eosinophil inflammation of the esophagus. It has been described as a component of the Allergic March and is often seen with other atopic diseases. Some atopic diseases, including asthma, are known to be heterogenous with endotypes that guide treatment. Similarly, we propose that EoE is a heterogenous disease with varying phenotypes and endotypes that might impact response to therapy.MethodsA single-center retrospective review of pediatric patients ≤18 years of age diagnosed with EoE was conducted. All gastrointestinal clinic visits and esophagogastroduodenoscopies (EGD) from disease presentation through the first three years after diagnosis were reviewed. Histologic remission rate and therapies utilized [proton pump inhibitor (PPI), topical steroid, dietary elimination] were assessed.ResultsOne hundred and thirty-seven patients were included, 80% of whom had at least one concurrent atopic condition at diagnosis, with food allergies being the most common (57%) followed by eczema (34%), and asthma (29%). The remission rate of the overall cohort was 65%, and by concurrent allergy, comorbid pollen food syndrome and eczema had the highest remission rates at 100% and 81%, respectively followed by asthma (62%), food allergies (62%), seasonal allergic rhinitis (60%), and history of anaphylaxis (56%). Kaplan-Meier curves for each atopic condition show that patients with eczema and pollen food syndrome achieve histologic remission faster than those without. All treatment modalities were more successful in patients with eczema than those without, and PPI was most effective treatment at inducing remission.ConclusionsIn a real-world pediatric cohort, 80% of patients with EoE had an underlying atopic condition. Patients with eczema and pollen food syndrome had a swifter response and were more likely to achieve histologic remission than patients with other atopic conditions. This study suggests that EoE, like other allergic diseases, may have heterogenous phenotypes that could affect response to treatment. There is currently a knowledge gap in classifying EoE based on endotypes and phenotypes at diagnosis and correlating responses to various treatment modalities.

Paediatric anaphylaxis in South Africa

IntroductionAnaphylaxis is a severe, life-threatening generalized hypersensitivity reaction. While guidelines to reduce the morbidity, risk, and mortality of anaphylaxis are widely available, adherence to these is often suboptimal. We aimed to audit paediatric anaphylaxis at a South African tertiary allergy referral centre, comparing our data to those of the large Network of Severe Allergic Reactions (NORA) registry. MethodsChildren treated for severe allergic reactions between January 2014 and August 2016 were identified for screening using ICD-10 coding of all admissions and discharges, pharmacy records of adrenaline autoinjector dispensing, and additional referrals from the allergy department to the study. Screened participants not meeting the inclusion criteria after preliminary questioning and/or folder review were excluded. Data were collected via a standardized questionnaire using direct interviews, and captured on a local web-based registry. ResultsOf the 156 episodes analysed, >40% were graded as severe and nearly two-thirds of patients were seen for a recurrent episode. Males, younger children, and individuals of mixed-race ethnicity were more frequently affected. Skin and mucosa were most commonly involved, followed by respiratory and gastrointestinal involvement; cardiovascular and other systemic involvement occurred infrequently. Specific IgE assay was the most frequently requested test. Food-related triggers (peanut, hen's egg, fish, cashew nuts and cows' milk) predominated and decreased with age. Anaphylaxis was strongly correlated with atopic conditions. While prophylactic measures were almost universally instituted, adrenaline was rarely used, by both lay persons and healthcare professionals. Hospital admissions were infrequent, and no deaths were recorded. ConclusionManagement of anaphylaxis should be improved. Specifically, the use of adrenaline prior to hospital arrival remains suboptimal. Ongoing education and training of patients, parents, teachers, and healthcare workers is identified as an area requiring intensification.

Homoeopathy and Atopic Dermatitis: An Evidence-Based Clinical Case Report

Atopic dermatitis is a common inflammatory skin disorder characterized by recurrent skin lesions with severe intolerable itching. This disease condition can affect all age groups. Multiple comorbidities are associated with atopic dermatitis-like atopic asthma, allergic rhinitis time mental disorders. There is no permanent recovery of this condition. Still, increasing numbers of innovative and targeted therapies like (corticosteroids, Antihistamines, Immuno-suppressant drugs, antibacterial medicines, light therapy, etc.) are being used to control the disease condition. There is a valuable role of homoeopathy in different skin diseases, including atopic dermatitis. This article illustrates a documented case report of a patient with atopic dermatitis. In this particular case, atopic dermatitis condition is treated by Natrum muriaticum, based on the constitutional totality of the patient. The improvement was documented by SCORAD (scoring atopic dermatitis) and photography evidence during follow up.[1]

Assessment of sleep disturbance in patients with atopic conditions

Sleep is critical to our overall health and well-being. Survey data of the Centers for Disease Control and Prevention report that 34.1% of children, 74.6% of adolescents, and 32.5% of adults have insufficient sleep.1 The coronavirus disease 2019 pandemic further negatively affected sleep among all age groups. Atopic conditions in children affect sleep, causing adverse changes in behavior, concentration, school performance, and growth.2,3 Sleep disturbances in children also directly affect their caregivers’ sleep.

Infant Exposure to Acid Suppressant Medications Increases Risk of Recurrent Wheeze and Asthma in Childhood

Acid suppressant medications (ASMs) are commonly prescribed in infancy. Little is known about the relationship between ASM exposure and risk of childhood asthma and atopic conditions. We sought to examine the association between infant ASM exposure and risk for developing recurrent wheeze, allergen sensitization, and asthma in early childhood. We used data from a diverse, multicenter, prospective cohort study of 921 infants with a history of bronchiolitis. ASM exposure (histamine-2 receptor antagonists and/or proton pump inhibitors) during infancy (age: <12 months) was ascertained by parent report and medical record review. The outcomes were recurrent wheeze by age 3 years, early childhood allergen sensitization (serum specific IgE), and asthma by age 6 years. We constructed multivariable Cox proportional hazards models and multivariable logistic regression models adjusting for multiple confounders. Of the 921 children in the cohort, 202 (22%) were exposed to ASMs during infancy. Compared with unexposed children, those exposed to ASM were more likely to develop recurrent wheeze by age 3 years (adjusted hazard ratio: 1.58, 95% confidence interval [CI]: 1.20-2.08, P= .001) and asthma by age 6 years (adjusted odds ratio: 1.66, 95% CI: 1.22-2.27, P= .001). ASM exposure during infancy was not significantly associated with the development of early childhood allergen sensitization (adjusted odds ratio: 1.00, 95% CI: 0.70-1.44, P=.99). Although exposure to ASMs during infancy does not increase the risk of allergen sensitization in early childhood, ASM exposure during infancy increases the risk of recurrent wheeze and asthma during early childhood.

Molecular systems processes and cellular mechanisms-causing to itching tingling and aching in atopic dermatitis skin conditions and repercussions for innovative therapeutics

: Atopic dermatitis (AD) is a prolonged seditious, rabble rousing, and inflammatory—provocative skin disease. The subjects (i.e., patients) by means of atopic-dermatitis suffer incendiary lesions linked through extreme itching plus discomfort, and that is leading to sleep disorder (and also rarely apnea), weak mental and psychological health and also quality-of-life (QoL). : This study discusses the molecular systems processes/mechanisms causing to itching, tingling and irritation plus aching signs in atopic-dermatitis and examine the existing clinical, medical-advancement of therapies for mild-to-acute atopic-dermatitis. : The molecular pathology of AD contains abnormal immune, protected stimulation including substantial crisscross-talk amongst the skin and safe and neural cells/neuronal cells. Exogenous and endogenous triggers modulate stimulus of mediators including cytokine/chemokine expression/release by the skin and immune cells, which causes inflammation, skin barrier disruption, activation and growth of sensory neurons, itching and paining. These complex interactions among cell types are mediated primarily by cytokines, but also involve chemokines, neurotransmitters, lipids, proteases, antimicrobial peptides, and agonists of ion channels or various G protein–coupled receptors. : Patients with atopic dermatitis have a cytokine profile characterized by abnormal levels of interleukins 4,12,13,18,22,31 and 33; thymic stromal lymphopoietin; and interferon gamma. Cytokine receptors mainly signal through the Janus kinase/signal transducer and activator of transcription pathways. Among emerging novel therapeutics, several Janus kinase inhibitors are being developed for topical or (general nut systemic) systematic treatment of mild to acute AD tis as of their ability to regulate-cytokine countenance then make available. Janus-kinase hampers take the lead to variations in genetic representation which has positive impacts on provincial and general (universal) cytokine-release, and possibly additional intermediaries, so well regulating molecular-cellular-mechanisms accountable for irritation, itching, tingling followed by agony in AD. : This study explored the skin disorder in which the skin develops pink, inflamed plus wound.

Impact of comorbid pathology on the quality of life of patients with bronchial asthma

Aim. To study the impact of comorbidities on health-related quality of life (QoL) in patients with asthma, and their interaction with disease control.Materials and methods. We interviewed and examined 360 patients with mild-to-moderate asthma, aged 18 to 62 years, who received standard basic therapy. The examined patients were divided into 2 groups: without concomitant diseases (n=193) and with comorbid conditions (n=167). QoL and the state of the emotional sphere were assessed using the SF-36, AQLQ, HADS questionnaires. The level of asthma control was determined by the ACT questionnaire. The lung function was assessed by means of spirometryResults. Chronic rhinosinusitis, atopic conditions, obesity or overweight, gastroesophageal reflux disease, diseases of the hormonal system were noted among the most frequent comorbidities. Out of 167 asthma patients with comorbidities, 107 had one, and 60 had two or more comorbid conditions. Analysis of the overall QoL according to the SF-36 questionnaire showed a decrease in physical activity in patients with comorbidities. When analyzing specific QoL according to the AQLQ questionnaire, a significant difference was found in the “Activity” domain, the level of which was lower in the group of patients with comorbidity. Calculation of the odds ratio (OR) showed that the presence of comorbid conditions in a patient with asthma increases the likelihood of a decrease in QoL in the domain of physical activity by 2.7 times, and in the presence of two or more concomitant diseases – by 8.4 times.Conclusion. The presence of comorbid pathology reduces the physical functioning and general activity of patients with asthma. The chances of a decrease in QoL in the domain of physical activity increase many times in the presence of two or more comorbid conditions. The addition of concomitant diseases eliminates the influence of the emotional state and, in particular, anxiety, on general health, vitality, and the role of physical problems in limiting the life of asthma patients.

A clinic-corelative observational study on nasal smear eosinophilia in allergic rhinitis verses non-allergic rhinitis

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Diagnostic nasal cytology has been used in distinguishing allergic from nonallergic rhinitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We sought to determine prospectively the frequency of nasal eosinophilia in 100 patients in whom having allergic rhinitis, nonallergic rhinitis, and other atopic conditions not involving the respiratory tract have been diagnosed. A nasal smear was obtained from consenting adults using the rhino-probe curette. Patients taking local or systemic corticosteroids, those with chronic rhinitis associated with aspirin sensitivity, and those with sinusitis were excluded. All cytograms were coded and read by a single ‘blinded’ investigator. NE was considered significant if greater than 20% of sampled cells were eosinophils.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;28 of 50 (56%) patients were with AR had NE. No NE was detected in the control population or in the skin test negative group of patients in whom having nonallergic rhinitis was diagnosed. One of 36 patients with allergic disease not involving the respiratory tract exhibited NE; this patient had atopic dermatitis with peripheral eosinophilia. No cases of eosinophilic nonallergic rhinitis were detected. There was no significant correlation of symptoms or the number of positive skin tests with NE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; These data suggest that the nasal smear for eosinophils is an insensitive but specific test for the diagnosis of allergic rhinitis, when patients with nasal polyposis and aspirin sensitivity and/or negative skin tests are excluded.&lt;/p&gt;

A phase 1b/2 trial of dupilumab given in conjunction with PD-(L)1 blockade in the treatment of relapsed/refractory metastatic NSCLC.

TPS9139 Background: Although tumor microenvironments may contain chronic inflammatory cells, this milieu can lead to immune evasion and may contribute to resistance to immunotherapy. Dendritic cells are one of the most potent cross presenters of tumor antigen, and their function is crucial to tumor-directed adaptive immune responses. In the KP mouse model of lung adenocarcinoma (KrasG12D; Tp53-/-), we recently identified interleukin-4 (IL-4)-driven suppression of tumor-antigen charged dendritic cells, which was similarly seen in human lung cancer lesions (Maier, B., et al., A conserved dendritic-cell regulatory program limits antitumour immunity. Nature, 2020.580[7802]:257-262). In the mouse model IL-4 blockade resulted in an increase in IL-12, IFNg and TNF in CD8+ T cells and decreased tumor burden, and further antitumor activity was seen when combined with PD-L1 blockade. Dupilumab is a fully human monoclonal antibody that blocks the IL-4 receptor alpha subunit which disrupts signaling through receptors for both IL-4 and IL-13; it is FDA approved for patients with multiple atopic conditions, in whom series adverse effects are rare. Based on this pre-clinical data, we hypothesize that the addition of dupilumab to anti PD-(L)1 therapy will be well tolerated, and will rescue the anti-tumor effect of immune checkpoint blockade. Methods: This is a phase Ib/II trial. Patients with relapsed/refractory NSCLC who have received prior anti PD-(L)1 treatment are eligible for enrollment. In a phase Ib safety run-in, six patients will be enrolled in a modified set-dose 3+3 design. If no more than 1 DLT is observed during this phase, the trial will proceed to phase II. Phase II will enroll a further 15 patients in a minimax design with early stopping for futility to a maximum total of 21 patients. Patients will undergo pre-treatment biopsies and peripheral blood sampling prior to receiving 3 doses of dupilumab, administered every three weeks, in conjunction with continuing standard-of-care anti-PD-(L)1 therapy. Patients will undergo repeat biopsies 4 weeks after starting therapy. After completion of dupilumab (at 9 weeks) patients will undergo repeat staging. The primary endpoint of phase 1b is safety as measured by frequency and severity of adverse effects. The primary endpoint of phase II is overall response rate as assessed using RECIST 1.1 criteria at the time of post-dupilumab imaging. Exploratory endpoints include analysis of peripheral blood by CyTOF and O-link, and tissue biopsies will be analyzed by multiplex-IHC and bulk-RNA-sequencing. T cell receptor sequencing will be performed on tumor and matched peripheral blood samples, and circulating tumor DNA will be assessed at multiple time points. Phase 1b is currently enrolling as planned. Clinical trial information: NCT05013450.

Evaluating the Impact of Perinatal Depression on Fetal and Childhood Development

Perinatal maternal depression leads to a variety of biochemical and behavioral changes in utero. These alterations are linked to impaired fetal development and may also be detrimental to future neonatal, pediatric, and adolescent health. There is a marked rise in the incidence of atopic triad conditions, such as dermatitis and asthmatic wheezing, in children of pregnant mothers with antepartum depression, possibly due to an aberrant TH2 immunologic response and increased fetal oxidative stress. Maternal antepartum depression may also contribute to small-for-gestational age birth status, anomalous fetal neurotransmitter levels, and depression throughout infancy and adolescence. Cortisol has been implicated as a common causative factor responsible for many of these negative offspring outcomes. Minimal research on untreated major depression in pregnancy has been conducted. However, current studies emphasize the importance of holistically evaluating the risks associated with untreated major depression in pregnancy in order to minimize harmful effects on children.

A Non-Invasive Neonatal Signature Predicts Later Development of Atopic Diseases.

Background: Preterm birth is a major cause of morbidity and mortality in infants and children. Non-invasive methods for screening the neonatal immune status are lacking. Archaea, a prokaryotic life domain, comprise methanogenic species that are part of the neonatal human microbiota and contribute to early immune imprinting. However, they have not yet been characterized in preterm neonates. Objective: To characterize the gut immunological and methanogenic Archaeal (MA) signature in preterm neonates, using the presence or absence of atopic conditions at the age of one year as a clinical endpoint. Methods: Meconium and stool were collected from preterm neonates and used to develop a standardized stool preparation method for the assessment of mediators and cytokines and characterize the qPCR kinetics of gut MA. Analysis addressed the relationship between immunological biomarkers, Archaea abundance, and atopic disease at age one. Results: Immunoglobulin E, tryptase, calprotectin, EDN, cytokines, and MA were detectable in the meconium and later samples. Atopic conditions at age of one year were positively associated with neonatal EDN, IL-1β, IL-10, IL-6, and MA abundance. The latter was negatively associated with neonatal EDN, IL-1β, and IL-6. Conclusions: We report a non-invasive method for establishing a gut immunological and Archaeal signature in preterm neonates, predictive of atopic diseases at the age of one year.

Rates of and factors associated with atopy and allergies in posttraumatic stress disorder as compared to controls

ObjectiveSeveral studies suggest a relationship between atopy and psychiatric disorders, but few have investigated the association between atopic conditions and posttraumatic stress disorder (PTSD). We sought to compare the rates of atopy and allergies in a South African case-control study of 220 patients with PTSD (mean age 41.7 years, SD = 11.7) and 196 trauma exposed controls (TEC, mean age 45.4 years, SD = 14.7) conducted in Cape Town, South Africa from May 2014 to June 2017. MethodsSelf-reported atopic conditions and allergies were regressed on PTSD, as determined with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), in multivariate logistic regression models, controlling for age, gender, body mass index, physical activity, lifetime and childhood trauma, and time since index trauma. ResultsRates of lifetime atopy (p = 0.03), current asthma (p = 0.04), lifetime allergic rhinitis (p = 0.002), and current allergic rhinitis (p = 0.004) were significantly higher in patients than TEC on bivariate analysis. On multivariate analysis, rates of current atopy (Cohen's d = 0.26, p = 0.04) and current allergic rhinitis (Cohen's d = 0.34, p = 0.012) were significantly higher in patients with PTSD than in TEC. Current eczema (p = 0.24), current asthma (p = 0.26), and allergies (p = 0.59) were not associated with PTSD. ConclusionsRates of atopy are higher in participants with PTSD than TEC, and this effect is related to higher rates of allergic rhinitis. Further studies are needed to elucidate the pathways linking allergic rhinitis and PTSD.

Global Asthma Network Phase I, India: Results for allergic rhinitis and eczema in 127,309 children and adults.

The Global Asthma Network phase I study in India aimed to study the prevalence, time trends, and associated risk factors of allergic rhinitis and eczema among 6-7-year-old, and 13-14-year-old school children and their parents. Objectives:The objective of the study was to understand the current prevalence and associated risk factors of Allergic Rhinitis and Eczema in India among 6-7-year-olds, 13-14-year-olds and in their parents/guardians for newer directions to health care providers, policy makers and academicians. Cross-sectional, multicenter study using self- and parent-administered questionnaire among randomly selected school children aged 6 to 7 years from 8 centers and 13 to 14 years from 9 centers and their respective parents/guardians across India. Prevalence of allergic rhinitis (AR) (%, 95% CI) among 20,084 6-7-year-olds (children), 25,887 13-14-year-olds (adolescents), and 81,296 adults/parents was 7.7% (7.4%-8.1%), 23.5% (23.0%-24.1%), and 9.8% (9.55%-9.96%) and that of eczema was 2.5% (2.3%-2.7%), 3.5% (3.27%-3.71%), and 9.9% (9.7%-10.1%), respectively. Among 6-7-year-olds, AR and eczema showed a significantly (P< .001) declining time trend since the International Study of Asthma and Allergies in school children phase III in 2002-2003. Among 13-14-year-olds, AR (P< .01) but not eczema showed a significant temporal decline. Coexisting atopic condition, parental history of atopy, and some environmental factors consistent with previous studies were significant risk factors among children and adolescents. AR or eczema in either parent strongly predicted the same atopic condition among their adolescent offspring. Among adults, coexisting atopic condition was the strongest predictor of either AR or eczema. There is a slight declining time trend of AR and eczema in India over 2 decades among children and adolescents. Nearly 10% of Indian adults suffer from AR and eczema. Although genetic factors had the strongest association for AR and eczema among all age groups, certain early-life and environmental exposures need consideration to devise preventative strategies.

Atopy patch testing and associations with atopic conditions and specific IgE tests: a population-based study in adolescents

The clinical usefulness of the atopy patch test (APT) is unclear for investigating aeroallergen- and food-triggered atopic dermatitis (AD). This study aimed to assess the prevalence of positive APT reactions in a population of adolescents and investigate possible associations between the APT, specific serum (s) immunoglobulin E (IgE) tests, self-reported atopic conditions and health-related quality of life. A population-based study was performed on 211 adolescents (13-14 years old). Collected data included questionnaires, an APT with food and aeroallergens and s-IgE tests. Positive APT reactions were observed in 9.0% (19/211) of the adolescents. Timothy grass was the top allergen with 11 (5.2%) positive reactions, followed by cat dander (2.8%) and house dust mites (2.4%). Rhinoconjunctivitis increased the odds of any positive APT (crude odds ratio: 3.32; 95% confidence interval [CI]: 1.17–9.40), particularly when an APT was positive for aeroallergens (odds ratio: 5.02, 95% CI: 1.54-16.42). There was no association between a positive APT and AD. Four adolescents without AD and no IgE-sensitization had a positive APT. Based on a population of adolescents, the APT is associated with rhinoconjunctivitis but not AD. This finding should be taken into consideration in further attempts to clarify the role of the APT in the clinical setting.