Alan P. Baptist

Interleukin-25 induces type 2 cytokine production in a steroid-resistant interleukin-17RB + myeloid population that exacerbates asthmatic pathology

Interleukin-25 (IL-25) is a cytokine associated with allergy and asthma that functions to promote type 2 immune responses at mucosal epithelial surfaces and serves to protect against helminth parasitic infections in the intestinal tract. This study identifies the IL-25 receptor, IL-17RB, as a key mediator of both innate and adaptive pulmonary type 2 immune responses. Allergen exposure upregulated IL-25 and induced type 2 cytokine production in a previously undescribed granulocytic population, termed type 2 myeloid (T2M) cells. Il17rb−/− mice showed reduced lung pathology after chronic allergen exposure and decreased type 2 cytokine production in T2M cells and CD4+ T lymphocytes. Airway instillation of IL-25 induced IL-4 and IL-13 production in T2M cells, demonstrating their importance in eliciting T cell–independent inflammation. The adoptive transfer of T2M cells reconstituted IL-25–mediated responses in Il17rb−/− mice. High-dose dexamethasone treatment did not reduce the IL-25–induced T2M pulmonary response. Finally, a similar IL-4– and IL-13–producing granulocytic population was identified in peripheral blood of human subjects with asthma. These data establish IL-25 and its receptor IL-17RB as targets for innate and adaptive immune responses in chronic allergic airway disease and identify T2M cells as a new steroid-resistant cell population.

Social media, text messaging, and email-preferences of asthma patients between 12 and 40 years old.

Background. Electronic media such as social media (Facebook, Twitter, MySpace), email, and text messaging could be useful in the management of asthma. However, patient use and preferences for electronic media in asthma management is currently unknown. Methods. A survey was sent to asthma patients between 12–40 years of age. The survey collected demographic information, use of electronic media, interest in using electronic media to receive asthma information, and interest in using electronic media to communicate with a health care provider about asthma. Free text entries were encouraged. Results. 145 completed surveys were returned. Text messaging, email, and Facebook were used at least weekly by a majority of respondents (82%, 77%, and 65%, respectively). Email was clearly the most preferred method to receive asthma information and to communicate with a physician. There was some interest in using Facebook or text messaging, whereas Myspace and Twitter had minimal interest. On logistic regression analysis, female and Black or Hispanic participants were more likely to have an interest in the use of electronic media for asthma care. Frequent users (>1X/week) of each electronic media type had greater enthusiasm for their incorporation into asthma care. Free text entries revealed that many participants felt social media sites were for connecting with friends rather than for health care, and privacy concerns were also raised. Conclusion. Electronic media offers a novel way to improve asthma care. Email was the most preferred method, though text messaging and social media sites like Facebook may be appropriate for certain patients.

Food allergy and food allergy attitudes among college students

BACKGROUND Little information is known about food allergy among college students. OBJECTIVE We sought to assess food allergy trends and behavioral attitudes on a large university campus. METHODS An online survey was distributed by e-mail to local university undergraduate students. Symptom severity was determined based on previously published criteria for anaphylaxis. RESULTS A total of 513 individuals responded, with 57% reporting an allergic reaction to food. Of this group, 36.2% reported symptoms consistent with anaphylaxis, and these reactions frequently occurred while enrolled. Allergy to milk (P = .032), tree nut (P < .0001), shellfish (P < .0001), and peanut (P < .0001) was significantly associated with having symptoms of anaphylaxis. Some form of emergency medication was reportedly maintained in 47.7%, including self-injectable epinephrine (SIE; 21%), although only 6.6% reported always carrying this device. Medication maintenance was significantly lower among students who had not had a reaction while enrolled (P < .0001). Only 39.7% reported always avoiding foods to which they were allergic. Within the group that reported intentionally consuming known allergens, there were significantly lower numbers of individuals who reported carrying SIE (P < .0001) and significantly higher numbers of individuals with a history of a reaction that had not resulted in symptoms of anaphylaxis (P = .026). CONCLUSION Potentially life-threatening anaphylactic reactions to foods are occurring on college campuses. Only 39.7% of students with food allergy avoided a self-identified food allergen, and more than three fourths did not maintain SIE. Such behaviors might place these students at increased risk for adverse events.

Changes in weather and the effects on pediatric asthma exacerbations.

BACKGROUND Pediatric asthma exacerbations may correlate with changes in weather, yet this relationship is not well defined. OBJECTIVE To determine the effects of fluctuations in climatic factors (temperature, humidity, and barometric pressure) on pediatric asthma exacerbations. METHODS A retrospective study was performed at 1 large urban hospital during a 2-year period (January 1, 2004, to December 31, 2005). Children presenting to the emergency department (ED) for an asthma exacerbation were included. Data on climactic factors, pollutants, and aeroallergens were collected daily. The relationship of daily (intraday) or between-day (interday) changes in climactic factors and asthma ED visits was evaluated using time series analysis, controlling for seasonality, air pollution, and aeroallergen exposure. The effects of climactic factors were evaluated on the day of admission (T=0) and up to 5 days before admission (T-5 through T-1). RESULTS There were 25,401 asthma ED visits. A 10% intraday increase in humidity on day T-1 or day T-2 was associated with approximately 1 additional ED visit for asthma (P < .001 and P = .01, respectively). Interday changes in humidity from day T - 3 to T-2 were also associated with more ED visits (P < .001). Interday changes in temperature from T-1 to T = 0 increased ED visits, with a 10 degrees F increase being associated with 1.8 additional visits (P = .006). No association was found with changes in barometric pressure. CONCLUSION Fluctuations in humidity and temperature, but not barometric pressure, appear to influence ED visits for pediatric asthma. The additional ED visits occur 1 to 2 days after the fluctuation.

Age-Specific Factors Influencing Asthma Management by Older Adults

Although many asthma patients experience their first attack after age 40, the experiences and concerns of older adults with asthma remain largely unknown. We conducted six focus groups, each consisting of participants over the age of 65 with a physician diagnosis of asthma. Semistructured questions regarding asthma education, symptoms, and management were used. A total of 46 adults participated in the six focus groups. The mean age of the participants was 72.6 years, and 43.5% were African American. The majority of participants had coexisting cardiac disease or hypertension. Major age-specific domains identified in all focus groups were atypical asthma symptoms, inability to distinguish asthma from other medical conditions, use of complementary and alternative therapies, desire for independence in asthma management, and a lack of participation in asthma education. Participants acknowledged that they did not commonly address these issues with their physicians or with family members. Optimal care will require physicians and researchers to explicitly address these issues unique to the geriatric asthmatic population.

Rhinitis in the elderly.

By 2050, the US aging population will nearly double. It will be increasingly important for health care providers to diagnose and manage rhinitis. Nasal symptoms of rhinorrhea, congestion, sneezing, nasal/ocular pruritus, and postnasal drainage affect up to 32% of older adults, and can impact quality of life. Several underlying factors associated with aging may contribute to the pathogenesis of rhinitis in older adults. Although treatment options for rhinitis exist, special considerations need to be made because comorbidities, limited income, memory loss, and side effects of medications are common in older adults and may impact outcomes.

Autoimmune progesterone dermatitis in a patient with endometriosis: case report and review of the literature.

Autoimmune progesterone dermatitis (APD) is a condition in which the menstrual cycle is associated with a number of skin findings such as urticaria, eczema, angioedema, and others. In affected women, it occurs 3–10 days prior to the onset of menstrual flow, and resolves 2 days into menses. Women with irregular menses may not have this clear correlation, and therefore may be missed. We present a case of APD in a woman with irregular menses and urticaria/angioedema for over 20 years, who had not been diagnosed or correctly treated due to the variable timing of skin manifestations and menses. In addition, we review the medical literature in regards to clinical features, pathogenesis, diagnosis, and treatment options.

The effects of bariatric surgery on asthma severity.

BackgroundExcess body weight increases both the risk and severity of asthma. Several studies indicate that bariatric surgery decreases asthma severity, but either enrolled few patients or were not focused primarily on asthma. Furthermore, none compared the effects of different bariatric surgical procedures.MethodsSubjects underwent bariatric surgery at member institutions of the Michigan Bariatric Surgery Collaborative between 06/06/2006 and 5/14/2009. Patient records provided data on baseline demographics, asthma medication use, comorbidities, body mass index, type of procedure and perioperative complications. One year later, patients received a follow-up mail survey covering weight and use of asthma medications at that time.ResultsOf the 13,057 bariatric surgery patients, 2,562 (18.6%) reported use of asthma medications at baseline. Several comorbidities were significantly more common in asthma patients, who also experienced significantly more perioperative wound and respiratory complications. Among 257 asthma patients who participated in a 1-year follow-up survey, 13 of 28 who had initially used oral corticosteroids for symptom control no longer required them, while use of inhaled corticosteroids decreased from 49.8% to 29.6%. Reduction in intensity of asthma therapy correlated with presence of sleep disorders and extent of weight loss on univariate analysis but not multivariate analysis. Patients who underwent laparoscopic adjustable gastric banding (LAGB), which was associated with less weight loss than other surgical modalities, were significantly less likely to reduce the intensity of their asthma therapy.ConclusionsBariatric surgery decreases the intensity of medication required to control patients’ asthma symptoms, although LAGB appears to produce less significant effects.

Effect of age on asthma control: results from the National Asthma Survey

BACKGROUND two million US citizens older than 65 years have asthma, but little is known about asthma control in this population. OBJECTIVE to compared short- and long-term asthma control in elderly (≥ 65 years old) and young adult (18-64 years old) populations from the National Asthma Survey. METHODS data from the National Asthma Survey (sponsored by the Centers for Disease Control and Prevention) were analyzed. Demographic variables, health insurance status, smoking status, indoor allergen exposure, and asthma education were compared between the young adult and elderly populations. Asthma control was examined based on short-term measures (recent oral corticosteroid bursts or symptoms) and long-term measures (asthma attacks, urgent care visits, hospitalizations, and activity limitation in the previous year). RESULTS a total of 2,557 young and 398 elderly asthmatic patients were included. Elderly patients had a lower income, were less educated, were more obese, were more insured, had less indoor exposure, and were more likely to be former smokers. They were less educated about asthma attack interventions and asthma action plans (P < .05 for both). On multivariate analysis, elderly patients had worse control of asthma based on short-term measures (daytime symptoms in the previous month [odds ratio (OR), 1.73; 95% confidence interval (CI), 1.25-2.35] and any short-term measure [OR, 1.48; 95% CI, 1.11-1.97]) and long-term measures (activity limitation in the previous year [OR, 1.50; 95% CI, 1.12-2.01]). CONCLUSIONS elderly asthmatic patients have worse short- and long-term asthma control compared with the young adult population. Further studies are needed to elucidate whether these findings are due to pathophysiologic differences and whether tailored education or other novel strategies can provide better asthma control.

An Examination of Adverse Asthma Outcomes in U.S. Adults with Multiple Morbidities

RATIONALE More Americans are managing multiple chronic conditions. Little is known regarding combinations of multiple chronic conditions with asthma. OBJECTIVES To examine the prevalence and demographic distribution of five common chronic conditions (arthritis, heart disease, cancer, diabetes, and hypertension) in adults with and without asthma and the adverse asthma outcomes associated with multiple chronic conditions. METHODS Cross-sectional interview data from the National Health and Nutrition Examination Survey were analyzed (n = 22,172) between 2003 and 2010. Bivariate analysis methods and multivariate generalized linear regression were used to examine associations. MEASUREMENTS AND MAIN RESULTS Of the 10% of subjects with asthma, 54% had one or more coexisting health condition(s). The prevalence of two or three or more other chronic conditions was greater among those with asthma compared with those without (P < 0.001). Common comorbidities with asthma were hypertension (34%) and arthritis (31%). For every additional comorbid chronic condition, there was an increase in the prevalence of reported asthma symptom episodes (prevalence ratio [PR], 1.06; 95% confidence interval [CI], 1.00-1.13), frequent activity limitation (PR, 1.14; 95% CI, 1.04-1.25), sleep disturbances (PR, 1.22; 95% CI, 1.04-1.43), and emergency department visit for asthma (PR, 1.45; 95% CI, 1.19-1.76) when adjusted for socioeconomic and demographic factors and body mass index. The population-attributable risk for emergency department visits for asthma among individuals with asthma who have other chronic comorbidities was 19.5%. CONCLUSIONS Half of the adult population with asthma in the United States suffers from comorbid conditions, which are associated with adverse asthma-related outcomes and account for up to 20% of emergency room visits for asthma.