Dávila I

Validation of ARIA (Allergic Rhinitis and its Impact on Asthma) classification in a pediatric population: The PEDRIAL study

To cite this article: Jáuregui I, Dávila I, Sastre J, Bartra J, del Cuvillo A, Ferrer M, Montoro J, Mullol J, Molina X, Valero A. Validation of ARIA (Allergic Rhinitis and its Impact on Asthma) classification in a pediatric population: The PEDRIAL study. Pediatr Allergy Immunol 2011; 22: 388–392.

Epigenetic changes in B lymphocytes associated with house dust mite allergic asthma.

Although there is no doubt about the influence of the genetic background in the onset of the allergic diseases, Epigenome-Wide Association Studies are needed to elucidate the possible relationship between allergic diseases and epigenomic dysregulation. In this study we aimed to analyze the epigenetic patterns, in terms of DNA methylation, of three well-characterized populations of house dust mite allergic subjects, aspirin-intolerant asthmatics and controls. As a first, genome-wide phase, we used the HELP assay to study the methylation patterns in CD19+ B lymphocytes in these populations, and found that there are reproducible epigenetic differences at limited numbers of loci distinguishing the groups, corroborated by bisulphite MassArray in a second validation phase of an expanded 40 subject group. These validated epigenetic changes occur at loci characterized as important for the immune response. One such locus is a new candidate gene, CYP26A1, which shows differential methylation patterns and expression levels between groups. Our results suggest that epigenomic dysregulation may contribute to the susceptibility to allergic diseases, showing for the first time differences in DNA methylation between allergic and non-allergic healthy subjects, both globally and at specific loci. These observations indicate that the epigenome may offer new pathophysiological insights and therapeutic targets in atopic diseases.

Interleukin-4 (IL4) and Interleukin-4 receptor (IL4RA) polymorphisms in asthma: a case control study

BackgroundIL4/IL4RA pathway plays an important role in atopy and asthma. Different polymorphisms in IL4 and IL4RA genes have been described. Particularly, -33C>TIL4 and 576Q>RIL4RA SNPs have been independently associated to atopy and asthma. The purpose of this study was to analyse these polymorphisms in a population of patients with a well-characterized asthma phenotype.MethodsA total of 212 unrelated Caucasian individuals, 133 patients with asthma and 79 healthy subjects without symptoms or history of asthma or atopy and with negative skin prick tests were recruited. Lung function was measured by spirometry and asthma was specialist physician-diagnosed according to the ATS (American Thoracic Society) criteria and classified following the GINA (Global Initiative for Asthma) guidelines. Skin prick tests were performed according to EAACI recommendations. -33C>TIL4 was studied with TaqMan assay and 576Q>RIL4RA by PCR-RFLP technique. Hardy-Weinberg equilibrium was analysed in all groups. Dichotomous variables were analysed using χ2, Fisher exact test, Monte Carlo simulation test and odds ratio test. To model the effects of multiple covariates logistic regression was used.ResultsNo statistically significant differences between the group of patients with asthma and the controls were found when the allele and genotype distribution of -33C>TIL4 and 576Q>RIL4RA polymorphisms were compared. However, the T allele of the -33C>TIL4 SNP was more frequent in patients with persistent asthma. Multivariate analysis adjusted for age and sex confirmed that carriers of allele T had an increased risk of persistent asthma (OR:2.77, 95%CI:1.18–6.49; p = 0.019). Analysis of combination of polymorphisms showed that patients carrying both the T allele of -33C>TIL4 and the A allele of 576Q>RIL4RA had an increased risk of asthma. This association was particularly observed in persistent asthma [Fishers p value = 0.0021, Monte Carlo p value (after 104 simulations) = 0.0016, OR:3.39; 95% CI:1.50–7.66].ConclusionOur results show a trend of association between the genetic combination of the T allele of -33C>TIL4 and the A allele of 576Q>RIL4RA with asthma. This genetic variant was more frequently observed in patients with persistent asthma. As long as this study was performed in a small population, further studies in other populations are needed to confirm these results.

Hypersensitivity reactions to cephalosporins

At present, cephalosporins represent one of the most prescribed classes of antibiotics. Although allergic reactions have been estimated to be infrequent, the number of reactions to cephalosporins is increasing due to their wide use. Cross-reactivity with penicillins has mainly been evaluated in patients with penicillin allergy. It is higher between first- and second-generation cephalosporins with the same or similar side chain than between cephalosporins with different side chains. Unlike penicillins, cephalosporin haptens or determinants have not been defined, and therefore the diagnosis is complicated. Nevertheless, skin tests with cephalosporins are useful in the evaluation of several allergic reactions. Although more studies are necessary, a negative result in skin testing to penicillin and cephalosporins with different side chains seems to be a good predictor of tolerance, and could be used in select cases.

Validation of the modified allergic rhinitis and its impact on asthma (ARIA) severity classification in allergic rhinitis children: the PEDRIAL study

A modified allergic rhinitis and its impact on asthma (ARIA) (m‐ARIA) criterion to classify the severity of allergic rhinitis (AR) has recently been validated in both treated and untreated adult patients; however, such information in children is lacking. The aim of this study was to validate this m‐ARIA severity criterion, which allows for discrimination between moderate and severe AR, in a large pediatric patient sample population.

Validation of ARIA duration and severity classifications in Spanish allergic rhinitis patients - The ADRIAL cohort study.

INTRODUCTION Allergic rhinitis (AR) is an increasingly prevalent worldwide disease, which has an important impact on quality of life and generates high social and health care costs. The ARIA classification, that considers both the duration and severity of AR, seems more appropriate than previous classifications of AR, but few studies exist on the validation of the severity criteria proposed by the ARIA classification. OBJECTIVES To assess the ARIA duration and severity classification of AR in a large sample population of patients, by investigating whether different degrees of severity correlate with differences in symptom score, quality of life or the patients self evaluation of impairment. This study also assesses the relationship between AR severity and co morbidities. MATERIAL AND METHODS An observational, cross-sectional, multicentre study conducted in Spain. AR was classified based on the ARIA criteria, and compared to the classical classification based on allergen exposure. Rhinitis was evaluated by the Total 4-Symptom Score (T4SS) scale, quality of life was measured using the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and disease severity through a Visual Analogue Scale (VAS, 0-100 mm). Comorbidities were evaluated based both on the duration and severity of the symptoms of rhinitis. RESULTS AR patients, (n = 3,529; mean age 37.5 +/= 13.4 years; 52.3% women) were included in the study. AR patients were classified as intermittent (51.5%) and persistent (48.5%) based on the ARIA classification, and as seasonal (61.2%), perennial (35.1%), and occupational (3.7%) based on the allergen exposure classification. Significantly higher T4SS, RQLQ and VAS scores were obtained in moderate/severe compared to mild AR. The incidence of asthma was significantly higher in patients with persistent and moderate/severe AR compared to intermittent and mild AR. Asthma was the only co morbidity to reach statistical significance. CONCLUSION ARIA classification of severity reflects two different statuses of AR in terms of symptoms and quality of life. Asthma was the only concomitant pathology in which incidence was related to ARIA categories in terms of duration or severity.

Promoter genetic variants of prostanoid DP receptor (PTGDR) gene in patients with asthma

Background:  PTGDR gene has been identified as an asthma‐susceptibility gene. Recently, functional genetic variants have been associated with asthma. The objective of this work was to study −549T>C, −441C>T and −197T>C PTGDR promoter polymorphisms in a Spanish population.

Analysis of comorbidities and therapeutic approach for allergic rhinitis in a pediatric population in Spain

Allergic rhinitis (AR) is the most common chronic disease in children. The main objective of this study was to analyze the comorbidities and therapeutic approaches for AR in a Spanish pediatric population.

The impact of allergic rhinitis on symptoms, and quality of life using the new criterion of ARIA severity classification.

INTRODUCTION Allergic rhinitis (AR) is a common disease with major socieconomic burden and a significant impact on quality of life. OBJECTIVE The objective of the study was to assess the impact of AR severity, using the modified ARIA (m-ARIA) severity criterion in order to discriminate among moderate and severe AR, in symptoms and quality of life assessed with the questionnaire ESPRINT-15. METHODS The specific quality of life questionnaire (ESPRINT-15) was applied in over thousand untreated RA patients. Severity was evaluated by the m-ARIA classification, which categorizes AR as mild, moderate, and severe. Nasal symptoms were evaluated by using categorized (none, low, middle, and high) Total Four Symptom Score (T4SS). RESULTS Using the m-ARIA severity classification, significant differences in quality of life, both global score and specific domains, and categorized T4SS were found among the AR severity groups. CONCLUSION Modified ARIA severity classification in mild, moderate, and severe allergic rhinitis clearly discriminates the impact of AR in all domains of quality of life and categorized symptom`s score.

Chronic urticaria: do urticaria nonexperts implement treatment guidelines? A survey of adherence to published guidelines by nonexperts

Background  Guidelines including level of evidence and grade of recommendation were recently published for chronic urticaria (CU).