[The effectiveness of omalizumab in the control of severe uncontrolled asthma in Latin America. An exploratory systematic review and meta-analysis].
Rev Alerg Mex. 2020 Jan-Mar;67(1):19-24
Authors: Miranda P
BACKGROUND: Omalizumab is effective in the treatment of severe persistent allergic asthma that is not controlled with long-acting beta-agonists/ high-dose inhaled corticosteroids.
OBJECTIVE: To conduct a systematic exploratory review and meta-analysis of studies with omalizumab in Latin America.
METHODS: A search of real-life studies on the effectiveness of omalizumab in asthma control conducted in Latin America was carried out. The average of the aggregate effectiveness of omalizumab in asthma control (Pooled Analysis) was estimated by using a random effects model.
RESULTS: Nine open uncontrolled observational studies were identified; these studies included a total of 1 118 patients with severe uncontrolled asthma. The average of the estimated aggregate effectiveness of omalizumab in the good control of severe asthma was of 80.6 % in children and 78.9 % in adults.
CONCLUSIONS: The average of the estimated aggregate effectiveness of omalizumab in the control of severe asthma in both children and adults in Latin America was over 78 %. Randomized controlled studies are required in order to establish the efficacy and effectiveness of omalizumab in the control of severe asthma and in the different subgroups by level of eosinophils.
PMID: 32447864 [PubMed - as supplied by publisher]
Childhood asthma heterogeneity at the era of precision medicine: Modulating the immune response or the microbiota for the management of asthma attack.
Biochem Pharmacol. 2020 May 21;:114046
Authors: Stéphanie L, Antoine D, Rouzic Olivier L, Ilka E, Rodrigue D, Muriel P, Philippe G
Exacerbations are a main characteristic of asthma. In childhood, the risk is increasing with severity. Exacerbations are a strong phenotypic marker, particularly of severe and therapy-resistant asthma. These early-life events may influence the evolution and be involved in lung function decline. In children, asthma attacks are facilitated by exposure to allergens and pollutants, but are mainly triggered by microbial agents. Multiple studies have assessed immune responses to viruses, and to a lesser extend bacteria, during asthma exacerbation. Research has identified impairment of innate immune responses in children, related to altered pathogen recognition, interferon release, or anti-viral response. Influence of this host-microbiota dialog on the adaptive immune response may be crucial, leading to the development of biased T helper (Th)2 inflammation. These dynamic interactions may impact the presentations of asthma attacks, and have long-term consequences. The aim of this review is to synthesize studies exploring immune mechanisms impairment against viruses and bacteria promoting asthma attacks in children. The potential influence of the nature of infectious agents and/or preexisting microbiota on the development of exacerbation is also addressed. We then discuss our understanding of how these diverse host-microbiota interactions in children may account for the heterogeneity of endotypes and clinical presentations. Finally, improving the knowledge of the pathophysiological processes induced by infections has led to offer new opportunities for the development of preventive or curative therapeutics for acute asthma. A better definition of asthma endotypes associated with precision medicine might lead to substantial progress in the management of severe childhood asthma.
PMID: 32446884 [PubMed - as supplied by publisher]
School-Based Telemedicine Interventions for Asthma: A Systematic Review.
Acad Pediatr. 2020 May 21;:
Authors: Kim CH, Lieng MK, Rylee TL, Gee KA, Marcin JP, Melnikow JA
BACKGROUND: School health systems are increasingly investing in telemedicine platforms to address acute and chronic illnesses. Asthma, the most common chronic illness in childhood, is of particular interest given its high burden on school absenteeism.
OBJECTIVES: Conduct a systematic review evaluating impact of school-based telemedicine programs on improving asthma-related outcomes.
DATA SOURCES: PubMed, Cochrane CENTRAL, CINAHL, ERIC, PsycINFO, Embase, and Google Scholar STUDY ELIGIBILITY CRITERIA: Original research, including quasi-experimental studies, without restriction on the type of telemedicine.
PARTICIPANTS: School-aged pediatric patients with asthma and their families.
INTERVENTIONS: School-based telemedicine.
STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently screened each abstract, conducted full-text review, assessed study quality, and extracted information. A third author resolved disagreements.
RESULTS: Of 371 articles identified, 7 were included for the review. Outcomes of interest were asthma symptom-free days, asthma symptom frequency, quality-of-life, healthcare utilization, school absences, and spirometry. 4/7 studies reported significant increases in symptom-free days and/or decrease in symptom frequency. 5/6 reported increases in at least one quality-of-life metric, 2/7 reported a decrease in at least one healthcare utilization metric, 1/3 showed reductions in school absences, and 1/2 reported improvements in spirometry measures.
LIMITATIONS: Variability in intervention designs and outcome measures make comparisons and quantitative analyses across studies difficult. Only 2/7 studies were randomized controlled trials.
CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: High-quality evidence supporting the use of school-based telemedicine programs to improve patient outcomes is limited. While available evidence suggests benefit, only two comparative trials were identified, and the contribution of telemedicine to these studies' results is unclear.
PMID: 32446856 [PubMed - as supplied by publisher]
Dust mite-derived Enterobacterial fimbriae H protein enforces the allergen specific immunotherapy in asthma mice.
Allergol Immunopathol (Madr). 2020 May 20;:
Authors: Yang X, Wang H, Zhao D, Wang J, Liu X, Yuan X, Zhang M, Li G, Ran P, Yang P, Liu Z
BACKGROUND: The mite alimentary canal contains plenty of microbiota. It is accepted that some of the microbial products function as adjuvants to speed up immune responses.
OBJECTIVES: We identified five bacterial proteins from dust mite, and Enterobacterial fimbriae H (FimH) was one of them. This study aims to test a hypothesis that the FimH protein enforces immunotherapy in asthmatic mice.
METHODS: Asthmatic mice were treated by allergen specific immunotherapy (ASIT) with rDer f1/f2 or rDer f1/f2 plus FimH. Changes in inflammatory cell infiltration, airway hyperreactivity, frequency of Tregs, splenic CD4+IFN-γ+ cells, and serum levels of TGF-β, IL-10, IL-13 and IL-17A of asthmatic mice were checked.
RESULTS: ASIT with rDer f1/f2 plus FimH reduced inflammatory cell infiltration, airway hyperreactivity (AHR), and levels of IgE and IgG1 compared to ASIT with rDer f1/f2 alone, but the levels of IgG2a increased. Asthmatic mice that underwent ASIT with rDer f1/f2 plus FimH showed increased frequency of Tregs, splenic CD4+IFN-γ+ cells, serum levels of TGF-β and IL-10; and deceased splenic CD4+IL-4+ cells, and serum levels of IL-13 and IL-17A. In vitro study showed FimH triggered IL-10 expression in a concentration dependent manner and facilitated the differentiation of Tregs.
CONCLUSION: Used as an adjuvant, FimH enforces the effect of ASIT in asthmatic mice via augmenting Tregs.
PMID: 32446781 [PubMed - as supplied by publisher]