Cross-Sectional Study of Cholinergic Urticaria Subtypes And Bronchial Hyperresponsiveness

Background: Cholinergic urticaria (CholU) is classified into several subtypes: 1) conventional sweat allergy-type CholU (conventional SAT-CholU), 2) CholU with palpebral angioedema (CholU-PA), 3) CholU with acquired anhidrosis and/or hypohidrosis (CholU-Anhd); 1) and 2) include SAT based on pathogenesis. There have been no studies on differences in the prevalence of bronchial asthma among the subtypes. We evaluated the bronchial responsiveness of each subtype. Methods: We analyzed bronchial responsiveness using the methacholine dose indicator Dmin, respiratory symptoms, and exhaled nitric oxide (FeNO). Results: Median log10 Dmin (interquartile range) of patients with conventional SAT-CholU (n=11), CholU-PA (n=11), and CholU-Anhd (n=11) was 0.381 (−0.829, 1.079), 0.717 (0.249, 0.787), and 1.318 (0.121, 1.699), respectively (p=0.516). Respiratory symptoms evaluated using the International Primary Care Airways Group questionnaire were less frequently observed in CholU-Anhd (0 [0, 1]) than in conventional SAT-CholU (1 [0–2]) or CholU-PA (1 [1–3]) (p=0.049). FeNO of patients with conventional SAT-CholU, CholU-PA, and CholU-Anhd was 23 (18.5, 65.0), 39 (32.0, 59.5), and 25 (19.0, 33.0) ppb, respectively (p=0.237). Conclusions: Log Dmin tended to be lower in patients with SAT-CholU than in those with CholU-Anhd. Distinguishing between CholU subtypes may reveal different degrees of bronchial responsiveness based on a distinct pathogenesis.

Cross-sectional Study of Cholinergic Urticaria Subtypes and Bronchial Hyperresponsiveness

BackgroundCholinergic urticaria (CholU) is classified into several subtypes: 1) conventional sweat allergy-type CholU (conventional SAT-CholU), 2) CholU with palpebral angioedema (CholU-PA), 3) CholU with acquired anhidrosis and/or hypohidrosis (CholU-Anhd), and other rare type; 1) and 2) include SAT based on pathogenesis. There have been no studies on differences in the prevalence of bronchial asthma among the CholU subtypes. This is investigated in the present study by evaluating the bronchial responsiveness of each subtype.MethodsPatients 16–80 years of age with CholU were enrolled. We analyzed bronchial responsiveness, respiratory symptoms, and exhaled nitric oxide (FeNO). Bronchial responsiveness was assessed using the methacholine dose indicator Dmin.ResultsA total of 11 patients with conventional SAT-CholU, 11 with CholU-PA, and 11 with CholU-Anhd were enrolled. Median log10 Dmin (interquartile range) of patients with conventional SAT-CholU, CholU-PA, and CholU-Anhd was 0.381 (−0.829, 1.079), 0.717 (0.249, 0.787), and 1.318 (0.121, 1.699), respectively (p=0.516). Dmin was lower in patients with SAT (conventional SAT-CholU and CholU-PA) than in those with CholU-Anhd, although the differences among the 3 types were not significant. Respiratory symptoms evaluated using the International Primary Care Airways Group questionnaire were less frequently observed in CholU-Anhd (0 [0, 1]) than in conventional SAT-CholU (1 [0–2]) or CholU-PA (1 [1–3]) (p=0.049). FeNO of patients with conventional SAT-CholU, CholU-PA, and CholU-Anhd was 23 (18.5, 65.0), 39 (32.0, 59.5), and 25 (19.0, 33.0) ppb, respectively (p=0.237). One of 11 conventional SAT-CholU patients (9.1%) and 6 of 11 CholU-PA patients (54.5%) required treatment for bronchial asthma.ConclusionsLog Dmin tended to be lower in patients with SAT-CholU than in those with CholU-Anhd. Distinguishing between CholU subtypes may reveal different degrees of bronchial responsiveness based on a distinct pathogenesis.Trial registration numberUMIN 000025669; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000027550

Prenatal tobacco exposure and risk of asthma and allergy outcomes in childhood

BackgroundHarmful effects of prenatal tobacco exposure and possible interaction with 17q12-21 genetic variants have been shown for some asthma outcomes in childhood, whereas findings related to allergy outcomes are more inconsistent. This study aimed to examine the effect of prenatal tobacco exposure and relation to 17q12-21 genotype on a wide array of asthma and allergy-related outcomes in early childhood.MethodsPrenatal tobacco exposure was determined by maternal smoking during 3rd trimester (yes/no) in 411 children from the COPSAC2000 birth cohort with clinical follow-up till age 7 years. The rs7216389 SNP was used as main representative of the 17q12-21 locus. Asthma endpoints included asthma diagnosis, exacerbations, episodes with troublesome lung symptoms and lower respiratory tract infections (LRTI), spirometry, plethysmography, bronchial responsiveness to methacholine, exercise and cold dry air. Allergy-related endpoints included aeroallergen sensitisation, allergic rhinitis, fractional exhaled nitric oxide, blood eosinophil count and urine eosinophil protein X levels. Statistical analyses were done using Cox regression, linear regression, logistic regression and Quasi-Poisson regression.ResultsPrenatal tobacco exposure increased the risk of asthma (adjusted hazard ratio (aHR)=2.05, (95% CI 1.13; 3.73), p=0.02)), exacerbations (aHR=3.76, (2.05; 6.91), p<0.001), number of LRTIs (aIRR=1.87, (1.34; 2.55), p<0.001), and associated with decreased spirometry indices (FEV1: aMD=−0.07 L (−0.13; −0.005), p=0.03, MMEF: aMD=−0.19 L·s−1 (−0.34; −0.04), p=0.01) and increased bronchial responsiveness to methacholine (PD20: aGMR=0.55 (0.31; 0.96), p=0.04). In contrast, there was no association with any allergy-related endpoints. The effect on asthma depended on 17q12-21 genotype with an increased risk only among children without risk alleles.ConclusionPrenatal tobacco exposure was associated with asthma dependent on 17q12-21 genotype and with exacerbations, lung function and bronchial responsiveness, but not with any allergy-related outcomes. This suggests that tobacco exposure in utero leads to adverse lung developmental/structural effects rather than susceptibility to develop allergy and Type 2 inflammation.

Noninvasive ventilation and respiratory physical therapy reduce exercise-induced bronchospasm and pulmonary inflammation in children with asthma: randomized clinical trial

Background: Asthma is characterized by hyperresponsiveness of the airways, and exercise-induced bronchospasm (EIB) is a symptom that limits a large proportion of asthmatic patients, especially children. Continuous positive airway pressure (CPAP) leads to a reduction in the reactivity of the airways. The aim of this study was to evaluate the effect of outpatient treatment with CPAP and bilevel pressure combined with respiratory physical therapy for children and adolescents with asthma following bronchial hyperresponsiveness caused by an exercise bronchoprovocation test. Methods: A randomized, controlled, blind, clinical trial was conducted involving 68 asthmatic children and adolescents aged 4 to 16 years divided into three groups: G1, treated with bilevel pressure (inspiratory positive airway pressure: 12 cm H2O; expiratory positive airway pressure: 8 cm H2O), G2, treated with CPAP (8 cm H2O) and G3, treated with respiratory muscle training (RMT), considered as the control group. All groups were treated at an outpatient clinic and submitted to 10 1-hour sessions, each of which also included respiratory exercises. Evaluations were performed before and after treatment and involved spirometry, an exercise bronchoprovocation test, respiratory pressures, fraction of nitric oxide (FeNO), the Asthma Control Questionnaire (ACQ6) and anthropometric variables. This study received approval from the local ethics committee (certificate number: 1487225/2016) and is registered with ClinicalTrials [ ClinicalTrials.gov identifier: NCT02939625]. Results: A total of 64 patients concluded the protocol; the mean age of the patients was 10 years. All were in the ideal weight range and had adequate height ( z score: −2 to +2). The three groups demonstrated improved asthma control after the treatments, going from partial to complete control. A significant increase in maximal inspiratory pressure occurred in the three groups, with the greatest increase in the RMT group. A reduction in FeNO in the order of 17.4 parts per billion (effect size: 2.43) and a reduction in bronchial responsiveness on the exercise bronchoprovocation test occurred in the bilevel group. An improvement in FeNO on the order of 15.7 parts per billion (effect size: 2.46) and a reduction in bronchial responsiveness occurred in the CPAP group. No changes in lung function or responsiveness occurred in the RMT group. Conclusion: Positive pressure and respiratory exercises were effective in reducing pulmonary inflammation, exercise-innduced bronchoespasm (EIB), and increased the clinical control of asthma, as well as RMT, which also resulted in improved clinical control.