Risks for infection in patients with asthma (or other atopic conditions): Is asthma more than a chronic airway disease?
2014; Elsevier BV; Volume: 134; Issue: 2 Linguagem: Inglês
10.1016/j.jaci.2014.04.024
ISSN1097-6825
Autores Tópico(s)Allergic Rhinitis and Sensitization
ResumoMost of the research effort regarding asthma has been devoted to its causes, therapy, and prognosis. There is also evidence that the presence of asthma can influence patients' susceptibility to infections, yet research in this aspect of asthma has been limited. There is additional debate in this field, with current literature tending to view the increased risk of infection among atopic patients as caused by opportunistic infections secondary to airway inflammation, especially in patients with severe atopic diseases. However, other evidence suggests that such risk and its underlying immune dysfunction might be a phenotypic or clinical feature of atopic conditions. This review argues (1) that improved understanding of the effects of asthma or other atopic conditions on the risk of microbial infections will bring important and new perspectives to clinical practice, research, and public health concerning atopic conditions and (2) that research efforts into the causes and effects of asthma must be juxtaposed because they are likely to guide each other. Most of the research effort regarding asthma has been devoted to its causes, therapy, and prognosis. There is also evidence that the presence of asthma can influence patients' susceptibility to infections, yet research in this aspect of asthma has been limited. There is additional debate in this field, with current literature tending to view the increased risk of infection among atopic patients as caused by opportunistic infections secondary to airway inflammation, especially in patients with severe atopic diseases. However, other evidence suggests that such risk and its underlying immune dysfunction might be a phenotypic or clinical feature of atopic conditions. This review argues (1) that improved understanding of the effects of asthma or other atopic conditions on the risk of microbial infections will bring important and new perspectives to clinical practice, research, and public health concerning atopic conditions and (2) that research efforts into the causes and effects of asthma must be juxtaposed because they are likely to guide each other. Discuss this article on the JACI Journal Club blog: www.jaci-online.blogspot.com. Information for Category 1 CME CreditCredit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions.Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted.Date of Original Release: August 2014. Credit may be obtained for these courses until July 31, 2015.Copyright Statement: Copyright © 2014-2015. All rights reserved.Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease.Target Audience: Physicians and researchers within the field of allergic disease.Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.List of Design Committee Members: Young J. Juhn, MD, MPHDisclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: Y. J. Juhn has received research support from the National Institute of Allergy and Infectious DiseasesActivity Objectives1.To provide examples of specific immune dysfunction that might contribute to increased risk of infection in patients with asthma.2.To recognize asthma of all severities as a risk factor for respiratory and nonrespiratory tract infections.Recognition of Commercial Support: This CME activity has not received external commercial support.List of CME Exam Authors: Stephanie Albin, MD, Jennifer Camacho, MD, Tricia Lee, MD, Paul J. Maglione, MD, PhD, Manish Ramesh, MD, PhD, and Charlotte Cunningham-Rundles, MD, PhDDisclosure of Significant Relationships with Relevant CommercialCompanies/Organizations: Paul J. Maglione, MD, PhD, Mount Sinai School of Medicine (Clinical Fellow), disclosed the following competing relationships: Thrasher Research Fund: Grant, Clinical Immunology Society: Grant; Charlotte Cunningham-Rundles, MD, PhD, FAAAAI, Mt. Sinai Medical Center (Prof Med, Peds and Immunology), disclosed the following competing relationships: Baxter Healthcare: Medical Advisory Board, Biotest: Consultant, BPL: Consultant, CSL Behring: Medical Advisor, Grifols: Medical Advisory Board. The remaining CME exam authors disclosed no relevant financial relationships. Credit can now be obtained, free for a limited time, by reading the review articles in this issue. Please note the following instructions. Method of Physician Participation in Learning Process: The core material for these activities can be read in this issue of the Journal or online at the JACI Web site: www.jacionline.org. The accompanying tests may only be submitted online at www.jacionline.org. Fax or other copies will not be accepted. Date of Original Release: August 2014. Credit may be obtained for these courses until July 31, 2015. Copyright Statement: Copyright © 2014-2015. All rights reserved. Overall Purpose/Goal: To provide excellent reviews on key aspects of allergic disease to those who research, treat, or manage allergic disease. Target Audience: Physicians and researchers within the field of allergic disease. Accreditation/Provider Statements and Credit Designation: The American Academy of Allergy, Asthma & Immunology (AAAAI) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAAAI designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. List of Design Committee Members: Young J. Juhn, MD, MPH Disclosure of Significant Relationships with Relevant Commercial Companies/Organizations: Y. J. Juhn has received research support from the National Institute of Allergy and Infectious Diseases Activity Objectives1.To provide examples of specific immune dysfunction that might contribute to increased risk of infection in patients with asthma.2.To recognize asthma of all severities as a risk factor for respiratory and nonrespiratory tract infections. Recognition of Commercial Support: This CME activity has not received external commercial support. List of CME Exam Authors: Stephanie Albin, MD, Jennifer Camacho, MD, Tricia Lee, MD, Paul J. Maglione, MD, PhD, Manish Ramesh, MD, PhD, and Charlotte Cunningham-Rundles, MD, PhD Disclosure of Significant Relationships with Relevant Commercial Companies/Organizations: Paul J. Maglione, MD, PhD, Mount Sinai School of Medicine (Clinical Fellow), disclosed the following competing relationships: Thrasher Research Fund: Grant, Clinical Immunology Society: Grant; Charlotte Cunningham-Rundles, MD, PhD, FAAAAI, Mt. Sinai Medical Center (Prof Med, Peds and Immunology), disclosed the following competing relationships: Baxter Healthcare: Medical Advisory Board, Biotest: Consultant, BPL: Consultant, CSL Behring: Medical Advisor, Grifols: Medical Advisory Board. The remaining CME exam authors disclosed no relevant financial relationships. Globally, nearly 300 million persons are affected by asthma (4.3% to 8.6% of adults1To T. Stanojevic S. Moores G. Gershon A. Bateman E. Cruz A. et al.Global asthma prevalence in adults: findings from the cross-sectional world health survey.BMC Public Health. 2012; 12: 204Crossref PubMed Scopus (56) Google Scholar and 2.8% to 37% of children,2Asher M.I. Montefort S. Bjorksten B. Lai C.K. Strachan D.P. 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For example, the role of microbes in the cause of asthma (whether the role is protective or provocative) has been widely studied, whereas little is known about the burdens to society caused by morbidity and mortality resulting from the increased susceptibility to microbial infections associated with atopic conditions. This review aimed to synthesize the current literature on the effects of asthma or other atopic conditions on the risk of microbial infections. Given the paucity of other recent review articles,19James K.M. Peebles R.S. Hartert T.V. Response to infections in patients with asthma and atopic disease: an epiphenomenon or reflection of host susceptibility?.J Allergy Clin Immunol. 2012; 130: 343-351Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 20Juhn Y.J. Influence of asthma epidemiology on the risk for other diseases.Allergy Asthma Immunol Res. 2012; 4: 122-131Crossref PubMed Scopus (5) Google Scholar, 21Martinez F.D. Vercelli D. 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Risk of invasive pneumococcal disease in children and adults with asthma: a systematic review.Vaccine. 2013; 31: 4820-4826Crossref PubMed Scopus (1) Google Scholar The US Advisory Committee on Immunization Practices (ACIP) issued a recommendation in 2008 to give a single dose of 23-valent polysaccharide pneumococcal vaccine (PPV23) to asthmatic patients aged 19 to 64 years.35The Center for Disease Control and PreventionUpdated recommendations for prevention of invasive pneumococcal disease among adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23).MMWR Morb Mortal Wkly Rep. 2010; 59: 1102-1106PubMed Google Scholar We reported that both adults and children with atopic dermatitis, allergic rhinitis, or both had increased risk of serious pneumococcal disease compared with those without such conditions; this association was independent of asthma status (adjusted odds ratio [OR], 2.13; 95% CI, 1.04-4.35).29Jung J.A. Kita H. Yawn B.P. Boyce T.G. Yoo K.H. 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Lahr B. et al.Increased risk of pertussis in patients with asthma.J Allergy Clin Immunol. 2012; 129: 957-963Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Control subjects for this study were selected from matched subjects who had negative PCR test results for pertussis within 1 month of the index date for their corresponding cases. Thus detection bias (ie, exposure status differentially affecting detection of outcome events) is unlikely to account for the association. Also, neither corticosteroid therapy nor asthma control status was associated with risk of pertussis. The anti–pertussis toxin antibody level was slightly lower in persons with versus those without asthma, which might suggest a decreased humoral immune response to B pertussis or a more rapid waning of anti–pertussis toxin antibody over time in asthmatic patients. The study concluded that given the high prevalence of asthma and the ongoing risk of pertussis throughout the United States, consideration should be given to defining patients with asthma as a target group for pertussis vaccination (eg, replacing the decennial tetanus-diphtheria booster with tetanus-diphtheria-pertussis vaccine). Another case-control study showed that asthmatic children had a significantly higher proportion of seropositivity to Legionella pneumophila than did nonasthmatic children.51Boldur I. Beer S. Kazak R. Kahana H. Kannai Y. Predisposition of the asthmatic child to legionellosis?.Isr J Med Sci. 1986; 22: 733-736PubMed Google Scholar Recently, a population-based epidemiologic study showed a significantly increased risk of community-acquired Escherichia coli bloodstream infection (BSI) in persons with asthma compared with those without asthma (discussed in the next section).52Bang D.W. Yang H.J. Ryoo E. Al-Hasan M.N. Lahr B. 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