Allergen Management in Children with Type 2-High Asthma

Gray-Ffrench, Madeleine; Fernandes, Ricardo M; Sinha, Ian; Abrams, Elissa M.

doi:10.2147/jaa.s276994

Cited by 8 publications

(3 citation statements)

References 112 publications

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“…The literature on fungal sensitisation in children is predominantly for A. fumigatus [ 51 ] and data on other fungi are scarce [ 52 ]. The experts agreed that among children, only those with difficult-to-treat asthma require screening for A. fumigatus sensitisation rather than all asthmatic children [ 53 ].…”

Section: Resultsmentioning

confidence: 99%

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Agarwal,

Sehgal,

Muthu

et al. 2024

Eur Respir J

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BackgroundThe ISHAM working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) nearly a decade ago. There is a need to update these recommendations due to advances in diagnostics and therapeutics.MethodsAn international expert group was convened to develop guidelines for managing ABPA (caused byAspergillusspp.) and allergic bronchopulmonary mycosis (ABPM, fungi other thanAspergillusspp.) in adults and children using a modified Delphi method (two online rounds and one in-person meeting). We defined consensus as ≥70% agreement or disagreement. The terms “recommend” and “suggest” are used when the consensus was ≥70% and <70%.ResultsWe recommend screening forA. fumigatussensitization using fungus-specific IgE in all newly diagnosed adult asthmatics at tertiary care but only difficult-to-treat asthmatic children. We recommend diagnosing ABPA in those with predisposing conditions or compatible clinico-radiological presentation, with a mandatory demonstration of fungal sensitization and serum total IgE ≥500 IU·mL−1and two of the following: fungal-specific IgG, peripheral blood eosinophilia, or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normalA. fumigatus-IgE. Additionally, diagnosing ABPM requires repeated growth of the causative fungus from sputum.We do not routinely recommend treating asymptomatic ABPA patients. We recommend oral prednisolone or itraconazole monotherapy for treating acute ABPA (newly diagnosed or exacerbation), with prednisolone and itraconazole combination only for treating recurrent ABPA exacerbations. We have devised an objective multidimensional criterion to assess treatment response.ConclusionWe have framed consensus guidelines for diagnosing, classifying, and treating ABPA(M) for patient care and research.

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Section: Resultsmentioning

confidence: 99%

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Agarwal,

Sehgal,

Muthu

et al. 2024

Eur Respir J

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“…Recent work suggests a mechanism acting through gut microbiota [ 124 ]. Most evidence still points to an association between mould exposure and negative respiratory outcomes, with asthma at the centre [ 124 , 125 ]. For example, children experiencing homelessness face a heightened risk of respiratory problems such as asthma and chronic cough, often due to increased exposure to damp environments with mould allergens [ 126 ].…”

Section: Mouldmentioning

confidence: 99%

Impact of climate change on paediatric respiratory health: pollutants and aeroallergens

Domingo,

Gabaldon,

Hussari

et al. 2024

Eur Respir Rev

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Paediatric populations are particularly vulnerable to respiratory diseases caused and exacerbated by aeroallergens, pollutants and infectious agents. Worsening climate change is expected to increase the prevalence of pollutants and aeroallergens while amplifying disease severity and causing disproportionate effects in under-resourced areas. The purpose of this narrative review is to summarise the role of anthropogenic climate change in the literature examining the future impact of aeroallergens, pollutants and infectious agents on paediatric respiratory diseases with a focus on equitable disease mitigation. The aeroallergens selected for discussion include pollen, dust mites and mould as these are prevalent triggers of paediatric asthma worldwide. Human rhinovirus and respiratory syncytial virus are key viruses interacting with climate change and pollution and are primary causal agents of viral respiratory disease. Within this review, we present the propensity for aeroallergens, climate change and pollution to synergistically exacerbate paediatric respiratory disease and outline measures that can ameliorate the expected increase in morbidity and severity of disease through a health equity lens. We support shifting from fossil fuels to renewable energy worldwide, across sectors, as a primary means of reducing increases in morbidity.

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“…La alergia y la exposición prolongada a mascotas (particularmente la exposición a gato) también se asocian a un mayor riesgo de desarrollar asma y de exacerbaciones, y a una peor evolución clínica y un peor control de la enfermedad 37 . Los altos niveles de IgE específica inducida por la exposición a gatos, perros y caballos y la polisensibilización a los tres animales se definen como marcadores de asma más grave 38 .…”

Section: Alérgenosunclassified