Premenstrual asthma and atopy markers

Vega, A. Vega; Sánchez, José Luis; Maldonado, J.; Borrero, Fátima; Rico, Ignacio Vázquez; Vázquez, Rosa; Álvarez, Francisco; Ignacio, José; Romero, Pedro; Gil, Francisco

doi:10.1016/j.anai.2010.06.022

Cited by 10 publications

(11 citation statements)

References 23 publications

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“… ➢ The menstrual phase has also been shown to influence nasal reactivity, as the period of peak estrogen is correlated with the nasal mucosa becoming hyperreactive to histamine [ 52 ]. ➢ Bronchial hyperreactivity is more likely in the perimenstrual period than at other points in the cycle; PMA seems to be closely linked to total IgE levels but not to specific allergens [ 53 ]. ➢ Atopic asthma, a specific asthma phenotype, is often associated to an irregular menstrual cycle [ 54 , 55 ] …”

Section: Reviewmentioning

confidence: 99%

Perimenstrual asthma: from pathophysiology to treatment strategies

Graziottin

Serafini²

2016

Multidiscip Respir Med

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The prevalence of asthma is about 9,7 % in women and 5,5 % in men.Asthma can deteriorate during the perimenstrual period, a phenomenon known as perimenstrual asthma (PMA), which represents a unique, highly symptomatic asthma phenotype. It is distinguished from traditional allergic asthma by aspirin sensitivity, less atopy, and lower lung capacity.PMA incidence is reported to vary between 19 and 40 % of asthmatic women. The presence of PMA has been related to increases in asthma-related emergency department visits, hospitalizations and emergency treatment including intubations.It is hypothesized that hormonal status may influence asthma in women, focusing on the role of sex hormones, and specifically on the impact of estrogens’ fluctuations at ovulation and before periods.This paper will focus on the pathophysiology of hormone triggered cycle related inflammatory/allergic events and their relation with asthma. We reviewed the scientific literature on Pubmed database for studies on PMA. Key word were PMA, mastcells, estrogens, inflammation, oral contraception, hormonal replacement therapy (HRT), and hormone free interval (HFI).Special attention will be devoted to the possibility of reducing the perimenstrual worsening of asthma and associated symptoms by reducing estrogens fluctuations, with appropriate hormonal contraception and reduced HFI. This novel therapeutical approach will be finally discussed.

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Section: Reviewmentioning

confidence: 99%

Perimenstrual asthma: from pathophysiology to treatment strategies

Graziottin

Serafini²

2016

Multidiscip Respir Med

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“…Defi nitions have differed across studies, and no large-scale analyses have been performed. 15,16 To this end, . 500 women with a range of asthma severity recruited for SARP were analyzed for PMA.…”

Section: Hormonal Immunoinfl Ammatory Factors and Comorbiditiesmentioning

confidence: 99%

Characteristics of Perimenstrual Asthma and Its Relation to Asthma Severity and Control

Rao

Moore

Bleecker

et al. 2013

Chest

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A sthma is a complex disease with recognized sex differences. Adult asthma affects more women than men, and women may be predisposed to greater severity. [1][2][3][4] Additionally, women report onset of asthma later in life, often associated with times of hormonal change.In small studies, about 30% to 40% of women report worsening of asthma symptoms in relation to menstruation. [5][6][7][8] The presence of perimenstrual asthma (PMA) has been related to increases in asthmarelated ED visits, hospitalizations, ICU admissions, intubations, and near-fatal and fatal events. 5 Unfortunately, the small nature of previous studies limits the ability to characterize contributing factors or implications of PMA.There is growing support for the concept that asthma consists of multiple phenotypes, which may be more easily recognized in severe asthma. 9,10 Although the National Heart, Lung, and Blood Institute Severe Asthma Research Program (SARP), a large network to study severe asthma mechanisms, recently identifi ed a female-predominant, late-onset phenotype, 11Background: Although perimenstrual asthma (PMA) has been associated with severe and diffi cultto-control asthma, it remains poorly characterized and understood. The objectives of this study were to identify clinical, demographic, and infl ammatory factors associated with PMA and to assess the association of PMA with asthma severity and control. Methods: Women with asthma recruited to the National Heart, Lung, and Blood Institute Severe Asthma Research Program who reported PMA symptoms on a screening questionnaire were analyzed in relation to basic demographics, clinical questionnaire data, immunoinfl ammatory markers, and physiologic parameters. Univariate comparisons between PMA and non-PMA groups were performed. A severity-adjusted model predicting PMA was created. Additional models addressed the role of PMA in asthma control. Results: Self-identifi ed PMA was reported in 17% of the subjects (n 5 92) and associated with higher BMI, lower FVC % predicted, and higher gastroesophageal refl ux disease rates. Fifty-two percent of the PMA group met criteria for severe asthma compared with 30% of the non-PMA group. In multivariable analyses controlling for severity, aspirin sensitivity and lower FVC % predicted were associated with the presence of PMA. Furthermore, after controlling for severity and confounders, PMA remained associated with more asthma symptoms and urgent health-care utilization. Conclusions: PMA is common in women with severe asthma and associated with poorly controlled disease. Aspirin sensitivity and lower FVC % predicted are associated with PMA after adjusting for multiple factors, suggesting that alterations in prostaglandins may contribute to this phenotype. CHEST 2013; 143(4):984-992Abbreviations: F eno 5 fraction of exhaled nitric oxide; GERD 5 gastroesophageal refl ux disease; HCU 5 health-care utilization; PG 5 prostaglandin; PMA 5 perimenstrual asthma; SARP 5 Severe Asthma Research Program

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“…The results of some former studies suggested, that PMA seems to be closely linked to some atopy markers. In their study Pereira-Vega et al proved that women with PMA had total blood IgE values increased above normal (20). Authors however, did not compare total IgE concentrations between PMA and non-PMA asthmatics.…”

Section: Discussionmentioning

confidence: 99%

“…It is suggested that the exacerbations of asthma symptoms in PMA are associated with perimenstrual, increased airway hyperresponsiveness (12,13), dependent on fluctuating concentrations of sex hormones (9-11,14,17-19) and proinflammatory mediators (11,24,25). However, of the few studies conducted so far on the molecular basis of PMA, most focused on the markers of systemic inflammation (11,20) or was carried out in animal models (17,19,24). With this in mind, we designed a study to evaluate the possible involvement of proinflammatory cytokines in lower airways of PMA patients in the development of airway hyperresponsiveness and the co-related disease exacerbation in perimenstrual period.…”

Section: Discussionmentioning

confidence: 99%

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Bronchial hyperreactivity in perimenstrual asthma is associated with increased Th-2 response in lower airways

et al. 2017

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Background: perimenstrual asthma (PMA) is a commonly observed, usually difficult-to-treat asthma phenotype. The mechanisms underlying this phenomenon remain unexplained. The aim of the study was to assess the degree of airway hyperresponsiveness and its relationship to proinflammatory cytokines concentration in lower airways of PMA compared to non-PMA patients.Methods: Premenopausal women with regular menstrual cycles diagnosed as: PMA (n=12), non-PMA asthmatics (n=9), and healthy controls (n=10) were prospectively followed for 10 weeks over two consecutive menstrual cycles. The bronchial responsiveness (BR) test to methacholine was performed in each subject prior to the study. The serum for total immunoglobulin E (IgE) concentrations was taken and sputum was induced in the 26th day of each of the two cycles. Sputum concentration of eotaxin, IL-4 and IL-10 were measured by ELISA.Results: Levels of BR to metacholine as well, as total blood IgE concentrations in PMA subjects were significantly higher than in non-PMA asthmatics and healthy controls (P=0.001, P=0.022 respectively) and correlated with each other (P=0.030; r =−0.65). Sputum eotaxin and IL-4 concentrations in luteal phase were increased in PMA patients when compared with non-PMA asthmatics (P=0.016; P=0.041, respectively) and healthy subjects (P<0.001 both cytokines). No differences for the sputum levels of IL-10 among studied groups were seen.Conclusions: BR level in perimenstrual asthma is higher than in non-PMA asthmatics and correlates with increased total IgE serum concentration. The increased level of BR in PMA patients is associated with a shift in the type-1/type-2 cytokine balance toward a type-2 response.

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Premenstrual asthma and atopy markers

Cited by 10 publications

References 23 publications

Perimenstrual asthma: from pathophysiology to treatment strategies

Perimenstrual asthma: from pathophysiology to treatment strategies

Characteristics of Perimenstrual Asthma and Its Relation to Asthma Severity and Control

Bronchial hyperreactivity in perimenstrual asthma is associated with increased Th-2 response in lower airways

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