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Asthma affects about 1 in 11 American children, making it one of the most common diseases of childhood.  It carries a huge burden on families, especially during exacerbations when disease activity suddenly flares, leading to breathlessness and even death.  In this month’s issue of JACI, Hoch and colleagues discuss their research in validating the Seasonal Asthma Exacerbation Predictive Index, the saEPI ( J Allergy Clin Immunol 2017; 140(4): 1130-1137 ).  The saEPI is a score ranging from 0 to 16 that can help predict how likely a child is to have an asthma flare.  Using data from the Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations (PROSE) study, they looked at 348 children randomized to two groups: one with omalizumab, and another with guideline-based therapy alone.  They then calculated and validated the saEPI, moreover the authors looked at other factors that were associated with exacerbations.  In short, they found that children who req...

Wheezing is a common complaint among parents of infants.  About 1 in 5 children have acute wheezing illnesses in their first two years of life.  This is important because an overwhelming majority of these wheezing illnesses are related to viruses, and are linked to asthma development.  In this month’s issue of JACI, Jartti and Gern review the role of viral infections in the development of asthma in children ( J Allergy Clin Immunol 2017; 140(4): 895-906 ).  They survey the viruses -rhinoviruses, respiratory syncytial viruses, and others – and how they impact the developing set of lungs.  Genetic variation and low interferon responses are two factors that increase the risk of these types of infections.  In addition, increased eosinophil counts in blood and nasal mucus and atopic eczema all increase the risk of later asthma.  Additionally, viral infections can lead to exacerbations in children who already have asthma.  This may explain why the rates...

There are hundreds of viruses that cause respiratory tract infections.  While most of us think about them as nuisances causing cough and wheezing, they bear a huge toll on health, especially in people who have lung diseases like asthma and COPD, as well as an economic toll in lost workdays and inappropriate use of medical resources.  In this month’s issue of JACI, Papadopoulos and colleagues look at the treatment and prevention of these diseases ( J Allergy Clin Immunol 2017; 140(4): 921-932 ).  They look at new medications that target the specific viruses in their reproductive phases.  In addition, they review how natural products like echinacea can prevent recurrent respiratory tract infections.  On the other side, there are promising insights about the use of immunostimulators in order to boost the body’s own responses to these viruses.  Vitamin D, probiotic supplements, exercise and meditation are all helpful in resolving these infections. But perhaps t...

Cough is an important reflex we need to remove irritants from the airways, but for many people, a hypersensitive cough reflex can negatively affect quality of life.  A major trigger of chronic cough is airway inflammation from immune cells including type 2 helper T-cells (T H 2), but conventional tests required for diagnosis are technically challenging and often require specialist expertise.  Fortunately, measurement of the fractional exhaled nitric oxide (FENO), a potential marker of T H 2 airway inflammation, has become much more common in allergy and pulmonary practices.  In this month’s issue of JACI, Song and colleagues review the literature on the use of FENO to diagnose Cough-Variant Asthma (CVA) and Eosinophilic Bronchitis (EB), two major causes of T H 2-mediated chronic cough ( J Allergy Clin Immunol 2017; 140(3): 701-709 ). They looked at thousands of articles from multiple databases in order to answer the question “What is the diagnostic accuracy of FENO for CV...

Asthma is a complex disease of the airways characterized by inflammation and dynamic airway obstruction.  Despite the single, more recent evidence suggests that asthma is mediated by a set of distinct immune abnormalities.  In this month’s issue of JACI, Silkoff and colleagues report the results of the ADEPT (Airways Disease Endotyping for Personal Therapeutics) study, in which 83 patients with mild, moderate, and severe asthma as well as 25 healthy non-asthmatic subjects were examined for biomarkers of asthma ( J Allergy Clin Immunol 2017; 140(3): 710-719 ).  They underwent bronchoscopy to obtain tissue samples, and then had the biomarkers measured in the lab to characterize them as having either high or low levels of type 2 inflammatory mediators.  These were then correlated with clinical variables. They determined the presence of type 2 inflammation based on airway expression of CCL26, periostin, and IL-13 in vitro signature (IVS).  They then looked at the cl...

Along with wheezing illnesses, allergic sensitization during infancy is a major risk factor for childhood asthma.  But how exactly this allergic sensitization occurs is not very well known.  In this month’s issue of JACI, Gern and colleagues look at cytokine responses in 467 inner-city children from the URECA study (Urban Environment and Childhood Asthma) at ages 1 and 3 years ( J Allergy Clin Immunol 2017; 140(3): 836-844 ).  They then examined these cytokine responses in relation to environmental exposures to allergens and endotoxin as well as development of allergic sensitization and recurrent wheezing. They found that cytokine responses increased as the children grew older, but responses at birth were not predictive for responses at ages 1 and 3 years. Exposure to cockroach, mouse, and house dust mite was associated with enhanced Interferon-alpha and IL-10 cytokine responses.  This contrasts with reduced IL-10 responses at birth, which was associated with recurre...

Until a few years ago, it was thought that microbes don’t live in the lung’s passages.  But now we know that there is a diverse range of microbiota that lives there.  In this month’s issue of JACI, Sverrild and colleagues examine the relationship between these microbes and patterns of airway inflammation in healthy patients and in asthmatics who have not taken steroids ( J Allergy Clin Immunol 2017; 140(2): 407-417 ).  In order to do so, they took 10 healthy participants and 23 nonsmoking steroid-free asthmatics and had them undergo bronchoscopy so that they could get fluid from the lower passageways.  They then sequenced bacterial DNA and looked at the number and type of immune cells.  The 33 participants also had their asthma better characterized through other standardized measures of disease severity like airway hyperresponsiveness to mannitol and fraction of exhaled nitric oxide. They found that patients with eosinophilic asthma and those with hyperresponsiv...