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Silverberg J.I.,Beth Israel Medical Centers | Hanifin J.,Oregon Health And Science University | Simpson E.L.,Oregon Health And Science University
Journal of Investigative Dermatology

Atopic dermatitis (AD, also known as atopic eczema) is driven by a complex relationship between genetic predisposition and environmental exposures. We sought to determine the impact of specific climatic factors on the prevalence of AD in the United states. We used a merged analysis of the 2007 National Survey of Children's Health (NSCH) from a representative sample of 91,642 children aged 0-17 years and the 2006-2007 National Climate Data Center and Weather Service measurements of relative humidity (%), indoor heating degree days (HDD), clear-sky UV indices, ozone levels, and outdoor air temperature. As a proxy for AD, we used an affirmative response to the NSCH survey question asking whether the participant's child has been given a doctor diagnosis of "eczema or any other kind of skin allergy" in the previous 12 months. In multivariate models controlling for sex, race/ethnicity, age, and household income, eczema prevalence was significantly lower with the highest-quartile mean annual relative humidity (logistic regression, adjusted odds ratio (95% confidence interval)=0.82 (0.71-0.96), P=0.01) and issued UV index (0.73 (0.64-0.84), P<0.0001), and with two other factors associated with increased UV exposure. Eczema prevalence was decreased with the highest-quartile air temperature (0.80 (0.70-0.92), P=0.002) but increased with third-quartile mean annual HDD (1.26 (1.11-1.43), P=0.0003). This study provides evidence of climate influences on the US prevalence of childhood eczema. © 2013 The Society for Investigative Dermatology. Source

Smith-Norowitz T.A.,SUNY Downstate Medical Center | Silverberg J.I.,Beth Israel Medical Centers | Silverberg J.I.,SUNY Downstate Medical Center | Kusonruksa M.,SUNY Downstate Medical Center | And 7 more authors.
Pediatric Infectious Disease Journal

Background: Bronchial asthma is exacerbated by Mycoplasma pneumoniae-induced upper respiratory tract infections (URTIs) in children. Specific IgM and IgG isotypes are involved in the immune response to M. pneumoniae, but little is known about the role of specific IgE antibodies against M. pneumoniae in asthma. Objective: To investigate the role of IgM-, IgG- and IgE-specific antibody responses to M. pneumoniae in children with persistent asthma in relationship to history of URTI within the past 6 months. Methods: Total or specific anti-M. pneumoniae IgM, IgG and IgE antibody responses were studied in stable asthmatic pediatric patients (M. pneumoniae positive and negative) without current exacerbation and nonasthmatic controls (N = 23 and 13, respectively) (UniCAP total IgE Fluoroenzymeimmunoassay, enzyme-linked immunosorbent assay). Results: Values of specific IgM correlated with specific IgG (Spearman correlation, rho = 0.61, P < 0.0001) but not with specific IgE anti-M. pneumoniae antibodies (AMA) in asthmatic subjects compared with nonasthmatic controls. However, concentrations of specific IgG correlated with specific IgE AMA (rho = 0.49, P = 0.0017). Asthmatic subjects had higher levels of specific IgM AMA levels compared with nonasthmatics (median [interquartile range]: 0.57 [1.00] versus 0.21 [0.19]; Kruskal-Wallis test, P = 0.0008). In addition, IgM positivity was significantly higher in asthmatic compared with nonasthmatic subjects (39.1% versus 0.0%; Fisher's exact test, P = 0.01). These results were independent of URTI history in the past 6 months, which was not associated with higher IgM, IgG or IgE AMA levels compared with no URTI history (P = 0.25-0.64). Conclusions: Increased specific IgM anti-M. pneumoniae responses may indicate an important role for M. pneumoniae infection in asthma. Copyright © 2013 by Lippincott Williams & Wilkins. Source

Lee-Wong M.,Beth Israel Deaconess Medical Center | Chou V.,Illinois Allergy and Asthma Specialists | Silverberg J.I.,Beth Israel Medical Centers
Allergy and Asthma Proceedings

Allergic disorders and skin response to histamine have been noted to vary in different ethnicities. We investigated IgE-mediated allergic sensitization and skin response to histamine in Asian Pacific Americans (APAs), black and Hispanic Americans, and white adults. A retrospective questionnaire-based study was performed of 2222 adults presenting at a New York City allergy referral center from 1994 to 2003. Questionnaire data included sex, age, and ethnicity and personal and family history of atopic disorders. Skin-prick test (SPT) data included saline and histamine controls and response to a standardized panel of 10 aeroallergens. APA patients had a lower odds of asthma (adjusted odds ratio [aOR], 0.68; 95% confidence interval [CI], 0.52- 0.89; p = 0.005) and/or animal allergies (aOR, 0.64; 95% CI, 0.50-0.82; p = 0.0003). Histamine response was not significantly different in APA (aOR, 0.90; 95% CI, 0.73-1.12; p = 0.36) or Hispanic Americans (aOR, 1.03; 95% CI, 0.85-1.24; p = 0.76), but was higher in black Americans (aOR, 2.32; 95% CI, 1.67-3.21; p < 0.0001). APA had higher odds of a positive SPT to trees (aOR, 1.49; 95% CI, 1.16-1.91; p = 0.002), grasses (aOR, 1.32; 95% CI, 1.05-1.43; p = 0.02), feathers (aOR, 1.65; 95% CI, 1.31-2.09; p < 0.0001), and cockroaches (aOR, 1.37; 95% CI, 1.10-1.62; p = 0.005). Moreover, APA had a higher total number of positive SPTs when compared with white patients (5.5 ± 3.2 versus 4.9 ± 3.3; aOR, 1.34; 95% CI, 1.10-1.62 p = 0.004). APA adults in our patient population had more IgE sensitizations but not an increased skin response to histamine. In contrast, black Americans had increased skin response to histamine. Copyright © 2012, OceanSide Publications, Inc. Source

Fitzpatrick S.,New York University | Joks R.,New York University | Silverberg J.I.,New York University | Silverberg J.I.,Beth Israel Medical Centers
Clinical and Experimental Allergy

Background: Obesity is associated with increased asthma and atopy. Objective: To determine whether or not obesity in inner-city adults is associated with increased asthma prevalence, severity and exacerbations and IgE responses. Methods: This retrospective study involved 246 adults with asthma and other atopic disorders who were seen at an asthma clinic in New York City between 1997 and 2010. Height, weight, asthma diagnosis and symptoms, peak flow (PF), spirometry, serum IgE levels and white blood cell differentials were recorded. Results: Asthmatic patients had higher body mass index than non-asthmatics (median, interquartile range: 30.5, 10.2 vs. 27.8, 8.8; Mann-Whitney U-test, P = 0.0006). Class I and II/III obesity were associated with increased asthma (I: OR: 2.35, 95% CI: 1.04-5.34, P = 0.04; II/III: OR: 3.25, 95% CI: 1.36-7.74, P = 0.008). Class I and II/III obesity were associated with worsened asthma severity (ordinal logistic regression; I: OR: 4.23, 95% CI: 1.61-11.06, P = 0.003; II/III: OR: 2.76, 95% CI: 1.08-7.09, P = 0.03). Class II/III obesity was associated with increased asthma exacerbations requiring oral corticosteroids (repeated measures logistic regression, OR: 1.13, 95% CI: 1.03-1.25; P = 0.01) and increased requirement of inhaled corticosteroid for long-term asthma management (OR: 1.45, 95% CI: 1.29-1.62; P < 0.0001). In asthmatics, class II/III obesity was associated with decreased PF (general linear model, least squares mean ± SEM: 333.8 ± 37.4 vs. 396.2 ± 32.1 L/min; P = 0.007), forced expiratory volume in 1 s (75.2 ± 4.6 vs. 88.4 ± 5.6%; P = 0.03) and forced vital capacity (83.2 ± 4.7 vs. 109.2 ± 6.0%; P = 0.0002) and increased serum IgE (480.2 ± 88.3 vs. 269.0 ± 66.6 IU/mL; P = 0.04) and neutrophils (66.6 ± 3.7 vs. 60.1 ± 3.8%; P = 0.02). Class I obesity was also associated with increased serum IgE (458.7 ± 68.9, P = 0.03). Conclusion and clinical relevance: Obesity in inner-city adults may be both a risk and exacerbating factor for atopic asthma. © 2011 Blackwell Publishing Ltd. Source

Yi C.-H.,Beth Israel Medical Centers | Yi C.-H.,Beth Israel Deaconess Medical Center | Vega-Talbott M.L.,Beth Israel Medical Centers | Vega-Talbott M.L.,Pediatric Neurology Comprehensive Pediatric Epilepsy Center | Friedman M.T.,Beth Israel Medical Centers
Journal of Clinical Apheresis

While extensive data demonstrated that plerixafor improves stem cell harvest in difficult-to-mobilize patients, economic concerns limit a broader application. We retrospectively assessed the effect of an early plerixafor rescue regimen for mobilization in patients with multiple myeloma. Patients were intended for high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (ABSCT) and therefore received cyclophosphamide-based mobilization chemotherapy and consecutive stimulation with granulocyte colony-stimulating factor (G-CSF). Fifteen patients with poor stem cell harvest in the first leukapheresis session received plerixafor. Data were compared with a matched historic control group of 45 patients who also had a poor stem cell yield in the first apheresis session, but continued mobilization with G-CSF alone. Patients in the plerixafor group collected significantly more CD341 cells in total (median 4.9 vs. 3.7 [range 1.6-14.1 vs. 1.1-8.0] 3 106 CD341 cells /kg bw; P0.05), and also more CD341 cells per leukapheresis procedure (P0.001). Consequently, they required a significantly lower number of leukapheresis procedures to achieve the collection goal (median 2.0 vs. 4.0 [range 2-3 vs. 2-9] procedures; P0.001). The efficiency of the collected stem cells in terms of hematologic engraftment after ABSCT was found to be equal in both groups. These data demonstrate that rescue mobilization with plerixafor triggered by a low stem cell yield in the first leukapheresis session is effective. Although the actual economic benefit may vary depending on the local leukapheresis costs, the median saving of two leukapheresis procedures offsets most of the expenses for the substance in this setting. An exemplary cost calculation is provided to illustrate this effect. © 2014 Wiley Periodicals, Inc. Source

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