Rita Amaral1,2, Jean Bousquet3,4,5,6,7, Ana M Pereira1,8, Luís M Araújo8,9, Ana Sá-Sousa1, Tiago Jacinto1,2, Rute Almeida1, Luís Delgado8,9, Joao A Fonseca1,8,10. 1. CINTESIS - Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal. 2. Department of Cardiovascular and Respiratory Sciences, Porto Health School, Porto, Portugal. 3. MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France. 4. INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, France. 5. UMR-S 1168, Université Versailles St-Quentin-en-Yvelines, Montigny le Bretonneux, France. 6. Euforea, Brussels, Belgium. 7. Euforea, Charité, Germany. 8. Allergy Unit, Instituto & Hospital CUF, Porto, Portugal. 9. Basic & Clinical Immunology, Pathology Department, Faculdade Medicina da, Universidade do Porto, Porto, Portugal. 10. MEDCIDS, Department of Community Medicine, Information, and Health Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
Abstract
BACKGROUND: Refined phenotyping of allergic diseases may unravel novel phenotypes. Conjunctivitis as an independent disorder has never been approached. AIM: To identify distinct classes of allergic respiratory diseases using latent class analysis (LCA) and distinguish each class using classification and regression tree (CART) analysis. METHODS: Seven hundred and twenty-eight adults from the Portuguese general population study ICAR had a structured medical interview combined with blood collection, skin prick tests, spirometry with bronchodilation, and exhaled nitric oxide. LCA was applied to 19 variables. The CART algorithm selected the most likely variables distinguishing LCA-classes. RESULTS: A six-class model was obtained. Class 1 (25%): nonallergic participants without bronchial or ocular symptoms. Classes 2 (22%) and 3 (11%): nasal and ocular (low levels) symptoms without nasal impairment, monosensitized (Class 2) or polysensitized (Class 3). Class 4 (13%): polysensitized participants with high levels of nasal and ocular symptoms, and nasal impairment. Classes 5 (16%) and 6 (14%): high level of nasal, bronchial and ocular symptoms with nasal impairment (non-allergic or polysensitized, respectively). Participants in classes 5 and 6 had more bronchial exacerbations and unscheduled medical visits (P < 0.001). Ocular symptoms were significantly higher in classes with nasal impairment, compared to those without impairment (P < 0.001) or no nasal symptom (P < 0.001). CART highlighted ocular symptoms as the most relevant variable in distinguishing LCA-classes. CONCLUSION: Novel severe phenotypes of participants with co-occurrence of ocular, nasal and bronchial symptoms, and exacerbation-prone were identified. The tree algorithm showed the importance of the ocular symptoms in the expression of allergic diseases phenotypes.
BACKGROUND: Refined phenotyping of allergic diseases may unravel novel phenotypes. Conjunctivitis as an independent disorder has never been approached. AIM: To identify distinct classes of allergic respiratory diseases using latent class analysis (LCA) and distinguish each class using classification and regression tree (CART) analysis. METHODS: Seven hundred and twenty-eight adults from the Portuguese general population study ICAR had a structured medical interview combined with blood collection, skin prick tests, spirometry with bronchodilation, and exhaled nitric oxide. LCA was applied to 19 variables. The CART algorithm selected the most likely variables distinguishing LCA-classes. RESULTS: A six-class model was obtained. Class 1 (25%): nonallergic participants without bronchial or ocular symptoms. Classes 2 (22%) and 3 (11%): nasal and ocular (low levels) symptoms without nasal impairment, monosensitized (Class 2) or polysensitized (Class 3). Class 4 (13%): polysensitized participants with high levels of nasal and ocular symptoms, and nasal impairment. Classes 5 (16%) and 6 (14%): high level of nasal, bronchial and ocular symptoms with nasal impairment (non-allergic or polysensitized, respectively). Participants in classes 5 and 6 had more bronchial exacerbations and unscheduled medical visits (P < 0.001). Ocular symptoms were significantly higher in classes with nasal impairment, compared to those without impairment (P < 0.001) or no nasal symptom (P < 0.001). CART highlighted ocular symptoms as the most relevant variable in distinguishing LCA-classes. CONCLUSION: Novel severe phenotypes of participants with co-occurrence of ocular, nasal and bronchial symptoms, and exacerbation-prone were identified. The tree algorithm showed the importance of the ocular symptoms in the expression of allergic diseases phenotypes.
Authors: J Bousquet; A Bedbrook; W Czarlewski; G L Onorato; S Arnavielhe; D Laune; E Mathieu-Dupas; J Fonseca; E Costa; O Lourenço; M Morais-Almeida; A Todo-Bom; M Illario; E Menditto; G W Canonica; L Cecchi; R Monti; L Napoli; M T Ventura; G De Feo; W J Fokkens; N H Chavannes; S Reitsma; A A Cruz; J da Silva; F S Serpa; D Larenas-Linnemann; J M Fuentes Perez; Y R Huerta-Villalobos; D Rivero-Yeverino; E Rodriguez-Zagal; A Valiulis; R Dubakiene; R Emuzyte; V Kvedariene; I Annesi-Maesano; H Blain; P Bonniaud; I Bosse; Y Dauvilliers; P Devillier; J F Fontaine; J L Pépin; N Pham-Thi; F Portejoie; R Picard; N Roche; C Rolland; P Schmidt-Grendelmeier; P Kuna; B Samolinski; J M Anto; V Cardona; J Mullol; H Pinnock; D Ryan; A Sheikh; S Walker; S Williams; S Becker; L Klimek; O Pfaar; K C Bergmann; R Mösges; T Zuberbier; R E Roller-Wirnsberger; P V Tomazic; T Haahtela; J Salimäki; S Toppila-Salmi; E Valovirta; T Vasankari; B Gemicioğlu; A Yorgancioglu; N G Papadopoulos; E P Prokopakis; I G Tsiligianni; S Bosnic-Anticevich; R O'Hehir; J C Ivancevich; H Neffen; M E Zernotti; I Kull; E Melén; M Wickman; C Bachert; P W Hellings; G Brusselle; S Palkonen; C Bindslev-Jensen; E Eller; S Waserman; L P Boulet; J Bouchard; D K Chu; H J Schünemann; M Sova; G De Vries; M van Eerd; I Agache; I J Ansotegui; M Bewick; T Casale; M Dykewick; M Ebisawa; R Murray; R Naclerio; Y Okamoto; D V Wallace Journal: Clin Transl Allergy Date: 2019-03-11 Impact factor: 5.871
Authors: A Bédard; X Basagaña; J M Anto; J Garcia-Aymerich; P Devillier; S Arnavielhe; A Bedbrook; G L Onorato; W Czarlewski; R Murray; R Almeida; J A Fonseca; J Correia da Sousa; E Costa; M Morais-Almeida; A Todo-Bom; L Cecchi; G De Feo; M Illario; E Menditto; R Monti; C Stellato; M T Ventura; I Annesi-Maesano; I Bosse; J F Fontaine; N Pham-Thi; M Thibaudon; P Schmid-Grendelmeier; F Spertini; N H Chavannes; W J Fokkens; S Reitsma; R Dubakiene; R Emuzyte; V Kvedariene; A Valiulis; P Kuna; B Samolinski; L Klimek; R Mösges; O Pfaar; S Shamai; R E Roller-Wirnsberger; P V Tomazic; D Ryan; A Sheikh; T Haahtela; S Toppila-Salmi; E Valovirta; V Cardona; J Mullol; A Valero; M Makris; N G Papadopoulos; E P Prokopakis; F Psarros; C Bachert; P W Hellings; B Pugin; C Bindslev-Jensen; E Eller; I Kull; E Melén; M Wickman; G De Vries; M van Eerd; I Agache; I J Ansotegui; S Bosnic-Anticevich; A A Cruz; T Casale; J C Ivancevich; D E Larenas-Linnemann; M Sofiev; D Wallace; S Waserman; A Yorgancioglu; D Laune; J Bousquet Journal: Clin Transl Allergy Date: 2020-12-09 Impact factor: 5.871
Authors: Bernardo Sousa-Pinto; Luís Filipe Azevedo; Ana Sá-Sousa; Rafael José Vieira; Rita Amaral; Ludger Klimek; Wienczyslawa Czarlewski; Josep M Anto; Anna Bedbrook; Violeta Kvedariene; Maria Teresa Ventura; Ignacio J Ansotegui; Karl-Christian Bergmann; Luisa Brussino; G Walter Canonica; Victoria Cardona; Pedro Carreiro-Martins; Thomas Casale; Lorenzo Cecchi; Tomás Chivato; Derek K Chu; Cemal Cingi; Elisio M Costa; Alvaro A Cruz; Giulia De Feo; Philippe Devillier; Wytske J Fokkens; Mina Gaga; Bilun Gemicioğlu; Tari Haahtela; Juan Carlos Ivancevich; Zhanat Ispayeva; Marek Jutel; Piotr Kuna; Igor Kaidashev; Helga Kraxner; Désirée E Larenas-Linnemann; Daniel Laune; Brian Lipworth; Renaud Louis; Michaël Makris; Riccardo Monti; Mario Morais-Almeida; Ralph Mösges; Joaquim Mullol; Mikaëla Odemyr; Yoshitaka Okamoto; Nikolaos G Papadopoulos; Vincenzo Patella; Nhân Pham-Thi; Frederico S Regateiro; Sietze Reitsma; Philip W Rouadi; Boleslaw Samolinski; Milan Sova; Ana Todo-Bom; Luis Taborda-Barata; Peter Valentin Tomazic; Sanna Toppila-Salmi; Joaquin Sastre; Ioanna Tsiligianni; Arunas Valiulis; Dana Wallace; Susan Waserman; Arzu Yorgancioglu; Mihaela Zidarn; Torsten Zuberbier; João Almeida Fonseca; Jean Bousquet; Oliver Pfaar Journal: Clin Transl Allergy Date: 2022-03 Impact factor: 5.871