Allergy and Asthma Group and Clinical Health Care Science

Research projects

1. Our hypothesis is that early protection of the skin barrier in infants can prevent atopic dermatitis (AD) development, sensitisation and food allergy. This idea is based on the dual allergen exposure theory, which stresses that early exposure to food allergens through a disrupted skin barrier results in allergic sensitisation, whereas early oral food allergen exposure induces tolerance. Specific aims are to test the dual allergen exposure theory and analyse if the development of AD and food allergy to basic foods (milk, wheat and eggs) and peanuts is reduced in children subjected to regular protective skin emollient care from birth (intervention 1) and to early oral food allergen introduction before 4 months of age (intervention 2). The next planned research step is to identify and guide those at high risk for allergy to skin and food interventions and to understand the early origins of reduced skin barrier function and early development of lung function in children. Research incorporates information from clinical investigations during pregnancy, at birth and in early infancy in the Swedish and Norwegian PreventADALL (Preventing Atopic Dermatitis and Allergy in children) study. Specific aims are to analyse early developmental factors of allergy and allergic disease and the influence of markers of skin barrier function. We also analyse if pre- and postnatal stress modifies immune development and risk of AD and sensitisation in offspring.
2. We have developed and CE-marked Asthmatuner, a novel self-management system consisting of a patient app, cloud-based storage solution and healthcare interface. Patients use a Bluetooth spirometer (MIR, SmartOne) to measure lung function and register symptoms. They then receive automated feedback on asthma control and an image of the correct inhaler(s) to use and the dose. The goal is to provide symptom control and equal access to healthcare for patients with asthma in the Tiohundra municipality (Norrtälje, Sweden) and paediatric specialist care in Stockholm. Specific aims in this planned randomised controlled trial (RCT) are to evaluate if asthma control is better with Asthmatuner than with traditional non-digital self-management. We will also:
   - Assess if Asthmatuner reduces the number of health care visits,
   - Investigate if Asthmatuner improves adherence to asthma medication,
   - Characterise specific phenotypes based on biodata and time-serial measurements of lung function in relation to symptom occurrence and exacerbation in patients using Asthmatuner. The goal is to develop mathematical algorithms for generating action plans for prevention of exacerbation.
3. The inhalation flow app is an automated objective tool to measure the inhalation technique to customised treatment with metered dose inhaler (MDI) or dry powder inhaler (DPI). The app and wireless hand-held spirometer measure the peak inspiratory flow rate, inspiration time and inspiratory volume and hardware that provides inspiratory resistance that is concordant with a specific inhaler. The research purpose is to evaluate patients’ inhalation techniques in terms of the agreement between measured inhalation flow profile and applied criteria for use of a metered dose inhaler (MDI) or dry powder inhaler (DPI).
4. Asthmatuner Diagnosis is an easier and more time efficient digital tool for diagnosis of asthma. The development and validation of Asthmatuner Diagnosis is done in collaboration with the six clinics of Occupational and Environmental Medicine in Sweden. The method is CE-marked and available in clinical practice and upcoming asthma studies with the objective of investigating symptoms and variability in lung function over a period of time.
5. U-BIOPRED (Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes) is a European Union consortium of 20 academic institutions, 11 pharmaceutical companies and six patient organisations with the objective of improving the understanding of asthma disease mechanisms using a systems biology approach. Two clinical cohorts of adult and paediatric patients with severe asthma at Karolinska University Hospital were assessed.
6. Blood analyses containing preanalytical errors (PAEs) are hazardous for patients. We have shown that samples with PAEs were frequently clotted and insufficiently filled, and the distribution of errors varied within working shifts and specific analyses in paediatric tertiary care. The aim of this project is to reduce the number of PAE in paediatric health care by approaching nurses and nurse assistants with an educational intervention in blood sampling technique.

Group members

Gunilla Hedlin, senior professor and MD
Jon Konradsen, PhD and MD
Cilla Söderhäll, associate professor and geneticist
Anna Asarnoj, PhD And MD
Anders Bjerg Backlund, PhD and MD
Henrik Ljungberg, PhD and MD
Henrik Hjelmgren, PhD-student and paediatric nurse
Sandra Ganrud Tedner, PhD-student and MD
Martin Färdig, PhD-student and paediatric nurse
Caroline Mägi-Olsson, PhD-student and paediatric nurse
Sandra Götberg, MD and MSc
Ellen Tegnerud, paediatric nurse and MSc
Karina Barhag, paediatric nurse and MSc
Natasha Sedergren, administrator
Anna Carleborg, nurse and MSc

Collaborators

We collaborate with national and international research groups, patient organisations and the business community:

Karin Lödrup Carlsen vid Oslo University, Norway
Christine Monceyron Jonassen, Fredrikstad Hospital, Norway
Edgar Delgado-Eckert, Basel University, Schweiz
Katrin Dierschke, Lund University, Sweden
Eva Rönnmark, Umeå University, Sweden
Petter Brodin, Karolinska Institutet, Sweden
Johan Alm, Karolinska Institutet, Sweden
Annika Scheynius, Karolinska Institutet, Sweden
Lovisa Jäderlund Hagstedt, municipality of Tiohundra, Norrtälje, Sweden
Swedish Asthma and Allergy Association
Youth with Allergy, Sweden
Allergy diagnostics, Thermo Fisher Scientific
Digital solutions for asthma diagnosis and self-management, Medituner AB

Research fundings

Forte project funding
Swedish Asthma and Allergy Association
Stockholm County Council
Swedish Heart and Lung Foundation
Sweden’s Innovation Agency, Vinnova – Medtech4Health
Karolinska Institutet, Strategic Research within Health Care Science
Frimurarna Barnhuset Stockholm
Stiftelsen Samariten
Jerring Foundation
Sällskapet barnavård
Märta and Gunnar Philipson
Hesselman Research Foundation