{"paper_id":"e0e65bbd-02a6-47d1-9332-623eadb1ec45","body_text":"Unveiling the connection: asthma and endometriosis – a comprehensive systematic review and meta-analysis\nMain Article Content\nKeywords\nasthma, endometriosis, meta-analysis, reproductive health, systematic review\nAbstract\nIntroduction and Objective: Asthma and endometriosis are two prevalent chronic conditions that affect a significant portion of the population. Both conditions have been linked to inflammatory processes and immune dysregulation, suggesting the possibility of a shared pathophysiological mechanism. Despite the growing interest in the connection between asthma and endometriosis, the current literature remains inconclusive. This systematic review and meta-analysis aim to consolidate the available evidence and provide a comprehensive understanding of the association between asthma and endometriosis.\nMaterials and Methods: We searched Embase, PubMed, Scopus, Web of Science, and Google Scholar to identify studies that met our criteria. The random effects model was used to calculate the pooled odds ratios (ORs) and 95% confidence intervals (CIs) for individuals with endometriosis and non-endometriosis controls who have asthma. Additionally, we performed subgroup analyses based on geographic region to identify potential sources of heterogeneity. The research protocol was registered on PROSPERO (CRD42024567249).\nResults: Six eligible case-control studies involving 66,997 cases and 3,253,658 controls were used to examine the association between asthma and endometriosis. Through a comprehensive search and analysis of relevant studies, a significant association between asthma and endometriosis was identified (OR: 1.786, 95% CI: 1.511-2.111, P < 0.001). The correlation showed significant heterogeneity in the study (I2 = 75.709; P-value = 0.001), with geographic region identified as a significant factor contributing to this variation.\nConclusion: Our meta-analysis demonstrates a significant link between asthma and endometriosis, highlighting the need for comprehensive management that addresses both conditions.\nReferences\n2 Cano-Herrera G, Salmun Nehmad S, Ruiz de Chávez Gascón J, Méndez Vionet A, van Tienhoven XA, Osorio Martínez MF, et al. Endometriosis: A Comprehensive Analysis of the Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the Quality of Life of Patients. Biomedicines. 2024;12(7):1476. 10.3390/biomedicines12071476\n3 Oală IE, Mitranovici M-I, Chiorean DM, Irimia T, Cris¸an AI, Melinte IM, et al. Endometriosis and the Role of Pro-Inflammatory and Anti-Inflammatory Cytokines in Pathophysiology: A Narrative Review of the Literature. Diagnostics. 2024;14(3):312. 10.3390/diagnostics14030312\n4 Lamceva J, Uljanovs R, Strumfa I. The Main Theories on the Pathogenesis of Endometriosis. Int J Mol Sci. 2023;24(5). 10.3390/ijms24054254\n5 Abramiuk M, Grywalska E, Małkowska P, Sierawska O, Hrynkiewicz R, Niedźwiedzka-Rystwej P. The Role of the Immune System in the Development of Endometriosis. Cells. 2022;11(13). 10.3390/cells11132028\n6 Kapri A, Pant S, Gupta N, Paliwal S, Nain S. Asthma History, Current Situation, an Overview of Its Control History, Challenges, and Ongoing Management Programs: An Updated Review. Proc Natl Acad Sci India Sect B Biol Sci. 2023;93(3):539-51. 10.1007/s40011-022-01428-1\n7 Chowdhury NU, Guntur VP, Newcomb DC, Wechsler ME. Sex and gender in asthma. Eur Respir Rev. 2021;30(162):210067. 10.1183/16000617.0067-2021\n8 Hough KP, Curtiss ML, Blain TJ, Liu R-M, Trevor J, Deshane JS, et al. Airway Remodeling in Asthma. Front Med. 2020;7. 10.3389/fmed.2020.00191\n9 Luo W, Hu J, Xu W, Dong J. Distinct spatial and temporal roles for Th1, Th2, and Th17 cells in asthma. Front Immunol. 2022;13:974066. 10.3389/fimmu.2022.974066\n10 Harker JA, Lloyd CM. T helper 2 cells in asthma. J Exp Med. 2023;220(6). 10.1084/jem.20221094\n11 Banafea GH, Bakhashab S, Alshaibi HF, Natesan Pushparaj P, Rasool M. The role of human mast cells in allergy and asthma. Bioengineered. 2022;13(3):7049-64. 10.1080/21655979.2022.2044278\n12 McCallion A, Nasirzadeh Y, Lingegowda H, Miller JE, Khalaj K, Ahn S, et al. Estrogen mediates inflammatory role of mast cells in endometriosis pathophysiology. Front Immunol. 2022;13:961599. 10.3389/fimmu.2022.961599\n13 Chang L-Y, Shan J, Hou X-X, Li D-J, Wang X-Q. Synergy between Th1 and Th2 responses during endometriosis: A review of current understanding. J Reprod Immunol. 2023;158:103975. 10.1016/j.jri.2023.103975\n14 Murphy RC, Hallstrand TS. Exploring the origin and regulatory role of mast cells in asthma. Curr Opin Allergy Clin Immunol. 2021;21(1):71-8. 10.1097/ACI.0000000000000703\n15 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700. 10.1136/bmj.b2700\n16 Peng YH, Su SY, Liao WC, Huang CW, Hsu CY, Chen HJ, et al. Asthma is associated with endometriosis: A retrospective population-based cohort study. Respir Med. 2017;132:112-6. 10.1016/j.rmed.2017.10.004\n17 Pan G, Zhang P, Li S, Cao L, Yang C. Association of endometriosis with asthma: a study of the NHANES database in 1999–2006. J Health Popul Nutr. 2024;43(1):50. 10.1186/s41043-024-00541-3\n18 Ferrero S, Petrera P, Colombo BM, Navaratnarajah R, Parisi M, Anserini P, et al. Asthma in women with endometriosis. Hum Reprod. 2005;20(12):3514-7. 10.1093/humrep/dei263\n19 Gyawali S, Lønnebotn M, Johannessen A, Lindberg E, Modig L, Schlünssen V, et al. Asthma and asthma-like symptoms as associated with endometriosis and menstrual pain. Eur Respir J. 2023;62(Suppl 67):PA2073. 10.1183/13993003.congress-2023.PA2073\n20 Matalliotakis I, Cakmak H, Matalliotakis M, Kappou D, Arici A. High rate of allergies among women with endometriosis. J Obstet Gynaecol. 2012;32(3):291-3. 10.3109/01443615.2011.644358\n21 Alqaisi S, Yaqoob Z, Fadhil A, Al-Kindi S, Zein JG. Endometriosis Is Associated with Increased Risk of Asthma in Reproductive Age Women. C37 optimizing asthma care across diverse patients. p. A4840-A.\n22 Sapartini G, Wong GWK, Indrati AR, Kartasasmita CB, Setiabudiawan B. The Association between Vitamin D, Interleukin-4, and Interleukin-10 Levels and CD23+ Expression with Bronchial Asthma in Stunted Children. Biomedicines. 2023;11(9):2542. 10.3390/biomedicines11092542\n23 Pan R, Kuai S, Li Q, Zhu X, Wang T, Cui Y. Diagnostic value of IL-6 for patients with asthma: a meta-analysis. Allergy Asthma Clin Immunol. 2023;19(1):39. 10.1186/s13223-023-00794-3\n24 Silvestri M, Bontempelli M, Giacomelli M, Malerba M, Rossi GA, Di Stefano A, et al. High serum levels of tumour necrosis factor-alpha and interleukin-8 in severe asthma: markers of systemic inflammation? Clin Exp Allergy. 2006;36(11):1373-81. 10.1111/j.1365-2222.2006.02502.x\n25 Halwani R, Al-Muhsen S, Al-Jahdali H, Hamid Q. Role of Transforming Growth Factor–β in Airway Remodeling in Asthma. Am J Respir Cell Mol Biol. 2011;44(2):127-33. 10.1165/rcmb.2010-0027TR\n26 Wang L, Xu Z, Chen B, He W, Hu J, Zhang L, et al. The Role of Vascular Endothelial Growth Factor in Small-airway Remodelling in a Rat Model of Chronic Obstructive Pulmonary Disease. Sci Rep. 2017;7(1):41202. 10.1038/srep41202\n27 Bruner-Tran KL, Herington JL, Duleba AJ, Taylor HS, Osteen KG. Medical management of endometriosis: emerging evidence linking inflammation to disease pathophysiology. Minerva Ginecol. 2013;65(2):199-213.\n28 Donnez J, Cacciottola L. Endometriosis: An Inflammatory Disease That Requires New Therapeutic Options. Int J Mol Sci. 2022;23(3). 10.3390/ijms23031518\n29 Malutan AM, Drugan T, Costin N, Ciortea R, Bucuri C, Rada MP, et al. Pro-inflammatory cytokines for evaluation of inflammatory status in endometriosis. Cent Eur J Immunol. 2015;40(1):96-102. 10.5114/ceji.2015.50840\n30 Sikora J, Smycz-Kubańska M, Mielczarek-Palacz A, Bednarek I, Kondera-Anasz Z. The involvement of multifunctional TGF-β and related cytokines in pathogenesis of endometriosis. Immunol Lett. 2018;201:31-7. 10.1016/j.imlet.2018.10.011\n31 Dunican EM, Fahy JV. The Role of Type 2 Inflammation in the Pathogenesis of Asthma Exacerbations. Ann Am Thorac Soc. 2015;12(Suppl 2):S144-9. 10.1513/AnnalsATS.201506-377AW\n32 Méndez-Enríquez E, Hallgren J. Mast Cells and Their Progenitors in Allergic Asthma. Front Immunol. 2019;10. 10.3389/fimmu.2019.00821\n33 Amin K. The role of mast cells in allergic inflammation. Respir Med. 2012;106(1):9-14. 10.1016/j.rmed.2011.09.007\n34 Li T, Wang J, Guo X, Yu Q, Ding S, Xu X, et al. Possible involvement of crosstalk between endometrial cells and mast cells in the development of endometriosis via CCL8/CCR1. Biomed Pharmacother. 2020;129:110476. 10.1016/j.biopha.2020.110476\n35 Anaf V, Chapron C, El Nakadi I, De Moor V, Simonart T, Noël J-C. Pain, mast cells, and nerves in peritoneal, ovarian, and deep infiltrating endometriosis. Fertil Steril. 2006;86(5):1336-43. 10.1016/j.fertnstert.2006.03.057\n36 Borelli V, Martinelli M, Luppi S, Vita F, Romano F, Fanfani F, et al. Mast Cells in Peritoneal Fluid From Women With Endometriosis and Their Possible Role in Modulating Sperm Function. Front Physiol. 2019;10:1543. 10.3389/fphys.2019.01543\n37 Hart DA. Curbing Inflammation in Multiple Sclerosis and Endometriosis: Should Mast Cells Be Targeted? Int J Inflam. 2015;2015:452095. 10.1155/2015/452095\n38 Monnin N, Fattet AJ, Koscinski I. Endometriosis: Update of Pathophysiology, (Epi) Genetic and Environmental Involvement. Biomedicines. 2023;11(3):978. 10.3390/biomedicines11030978\n39 Bonds RS, Midoro-Horiuti T. Estrogen effects in allergy and asthma. Curr Opin Allergy Clin Immunol. 2013;13(1):92-9. 10.1097/ACI.0b013e32835a6dd6\n40 Adewuyi EO, Mehta D, Nyholt DR. Genetic overlap analysis of endometriosis and asthma identifies shared loci implicating sex hormones and thyroid signalling pathways. Hum Reprod. 2022;37(2):366-83. 10.1093/humrep/deab254\n41 Smorgick N, Marsh CA, As-Sanie S, Smith YR, Quint EH. Prevalence of pain syndromes, mood conditions, and asthma in adolescents and young women with endometriosis. J Pediatr Adolesc Gynecol. 2013;26(3):171-5. 10.1016/j.jpag.2012.12.006","source_license":"CC0","license_restricted":false}