Worldwide variations in prevalence of symptoms of allergic rhinoconjunctivitis in children: the International Study of Asthma and Allergies in Childhood (ISAAC)

Metabolomics analysis of baicalin on ovalbumin-sensitized allergic rhinitis rats

Allergic rhinitis (AR) is a global health problem that appears in all age groups and affects approximately 15-30% of people. Baicalin has been used for the treatment of various allergic diseases, including AR. However, the metabolic mechanisms of AR and baicalin against AR have not been systematically studied. Here, ovalbumin-sensitized AR rats were used as a model, and animal behaviour, histological analysis, enzyme-linked immunosorbent assay (ELISA) and metabolomics were used to elucidate the mechanism of baicalin for AR. The results indicated that baicalin has a protective effect on AR rats by inhibiting the release of immunoglobulin E (IgE), histamine, interleukin-1 beta (IL-1β), interleukin-4 (IL-4), interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α). In addition, ovalbumin-induced AR included modulation of arachidonic acid, leukotriene A4 (LTA4), leukotriene B4 (LTB4), α-ketoglutaric acid, phosphatidylcholine PC (20 : 4/0 : 0), PC (16 : 0/0 : 0), citric acid, fumarate, malate, 3-methylhistidine, histamine and other amino acids that are involved in arachidonic acid, histidine metabolism, the TCA cycle and amino acid metabolism. Thus, AR could be alleviated or reversed by baicalin.

Associations of greenness, greyness and air pollution exposure with children's health: a cross-sectional study in Southern Italy

BACKGROUND

Due to the complex interplay among different urban-related exposures, a comprehensive approach is advisable to estimate the health effects. We simultaneously assessed the effect of "green", "grey" and air pollution exposure on respiratory/allergic conditions and general symptoms in schoolchildren.

METHODS

This study involved 219 schoolchildren (8-10 years) of the Municipality of Palermo, Italy. Data were collected through questionnaires self-administered by parents and children. Exposures to greenness and greyness at the home addresses were measured using the normalized difference vegetation index (NDVI), residential surrounding greyness (RSG) and the CORINE land-cover classes (CLC). RSG was defined as the percentage of buffer covered by either industrial, commercial and transport units, or dump and construction sites, or urban fabric related features. Two specific categories of CLC, namely "discontinuous urban fabric - DUF" - and "continuous urban fabric - CUF" - areas were found. Exposure to traffic-related nitrogen dioxide (NO₂) was assessed using a Land-Use Regression model. A symptom score ranging from 0 to 22 was built by summing affirmative answers to twenty-two questions on symptoms. To avoid multicollinearity, multiple Logistic and Poisson ridge regression models were applied to assess the relationships between environmental factors and self-reported symptoms.

RESULTS

A very low exposure to NDVI ≤0.15 (1st quartile) had a higher odds of nasal symptoms (OR = 1.47, 95% CI [1.07-2.03]). Children living in CUF areas had higher odds of ocular symptoms (OR = 1.49, 95% CI [1.10-2.03]) and general symptoms (OR = 1.18, 95% CI [1.00-1.48]) than children living in DUF areas. Children living in proximity (≤200 m) to High Traffic Roads (HTRs) had increased odds of ocular (OR = 1.68, 95% CI [1.31-2.17]) and nasal symptoms (OR = 1.49, 95% CI [1.12-1.98]). A very high exposure to NO₂ ≥ 60 μg/m³ (4th quartile) was associated with a higher odds of general symptoms (OR = 1.28, 95% CI [1.10-1.48]). No associations were found with RGS. A Poisson ridge regression model on the symptom score showed that children living in proximity to HTRs (≤200 m) had a higher symptoms score (RR = 1.09, 95% CI [1.02-1.17]) than children living > 200 m from HTRs. Children living in CUF areas had a higher symptoms score (RR = 1.11, 95% CI [1.03-1.19]) than children living in DUF areas.

CONCLUSIONS

Multiple exposures related to greenness, greyness (measured by CORINE) and air pollution within the urban environment are associated with respiratory/allergic and general symptoms in schoolchildren. No associations were found when considering the individual exposure to greyness measured using the RSG indicator.

Sublingual Immunotherapy Decreases Expression of Interleukin-33 in Children with Allergic Rhinitis

OBJECTIVES

To identify the expression of IL-33 during SLIT (Sublingual immunotherapy) in AR (Allergic rhinitis) children.

METHODS

Thirty children received house dust mite (HDM) allergen extract for SLIT and thirty children received placebo in this study. Serum and nasal lavage samples of cases and controls were collected at different time points during SLIT. Interleukin (IL)-33 and other cytokines were estimated in these samples by enzyme-linked immuno sorbent assay (ELISA). Peripheral blood mononuclear cells (PBMC) were prepared and stimulated with rhIL-33 (with or without other stimulators) at different time points during SLIT.

RESULTS

The present results showed that both serum and nasal lavage of IL-33 levels decreased significantly after 12 mo treatment and this trend maintained at least until 24 mo. The decreased nasal IL-33 level was positively correlated to local Th2 cytokines and increased IL-10 expression at 2 y post SLIT treatment. In vitro experiments showed that IL-33 promotes IL-4 and IL-5 and inhibits IL-10 expression by peripheral blood mononuclear cells (PBMCs) in AR.

CONCLUSIONS

Decreased IL-33 expression during SLIT may contribute to low Th2 response and enhanced Regulatory T cell cytokines expression. Thus, IL-33 maybe an important predictor during SLIT.

Role of leptin in allergic rhinitis during sublingual immunotherapy

OBJECTIVE

Increasing evidence suggests that leptin is upregulated during allergic reactions in the airway and related to the severity of disease in allergic rhinitis (AR). In this study, we aimed to investigate the expression of leptin during sublingual immunotherapy (SLIT) in AR patients.

METHODS

Forty AR patients without obesity were recruited in this study. Twenty patients received house dust mite (HDM) allergen extract for SLIT and twenty patients received placebo randomly. Protein expression of leptin in serum and nasal lavage was tested by enzyme-linked immuno sorbent assay (ELISA) 1 and 2 years after SLIT treatment, respectively. Peripheral blood mononuclear cells (PBMCs) and human nasal epithelial cell were prepared and stimulated by recombinant leptin after 24 months' SLIT treatment and the induction of Th2 cytokines (IL-4/IL-5/IL-13) were detected by ELISA.

RESULTS

SLIT treatment decreased the expression of leptin protein in serum and nasal lavage significantly compared with placebo group 1 and 2 years after SLIT treatment. Nasal leptin level was correlated to decreased Th2 response (IL-4/IL-5/IL-13) and enhanced Treg (IL-10/TGF-beat) response after 2 years' SLIT. We also found that SLIT decreased the ability of leptin in promoting Th2 cytokines expression by PBMCs and human nasal epithelial cell after 2 years' SLIT treatment.

CONCLUSION

Changes of leptin expression in serum and nasal lavage may be correlated with Th2/Treg regulation during SLIT. Our results suggested that leptin served as an important biomarker during SLIT.

Exposure to air pollution and risk of prevalence of childhood allergic rhinitis: A meta-analysis

OBJECTIVES

Allergic rhinitis (AR), a common chronic inflammatory disease in the upper airways. The prevalence of AR in children seems to be increasing recently, and the most significant causes of the increase are thought to be changes in environmental factors, especially air pollution. However, we could not find any meta-analysis on the risk of air pollution exposure on the prevalence of AR in childhood. The aim of this research was to carry out a meta-analysis on the results of recent studies (21 s t century) to present valid information about exposure to air pollution and risk of prevalence of childhood AR.

METHODS

PubMed, Science, Google Scholar, Elsevier and MDPI web database were searched up to January 1, 2000 to February 28, 2018. Including of air pollution and AR in childhood related to the observation of literature. Meta-analysis, study quality assessment, heterogeneity analysis and publication bias test were using Stata-MP 14.1 and Review Manager version 5.3 software.

RESULTS

13 studies will be included in the meta-analysis (8 cross-sectional studies, 5 cohort studies). Exposure to NO₂ (OR_Europe = 1.031, 95%CI [1.002,1.060], P = 0.033; OR_Asia = 1.236, 95%CI [1.099,1.390], P = 0.000; OR_overall = 1.138, 95%CI [1.052,1.231], P = 0.001); Exposure to SO₂ (OR_Europe = 1.148, 95%CI [1.030,1.279], P = 0.012; OR_Asia = 1.044, 95%CI [0.954,1.142], P = 0.352; OR_overall = 1.085, 95%CI [1.013,1.163], P = 0.020); Exposure to PM₁₀ (OR_Europe = 1.190, 95%CI [1.092,1.297], P = 0.000; OR_Asia = 1.075, 95%CI [0.995,1.161], P = 0.066; OR_overall = 1.125, 95%CI [1.062,1.191], P = 0.000); Exposure to PM_2.5 (OR_Europe = 1.195, 95%CI [1.050,1.360], P = 0.007; OR_Asia = 1.163, 95%CI [1.074,1.260], P = 0.000; OR_overall = 1.172, 95%CI [1.095,1.254], P = 0.000).

CONCLUSIONS

Exposed to air pollution probable is a risk of prevalence of childhood AR. And the prevalence of AR will be increase when exposed to NO₂, SO₂, PM₁₀ and PM_2.5, but maybe the relationship between SO₂/PM₁₀ and prevalence of AR are not closely in Asia.

Leptin/osteopontin axis contributes to enhanced T helper 17 type responses in allergic rhinitis

BACKGROUND

Recent studies suggest that T helper 17 (Th17) cell subset, a distinct pro-inflammatory CD4 +  T cell lineage, may play an important role in the pathophysiology of allergic rhinitis (AR). However, the regulation of Th17 response in allergic disease is not well characterized.

METHODS

Thirty AR and 30 healthy children were enrolled. Serum leptin and OPN levels were measured, and their correlation with IL-17 expression was analyzed using enzyme-linked immunosorbent assay (ELISA). Th17 cell differentiation and cytokine production in peripheral blood mononuclear cell (PBMCs) stimulated by leptin and OPN and related inhibitors were analyzed by ELISA. AR mice models were also established to verify the effect of leptin and OPN on Th17 cell regulation. Immunoprecipitation was performed to explore the interaction between OPN and leptin in Th17 cells.

RESULTS

Our results showed that elevated serum leptin and OPN in AR children were correlated with serum IL-17 level (r = .53, P < .01). The recombinant leptin and OPN enhanced Th17 responses from PBMCs synergistically through nuclear factor κB (NF-κB), mitogen-activated protein kinase (MAPK), and c-Jun N-terminal kinase (JNK) pathway and β3 integrin receptor. The AR mice showed as more severe Th17 responses and symptoms compared with control mice. Immunoprecipitation showed that OPN and leptin may interact with each other directly, and this process may be mediated by β3 integrin.

CONCLUSIONS

Our data provide evidence that upregulation of leptin and OPN promotes Th17 responses in AR, and this process may be achieved through NF-κB, MAPK, and JNK pathway and β3 integrin.

Patient characteristics in German allergological practices - a nationwide survey

Introduction: In Western societies a significant incidence and prevalence of allergic asthma and other allergic diseases is observable. The present study investigated epidemiological patterns of allergic diseases and the utilization of health care resources by subjects who are already under specialized allergological treatment. Furthermore the study was performed to identify factors which had a significant impact on accessibility to specific immunotherapy (SIT). Methods: The study was based on a cross-sectional survey on patient characteristics, which was performed by participating physicians, who were specialized in the field of allergological disorders and SIT, in collaboration with their patients. The analysis of data was divided into descriptive analyses and an analytical part, in which influencing factors for accessibility to specific immunotherapy were investigated. Logistic regression models to identify several predictor variables were used. Results: 495 physicians documented the data of 19,990 patients. 18,177 patients were included in the analyses. Patients had a mean age of 31.5 ± 15.5 years and 53.2% were female. The most frequent and most severe allergic disorders observable in German allergological practices were conjunctivitis and rhinitis. The seasonal symptoms occurred mainly during March to August, while seasonal disease manifestation was 2.5 times more frequent than perennial forms. The most received anti-symptomatic medications are antihistamines and corticosteroids. Patients who receive SIT were mainly treated using subcutaneous immunotherapy (SCIT) – only in lower age groups, the likelihood of receiving sublingual immunotherapy (SLIT) was increased. Conclusion: In Germany, conjunctivitis and rhinitis are the most severe allergic disorders in allergological practices. Compared to the German general patient population, people who were already in allergological treatment had better access to SIT.

Epidemiology of allergic rhinitis and associated risk factors in Asia

This review article aims to present the epidemiology and associated risk factors of allergic rhinitis (AR) in Asia. AR-related literature published on Asia was systematically reviewed and the associated risk factors were investigated.

The prevalence of AR in Asia varied considerably depending on the geographical location, study design and population involved. Several risk factors were observed to have strong association with disease presentation across multiple studies. Among these, family income, family size, daily personal computer usage time, personal and parental education attainment, and stress level have shown some level of biological gradient influence when multiple risk levels were analyzed. This suggests that AR manifestation and presentation possibly might be strongly affected by various personal and family factors. These findings are beneficial as they may provide insights into modifiable factors that may influence AR presentation. In addition, these results indicate that strategies to reduce personal and family-related risk factors have to be developed in order to alleviate the odds of AR expression.

Respiratory function in healthy Emirati children using forced oscillations

BACKGROUND

The forced oscillation technique (FOT) allows the quantification of respiratory function, does not require active cooperation and as such is ideally suited for use in young children. The application of the FOT in non-Caucasian populations is limited and it remains unclear if current reference ranges for the FOT in Caucasian children are appropriate for children in the Arabian Peninsula. This study explored the use of the FOT in healthy school-aged children in the United Arab Emirates (UAE).

METHODS

Lung function using FOT was assessed in healthy Emirati children aged 4-12 years. Using a validated questionnaires general medical and respiratory histories were obtained. Prediction equations for resistance (Rrs), reactance (Xrs), and area under reactance curve (AX) were calculated and compared to previous studies.

RESULTS

FOT was successfully obtained in 291 healthy Emirati children. Linear regression modelling including weight, height, age, and gender in transformed FOT outcomes demonstrated that height was the strongest predictor of FOT outcomes (P < 0.001). Using the equated prediction equation Z-scores were calculated. FOT outcomes in Emirati children did not match previously published reference equations in Caucasians children (P < 0.001).

CONCLUSION

FOT measurements were feasible in Emirati school-children. New FOT reference equation in Emirati children were derived. FOT reference equation in Emirati children was different from published equations in Caucasians.

Prevalence of pollen-induced allergic rhinitis with high pollen exposure in grasslands of northern China

BACKGROUND

The aim of this study was to investigate the prevalence of epidemiologic and physician-diagnosed pollen-induced AR (PiAR) in the grasslands of northern China and to study the impact of the intensity and time of pollen exposure on PiAR prevalence.

METHODS

A multistage, clustered and proportionately stratified random sampling with a field interviewer-administered survey study was performed together with skin prick tests (SPT) and measurements of the daily pollen count.

RESULTS

A total of 6043 subjects completed the study, with a proportion of 32.4% epidemiologic AR and 18.5% PiAR. The prevalence was higher in males than females (19.6% vs 17.4%, P = .024), but no difference between the two major residential and ethnic groups (Han and Mongolian) was observed. Subjects from urban areas showed higher prevalence of PiAR than rural areas (23.1% vs 14.0%, P < .001). Most PiAR patients were sensitized to two or more pollens (79.4%) with artemisia, chenopodium, and humulus scandens being the most common pollen types, which were similarly found as the top three sensitizing pollen allergens by SPT. There were significant regional differences in the prevalence of epidemiologic AR (from 18.6% to 52.9%) and PiAR (from 10.5% to 31.4%) among the six areas investigated. PiAR symptoms were positively associated with pollen counts, temperature, and precipitation (P < .05), but negatively with wind speed and pressure P < .05).

CONCLUSION

Pollen-induced AR (PiAR) prevalence in the investigated region is extremely high due to high seasonal pollen exposure, which was influenced by local environmental and climate conditions.

Allergic Rhinitis and Atopy in 18-Year-Old Students

Background

The aim of this study was to investigate the prevalence of allergic rhinitis and atopy in adolescents and whether air pollution in their schools contributed to allergic sensitization.

Methods

Analyses were performed in 1992–1994 on 511 18-year-old students at four schools and on the indoor air and floor dust of their classrooms. The students underwent skin-prick tests (SPTs) and a nasal lavage and answered a computer-based questionnaire containing questions on allergy and nasal symptoms.

Results

Atopy, defined as at least one positive SPT response, was found among 37% of the students, with no difference between students of the four schools, regardless of whether the data were adjusted for gender, hereditary disposition to allergy, and smoking habits. The number of students who had positive SPT and reported nasal symptoms when exposed to possible allergens, which were found among 35%, did not differ between the schools. No correlation was found between the prevalence of atopic individuals and the levels of different indoor air pollutants in the schools.

Conclusion

The prevalence of allergic rhinitis among adolescents is very high and suggests that it is, at least at the time of our study and in comparison with other studies, still increasing. Our results indicate that the indoor air and floor dust at the schools of the students do not contribute to allergic sensitization.

Risk factors for asthma after infant bronchiolitis

BACKGROUND

Five studies carried out after bronchiolitis at less than 24 months of age, with a follow-up of more than 10 years, reported that atopic dermatitis, family asthma, early-life exposure to tobacco smoke and rhinovirus aetiology were early-life risk factors for later asthma. This study evaluated the long-term outcome at 11-13 years of age of children who were hospitalized for bronchiolitis in early infancy.

METHODS

We previously prospectively followed 166 children hospitalized for bronchiolitis at less than 6 months of age until 5-7 years of age. The current study included a structured questionnaire, parental interviews, clinical examinations and bronchodilation test of 138 of those children at 11-13 years of age.

RESULTS

Respiratory syncytial virus caused 66% of the bronchiolitis cases, and nearly half of the patients were exposed to tobacco smoke in early life. Doctor-diagnosed asthma was present in 13% of the former bronchiolitis patients at 11-13 years of age. Maternal asthma was the only independently significant risk factor in early life (adjusted OR 3.45, 95% CI 1.07-11.74), as was allergic rhinitis at 5-7 years of age (adjusted OR 4.06, 95% CI 1.35-12.25).

CONCLUSIONS

After bronchiolitis at less than 6 months of age, the risk of doctor-diagnosed asthma at 11-13 years was about twice that of the general Finnish population. Maternal asthma was the only independently significant early-life risk factor for current asthma at 11-13 years of age.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

BACKGROUND

Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR).

METHODS

Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus.

RESULTS

The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR.

CONCLUSION

This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

Pathophysiology of IL-33 and IL-17 in allergic disorders

Allergic diseases are among common clinical conditions, affecting millions of children and adults throughout the world. Food allergies, skin allergies (atopic dermatitis), and respiratory allergies (allergic rhinitis and asthma) are the common types of allergies. Recently discovered cytokines IL-17 and IL-33 have been found to play an important role in the pathogenicity of various hypersensitive disorders. After exposure to allergens or infection with parasites or viruses, IL-17 and IL-33 producing cells, such as Th17 and specialized epithelial cells respectively, become activated and trigger the pathogenic immune responses in different susceptible conditions. Potent inhibitors of these cytokines have been identified recently that may represent potential therapeutic agents to overcome the clinical complications of allergies. In the present review, we have discussed the cellular sources, modes of action and regulation of IL-17 and IL-33 in the context of hypersensitive diseases. We have also assessed the therapeutic potential of inhibitory molecules that may alter production of both these cytokines, and thus modulate susceptible conditions.

Staphylococcal Biofilms in Atopic Dermatitis

PURPOSE OF REVIEW

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disorder that is a major public health burden worldwide. AD lesions are often colonized by Staphylococcus aureus and Staphylococcus epidermidis. An important aspect of Staphylococcus spp. is their propensity to form biofilms, adhesive surface-attached colonies that become highly resistant to antibiotics and immune responses, and recent studies have found that clinical isolates colonizing AD skin are often biofilm-positive. Biofilm formation results in complex bacterial communities that have unique effects on keratinocytes and host immunity. This review will summarize recent studies exploring the role of staphyloccocal biofilms in atopic dermatitis and the implications for treatment.

RECENT FINDINGS

Recent studies suggest an important role for biofilms in the pathogenesis of numerous dermatologic diseases including AD. S. aureus biofilms have been found to colonize the eccrine ducts of AD skin, and these biofilms influence secretion of keratinocyte cytokines and trigger differentiation and apoptosis of keratinocytes. These activities may act to disrupt barrier function and promote disease pathogenesis as well as allergen sensitization. Formation of biofilm is a successful strategy that protects the bacteria from environmental danger, antibiotics, and phagocytosis, enabling chronic persistence in the host. An increasing number of S. aureus skin isolates are resistant to conventional antibiotics, and staphylococcal biofilm communities are prevalent on the skin of individuals with AD. Staphylococcal colonization of the skin impacts skin barrier function and plays multiple important roles in AD pathogenesis.

The immunology of the allergy epidemic and the hygiene hypothesis

The immunology of the hygiene hypothesis of allergy is complex and involves the loss of cellular and humoral immunoregulatory pathways as a result of the adoption of a Western lifestyle and the disappearance of chronic infectious diseases. The influence of diet and reduced microbiome diversity now forms the foundation of scientific thinking on how the allergy epidemic occurred, although clear mechanistic insights into the process in humans are still lacking. Here we propose that barrier epithelial cells are heavily influenced by environmental factors and by microbiome-derived danger signals and metabolites, and thus act as important rheostats for immunoregulation, particularly during early postnatal development. Preventive strategies based on this new knowledge could exploit the diversity of the microbial world and the way humans react to it, and possibly restore old symbiotic relationships that have been lost in recent times, without causing disease or requiring a return to an unhygienic life style.

Symptoms of allergic rhinitis in Parakou, Benin: Prevalence, severity and associated factors

AIMS

Allergic rhinitis (AR) is an extremely common disease. This study aimed to determine the prevalence and severity of AR symptoms and potential associated factors, in Parakou, a city in Benin.

MATERIALS AND METHODS

A cross-sectional study was conducted between April and July 2016, involving inhabitants of the city aged between 6 and 65 years. Cluster sampling was carried out. AR symptoms were defined as the simultaneous presence of rhinorrhea, nasal obstruction and sneezing without evidence of respiratory infection. Data were analyzed on EpiData Analysis v2.2.2.183 and then on R.3.2.1.

RESULTS

Three hundred and ninety-five inhabitants were questioned, with a male/female ratio of 1.32, and median age of 19 years. One hundred and forty-one (35.7%) had AR symptoms, 47 (33.3%) had family history of atopy, and 87 (61.7%) had allergic conjunctivitis. The main triggers were house dust (139; 98.5%) and air pollution (111; 78.7%). On multivariate analysis, associated factors were age<18 years (P<0.05), exposure to house dust (P<0.001), and personal history of urticaria (P<0.001) or allergic conjunctivitis (P<0.01). Twenty-eight subjects (19.9%) had persistent symptoms. Forty-three (30.5%) had moderate/severe symptoms, associated with age≥18 years (P<0.01), family history of atopy (P<0.01), personal history of atopic eczema/dermatitis (P<0.01), and presence of a dog or cat at home (P=0.01).

CONCLUSION

The prevalence of AR symptoms in Parakou was high. A non-negligible proportion of symptoms were severe. This disease merits special attention in the city.

Environment Changes Genetic Effects on Respiratory Conditions and Allergic Phenotypes

The prevalence of asthma and allergic diseases is disproportionately distributed among different populations, with an increasing trend observed in Western countries. Here we investigated how the environment affected genotype-phenotype association in a genetically homogeneous, but geographically separated population. We evaluated 18 single nucleotide polymorphisms (SNPs) corresponding to 8 genes (ADAM33, ALOX5, LT-α, LTC4S, NOS1, ORMDL3, TBXA2R and TNF-α), the lung function and five respiratory/allergic conditions (ever asthma, bronchitis, rhinitis, dermatitis and atopy) in two populations of Inuit residing either in the westernized environment of Denmark or in the rural area of Greenland. Our results showed that lung function was associated with genetic variants in ORMDL3, with polymorphisms having a significant interaction with place of residence. LT-α SNP rs909253 and rs1041981 were significantly associated with bronchitis risk. LT-α SNP rs2844484 was related to dermatitis susceptibility and was significantly influenced by the place of residence. The observed gene-phenotype relationships were exclusively present in one population and absent in the other population. We conclude that the genotype-phenotype associations relating to bronchitis and allergy susceptibility are dependent on the environment and that environmental factors/lifestyles modify genetic predisposition and change the genetic effects on diseases.

Allergen sensitization affected the change trend of prevalence of symptoms of rhinitis coexisting with wheeze among adolescents in Guangzhou City from 1994 to 2009

BACKGROUND

Few studies have assessed the time trends of prevalence of symptoms of rhinitis (SR) with wheezing and their associations in Chinese adolescents.

OBJECTIVE

To explore the trend of prevalence of SR with wheezing and allergen sensitization in adolescents during the past 15 years.

METHODS

A total of 6928 adolescents aged 13-14 years in 2009 were recruited for the study using the Phase III Protocol of the International Study of Asthma and Allergic disease in Childhood (ISAAC) and allergic sensitization to seven inhalant allergens in 2531 was assessed by skin prick test in 2010. The results were compared to those obtained in the Phase I (1994/95) and III (2001/02) ISAAC studies.

RESULTS

The prevalence of 'SR ever' and 'current symptoms of rhino-conjunctivitis' increased from 46.3% and 8.7% in 1994 to 53.2% and 11.1% in 2001 (p < 0.001), respectively, and remained stable at 52.6% and 10.4% in 2009 (p > 0.05). The prevalence of 'SR ever and wheeze ever' and 'SR ever and current wheeze' increased from 6.2% and 3.4% in 1994 to 8.6% and 4.8% in 2001 (p < 0.001) to 10.9% and 5.9% in 2009 (p < 0.05). The sensitization rate to common inhaled allergens was higher in 2010 than in 2002 (p < 0.001). Sensitization to house dust mites (HDMs) was associated with increases in the prevalence of SR (OR, 2.06-2.86), especially with coexistence of wheeze (OR, 6.07-7.43).

CONCLUSION

The prevalence of symptoms of rhinitis and coexistence with wheezing has increased significantly since 1994. Sensitization to HDMs is the main risk factor associated with this increase.

Life-course of atopy and allergy-related disease events in tropical sub-Saharan Africa: A birth cohort study

BACKGROUND

In high-income countries, allergy-related diseases (ARDs) follow a typical sequence, the 'Atopic March'. Little is known about the life-course of ARDs in the markedly different, low-income, tropical environment. We describe ARDs in a tropical, African birth cohort.

METHODS

Ugandan children were followed from birth to 9 years. ISAAC questionnaires were completed at intervals; doctor-diagnosed ARDs were recorded throughout follow-up. Skin prick tests (SPTs) were performed at 3 and 9 years. Atopy was defined as ≥1 positive SPT.

RESULTS

Of the 2345 live-born children, 1214 (52%) were seen at 9 years. Wheeze and eczema were common in infancy, but by 9 years, only 4% reported recent wheeze, 5% eczema and 5% rhinitis. Between 3 and 9 years, atopy prevalence increased from 19% to 25%. Atopy at 3 or 9 years was associated with reported ARD events at 9 years, for example OR = 5.2 (95% CI 2.9-10.7) for atopy and recent wheeze at 9 years. Reported or doctor-diagnosed ARD events in early childhood were associated with the same events in later childhood, for example OR = 4.4 (2.3-8.4) for the association between reported wheeze before 3 years with reported recent wheeze at 9 years, but progression from early eczema to later rhinitis or asthma was not observed.

CONCLUSION

Allergen sensitization started early in childhood and increased with age. Eczema and wheeze were common in infancy and declined with age. Atopy was strongly associated with ARD among the few affected children. The typical Atopic March did not occur. Environmental exposures during childhood may dissociate atopy and ARD.

Asthma treatment in children and adolescents in an urban area in southern Brazil: popular myths and features

Objective:

To describe the frequency of popular myths about and features of asthma treatment in children and adolescents in an urban area in southern Brazil.

Methods:

The parents or legal guardians of public school students (8-16 years of age) completed a specific questionnaire regarding their understanding of asthma, asthma control, and treatment characteristics. The sample included parents or legal guardians of students with asthma (n = 127) and healthy controls (n = 124).

Results:

The study involved 251 parents or legal guardians, of whom 127 (68.5%) were the mothers and 130 (51.8%) were White. The mean age of these participants was 38.47 ± 12.07 years. Of the participants in the asthma and control groups, 37 (29.1%) and 26 (21.0%), respectively, reported being afraid of using asthma medications, whereas 61 (48%) and 56 (45.2%), respectively, believed that using a metered dose inhaler can lead to drug dependence. However, only 17 (13.4%) and 17 (13.7%) of the participants in the asthma and control groups, respectively, reported being afraid of using oral corticosteroids. In the asthma group, 55 students (43.3%) were diagnosed with uncontrolled asthma, only 41 (32.3%) had a prescription or written treatment plan, and 38 (29.9%) used asthma medications regularly.

Conclusions:

Popular myths about asthma treatment were common in our sample, as were uncontrolled asthma and inappropriate asthma management. Further studies in this field should be conducted in other developing countries, as should evaluations of pediatric asthma treatment programs in public health systems.

Prevalence and allergen of allergic rhinitis in Korean children

BACKGROUND

In recent decades, the amount of data about allergic rhinitis (AR) in Korean National Health Insurance Service has increased.

OBJECTIVE

To investigate the prevalence and quality of sensitized allergens of AR in Korean children and adolescents.

METHODS

This study obtained the results of the Korean International Study of Asthma and Allergies in Childhood questionnaires and the skin-prick test (SPT) results of 14,356 students who participated in a health screening from 2010 to 2014. AR was defined as one with current symptoms of AR with at least one or more positive results of an SPT with inhalant allergens.

RESULTS

The prevalence of AR in children was 20.8%. Positive rates of the allergen group were 87.3% for house-dust mites, 37.0% for pollen, 12.4% for mold, and 8.4% for pets. The common allergens in descending order were Dermatophagoides pteronyssinus, Dermatophagoides farinae, Betula, Humulus, Alnus, and Alternaria. As the children became older, pollen-sensitization rates tended to increase (p value for trends, <0.001). In metropolitan and middle inland areas, weed pollen was the most common pollen. The rates of tree-pollen sensitization were the highest at the seaside and in the southern inland. The most common comorbid allergic diseases associated with AR were pollen allergy and allergic conjunctivitis at 37.0% and 34.5%, respectively.

CONCLUSIONS

This was the first study conducted in Korea to investigate the prevalence of AR in the general population by using both questionnaires and SPTs. The allergens used for the SPTs were chosen based on the common allergens in this study, and this current pollen data will contribute to establish the cause of increasing AR prevalence in Korea.

Anaphylaxis in a 4-year-old male caused by contact with grasses: a case report

Background

Acute urticaria is the presence of urticaria for <6 weeks, and it is the most common type of urticaria in children. Sometimes, it may be associated with anaphylaxis, a life-threatening condition. Urticaria must be differentiated from anaphylaxis because the latter may require emergency treatment. We describe a child with anaphylaxis exposed to grasses on two occasions.

Case presentation

We described a 4-year-old male child with anaphylaxis exposed to grasses. Patient also suffered mild neurologic/respiratory symptoms but it is unlikely that he had anaphylaxis. Skin-prick tests were positive to Cynodon dactylis, Phalaris arundinacea and Festuca elatior. Little is known about the importance of pollens as a cause of urticaria in young children.

Conclusions

The case reported here is particularly interesting because, to the best of our knowledge, anaphylaxis due to pollen exposure in children aged <4 years has not been reported before. We strongly encourage all physicians searching for the cause of acute urticaria (allergists, dermatologists, primary-care physicians) to consider the possibility of pollen allergy, and to screen these patients for pollen sensitization.

Multimorbidities of asthma, allergies, and airway illnesses in childhood: Chance or not chance?

OBJECTIVES

We investigated patterns of multimorbidities among asthma, allergies, and respiratory illnesses in preschool children. We investigated multimorbidities of lifetime asthma, allergic rhinitis, eczema, food allergy, pneumonia, and ear infections; and multimorbidities of current (in the last year before the survey) wheeze, dry cough, rhinitis, eczema, and common cold during childhood. We further analyzed whether prevalences of these multimorbidities were due to chance.

METHODS

A cross-sectional study was conducted in 72 kindergartens of Shanghai, China. Parents of preschool children were surveyed with a modified ISAAC questionnaire. Observed prevalences (OPs), expected prevalences (EPs), absolute excess comorbidities (AECs), and relative excess comorbidities (RECs) of various combinations of illnesses were calculated to indicate whether the combined illnesses were related.

RESULTS

We analyzed questionnaires for children aged 4-6 years, whose 13,335 questionnaires were the majority of the total 15,266 returned questionnaires (response rate: 85.3%). The studied illnesses were common. For children who had more than three lifetime or current illnesses, OPs tended to be higher than EPs. Most OPs and EPs were higher in boys than in girls, and were higher in children with a family history of atopy (FHA) than in children without FHA. AECs and RECs between boys and girls as well as between children with and without FHA were substantially different.

CONCLUSIONS

Our findings suggest that multimorbidities among childhood asthma, allergies, and respiratory illnesses are likely not random, but rather share etiology. Specific patterns of childhood asthma multimorbidities perhaps differ between boys and girls and between children with and without FHA.

Following up infant bronchiolitis patients provided new evidence for and against the united airway disease hypothesis

AIM

The united airway disease (UAD) hypothesis suggests that allergic rhinitis and asthma develop together. We evaluated the evidence for and against the UAD hypothesis at five to seven years of age after hospitalisation for bronchiolitis at less than six months.

METHODS

This study used prospective follow-up data for 102 children hospitalised for bronchiolitis under the age of six months. We included the presence of previous and current asthma, prolonged rhinitis and skin prick tests (SPT) to common inhaled allergens and lung function by impulse oscillometry (IOS) at five to seven years of age. Bronchial hyper-reactivity (BHR) was assessed using the exercise challenge test and bronchodilation test.

RESULTS

Current asthma, but not previous transient asthma, was associated with prolonged rhinitis and a positive SPT. BHR, which reflected reactive airways, but not lung function, was associated with respiratory allergy, namely the combination of current asthma, prolonged rhinitis and a positive SPT.

CONCLUSION

This post-bronchiolitis follow-up study suggested an association between respiratory allergy and reactive airways at five to seven years of age, which supported the UAD hypothesis. However, previous transient asthma and a reduction in lung function reduction did not support the hypothesis.

CD14: a bridge between innate immunity and adaptive IgE responses

Total IgE levels are known to be under genetic control. Linkage studies have indicated that one or more loci on chromosome 5q may control total IgE, as well as asthma and bronchial hyper-responsiveness to non-specific stimuli. Our group has undertaken a systematic analysis of chromosome 5q, and has recently characterized five single nucleotide polymorphisms at position —1619, —1359, —1145, —809, and —159 in the promoter of the gene encoding CD14, the myeloid pattern recognition receptor that is critical for efficient innate immune responses to lipopolysaccharide and bacterial ligands. Individuals homozygous for the three major CD14 haplotypes found in the Children Respiratory Study population ( n = 390) were analyzed for serum levels of total IgE and soluble CD14. A strong inverse correlation was found between these two parameters, i.e. carriers of the —1359T/—1145A/—159C haplotype had the highest levels of IgE, and the lowest levels of sCD14. Conversely, carriers of the —1359G/—1145G/—159T haplotype had the highest levels of sCD14 and the lowest IgE values. Our results suggest that genetic variation in CD14, a key gene of innate immunity, may modulate the effects that exposure to bacterial ligands has on the development of Th2 responses.

Management of Allergic Rhinitisand Sinusitis

Allergic rhinitis and sinusitis are chronic conditions of the airway and cause significant morbidity. Both can require pharmacotherapy with nonprescription products to relieve symptoms or with prescription products to treat the underlying pathophysiology. Because these diseases are prevalent conditions, the pharmacist is in the unique position of being the first health professional contact for many patients. The pharmacist can assist the patient in selection of nonprescription antihistamines, decongestants, and nasal saline sprays as well as provide instruction on the use of steam therapy, aromatic vapors, and warm compresses for the relief of symptoms. Equally important, the pharmacist can encourage patients to seek care from a physician when treatment with intranasal corticosteroids, antibiotics, and nonsedating antihistamines are needed.

Natural Course of Allergic and Nonallergic Rhinitis After 2 Years in Korean Children

Objectives.

Allergic and nonallergic rhinitis are very common disease for children, however, little is known about their natural courses in the general population. The purpose is to evaluate the natural course of allergic and nonallergic rhinitis in children.

Methods.

We analyzed data from Snoring Child Cohort of 178 children (107 boys and 71 girls). All children entered the study at the age of 7 years (range, 6.5 to 7.4 years). Questionnaires regarding chronic rhinitis, a skin prick test (SPT) for 5 inhalent allergens, and specific IgE for 2 dust mites were administered. Children were classified into 4 groups: allergic rhinitis (rhinitis, positive SPT), nonallergic rhinitis (rhinitis, negative SPT), sensitization only (no rhinitis, positive SPT), and control (no rhinitis, negative SPT). We repeated follow them annually, and analyzed the data of first and third year for this study.

Results.

Finally, the data of 122 children were analyzed. Among 18 children with allergic rhinitis at 7 years, 13 (72%) became sensitization only after 2 years and 5 (28%) were remained having allergic rhinitis. Five out of 19 children (26%) with nonallergic rhinitis developed into allergic rhinitis and 7 (37%) into control at 9 years. Twenty-four out of 28 children (86%) with sensitization only at 7 years remained the same at 9 years. Among 57 control children at 7 years, 2 (4%) developed into allergic rhinitis, 7 (12%) with nonallergic rhinitis, and 16 (28%) with sensitization only at 9 years.

Conclusion.

The status of chronic rhinitis and allergen sensitization is ever-changing in children.

Inhibitory effect of baicalin on allergic response in ovalbumin-induced allergic rhinitis guinea pigs and lipopolysaccharide-stimulated human mast cells

OBJECTIVE

Baicalin, a flavonoid compound purified from the dry roots of Scutellaria baicalensis Georgi, has generally been used for the treatment of various allergic diseases. However, there is little information about the anti-inflammatory effects of baicalin for allergic rhinitis. This study aims to investigate the anti-allergic effect of baicalin on allergic response in ovalbumin (OVA)-induced allergic rhinitis guinea pigs and lipopolysaccharide (LPS)-stimulated human mast cells.

METHODS

Using in vivo models, we evaluated the effect of baicalin on allergic rhinitis symptoms via recording the number of nasal rubs and sneezes. The levels of histamine, OVA-specific immunoglobulin E(IgE), eosinophil cationic protein (ECP) and inflammatory cytokines were measured using enzyme-linked immunosorbent assay (ELISA). The histological changes of nasal mucosa were observed by light microscope after HE staining. In vitro, the release of histamine and β-hexosaminidase of compound 48/80-induced human mast cells were measured by ELISA and PNP-NAG colorimetry, respectively. The productions of inflammatory cytokines of LPS-stimulated human mast cells were determined using ELISA. Western blot was used to test the protein expression of JAK2, p-JAK2, STAT5, p-STAT5, IKKβ, p-IKKβ, IκBα, p-IκBα and NF-κB (p65) of LPS-stimulated human mast cells.

RESULTS

The oral administration of baicalin at doses of 50 and 200 mg/kg improved allergic rhinitis symptoms and the histological changes of nasal mucosa and decreased the serum levels of histamine, ECP, interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor (TNF)-α and OVA-specific IgE in OVA-induced allergic rhinitis guinea pigs. In vitro, baicalin suppressed the release of histamine and β-hexosaminidase in compound 48/80-induced human mast cells. In addition, baicalin also inhibited the productions of inflammatory cytokines such as IL-1β, IL-6, IL-8 and TNF-α and suppressed the phosphorylation of JAK2, STAT5, IKKβ, IκBα and the nuclear translocation of NF-κB (p65) subunit in LPS-stimulated human mast cells.

CONCLUSIONS

These results suggest that baicalin can effectively prevent allergic response in OVA-induced allergic rhinitis guinea pigs and inhibit inflammatory response via blocking JAK2-STAT5 and NF-κB signaling pathways in LPS-stimulated human mast cells. Considered together,the results show that baicalin may be a useful drug in the treatment of allergic rhinitis.

Decreased level of osteopontin in children with allergic rhinitis during sublingual immunotherapy

OBJECTIVE

Sublingual immunotherapy (SLIT) is proven to be very effective in the treatment of allergic rhinitis (AR), but its regulatory mechanism and biomarkers for predicting efficacy are still unknown. Osteopontin (OPN), as a recently described Th2 inflammation related protein, plays key role in the pathogenesis of AR. The aim of this study was to identify the expression and role of OPN during SLIT in children.

METHODS

Fifty house dust mite (HDM)-sensitized children with AR were enrolled in this study. AR children received HDM allergen extract or placebo for SLIT. Serum of different time points during treatment was collected and used for enzyme-linked immuno sorbent assay (ELISA) of OPN and related cytokines, respectively. Peripheral blood mononuclear cells from children after SLIT or placebo treatment were collected and stimulated with HDM with or without OPN/anti-OPN after one year's treatment.

RESULTS

Our results showed that expression of OPN protein was decreased after one year's therapy. The decreased OPN expression was positively related to decreased Th2 cytokines and negatively related to enhanced IL-10 and TGF-β expression. In vitro experiments confirmed that children received SLIT treatment showed decreased production of Th2 cytokines by PBMCs after HDM stimulation.

CONCLUSION

During SLIT, decreased OPN expression was related to low Th2 cytokine expression and enhanced IL-10 and TGF-β expression. High serum OPN expression predicts poor treatment efficacy. OPN may be used as a biomarker for SLIT treatment.

Factors associated with the development and remission of allergic diseases in an epidemiological survey of high school students in Japan

BACKGROUND

Allergic diseases are an important health problem for children and adults. It is important to know how allergic diseases develop and remit from infancy to adolescence. Early intervention is effective in treating allergic diseases.

OBJECTIVE

We performed a large-scale questionnaire survey of high school students in Fukui Prefecture, Japan, and analyzed the factors associated with the development and remission of allergic diseases.

METHODS

A total of 21,802 students participated in the epidemiologic survey, and the valid response rate was 89.3% (19,461). We applied an inverse probability weighting method with propensity scores.

RESULTS

The present prevalence rate of allergic rhinitis (AR) was 19.2%. The remission rate of AR was 15.3%. Only children and firstborns had a significantly higher risk of developing symptoms of allergic diseases [only child: AR, 1.37; bronchial asthma (BA), 1.30; food allergy (FA), 1.33 and firstborn: AR, 1.38; BA, 1.10]. Constipation was an associated factor for development of atopic dermatitis (AD) (1.17) and AR (1.17), regular intake of lactic acid bacteria was not an associated factor for development of allergic diseases but was a factor for remission of AD (1.22). Hypohidrosis was an associated factor for development of AD (1.25). High academic performance was an associated factor for development of AR (1.20) but was a negative factor for development of BA (0.89). The values in parentheses are significant adjusted odds ratios.

CONCLUSION

This epidemiologic survey showed that the hygiene hypothesis and intestinal bacterial flora might influence the development of symptoms and remission of allergic diseases.

Food-induced immunoglobulin E-mediated allergic rhinitis

Food allergies are estimated about 1–2% in adults and 8% in children younger than 6 years. Allergic rhinitis is a common disease with a prevalence of 40% among different societies. Although, some foods play a role on exacerbation of allergic rhinitis symptoms, but still there are controversies about the role of diet on incidence or worsening the symptoms. The ongoing research demonstrates a possible relationship between certain foods and their induction of allergic reactions by modulating immunoglobulin E. A total of 100 patients (including both children and adults), between the ages 10 to 60 years, diagnosed with allergic rhinitis were selected for the study. Pregnant females and treated patients with antihistamine were excluded from the study. In vitro serum immunoglobulin E (IgE) levels mediated by a combination of food and inhalant allergens were detected by RIDA^® Allergy Screen in blood samples. Data were presented as mean, standard deviation and standard error. A statistical analysis was performed by one-way analysis of variance (ANOVA). A p value < 0.05 was considered statistically significant. We reported that 63% of patients with allergic rhinitis were sensitized to common food allergens whereas the rest 37% of patients were not sensitive to any of the food allergens. Similarly, a correlation between the age groups of patients with allergic rhinitis and food allergy were also accomplished. We found the highest response rate for allergic rhinitis and food allergy (53.2%) for the people between aged between 21 years and 40 years. We also demonstrated that females are more prone to mediate allergic rhinitis as induced by food allergies as compare to males (i.e., 66.2% vs. 33.3%). Food allergy is estimated to be 4.5% in adolescents and adults with asthma, rhinitis or both. Rice, citrus fruits, black grams and banana are identified as major allergens for inducing allergic-rhinitis symptoms.

Inter-Relationship between Rhinitis and Conjunctivitis in Allergic Rhinoconjunctivitis and Associated Risk Factors in Rural UK Children

Objective

Allergic conjunctivitis (AC) is a common condition, especially in childhood. The extent to which it occurs concurrently with or independently from allergic rhinitis (AR) has not been well described.

Aim

To examine the inter-relationship between rhinitis and conjunctivitis and the epidemiological risk factors for these conditions in a rural UK population.

Methods

Cross-sectional study of rural school children (aged 5–11 years). Parental questionnaires were used to diagnose allergic outcomes (including conjunctivitis, rhinitis and rhinoconjunctivitis), and to collect data on atopic history, demographic and environmental exposures. Odds ratios of allergic outcome by exposure were examined adjusted for age, sex, breastfeeding, family history of allergy, number of older and younger siblings.

Results

Prevalence of conjunctivitis was 17.5%, rhinitis 15.1% and rhinoconjunctivitis 13.0%. Seasonality of symptoms varied by condition: 64.7% of those with conjunctivitis had seasonal symptoms (April-Sept only), 46.7% of those with rhinitis and 92.2% of those with rhinoconjunctivitis. Living on a farm consistently reduced the risk of conjunctivitis (odds ratio 0.47, 95%CI 0.29–0.79, p = 0.004), rhinitis (OR 0.57, 95%CI 0.33–1.01, p = 0.05) and rhinoconjunctivitis (OR 0.57, 95%CI 0.32–1.03, p = 0.06). Exposure to farm animals (particularly in early life), current consumption of unpasteurised milk and playing in a barn or stable significantly reduced the risk of all three conditions.

Conclusion

More children had parent-reported conjunctivitis than rhinitis. The majority of children with either condition also reported symptoms with the other condition. Farmers’ children have less eye and/or nasal symptoms. A number of farming variables linked with the farm microbial environment are likely to be mediating the protective effect.

Prevalence and risk factors for allergic rhinitis in two resource-limited settings in Peru with disparate degrees of urbanization

BACKGROUND

Allergic rhinitis is a disease with a high global disease burden, but risk factors that contribute to this condition are not well understood.

OBJECTIVE

To assess the prevalence and risk factors of allergic rhinitis in two Peruvian populations with disparate degrees of urbanization.

METHODS

We conducted a population-based, cross-sectional study on 1441 children aged 13-15 years at enrollment (mean age 14.9 years, 51% boys) to investigate the prevalence of allergic disease. We used a standardized, Spanish validated questionnaire to determine the prevalence of allergic rhinitis and asked about sociodemographics and family history of allergies. Children also underwent spirometry, exhaled nitric oxide, allergy skin testing to 10 common household allergens and provided a blood sample for measurement of 25OH vitamin D and total serum IgE.

RESULTS

Overall prevalence of allergic rhinitis was 18% (95% CI 16% to 20%). When stratified by site, the prevalence of allergic rhinitis was 23% Lima vs. 13% in Tumbes (P < 0.001); however, this difference was no longer significant after controlling for subject-specific factors (P = 0.95). There was a strong association with other allergic diseases: 53% of children with asthma had allergic rhinitis vs. 15% in those without asthma (P < 0.001) and 42% of children with eczema vs. 17% of those without eczema (P < 0.001). Important risk factors for allergic rhinitis were parental rhinitis (adjusted OR = 3.0, 95% CI 1.9-4.7 for 1 parent and adjusted OR = 4.4, 95% CI 1.5-13.7 for 2 parents); allergic sensitization to common household aeroallergens (1.6, 1.1-2.3); being overweight (1.5, 1.0-2.3); exhaled nitric oxide ≥ 20 ppb (1.9, 1.3-2.7); and total serum IgE ≥ 95th percentile (2.4, 1.2-4.8). Population attributable risk of important factors for allergic rhinitis were 25% for high exhaled nitric oxide, 22% for allergic sensitization to common household aeroallergens, 22% for paternal rhinitis, 10% for being overweight and 7% for an elevated total serum IgE.

CONCLUSION AND CLINICAL RELEVANCE

Allergic rhinitis was prevalent in both settings, and important risk factors include elevated exhaled nitric oxide, allergic sensitization to common household aeroallergens, parental rhinitis, being overweight and high total serum IgE. When considering subject-specific factors, the difference in prevalence between the urban and rural settings became non-important.

Asthma in adolescents--Prevalence trends and associated factors in northeast Brazil

BACKGROUND

Asthma is the most common chronic disease affecting children and adolescents (AD). We evaluated the prevalence of asthma and associated factors in adolescents living in a developing region in northeast Brazil using the ISAAC (International Study of Asthma and Allergies in Childhood) methodology.

METHODS

According to the ISAAC protocol, AD (13-14 year olds, n=3,043 in 2003 and 3,009 in 2011-12) answered the standardised written questionnaire by themselves. In addition, in 2011-12 a random sample of these AD (n=430) also answered a complementary questionnaire (associated factors) and underwent a skin prick test with aeroallergens (Dermatophagoides pteronyssinus, Blomia tropicalis, Blatella germanica, Periplaneta americana, dog dander, cat dander, mixed grass pollen and mixed moulds, including 10mg/mL histamine and negative controls). Data were analysed by univariate and multivariate analysis using Poisson regression.

RESULTS

The prevalence of asthma in 2011-12 in Aracaju was 12.8%, which is lower than that recorded in 2003 (18.7%). Individuals with a dog outside the home (PR=0.93; 95%CI=0.88-0.98; p=0.018) and those with an older sibling (PR=0.94; 95%CI=0.91-0.98; p=0.005) were identified as protective. The presence of smokers in the residence (PR=1.04; 95%CI=1.00-1.09; p=0.039) was associated with an increased risk of developing asthma.

CONCLUSIONS

The prevalence of asthma was significantly lower than the last ISAAC figures reported for Aracaju. Tobacco smoking, a preventable factor, continues to be associated with an increase in the occurrence of asthma and other associations may concur with the hygiene hypothesis.

Consecutive Food and Respiratory Allergies Amplify Systemic and Gut but Not Lung Outcomes in Mice

Epidemiological data suggest a link between food allergies and the subsequent development of asthma. Although this progression may result from the additional effects of exposure to multiple allergens, whether both allergies amplify each other's effects remains unknown. This study investigated whether oral exposure to food allergens influences the outcomes of subsequent respiratory exposure to an asthma-inducing allergen. Mice were sensitized and orally challenged with wheat (FA) and then exposed to house dust mite (HDM) extract (RA). Immunoglobulin (Ig), histamine, and cytokine levels were assayed by ELISA. Intestinal and lung physiology was assessed. Ig levels, histamine release, and cytokine secretion were higher after exposure to both allergens than after separate exposure to each. Intestinal permeability was higher, although airway hyper-responsiveness and lung inflammation remained unchanged. Exposure to food and respiratory allergens amplifies systemic and gut allergy-related immune responses without any additional effect on lung function and inflammation.

Interrelationships between Atopic Disorders in Children: A Meta-Analysis Based on ISAAC Questionnaires

Purpose

To study the prevalence and interrelationship between asthma, allergic rhinitis and eczema using data obtained from ISAAC questionnaires.

Method

The Medline, Pubmed Publisher, EMBASE, Google Scholar and the Cochrane Controlled Clinical Trials Register databases were systematically reviewed to evaluate epidemiological data of children with atopic disorders. To study these interrelationships, a new approach was used. Risk ratios were calculated, describing the risk of having two different atopic disorders when the child is known with one disorder.

Results

Included were 31 studies, covering a large number of surveyed children (n=1,430,329) in 102 countries. The calculated worldwide prevalence for asthma, eczema and allergic rhinitis is 12.00% (95% CI: 11.99-12.00), 7.88% (95% CI: 7.88-7.89) and 12.66% (95% CI: 12.65-12.67), respectively. The observed prevalence [1.17% (95% CI: 1.17-1.17)] of having all three diseases is 9.8 times higher than could be expected by chance. For children with asthma the calculated risk ratio of having the other two disorders is 5.41 (95% CI: 4.76-6.16), for children with eczema 4.24 (95% CI: 3.75-4.79), and for children with allergic rhinitis 6.20 (95% CI: 5.30-7.27). No studied confounders had a significant influence on these risk ratios.

Conclusions

Only a minority of children suffers from all three atopic disorders, however this co-occurrence is significantly higher than could be expected by chance and supports a close relationship of these disorders in children. The data of this meta-analysis supports the hypothesis that there could be a fourth distinct group of children with all three disorders. Researchers and clinicians might need to consider these children as a separate group with distinct characteristics regarding severity, causes, treatment or prognosis.

Topical antihistamines and mast cell stabilisers for treating seasonal and perennial allergic conjunctivitis

BACKGROUND

Seasonal/perennial allergic conjunctivitis is the most common allergic conjunctivitis, usually with acute manifestations when a person is exposed to allergens and with typical signs and symptoms including itching, redness, and tearing. The clinical signs and symptoms of allergic conjunctivitis are mediated by the release of histamine by mast cells. Histamine antagonists (also called antihistamines) inhibit the action of histamine by blocking histamine H1 receptors, antagonising the vasoconstrictor, and to a lesser extent, the vasodilator effects of histamine. Mast cell stabilisers inhibit degranulation and consequently the release of histamine by interrupting the normal chain of intracellular signals. Topical treatments include eye drops with antihistamines, mast cell stabilisers, non-steroidal anti-inflammatory drugs, combinations of the previous treatments, and corticosteroids. Standard treatment is based on topical antihistamines alone or topical mast cell stabilisers alone or a combination of treatments. There is clinical uncertainty about the relative efficacy and safety of topical treatment.

OBJECTIVES

The objective of this review was to assess the effects of topical antihistamines and mast cell stabilisers, alone or in combination, for use in treating seasonal and perennial allergic conjunctivitis.

SEARCH METHODS

We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2014, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to July 2014), EMBASE (January 1980 to July 2014), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 17 July 2014. We also searched the reference lists of review articles and relevant trial reports for details of further relevant publications.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) comparing topical antihistamine and mast cell stabilisers, alone or in combination, with placebo, no treatment or to any other antihistamine or mast cell stabiliser, or both, that examined people with seasonal or perennial allergic conjunctivitis, or both. The primary outcome was any participant-reported evaluation (by questionnaire) of severity of four main ocular symptoms: itching, irritation, watering eye (tearing), and photophobia (dislike of light), both separately and, if possible, by an overall symptom score. We considered any follow-up time between one week and one year.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted data and assessed risk of bias. Disagreements were resolved by discussion among review authors and the involvement of a third review author. We followed standard methodological approaches used by Cochrane.

MAIN RESULTS

We identified 30 trials with a total of 4344 participants randomised, with 17 different drugs or treatment comparisons. The following antihistamines and mast cell stabilisers were evaluated in at least one RCT: nedocromil sodium or sodium cromoglycate, olopatadine, ketotifen, azelastine, emedastine, levocabastine (or levocabastine), mequitazine, bepotastine besilate, combination of antazoline and tetryzoline, combination of levocabastine and pemirolast potassium. The most common comparison was azelastine versus placebo (nine studies).We observed a large variability in reporting outcomes. The quality of the studies and reporting was variable, but overall the risk of bias was low. Trials evaluated only short-term effects, with a range of treatment of one to eight weeks. Meta-analysis was only possible in one comparison (olopatadine versus ketotifen). There was some evidence to support that topical antihistamines and mast cell stabilisers reduce symptoms and signs of seasonal allergic conjunctivitis when compared with placebo. There were no reported serious adverse events related to the use of topical antihistamine and mast cell stabilisers treatment.

AUTHORS' CONCLUSIONS

It seems that all reported topical antihistamines and mast cell stabilisers reduce symptoms and signs of seasonal allergic conjunctivitis when compared with placebo in the short term. However, there is no long-term data on their efficacy. Direct comparisons of different antihistamines and mast cell stabilisers need to be interpreted with caution. Overall, topical antihistamines and mast cell stabilisers appear to be safe and well tolerated. We observed a large variability in outcomes reported. Poor quality of reporting challenged the synthesis of evidence.

The Burden of Asthma in Oman

Asthma is a common lung disease worldwide, although its prevalence varies from country to country. Oman is ranked in the intermediate range based on results from the International Study of Asthma and Allergies in Childhood. A 2009 study revealed that the majority of asthmatic patients in Oman reported both daytime and nocturnal symptoms, while 30% of adults and 52% of children reported absences from work or school due to their symptoms. Despite these findings, there is little data available on the economic burden of asthma in Oman. The only accessible information is from a 2013 study which concluded that Oman's highest asthma-related costs were attributable to inpatient (55%) and emergency room (25%) visits, while asthma medications contributed to less than 1% of the financial toll. These results indicate a low level of asthma control in Oman, placing a large economic burden on healthcare providers. Therefore, educating asthmatic patients and their families should be prioritised in order to improve the management and related costs of this disease within Oman.

Occurrence of common allergic diseases in children with idiopathic nephrotic syndrome

Background

Clinical and immunological studies have consistently shown a possible link between atopy and idiopathic nephrotic syndrome (INS). However, whether allergic diseases occur after INS develops is unknown.

Methods

From Taiwan’s National Health Insurance database, 1340 children with newly diagnosed INS and 5360 non-INS matched controls were identified in 2000–2007. By the end of 2008, the incidences and hazard ratios of four allergic diseases (allergic conjunctivitis, allergic rhinitis, atopic dermatitis, and asthma) were calculated.

Results

The incidence rates of all four allergic diseases were greater in the INS cohort than in the non-INS cohort in all age groups and decreased sharply as age increased in both cohorts. Children with INS had the highest adjusted hazard ratio (4.13; 95% confidence interval [CI], 2.50–6.83) for atopic dermatitis and the lowest adjusted hazard ratio (1.71; 95% CI, 1.39–2.09) for allergic rhinitis. Most of the allergic diseases appeared within 2–6 months after INS developed, and the incidences declined with increasing follow-up duration.

Conclusions

Allergic disorders are common in children with INS, especially within the first year after diagnosis. The role of INS in the development of allergic disorders should be elucidated to establish innovative disease intervention programs.

Useful biomarkers for assessing the adverse health effects of PCBs in allergic children: pediatric molecular epidemiology

The incidences of childhood allergies have been increasing in recent years in many parts of the world. The development of allergic disorders is attributed to a complex series of interactions between individuals' genetic backgrounds and their immune and psychoneurotic responses to environmental factors. Among the various possible environmental causes of childhood allergies, the early exposure of developing infants to air pollutants and the presence of persistent chemical pollutants such as pesticides have been suggested most frequently. Therefore, it is very important to obtain epidemiological evidence of direct associations between clearly defined adverse health effects and exposure to low levels of pollutants. However, there are no useful biomarkers for assessing such associations. Thus, we planned to establish reliable health-related biomarkers that could be used to investigate these relationships in children. The serum concentrations of several sub-types of polychlorinated biphenyl (PCB) congeners were found to be significantly correlated with interleukin (IL)-8 mRNA expression among asthmatic children. In addition, IL-22 mRNA expression was found to be particularly useful for detecting the effects of environmental pollutants, especially PCB congeners, in a sub-population of vulnerable children who exhibited positive immunoglobulin E (IgE) responses to milk or egg. Furthermore, we detected significant differences in IL-22 mRNA expression between the IgE-negative non-asthmatic subjects and the asthmatic children who exhibited positive IgE reactions toward egg or milk. In conclusion, IL-8 and IL-22 mRNA expressions could be useful biomarkers for detecting sub-populations of children who are particularly vulnerable to the adverse health effects of environmental pollutants, especially PCBs.

Interleukin-31 promotes helper T cell type-2 inflammation in children with allergic rhinitis

BACKGROUND

Interleukin-31 (IL-31) is a recently described cytokine that is involved in helper T cell type-2 (Th2)-mediated diseases. However, its regulatory effect in the pathogenesis of children allergic rhinitis (AR) needs to be further characterized. This study sought to evaluate the expression and role of IL-31 in children with AR.

METHODS

Sixty children with AR and 20 normal controls were included. IL-31 and Th2 cytokines production in tissue, serum, and nasal lavage was examined by immunohistochemistry, quantitative polymerase chain reaction (qPCR), and enzyme-linked immunosorbent assay, respectively. Peripheral blood mononuclear cells (PBMCs) were purified for in vitro regulation experiment of IL-31. Nasal epithelial cells (NECs) were cultured and stimulated by recombinant IL-31.

RESULTS

The IL-31 mRNA and protein levels in both serum and nasal lavage were significantly enhanced in AR compared with normal controls, especially in children with asthma. The nasal IL-31 was associated with enhanced local Th2 cytokines and mucin 5AC (MUC5AC) expression. In vitro study showed that IL-31 promotes Th2 cytokines expression and MUC5AC upregulation and thus amplified Th2 inflammation.

CONCLUSION

Our results demonstrate that IL-31 expression in AR aggravated and amplified Th2 inflammation as well as mucin production, and provide a possible explanation for IL-31's regulatory role in the pathogenesis of AR.