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A fifteen-year review of skin allergy testing in Irish patients with symptomatic rhinitis. World J Otorhinolaryngol Head Neck Surg 2021; 7:338-343. [PMID: 34632349 PMCID: PMC8486687 DOI: 10.1016/j.wjorl.2020.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/24/2020] [Accepted: 10/03/2020] [Indexed: 01/20/2023] Open
Abstract
Objective Our objective was to review skin prick allergy testing (SPAT) results in patients with symptomatic rhinitis in an Irish population. Methods A fifteen-year retrospective review of our database of symptomatic patients with rhinitis was performed. All patients who had SPAT performed during this interval were included. Data was analysed in terms of demographics and dominant allergens. Results 1158 patients were included. 617 Females vs 541 Males. Age range five to eighty-five years old. Mean age thirty-four years. 49% of our patients tested positive to at least one aeroallergen. The most common allergens were dust mites (23%) and timothy grass (22%). Patients born during the Irish pollen season (April–July) were between 5 and 7 times more likely to be sensitive to timothy and ryegrass pollens compared to others tested. 241 patients had both SPAT and serum allergen specific IgE testing (SASIgET) performed; positive results were consistent between both groups. Conclusion Results demonstrated that half of our patients with symptomatic rhinitis had allergen sensitisation. Dust mites and grass were the main allergens in our area. Our nurse led clinic has allowed efficient patient education and the development of a unique Irish SPAT database. Retesting a patient with a known allergy test result it is not indicated.
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Abstract
Allergic rhinitis is a common disorder that regularly occurs in children and adolescents. The disease is associated with other allergic diseases, such as asthma, and it carries a heavy burden, with effects on sleep, school performance, and quality of life. Classic symptoms include sneezing, rhinorrhea, nasal obstruction, and nasal itching. When the eyes are involved, the term allergic rhinoconjunctivitis is used. Triggers may include airborne pollens, molds, dust mites, and animals. Skin or blood allergy testing can be a useful diagnostic modality that may guide therapy. Immunotherapy can prevent the development of further allergic sensitizations as well as subsequent asthma.
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Affiliation(s)
- Charles Frank Schuler Iv
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA.
| | - Jenny Maribel Montejo
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA
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Soh H, Lee HJ, Han K, Park S, Hong SW, Moon JM, Kang EA, Lee J, Chun J, Im JP, Kim JS. Atopic Diseases Are Associated With Development of Inflammatory Bowel Diseases in Korea: A Nationwide Population-based Study. Clin Gastroenterol Hepatol 2021; 19:2072-2081.e6. [PMID: 32712393 DOI: 10.1016/j.cgh.2020.07.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The association between atopic diseases and inflammatory bowel diseases (IBD) is unclear. We conducted a nationwide population-based study in Korea to investigate the effect of atopic diseases on the development of IBD. METHODS A total of 9,923,521 participants, who received a medical check-up in 2009, were included and followed through 2017. The presence of any atopic diseases, including atopic dermatitis (AD), allergic rhinitis (AR), and asthma, was evaluated. Patients who developed IBD, including Crohn's disease (CD) and ulcerative colitis (UC), were identified using claims data from National Health Insurance; the association between atopic diseases and the risk of IBD was evaluated using Cox proportional hazard models, and presented as adjusted hazard ratios (aHRs) with 95% CIs. RESULTS During a mean follow-up period of 7.3 years, 1419 patients (0.014%) developed CD and 5897 patients (0.059%) developed UC. The incidences of CD (per 100,000 person-years) were 3.756, 2.248, and 2.346 in patients with AD, AR, or asthma, respectively. The incidences of UC were 11.952, 9.818, and 9.358 in patients with AD, AR, or asthma, respectively. Multivariable analysis revealed that the aHRs for incident CD in patients with AD, AR, or asthma were 2.02, 1.33, and 1.60 (95% CIs, 1.118-3.663, 1.149-1.529, and 1.193-2.136, respectively) compared with controls. The risks of incident UC in patients with AD, AR, or asthma were 1.51, 1.32, and 1.29 (95% CIs, 1.082-2.104, 1.229-1.410, and 1.115-1.491, respectively) compared with controls. Moreover, an increase in the number of atopic diseases gradually increased the risk for CD and UC; for 1 or 2 or more atopic diseases, the aHRs for CD were 1.35 and 1.65 (95% CIs, 1.171-1.560 and 1.146-2.376), and the aHRs for UC were 1.30 and 1.49 (95% CIs, 1.211-1.392 and 1.249-1.774), respectively. CONCLUSIONS Based on a nationwide population-based study in Korea, patients with any atopic disease, including AD, AR, or asthma, have an increased risk for CD and UC. The risk for IBD increases with the increase in the number of atopic diseases.
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Affiliation(s)
- Hosim Soh
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seona Park
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Wook Hong
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Min Moon
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eun Ae Kang
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jooyoung Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Healthcare Research Institute, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Republic of Korea
| | - Jaeyoung Chun
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Ramsey N, Berin MC. Pathogenesis of IgE-mediated food allergy and implications for future immunotherapeutics. Pediatr Allergy Immunol 2021; 32:1416-1425. [PMID: 33715245 PMCID: PMC9096874 DOI: 10.1111/pai.13501] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/29/2021] [Accepted: 02/22/2021] [Indexed: 12/13/2022]
Abstract
Our understanding of the immune basis of food allergy has grown rapidly in parallel with the development of new immune-targeted interventions for the treatment of food allergy. Local tissue factors, including the composition of skin and gastrointestinal microbiota and production of Th2-inducing cytokines (TSLP, IL-33, and IL-25) from barrier sites, have been shown not only to contribute to the development of food allergy, but also to act as effective targets for treatment in mice. Ongoing clinical trials are testing the targeting of these factors in human disease. There is a growing understanding of the contribution of IL-13 to the induction of high-affinity IgE and the need for continual T-cell help in the maintenance of long-lived IgE. This provides a strong rationale to test biologics targeting both IL-4 and IL-13 in the treatment of established food allergy. Various forms of allergen immunotherapy for food allergy have clearly shown that low specific IgE and elevated specific IgG4 are predictive of sustained treatment effect. Treatments that mimic that immune response, for example, lowering IgE, with monoclonal antibodies such as omalizumab, or administering allergen-specific IgG, are in various stages of investigation. As we gain more opportunities to use immune-modifying treatments for the treatment of food allergy, studies of the immune and clinical response to those interventions will continue to rapidly advance our understanding of the immune basis of food allergy and tolerance.
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Affiliation(s)
- Nicole Ramsey
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Cecilia Berin
- Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Wang YH, Wu PH, Su HH, Wang CY, Hsu L. Cross-Sectional Study to Identify Potential Risk Factors for Eczema within the Common Household Environment in Taiwan. Indian J Dermatol 2021; 66:272-278. [PMID: 34446950 PMCID: PMC8375532 DOI: 10.4103/ijd.ijd_452_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Much attention has been focused on environmental risk factors and their roles in eczema development. In this regard, the specific eczema risk factors in Taiwan were relatively unknown. As such, this study investigated the common indoor risk factors present in Taiwanese households. Aims To discuss the effects of several indoor risk factors on the prevalence of atopic eczema in Taiwan. Materials and Methods A cross-sectional, population-based study was performed in Kaohsiung, Taiwan, using both survey investigation and fungal culturing. A total of 998 participants were enrolled in the survey, with 513 participants selected for fungal culture. Risks of atopic eczema were calculated as odds ratios for various risk factors using logistic regression. The correlation between potential risk factors and the fungal level was analyzed with linear regression. Results Pet and house plants have an adjusted odds ratio of 1.434 (95% CL: 1.011-2.033) and 1.820 (95% CL: 1.229-2.696), respectively. Additionally, smoking was shown to possess an odds ratio of 1.461 (95% CL: 1.064-2.006). Wood wall has an adjusted odds ratio of 2.143 (95% CL: 1.235-3.658). Frequent bedroom shower use (β = 0.254) and hours of opened windows (β = 0.106) have shown significant positive associations with indoor fungal level. Conclusion Pets, house plants, and smoking were concluded to be major risk factors for atopic eczema. Wood wall remained controversial due to its limited sample size and possible confounders. Bedroom shower and window-opening have been shown to increase mold growth, but the lack of association with eczema suggested other allergens besides mold to be the primary eczema trigger.
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Affiliation(s)
- Yu-Hao Wang
- Department of Microbiology and Immunology, University of Rochester, NY 14642, USA
| | - Pi-Hsiung Wu
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Pingtung Branch, Pingtung 91245, Pingtung
| | - Hsing-Hao Su
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, ROC
| | | | - Lan Hsu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan, ROC
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Zhou Y, Chen J, Dong Y, Shen J, Tian M, Yang Y, Song L, Li J. Maternal tobacco exposure during pregnancy and allergic rhinitis in offspring: A systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26986. [PMID: 34449468 PMCID: PMC8389918 DOI: 10.1097/md.0000000000026986] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 07/26/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Maternal tobacco exposure during pregnancy is known to cause a potential hazard to the offspring's health. So far, published studies have shown no consistent results with whether tobacco exposure in utero is causally linked to the development of allergic rhinitis in offspring. The aim of this study was to comprehensively evaluate the association between maternal tobacco exposure during pregnancy and allergic rhinitis in offspring by meta-analysis and to provide reference for clinical work. METHODS Literatures were searched in CNKI, Wanfang Data, VIP, SinoMed, PubMed, Web of science and Embase up to September 30,2020. Screening, inclusion, quality assessment, data extraction and data analysis of the literatures were conducted. Meta-analysis was performed with Revman 5.3 and State15.1 software. Odds ratio (OR) and 95%CI were used as observation indicators. RESULTS We had retrieved 16 articles with 22 independent datasets and 11,49,879 sample size. When all the studies were analyzed together, the results showed that maternal smoking exposure during pregnancy would increase the risk of allergic rhinitis in offspring (OR = 1.13, 95%CI:1.02-1.26), especially maternal passive smoking during pregnancy (OR = 1.39, 95%CI:1.05-1.84). But subgroup analysis showed that maternal active smoking during pregnancy was only significantly associated with offspring allergic rhinitis in cross-sectional studies (OR = 1.24, 95%CI:1.07-1.45) and study done in America study (OR = 1.22, 95%CI:1.05-1.42). CONCLUSIONS Tobacco exposure during pregnancy could increase the risk of allergic rhinitis in offspring. The importance of avoiding prenatal tobacco exposure should be emphasized more for the health of next generation in the public.
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Affiliation(s)
- Yaqian Zhou
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
| | - JunRong Chen
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
| | - Yunpeng Dong
- Department of Otolatyngoloty-Head and Neck Surgery, Yichang Central People's Hospital, the First College of Clinical Medical Science, Three Gorges University, Hubei, China
| | - Jinhua Shen
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
| | - Mei Tian
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
| | - Yide Yang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
| | - Liujiang Song
- Gene Therapy Center, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Jian Li
- Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, China
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Wu AC, Dahlin A, Wang AL. The Role of Environmental Risk Factors on the Development of Childhood Allergic Rhinitis. CHILDREN 2021; 8:children8080708. [PMID: 34438599 PMCID: PMC8391414 DOI: 10.3390/children8080708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 01/20/2023]
Abstract
Environmental factors play an important role in the development and exacerbation of allergic rhinitis (AR) in childhood. Indoor air pollution, such as house dust mites and secondhand smoke, can significantly increase the onset of AR, while pet dander may affect the exacerbation of AR symptoms in children. Furthermore, traffic related air pollution and pollen are outdoor air pollutants that can affect immune competency and airway responsiveness, increasing the risk of AR in children. Climate change has increased AR in children, as growth patterns of allergenic species have changed, resulting in longer pollen seasons. More extreme and frequent weather events also contribute to the deterioration of indoor air quality due to climate change. Additionally, viruses provoke respiratory tract infections, worsening the symptoms of AR, while viral infections alter the immune system. Although viruses and pollution influence development and exacerbation of AR, a variety of treatment and prevention options are available for AR patients. The protective influence of vegetation (greenness) is heavily associated with air pollution mitigation, relieving AR exacerbations, while the use of air filters can reduce allergic triggers. Oral antihistamines and intranasal corticosteroids are common pharmacotherapy for AR symptoms. In this review, we discuss the environmental risk factors for AR and summarize treatment strategies for preventing and managing AR in children.
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Zhu F, Jiao J, Zhuang P, Huang M, Zhang Y. Association of exposures to perchlorate, nitrate, and thiocyanate with allergic symptoms: A population-based nationwide cohort study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 283:117068. [PMID: 33892368 DOI: 10.1016/j.envpol.2021.117068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/05/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
Allergic diseases have been one of the leading causes of chronic disorders in the United States. Animal studies have suggested that exposures to perchlorate, nitrate, and thiocyanate could induce allergic inflammation. However, the associations have not been examined among general populations. Here, we investigated data of 7030 participants aged ≥6 years from the National Health and Nutritional Examination Survey (NHANES) 2005-2006. Urinary levels of perchlorate, nitrate, and thiocyanate were measured by ion chromatography combined with electrospray tandem mass spectrometry. Information on allergic symptoms (hay fever, allergy, rash, sneeze, wheeze, eczema, and current asthma) was collected by questionnaire. Allergic sensitization was defined by a concentration ≥150 kU/L for total immunoglobulin E (IgE) levels. The associations were estimated using multivariate-adjusted logistic regression models. A positive association was observed for urinary nitrate and eczema (p < 0.001 for the trend). Compared with quartile 1 (lowest quartile), the odds ratios of eczema with 95% confidence intervals [ORs (95% CIs)] from quartiles 2 to 4 were 1.72 (95% CI, 1.41, 2.09), 1.94 (1.53, 2.47) and 2.10 (1.49, 2.97) for urinary nitrate. In addition, urinary thiocyanate was positively related to sneeze (ORQ4 vs. Q1: 1.25, 95% CI: 1.01, 1.55; p = 0.015 for the trend). However, urinary perchlorate was not correlated with any allergic-related outcome. Additionally, the associations were different among subgroups in a four-level polytomous model. Thus, our results suggested that exposures to nitrate and thiocyanate may be associated with allergic symptoms. Further investigations are warranted to concentrate on the practical strategies to monitor exposure levels and the latent mechanisms of the relationship between exposure and allergy.
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Affiliation(s)
- Fanghuan Zhu
- National Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Fuli Institute of Food Science, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jingjing Jiao
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pan Zhuang
- National Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Fuli Institute of Food Science, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Mengmeng Huang
- National Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Fuli Institute of Food Science, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yu Zhang
- National Engineering Laboratory of Intelligent Food Technology and Equipment, Zhejiang Key Laboratory for Agro-Food Processing, Fuli Institute of Food Science, College of Biosystems Engineering and Food Science, Zhejiang University, Hangzhou, Zhejiang, China.
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Norbäck D, Zhang X, Tian L, Zhang Y, Zhang Z, Yang L, Chen X, Zeng Z, Lu C, Zhao Z. Prenatal and perinatal home environment and reported onset of wheeze, rhinitis and eczema symptoms in preschool children in Northern China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 774:145700. [PMID: 33609817 DOI: 10.1016/j.scitotenv.2021.145700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 06/12/2023]
Abstract
Early life environment can affect asthma and allergies but few cohort studies on this issue are available from China. Our aim was to investigate reported onset of childhood wheeze, rhinitis and eczema symptoms in relation to prenatal, perinatal and postnatal home environment. Data on home environment and symptoms (ISAAC based questions) in first two years of life and in the past 12 months were reported by parents of the children (3-6 y) in a cross-sectional questionnaire survey in ten day care centers in Taiyuan, northern China (N = 3606). Changes of symptoms from the first 2 years of life to the past 12 months (recall period) were calculated retrospectively. Multilevel logistic regression analysis was applied. Reported onset of wheeze, rhinitis and eczema were 11.8%, 22.2% and 3.3%, respectively. Redecorating during pregnancy increased reported onset of rhinitis (OR = 2.29) and eczema (OR = 4.91). New furniture during pregnancy increased reported onset of rhinitis (OR = 1.47). Perinatal indoor mould increased reported onset of wheeze (OR = 1.51), rhinitis (OR = 1.65) and eczema (OR = 1.91). Perinatal mould odour increased reported onset of wheeze (OR = 1.85). Perinatal window pane condensation increased reported onset of wheeze (OR = 1.54) and rhinitis (OR = 1.24). Perinatal stuffy air and dry air in the home increased reported onset of all three symptoms (ORs 1.46-2.24). Dog keeping increased reported onset of wheeze (OR = 1.69) and eczema (OR = 2.13). Based on principal component analysis, four exposure scores were calculated (renovation, new furniture, mould and indoor air quality scores). Dose-response relationships were observed between these exposure scores and reported onset of symptoms. In conclusion, prenatal and postnatal exposure to emissions from renovation and new furniture can increase reported onset of childhood wheeze, rhinitis and eczema. Perinatal indoor mould, mould odour, condensation on window panes and impaired indoor air quality at home can be associated with reported development of wheeze, rhinitis and eczema in preschoolers in northern China.
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Affiliation(s)
- Dan Norbäck
- Institute of Environmental Science, Shanxi University, Taiyuan, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Xin Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China.
| | - Li Tian
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Yifei Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Zefei Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Liu Yang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Xingyi Chen
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Zhaohua Zeng
- School of Public Health, Xiamen University, Xiamen, China
| | - Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, China
| | - Zhuohui Zhao
- School of Public Health, Fudan University, Shanghai, China
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Primary Prevention of Food Allergy-Environmental Protection beyond Diet. Nutrients 2021; 13:nu13062025. [PMID: 34204606 PMCID: PMC8231128 DOI: 10.3390/nu13062025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023] Open
Abstract
A food allergy is a potentially life-threatening disease with a genetic and environmental background. As its prevalence has increased significantly in recent years, the need for its effective prevention has been emphasized. The role of diet modifications and nutrients in food allergy reduction has been extensively studied. Much less is known about the role of other environmental factors, which can influence the incidence of this disease. Changes in neonates gut microbiome by delivery mode, animal contact, inhalant allergens, oral and then cutaneous allergen exposure, air pollution, smoking, infections and vaccinations can be the potential modifiers of food allergy development. There is some data about their role as the risk or preventive factors, but yet the results are not entirely consistent. In this paper we present the current knowledge about their possible role in primary prevention of food allergies. We discuss the mechanisms of action, difficulties in designing accurate studies about food allergy and the potential biases in interpreting the connection between environmental factors and food allergy prevention. A better understanding of the role of environmental factors in food allergies development may help in implementing practical solutions for food allergy primary prevention in the future.
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Yin X, Wang B, Yan Z, Hu L, Zhang X. Association between SP-A rs1965708 gene polymorphism and allergic rhinitis risk in Chinese population. J Clin Lab Anal 2021; 35:e23828. [PMID: 34028080 PMCID: PMC8274983 DOI: 10.1002/jcla.23828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/24/2021] [Accepted: 05/03/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pulmonary surfactant protein A (SP-A) in the respiratory tract plays an important role in host. In the present, we assessed the association between SP-A gene polymorphism and allergic rhinitis. METHODS Using a case-control design, we compared the genotype frequencies of SP-A rs1965708 between allergic rhinitis patients and healthy control group. Genotyping was performed using real-time quantitative PCR-based molecular identification methods. Univariate and multivariate logistic regression were performed to quantitatively assess the association between rs1965708 polymorphism and allergic rhinitis, and the odds ratio (OR) and 95% confidence interval (CI) were also calculated. RESULTS 500 patients with allergic rhinitis and 500 healthy controls were included in the study. Compared with the CC genotype, we found that AA genotype of rs1965708 could increase the allergic rhinitis risk in the univariate analysis (OR = 2.63, 95% CI: 1.56-4.54, p = 0.000). For dominant model, we found no significant difference in the dominant model (OR = 1.14, 95% CI: 0.86-1.52, p = 0.367). In the recessive model, the CC genotype could elevate the risk of allergic rhinitis compared with CC + AA genotype (OR = 2.70, 95% CI: 1.61-4.54, p = 0.000). Similar results were also found in the allele model (OR = 1.28, 95% CI: 1.07-1.54, p = 0.008). Interactions between rs1965708 AA or AC and smoking increased the allergic rhinitis risk. CONCLUSIONS The rs1965708 variants of SP-A gene polymorphism are associated with allergic rhinitis, and the A allele could increase the allergic rhinitis risk. The AA SNP variants that interact with smoking may alter the susceptibility to allergic rhinitis.
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Affiliation(s)
- Xinghong Yin
- Department of Otolaryngology-Head & Neck Surgery, Fuyang People's Hospital, Fuyang, China
| | - Bo Wang
- Department of Otolaryngology-Head & Neck Surgery, Fuyang People's Hospital, Fuyang, China
| | - Zhiqiang Yan
- Department of Otolaryngology-Head & Neck Surgery, Fuyang People's Hospital, Fuyang, China
| | - Lulu Hu
- Department of Otolaryngology-Head & Neck Surgery, Fuyang People's Hospital, Fuyang, China
| | - Xinhai Zhang
- Department of Otolaryngology-Head & Neck Surgery, Fuyang People's Hospital, Fuyang, China
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Ecevit MC, Özcan M, Haberal Can İ, Çadallı Tatar E, Özer S, Esen E, Atan D, Göde S, Elsürer Ç, Eryılmaz A, Uslu Coşkun B, Yazıcı ZM, Dinç ME, Özdoğan F, Günhan K, Bilal N, Korkut AY, Kasapoğlu F, Türk B, Araz Server E, Önerci Çelebi Ö, Şimşek T, Kum RO, Adalı MK, Eren E, Yüksel Aslıer NG, Bayındır T, Çakır Çetin A, Enise Göker A, Adadan Güvenç I, Köseoğlu S, Soylu Özler G, Şahin E, Şahin Yılmaz A, Güne C, Aksoy Yıldırım G, Öca B, Durmuşoğlu M, Kantekin Y, Özmen S, Orhan Kubat G, Köybaşı Şanal S, Altuntaş EE, Selçuk A, Yazıcı H, Baklacı D, Yaylacı A, Hancı D, Doğan S, Fidan V, Uygur K, Keleş N, Cingi C, Topuz B, Çanakçıoğlu S, Önerci M. Turkish Guideline for Diagnosis and Treatment of Allergic Rhinitis (ART). Turk Arch Otorhinolaryngol 2021; 59:1-157. [PMID: 34212158 PMCID: PMC8221269 DOI: 10.4274/tao.2021.suppl.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECT To prepare a national guideline for Otorhinolaryngologist who treat allergic rhinitis patients. METHODS The study was conducted by three authors, namely the writing support team. The support team made the study plan, determined the writing instructions, chose the subgroups including the advisory committee, the advisors for authors and the authors. A workshop was organized at the very beginning to explain the details of the study to the team. Advisors took the chance to meet their coworkers in their subgroups and determined the main headings and subheadings of the guideline, together with the authors. After key words were determined by the authors, literature search was done in various databases. The authors keep in touch with the advisors and the advisors with the advisory committee and the support group at every stage of the study. National and International published articles as well as the abstracts of unpublished studies, imperatively presented in National Congresses, were included in this guideline. Only Guideline and meta-analyses published in last seven years (2013-2017) and randomized controlled studies published in last two years (2015-2017) were included. After all work was completed by the subgroups, support team brought all work together and edited the article. RESULTS A detailed guideline about all aspects of allergic rhinitis was created. CONCLUSION The authors believe that this guideline will enable a compact and up-to-date information on allergic rhinitis to healthcare professionals. This guideline is the first in the field of Otolaryngology in Turkey. It should be updated at regular intervals.
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Affiliation(s)
- Mustafa Cenk Ecevit
- Department of Otorhinolaryngology, Dokuz Eylül University Faculty of Medicine, İzmir
| | - Müge Özcan
- Department of Otorhinolaryngology, University of Health Sciences Turkey Faculty of Medicine, Ankara
| | - İlknur Haberal Can
- Department of Otorhinolaryngology, Yozgat Bozok University Faculty of Medicine, Yozgat
| | - Emel Çadallı Tatar
- Department of Otorhinolaryngology, University of Health Sciences Turkey Faculty of Medicine, Ankara
| | - Serdar Özer
- Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara
| | - Erkan Esen
- Department of Otorhinolaryngology, Derince Training and Research Hospital, İzmit
| | - Doğan Atan
- Department of Otorhinolaryngology, Lokman Hekim Hospital, Ankara
| | - Sercan Göde
- Department of Otorhinolaryngology, Ege University Faculty of Medicine, İzmir
| | - Çağdaş Elsürer
- Department of Otorhinolaryngology, Selçuk University Faculty of Medicine, Konya
| | - Aylin Eryılmaz
- Department of Otorhinolaryngology, Adnan Menderes University Faculty of Medicine, Aydın
| | - Berna Uslu Coşkun
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul
| | - Zahide Mine Yazıcı
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Faculty of Medicine, İstanbul
| | - Mehmet Emre Dinç
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul
| | - Fatih Özdoğan
- Department of Otorhinolaryngology, Derince Training and Research Hospital, İzmit
| | - Kıvanç Günhan
- Department of Otorhinolaryngology, Celal Bayar University, Manisa
| | - Nagihan Bilal
- Department of Otorhinolaryngology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş
| | - Arzu Yasemin Korkut
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul
| | - Fikret Kasapoğlu
- Department of Otorhinolaryngology, Uludağ University Faculty of Medicine, Bursa
| | - Bilge Türk
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul
| | - Ela Araz Server
- Department of Otorhinolaryngology, University of Health Sciences Turkey, İstanbul Training and Research Hospital, İstanbul
| | - Özlem Önerci Çelebi
- Department of Otorhinolaryngology, University of Health Sciences Turkey, İstanbul Training and Research Hospital, İstanbul
| | - Tuğçe Şimşek
- Department of Otorhinolaryngology, Amasya University Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya
| | - Rauf Oğuzhan Kum
- Department of Otorhinolaryngology, University of Health Sciences Turkey Faculty of Medicine, Ankara
| | - Mustafa Kemal Adalı
- Department of Otorhinolaryngology, Trakya University Faculty of Medicine, Edirne
| | - Erdem Eren
- Department of Otorhinolaryngology, Atatürk Training and Research Hospital, İzmir
| | - Nesibe Gül Yüksel Aslıer
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Bursa Yüksek İhtisas Training and Research Hospital, Bursa
| | - Tuba Bayındır
- Department of Otorhinolaryngology, İnönü University Faculty of Medicine, Malatya
| | - Aslı Çakır Çetin
- Department of Otorhinolaryngology, Dokuz Eylül University Faculty of Medicine, İzmir
| | - Ayşe Enise Göker
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul
| | - Işıl Adadan Güvenç
- Department of Otorhinolaryngology, Bakırçay University Faculty of Medicine, Çiğli Training and Research Hospital, İzmir
| | - Sabri Köseoğlu
- Department of Otorhinolaryngology, Sıtkı Koçman University Faculty of Medicine, Muğla
| | - Gül Soylu Özler
- Department of Otorhinolaryngology, Mustafa Kemal University Faculty of Medicine, Hatay
| | - Ethem Şahin
- Bayındır Heathcare Group İçerenköy Hospital, İstanbul
| | - Aslı Şahin Yılmaz
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Ümraniye Training and Research Hospital, İstanbul
| | - Ceren Güne
- Department of Otorhinolaryngology, Atatürk Training and Research Hospital, İzmir
| | - Gökçe Aksoy Yıldırım
- University of Health Sciences Turkey, Bozyaka Training and Research Hospital, Department of Otorhinolaryngology, İzmir
| | - Bülent Öca
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul
| | - Mehmet Durmuşoğlu
- Department of Otorhinolaryngology, Bakırçay University Faculty of Medicine, Çiğli Training and Research Hospital, İzmir
| | - Yunus Kantekin
- Department of Otorhinolaryngology University of Health Sciences Turkey, Kayseri City Hospital, Kayseri
| | - Süay Özmen
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Bursa Yüksek İhtisas Training and Research Hospital, Bursa
| | - Gözde Orhan Kubat
- Department of Otorhinolaryngology, Alanya Alaaddin Keykubat University Faculty of Medicine, Antalya
| | - Serap Köybaşı Şanal
- Department of Otorhinolaryngology, Abant İzzet Baysal University Faculty of Medicine, Bolu
| | - Emine Elif Altuntaş
- Department of Otorhinolaryngology, Sivas Cumhuriyet University Faculty of Medicine, Sivas
| | - Adin Selçuk
- Department of Otorhinolaryngology, Bahçeşehir University Faculty of Medicine, İstanbul
| | - Haşmet Yazıcı
- Department of Otorhinolaryngology, Balıkesir University Faculty of Medicine, Balıkesir
| | - Deniz Baklacı
- Department of Otorhinolaryngology, Bülent Ecevit University Faculty of Medicine, Zonguldak
| | - Atılay Yaylacı
- Department of Otorhinolaryngology, Kocaeli University Faculty of Medicine, Kocaeli
| | - Deniz Hancı
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul
| | - Sedat Doğan
- Department of Otorhinolaryngology, Adıyaman University Faculty of Medicine, Adıyaman
| | - Vural Fidan
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Eskişehir City Hospital, Eskişehir
| | - Kemal Uygur
- Department of Otorhinolaryngology, Gazi University Faculty of Medicine, Ankara
| | - Nesil Keleş
- Department of Otorhinolaryngology, İstanbul University İstanbul Faculty of Medicine, İstanbul
| | - Cemal Cingi
- Department of Otorhinolaryngology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir
| | - Bülent Topuz
- Department of Otorhinolaryngology, Pamukkale University Faculty of Medicine, Denizli
| | - Salih Çanakçıoğlu
- Department of Otorhinolaryngology, İstanbul University İstanbul Faculty of Medicine, İstanbul
| | - Metin Önerci
- Department of Otorhinolaryngology, Hacettepe University Faculty of Medicine, Ankara
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Nugmanova D, Feshchenko Y, Khegay Y, Iashyna L, Gyrina O, Vasylyev A, Mustafayev I, Aliyeva G, Moibenko M, Tariq L, Makarova J. The Prevalence of Allergic Rhinitis, its Triggers, and Associated Factors in Commonwealth of Independent States Countries (Ukraine, Kazakhstan, and Azerbaijan): Results of the CORE Study. DUBAI MEDICAL JOURNAL 2021. [DOI: 10.1159/000514318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> In the Commonwealth of Independent States (CIS) countries the epidemiology of allergic rhinitis (AR) is poorly characterized. The rationale and design of the CORE (Chronic Obstructive REspiratory diseases) study have been described elsewhere. <b><i>Methods:</i></b> A total of 2,842 adults (≥18 years) were recruited (964 in Kiev, Ukraine, 945 in Almaty, Kazakhstan, and 933 in Baku, Azerbaijan) between 2013 and 2015 and interviewed during household visits. Two-step cluster randomization was used for the sampling strategy. “Doctor-diagnosed AR” was considered when the respondent had previously been diagnosed with AR by a doctor, “self-reported AR symptoms” (was defined as watery runny nose during the last 12 months alone or in combination with any of the following: sneezing, nasal obstruction, nasal itching, or conjunctivitis). <b><i>Results:</i></b> The prevalence of doctor-diagnosed AR was 33.4, 92.1, and 82.7 per 1,000 persons, and the prevalence of self-reported AR symptoms was 44.7, 97.4, and 85.7 per 1,000 persons, in Ukraine, Kazakhstan, and Azerbaijan, respectively. In Ukraine, the peak of AR symptoms was in May, in Kazakhstan – in May–September, and in Azerbaijan in March–May. Sneezing and nasal congestion were the most frequent symptoms. Pollen as AR trigger was reported by 71.9% respondents in Ukraine, 70.1% in Kazakhstan, and 68.8% in Azerbaijan. Only 35–56% respondents with doctor diagnosed AR have had specific investigations (skin test, analysis for immunoglobulin etc.). The percent of subjects with chronic (nonrespiratory) health condition was higher in the respondents with self-reported AR symptoms compared to rest of the respondent: 100 versus 42% in Ukraine, 100 versus 21% in Kazakhstan, and 100 versus 50% in Azerbaijan, respectively. <b><i>Conclusion:</i></b> In CIS countries, the prevalence of self-reported AR symptoms was slightly higher than the prevalence of doctor-diagnosed AR. Compared to countries from other continents, the prevalence of doctor-diagnosed AR was similar; however, the prevalence of AR symptoms seems to be relatively lower.
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Lu C, Norbäck D, Zhang Y, Li B, Zhao Z, Huang C, Zhang X, Qian H, Sun Y, Sundell J, Wang J, Liu W, Deng Q. Onset and remission of eczema at pre-school age in relation to prenatal and postnatal air pollution and home environment across China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 755:142467. [PMID: 33035972 DOI: 10.1016/j.scitotenv.2020.142467] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 06/11/2023]
Abstract
We investigated associations between prenatal and postnatal environmental factors and onset and remission of preschool childhood eczema across China. The study population was preschoolers in randomized day care centers in seven cities (N = 39,782). Data on eczema and prenatal and postnatal indoor and outdoor environment were obtained from a cross-sectional questionnaire sent to parents or other guardians. Reports on eczema in the first 2 years and in the past year was used to retrospectively calculate onset and remission (changes of reported eczema). Prenatal and postnatal outdoor temperature, NO2 and PM10 were modelled from official air pollution data. Associations were estimated by two-level logistic regression. Calculated onset rate was 3.2%/y and remission rate 29.2%/y. Exposure to NO2 during pregnancy was associated with onset of eczema, similarly for all trimesters. Postnatal PM10 and NO2 were related to decreased remission. Postnatal outdoor temperature was associated with onset of eczema. Pre-natal and current redecoration or buying new furniture, and perinatal as well as current dampness and indoor mould, were associated with increased onset and decreased remission. Cockroaches in current home was another indoor risk factors. Prenatal exposure to farm environment and large family size were all negatively associated with eczema. In conclusion, a warmer climate and prenatal NO2 can be associated with increased onset of eczema in Chinese preschoolers. Postnatal PM10 and NO2 can be associated with reduced remission. Perinatal and current dampness, indoor mould and cockroaches may increase onset and decrease remission. Exposure to chemical emissions from indoor materials after first year of life may increase onset. Prenatal exposure to farm environment and large family size could be protective.
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Affiliation(s)
- Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Norbäck
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China; School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- Department of Environmental Health, Fudan University, Shanghai, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Xin Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Hua Qian
- School of Energy & Environment, Southeast University, Nanjing, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China; School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Juan Wang
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Wei Liu
- School of Architecture, Tsinghua University, Beijing, China; Institute for Health and Environment, Chongqing University of Science and Technology, Chongqing, China
| | - Qihong Deng
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China; School of Energy Science and Engineering, Central South University, Changsha, Hunan, China.
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Wang J, Zhang Y, Li B, Zhao Z, Huang C, Zhang X, Deng Q, Lu C, Qian H, Yang X, Sun Y, Sundell J, Norbäck D. Asthma and allergic rhinitis among young parents in China in relation to outdoor air pollution, climate and home environment. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 751:141734. [PMID: 32882555 DOI: 10.1016/j.scitotenv.2020.141734] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 05/14/2023]
Abstract
We estimated associations between ambient air pollution, home environment and asthma as well as rhinitis among adults across China. A total of 40,279 young adults from eight Chinese cities participated in a questionnaire survey (participation rate 75%). There were questions on health and home environment. Information on city level gross domestic product (GDP) per capita, ambient temperature and PM10 and NO2 were collected from registers. Two-level logistic regression models were used to study health associations. Totally 1.6% reported asthma and 6.6% reported allergic rhinitis (AR). Higher temperature was associated with more asthma but less AR. Higher GDP was associated with less asthma but more AR. Higher degree of urbanization, higher level of NO2 and living near heavily trafficked road were risk factors for asthma and AR. Participants in older buildings reported more asthma. Redecoration and buying new furniture were related to more asthma and AR (OR = 1.15-1.91). Using natural gas (OR = 1.34) and biomass (OR = 1.35) for cooking were risk factors for AR. Burning mosquito coils and incense increased the risk of asthma and AR. Cat keeping (OR = 2.88), dog keeping (OR = 2.04), cockroaches (OR = 1.54) and rats or mice (OR = 1.46) were associated with asthma. Cockroaches increased the risk of AR (OR = 1.22). Air humidifier and air cleaner were linked to asthma and AR. Frequent cleaning and exposing bedding to sunshine were protective. In conclusion, urbanization, NO2 and traffic exhaust can increase the risk of adult asthma and AR. Higher ambient temperature was related to more asthma but less AR. Indoor animals such as cats, dogs, rats/mice and presence of cockroaches were associated with asthma or AR. Indoor chemical sources such as redecoration and new furniture were other risk factors. Cooking with natural gas or biomass and burning mosquito coils and incense were associated with asthma or AR. Frequent cleaning and exposing bedding to sunshine were protective.
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Affiliation(s)
- Juan Wang
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- Department of Environmental Health, Fudan University, Shanghai, China
| | - Chen Huang
- Department of Building Environment and Energy Engineering, School of environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Xin Zhang
- Research Center for Environmental Science and Engineering, Shanxi University, Taiyuan, China
| | - Qihong Deng
- Xiangya School of Public Health, Central South University, Changsha, China; School of Energy Science and engineering, Central South University, Changsha, China
| | - Chan Lu
- Xiangya School of Public Health, Central South University, Changsha, China; School of Energy Science and engineering, Central South University, Changsha, China
| | - Hua Qian
- School of Energy Environment, Southeast University, Nanjing, China
| | - Xu Yang
- College of Life Sciences, Central China Normal University, Wuhan, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Dan Norbäck
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Altaii HA, Al-Tae FMD. Investigation of Serum Total IgE and Eosinophil Levels in Different Allergic Diseases Together with the Study of Their Correlations with Various Possible Allergens in Mosul City. Immunol Invest 2020; 51:567-587. [PMID: 33283561 DOI: 10.1080/08820139.2020.1853154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Serum total IgE (tIgE) is frequently used in the diagnosis of allergic diseases in Mosul city and Iraq. However, neither normal nor elevated levels can exclude or confirm the diagnosis of these diseases. Here, we tried to evaluate the validity of tIgE in the diagnosis of allergic asthma(AS), allergic rhinitis(AR) and atopic dermatitis(AD) in a sample of Mosul population, to set up an optimum cut-off value for diagnosis of these diseases and to study its correlation with different parameters that might affect its level. 38 patients with AS, 27 with AR, 46 with AD and 45 healthy controls were included in this study. tIgE were determined by ELISA and compared between allergic diseases and controls. Blood eosinophilia was ascertained and correlated with tIgE levels. The geometric means of tIgE were 316.87 IU/ml (95% CI: 234.69 to 427.82) in AS, 262.07 IU/ml (95% CI:174.24 to 394.18) in AR and 270.48 IU/ml (95% CI:202.57 to 361.16) in AD compared to 16.90 IU/ml (95% CI:12.32 to 23.18) in healthy controls. tIgE in allergic diseases was significantly increased in comparison to healthy controls (P <.0001). Female gender influenced tIgE in AS, but not in AR or AD. tIgE predominated in younger age groups; however, no significant difference was found between younger and older groups. Optimum values for tIgE with best discriminative accuracy were 77 IU/ml for AS and 81 IU/ml for AR and AD. Eosinophils count appeared to be a useful adjunct, and correlate well with tIgE in the diagnosis of allergic diseases.
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Affiliation(s)
- Hiyam A Altaii
- Department of Biology, College of Science, University of Mosul, Mosul, Iraq
| | - Firas M D Al-Tae
- Department of Microbiology and Immunology, College of Medicine, University of Mosul, Mosul, Iraq
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Association of secondhand smoke exposure with allergic multimorbidity in Korean adolescents. Sci Rep 2020; 10:16409. [PMID: 33009485 PMCID: PMC7532152 DOI: 10.1038/s41598-020-73430-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/15/2020] [Indexed: 12/20/2022] Open
Abstract
This study aimed to examine the health effect of secondhand smoke (SHS) exposure at home, school, and/or public places on allergic multimorbidity using nationwide data among school-attending adolescents in Korea. Allergic multimorbidity was defined as two or more coexisting allergic diagnoses of asthma, allergic rhinitis, and/or atopic dermatitis during the past 12 months. A multinomial logistic regression analysis was performed to evaluate the association of SHS exposure and allergic multimorbidity. Of the study participants, 24.3% were diagnosed as having any allergic disease currently and 66.3% reported SHS exposure. Any SHS exposure that includes public places conferred increased odds of atopic dermatitis in non-current smokers (adjusted odds ratio 1.21-1.46; 95% confidence interval [CI] 1.10-1.66). Moreover, when controlling for current smoking additionally, SHS exposure at the three sites was 1.37 and 1.96 times more likely to be associated with allergic single and multiple morbidities, respectively (95% CI 1.26-1.49 and 1.65-2.31, respectively). In conclusion, this study found positive associations of SHS exposure with single or multiple allergic morbidity compared to no exposure at all. Further studies with longitudinal designs and objective measurement of SHS exposure and allergic diagnosis are warranted.
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Thetkathuek A, Yingratanasuk T, Ekburanawat W, Jaidee W, Sa-Ngiamsak T. The risk factors for occupational contact dermatitis among workers in a medium density fiberboard furniture factory in Eastern Thailand. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2020; 76:255-265. [PMID: 32924862 DOI: 10.1080/19338244.2020.1819185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to determine the occupational exposure to formaldehyde on the medium-density fiberboard (MDF) dust and allergic contact dermatitis among the workers at a furniture factory. Data were collected from 439 subjects using questionnaires and patch testing to evaluate allergic contact dermatitis resulting from formaldehyde on wood dust exposure in the workplace. The geometric mean concentration of formaldehyde on MDF dust that the workers in the production department were exposed to was 2.07 ppm (GSD 4.54). Patch test results revealed that some subjects developed allergy to various substances, including epoxy resin (16.7%) and formaldehyde (5.6%). The odds ratios (95% CI) for contact dermatitis were 3.6 (1.7-7.3) among those with a history of metal allergy, 1.8 (0.6-5.2) whose family members having a history of allergic contact dermatitis. Exposure to MDF dust in the workplace should be reduced, as the current levels of exposure exceed the permissible OSHA standard.
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Affiliation(s)
- Anamai Thetkathuek
- Department of Industrial Hygiene and Safety, Faculty of Public Health, Burapha University, Chonburi, Thailand
| | - Tanongsak Yingratanasuk
- Department of Industrial Hygiene and Safety, Faculty of Public Health, Burapha University, Chonburi, Thailand
| | - Wiwat Ekburanawat
- Department of Industrial Hygiene and Safety, Faculty of Public Health, Burapha University, Chonburi, Thailand
| | - Wanlop Jaidee
- Department of Public Health Foundations, Faculty of Public Health, Burapha University, Chonburi, Thailand
| | - Teerayuth Sa-Ngiamsak
- Department of Industrial Hygiene and Safety, Faculty of Public Health, Burapha University, Chonburi, Thailand
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Gallay C, Meylan P, Mermoud S, Johannsen A, Lang C, Rivolta C, Christen-Zaech S. Genetic predisposition and environmental factors associated with the development of atopic dermatitis in infancy: a prospective birth cohort study. Eur J Pediatr 2020; 179:1367-1377. [PMID: 32144501 DOI: 10.1007/s00431-020-03616-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
The influence of environmental factors on atopic dermatitis (AD) has been investigated in many cross-sectional studies. It remains however unclear if they could influence AD development early in life. This prospective birth cohort study aimed to monitor aspects of family lifestyle and child's nutrition within a Caucasian population and to assess its association with AD development over the first 2 years of life. Genetic predisposition was evaluated based on family history and profilaggrin genotyping. Of 149 included children, 36 developed AD. Infants with a family history of atopy developed AD 2.6 times more frequently (30 of 97) than infants without atopic predisposition (6 of 52). Genotyping was carried out on 50% of the children included. Profilaggrin mutations (R501X, 2282del4, R2447X, and S3247X) were infrequent in our population. Lower incidence of AD was observed in infants exposed to a damp housing environment, lower household income, and smoking mothers with a higher but not with a lower education level.Conclusion: Family history of atopy was a significant risk factor for AD regardless of the most common, currently defined, FLG mutations. Humidity at home and passive smoking seem associated with AD development in infancy. What is Known: • Atopic dermatitis (AD) is associated with mutations in various genes of the immune system and the epidermal barrier complex in particular filaggrin (FLG) mutation. • Inherited factors alone cannot explain the rising AD; environmental factors are therefore likely to play a decisive role in this rise but the exact role that these factors may play in increasing AD risk in infancy remains unclear. Moreover, the relationship between environmental factors and AD has been the focus of mostly cross-sectional studies and not prospective studies. What is New: • This prospective birth cohort study demonstrates that family history of atopy is a significant risk factor for AD regardless of the most common, currently defined, FLG mutations. • A lower incidence of AD was observed in infants exposed to a moist housing environment, lower household income, and smoking of mothers with a higher but not with a lower education level.
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Affiliation(s)
- Caroline Gallay
- Pediatric Dermatology Unit, Departments of Dermatology & Venereology, and Pediatrics, University Hospital Lausanne, University of Lausanne, Chemin de Montétan 16, 1004, Lausanne, Switzerland
| | - Patrick Meylan
- Pediatric Dermatology Unit, Departments of Dermatology & Venereology, and Pediatrics, University Hospital Lausanne, University of Lausanne, Chemin de Montétan 16, 1004, Lausanne, Switzerland
| | - Sophie Mermoud
- Pediatric Dermatology Unit, Departments of Dermatology & Venereology, and Pediatrics, University Hospital Lausanne, University of Lausanne, Chemin de Montétan 16, 1004, Lausanne, Switzerland
| | - Alexandre Johannsen
- Pediatric Dermatology Unit, Departments of Dermatology & Venereology, and Pediatrics, University Hospital Lausanne, University of Lausanne, Chemin de Montétan 16, 1004, Lausanne, Switzerland
| | - Caroline Lang
- Pediatric Dermatology Unit, Departments of Dermatology & Venereology, and Pediatrics, University Hospital Lausanne, University of Lausanne, Chemin de Montétan 16, 1004, Lausanne, Switzerland
| | - Carlo Rivolta
- Department of Computational Biology, Unit of Medical Genetics, University of Lausanne, Lausanne, Switzerland.,Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Stephanie Christen-Zaech
- Pediatric Dermatology Unit, Departments of Dermatology & Venereology, and Pediatrics, University Hospital Lausanne, University of Lausanne, Chemin de Montétan 16, 1004, Lausanne, Switzerland.
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70
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Lin YT, Lin MH, Wu KY, Lee YL. Secondhand smoke effects on rhinoconjunctivitis and sleep quality in an adolescent asthma study. Ann Allergy Asthma Immunol 2020; 125:717-719. [PMID: 32795606 DOI: 10.1016/j.anai.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Yi-Tsen Lin
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ming-Hung Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuen-Yuh Wu
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yungling Leo Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; College of Public Health, China Medical University, Taichung, Taiwan.
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71
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Logan K, Du Toit G, Giovannini M, Turcanu V, Lack G. Pediatric Allergic Diseases, Food Allergy, and Oral Tolerance. Annu Rev Cell Dev Biol 2020; 36:511-528. [PMID: 32634325 DOI: 10.1146/annurev-cellbio-100818-125346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pediatric allergic disease is a significant health concern worldwide, and the prevalence of childhood eczema, asthma, allergic rhinitis, and food allergy continues to increase. Evidence to support specific interventions for the prevention of eczema, asthma, and allergic rhinitis is limited, and no consensus on prevention strategies has been reached. Randomized controlled trials investigating the prevention of food allergy via oral tolerance induction and the early introduction of allergenic foods have been successful in reducing peanut and egg allergy prevalence. Infant weaning guidelines in the United Sates were recently amended to actively encourage the introduction of peanut for prevention of peanut allergy.
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Affiliation(s)
- Kirsty Logan
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - George Du Toit
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
| | - Mattia Giovannini
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom; .,Allergy Unit, Department of Pediatrics, Anna Meyer Children's University Hospital, 50139 Florence, Italy
| | - Victor Turcanu
- School of Immunology and Microbial Sciences and School of Life Course Sciences, King's College London, London WC2R 2LS, United Kingdom
| | - Gideon Lack
- Paediatric Allergy Research Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London SE1 7EH, United Kingdom;
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72
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Kim HK, Kweon CO, Kim BW, Kim SH, Ryu JK. Effects of Dietary Yogurt: Changes in Blood Components on Healthy Men Smokers. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2020. [DOI: 10.15324/kjcls.2020.52.2.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hyun-Kyung Kim
- Department of Biomedical Laboratory Science, College of Nursing and Health Science, Gimcheon University, Gimcheon, Korea
| | - Chang-Oh Kweon
- Department of Biomedical Laboratory Science, College of Nursing and Health Science, Gimcheon University, Gimcheon, Korea
| | - Byung-Won Kim
- Department of Biomedical Laboratory Science, College of Nursing and Health Science, Gimcheon University, Gimcheon, Korea
| | - Soo-Hwan Kim
- Department of Biomedical Laboratory Science, College of Nursing and Health Science, Gimcheon University, Gimcheon, Korea
| | - Jae-Ki Ryu
- Department of Biomedical Laboratory Science, College of Nursing and Health Science, Gimcheon University, Gimcheon, Korea
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73
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Sprio AE, Ciprandi G, Riccardi E, Giannoccaro F, Carriero V, Bertolini F, Ricciardolo FLM. The influence of smoking on asthma in the real-life. Respir Med 2020; 170:106066. [PMID: 32843181 DOI: 10.1016/j.rmed.2020.106066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Asthmatic smokers have reduced quality of life and need frequent specialist visits/hospitalization. Smoking habit represents for asthmatics a higher risk for comorbidities and lung function impairment. The impact of cigarette smoking on asthmatics should be addressed to evaluate the related risk factors. METHODS This real-life observational study evaluated demographic, clinical/functional, and biological parameters of 521 asthmatic patients stratified as never (0 PY), light (1-10 PY), and heavy smokers (>10PY). RESULTS The heavy smokers with asthma were more frequently older, male, overweight, and non-allergic than other asthmatics. Although similar ICS dose and severity among groups, heavy smokers had more significant airflow limitation (FEV1/FVC = 0.65 ± 0.10, p < 0.01; FEV1%pred = 79.20 ± 21.20, p < 0.01), air trapping (RV %pred. = 135.6 ± 44.8, p < 0.05; RV/TLC = 0.48 ± 0.12, p < 0.05), and fixed airflow obstruction (post-bronchodilation FEV1/FVC = 0.66 ± 0.10; p = 0.01) than never and light smokers with asthma. Heavy smokers also demonstrated reduced blood eosinophils (p < 0.05) and FeNO (p < 0.01), increased frequency of type-2 low inflammation and LABA/LAMA use but had less frequently persistent rhinitis and chronic rhinosinusitis with nasal polyposis. Heavy smokers showed higher prevalence of paraseptal/bullous emphysema and arterial hypertension. Considering the risk analysis, heavy smokers showed less chance to have allergy (OR = 0.5), persistent rhinitis (OR = 0.6), chronic rhinosinusitis with nasal polyposis (OR = 0.3), or high FeNO (OR = 0.4), but they were prone to develop fixed airflow obstruction (post-bronchodilation FEV1%pred<80%, OR = 2.0, and post-bronchodilation FEV1/FVC≤0.70, OR = 2.0). CONCLUSIONS Heavy smokers had more severe obstructive impairments than light and never smokers with similar ICS dose, showing a steroid insensitivity, but displayed less allergy with low FeNO and blood eosinophil count, thus being a definite phenotype.
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Affiliation(s)
- Andrea E Sprio
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | | | - Elisa Riccardi
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Fabiana Giannoccaro
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Vitina Carriero
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Francesca Bertolini
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Fabio L M Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
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74
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Abstract
PURPOSE OF REVIEW The recent increase in childhood food allergy prevalence strongly suggests that environmental exposures are contributing to food allergy development. This review summarizes current knowledge about the role of the external exposome in food allergy. RECENT FINDINGS There is growing evidence that environmental exposure to food antigens in house dust through non-oral routes contributes to food sensitization and allergy. Co-exposure to environmental adjuvants in house dust, such as microbial products and fungal allergens, may also facilitate allergic sensitization. While a high-microbe environment is associated with decreased atopy, studies are mixed on whether endotoxin exposure protects against food sensitization. Several chemicals and air pollutants have been associated with food sensitization, but their role in food allergy remains understudied. Children are exposed to numerous environmental agents that can influence food allergy risk. Further studies are needed to identify the key early-life exposures that promote or inhibit food allergy development.
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Affiliation(s)
- Timothy P Moran
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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75
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Kuppens S, Moore SC, Gross V, Lowthian E, Siddaway AP. The Enduring Effects of Parental Alcohol, Tobacco, and Drug Use on Child Well-being: A Multilevel Meta-Analysis. Dev Psychopathol 2020; 32:765-778. [PMID: 31274064 PMCID: PMC7525110 DOI: 10.1017/s0954579419000749] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 02/04/2019] [Accepted: 03/21/2019] [Indexed: 11/07/2022]
Abstract
The effects of psychoactive substance abuse are not limited to the user, but extend to the entire family system, with children of substance abusers being particularly at risk. This meta-analysis attempted to quantify the longitudinal relationship between parental alcohol, tobacco, and drug use and child well-being, investigating variation across a range of substance and well-being indices and other potential moderators. We performed a literature search of peer-reviewed, English language, longitudinal observational studies that reported outcomes for children aged 0 to 18 years. In total, 56 studies, yielding 220 dependent effect sizes, met inclusion criteria. A multilevel random-effects model revealed a statistically significant, small detriment to child well-being for parental substance abuse over time (r = .15). Moderator analyses demonstrated that the effect was more pronounced for parental drug use (r = .25), compared with alcohol use (r = .13), tobacco use (r = .13), and alcohol use disorder (r = .14). Results highlight a need for future studies that better capture the effect of parental psychoactive substance abuse on the full breadth of childhood well-being outcomes and to integrate substance abuse into models that specify the precise conditions under which parental behavior determines child well-being.Registration: PROSPERO CRD42017076088.
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Affiliation(s)
- Sofie Kuppens
- Department of Public Health and Primary Care, KU Leuven, Centre for Environment and Health, Leuven, Belgium
- Karel de Grote University of Applied Sciences and Arts, Antwerp, Belgium
| | - Simon C. Moore
- School of Dentistry, Cardiff University, Cardiff, Wales, UK
- Crime and Security Research Institute Friary House, Cardiff, Wales, UK
| | - Vanessa Gross
- School of Dentistry, Cardiff University, Cardiff, Wales, UK
| | - Emily Lowthian
- DECIPHer, Cardiff School of Social Sciences, Cardiff University, Cardiff, Wales, UK
| | - Andy P. Siddaway
- Stirling Management School, University of Stirling, Stirling, Stirlingshire, Scotland, UK
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76
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Tong H, Gao L, Deng Y, Kong Y, Xiang R, Tan L, Tao Z, Xu Y. Prevalence of Allergic Rhinitis and Associated Risk Factors in 6 to 12 Years Schoolchildren From Wuhan in Central China: A Cross-sectional Study. Am J Rhinol Allergy 2020; 34:632-641. [PMID: 32326719 DOI: 10.1177/1945892420920499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Over the past decade, the prevalence of allergic rhinitis (AR) in China increased and showed a trend of younger age. The clinical features of AR in primary schoolchildren are still not clear enough. OBJECTIVE To investigate the prevalence and epidemiological characteristics of AR among 6- to 12-year-old children in the central region of China. METHODS Children from 6 primary schools were randomly selected from urban area of Wuhan, which lies in the central region of China. The questionnaires were distributed by mobile APP and filled out by the children and their parents online together. AR was diagnosed by Score for Allergic Rhinitis. Logistic regression analysis was performed to assess the risk factors for AR. RESULTS A total of 5550 valid questionnaires were returned for evaluation. The prevalence of AR among 6- to 12-year-old children in urban area of Wuhan was 28.6%. Multivariate analysis revealed that male (odds ratio [OR] = 1.521, 95% confidence interval [CI] = [1.335, 1.732]), family history of atopy (OR = 3.220, 95% CI = [2.818, 3.681]), previous food allergy (OR = 1.590, 95% CI = [1.302, 1.942]), air purifier (OR = 1.420, 95% CI = [1.240, 1.625]), exposure to dust (OR = 1.764, 95% CI = [1.410, 2.207]), maternal exposure to smoke during pregnancy (OR = 1.242, 95% CI = [1.047, 1.473]), living in towns (OR = 1.468, 95% CI = [1.043, 2.006]) or metropolis (OR = 1.629, 95% CI = [1.205, 2.201]) before 2 years old, frequent application of antibiotics are risk factors for AR, while daily outdoor time for more than 1 hour (OR = 0.770, 95% CI = [0.673, 0.881]) and breastfeeding for more than 6 months (OR = 0.799, 95% CI = [0.701, 0.910]) reduced the risk significantly. CONCLUSIONS We found an unexpectedly high prevalence of AR among primary schoolchildren aged 6 to 12 years in the central region of China. Both genetic and environmental factors were associated with the development of AR.
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Affiliation(s)
- Huan Tong
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ling Gao
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuqin Deng
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.,Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yonggang Kong
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.,Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Rong Xiang
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lu Tan
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zezhang Tao
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.,Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu Xu
- Department of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.,Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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77
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Laulajainen-Hongisto A, Toppila-Salmi SK, Luukkainen A, Kern R. Airway Epithelial Dynamics in Allergy and Related Chronic Inflammatory Airway Diseases. Front Cell Dev Biol 2020; 8:204. [PMID: 32292784 PMCID: PMC7118214 DOI: 10.3389/fcell.2020.00204] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/10/2020] [Indexed: 12/12/2022] Open
Abstract
Allergic rhinitis, chronic rhinosinusitis, and asthma are highly prevalent, multifactorial chronic airway diseases. Several environmental and genetic factors affect airway epithelial dynamics leading to activation of inflammatory mechanisms in the airways. This review links environmental factors to host epithelial immunity in airway diseases. Understanding altered homeostasis of the airway epithelium might provide important targets for diagnostics and therapy of chronic airway diseases.
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Affiliation(s)
- Anu Laulajainen-Hongisto
- Department of Otorhinolaryngology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Laboratory of Cellular and Molecular Immunology, Institute of Microbiology of the Czech Academy of Sciences, Prague, Czechia
| | - Sanna Katriina Toppila-Salmi
- Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland.,Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Annika Luukkainen
- Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland
| | - Robert Kern
- Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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78
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Yamasaki A, Burks CA, Bhattacharyya N. Cognitive and Quality of Life-Related Burdens of Illness in Pediatric Allergic Airway Disease. Otolaryngol Head Neck Surg 2020; 162:566-571. [PMID: 32122241 DOI: 10.1177/0194599820908202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To analyze the prevalence of pediatric allergic airway disease (PAA) and recognize its impact on cognitive function, childhood activities, use of early intervention, and missed school days. STUDY DESIGN Cross-sectional analysis of National Health Interview Survey (NHIS), 2014 to 2017. SETTING US households. SUBJECTS AND METHODS An NHIS survey of US children and responding caregivers was analyzed to determine the prevalence of PAA, including allergic rhinitis and allergic asthma. Associations were determined between the presence of PAA and activities limited by difficulty remembering, limitation in the amount of childhood play, use of special education/early intervention, and number of missed school days in the past 12 months. Multivariate analysis was used to adjust for age, sex, race, ethnicity, and income level. RESULTS An estimated 11.1 million (10.6-11.6 million, 95% confidence interval) children (mean age, 9.9 years; 56.9% male) reported a diagnosis of PAA (15.1% [14.6-15.6%]). Children with PAA missed 4.0 (3.7-4.4) school days per year vs 2.2 (2.1-2.4) days for those without PAA (P < .001, adjusted). PAA was associated with limited daily activities due to difficulty with memory (odds ratio, 1.8 [1.2-2.9]), limitations in childhood play (3.2 [2.2-4.7]), and need for special education/early intervention services (1.6 [1.4-1.8]) after adjusting for age, sex, race, ethnicity, and income level. CONCLUSION PAA is a common condition and is associated with declines in cognitive function and school attendance as well as increased use of special education/early intervention. Given the significant prevalence and burden of illness of PAA, further attention is needed to ensure timely diagnosis and treatment.
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Affiliation(s)
- Alisa Yamasaki
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Ciersten A Burks
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Bhattacharyya
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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79
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Ueha R, Ueha S, Kondo K, Nishijima H, Yamasoba T. Effects of Cigarette Smoke on the Nasal Respiratory and Olfactory Mucosa in Allergic Rhinitis Mice. Front Neurosci 2020; 14:126. [PMID: 32132898 PMCID: PMC7040099 DOI: 10.3389/fnins.2020.00126] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/31/2020] [Indexed: 12/13/2022] Open
Abstract
Objective Cigarette smoke (CS) exposure reportedly enhances allergic airway inflammation. However, some studies have shown an association between current cigarette smoke exposure and a low risk for allergic rhinitis. Thus, the impact of CS exposure on allergic rhinitis remains poorly understood. The purpose of this study was to investigate the effects of CS on the respiratory mucosa (RM) and the olfactory epithelium (OE) of mice with allergic rhinitis, as the effects may differ depending on the nasal histological compartments. Methods Eight-week-old male BALB/c mice were used for this study. We developed a mouse model of smoking by intranasally administering 10 doses of a CS solution (CSS), and a mouse model of allergic rhinitis by sensitization with intraperitoneal ovalbumin (OVA) injection and intranasal challenge with OVA. We examined the effects of CS on the nasal RM and OE in mice with or without allergic rhinitis using histological, serum, and genetic analyses. First, we examine whether CSS exposure induces allergic responses and then, examined allergic responses in the OVA-sensitized allergic rhinitis mice with or without CSS exposure. Results Short-term CSS administration intensified allergic responses including increased infiltration of eosinophils and inflammatory cells and upregulation of interleukin-5 expression in the nasal RM of OVA-immunized mice, although only CSS induced neither allergic responses nor impairment of the RM and OE. Notably, repetitive OVA-immunization partially impaired the OE in the upper-lateral area, but CSS administration did not reinforce this impairment in OVA-induced allergic mice. Conclusion Short-term CSS exposure strengthened allergic responses in the nasal RM and did not change the structure of the OE. These results suggest that patients with allergic rhinitis could experience exacerbation of allergic symptoms after CS exposure.
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Affiliation(s)
- Rumi Ueha
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | - Satoshi Ueha
- Division of Molecular Regulation of Inflammatory and Immune Diseases, Research Institute for Biomedical Sciences, Tokyo University of Science, Chiba, Japan
| | - Kenji Kondo
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
| | | | - Tatsuya Yamasoba
- Department of Otolaryngology, The University of Tokyo, Tokyo, Japan
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80
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Qi C, Jiang Y, Yang IV, Forno E, Wang T, Vonk JM, Gehring U, Smit HA, Milanzi EB, Carpaij OA, Berg M, Hesse L, Brouwer S, Cardwell J, Vermeulen CJ, Acosta-Pérez E, Canino G, Boutaoui N, van den Berge M, Teichmann SA, Nawijn MC, Chen W, Celedón JC, Xu CJ, Koppelman GH. Nasal DNA methylation profiling of asthma and rhinitis. J Allergy Clin Immunol 2020; 145:1655-1663. [PMID: 31953105 DOI: 10.1016/j.jaci.2019.12.911] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/27/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Epigenetic signatures in the nasal epithelium, which is a primary interface with the environment and an accessible proxy for the bronchial epithelium, might provide insights into mechanisms of allergic disease. OBJECTIVE We aimed to identify and interpret methylation signatures in nasal epithelial brushes associated with rhinitis and asthma. METHODS Nasal epithelial brushes were obtained from 455 children at the 16-year follow-up of the Dutch Prevention and Incidence of Asthma and Mite Allergy birth cohort study. Epigenome-wide association studies were performed on children with asthma, rhinitis, and asthma and/or rhinitis (AsRh) by using logistic regression, and the top results were replicated in 2 independent cohorts of African American and Puerto Rican children. Significant CpG sites were related to environmental exposures (pets, active and passive smoking, and molds) during secondary school and were correlated with gene expression by RNA-sequencing (n = 244). RESULTS The epigenome-wide association studies identified CpG sites significantly associated with rhinitis (n = 81) and AsRh (n = 75), but not with asthma. We significantly replicated 62 of 81 CpG sites with rhinitis and 60 of 75 with AsRh, as well as 1 CpG site with asthma. Methylation of cg03565274 was negatively associated with AsRh and positively associated with exposure to pets during secondary school. DNA methylation signals associated with AsRh were mainly driven by specific IgE-positive subjects. DNA methylation related to gene transcripts that were enriched for immune pathways and expressed in immune and epithelial cells. Nasal CpG sites performed well in predicting AsRh. CONCLUSIONS We identified replicable DNA methylation profiles of asthma and rhinitis in nasal brushes. Exposure to pets may affect nasal epithelial methylation in relation to asthma and rhinitis.
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Affiliation(s)
- Cancan Qi
- Department of Pediatric Pulmonology and Pediatric Allergy, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Yale Jiang
- Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa; School of Medicine, Tsinghua University, Beijing, China
| | - Ivana V Yang
- Department of Medicine, University of Colorado, Aurora, Colo
| | - Erick Forno
- Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Ting Wang
- Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Judith M Vonk
- Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Henriëtte A Smit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Edith B Milanzi
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Orestes A Carpaij
- Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marijn Berg
- Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Laura Hesse
- Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sharon Brouwer
- Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Cornelis J Vermeulen
- Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Edna Acosta-Pérez
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Glorisa Canino
- Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico
| | - Nadia Boutaoui
- Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Maarten van den Berge
- Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sarah A Teichmann
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, United Kingdom; Theory of Condensed Matter Group, Cavendish Laboratory/Department of Physics, University of Cambridge, Cambridge, United Kingdom
| | - Martijn C Nawijn
- Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wei Chen
- Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Juan C Celedón
- Division of Pulmonary Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pa; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Cheng-Jian Xu
- Department of Pediatric Pulmonology and Pediatric Allergy, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Gastroenterology, Hepatology and Endocrinology, Centre for Individualised Infection Medicine, CiiM, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany; TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Gerard H Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergy, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Gronigen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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81
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Lee A, Lee SY, Lee KS. The Use of Heated Tobacco Products is Associated with Asthma, Allergic Rhinitis, and Atopic Dermatitis in Korean Adolescents. Sci Rep 2019; 9:17699. [PMID: 31776400 PMCID: PMC6881368 DOI: 10.1038/s41598-019-54102-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/08/2019] [Indexed: 01/27/2023] Open
Abstract
The increasing use of new and emerging tobacco products has raised public health concern worldwide. This study aimed to assess the association between tobacco product use and the risk of allergic diseases. We used cross-sectional data of 58,336 students aged 12–18 years from the 2018 Korea Youth Risk Behavior Survey. This study considered three tobacco products, namely cigarettes, electronic cigarettes (e-cigarettes), and heated tobacco products. Descriptive analyses, as well as simple and multinomial logistic regression analyses with a complex sampling design, were performed. Multiple tobacco use had an association with the risk of each allergic disease. Use of each tobacco product was significantly associated with an increased risk of multi-morbidity of asthma, allergic rhinitis, and atopic dermatitis. Furthermore, lifetime use of each tobacco product was associated with the prevalence of atopic dermatitis. This highlights the importance of paying close attention to smoking by adolescents and its association with allergy epidemics. Future research should consider intensity of smoking and/or severity of allergic symptoms.
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Affiliation(s)
- Ahnna Lee
- Department of Public Health, Graduate School, The Catholic University of Korea, Seoul, Korea.,Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sook Young Lee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kang-Sook Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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82
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Qi C, Xu CJ, Koppelman GH. The role of epigenetics in the development of childhood asthma. Expert Rev Clin Immunol 2019; 15:1287-1302. [PMID: 31674254 DOI: 10.1080/1744666x.2020.1686977] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: The development of childhood asthma is caused by a combination of genetic factors and environmental exposures. Epigenetics describes mechanisms of (heritable) regulation of gene expression that occur without changes in DNA sequence. Epigenetics is strongly related to aging, is cell-type specific, and includes DNA methylation, noncoding RNAs, and histone modifications.Areas covered: This review summarizes recent epigenetic studies of childhood asthma in humans, which mostly involve studies of DNA methylation published in the recent five years. Environmental exposures, in particular cigarette smoking, have significant impact on epigenetic changes, but few of these epigenetic signals are also associated with asthma. Several asthma-associated genetic variants relate to DNA methylation. Epigenetic signals can be better understood by studying their correlation with gene expression, which revealed higher presence and activation of blood eosinophils in asthma. Strong associations of nasal methylation signatures and atopic asthma were identified, which were replicable across different populations.Expert commentary: Epigenetic markers have been strongly associated with asthma, and might serve as biomarker of asthma. The causal and longitudinal relationships between epigenetics and disease, and between environmental exposures and epigenetic changes need to be further investigated. Efforts should be made to understand cell-type-specific epigenetic mechanisms in asthma.
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Affiliation(s)
- Cancan Qi
- Dept. of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Cheng-Jian Xu
- Dept. of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Gastroenterology, Hepatology and Endocrinology, CiiM, Centre for individualised infection medicine, A joint venture between Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany.,TWINCORE, Centre for Experimental and Clinical Infection Research, a joint venture between the Hannover Medical School and the Helmholtz Centre for Infection Research, Hannover, Germany
| | - Gerard H Koppelman
- Dept. of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,GRIAC Research Institute, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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83
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Abstract
Allergic rhinitis is a common disorder that regularly occurs in children and adolescents. The disease is associated with other allergic diseases, such as asthma, and it carries a heavy burden, with effects on sleep, school performance, and quality of life. Classic symptoms include sneezing, rhinorrhea, nasal obstruction, and nasal itching. When the eyes are involved, the term allergic rhinoconjunctivitis is used. Triggers may include airborne pollens, molds, dust mites, and animals. Skin or blood allergy testing can be a useful diagnostic modality that may guide therapy. Immunotherapy can prevent the development of further allergic sensitizations as well as subsequent asthma.
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Affiliation(s)
- Charles Frank Schuler Iv
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA.
| | - Jenny Maribel Montejo
- Division of Allergy and Clinical Immunology, University of Michigan, Domino's Farms, 24 Frank Lloyd Wright Drive, PO Box 442, Suite H-2100, Ann Arbor, MI 48105, USA
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84
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Rauschert S, Melton PE, Burdge G, Craig JM, Godfrey KM, Holbrook JD, Lillycrop K, Mori TA, Beilin LJ, Oddy WH, Pennell C, Huang RC. Maternal Smoking During Pregnancy Induces Persistent Epigenetic Changes Into Adolescence, Independent of Postnatal Smoke Exposure and Is Associated With Cardiometabolic Risk. Front Genet 2019; 10:770. [PMID: 31616461 PMCID: PMC6764289 DOI: 10.3389/fgene.2019.00770] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Several studies have shown effects of current and maternal smoking during pregnancy on DNA methylation of CpG sites in newborns and later in life. Here, we hypothesized that there are long-term and persistent epigenetic effects following maternal smoking during pregnancy on adolescent offspring DNA methylation, independent of paternal and postnatal smoke exposure. Furthermore, we explored the association between DNA methylation and cardiometabolic risk factors at 17 years of age. Materials and Methods: DNA methylation was measured using the Illumina HumanMethylation450K BeadChip in whole blood from 995 participants attending the 17-year follow-up of the Raine Study. Linear mixed effects models were used to identify differential methylated CpGs, adjusting for parental smoking during pregnancy, and paternal, passive, and adolescent smoke exposure. Additional models examined the association between DNA methylation and paternal, adolescent, and passive smoking over the life course. Offspring CpGs identified were analyzed against cardiometabolic risk factors (blood pressure, triacylglycerols (TG), high-density lipoproteins cholesterol (HDL-C), and body mass index). Results: We identified 23 CpGs (genome-wide p level: 1.06 × 10-7) that were associated with maternal smoking during pregnancy, including associated genes AHRR (cancer development), FTO (obesity), CNTNAP2 (developmental processes), CYP1A1 (detoxification), MYO1G (cell signalling), and FRMD4A (nicotine dependence). A sensitivity analysis showed a dose-dependent relationship between maternal smoking and offspring methylation. These results changed little following adjustment for paternal, passive, or offspring smoking, and there were no CpGs identified that associated with these variables. Two of the 23 identified CpGs [cg00253568 (FTO) and cg00213123 (CYP1A1)] were associated with either TG (male and female), diastolic blood pressure (female only), or HDL-C (male only), after Bonferroni correction. Discussion: This study demonstrates a critical timing of cigarette smoke exposure over the life course for establishing persistent changes in DNA methylation into adolescence in a dose-dependent manner. There were significant associations between offspring CpG methylation and adolescent cardiovascular risk factors, namely, TG, HDL-C, and diastolic blood pressure. Future studies on current smoking habits and DNA methylation should consider the importance of maternal smoking during pregnancy and explore how the persistent DNA methylation effects of in utero smoke exposure increase cardiometabolic risk.
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Affiliation(s)
- Sebastian Rauschert
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Phillip E. Melton
- Centre for Genetic Origins of Health and Disease, The University of Western Australia and Curtin University, Perth, WA, Australia
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia
| | - Graham Burdge
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Jeffrey M. Craig
- Early Life Epigenetics Group, MCRI, Royal Children’s Hospital, Flemington Road, Parkville, VIC, Australia
- Centre for Molecular and Medical Research, School of Medicine, Deakin University, Geelong, VIC, Australia
| | - Keith M. Godfrey
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Joanna D. Holbrook
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Karen Lillycrop
- Centre for Biological Sciences, Faculty of Natural and Environmental Sciences, University of Southampton, Southampton, United Kingdom
| | - Trevor A. Mori
- Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, WA, Australia
| | - Lawrence J. Beilin
- Medical School, Royal Perth Hospital Unit, University of Western Australia, Perth, WA, Australia
| | - Wendy H. Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | | | - Rae-Chi Huang
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
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85
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Almehizia AA, AlEssa RK, Alwusaidi KM, Alzamil KA, AlJumah M, Aljohani S, Almutairi AF, Salam M. Allergic rhinitis: Disease characteristics and coping measures in Saudi Arabia. PLoS One 2019; 14:e0217182. [PMID: 31242201 PMCID: PMC6594581 DOI: 10.1371/journal.pone.0217182] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/07/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Despite allergic rhinitis (AR) being a highly prevalent disease, according to literature, it is often underdiagnosed or undertreated. AIM This study explored the disease characteristics of AR in the Saudi community and the non-conventional coping measures used to alleviate symptoms. METHODS The study was a nationwide cross-sectional study, using a self-report electronic survey distributed via social media networks in 2018. The survey included an explanatory letter and consent. The sample size comprised 3,458 participants and 2,849 adults had at least one of the four signs of AR, i.e. watery-nose, sneezing, nasal obstruction, itchy nose, watery eyes, in the past year, not related to cold/flu. The outcomes of the study were the triggers, pattern, severity and the classification of AR (2016 ARIA guidelines) and coping measures. Descriptive statistics, univariate analytic statistics and binary logistic regression analyses were conducted. The P-value was considered statistically significant at <0.05. RESULTS The leading reported trigger of AR was dust (74%, n = 2118), followed by pollen (17%, n = 477), mold (5%, n = 140) and fur (4%, n = 114). The prevalence of intermittent AR was (54%, n = 1,635), while that of persistent AR was (46%, n = 1,314). Almost one-third (34%, n = 959) complained of mild forms of AR, while others complained of moderate to severe forms (66%, n = 1890). The coping measures were mainly shower/humidification 368(12.9%) and herbal hot drinks 266(9.3%). Older participants (adj.OR = 1.3[1.1-1.5]) and overweight participants, (adj.OR = 1.2[1.1-1.4]) reported more persistent forms of rhinitis compared to their counter groups, (adj.P<0.001 and adj.P = 0.032) respectively. Female participants (adj.OR = 0.8[0.7-0.9]) had significantly milder forms of AR, in comparison to males, adj.P = 0.006. CONCLUSION This study presented the disease characteristics of self-reported AR and its associated factors in Saudi Arabia. Special attention should be paid to older age groups and overweight patients who reported persistent forms of AR. Males reported more severe and persistent forms of AR.
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Affiliation(s)
- Abdulmohsin A. Almehizia
- King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Reema K. AlEssa
- King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | | | | | - Sarah Aljohani
- King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Adel F. Almutairi
- King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Salam
- King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- * E-mail:
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86
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Larsen AI, Cederkvist L, Lykke AM, Wagner P, Johnsen CR, Poulsen LK. Allergy Development in Adulthood: An Occupational Cohort Study of the Manufacturing of Industrial Enzymes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:210-218.e5. [PMID: 31233941 DOI: 10.1016/j.jaip.2019.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/16/2019] [Accepted: 06/03/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Occupational allergy may serve as a model of allergy development in adults. OBJECTIVE We aimed at describing respiratory allergy and IgE sensitization across different exposure strata defined by time, technology, and exposure control. METHODS In a retrospective (1970-2017) cohort of industrial enzyme production employees, monitored by an occupational medical center, 5024 individuals were surveyed. Five exposure groups and risk levels for sensitization and allergic disease were analyzed on the basis of demographic characteristics, hiring decade, and smoking status. RESULTS Of all persons entering the company 47 years from 1970, 149 developed occupational allergy (incidence rate, 2.72/1000 person-years). In a multivariate cause-specific Cox proportional hazards model, the hazard of allergy was significantly related to decade of recruitment. Compared with the 1970s, the hazard ratio (HR) uniformly decreased from 0.85 (95% CI, 0.57-1.27) in the 1980s to 0.16 (95% CI, 0.05-0.52) in the 2010s. Compared with expected highest exposed group, the HRs were 0.48 (95% CI, 0.31-76) and 0.13 (95% CI, 0.06-0.30) in less exposed production areas and 0.92 (95% CI, 0.48-1.73) and 0.23 (95% CI, 0.10-0.53) in different laboratory areas. The HR of smoking was 2.03 (95% CI, 1.41-2.93). The pattern of sensitizations also showed clear associations to recruitment decade, exposure, and smoking. Among individuals sensitized but not yet allergic, a high IgE level was the only risk factor (HR, 3.03; 95% CI, 1.82-5.04) for subsequent allergy development. CONCLUSIONS The impact of exposure is dose-related and linked to the sensitization step, which may subsequently lead to allergy development. For primary prevention of enzyme allergy, exposure control is mandatory and achievable despite increasing production volumes.
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Affiliation(s)
| | | | - Anne Mette Lykke
- Global Occupational Health and Safety Department, Novozymes A/S, Copenhagen, Denmark
| | - Poul Wagner
- Global Medical Centre, Novozymes A/S, Copenhagen, Denmark
| | - Claus R Johnsen
- Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark
| | - Lars K Poulsen
- Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark.
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87
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Rarani MA, Heshmat R, Djalalinia S, Motlagh ME, Ziaodini H, Mahdavi-Gorabi A, Taheri M, Ahadi Z, Qorbani M, Kelishadi R. Decomposition of passive smoking inequality in Iranian children and adolescents: the CASPIAN-V Study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:18921-18929. [PMID: 31041703 DOI: 10.1007/s11356-019-05146-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/09/2019] [Indexed: 06/09/2023]
Abstract
To investigate the socioeconomic inequality in passive smoking in Iranian children and adolescents. Through a multistage random cluster sampling method, a representative sample of 14,400 school students, aged 6-18 years, were enrolled from urban and rural areas of 30 provinces of Iran. Using a non-linear principal component analysis (NLPCA), the correlated variables were summarized as socioeconomic status (SES). Normalized concentration index (NCI) was used to measure inequality in passive smoking at national and regional SES levels. We decomposed total socioeconomic inequality in passive smoking into explanatory variables to identify the main contributors of inequality in passive smoking in the population studied. Data of 12,327 students and parents were complete for the current study. The response rate was 85.6% (50.9% boys, 71.2% urban residents). About 44% of Iranian students were exposed to passive smoking. The NCI for passive smoking at a national level was - 0.043 (95% confidence interval - 0.035, - 0.012), indicating that passive smoking was more concentrated among poorer children and adolescents. This inequality was statistically significant at a national level and in all regions except for regions with lower middle- and lowest SES levels. Considering the decomposition analysis, the household SES (63%), mothers' educational level (37%), fathers' educational level (29%), and school type (18%) made the largest positive contribution to inequality in passive smoking of children and adolescents. Passive smoking was distributed unequally among Iranian children and adolescents; it was more concentrated among socioeconomically disadvantaged families. Public health policies attentions should be given to reduce passive smoking among low SES children and adolescents living with illiterate or low-educated parents.
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Affiliation(s)
- Mostafa Amini Rarani
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Heshmat
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Hasan Ziaodini
- Health Psychology Research Center, Education Ministry, Tehran, Iran
| | - Armita Mahdavi-Gorabi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Majzoubeh Taheri
- Office of Adolescents and School Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Zeinab Ahadi
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
- Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran.
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88
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Kim J, Lee E, Lee K, Kim K. Relationships Between Secondhand Smoke Incursion and Wheeze, Rhinitis, and Eczema Symptoms in Children Living in Homes Without Smokers in Multi-Unit Housing. Nicotine Tob Res 2019. [PMID: 29518241 DOI: 10.1093/ntr/nty027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) incursion can occur in units of multi-unit housing (MUH). The purpose of this study was to determine the relationship between SHS incursion and allergic symptoms in children living in MUH without smokers. METHODS We conducted a cross-sectional study from May to September 2015 in Seoul, Korea. Children were recruited from elementary schools, kindergartens, and daycare centers. In total, 16676 children between 1 and 13 years of age living in MUH without smokers were included in the analysis. Allergic symptoms during the previous 12 months (current wheeze, rhinitis, and eczema) and home environmental factors, including the frequency of SHS incursion during the previous 12 months, were examined using a questionnaire filled out by the parents or guardians of the children. RESULTS The prevalence of current allergic symptoms in children was 4.9% for wheeze, 42.0% for rhinitis, and 28.1% for eczema. The prevalence of SHS incursion into the children's homes was 61.6%. In a multivariable logistic regression analysis adjusted for demographic and home environmental factors, children living in homes with SHS incursion (either no more than once a month or more than once a month) were more likely to have current wheeze, rhinitis, and eczema than those with no SHS incursion. CONCLUSIONS More than half of the children's homes in MUH without smokers had SHS incursion. SHS incursion into homes was associated with wheeze, rhinitis, and eczema symptoms in children. IMPLICATIONS Children living in multi-unit housing (MUH) can be exposed to secondhand smoke (SHS) from smoke transferred from neighboring units with smokers. This study found that more than half of the children's homes without smokers in MUH had SHS incursion. Children living in homes with SHS incursion (either no more than once a month or more than once a month) were more likely to have current wheeze, rhinitis, and eczema than those with no SHS incursion. We confirmed that SHS incursion was associated with allergic symptoms in children.
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Affiliation(s)
- Jeonghoon Kim
- Department of Environmental Health Research, Seoul Medical Center, Seoul, South Korea.,Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Eunsun Lee
- Department of Environmental Health Research, Seoul Medical Center, Seoul, South Korea
| | - Kiyoung Lee
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea.,Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - KyooSang Kim
- Department of Environmental Health Research, Seoul Medical Center, Seoul, South Korea
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89
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Peng C, Van Meel ER, Cardenas A, Rifas-Shiman SL, Sonawane AR, Glass KR, Gold DR, Platts-Mills TA, Lin X, Oken E, Hivert MF, Baccarelli AA, De Jong NW, Felix JF, Jaddoe VW, Duijts L, Litonjua AA, DeMeo DL. Epigenome-wide association study reveals methylation pathways associated with childhood allergic sensitization. Epigenetics 2019; 14:445-466. [PMID: 30876376 DOI: 10.1080/15592294.2019.1590085] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Epigenetic mechanisms integrate both genetic variability and environmental exposures. However, comprehensive epigenome-wide analysis has not been performed across major childhood allergic phenotypes. We examined the association of epigenome-wide DNA methylation in mid-childhood peripheral blood (Illumina HumanMethyl450K) with mid-childhood atopic sensitization, environmental/inhalant and food allergen sensitization in 739 children in two birth cohorts (Project Viva-Boston, and the Generation R Study-Rotterdam). We performed covariate-adjusted epigenome-wide association meta-analysis and employed pathway and regional analyses of results. Seven-hundred and five methylation sites (505 genes) were significantly cross-sectionally associated with mid-childhood atopic sensitization, 1411 (905 genes) for environmental and 45 (36 genes) for food allergen sensitization (FDR<0.05). We observed differential methylation across multiple genes for all three phenotypes, including genes implicated previously in innate immunity (DICER1), eosinophilic esophagitis and sinusitis (SIGLEC8), the atopic march (AP5B1) and asthma (EPX, IL4, IL5RA, PRG2, SIGLEC8, CLU). In addition, most of the associated methylation marks for all three phenotypes occur in putative transcription factor binding motifs. Pathway analysis identified multiple methylation sites associated with atopic sensitization and environmental allergen sensitization located in/near genes involved in asthma, mTOR signaling, and inositol phosphate metabolism. We identified multiple differentially methylated regions associated with atopic sensitization (8 regions) and environmental allergen sensitization (26 regions). A number of nominally significant methylation sites in the cord blood analysis were epigenome-wide significant in the mid-childhood analysis, and we observed significant methylation - time interactions among a subset of sites examined. Our findings provide insights into epigenetic regulatory pathways as markers of childhood allergic sensitization.
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Affiliation(s)
- Cheng Peng
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Evelien R Van Meel
- b The Generation R Study Group, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,c Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Andres Cardenas
- d Division of Environmental Health Science , University of California, Berkeley, School of Public Health , Berkeley , CA , USA
| | - Sheryl L Rifas-Shiman
- e Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Abhijeet R Sonawane
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA
| | - Kimberly R Glass
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA.,f Department of Biostatistics , Harvard T.H Chan School of Public Health , Boston , MA , USA
| | - Diane R Gold
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA.,g Department of Environmental Health , Harvard T. H. Chan School of Public Health , Boston , MA , USA
| | - Thomas A Platts-Mills
- h Division of Allergy and Clinical Immunology , University of Virginia School of Medicine , Charlottesville , VA , USA
| | - Xihong Lin
- f Department of Biostatistics , Harvard T.H Chan School of Public Health , Boston , MA , USA.,i Department of Statistics , Harvard University , Cambridge , MA , USA
| | - Emily Oken
- e Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Marie-France Hivert
- e Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine , Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA.,j Diabetes Unit , Massachusetts General Hospital , Boston , MA , USA
| | - Andrea A Baccarelli
- k Department of Environmental Health Sciences , Columbia University Mailman School of Public Health , New York , NY , USA
| | - Nicolette W De Jong
- l Department of Internal Medicine, Allergology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Janine F Felix
- b The Generation R Study Group, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,m Department of Epidemiology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,n Department of Pediatrics, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Vincent W Jaddoe
- b The Generation R Study Group, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,m Department of Epidemiology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,n Department of Pediatrics, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Liesbeth Duijts
- b The Generation R Study Group, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,c Department of Pediatrics, Division of Respiratory Medicine and Allergology, Erasmus MC , University Medical Center Rotterdam , Rotterdam , the Netherlands.,o Department of Pediatrics, Division of Neonatology , Erasmus MC, University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Augusto A Litonjua
- p Department of Pediatrics, Division of Pulmonary Medicine , University of Rochester Medical Center , Rochester , NY , USA
| | - Dawn L DeMeo
- a Channing Division of Network Medicine, Department of Medicine , Brigham and Women's Hospital, Harvard Medical School , Boston , MA , USA.,q Division of Pulmonary and Critical Care, Harvard Medical School , Department of Medicine, Brigham and Women's Hospital , Boston , MA , USA
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90
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Cingi C, Bayar Muluk N, Scadding GK. Will every child have allergic rhinitis soon? Int J Pediatr Otorhinolaryngol 2019; 118:53-58. [PMID: 30580075 DOI: 10.1016/j.ijporl.2018.12.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/13/2018] [Accepted: 12/13/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Given the increasing prevalence of AR amongst children, we aimed to review the literature regarding the future of AR in this population. METHODS We searched the PubMed, Google and Proquest Central databases at Kırıkkale University Library. Search terms used were: "allergic rhinitis", "children", "paediatric", "allergy", "future", "risk factors", "treatment", "pharmacotherapy" and/or "allergen - specific immunotherapy". With regard to risk factors for allergic rhinitis, the terms "Environmental factors", "Improved hygiene", "Increased indoor allergen exposure", "Farms, villages, worms, and other parasites", "Environmental toxicants", "Diet", "Lifestyle changes", "Air pollution" and "Climate factors" were searched for. "Prevention of allergic diseases" and "Allergen-specific immunotherapy in the future" were also included in the search. RESULTS AR has a high prevalence and causes considerable morbidity, has associated comorbidity and features specific complications. The principal treatments rely on avoiding the allergens responsible, and administering drug treatment or immunotherapy, which targets specific antigens. Genetic drift does not explain the rising prevalence of allergic disorders, but multifactorial environmental factors are likely culprits. Amongst such environmental factors to consider are the rise in caesarean births, decreases in breast feeding, dietary changes resulting in less fresh produce being consumed, the eradication of intestinal worm infestations, alterations in the way homes are aired and heated, children taking less exercise and being outdoors for shorter periods, whilst also having more contact with pollution. CONCLUSION Barring substantial lifestyle alterations, more and more children are likely to develop AR. It may prove feasible to stop allergy developing in the first place through manipulation of the microbiome, but the exact format such a modification should involve remains to be discovered. Molecular allergological techniques do offer the prospect of more precisely targeted immunotherapy, the sole disease modifier at present. However, at present the complexity and cost of such interventions prevents their widespread use and research in this area is still needed. The majority of children with AR are going to be managed using nasal saline sprays, since they are the most straightforward and least risky alternative for first line treatment.
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Affiliation(s)
- Cemal Cingi
- Eskisehir Osmangazi University, Medical Faculty, Department of Otorhinolaryngology, Eskisehir, Turkey.
| | - Nuray Bayar Muluk
- Kirikkale University, Medical Faculty, Department of Otorhinolaryngology, Kirikkale, Turkey.
| | - Glenis K Scadding
- Honorary Consultant Allergist & Rhinologist, RNTNE Hospital, University College Hospitals, London, United Kingdom.
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91
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Murrison LB, Brandt EB, Myers JB, Hershey GKK. Environmental exposures and mechanisms in allergy and asthma development. J Clin Invest 2019; 129:1504-1515. [PMID: 30741719 DOI: 10.1172/jci124612] [Citation(s) in RCA: 177] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Environmental exposures interplay with human host factors to promote the development and progression of allergic diseases. The worldwide prevalence of allergic disease is rising as a result of complex gene-environment interactions that shape the immune system and host response. Research shows an association between the rise of allergic diseases and increasingly modern Westernized lifestyles, which are characterized by increased urbanization, time spent indoors, and antibiotic usage. These environmental changes result in increased exposure to air and traffic pollution, fungi, infectious agents, tobacco smoke, and other early-life and lifelong risk factors for the development and exacerbation of asthma and allergic diseases. It is increasingly recognized that the timing, load, and route of allergen exposure affect allergic disease phenotypes and development. Still, our ability to prevent allergic diseases is hindered by gaps in understanding of the underlying mechanisms and interaction of environmental, viral, and allergen exposures with immune pathways that impact disease development. This Review highlights epidemiologic and mechanistic evidence linking environmental exposures to the development and exacerbation of allergic airway responses.
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Affiliation(s)
- Liza Bronner Murrison
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Eric B Brandt
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA
| | - Jocelyn Biagini Myers
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gurjit K Khurana Hershey
- Division of Asthma Research, Cincinnati Children's Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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92
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Juszczak H, Aubin‐Pouliot A, Sharon JD, Loftus PA. Sinonasal risk factors for eustachian tube dysfunction: Cross‐sectional findings from NHANES 2011‐2012. Int Forum Allergy Rhinol 2019; 9:466-472. [DOI: 10.1002/alr.22275] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/02/2018] [Accepted: 12/04/2018] [Indexed: 12/29/2022]
Affiliation(s)
| | - Annick Aubin‐Pouliot
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco CA
| | - Jeffrey D. Sharon
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco CA
| | - Patricia A. Loftus
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California San Francisco CA
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93
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Cid BJ, Perez-Mateluna G, Iturriaga C, Zambrano MJ, Vives MI, Valenzuela PM, Borzutzky A. Is there an association between indoor allergens and the severity of atopic dermatitis? Int J Dermatol 2018; 58:433-439. [DOI: 10.1111/ijd.14281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/17/2018] [Accepted: 10/01/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Barbara J. Cid
- Division of Pediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Guillermo Perez-Mateluna
- Department of Pediatric Infectious Diseases and Immunology; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Carolina Iturriaga
- Department of Pediatric Infectious Diseases and Immunology; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - María J. Zambrano
- Department of Dermatology; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - María I. Vives
- Division of Pediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Patricia M. Valenzuela
- Division of Pediatrics; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
| | - Arturo Borzutzky
- Department of Pediatric Infectious Diseases and Immunology; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
- Millennium Institute on Immunology and Immunotherapy; School of Medicine; Pontificia Universidad Católica de Chile; Santiago Chile
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94
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Abstract
Purpose of review The aim of this paper is to review and summarize the current knowledge of prevention of airway allergy. Recent findings Allergic rhinitis and asthma are allergic airway diseases. Due to their increasing incidence and socioeconomic burden, allergic airway diseases have recently gained attention worldwide. The primary prevention of allergic airway diseases focuses on offspring’s gestational and childhood environment, such as maternal smoking and diet during pregnancy and breastfeeding as well as exposure to environmental microbes and irritants. Summary Asthma and allergic rhinitis are a major public health problem worldwide. They have increasing prevalence and thus attempts to their prevention are mandatory. Rapid action needs to be taken to restrain smoking among children and adolescents in order to prevent burden of allergic airway diseases. Exposure to pollution and environmental issues concerning hygiene and lifestyle would also need to be actively addressed. More evidence is still needed in order to draw linings concerning maternal diet and other factors during the offspring’s whole life span.
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95
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Oh H, Koyanagi A, DeVylder JE, Stickley A. Seasonal Allergies and Psychiatric Disorders in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091965. [PMID: 30205581 PMCID: PMC6164754 DOI: 10.3390/ijerph15091965] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/06/2018] [Accepted: 09/06/2018] [Indexed: 12/22/2022]
Abstract
Seasonal allergies have been associated with mental health problems, though the evidence is still emergent, particularly in the United States. We analyzed data from the National Comorbidity Survey Replication and the National Latino and Asian American Survey (years 2001–2003). Multivariable logistic regression models were used to examine the relations between lifetime allergies and lifetime psychiatric disorders (each disorder in a separate model), adjusting for socio-demographic variables (including region of residence) and tobacco use. Analyses were also stratified to test for effect modification by race and sex. A history of seasonal allergies was associated with greater odds of mood disorders, anxiety disorders, and eating disorders, but not alcohol or substance use disorders, after adjusting for socio-demographic characteristics and tobacco use. The associations between seasonal allergies and mood disorders, substance use disorders, and alcohol use disorders were particularly strong for Latino Americans. The association between seasonal allergies and eating disorders was stronger for men than women. Seasonal allergies are a risk factor for psychiatric disorders. Individuals complaining of seasonal allergies should be screened for early signs of mental health problems and referred to specialized services accordingly.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34 th St., Los Angeles, CA 90089-0411, USA.
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Deu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain.
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, 28029 Madrid, Spain.
| | - Jordan E DeVylder
- Graduate School of Social Service, Fordham University, 113 W 60th Street, New York, NY 10023, USA.
| | - Andrew Stickley
- The Stockholm Center for Health and Social Change (SCOHOST), Södertörn University, 141 89 Huddinge, Sweden.
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashicho, Kodaira, Tokyo 1878553, Japan.
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96
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The Effect of Digestion and Digestibility on Allergenicity of Food. Nutrients 2018; 10:nu10091129. [PMID: 30134536 PMCID: PMC6164088 DOI: 10.3390/nu10091129] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/03/2018] [Accepted: 08/13/2018] [Indexed: 01/08/2023] Open
Abstract
Food allergy prevalence numbers are still on the rise. Apart from environmental influences, dietary habits, food availability and life-style factors, medication could also play a role. For immune tolerance of food, several contributing factors ensure that dietary compounds are immunologically ignored and serve only as source for energy and nutrient supply. Functional digestion along the gastrointestinal tract is essential for the molecular breakdown and a prerequisite for appropriate uptake in the intestine. Digestion and digestibility of carbohydrates and proteins thus critically affect the risk of food allergy development. In this review, we highlight the influence of amylases, gastric acid- and trypsin-inhibitors, as well as of food processing in the context of food allergenicity.
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97
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Yu JE, Mallapaty A, Miller RL. It's not just the food you eat: Environmental factors in the development of food allergies. ENVIRONMENTAL RESEARCH 2018; 165:118-124. [PMID: 29689456 DOI: 10.1016/j.envres.2018.03.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Abstract
The dramatic rise in the prevalence of food allergy and food allergy-associated anaphylaxis in the past few decades has fueled investigative interest into understanding this puzzling trend. Here, we review the question as to whether important external environmental determinants beyond dietary habits and exposure to food allergens are involved. This review will summarize our current understanding of these environment determinants, derived from the latest experimental and epidemiological research. Specifically, we will review the role of exposures that affect skin barrier function, development of a diverse microbiome, and food processing. Additional exposures of concern are insufficient sunlight, endocrine disrupting chemicals and pesticides, and use of specific pharmaceutical agents that may drive or modify the risk for food allergy. Despite limitations in the quantity and quality of research to date, many new epidemiological associations and experimental data in support of this paradigm have emerged.
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Affiliation(s)
- Joyce E Yu
- Division of Allergy, Immunology, Rheumatology, Department of Pediatrics, PH8E-101, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032, USA
| | - Anu Mallapaty
- Division of Allergy, Immunology, Rheumatology, Department of Pediatrics, PH8E-101, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032, USA
| | - Rachel L Miller
- Division of Allergy, Immunology, Rheumatology, Department of Pediatrics, PH8E-101, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032, USA; Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, PH8E-101, Columbia University Medical Center, 630 W. 168th St., New York, NY 10032, USA; Department of Environmental Health Sciences, Mailman School of Public Health, 722 W. 168th St., New York, NY 10032, USA.
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98
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Feldman LY, Thacher JD, van Hage M, Kull I, Melén E, Pershagen G, Wickman M, To T, Protudjer JL, Bergström A. Early-life secondhand smoke exposure and food hypersensitivity through adolescence. Allergy 2018; 73:1558-1561. [PMID: 29675922 DOI: 10.1111/all.13463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- L. Y. Feldman
- Child Health Evaluative Sciences; The Hospital for Sick Children; Toronto ON Canada
| | - J. D. Thacher
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
| | - M. van Hage
- Department of Medicine Solna; Immunology and Allergy Unit; Karolinska Institutet; Stockholm Sweden
- Karolinska University Hospital; Stockholm Sweden
| | - I. Kull
- Department of Clinical Science and Education; Stockholm South General Hospital; Stockholm Sweden
- Sachs' Children's Hospital; Stockholm South General Hospital; Stockholm Sweden
| | - E. Melén
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Sachs' Children's Hospital; Stockholm South General Hospital; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - G. Pershagen
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - M. Wickman
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Clinical Research Sörmland; Uppsala University; Eskilstuna Sweden
| | - T. To
- Child Health Evaluative Sciences; The Hospital for Sick Children; Toronto ON Canada
- Dalla Lana School of Public Health; University of Toronto; Toronto ON Canada
| | - J. L. Protudjer
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Allergy Research; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
| | - A. Bergström
- Institute for Environmental Medicine; Karolinska Institutet; Stockholm Sweden
- Centre for Occupational and Environmental Medicine; Stockholm County Council; Stockholm Sweden
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99
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Strzelak A, Ratajczak A, Adamiec A, Feleszko W. Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation, Allergy, Asthma and Other Lung Diseases: A Mechanistic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1033. [PMID: 29883409 PMCID: PMC5982072 DOI: 10.3390/ijerph15051033] [Citation(s) in RCA: 322] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 02/06/2023]
Abstract
Many studies have been undertaken to reveal how tobacco smoke skews immune responses contributing to the development of chronic obstructive pulmonary disease (COPD) and other lung diseases. Recently, environmental tobacco smoke (ETS) has been linked with asthma and allergic diseases in children. This review presents the most actual knowledge on exact molecular mechanisms responsible for the skewed inflammatory profile that aggravates inflammation, promotes infections, induces tissue damage, and may promote the development of allergy in individuals exposed to ETS. We demonstrate how the imbalance between oxidants and antioxidants resulting from exposure to tobacco smoke leads to oxidative stress, increased mucosal inflammation, and increased expression of inflammatory cytokines (such as interleukin (IL)-8, IL-6 and tumor necrosis factor α ([TNF]-α). Direct cellular effects of ETS on epithelial cells results in increased permeability, mucus overproduction, impaired mucociliary clearance, increased release of proinflammatory cytokines and chemokines, enhanced recruitment of macrophages and neutrophils and disturbed lymphocyte balance towards Th2. The plethora of presented phenomena fully justifies a restrictive policy aiming at limiting the domestic and public exposure to ETS.
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Affiliation(s)
- Agnieszka Strzelak
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warszawa, Poland.
| | - Aleksandra Ratajczak
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warszawa, Poland.
| | - Aleksander Adamiec
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warszawa, Poland.
| | - Wojciech Feleszko
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warszawa, Poland.
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100
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Soyiri IN, Sheikh A, Reis S, Kavanagh K, Vieno M, Clemens T, Carnell EJ, Pan J, King A, Beck RC, Ward HJT, Dibben C, Robertson C, Simpson CR. Improving predictive asthma algorithms with modelled environment data for Scotland: an observational cohort study protocol. BMJ Open 2018; 8:e023289. [PMID: 29780034 PMCID: PMC5961591 DOI: 10.1136/bmjopen-2018-023289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Asthma has a considerable, but potentially, avoidable burden on many populations globally. Scotland has some of the poorest health outcomes from asthma. Although ambient pollution, weather changes and sociodemographic factors have been associated with asthma attacks, it remains unclear whether modelled environment data and geospatial information can improve population-based asthma predictive algorithms. We aim to create the afferent loop of a national learning health system for asthma in Scotland. We will investigate the associations between ambient pollution, meteorological, geospatial and sociodemographic factors and asthma attacks. METHODS AND ANALYSIS We will develop and implement a secured data governance and linkage framework to incorporate primary care health data, modelled environment data, geospatial population and sociodemographic data. Data from 75 recruited primary care practices (n=500 000 patients) in Scotland will be used. Modelled environment data on key air pollutants at a horizontal resolution of 5 km×5 km at hourly time steps will be generated using the EMEP4UK atmospheric chemistry transport modelling system for the datazones of the primary care practices' populations. Scottish population census and education databases will be incorporated into the linkage framework for analysis. We will then undertake a longitudinal retrospective observational analysis. Asthma outcomes include asthma hospitalisations and oral steroid prescriptions. Using a nested case-control study design, associations between all covariates will be measured using conditional logistic regression to account for the matched design and to identify suitable predictors and potential candidate algorithms for an asthma learning health system in Scotland.Findings from this study will contribute to the development of predictive algorithms for asthma outcomes and be used to form the basis for our learning health system prototype. ETHICS AND DISSEMINATION The study received National Health Service Research Ethics Committee approval (16/SS/0130) and also obtained permissions via the Public Benefit and Privacy Panel for Health and Social Care in Scotland to access, collate and use the following data sets: population and housing census for Scotland; Scottish education data via the Scottish Exchange of Data and primary care data from general practice Data Custodians. Analytic code will be made available in the open source GitHub website. The results of this study will be published in international peer reviewed journals.
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Affiliation(s)
- Ireneous N Soyiri
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, Centre for Medical Informatics, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, Centre for Medical Informatics, The University of Edinburgh, Edinburgh, UK
| | - Stefan Reis
- Atmospheric Chemistry and Effects, NERC Centre for Ecology & Hydrology, Penicuik, UK
- Knowledge Spa, University of Exeter Medical School, Truro, UK
| | - Kimberly Kavanagh
- Department of Mathematics and Statistics, The University of Strathclyde, Glasgow, UK
| | - Massimo Vieno
- Atmospheric Chemistry and Effects, NERC Centre for Ecology & Hydrology, Penicuik, UK
| | - Tom Clemens
- School of Geosciences, Institute of Geography, The University of Edinburgh, Edinburgh, UK
| | - Edward J Carnell
- Atmospheric Chemistry and Effects, NERC Centre for Ecology & Hydrology, Penicuik, UK
| | - Jiafeng Pan
- Department of Mathematics and Statistics, The University of Strathclyde, Glasgow, UK
| | - Abby King
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, Centre for Medical Informatics, The University of Edinburgh, Edinburgh, UK
| | - Rachel C Beck
- Atmospheric Chemistry and Effects, NERC Centre for Ecology & Hydrology, Penicuik, UK
| | - Hester J T Ward
- Information Services Division and Health Protection Scotland, NHS National Services Scotland, Edinburgh, UK
| | - Chris Dibben
- School of Geosciences, Institute of Geography, The University of Edinburgh, Edinburgh, UK
| | - Chris Robertson
- Department of Mathematics and Statistics, The University of Strathclyde, Glasgow, UK
| | - Colin R Simpson
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, Centre for Medical Informatics, The University of Edinburgh, Edinburgh, UK
- Faculty of Health, Victoria University of Wellington, Wellington, New Zealand
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