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

IL5RA polymorphisms, smoking and eczema in Japanese women: the Kyushu Okinawa Maternal and Child Health Study

The present case-control study examined the relationship between IL5RA SNPs and eczema in young adult Japanese women. Cases and control subjects were selected from pregnant women who participated in the baseline survey of the Kyushu Okinawa Maternal and Child Health Study, which is an ongoing prebirth cohort study. Cases comprised 188 women with eczema in the previous 12 months as defined according to the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC), regardless of the presence of a doctor's diagnosis of atopic eczema. Control subjects comprised 1130 women without eczema as defined according to the ISAAC criteria who also had not been diagnosed with atopic eczema by a doctor. Compared with the AA genotype of IL5RA SNP rs17881144, the AT genotype, but not the TT genotype, was significantly associated with a decreased risk of eczema. The ATTAGA haplotype and the GTAGCA haplotype of rs17882210, rs3804797, rs334809, rs9831572, rs6771148 and rs17881144 were significantly associated with an increased risk of eczema. In contrast, the GCTGCA haplotype was significantly related to a decreased risk of eczema. Multiplicative interactions between IL5RA SNPs rs334809 and rs17881144 and smoking with respect to eczema were marginally significant (P = 0.07 and 0.07, respectively). This is the first study to show significant associations between IL5RA SNP rs17881144, the ATTAGA haplotype, the GTAGCA haplotype, and the GCTGCA haplotype and eczema. Smoking may modify the relationships between SNPs rs334809 and rs17881144 and eczema.

Polymorphisms of EHF-ELF5 genomic region and its association with pediatric asthma in the Taiwanese population

BACKGROUND

The EHF and ELF5 genes, located on chromosome 11p and linked to asthma phenotypes, are high-potential candidate genes conferring asthma susceptibility. The purpose of this study was to investigate the genetic association among single nucleotide polymorphisms (SNPs) of EHF and ELF5, and their relationship with asthma in the Taiwanese population.

METHODS

We selected and performed genotyping on 16 SNPs that encompass the genomic region of EHF and ELF5 in Taiwanese children with or without asthma. A total of 1983 children, 523 in the test group and 619 and 842 in two validation groups, were recruited for this study.

RESULTS

The SNP rs3910901, located in the 5' upstream region of ELF5, was found to have a weak association (p = 0.043) with asthma in the odds ratio analysis. The genotype distribution was similar in all comparison groups, but the CC genotype was more frequent in asthma patients. Logistic regression adjusted allergy comorbidity showed obviously diluted association.

CONCLUSION

The results indicated that SNP rs3910901 may have a minor impact on pediatric asthma in the Taiwanese population.

CD24(hi)CD27(+) B cells from patients with allergic asthma have impaired regulatory activity in response to lipopolysaccharide

BACKGROUND

Regulatory B cells have been identified that strongly reduce allergic and auto-immune inflammation in experimental models by producing IL-10. Recently, several human regulatory B-cell subsets with an impaired function in auto-immunity have been described, but there is no information on regulatory B cells in allergic asthma.

OBJECTIVE

In this study, the frequency and function of IL-10 producing B-cell subsets in allergic asthma were investigated.

METHODS

Isolated peripheral blood B cells from 13 patients with allergic asthma and matched healthy controls were analyzed for the expression of different regulatory B-cell markers. Next, the B cells were activated by lipopolysaccharide (LPS), CpG or through the B-cell receptor, followed by co-culture with endogenous memory CD4(+) T cells and house dust mite allergen DerP1.

RESULTS

Lower number of IL-10 producing B cells were found in patients in response to LPS, however, this was not the case when B cells were activated through the B-cell receptor or by CpG. Further dissection showed that only the CD24(hi)CD27(+) B-cell subset was reduced in number and IL-10 production to LPS. In response to DerP1, CD4(+) T cells from patients co-cultured with LPS-primed total B cells produced less IL-10 compared to similar cultures from controls. These results are in line with the finding that sorted CD24(hi)CD27(+) B cells are responsible for the induction of IL-10(+) CD4(+) T cells.

CONCLUSIONS

Taken together, these data indicate that CD24(hi)CD27(+) B cells from allergic asthma patients produce less IL-10 in response to LPS leading to a weaker IL-10 induction in T cells in response to DerP1, which may play a role in allergic asthma.

Dietary habits and prevalence of allergic rhinitis in 6 to 7-year-old schoolchildren in Turkey

BACKGROUND

The prevalence of allergic rhinitis and other allergies has risen worldwide. Dietary habits are considered to be among the potential risk factors. The aim of this study was to evaluate the prevalence of allergic rhinitis and its relationship with dietary habits and other risk factors among 6 to 7-year-old Turkish schoolchildren.

METHODS

In this cross-sectional study, a total of 11483 children aged 6-7 years were surveyed. The prevalence of symptoms of allergic rhinitis was assessed using the ISAAC protocol. Dietary information was collected using a food frequency questionnaire.

RESULTS

Of them, 9875 (50.7% M 49.3% F) questionnaires were appropriately completed. The prevalence rates of lifetime rhinitis, current rhinitis, current rhinoconjunctivitis and physician-diagnosed allergic rhinitis, were 44.3%, 29.2%, 8.5% and 8.1%, respectively. Consumption of rice, and cereals ≥3 times per week showed protective effect on physician-diagnosed allergic rhinitis (aOR = 0.53, 95% CI = 0.32-0.87 and aOR = 0.58, 95% CI = 0.36-0.92). Eating pasta, and chocolates ≥3 times per week showed protective effect on current rhinoconjunctivitis (aOR = 0.45, 95% CI = 0.25-0.79 and aOR = 0.50, 95% CI = 0.29-0.86). Eating lollipops, candies and animal fats ≥3 times per week was positively associated with current rhinoconjunctivitis (aOR = 1.47, 95% CI = 1.00-2.17 and aOR = 2.25, 95% CI = 1.11-4.56). Protective effect of the Mediterranean diet was not significant.

CONCLUSIONS

Frequent consumption of cereals, rice, pasta and chocolates may have beneficial effect on symptoms of rhinoconjunctivitis. Although dietary habits may affect the prevalence of symptoms of current rhinoconjunctivitis, the Mediterranean diet alone may not be protective against rhinoconjunctivitis.

Elevated B cell-activating factor (BAFF) in children with allergic rhinitis

OBJECTIVE

To evaluate the possible role of B cell-activating factor (BAFF) in children with allergic rhinitis (AR).

METHODS

Twenty-four AR children and 20 normal children were enrolled in this study and nasal lavage and serum were collected. The nasal and serum levels of BAFF were measured using enzyme-linked immunosorbent assay (ELISA). The relationship between serum BAFF and immunoglobulin A (IgA) was evaluated in AR children.

RESULTS

Our results showed that the nasal and serum levels of BAFF were significantly increased in AR children compared with controls (p<0.05). The nasal and serum levels of BAFF in AR children were significantly associated with disease severity (p<0.05). Moreover, the level of serum BAFF was negatively related to serum IgA level (p<0.05).

CONCLUSION

Our findings show BAFF expression was significantly increased and related to disease severity, indicating BAFF may be implicated in new treatment modalities for AR children.

Cord serum 25-hydroxyvitamin D correlates with early childhood viral-induced wheezing

BACKGROUND

There are investigations concluding that reduced vitamin D status in pregnancy, may be a risk factor for the development of allergic outcomes in offspring. However, studies on the relationship between cord levels of 25-hydroxyvitamin D (25[OH]D) and risk of early childhood wheezing and early-onset atopic dermatitis/food allergy are very limited.

OBJECTIVE

To assess the associations between cord blood concentration of 25[OH]D and occurrence of the incidence of wheezing, atopic dermatitis, food allergy, during the first two years of life.

METHODS

We evaluated 240 children by the age of 2 years from the Polish Mother and Child Cohort Study. Women were interviewed during pregnancy to collect demographic and socioeconomic data, the medical and reproductive history. At delivery, umbilical cord blood plasma was sampled. The child's health status were examined at approximately 2 years. In the analyses multivariable model was used.

RESULTS

Data from 190 participants were included into the analysis. The median value and quartile range of 25[OH]D in cord blood [ng/ml] were as follows: 6.33, 4.16-8.53. 25[OH]D in cord blood below lower quartile increases the risk of multi-triggered wheezing (MTW) in children during first 2 years of life (OR: 2.81; 95% CI: 1.13-7.00). Higher cord serum level of 25[OH]D reduces the risk of viral induced wheezing (VIW). The cord serum level of 25[OH]D below median value (OR: 6.06; 95% CI: 1.3-28.3) or below lower quartile (OR: 5.43; 95% CI: 1.66-17.7) increases the risk of VIW. All above effects of vitamin D level in cord blood were corrected for the effects other independent risk factors of wheezing and VIW in this cohort.

CONCLUSIONS

Cord serum 25[OH]D levels were inversely associated with the risk of multi-triggered wheezing, and especially viral-induced wheezing by the age of 2 years, but no association was found with food allergy, atopic dermatitis and frequencies of infections.

Retrospective review on the use of topical cyclosporin a 0.05% for paediatric allergic conjunctivitis in Hong Kong Chinese

Purpose. To evaluate the efficacy of using topical cyclosporin A 0.05% (Restasis) for the treatment of paediatric allergic conjunctivitis. Methods. This retrospective study included consecutive cases of paediatric allergic conjunctivitis treated with Restasis between 2010 and 2013. Subjects with follow-up time less than 3 months after using Restasis were excluded. Itch severity score, symptom score, and sign score were compared before (baseline) and 3 months after using Restasis. Results. In 27 eyes of 14 patients (mean age 10.8 ± 3.2 years), 44.4% had allergic conjunctivitis, 33.3% had vernal keratoconjunctivitis, and 22.2% had atopic keratoconjunctivitis. The mean duration of ocular symptoms was 20.4 ± 13.2 months. 92.6% of subjects were using steroid eye drop before Restasis. After 3 months of topical Restasis, there were statistically significant reductions in the symptom, sign, and itch severity scores compared with baseline (all P ≤ 0.001) and 78.6% of subjects were able to be tapered off steroid eye drops. Conclusion. Topical Restasis was effective and safe in significantly reducing ocular itchiness, sign, and symptom scores at 3 months after use in paediatric allergic ocular conditions.

A hospital-based survey on the prevalence of bronchial asthma in patients with allergic rhinitis in southern China

BACKGROUND

The prevalence of bronchial asthma (BA) and the underlying risk factors in patients with allergic rhinitis (AR) in China are largely unknown. Thus, this study is designed to assess the BA comorbidity in AR patients in two cities (Guangzhou and Zhuhai) of southern China and to determine the risk factors of BA in these AR patients.

METHODS

We performed a cross-sectional, hospital-based survey in two modernized cities in southern China. The BA prevalence was evaluated in 1931 AR patients. Participants were asked to complete a questionnaire containing specific items for AR and BA. A logistic regression analysis was used to assess the risk factors of BA comorbidity in AR patients.

RESULTS

The prevalence of concomitant BA in AR patients is 5.33% (103/1931). Most of the participants (98.4%) were sensitized to more than one allergen, and the most common sensitization was to house-dust mites. The strongest risk factor of BA determined by a multiple logistic regression analysis was a duration of AR of >5 years (adjusted odds ratio [OR], 8.67; 95% confidence interval [CI], 3.74-20.06), followed by smoking (adjusted OR, 7.21; 95% CI, 1.86-8.23) and self-medication with antibiotics (adjusted OR, 6.35; 95% CI, 3.43-11.78).

CONCLUSION

Our findings suggested the risk factors of concomitant BA in AR patients may be helpful to establish preventive strategies.

Anti-inflammatory effect of IL-37b in children with allergic rhinitis

Background. Interleukin-37 (IL-37), a newly described member of IL-1family, functioned as a fundamental inhibitor of innate inflammatory and immune responses, especially its isoform IL-37b. Objective. This study was undertaken to evaluate the expression and regulation of IL-37b in children with allergic rhinitis (AR). Methods. Forty children with AR and twenty-five normal controls were included. The relationship between IL-37b and Th1/2 cytokines production in serum and nasal lavage was examined by enzyme-linked immunosorbent assay (ELISA). Peripheral blood mononuclear cells (PBMCs) were purified for in vitro regulation experiment of IL-37b. Intranasal mometasone furoate was given in AR children and IL-37b change after one-month treatment was detected using ELISA. Results. We observed significantly decreased IL-37b expression levels in both serum and nasal lavage compared to controls. IL-37b was negatively correlated with Th2 cytokines. Our results also showed that IL-37b downregulated Th2 cytokine expressed by PBMCs and this modulation was through mitogen-activated protein kinase (MAPK) and phosphatidylinositol 3-kinase (PI3K) pathway. We also found that intranasal mometasone furoate therapy can promote nasal IL-37b expression. Conclusion. IL-37b may be involved in Th2 cytokine regulation in AR and its expression was related to the efficacy of intranasal steroid therapy.

Prevalence and triggers of allergic rhinitis in the United Arab Emirates

BACKGROUND AND OBJECTIVES

Allergic rhinitis is a morbid condition that is frequently overlooked by patients and physicians. This type of atopy has not been adequately investigated in the United Arab Emirates.

METHODS

This cross-sectional, population-based observational study was conducted in the seven Emirates (Abu Dhabi, Dubai, Sharjah, Ajman, Umm Al-Quwain, Ras Al-Khaimah, and Fujairah). It used the European Community Respiratory Health Survey (ECRHS II) to screen for allergic rhinitis in people living in this region.

RESULTS

Symptoms of allergic rhinitis were present in 85 (7%) of the 1,229 study population. Only 33 (39%) patients received treatment. Seventy-six (89%) patients had asthma. Thirty-seven (44%) patients were poly-sensitized. Symptoms were aggravated by dust (59%), grass/pollens (44%) and proximity to animals (21%). Winter was the peak season (37%), followed by spring (30%), autumn (18%) and summer (15%). Grass/pollen allergies were clustered in the winter, spring and summer (p ≤ 0.001). Dust was non-seasonal (p ≥ 0.121) and animal allergy was worse in the winter (p = 0.024) and spring (p = 0.044). Spring symptoms were less common in people living in the inner city (p = 0.003).

CONCLUSIONS

At least 7% of the studied population had allergic rhinitis. Most (71%) of these patients had environmental triggers and remained untreated. Allergic rhinitis awareness and measures to control allergens and dust are needed. The impact of preventing allergic rhinitis on other common atopies in the region deserves future studies.

Role of BAFF in pediatric patients with allergic rhinitis during sublingual immunotherapy

Sublingual immunotherapy (SLIT) is the only therapeutic option for allergic rhinitis (AR) that modifies the immunological process to an allergen, rather than treating symptoms simply. However, its regulatory mechanisms are largely unknown. B-cell-activating factor of the TNF family (BAFF) plays very important roles in the development, differentiation, and proliferation of B cells and T cells. The aim of this study was to identify the role of BAFF during SLIT in pediatric patients with AR. Seventy-two house dust mite (HDM)-sensitized pediatric patients with AR were enrolled in this study. Thirty-six pediatric patients received HDM allergen extract for SLIT and 36 pediatric patients received placebo. Serum and nasal aspirate of different time points during treatment was collected and used for enzyme-linked immunosorbent assay (ELISA) of BAFF and related cytokines, respectively. Peripheral blood mononuclear cells were collected and stimulated by HDM allergen with or without rhBAFF after 12 months of treatment. Our results showed that the expression of BAFF protein decreased during the SLIT treatment compared with that in the placebo group after 6 months of therapy, and this trend lasted for 12 months. The decreased BAFF expression was positively related to Th2 cytokines and increased IL-10 expression. BAFF was also related to local production of IgA. In vitro experiments showed that BAFF can promote Th2 cytokines and inhibit IL-10 expression by PBMCs.

CONCLUSION

During SLIT, BAFF expression was decreased and related to low Th2 cytokine expression and enhanced IL-10 expression. Besides, BAFF may contribute to local production of IgA. Our results suggested that BAFF may be an important biomarker during SLIT. Authors' summary. Sublingual immunotherapy (SLIT) is the only therapeutic option for allergic rhinitis (AR) that modifies the immunological process to an allergen, rather than simply treating symptoms. However, its regulatory mechanisms are largely unknown. B-cell-activating factor of the TNF family (BAFF) plays very important roles in the development, differentiation, and proliferation of B cells and T cells. Our results showed that during SLIT, BAFF expression was decreased and related to low Th2 cytokine expression and enhanced IL-10 expression. Besides, BAFF may contribute to local production of IgA. Our results suggested that BAFF may be an important biomarker during SLIT.

Antibiotics in the first week of life is a risk factor for allergic rhinitis at school age

BACKGROUND

Heredity as well as external factors influences the development of allergic rhinitis. The aim of this study was to analyse early risk factors and protective factors for allergic rhinitis at school age.

METHODS

This is a prospective, longitudinal study of children born in western Sweden in 2003 where 50% of the birth cohort was randomly selected. The parents answered questionnaires at 6 months, 12 months, 4.5 yr and 8 yr. At 8 yr, 5044 questionnaires were distributed. Of these, 4051 responded, that is, 80.3%. Current allergic rhinitis was defined as symptoms and use of medication during the past 12 months.

RESULTS

Current allergic rhinitis at 8 yr was reported by 10.9%. Mean onset age was 5.7 yr, and 61.9% were boys. In a multivariate analysis, antibiotics in the first week of life increased the risk of allergic rhinitis (adjusted odds ratio 1.75, 95% confidence interval (1.03, 2.97)). Increased risk was also seen with parental allergic rhinitis (aOR 2.73 (2.12, 3.52)), food allergy first year (aOR 2.45 (1.61, 3.73)), eczema first year (aOR 1.97 (1.50, 2.59)) and male gender (aOR 1.35 (1.05, 1.74)). Living on a farm at 4.5 yr reduced the risk (aOR 0.31 (0.13, 0.78)).

CONCLUSION

Antibiotics in the first week of life increased the risk of allergic rhinitis at school age, while living on a farm at preschool age reduced the risk. Both findings are compatible with the hygiene hypothesis.

IL3 rs40401 polymorphism and interaction with smoking in risk of asthma in Japanese women: the Kyushu Okinawa Maternal and Child Health study

Three previous genetic association studies conducted in Korea and China investigated the relationship between IL3 single nucleotide polymorphism (SNP) rs40401 and asthma, but their results were inconsistent. We examined this relationship and the possibility of an interaction between IL3 SNP rs40401 and smoking in young adult Japanese women. Included were 89 women who met the criteria of the European Community Respiratory Health Survey (ECRHS) for asthma. Control subjects were 700 women without asthma according to the ECRHS criteria who had not been diagnosed with asthma and/or allergic rhinitis by a doctor and/or who had not met the criteria of the International Study of Asthma and Allergies in Childhood for rhinoconjunctivitis. A significant positive association was found between SNP rs40401 and the risk of asthma, with the TT genotype as the reference under the additive model: the adjusted odds ratio was 1.39 (95% CI: 1.004-1.93). The positive association was not statistically significant in any other genetic model. Compared with subjects with the TT or TC genotype of SNP rs40401 who had never smoked, those with the CC genotype who had ever smoked had a significantly increased risk of asthma: the adjusted OR was 2.67 (95% CI: 1.23-5.79); the additive interaction, but not the multiplicative interaction, was significant. This study suggests that IL3 SNP rs40401 is significantly associated with the risk of asthma in young adult Japanese women and reveals that the combination of ever smoking and having the CC genotype of IL3 SNP rs40401 is significantly positively associated with asthma.

Parental hay fever reinforces IgE to pollen as pre-clinical biomarker of hay fever in childhood

BACKGROUND

An early IgE response to grass or birch pollen can anticipate seasonal allergic rhinitis to pollen later in life or remain clinically silent.

OBJECTIVE

To identify risk factors early in life that allow discriminating pathogenic from non-pathogenic IgE responses and contribute to the development of seasonal allergic rhinitis to grass pollen.

METHODS

The German Multicentre Allergy Study examined a birth cohort born in 1990. A questionnaire was yearly administered and blood samples collected at age 1,2,3,5,6,7,10,13 yr. The definition of the primary outcome grass- and birch-pollen-related seasonal allergic rhinitis (SARg, SARb) was based on nasal symptoms in June/July and April, respectively. Serum IgE antibodies to Phleum pratense and Betula verrucosae extracts were monitored with immune-enzymatic singleplex assays.

RESULTS

Of the 820 examined children, 177 and 148 developed SARg and SARb, respectively. Among healthy children aged 3 or more years, IgE to grass pollen was the strongest risk factor of SARg (OR 10.39, 95%CI 6.1-17.6, p < 0.001), while parental hay fever was the only risk factor in early childhood independently associated with future SARg (1 parent: OR 2.56, 95%CI 1.4-4.5, p < 0.001; 2 parents: OR 4.17, 95%CI 1.7-10.1) and SARb (1 parent OR: 5.21, 95%CI 2.20-12.4, p < 0.001; 2 parents: OR 8.02, 95%CI 2.0-32.9, p < 0.001). Parental hay fever was associated with an increase of the concentration of pollen-specific IgE in seropositive subjects, after the age of 6 and was also a hallmark of molecularly more complex specific IgE responses to grass or birch pollen at age 6 or older.

CONCLUSIONS

Parental hay fever and specific IgE to grass and/or birch pollen are strong pre-clinical determinants and potentially good predictors of seasonal allergic rhinitis.

Determinants of allergic rhinitis in young children with asthma

Background

In the preschool period, allergic rhinitis (AR) is infrequent and thus under-diagnosed. However, recent works have highlighted the occurrence of AR in toddlers although the causes of AR in this young population remain unknown. The objective of this study was to identify determinants of AR in young children with asthma.

Methods

We carried out a case-control study of 227 children with active asthma and enrolled in the Trousseau Asthma Program. AR and other allergic diseases (asthma, food allergy and eczema) were diagnosed by medical doctors using standardized questionnaires. Parental history of AR and asthma, biological markers of atopy (total IgE, blood eosinophilia, allergic sensitization towards food and aeroallergens) and environmental parameters were also collected.

Results

Forty one of the children (18.1%) had AR. By univariate logistic regression analysis, AR was mainly associated with peanut sensitization (OR = 6.75; p = 0.002); food allergy (OR = 4.31; p = 0.026); mold exposure (OR = 3.81 p<0.01) and parental history of AR (OR = 1.42; p = 0.046). Due to the strong link between food allergy and peanut sensitization three models of multivariate logistic regression were performed and confirmed that AR is associated with peanut sensitization but also food allergy and mold exposure. A random forest analysis was also performed to explain AR. The results reinforced the logistic analysis that peanut sensitization and mold exposure were the principal determinants of AR.

Conclusions & Clinical Relevance

These results stress the importance of investigating AR in young children with asthma to potentially diagnose a particularly severe allergic asthmatic phenotype. Moreover, these data evoke the hypothesis that peanut could be an aeroallergen.

Allergic rhinitis in preschool children from Southern Brazil

There are few published studies on prevalence of allergic rhinitis in preschool children. The aims of this study were to verify the prevalence, clinical characteristics, and treatment of allergic rhinitis (AR) symptoms in the first year of life adding supplementary questions to the EISL instrument. A cross-sectional study used Phase III EISL written questionnaire in addition to modified allergic rhinitis ISAAC questions. One thousand and three parents of infants answered the questionnaire: 484 (48.3%) had at least one sneezing, or a runny or blocked nose episodes without cold or flu in the first year of life. A quarter of infants had recurrent wheezing (≥3 episodes) and more frequent in the presence of AR symptoms. Physician diagnosis of AR and the use of intranasal steroids and both antihistamines and intranasal steroids were more common among those infants with AR symptoms. The prevalence of AR symptoms was high and starting early in life.

Continuous 6-year follow-up study of sensitization to Japanese cedar pollen and onset in schoolchildren

BACKGROUND

Intra individual longitudinal data has been lacking for IgE-mediated seasonal allergic rhinitis (SAR), especially in young children. Little is known about the development and natural course of SAR in terms of prevalence and incidence rates in schoolchildren.

METHODS

In May or June each year from 1994 to 2007, schoolchildren were assessed for serum Japanese cedar pollen (JCP)-IgE and house dust mite (HDM)-IgE levels, and surveyed regarding nasal symptoms.

RESULTS

Among the 220 children initially assessed in the first grade, 69 (31.4%) were already sensitized to JCP at first grade and 119 (54.1%) did not develop JCP sensitivity during the 6-year study at all. In the first grade children who were HDM-sensitized but JCP non-sensitized, JCP-IgE level was significantly elevated compared to the JCP and HDM non-sensitized group. This seems to indicate that HDM sensitization was very strongly associated with JCP sensitization.

CONCLUSIONS

Elevated serum IgE is a consequence of specific sensitization to HDM and HDM sensitization appeared to develop prior to the start of primary school which distinguishes HDM sensitization from JCP sensitization.

Profile of Patients with Allergic Rhinitis (AR): A Clinic Based Cross-Sectional Study from Kolkata, India

BACKGROUND

Allergic Rhinitis (AR) though quite common in India, does not receive its due importance as it deserves.

AIM OF THE STUDY

To identify the demographic and clinical profile of the patients with AR and to find the association of pre-dominant disease symptoms with common allergens, type and severity of the disease and other co-morbidities.

SETTINGS AND DESIGN

This clinic-based cross-sectional, observational study was conducted among adult patients presenting with signs and symptoms suggestive of AR.

METHODS AND MATERIAL

Consecutive 548 patients were initially screened for possible cases of AR by proper history taking and physical examination and confirmation was done by a battery of investigations, including modified skin prick test. A total of 462 patients who were finally diagnosed with AR were included in the study. Categorization of these patients was done following Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines. Pulmonary function tests and X-ray/CT-scan of the para-nasal sinuses were done to confirm the presence of bronchial asthma and sinusitis, respectively.

STATISTICAL ANALYSIS USED

Data were analyzed by Statistical Package for Social Scientists (SPSS version 10). Z-test was applied to compare between two rates, at 5% level of significance.

RESULTS

Proportion of "blockers" was found to be much higher than that of "sneezers-runners" (64.1% vs. 35.9%). "Blockers" had significantly more sensitization to polyvalent house dust, house dust mites and fungi (p < 0.05), while, "sneezers-runners" had more sensitization to pollens (p < 0.05). Significantly more "blockers" had "moderate/severe persistent" and "mild persistent" types of the disease (p < 0.05), while "mild intermittent" and moderate/severe intermittent" type of disease were significantly more common among "sneezers-runners" (p < 0.05). Both bronchial asthma and sinusitis were significantly more common among the "blockers" (p < 0.05).

CONCLUSION

It can be concluded from the present study that the clinical profiles of the two main categories of AR namely "sneezers-runners" and "blockers" were distinct from each other. This knowledge can be useful to physicians at all levels for better management of patients with AR.

Recent advances on diagnosis and management of childhood asthma and food allergies

The epidemic of childhood allergic disorders has been associated to the decline of infectious disease. However, exposure to many triggers (airborne viruses, tobacco smoke, pollution, indoor allergens, etc.) contribute to the disease. Breast feeding practices, nutrition, dietary and obesity also play a multifaceted role in shaping the observed worldwide trends of childhood allergies. Guidelines for treatment are available, but their implementation is suboptimal. Then developed countries are slowing learning integrating the development of suitable guidelines with implementation plans. Awareness, psychosocial and family factors strongly influence asthma and food allergy control. Moreover, monitoring tools are necessary to facilitate self-management. By taking into consideration these and many other pragmatic aspects, national public health programs to control the allergic epidemic have been successful in reducing its impact and trace the need for future research in the area.

Prevalence of allergic rhinitis in china

Allergic rhinitis (AR) is a serious systemic allergic disease, which together with comorbid asthma causes major illness and disability worldwide. Recent epidemiological studies have revealed wide variations in the increasing prevalence of AR and allergies globally, including in China. Despite a markedly higher population than western countries, and a landmass close to Europe in area, little epidemiological data is available on AR in China. Thus, the present study reviewed the prevalence, comorbid allergic diseases, trends and pattern of sensitizing allergens in adults and children suffering from AR in China. Available data indicated that despite variations in the prevalence of AR in different regions of the country, the prevalence of AR has increased in both adults and children over the last 2 decades. Similarly, there has been an increase in a "western"-type lifestyle, industrialization and air pollution over this period, which may have contributed to the increased prevalence of AR observed in China.

Case-control study of rhinoconjunctivitis associated with IL5RA polymorphisms in Japanese women: the Kyushu Okinawa Maternal and Child Health Study

BACKGROUND

Epidemiological research on the relationship between single nucleotide polymorphisms (SNPs) in the IL5RA gene and allergic disorders is limited. We examined the relationship between IL5RA SNPs and risk of rhinoconjunctivitis in young adult Japanese women.

METHODS

Included were 393 women who met the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) for rhinoconjunctivitis. Controls were 767 women without rhinoconjunctivitis according to the ISAAC criteria who had not been diagnosed with allergic rhinitis by a doctor. Adjustment was made for age, region of residence, presence of older siblings, smoking, and education.

RESULTS

Compared with the CC genotype of SNP rs6771148, the CG genotype, but not the GG genotype, was significantly associated with a reduced risk of rhinoconjunctivitis: the adjusted OR for the CG genotype was 0.76 (95% CI: 0.58-0.99). No evident associations were found between SNPs rs17882210, rs3804797, rs334809, rs9831572, or rs17881144 and rhinoconjunctivitis. The ACTAGA haplotype of rs17882210, rs3804797, rs334809, rs9831572, rs6771148, and rs17881144 was significantly inversely associated with rhinoconjunctivitis (crude OR=0.58, 95% CI: 0.37-0.88) while the GTAGCA haplotype was significantly positively related to rhinoconjunctivitis (crude OR=1.74, 95% CI: 1.14-2.65). No significant interactions affecting rhinoconjunctivitis were observed between any of the six SNPs and smoking.

CONCLUSION

This is the first study to show significant associations between IL5RA SNP rs6771148, the ACTAGA haplotype, and the GTAGCA haplotype and the risk of rhinoconjunctivitis. We did not find evidence for interactions affecting rhinoconjunctivitis between any of the IL5RA SNPs and smoking.

Gene polymorphisms of Interleukin-4 in allergic rhinitis and its association with clinical phenotypes

BACKGROUND

Allergic rhinitis (AR) is an inflammatory disorder of the upper airway. T-helper (Th)2 cytokines seems to have major roles behind the scene of unpleasant symptoms resulted from AR. Expression of interleukin (IL)-4 and its receptor could be affected by single nucleotide polymorphisms (SNPs). This study assessed the effect of 4 genetic variants within genes of IL-4 and IL-4R in AR.

METHODS

Allele frequencies of one IL-4R variant (rs1801275) and three SNPs of IL-4 (rs2243248, rs2243250, and rs2070874) were investigated in 98 patients with AR, compared to a group of controls, using PCR sequence-specific-primers (PCR-SSP) method.

RESULTS

Homozygosity for the C allele of rs2243250 in IL-4 was significantly overrepresented in the patient group. CC genotype in rs2070874 significantly was correlated with AR. GG/CC/CC and TT/TT/TT (rs2243248, rs2243250, and rs2070874) haplotypes in the IL-4 gene had a significant negative correlation with AR.

CONCLUSION

SNPs in IL-4 are associated with AR and could change the clinical picture of the disease in patients.

Analysis of comorbidities and therapeutic approach for allergic rhinitis in a pediatric population in Spain

BACKGROUND

Allergic rhinitis (AR) is the most common chronic disease in children. The main objective of this study was to analyze the comorbidities and therapeutic approaches for AR in a Spanish pediatric population.

METHODS

Children aged 6 to 12 years with AR were included in an observational, cross-sectional, multicenter study.

RESULTS

1,275 children were recruited from 271 centers. AR was intermittent in 59.5% of cases, persistent in 40.5%, seasonal in 60.7%, and perennial in 39.3% of patients. The most frequent comorbidities were conjunctivitis (53.6%), asthma (49.5%), atopic dermatitis (40%), rhinosinusitis(26.1%), otitis media (23.8%), and adenoid hypertrophy (17.3%). Overall, patients with persistent, moderate or severe, AR were more likely to present comobidities, except for food allergy and urticaria. The most common drugs used for treatment of AR were oral antihistamines(76%), nasal corticosteroids(49%) and a combination of both (45%). Antihistamines and nasal corticosteroids were used on demand (<18 days) in 38 and 41% of patients, respectively; for 18-30 days in 22 and 27%; for 1-3 months in 31 and 29%; and for more than 3 months in 8 and 3%, respectively. Eye drops were used in 32% and specific immunotherapy in 21% of patients.

CONCLUSION

Comorbidities are frequent in children with AR, supporting the notion of allergy as a systemic disease. Severity and duration of AR were significantly associated with presence of most of comorbidities. The most common drugs used for AR treatment were oral antihistamines, followed by nasal corticosteroids and a combination of both used on demand.

Proposed model for Iranian national system of registration of allergy and asthma

Introduction:

Asthma and allergies in addition to demanding social costs–the economic community, one of the major causes of morbidity and mortality in the world is considered. In the last decade in Iran despite the positive developments in many areas of health records into categories based asthma and allergy international standards, less attention has been paid. Improving the quality of care system, identifying groups at risk of asthma and allergies, control plan, prevention and assessment of asthma and allergies due to possible that when allergy and asthma information registration system and create the complete and timely data to be collected. Considering now an efficient national system of registration allergy and asthma that can meet the health needs can no need for this study was felt.

Materials and Methods:

This study, study–the comparison was done in the years 2010-2011. In this research, using library resources, information networks and consultations with experts inside the country gathered on the main axis and branches of national registration system, asthma and allergies in American countries–Australia and England were examined and given economic conditions, cultural and geographical themes for our records system, the axes were proposed objectives, structure, data elements, standard registration process? Data and classification systems are given.

Results:

The proposed model for national registration system, asthma and allergies in the country is shown in a table. In this table the proposed system based on six main “targets”, “structure”, “data elements”, “data collection process,” “registration criteria” and “classification system” is designed.

Conclusion:

The results and recommendations to the International Institute for asthma and allergies, reduction in low registers, and can increase the quality of the proposed model, including advantages in comparison with the existing system of the country noted.

Prevalence and classification of rhinitis in preschool children in Portugal: a nationwide study

BACKGROUND

Information on rhinitis epidemiology in preschool children is scarce.

OBJECTIVES

To estimate, in children with 3-5 years of age, current rhinitis prevalence, to describe rhinitis symptoms and associated sociodemographic characteristics, and to report allergic rhinitis and its impact on asthma (ARIA) classification.

METHODS

Cross-sectional, nationwide, population-based study including children aged 3-5 years. A multistep selection strategy was used to obtain a representative sample. Data were collected at kindergartens and parish centers by face-to-face interview to caregivers, using an adapted ISAAC questionnaire. 'Current rhinitis' (CR) was defined as the presence of ≥1 rhinitis symptom (repeated sneezing and/or itchy nose, blocked nose for >1 h, or runny nose without having a cold/flu) in the last year. Rhinitis lasting ≥4 days/week and ≥4 consecutive weeks was classified as persistent. Moderate-severe disease interfered 'a moderate amount' or 'a lot' in daily activities.

RESULTS

Five thousand and eighteen children were included. CR prevalence was 43.4% [95% CI (42.0-44.8%); n = 2179] and that of physician-diagnosed rhinitis was 11.7% [95% CI (10.8-12.6%); n = 588]. Of children with CR, 67% reported blocked nose, 48% rhinorrhea, and 46% sneezing/itchy nose. Considering ARIA classification, 30% of the population had mild intermittent, 3% mild persistent, 7% moderate-severe intermittent, and 3% moderate-severe persistent rhinitis. Children with CR had more current wheezing, physician-diagnosed asthma, self-reported food allergy, and family history of allergic disease. These characteristics were also associated with persistent and moderate-severe rhinitis.

CONCLUSIONS

This is the first nationwide population-based study reporting rhinitis prevalence and ARIA classification in preschool children. In this age-group, rhinitis is frequent and underdiagnosed. About 25% children with rhinitis presented moderate-severe disease.

Effects of dietary habits and risk factors on allergic rhinitis prevalence among Turkish adolescents

BACKGROUND

Allergic rhinitis (AR) is a global health problem affecting many people from childhood to adulthood. The aim of this study was to evaluate the prevalence of AR and related symptoms, and to assess the risk factors, dietary habits and the Mediterranean diet affecting AR.

METHODS

In a cross-sectional study design, 9991 children, aged 13-14 years in 61 primary schools in 32 districts of Istanbul were evaluated. The prevalence of AR symptoms among the children was evaluated using the ISAAC protocol.

RESULTS

In our study, total of 10,984 questionnaires were distributed to 13-14yr-old schoolchildren to 61 schools in 32 district of Istanbul and 9991 questionnaires were suitable for analysis with an overall response of 91.7%. The rates of lifetime rhinitis, rhinitis in last 12 months and lifetime doctor diagnosed AR prevalence were 53.5%, 38.3% and 4.5%, respectively. The variation among districts in the prevalence of doctor diagnosed AR was very high. The highest prevalence was about 10 times higher than in the district with the lowest prevalence (range: 1.4-14.5) of Istanbul. A family history of atopy, mother with a university degree, presence of cat at home during last 12 months and adenoidectomy were significant for increased doctor diagnosed AR risk. Additionally, although fish and other sea foods, fermented drinks made from millets and various seeds, animal fats and butter were independent risk factors for doctor diagnosed AR, fish oil and hamburger were protective foods for doctor diagnosed AR. The MD was not associated with the prevalence of doctor diagnosed AR.

CONCLUSIONS

This study shows that that there are wide variations for the prevalence of AR related symptoms in 13-14yr-old schoolchildren among districts of Istanbul in Turkey. Socio-economical, environmental factors, some dietary habits, but not Mediterranean diet may affect the prevalence of AR.

Rising trend of allergic rhinitis prevalence among Turkish schoolchildren

OBJECTIVES

To assess the time trends and possible risk factors associated with allergic rhinitis symptoms in schoolchildren from Denizli, Turkey.

METHOD

Two identical cross-sectional surveys were performed in the 13- to 14-yr age group at intervals of six years using ISAAC questionnaire. Possible risk factors were also asked and the children completed questionnaires by self.

RESULTS

A total of 4078 children (response rate 75%) in the 2008 and 3004 children (response rate, 93.8%) in 2002 were included. The lifetime prevalence of rhinitis, 12-month prevalence of rhinitis, prevalence of associated itchy eye in the previous 12 months and doctor diagnosed allergic rhinitis prevalence were increased from 34.2% to 49.4% (POR=1.87, 95% CI=47.8-50.9 and p ≤ 0.001), from 23.5.0% to 32.9% (POR=1.59, 95% CI=31.4-34.3 and p ≤ 0.001), from 9.6% to 14.9% (POR=1.64, 95% CI=13.8-16.0 and p ≤ 0.001), and from 4.3% to 7% (POR=1.67, 95% CI=6.2-7.8 and p ≤ 0.001) respectively. Severe interference with daily activity in the previous 12 months did not change. In multivariate analysis, history of family atopy, stuffed toys, high annual family income, presence of allergy in mother, father and accompaniment of children to their parents after school hours in textile industry were found as risk factors in 2008 study.

CONCLUSION

The prevalence of allergic rhinitis increased significantly in 2008. Family history of atopy, stuffed toys, high annual family income and accompaniment of children to their parents in textile industry were found as risk factors for doctor diagnosed allergic rhinitis.

Prevalence and comorbidity of allergic diseases in preschool children

Purpose

Allergic disease and its comorbidities significantly influence the quality of life. Although the comorbidities of allergic diseases are well described in adult populations, little is known about them in preschool children. In the present study, we aimed to assess the prevalence and comorbidity of allergic diseases in Korean preschool children.

Methods

We conducted a cross-sectional study comprising 615 Korean children (age, 3 to 6 years). Symptoms of allergic diseases were assessed using the Korean version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire that was modified for preschool children. Comorbidities of allergic diseases were assessed by 'In the last 12 months, has your child had symptoms?'.

Results

The prevalence of symptoms of asthma, allergic rhinitis, and atopic dermatitis as recorded using the ISAAC questionnaire, within the last 12 months was 13.8%, 40.7%, and 20.8%, respectively. The symptom rates of allergic conjunctivitis, food allergy, and drug allergy were 14.8%, 10.4%, and 0.8%, respectively. The prevalence of allergic rhinitis in children with asthma was 64.3% and that of asthma in children with allergic rhinitis was 21.6%. The prevalence of rhinitis in children with conjunctivitis was 64.8% and that of conjunctivitis in children with rhinitis was 23.6%.

Conclusion

The prevalence of current rhinitis in our preschool children is shown to be higher than that previously reported. Allergic conjunctivitis is closely associated with asthma and allergic rhinitis. However, further studies are warranted to determine the prevalence and effects of these comorbidities on health outcomes in preschool children.

IL3 SNP rs40401 variant is a risk factor for rhinoconjunctivitis in Japanese women: the Kyushu Okinawa maternal and child health study

BACKGROUND

No studies have investigated the relationship between IL3 single nucleotide polymorphism (SNP) rs40401 and allergic rhinitis. We performed a case-control study to examine this issue and to assess interactions between the SNP and smoking or older siblings in young adult Japanese women.

METHODS

Included were 393 women who met the criteria of the International Study of Asthma and Allergies in Childhood (ISAAC) for rhinoconjunctivitis. Controls were 767 women without rhinoconjunctivitis according to the ISAAC criteria who had not been diagnosed with allergic rhinitis by a doctor.

RESULTS

Compared with women with the TT genotype of SNP rs40401, those with the CC genotype had a significantly increased risk of rhinoconjunctivitis: the adjusted OR was 1.52 (95% CI: 1.05-2.19). This positive relationship was significant under the additive model: the adjusted OR was 1.23 (95% CI: 1.02-1.47). The positive association fell just short of the significance level under the dominant or recessive model. There was no significant interaction between SNP rs40401 and smoking with respect to rhinoconjunctivitis. Compared with subjects with the TT or TC genotype of IL3 SNP rs40401 who had one or more older siblings, those with the CC genotype who had no older siblings had a 2.33-fold increased risk of rhinoconjunctivitis; nevertheless, the interaction was not significant.

CONCLUSION

This is the first study to show a significant positive association between IL3 SNP rs40401 variant and the risk of rhinoconjunctivitis. We could not find evidence for interactions between SNP rs40401 and smoking or older siblings affecting rhinoconjunctivitis.

Rhinitis has an association with asthma in school children

BACKGROUND

A relevant relationship exists between the upper and lower airway, indicating the concept of a unified airway. This study aimed to evaluate whether rhinitis has an association with asthma in children.

METHODS

A cross-sectional nationwide survey was performed among children 6-7, 13-14, and 16-17 years old, using the International Study of Asthma and Allergies in Children (ISAAC) questionnaire in Japan. According to the responses to the ISAAC core questions, a child who had experienced nasal symptoms in the past 12 months in the absence of a cold was defined as having current rhinitis.

RESULTS

After excluding 11,475 children because of incomplete data, 136,506 children were analyzed. Even after adjusting for demographics, sex, and obesity, children with current rhinitis were more likely to have asthma (adjusted odds ratio [OR], 3.10 [95% CI, 2.92-3.30] in children aged 6-7 years; OR, 3.76 [95% CI, 3.45-4.10] in children aged 13-14 years; and OR, 3.59 [95% CI, 3.33-3.88] in children aged 16-17 years). Children whose daily activities were more impaired by rhinitis symptoms had a significantly higher prevalence of severe asthma. The adjusted ORs for severe asthma among asthmatic children whose daily activities were severely impaired by rhinitis symptoms were 3.66 (95% CI, 2.29-5.85) in children aged 6-7 years, 2.55 (95% CI, 1.64-3.96) in children aged 13-14 years, and 1.87 (95% CI, 1.24-2.82) in children aged 16-17 years compared with asthmatic children whose daily activities were not impaired at all.

CONCLUSION

There was a close association between rhinitis and asthma in young children to adolescents. Asthma should be examined in children with rhinitis symptoms.

The global decline in asthma death rates: can we relax now?

Whilst global asthma mortality seems to be decreasing, childhood asthma incidence is rising, and early warnings from Australia show an increase in asthma-related deaths in under-15s; this article considers whether we should view the future impact of asthma with trepidation. Age-adjusted mortality statistics for asthma have been reevaluated to provide an international standard. Comparisons across regions and time are complex, yet over the last two decades asthma mortality has clearly decreased, coinciding with a significant change in asthma management. The majority of remaining asthma deaths are preventable. Nonetheless, ongoing vigilance is required. Asthma remains under-diagnosed and under-treated. Childhood asthma has become more common; it is a matter of debate whether it is also more severe. Rather than being encouraged by the fall in numbers of asthma deaths, we should focus on the surging numbers of children suffering from the disease - and the worrying increase in asthma death rates in Australian children - and work to avert future issues.

Analysis of the association between air pollution and allergic diseases exposure from nearby sources of ambient air pollution within elementary school zones in four Korean cities

The objectives of this study were to survey elementary school students regarding the environmental conditions of their elementary schools and to assess the relationship between air pollution and allergic disease using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Therefore, this study was designed as a cross-sectional study. In this study, seven elementary schools were selected and they were classified into three categories. The selection included one school with no traffic-related or other pollutants, three with traffic-related pollutants, and three with traffic-related and other pollutants from industrial and filling station sources. The ISAAC questionnaire survey was given to all of the students except to those in the 1st grade who were presumed to be less likely to be exposed to the school environment than the remainder of the students attending those seven schools. The assessment of allergic disease was conducted on a total of 4,545 students. Three school zones with critical exposure were selected within each school and they were evaluated based on the levels of black carbon (BC), PM10, SO2, NO2, and O3. There was a significant increase in the risks based on the odds ratios of treatment experiences (within 1 year) for allergy-related diseases such as asthma and allergic rhinitis (a) in the school group with traffic-related pollutants and the school group with complex pollutants were 2.12 (1.41-3.19) and 1.59 (1.06-2.37), respectively, in comparison to the school groups with no exposure to pollutants. This was determined based on the odds ratio of symptoms and treatment experiences for allergy-related diseases by group based on the home town zone as a reference. Also, in the case of atopic dermatitis, the odds ratio of treatment experiences (within 1 year) was 1.42 (1.02-1.97), which indicated elevated risks compared to the students in the S1 school. A regression analysis was used to assess the relationship between the substances and the symptomatic experiences within the last year. There were significant increases in the odds ratio of the symptoms associated with allergic rhinitis and the BC and SO2 in the complex pollution areas. The results of the assessment of the relationship between atopic dermatitis-associated symptoms and O3 showed that the odds ratio increased with statistical significance.

Comparative analysis of allergic rhinitis in children and adults

Allergic rhinitis (AR) is a worldwide health problem that generates a significant healthcare burden in adults, adolescents, and children. Epidemiological studies have indicated that the prevalence of AR has progressively increased over the last three decades in developed and industrialized countries. AR currently affects up to 40 % of the worldwide population, with differences between adults and children and different countries of the World. Although not life-threatening, AR symptoms are frequently bothersome, adversely affecting work and quality of life of the affected patients, and causing a significant burden on both the individual and society. The symptoms have the potential to lead to both physical and mental complications, with sleep-disordered breathing in childhood and adolescence being associated with disorders in learning performance, behavior, and attention. Clinical features and comorbidities are very important for the "allergic march", and in both adults and children there is some evidence of association between AR and asthma. ARIA classifications of both symptom duration (intermittent, persistent) and severity (mild, moderate, severe) have been validated in both adult and pediatric populations. Based on the duration and severity of patient's disease, an appropriate treatment strategy has been issued for both adults and children, which consists of patient's education, allergen avoidance, and pharmacological as well as allergen-specific immunotherapy treatment. The present review will attempt to compare the characteristics of AR between children and adults, either in the epidemiology, clinical features, impact on QOL, and management of the disease.

Phenotyping of allergic rhinitis

Allergic rhinitis (AR) is characterized by immune-mediated inflammation of the nasal mucosal lining. Although this chronic disease is not fatal, it is associated with many debilitating symptoms. Like many other chronic diseases, AR has a wide range of clinical aspects, and comorbidities such as asthma, rhinosinusitis, dermatitis, and conjunctivitis may accompany the disease to different degrees. These comorbidities and features determine the clinical phenotypes of AR. Different phenotypes and other characteristics of AR are discussed in this review. It is important for clinicians to be aware of these variable clinical phenotypes of AR to diagnose and treat the disease properly.

Changing prevalence of allergic diseases in the Asia-pacific region

Asia-Pacific is one of the most densely populated regions of the world and is experiencing rapid economic changes and urbanization. Environmental pollution is a significant problem associated with the rapid modernization of many cities in South Asia. It is not surprising that the prevalences of asthma and allergies are increasing rapidly, although the underlying reasons remain largely unknown. Many studies from this region have documented the changing prevalence of allergic diseases in various parts of the world. However, the methodologies used were neither standardized nor validated, making the results difficult to evaluate. The International Study of Asthma and Allergies in Childhood (ISAAC) has provided a global epidemiology map of asthma and allergic diseases, as well as the trend of changes in the prevalence of these diseases. Allergic sensitization is extremely common in many Asian communities. However, the prevalence of allergic diseases remains relatively rare. The rapid urbanization in the region, which increases environmental pollution and can affect the rural environment, will likely increase the prevalence of asthma and allergies in Asia.

The International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three: a global synthesis

This ISAAC Phase Three synthesis provides summarised information on the main findings of the study, regional tables and figures related to the prevalence and severity of current symptoms of asthma, rhinoconjunctivitis and eczema in the main regions of the world. The large number of surveyed children (≈1,200,000), the large number of centres (233) and countries (98) that participated in ISAAC Phase Three makes this study the most comprehensive survey of these diseases ever undertaken. Globally, the prevalence for current asthma, rhinoconjunctivitis and eczema in the 13-14-year age group was 14.1%, 14.6% and 7.3%, respectively. In the 6-7-year age group the prevalence for current asthma, rhinoconjunctivitis and eczema was 11.7%, 8.5% and 7.9%, respectively. The study shows a wide variability in the prevalence and severity of asthma, rhinoconjunctivitis and eczema which occurs not just between regions and countries but between centres in the same country and centres in the same city. This study definitively establishes that the prevalence of those diseases can be very high in non-affluent centres with low socioeconomic conditions. The large variability also suggests a crucial role of local environment characteristics to determine the differences in prevalence between one place and another. Thus, ISAAC Phase Three has provided a large body of epidemiological information on asthma, rhinoconjunctivitis and eczema in childhood from contrasting environments which is expected to yield new clues about the aetiology of those conditions and reasons for their marked global variability.

Allergic rhinitis in adolescence increases the risk of depression in later life: a nationwide population-based prospective cohort study

BACKGROUND

Many cross-sectional studies have suggested an association between allergic rhinitis (AR) and depression, but the timing relationship was not determined. Using a nationwide population-based prospective cohort study (1:4, age-/gender-matched), we hypothesized that AR in adolescence would increase the risk of depression in later life.

METHODS

In all, 1673 adolescents aged 12-15 that had AR between 1996 and 2000 were recruited for our study. Cases of major depressive disorder and any depressive disorder that occurred to the end of follow-up (December 31, 2010) were identified.

RESULT

Adolescents with AR had a higher prevalence of major depression (2.5% vs. 1.2%, p<0.001) and any depressive disorder (4.9% vs. 2.8%, p<0.001) and an earlier onset of major depression (19.31 ± 2.91 vs. 20.43 ± 2.71 years, p=0.038) and any depressive disorder (19.35 ± 2.63 vs. 20.43 ± 2.62 years, p=0.002) compared with the controls. The Cox regression model showed that adolescents with AR had increased HRs of major depression (HR: 1.59, 95% CI: 1.02-2.50) and any depressive disorder (HR: 1.42, 95% CI: 1.04-1.93) after controlling residence location and comorbid allergic diseases.

LIMITATIONS

The prevalence of depressive disorder may be underestimated because only those who had medicine-seeking behaviors were enrolled.

CONCLUSIONS

This first cohort case-control study showed an association between AR in early adolescence and depression in late adolescence and early adulthood. Our results suggested that allergic responses played important roles in the development of depression.

Recognition of allergic conjunctivitis in patients with allergic rhinitis

AIMS

To identify the incidence of allergic conjunctivitis in patients with allergic rhinitis.

METHODS

One hundred and eighty seven consecutive patients with allergic rhinitis (AR) were directly questioned if they have allergic conjunctivitis (AC) and this was clarified using standard screening questions relating to red, itchy and watery eyes recorded through a total ocular symptom score (TOSS). Patients were also asked about further symptoms that may be attributable to AC: eyelid dermatitis, frequent blinking; eye sensitivity and frontal headache from squinting or. blinking. All patients were given a drop of olopatadine hydrochloride 0.1% in each eye to help identify "silent" disease. 20 healthy non-atopic controls were also treated with olopatadine drops and questioned on ocular symptoms.

RESULTS

Fifty five percent of patients with AR were identified as having AC by direct questioning and the use of the TOSS questionaire. A further 41% were identifiable by asking additional questions and performing therapeutic challenge with olopadatine.

CONCLUSIONS

AC is a frequent comorbid condition occurring in 95% of our patients with AR. Only 55% of patients were able to identify that they had AC based on standard screening questions. Additional specific questioning and a therapeutic challenge in suspected patients can help identify patients who may benefit from treatment of AC.

Does change of residence affect pollinosis? A study of Japanese university students

The effects of change of residence on pollinosis symptoms remain unclear. We investigated the effects of geographical change of residence on pollinosis symptoms among university freshmen. All freshmen (n = 2142) entering Shinshu University in 2011 completed self-administered questionnaires. Associations between history of pollinosis and environmental factors were assessed. Subjects were classified into three groups according to pollen count at previous residences (stationary, low pollen, and high pollen). Pollinosis both before and after relocation were compared among and within the groups. Of the 1558 subjects, 540 (34.7%) developed pollinosis before and 483 (31.0%) after entering university. The rates of pre- and post-university entrance pollinosis were 40.0 and 32.5% in the high pollen group (P < 0.001) but were similar in the other two groups. Pollinosis symptoms decreased among students that moved from high to low pollen areas, indicating that pollinosis was affected by geographic environmental factors.

Exposure to cats and dogs, and symptoms of asthma, rhinoconjunctivitis, and eczema

BACKGROUND

Associations between exposure to cats and dogs and respiratory and allergic outcomes in children have been reported in affluent countries, but little is known about such associations in less-affluent countries.

METHODS

The International Study of Asthma and Allergies in Childhood, phase 3 was carried out in children aged 6-7 years and adolescents aged 13-14 years across the world. Questions about cats and dogs in the home were included in an additional questionnaire. Using logistic regression, we investigated the association between such exposures and symptoms of asthma, rhinoconjunctivitis, and eczema. Adjustments were made for sex, region of the world, language, gross national income per capita, and 10 other covariates.

RESULTS

Among children (6-7 years of age), cat exposure in the first year of life was associated with current symptoms of asthma, wheeze, rhinoconjunctivitis, and eczema, especially in less-affluent countries. Among adolescents (13-14 years of age), we found a positive association between exposure to cats or dogs and symptom prevalence in more-affluent and less-affluent countries. The global multivariate odds ratios for children with complete covariate data were 1.17 (95% confidence interval = 1.08-1.29) for current symptoms of asthma, 1.13 (1.05-1.23) for rhinoconjunctivitis, and 1.38 (1.26-1.52) for eczema. Smaller odds ratios were found for exposure to only dogs. Exposure to only cats was associated with eczema.

CONCLUSION

Early-life exposure to cats is a risk factor for symptoms of asthma, rhinoconjunctivitis, and eczema in 6- to 7-year-old children, especially in less-affluent countries. Current exposure to cats and dogs combined, and only to dogs, is a risk factor for symptom reporting by 13- to 14-year-old adolescents worldwide.

Nasal mucosa temperature as a marker of disease in children with allergic rhinitis

BACKGROUND

Allergic rhinitis (AR) is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the nasal mucosa. This study was designed to investigate the role of nasal mucosa temperature in AR.

METHODS

We investigated the relationship between eosinophilic infiltration, nasal obstruction, and nasal mucosa temperature in 35 children with rhinitis aged 6-12 years.

RESULTS

A significant relationship was shown between nasal temperature values and eosinophil infiltration at nasal cytology (p < 0.01). Nasal temperature was also significantly associated with nasal obstruction, assessed in terms of nasal volume (Vol [2-5 cm]; p < 0.05) and minimum cross-sectional area (p < 0.01). No significant correlation emerged between the degree of nasal obstruction and presence of eosinophils at nasal cytology (p > 0.05).

CONCLUSION

These results suggest a relationship between nasal temperature and nasal mucosa inflammation and obstruction.