1
|
Conley N. Social Determinants of Health, Chronic Disease Management, and the Role of the Primary Care Provider-to Include Cardiovascular Disease, Cancer, Diabetes, Major Causes of Morbidity and Mortality as Affected by Social Determinants of Health. Prim Care 2023; 50:671-678. [PMID: 37866839 DOI: 10.1016/j.pop.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Despite advances in health science and medical technology, health outcomes continue to fall behind in certain communities. A recent study linking health outcomes to zip code may explain part of this disparity, social determinants of health. Although well known that patients in resource-poor environments have worse outcomes than patients with advantages, the exact reason for this disparity may not be so well known. This article aims to explore the physiologic basis for worsening disease states in patients with poor social determinants of health, as well as start a discussion surrounding possible screening and interventions that can be performed in a primary care office to promote patient health.
Collapse
Affiliation(s)
- Nicholas Conley
- Cooperative Recovery, Integrated Health Cooperative at Mental Health Cooperative, 275 Cumberland Bend, Nashville TN 37228, USA.
| |
Collapse
|
2
|
Zheng K, Bassal M, Mitsakakis N, Cepalo T, Hamid JS, Momoli F, Reisman J, Nair V, Radhakrishnan D. A longitudinal analysis of early lung function trajectory in survivors of childhood Hodgkin lymphoma. Cancer Rep (Hoboken) 2022; 6:e1661. [PMID: 35760768 PMCID: PMC9875613 DOI: 10.1002/cnr2.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Childhood Hodgkin lymphoma survivors suffer from long-term effects decades after treatment completion with a prevalence of pulmonary dysfunction of up to 65.2%. AIMS This study explored the early trajectory of pulmonary function in pediatric cancer patients with Hodgkin lymphoma who received pulmonary toxic therapy. METHODS AND RESULTS In this single-center, 20-year retrospective cohort study, we included patients who were <18 years old at diagnosis of Hodgkin lymphoma between January 1994 and December 2014, and received bleomycin or thoracic radiation. We measured pulmonary function and reported on percent predicted values for forced expiratory volume in 1 s, total lung capacity, and diffusing capacity of the lungs. We used linear mixed models to identify the association of clinical factors with longitudinal changes in lung function at time points before and after treatment completion. Of 80 children who met inclusion criteria, all were treated with bleomycin, and 83.8% received thoracic radiation. More than half (51.2%) of patients had any abnormalities in lung function measures during the study observation period which averaged 24.2 months (±31.1SD). Females, younger age at diagnosis and treatment with radiation were associated with lower lung function measurements at various time points. While the majority of children experienced a recovery of their lung function within 1-2 years after treatment completion, some children with these risk factors did not. CONCLUSION Pulmonary function abnormalities begin early in children treated for Hodgkin lymphoma. While the majority of children demonstrate a slow and continuous improvement in lung function back to baseline over time, we recommend routine asymptomatic screening of pulmonary function in certain childhood cancer survivors, particularly females, those diagnosed young and patients who received radiation therapy.
Collapse
Affiliation(s)
- Katina Zheng
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada
| | - Mylène Bassal
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Department of Pediatrics, Division of Hematology/OncologyChildren's Hospital of Eastern OntarioOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | - Nicholas Mitsakakis
- Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | | | - Jemila Seid Hamid
- Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada
| | - Franco Momoli
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada,Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Joseph Reisman
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada,Department of Pediatrics, Division of RespirologyChildren's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Vimoj Nair
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada,Ottawa Hospital Research InstituteOttawaOntarioCanada,Division of Radiation OncologyUniversity of OttawaOttawaOntarioCanada
| | - Dhenuka Radhakrishnan
- Faculty of MedicineUniversity of OttawaOttawaOntarioCanada,Children's Hospital of Eastern Ontario Research InstituteOttawaOntarioCanada,Department of Pediatrics, Division of RespirologyChildren's Hospital of Eastern OntarioOttawaOntarioCanada,ICES uOttawaOttawaOntarioCanada
| |
Collapse
|
3
|
Malliori S, Ntzounas A, Lampropoulos P, Koliofoti E, Priftis KN, Fouzas S, Anthracopoulos MB. Diverging trends of respiratory allergies and eczema in Greek schoolchildren: Six surveys during 1991-2018. Allergy Asthma Proc 2022; 43:e17-e24. [PMID: 34983719 DOI: 10.2500/aap.2022.43.210110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: The prevalence of childhood asthma, rhinoconjunctivitis, and eczema in the city of Patras, Greece, has been followed in four consecutive surveys since 1991. After a continuous rise in the prevalence of all three of these disorders, a plateau was reached for asthma between 2003 and 2008, whereas the prevalence of rhinoconjunctivitis and eczema continued to increase. Objective: To investigate these trends in the same population into the following decade. Methods: We repeated two methodologically identical cross-sectional parental questionnaire surveys in 2013 and 2018 among 8-9-year-old schoolchildren (N = 2554 and N = 2648, respectively). In 2018, spirometry and fractional exhaled nitric oxide (FeNO) measurements were also performed. Results: Current asthma (i.e., wheeze/asthma in the past 2 years) decreased from 6.9% in 2008 to 5.2% in 2013 and 4.3% in 2018 (p for trend < 0.001). The prevalence of lifetime ("ever had") rhinoconjunctivitis also declined (5.1% in 2008, 4.4% in 2013, 3.0% in 2018; p for trend < 0.001), whereas that of lifetime eczema increased (10.8%, 13.6%, and 16.1%, respectively; p for trend < 0.001). The relative risk of current asthma in children with ever-had rhinoconjundtivitis was 7.73 in 2008, 6.00 in 2013, and 6.69 in 2018, whereas the relative risk in those with ever-had eczema was 5.15, 2.80, and 2.22, respectively. Among children with asthma, those with rhinoconjunctivitis had lower forced expiratory volume in the first second of expiration and higher FeNO values than those with eczema. Conclusion: The prevalence of asthma and rhinoconjunctivitis declined during the past decade in Greek schoolchildren, whereas the prevalence of eczema continued to rise. Nevertheless, the relationship between rhinoconjunctivitis and asthma remained strong, whereas the association between eczema and asthma appears to have weakened.
Collapse
Affiliation(s)
- Styliani Malliori
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Alexandros Ntzounas
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Panagiotis Lampropoulos
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Eleana Koliofoti
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Kostas N. Priftis
- Third Department of Paediatrics, “Attikon” Hospital, University of Athens Medical School, Athens, Greece
| | - Sotirios Fouzas
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| | - Michael B. Anthracopoulos
- From the Pediatric Respiratory Unit, University Hospital of Patras, University of Patras Medical School, Rion, Patras, Greece; and
| |
Collapse
|
4
|
Ahmad K, Kabir E, Ormsby GM, Khanam R. Are wheezing, asthma and eczema in children associated with mother's health during pregnancy? Evidence from an Australian birth cohort. ACTA ACUST UNITED AC 2021; 79:193. [PMID: 34749801 PMCID: PMC8577022 DOI: 10.1186/s13690-021-00718-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study investigated the prevalence of wheezing, asthma, and eczema among Australian children using longitudinal data from birth to 15 years of age. This study also examined the association between maternal health status during pregnancy and their offspring's respiratory and allergic morbidities using sex-segregated data. METHODS This study used data from the Longitudinal Study of Australian Children (LSAC) where approximately 5000 children of a birth cohort across Australia were surveyed in 2004. These children were followed biennially in eight waves up to their age of 15 years until 2018. The status of the children's wheezing, asthma, and eczema were reported by the mothers upon doctors' diagnosis (for asthma) or self-assessment (for wheezing or eczema). Binomial logistic regression models were used to analyse associations between maternal health during pregnancy and their children's health outcomes. RESULTS Asthma prevalence among 0-1-year aged children was 11.7%, increased to 15.4% when the children were 10-11 years old, and then decreased to 13.6% when they were 14-15 years old. Wheezing and eczema were most prevalent when the children were 2-3 years old (26.0 and 17.8% respectively) and were least prevalent when the children were 14-15 years old (7.3 and 9.5% respectively). Maternal asthma, smoking during pregnancy, and pre-pregnancy obesity were significantly associated with an increased risk of wheezing and asthma in Australian children. Childhood eczema was associated only with maternal asthma. These associations were stronger among male children up to age 10-11 and during adolescence (12-15 years of age), female children were more prone to wheezing, asthma, and eczema. CONCLUSION This is a comprehensive longitudinal study of Australian children (0-15 years of age) to assess the prevalence (with sex-specific differences) of wheezing, asthma and eczema as well as the association between these respiratory and allergic morbidities and maternal health during pregnancy. The study findings suggest that careful medical and obstetric monitoring, improved specific age-sex wise risk factor prevention for children and health promotion for pregnant women would help protect child health.
Collapse
Affiliation(s)
- Kabir Ahmad
- School of Business, Faculty of Business, Education, Law and Arts, and Centre for Health Research, University of Southern Queensland, Toowoomba, Australia. .,Research Unit, Purple Informatics, Dhaka, Bangladesh. .,Present Address: School of Business, Faculty of Business, Education, Law and Arts, and Centre for Health Research, University of Southern Queensland, Toowoomba, Australia.
| | - Enamul Kabir
- School of Sciences, Faculty of Health, Engineering and Sciences, and Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Gail M Ormsby
- Independent Researcher, Professional Studies, Faculty of Business, Education, Law and Arts, University of Southern Queensland, Toowoomba, Australia
| | - Rasheda Khanam
- School of Business, Faculty of Business, Education, Law and Arts, and Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| |
Collapse
|
5
|
Ntzounas A, Giannakopoulos I, Lampropoulos P, Vervenioti A, Koliofoti EG, Malliori S, Priftis KN, Dimitriou G, Anthracopoulos MB, Fouzas S. Changing trends in the prevalence of childhood asthma over 40 years in Greece. Pediatr Pulmonol 2021; 56:3242-3249. [PMID: 34288606 DOI: 10.1002/ppul.25575] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 06/08/2021] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND A series of repeated questionnaire surveys among 8- to 9-year-old school children in the city of Patras, Greece, demonstrated a continuous rise in the prevalence of wheeze/asthma from 1978 to 2003, with a plateau between 2003 and 2008. We further investigated wheeze/asthma trends within the same environment over the last decade. METHODS Two follow-up surveys were conducted in 2013 (N = 2554) and 2018 (N = 2648). Physician-diagnosed wheeze and asthma were analyzed in relation to their occurrence (recent-onset: within the last 2 years; noncurrent: before 2 years; persistent: both prior and within the last 2 years). In 2018, spirometry was also performed in participants reporting symptoms and in a sample of healthy controls. RESULTS The prevalence of current wheeze/asthma declined from 6.9% in 2008% to 5.2% in 2013% and 4.3% in 2018. The persistent and noncurrent wheeze/asthma groups followed this overall trend (P-for-trend <0.001), while the prevalence of recent-onset wheeze/asthma remained unchanged (P-for-trend >0.05). Persistent and noncurrent wheezers were also more frequently diagnosed with asthma, in contrast to those with recent-onset wheeze. The FEV1 z-score was less than -1 in 32.1% of children with recent-onset and in 22.4% of those with persistent wheeze/asthma; both rates were higher than those of the Noncurrent wheeze/asthma group (7.1%; p < .05) and of healthy controls (3.5%; p < .001). CONCLUSIONS The prevalence of childhood wheeze/asthma has declined significantly during the last decade in Greece. The reversing trend may in part be attributed to changing asthma perceptions among physicians and/or parents, especially in the case of younger children with troublesome respiratory symptoms.
Collapse
Affiliation(s)
- Alexandros Ntzounas
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Ioannis Giannakopoulos
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Panagiotis Lampropoulos
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Aggeliki Vervenioti
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Eleana-Georgia Koliofoti
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Styliani Malliori
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Kostas N Priftis
- Third Department of Pediatrics, "Attikon" Hospital and Athens University Medical School, Athens, Greece
| | - Gabriel Dimitriou
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Michael B Anthracopoulos
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| | - Sotirios Fouzas
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras and University of Patras Medical School, Rion, Patras, Greece
| |
Collapse
|
6
|
Mackey E, Thelen KM, Bali V, Fardisi M, Trowbridge M, Jordan CL, Moeser AJ. Perinatal androgens organize sex differences in mast cells and attenuate anaphylaxis severity into adulthood. Proc Natl Acad Sci U S A 2020; 117:23751-23761. [PMID: 32917815 PMCID: PMC7519313 DOI: 10.1073/pnas.1915075117] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Mast cell (MC)-associated diseases, including allergy/anaphylaxis and neuroinflammatory pain disorders, exhibit a sex bias, with females at increase risk. While much attention has been directed toward adult sex hormones as drivers of sex differences, that female sex bias in MC-associated diseases is evident in prepubertal children, suggesting early-life origins of sex differences which have yet to be explored. Utilizing rodent models of MC-mediated anaphylaxis, our data here reveal that, 1) compared with females, males exhibit significantly reduced severity of MC-mediated anaphylactic responses that emerge prior to puberty and persist into adulthood, 2) reduced severity of MC-mediated anaphylaxis in males is linked with the naturally high level of perinatal androgens and can be recapitulated in females by perinatal exposure to testosterone proprionate, 3) perinatal androgen exposure guides bone marrow MC progenitors toward a masculinized tissue MC phenotype characterized by decreased concentration of prestored MC granule mediators (e.g., histamine, serotonin, and proteases) and reduced mediator release upon degranulation, and 4) engraftment of MC-deficient Kit W-sh/W-sh mice with adult male, female, or perinatally androgenized female MCs results in MC-mediated anaphylaxis response that reflects the MC sex and not host sex. Together, these data present evidence that sex differences in MC phenotype and resulting disease severity are established in early life by perinatal androgens. Thus, factors affecting levels of perinatal androgens could have a significant impact on MC development and MC-associated disease risk across the life span.
Collapse
Affiliation(s)
- Emily Mackey
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824
- Comparative Biomedical Sciences Program, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27603
| | - Kyan M Thelen
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824
| | - Vedrana Bali
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824
- Department of Physiology, Michigan State University, East Lansing, MI 48824
| | - Mahsa Fardisi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824
| | - Madalyn Trowbridge
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824
| | - Cynthia L Jordan
- Department of Physiology, Michigan State University, East Lansing, MI 48824
- Neuroscience Program, Michigan State University, East Lansing, MI 48824
- Psychology Department, Michigan State University, East Lansing, MI 48824
| | - Adam J Moeser
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824;
- Department of Physiology, Michigan State University, East Lansing, MI 48824
- Neuroscience Program, Michigan State University, East Lansing, MI 48824
| |
Collapse
|
7
|
Norlander AE, Peebles RS. Innate Type 2 Responses to Respiratory Syncytial Virus Infection. Viruses 2020; 12:E521. [PMID: 32397226 PMCID: PMC7290766 DOI: 10.3390/v12050521] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 12/15/2022] Open
Abstract
Respiratory syncytial virus (RSV) is a common and contagious virus that results in acute respiratory tract infections in infants. In many cases, the symptoms of RSV remain mild, however, a subset of individuals develop severe RSV-associated bronchiolitis. As such, RSV is the chief cause of infant hospitalization within the United States. Typically, the immune response to RSV is a type 1 response that involves both the innate and adaptive immune systems. However, type 2 cytokines may also be produced as a result of infection of RSV and there is increasing evidence that children who develop severe RSV-associated bronchiolitis are at a greater risk of developing asthma later in life. This review summarizes the contribution of a newly described cell type, group 2 innate lymphoid cells (ILC2), and epithelial-derived alarmin proteins that activate ILC2, including IL-33, IL-25, thymic stromal lymphopoietin (TSLP), and high mobility group box 1 (HMGB1). ILC2 activation leads to the production of type 2 cytokines and the induction of a type 2 response during RSV infection. Intervening in this innate type 2 inflammatory pathway may have therapeutic implications for severe RSV-induced disease.
Collapse
Affiliation(s)
| | - R. Stokes Peebles
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232-2650, USA;
| |
Collapse
|
8
|
James P, Cornish A, Brady K, Morrison J, Giunta Y, Zuckerman B, Hahn B. Is There Benefit in Identifying Asthma Triggers During an Exacerbation? Clin Pediatr (Phila) 2020; 59:142-147. [PMID: 31718283 DOI: 10.1177/0009922819887399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction. Allergen-specific IgE (sIgE) testing provides an objective assessment of sensitization to an allergen. Goal. To identify the time when serum measurements of sIgE would be most sensitive. Methods. This was a prospective study conducted between September 1, 2015, and February 25, 2019. Subjects ≥5 and ≤18 years of age, seen in the ED or admitted with an asthma exacerbation, were tested for total IgE and 8 perennial sIgE levels. Subjects with elevated sIgE were tested again after symptom resolution. Results. A total of 104 subjects were enrolled; 50 subjects were eligible for inclusion in the analysis. There were statistically significant differences between the visits for all sIgE, except Alternaria alternatum. Conclusions. In pediatric patients, serum sIgE levels measured during an asthma exacerbation were elevated compared with when their asthma was in better control. sIgE testing during an asthma exacerbation may help identify asthma triggers, mitigate exposure, and hence improve asthma control.
Collapse
Affiliation(s)
- Pushpom James
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Anna Cornish
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Kaylan Brady
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Jennifer Morrison
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Yvonne Giunta
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Batya Zuckerman
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Barry Hahn
- Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| |
Collapse
|
9
|
Morikawa E, Sasaki M, Yoshida K, Adachi Y, Odajima H, Akasawa A. Nationwide survey of the prevalence of wheeze, rhino-conjunctivitis, and eczema among Japanese children in 2015. Allergol Int 2020; 69:98-103. [PMID: 31548125 DOI: 10.1016/j.alit.2019.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/15/2019] [Accepted: 08/23/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Global surveys and cohort studies have been conducted to evaluate the prevalence of allergic disease in childhood, but only a few nationwide surveys have been conducted in Japan. We aimed to report the prevalence of childhood allergic disease in Japan and determine the prevalence distribution by sex and prefecture. METHODS In 2015, we conducted a school-based questionnaire survey using the Japanese version of the International Study of Asthma and Allergies in Childhood questionnaire among two age groups: primary school students (PS, 6-8 years old) and middle school students (MS, 13-15 years old). The schools were randomly selected from each prefecture. RESULTS Valid responses were obtained from 42,582 PS and 36,638 MS. Among PS and MS, the prevalence of wheeze was 10.2% and 8.2%, that of allergic rhino-conjunctivitis was 18.7% and 26.7%, and that of eczema was 14.6% and 9.7%, respectively. In terms of sex, the prevalence of wheeze and rhino-conjunctivitis was higher in male PS while that of rhino-conjunctivitis and eczema was higher in female MS. In terms of prefecture, there was a two-fold difference in the prevalence of wheeze and eczema and a four-fold difference in the prevalence of rhino-conjunctivitis, with each disease showing different distribution patterns. CONCLUSIONS We demonstrated the prevalence of allergic disease among PS and MS in 2015. The prevalence tended to be higher in male PS and female MS. Each disease exhibited different prevalence ranges and distributions. Identifying the factors behind these differences is a topic for future research.
Collapse
|
10
|
Ranathunga N, Perera P, Nandasena S, Sathiakumar N, Kasturiratne A, Wickremasinghe R. Effect of household air pollution due to solid fuel combustion on childhood respiratory diseases in a semi urban population in Sri Lanka. BMC Pediatr 2019; 19:306. [PMID: 31477087 PMCID: PMC6720872 DOI: 10.1186/s12887-019-1674-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 08/19/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Household air pollution from combustion of solid fuels for cooking and space heating is one of the most important risk factors of the global burden of disease. This study was aimed to determine the association between household air pollution due to combustion of biomass fuel in Sri Lankan households and self-reported respiratory symptoms in children under 5 years. METHODS A prospective study was conducted in the Ragama Medical Officer of Health area in Sri Lanka. Children under 5 years were followed up for 12 months. Data on respiratory symptoms were extracted from a symptom diary. Socioeconomic data and the main fuel type used for cooking were recorded. Air quality measurements were taken during the preparation of the lunch meal over a 2-h period in a subsample of households. RESULTS Two hundred and sixty two children were followed up. The incidence of infection induced asthma (RR = 1.77, 95%CI;1.098-2.949) was significantly higher among children resident in households using biomass fuel and kerosene (considered as the high exposure group) as compared to children resident in households using Liquefied Petroleum Gas (LPG) or electricity for cooking (considered as the low exposure group), after adjusting for confounders. Maternal education was significantly associated with the incidence of infection induced asthma after controlling for other factors including exposure status. The incidence of asthma among male children was significantly higher than in female children (RR = 1.17; 95% CI 1.01-1.37). Having an industry causing air pollution near the home and cooking inside the living area were significant risk factors of rhinitis (RR = 1.39 and 2.67, respectively) while spending less time on cooking was a protective factor (RR = 0.81). Houses which used biomass fuel had significantly higher concentrations of carbon monoxide (CO) (mean 2.77 ppm vs 1.44 ppm) and particulate matter2.5 (PM2.5) (mean 1.09 mg/m3 vs 0.30 mg/m3) as compared to houses using LPG or electricity for cooking. CONCLUSION The CO and PM2.5 concentrations were significantly higher in households using biomass fuel for cooking. There was a 1.6 times higher risk of infection induced asthma (IIA) among children of the high exposure group as compared to children of the low exposure group, after controlling for other factors. Maternal education was significantly associated with the incidence of IIA after controlling for exposure status and other variables.
Collapse
Affiliation(s)
- Nayomi Ranathunga
- Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka.
| | - Priyantha Perera
- Faculty of Medicine, University of Kelaniya, P.O. Box 6, Thalagolla Road, Ragama, 11010, Sri Lanka
| | | | - Nalini Sathiakumar
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, 11010, Sri Lanka
| | - Rajitha Wickremasinghe
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, 11010, Sri Lanka
| |
Collapse
|
11
|
Sex-associated TSLP-induced immune alterations following early-life RSV infection leads to enhanced allergic disease. Mucosal Immunol 2019; 12:969-979. [PMID: 31076663 PMCID: PMC6599479 DOI: 10.1038/s41385-019-0171-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/23/2019] [Accepted: 04/22/2019] [Indexed: 02/04/2023]
Abstract
Many studies have linked severe RSV infection during early-life with an enhanced likelihood of developing childhood asthma, showing a greater susceptibility in boys. Our studies show that early-life RSV infection leads to differential long-term effects based upon the sex of the neonate; leaving male mice prone to exacerbation upon secondary allergen exposure while overall protecting female mice. During initial viral infection, we observed better viral control in the female mice with correlative expression of interferon-β that was not observed in male mice. Additionally, we observed persistent immune alterations in male mice at 4 weeks post infection. These alterations include Th2 and Th17-skewing, innate cytokine expression (Tslp and Il33), and infiltration of innate immune cells (DC and ILC2). Upon exposure to allergen, beginning at 4 weeks following early-life RSV-infection, male mice show severe allergic exacerbation while female mice appear to be protected. Due to persistent expression of TSLP following early-life RSV infection in male mice, genetically modified TSLPR-/- mice were evaluated and demonstrated an abrogation of allergen exacerbation in male mice. These data indicate that TSLP is involved in the altered immune environment following neonatal RSV-infection that leads to more severe responses in males during allergy exposure, later in life. Thus, TSLP may be a clinically relevant therapeutic target early in life.
Collapse
|
12
|
Zazara DE, Arck PC. Developmental origin and sex-specific risk for infections and immune diseases later in life. Semin Immunopathol 2018; 41:137-151. [DOI: 10.1007/s00281-018-0713-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022]
|
13
|
Radhakrishnan D, Dell SD, Guttmann A, Shariff SZ, To T. 20-Year trends in severe childhood asthma outcomes: Hospitalizations and intensive care visits. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2018. [DOI: 10.1080/24745332.2018.1474401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Dhenuka Radhakrishnan
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Sharon D. Dell
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | | | - Teresa To
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Ajdacic-Gross V, Bechtiger L, Rodgers S, Müller M, Kawohl W, von Känel R, Mutsch M, Rössler W, Seifritz E, Castelao E, Strippoli MPF, Vandeleur C, Preisig M, Howell P. Subtypes of stuttering determined by latent class analysis in two Swiss epidemiological surveys. PLoS One 2018; 13:e0198450. [PMID: 30086147 PMCID: PMC6080750 DOI: 10.1371/journal.pone.0198450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/18/2018] [Indexed: 02/03/2023] Open
Abstract
Aims Associations between stuttering in childhood and a broad spectrum of risk factors, associated factors and comorbidities were examined in two large epidemiological studies. Subtypes of stuttering were then identified based on latent class analysis (LCA). Methods Data were from two representative Swiss population samples: PsyCoLaus (N = 4,874, age 35–82 years) and the ZInEP Epidemiology Survey (N = 1,500, age 20–41 years). Associations between stuttering and sociodemographic characteristics, familial aggregation, comorbidity and psychosocial risk / associated factors were investigated in both samples. LCAs were conducted on selected items from people in both samples who reported having stuttered in childhood. Results Initial analyses linked early anxiety disorders, such as separation anxiety disorder and overanxious disorder, to stuttering (PsyCoLaus). ADHD was associated with stuttering in both datasets. In the analyses of risk / associated factors, dysfunctional parental relationships, inter-parental violence and further childhood adversities were mutual predictors of stuttering. Moreover, comorbidities were seen with hay fever, asthma, eczema and psoriasis (PsyCoLaus). Subsequent LCA identified an unspecific group of persons who self-reported that they stuttered and a group defined by associations with psychosocial adversities (ZINEP, PsyCoLaus) and atopic diseases (PsyCoLaus). Conclusions The two subtypes of developmental stuttering have different risk / associated factors and comorbidity patterns. Most of the factors are associated with vulnerability mechanisms that occur early in life and that have also been linked with other neurodevelopmental disorders. Both psychosocial and biological factors appear to be involved in the etiopathogenesis of stuttering.
Collapse
Affiliation(s)
- Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- * E-mail: (VA); (PH)
| | - Laura Bechtiger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Margot Mutsch
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
- ZInEP, The Zurich Program for Sustainable Development of Mental Health Services, University of Zurich, Zurich, Switzerland
- Collegium Helveticum, University of Zurich and Swiss Federal Institute of Technology, Zurich, Switzerland
- Institute of Psychiatry, Laboratory of Neuroscience (LIM27), University of Sao Paulo, Sao Paulo, Brazil
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | | | - Caroline Vandeleur
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital, Prilly, Switzerland
| | - Peter Howell
- Department of Experimental Psychology, University College, London, United Kingdom
- * E-mail: (VA); (PH)
| |
Collapse
|
15
|
Arathimos R, Granell R, Henderson J, Relton CL, Tilling K. Sex discordance in asthma and wheeze prevalence in two longitudinal cohorts. PLoS One 2017; 12:e0176293. [PMID: 28441402 PMCID: PMC5404857 DOI: 10.1371/journal.pone.0176293] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 04/07/2017] [Indexed: 01/22/2023] Open
Abstract
Sex discordance in asthma prevalence has been previously reported, with higher prevalence in males before puberty, and in females after puberty; the adolescent "switch". However, cross-sectional studies have suggested a narrowing of this discordance in recent decades. We used a combination of cross-sectional and longitudinal modelling to examine sex differences in asthma, wheeze and longitudinal wheezing phenotypes in two UK birth cohorts, the Avon Longitudinal Study of Parents and Children (ALSPAC; born 1991-92 with data from age 0-18 years) and the Millennium Cohort Study (MCS; born 2000-02 with data from age 3-10 years). We derived measures of asthma and wheeze from questionnaires completed by mothers and cohort children. Previously-derived ALSPAC wheezing phenotype models were applied to MCS. Males had a higher prevalence of asthma at 10.7 years in ALSPAC (OR 1.45 95%CI: 1.26, 1.66 n = 7778 for current asthma) and MCS (OR 1.42 95%CI: 1.29, 1.56 n = 6726 for asthma ever) compared to females, decreasing in ALSPAC after puberty (OR 0.94 95%CI: 0.79, 1.11 n = 5023 for current asthma at 16.5 years). In longitudinal models using restricted cubic splines, males had a clear excess for asthma in the last 12 months and wheeze in the last 12 months up until 16.5 years of age in ALSPAC. Males had an increased risk of all derived longitudinal wheezing phenotypes in MCS when compared to never wheeze and no evidence of being at lower risk of late wheeze when compared to early wheeze. By comparing data in two large, contemporary cohorts we have shown the persistence of sex discordance in childhood asthma, with no evidence that the sex discordance is narrowing in recent cohorts.
Collapse
Affiliation(s)
- Ryan Arathimos
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Medical Research Council / University of Bristol Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
- * E-mail:
| | - Raquel Granell
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Caroline L. Relton
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Medical Research Council / University of Bristol Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Kate Tilling
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- Medical Research Council / University of Bristol Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
16
|
Barnish MS, Tagiyeva N, Devereux G, Aucott L, Turner S. Changes in the relationship between asthma and associated risk factors over fifty years. Pediatr Allergy Immunol 2017; 28:162-169. [PMID: 27779796 DOI: 10.1111/pai.12674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childhood asthma is a common condition whose prevalence is changing. We hypothesized that the relationship between asthma and associated risk factors has changed over a 50-year period. METHODS An ecological study design was used. Children aged 8-13 attending schools in Aberdeen city were surveyed on seven occasions between 1964 and 2014. The following were determined: history of asthma, history of eczema, parental smoking, parental asthma, sex and socio-economic status. Analysis was by a structural change model with two knots. The outcome reported was the change in odds ratio between asthma and a given risk factor during a given period. RESULTS There were 23,241 questionnaires distributed and 17,439 returned (75%). The odds ratio (OR) for a child with asthma to have eczema increased between 1989 and 1999 by 1.031 [95% CI 1.028, 1.035] and by 1.042 between 2004 and 2014 [1.038, 1.047]. The OR for a child with asthma to have a parent who smoked rose by 1.032 [1.028, 1.036] between 1989 and 1999 and by 1.043 [1.038, 1.047] between 2004 and 2014), and to have a parent with asthma (1.027 [1.022, 1.031] for 1994-99 and 1.042 [1.037, 1.048] for 2004-2014). The OR for a child with asthma being male, but not and being from the most deprived communities, rose between 1989-1999 and 2004-2014. CONCLUSIONS The relationship between asthma prevalence and particular risk factors changed over the 50-year period of study, and this might reflect changes in children's environment and/or susceptibility.
Collapse
Affiliation(s)
- Maxwell S Barnish
- Child Health, University of Aberdeen, Aberdeen, UK.,Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | | | - Graham Devereux
- Child Health, University of Aberdeen, Aberdeen, UK.,Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Medical Statistics, University of Aberdeen, Aberdeen, UK
| | - Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
17
|
Lee KS, Rha YH, Oh IH, Choi YS, Choi SH. Socioeconomic and sociodemographic factors related to allergic diseases in Korean adolescents based on the Seventh Korea Youth Risk Behavior Web-based Survey: a cross-sectional study. BMC Pediatr 2016; 16:19. [PMID: 26819079 PMCID: PMC4728782 DOI: 10.1186/s12887-016-0549-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 01/12/2016] [Indexed: 12/31/2022] Open
Abstract
Background Various international reports have shown that socioeconomic and sociodemographic variables are correlated with allergic diseases; however, little is known about how these variables affect Korean adolescents. This study was conducted to identify socioeconomic and sociodemographic risk factors for allergic diseases in Korean adolescents to provide information for preventing and managing such conditions. Methods Data from the 2011 Korea Youth Risk Behavior Web-based Survey (KYRBWS-VII) of 75,643 adolescents were used. An anonymously administered online survey was conducted to collect dependent variable information on perceived sexes, residence, family affluence (Family Affluence Scale; FAS), parental education levels, subjective academic achievement, obesity, drinking and smoking. The independent variables were asthma, allergic rhinitis and atopic dermatitis. Multivariate logistic regression was used to analyze the correlations between the dependent and independent variables. Results Low subjective academic achievement, obesity, drinking and smoking were risk factors for asthma. High FAS, parental bachelor’s degree and high subjective academic achievement were risk factors for allergic rhinitis. Finally, high FAS, maternal bachelor’s degree and high subjective academic achievement were risk factors for atopic dermatitis. Conclusion We found that high socioeconomic status (SES) was a risk factor for allergic diseases in Korean adolescents. We propose that the greater access to medical services and immunization (e.g., hygiene hypothesis) afforded by high SES influenced the prevalence of allergic diseases. Thus, as the Korean economy develops further, the prevalence of allergic diseases is likely to increase. Controlling harmful behavioral risk factors, such as drinking and smoking, may help to prevent adolescent allergic diseases.
Collapse
Affiliation(s)
- Kyung-Suk Lee
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13496, South Korea
| | - Yeong-Ho Rha
- Department of Pediatrics, Kyung Hee University School of Medicine, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea
| | - Sun-Hee Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea. .,Department of Pediatrics, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gandong-gu, Seoul, 05278, South Korea.
| |
Collapse
|
18
|
Crawford S. On the origins of autism: The Quantitative Threshold Exposure hypothesis. Med Hypotheses 2015; 85:798-806. [PMID: 26481157 DOI: 10.1016/j.mehy.2015.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 09/21/2015] [Accepted: 10/08/2015] [Indexed: 12/27/2022]
Abstract
The Quantitative Threshold Exposure (QTE) hypothesis is a multifactorial threshold model that accounts for the cumulative effects of risk factor exposure in both the causation of autism spectrum disorder (ASD) and its dramatic increase over the past 30 years. The QTE hypothesis proposes that ASD is triggered by the cumulative effects of high-level exposure to endogenous and environmental factors that act as antigens to impair normal immune system (IS) and associated central nervous system (CNS) functions during critical developmental stages. The quantitative threshold parameters that comprise a cumulative risk for the development of ASD are identified by the assessment of documented epidemiological factors that, in sum, determine the likelihood that ASD will occur as a result of their effects on critically integrated IS and CNS pathways active during prenatal, neo-natal and early childhood brain maturation. The model proposes an explanation for the relationship between critical developmental stages of brain/immune system development in conjunction with the quantitative effects of genetic and environmental risk factors that may interface with these critical developmental windows. This model may be useful even when the individual contributions of specific risk factors cannot be quantified, as it proposes that the combined quantitative level of exposure to risk factors for ASD rather than exposure to any one risk factor per se defines threshold occurrence rates.
Collapse
Affiliation(s)
- S Crawford
- Department of Biology, Southern Connecticut State University, 501 Crescent Street, New Haven, CT 06515, United States.
| |
Collapse
|
19
|
Shackleton N, Hale D, Viner RM. Trends and socioeconomic disparities in preadolescent's health in the UK: evidence from two birth cohorts 32 years apart. J Epidemiol Community Health 2015; 70:140-6. [PMID: 26359506 DOI: 10.1136/jech-2015-205603] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 08/21/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared to children and adults, little is known about changes in adolescent health over time. This study profiles the health of preadolescents in two distinct time periods, 1980 and 2012. METHODS Secondary analysis of the British Cohort Study and the Millennium Cohort Study for preadolescents mostly aged between 10 and 11.5 years (range 9.75-13 years). The prevalence/average of, and socioeconomic gradients in, the following were compared between 1980 and 2012; general health problems, anthropometrics, allergic conditions, infectious diseases, health service use, smoking and parental smoking behaviour and maternal adiposity. Socioeconomic status was measured by familial income (3 groups). RESULTS There were decreases in the proportion of hospital admissions (Δ=-0.10(-0.09:-0.11)) smoking (Δ=-0.12(-0.11:-0.13)), parental smoking (mother: (Δ=-0.19(-0.18:-0.21)) father: (Δ=-0.35(-0.34:-0.37), infectious diseases (measles: (Δ=-0.46(-0.45:-0.47)) whooping cough: (Δ=-0.07(-0.06:-0.07)) and hearing problems (Δ=-0.04(-0.03:-0.05)). There were no changes in limiting long-standing illness (Δ=0.00 (-0.00:0.00)), or the proportion of children having two or more accidents requiring medical attention (Δ=-0.02(-0.00:-0.02)). There were increases in the proportion overweight (Δ=0.18(0.17:0.19)), maternal overweight(Δ=0.22(0.21:0.23)) and obesity(Δ=0.12(0.11:0.13)), height for age(Δ=0.47(0.44:0.49)), weight for age (Δ=0.68(0.65:0.71)), proportion reporting chicken pox (Δ=0.28(0.27:0.29)), allergic conditions (eczema Δ=0.19(0.18:0.20)), asthma Δ=0.12(0.11:0.13), hay fever Δ=0.15(0.14:0.16)) and wearing glasses (Δ=0.08(0.07:0.09)). There were increases in socioeconomic gradients for limiting long-standing illness, smoking, overweight, weight for age, height for age, wearing glasses, asthma and the onset of puberty. CONCLUSIONS There have been reductions in infectious diseases and tobacco exposure among British preadolescents, but overweight and allergic conditions have risen dramatically. Children from deprived families have benefitted least from improvements in health status, and have experienced the largest increases in health risks.
Collapse
Affiliation(s)
- Nichola Shackleton
- Department of General and Adolescent Paediatrics, Population, Policy & Practice Programme, Institute Of Child Health, University College London, London, UK
| | - Daniel Hale
- Department of General and Adolescent Paediatrics, Population, Policy & Practice Programme, Institute Of Child Health, University College London, London, UK
| | - Russell M Viner
- Department of General and Adolescent Paediatrics, Population, Policy & Practice Programme, Institute Of Child Health, University College London, London, UK
| |
Collapse
|
20
|
Gough H, Grabenhenrich L, Reich A, Eckers N, Nitsche O, Schramm D, Beschorner J, Hoffmann U, Schuster A, Bauer CP, Forster J, Zepp F, Lee YA, Bergmann RL, Bergmann KE, Wahn U, Lau S, Keil T. Allergic multimorbidity of asthma, rhinitis and eczema over 20 years in the German birth cohort MAS. Pediatr Allergy Immunol 2015; 26:431-7. [PMID: 26011739 PMCID: PMC4744942 DOI: 10.1111/pai.12410] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND The occurrence of allergic multimorbidity (coexistence of asthma, allergic rhinitis and eczema) has not been evaluated longitudinally from early childhood up to adulthood in a population-based study sample. We aimed to determine the prevalence of allergic multimorbidity up to age 20 stratified by parental allergies and sex/gender using extensive prospective follow-up data from two decades of a birth cohort study. METHODS In 1990, we recruited 1314 healthy newborns from 6 maternity wards across Germany for the population-based MAS birth cohort study. The sample was purposely risk-enriched by increasing the proportion of children at high allergy risk (i.e. at least 2 allergic family members among parents and siblings) from 19% in the source population to 38% in the final sample. The remaining 62% of all MAS children had a low or no allergy risk. Symptoms, medication and doctor's diagnoses of allergic diseases have been assessed using standardized questionnaires including validated ISAAC questions in 19 follow-up assessments up to age 20. Allergic multimorbidity at each time point was defined as the coexistence of at least 2 of the following diseases in one participant: asthma, allergic rhinitis and eczema. RESULTS Response at age 20 was 72% (n = 942) of all recruited participants. At age 20, 18.5% (95% CI, 15.0-22.5%) of all participants with allergic parents had 2 or 3 concurrent allergies as compared to only 6.3% (95% CI, 4.3-9.0%) of those with non-allergic parents. At this age, allergic multimorbidity was similar in women and men (12.7% (95% CI, 9.7-16.2%) vs. 11.6% (95% CI, 8.9-14.8%)), whereas single allergic diseases were slightly more common in women than men (24.2% (95% CI, 20.2-28.5%) vs. 20.1% (95% CI, 16.6-24.0%)). Asthma occurred more frequently with coexisting allergic rhinitis and/or eczema than as a single entity from pre-puberty to adulthood. CONCLUSION Having parents with allergies is not only a strong predictor to develop any allergy, but it strongly increases the risk of developing allergic multimorbidity. In males and females alike, coexisting allergies were increasingly common throughout adolescence up to adulthood. Particularly asthma occurred in both sexes more frequently with coexisting allergies than as a single entity.
Collapse
Affiliation(s)
- Hannah Gough
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Linus Grabenhenrich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Reich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nora Eckers
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Oliver Nitsche
- Centre for Paediatric and Adolescent Medicine, University Medical Centre Mainz, Mainz, Germany
| | - Dirk Schramm
- Department of Paediatrics, University Medical Centre Düsseldorf, Düsseldorf, Germany
| | - John Beschorner
- Department of Paediatrics, Westmecklenburg Hospital, Hagenow, Germany
| | - Ute Hoffmann
- Department of Paediatrics, Technical University of Munich, Munich, Germany
| | - Antje Schuster
- Department of Paediatrics, University Medical Centre Düsseldorf, Düsseldorf, Germany
| | - Carl-Peter Bauer
- Department of Paediatrics, Technical University of Munich, Munich, Germany
| | - Johannes Forster
- Department of Paediatrics, St. Josefs Hospital, Freiburg, Germany
| | - Fred Zepp
- Centre for Paediatric and Adolescent Medicine, University Medical Centre Mainz, Mainz, Germany
| | - Young-Ae Lee
- Max-Delbrück-Centre for Molecular Medicine, Berlin-Buch, Germany.,Experimental and Clinical Research Centre, Charité Campus Buch, Berlin, Germany
| | - Renate L Bergmann
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karl E Bergmann
- Department of Obstetrics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ulrich Wahn
- Department of Paediatrics, Division of Pneumonology, Immunology and Intensive Care Medicine incl. Rescue Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Lau
- Department of Paediatrics, Division of Pneumonology, Immunology and Intensive Care Medicine incl. Rescue Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | | |
Collapse
|
21
|
Ziyab AH, Karmaus W, Zhang H, Holloway JW, Steck SE, Ewart S, Arshad SH. Allergic sensitization and filaggrin variants predispose to the comorbidity of eczema, asthma, and rhinitis: results from the Isle of Wight birth cohort. Clin Exp Allergy 2015; 44:1170-8. [PMID: 24708301 DOI: 10.1111/cea.12321] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 02/25/2014] [Accepted: 03/26/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Allergic sensitization and filaggrin gene (FLG) variants are important risk factors for allergic disorders; however, knowledge on their individual and interactive effects on the coexistence of eczema, asthma, and rhinitis is lacking. OBJECTIVE This study aimed at investigating the single and combined effects of allergic sensitization and FLG variants on the development of single and multiple allergic disorders. METHODS The Isle of Wight birth cohort (n = 1456) has been examined at 1, 2, 4, 10, and 18 years of age. Repeated measurements of eczema, asthma, rhinitis, and skin prick tests were available for all follow-ups. FLG variants were genotyped in 1150 participants. Associations of allergic sensitization and FLG variants with single and multiple allergic disorders were tested in log-binomial regression analysis. RESULTS The prevalence of eczema-, asthma-, and rhinitis-only ranged from 5.6% to 8.5%, 4.9% to 10.2%, and 2.5% to 20.4%, respectively, during the first 18 years of life. The coexistence of allergic disorders is common, with approximately 2% of the population reporting the comorbidity of 'eczema, asthma, and rhinitis' during the study period. In repeated measurement analyses, allergic sensitization and FLG variants, when analysed separately, were associated with having single and multiple allergic disorders. Of particular significance, their combined effect increased the risk of 'eczema and asthma' (RR = 13.67, 95% CI: 7.35-25.42), 'asthma and rhinitis' (RR = 7.46, 95% CI: 5.07-10.98), and 'eczema, asthma, and rhinitis' (RR = 23.44, 95% CI: 12.27-44.78). CONCLUSIONS AND CLINICAL RELEVANCE The coexistence of allergic disorders is frequent, and allergic sensitization and FLG variants jointly increased risk of allergic comorbidities, which may represent more severe and complex clinical phenotypes. The interactive effect and the elevated proportion of allergic comorbidities associated with allergic sensitization and FLG variants emphasize their joint importance in the pathogenesis of allergic disorders.
Collapse
Affiliation(s)
- A H Ziyab
- Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | | | | | | | | | | | | |
Collapse
|
22
|
El Mahdi Boubkraoui M, Benbrahim F, Assermouh A, El Hafidi N, Benchekroun S, Mahraoui C. [Epidemiological profile and management of asthma exacerbations in children at the Rabat Children Hospital in Morocco]. Pan Afr Med J 2015; 20:73. [PMID: 26090031 PMCID: PMC4450034 DOI: 10.11604/pamj.2015.20.73.4031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 01/25/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction Méthodes Résultats Conclusion
Collapse
Affiliation(s)
- Mohamed El Mahdi Boubkraoui
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Fadoua Benbrahim
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Abdellah Assermouh
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Naima El Hafidi
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Soumia Benchekroun
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| | - Chafiq Mahraoui
- Unité de Pneumoallergologie Pédiatrique, Hôpital d'Enfants de Rabat, CHU Ibn Sina, Faculté de Médecine et de Pharmacie, Université Mohamed V Souissi, Rabat, Maroc
| |
Collapse
|
23
|
Jang GC, Shim JY, Ahn YM, Jung JA, Kim SW, Chung HL. Clinical characteristics related to onset age of wheeze in school-age children and adolescents with asthma. ALLERGY ASTHMA & RESPIRATORY DISEASE 2015. [DOI: 10.4168/aard.2015.3.5.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Min Ahn
- Department of Pediatrics, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Jin-A Jung
- Department of Pediatrics, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Sung Won Kim
- Department of Pediatrics, Busan St. Mary's Medical Center, Busan, Korea
| | - Hai Lee Chung
- Department of Pediatrics, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, Korea
| | | |
Collapse
|
24
|
Genuneit J. Sex-specific development of asthma differs between farm and nonfarm children: a cohort study. Am J Respir Crit Care Med 2014; 190:588-90. [PMID: 25171311 DOI: 10.1164/rccm.201403-0428le] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
25
|
Gauderman WJ, Zhang P, Morrison JL, Lewinger JP. Finding novel genes by testing G × E interactions in a genome-wide association study. Genet Epidemiol 2013; 37:603-13. [PMID: 23873611 PMCID: PMC4348012 DOI: 10.1002/gepi.21748] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 05/30/2013] [Accepted: 06/13/2013] [Indexed: 11/06/2022]
Abstract
In a genome-wide association study (GWAS), investigators typically focus their primary analysis on the direct (marginal) associations of each single nucleotide polymorphism (SNP) with the trait. Some SNPs that are truly associated with the trait may not be identified in this scan if they have a weak marginal effect and thus low power to be detected. However, these SNPs may be quite important in subgroups of the population defined by an environmental or personal factor, and may be detectable if such a factor is carefully considered in a gene-environment (G × E) interaction analysis. We address the question "Using a genome wide interaction scan (GWIS), can we find new genes that were not found in the primary GWAS scan?" We review commonly used approaches for conducting a GWIS in case-control studies, and propose a new two-step screening and testing method (EDG×E) that is optimized to find genes with a weak marginal effect. We simulate several scenarios in which our two-step method provides 70-80% power to detect a disease locus while a marginal scan provides less than 5% power. We also provide simulations demonstrating that the EDG×E method outperforms other GWIS approaches (including case only and previously proposed two-step methods) for finding genes with a weak marginal effect. Application of this method to a G × Sex scan for childhood asthma reveals two potentially interesting SNPs that were not identified in the marginal-association scan. We distribute a new software program (G×Escan, available at http://biostats.usc.edu/software) that implements this new method as well as several other GWIS approaches.
Collapse
Affiliation(s)
- W James Gauderman
- Department of Preventive Medicine, University of Southern California, Los Angeles, California 90089, USA.
| | | | | | | |
Collapse
|
26
|
Ziyab AH, Davies GA, Ewart S, Hopkin JM, Schauberger EM, Wills-Karp M, Holloway JW, Arshad SH, Zhang H, Karmaus W. Interactive effect of STAT6 and IL13 gene polymorphisms on eczema status: results from a longitudinal and a cross-sectional study. BMC MEDICAL GENETICS 2013; 14:67. [PMID: 23815671 PMCID: PMC3700873 DOI: 10.1186/1471-2350-14-67] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 06/27/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Eczema is a prevalent skin disease that is mainly characterized by systemic deviation of immune response and defective epidermal barrier. Th2 cytokines, such as IL-13 and transcription factor STAT6 are key elements in the inflammatory response that characterize allergic disorders, including eczema. Previous genetic association studies showed inconsistent results for the association of single nucleotide polymorphisms (SNPs) with eczema. Our aim was to investigate whether SNPs in IL13 and STAT6 genes, which share a biological pathway, have an interactive effect on eczema risk. METHODS Data from two independent population-based studies were analyzed, namely the Isle of Wight birth cohort study (IOW; n = 1,456) and for the purpose of replication the Swansea PAPA (Poblogaeth Asthma Prifysgol Abertawe; n = 1,445) cross-sectional study. Log-binomial regressions were applied to (i) account for the interaction between IL13 (rs20541) and STAT6 (rs1059513) polymorphisms and (ii) estimate the combined effect, in terms of risk ratios (RRs), of both risk factors on the risk of eczema. RESULTS Under a dominant genetic model, the interaction term [IL13 (rs20541) × STAT6 (rs1059513)] was statistically significant in both studies (IOW: adjusted P(interaction) = 0.046; PAPA: P(interaction) = 0.037). The assessment of the combined effect associated with having risk genotypes in both SNPs yielded a 1.52-fold increased risk of eczema in the IOW study (95% confidence interval (CI): 1.05 - 2.20; P = 0.028) and a 2.01-fold higher risk of eczema (95% CI: 1.29 - 3.12; P = 0.002) in the PAPA study population. CONCLUSIONS Our study adds to the current knowledge of genetic susceptibility by demonstrating for the first time an interactive effect between SNPs in IL13 (rs20541) and STAT6 (rs1059513) on the occurrence of eczema in two independent samples. Findings of this report further support the emerging evidence that points toward the existence of genetic effects that occur via complex networks involving gene-gene interactions (epistasis).
Collapse
Affiliation(s)
- Ali H Ziyab
- Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Duggan EM, Sturley J, Fitzgerald AP, Perry IJ, Hourihane JO. The 2002-2007 trends of prevalence of asthma, allergic rhinitis and eczema in Irish schoolchildren. Pediatr Allergy Immunol 2012; 23:464-71. [PMID: 22435792 DOI: 10.1111/j.1399-3038.2012.01291.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Irish adolescents have the third highest asthma prevalence in the world. Few data examine trends of prevalence of asthma and allergic disorders in younger Irish children. We compared the prevalence of asthma, allergic rhinitis and eczema in school children, aged 6-9 in 2002 and 2007. METHODS In two cross-sectional studies, parents of children aged 6-9, completed identical ISAAC-based questionnaires in the same 24 Cork City schools in 2002 (n = 1474, response rate = 74.8%) and in 2007 (n = 1535, response rate = 76.2%). RESULTS The prevalence of asthma in our study population of schoolchildren, aged 6-9 remained stable in 2007 (23.5%) since the 2002 finding of 21.7% (p = 0.27). Significant increases were found in the prevalence of rhino-conjunctivitis (7.6-10.6%, p = 0.005) and eczema (8.9-13.5%, p < 0.001). In 2007, male preponderance for suffering the symptoms of current asthma existed (M:F 1.2:1, p = 0.075), although it had lost its significance since 2002 (M:F 1.5:1, p < 0.001). M:F ratio for most allergic rhinitis related symptoms moved from equal sex distribution to male predominance (nasal problems ever: 2002 - M:F, 1.1:1, p = 0.117; 2007 - M:F, 1.2:1, p = 0.012, current rhinitis: 2002 - M:F 1.2:1, p = 0.98; 2007 M:F 1.3:1, p = 0.009, hay fever ever: 2002 - M:F 1:1, p = 0.57; 2007 - M:F 1.5:1, p = 0.007). The sex-specific prevalence of rhino-conjunctivitis and the severity of symptoms suffered, remained equally sex distributed in both timeframes. From 2002 to 2007, the prevalence of all the reported symptoms of eczema were equally distributed between the sexes, while lifetime prevalence of eczema moved from male predominance to equal distribution. CONCLUSION The prevalence of asthma in 6-9 yr old Cork schoolchildren remained static between 2002 and 2007; however, rhino-conjunctivitis and eczema have become increasingly prevalent. Co-morbidity of allergic conditions continues to pose a considerable health burden in this young population. We also demonstrated an alteration in the sex-specific profile of current asthma and lifetime allergic rhinitis towards equalization in distribution.
Collapse
Affiliation(s)
- Eileen M Duggan
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland.
| | | | | | | | | |
Collapse
|
28
|
Deckers IAG, McLean S, Linssen S, Mommers M, van Schayck CP, Sheikh A. Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies. PLoS One 2012; 7:e39803. [PMID: 22808063 PMCID: PMC3394782 DOI: 10.1371/journal.pone.0039803] [Citation(s) in RCA: 363] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 05/30/2012] [Indexed: 02/06/2023] Open
Abstract
The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner.
Collapse
Affiliation(s)
- Ivette A G Deckers
- Allergy and Respiratory Research Group, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, United Kingdom.
| | | | | | | | | | | |
Collapse
|
29
|
Peñaranda A, Aristizabal G, García E, Vásquez C, Rodríguez-Martinez CE. Rhinoconjunctivitis prevalence and associated factors in school children aged 6-7 and 13-14 years old in Bogota, Colombia. Int J Pediatr Otorhinolaryngol 2012; 76:530-5. [PMID: 22301354 DOI: 10.1016/j.ijporl.2012.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 01/07/2012] [Accepted: 01/08/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Allergic rhinitis is one of the most frequent chronic diseases among children. The objective of the study was to assess the prevalence of rhinoconjunctivitis and determine clinical, social and environmental associated factors, among school children aged 6-7 years and adolescents aged 13-14 years in Bogotá, Colombia. METHODS We used ISAAC (International Study of Asthma and Allergies in Childhood) phase III study methodology and questionnaire for design and data collection, and we did a secondary analysis of these data. The sample consisted of 3830 registers from adolescents between 13 and 14 years old and 3256 registers from children between 6 and 7 years. RESULTS The prevalence of rhinoconjunctivitis symptoms in the last year was 17.2% (95% CI, 15.9-18.5) in children vs. 24.9% (95% CI, 23.6-26.3) in adolescents. In both groups there was a female predominance in children (17.8% vs. 16.5%), and in the teenagers group (28.0% vs. 21.4%), though the differences were not statistically significant. The factors associated with rhinoconjunctivitis in the group of 6-7 years where: asthma [OR 3.9; (95% CI, 2.8-5.4)], atopic dermatitis [OR 2.3; (95% CI, 1.7-3.1)], use of acetaminophen in the last year [OR 2.6; (95% CI, 1.4-4.9)], use of antibiotics in the first year of live [OR 1.7; (95% CI, 1.3-2.3)], higher maternal education [OR 1.5; (95% CI, 1.0-2.3)] and cesarean delivery [OR 1.6; (95% CI, 1.2-2.1)]. Among the 13-14 year age-group, factors associated with rhinoconjunctivitis included: asthma [OR 2.6; (95% CI, 2.0-3.4)], atopic dermatitis [OR 1.8; (95% CI, 1.4-2.3)], use of acetaminophen in the last year [OR 1.8; (95% CI, 1.4-2.4)], consumption of fast-food three times or more per week [OR 1.5; (95% CI, 1.2-2.0), ever smoked [OR 1.4; (95% CI, 1.2-1.7)] and meat consumption was protective factor [OR 0.7; (95% CI, 0.5-0.9)]. CONCLUSION In both studied groups, the estimated prevalence of rhinoconjunctivitis symptoms was relatively high. Future in-depth research is needed to assess the complex interactions between allergic rhinoconjunctivitis symptoms and social and environmental factors.
Collapse
Affiliation(s)
- Augusto Peñaranda
- Division of Otolaryngology, Fundación Santafé de Bogotá, Avenida 9 N° 116-20, Second Floor, Bogotá, Colombia.
| | | | | | | | | |
Collapse
|
30
|
Ziyab AH, Karmaus W, Yousefi M, Ewart S, Schauberger E, Holloway JW, Zhang H, Arshad SH. Interplay of filaggrin loss-of-function variants, allergic sensitization, and eczema in a longitudinal study covering infancy to 18 years of age. PLoS One 2012; 7:e32721. [PMID: 22403702 PMCID: PMC3293849 DOI: 10.1371/journal.pone.0032721] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 01/30/2012] [Indexed: 01/19/2023] Open
Abstract
Background Immune specific genes as well as genes regulating the formation of skin barrier are major determinants for eczema manifestation. There is a debate as to whether allergic sensitization and filaggrin gene (FLG) variants lead to eczema or FLG variants and eczema increase the risk of allergic sensitization. To investigate the time-order between eczema and allergic sensitization with respect to FLG variants, data from a large prospective study covering infancy to late adolescence were analyzed. Methodology/Principal Findings Repeated measurements of eczema and allergic sensitization (documented by skin prick tests) at ages 1, 2, 4, 10, and 18 years were ascertained in the Isle of Wight birth cohort (n = 1,456). Three transition periods were analyzed: age 1-or-2 to 4, 4 to 10, and 10 to 18 years. FLG variants were genotyped in 1,150 participants. Over the three transition periods, in temporal sequence analyses of initially eczema-free participants, the combined effect of FLG variants and allergic sensitization showed a 2.92-fold (95% CI: 1.47–5.77) increased risk ratio (RR) of eczema in subsequent examinations. This overall risk was more pronounced at a younger age (transition period 1-or-2 to 4, RR = 6.47, 95% CI: 1.96–21.33). In contrast, FLG variants in combination with eczema showed a weaker, but significant, risk ratio for subsequent allergic sensitization only up to 10 years of age. Conclusions/Significance Taking the time order into account, this prospective study demonstrates for the first time, that a combination of FLG variants and allergic sensitization increased the risk of eczema in subsequent years. Also FLG variants interacted with eczema and increased the risk of subsequent allergic sensitization, which, was limited to the younger age. Hence, early restoration of defective skin barrier could prevent allergic sensitization and subsequently reduce the risk of eczema development.
Collapse
Affiliation(s)
- Ali H. Ziyab
- Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Wilfried Karmaus
- Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
- * E-mail:
| | - Mitra Yousefi
- Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Susan Ewart
- College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - Eric Schauberger
- Genetics Graduate Program, Michigan State University, East Lansing, Michigan, United States of America
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, United States of America
| | - John W. Holloway
- Academic Units of Clinical and Experimental Medicine, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Academic Units of Human Genetics, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Hongmei Zhang
- Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United States of America
| | - Syed Hasan Arshad
- Academic Units of Clinical and Experimental Medicine, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- David Hide Asthma and Allergy Research Centre, Isle of Wight, United Kingdom
| |
Collapse
|
31
|
Wehrmeister FC, Menezes AMB, Cascaes AM, Martínez-Mesa J, Barros AJD. Time trend of asthma in children and adolescents in Brazil, 1998-2008. Rev Saude Publica 2012; 46:242-50. [PMID: 22310651 DOI: 10.1590/s0034-89102012005000008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 10/09/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To analyze the trends in asthma prevalence in children and adolescents between 1998 and 2008 in Brazil. METHODS Data on asthma prevalence from the 1998, 2003 and 2008 National Household Sample Surveys were analyzed. The sample was comprised of 141,402, 144,443 and 134,032 individuals in 1998, 2003 and 2008, respectively, and the analysis was adjusted for the sample design. Trends in asthma prevalence were described for sex, Brazilian regions and place of residence of children (zero to nine years of age) and adolescents (ten to 19 years of age). RESULTS The prevalence of asthma in children was 7.7% in 1998, 8.1% in 2003 and 8.5% in 2008, with an annual increase of 1%. The highest annual increase was observed in the Southeast and North regions (1.4%). Among adolescents, the prevalence of asthma was 4.4% in 1998, 5.0% in 2003 and 5.5% in 2008, with an increase of 2.2% per year. In the Northeast region, the annual increase in the prevalence of asthma was 3.5%. The greatest increases were observed in boys and in residents of rural areas. CONCLUSIONS Although asthma has decreased in some developing countries, the results found in Brazil point to an increase in this disease in children and adolescents between 1998 and 2008, especially in rural areas.
Collapse
|
32
|
Anthracopoulos MB, Pandiora A, Fouzas S, Panagiotopoulou E, Liolios E, Priftis KN. Sex-specific trends in prevalence of childhood asthma over 30 years in Patras, Greece. Acta Paediatr 2011; 100:1000-5. [PMID: 21382080 DOI: 10.1111/j.1651-2227.2011.02255.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM According to four surveys conducted during 1978-2003, the prevalence of childhood asthma and wheezing has risen in the city of Patras, Greece, albeit at a decelerating rate. We examined sex-specific wheeze and asthma prevalence in the same urban environment in 2008. METHODS A cross-sectional parental questionnaire survey was performed in 2008 among third and fourth grade schoolchildren (8-9 year old), which was identical to previously conducted surveys in 1978 (n = 3003), 1991 (n = 2417), 1998 (n = 3076) and 2003 (n = 2725). RESULTS The prevalence of current wheeze and asthma in 1978, 1991, 1998, 2003 and 2008 (n = 2688) was 1.5%, 4.6%, 6.0%, 6.9% and 6.9%, respectively (p for trend <0.001). Respective values for lifetime (ever had) wheeze and asthma in the 1991-2008 surveys were 8.0%, 9.6%, 12.4% and 12.6% (p for trend <0.001). The male:female ratio of current and lifetime wheeze and asthma increased during the 30-year surveillance period (p for trend <0.001). Irrespective of sex, diagnosed asthma declined among current wheezers by 17% (p < 0.001), but not among non-current ones (6.7%, p = 0.16) during 2003-2008. CONCLUSIONS Childhood wheeze and asthma have reached a plateau in an urban environment in Greece, while the male:female ratio increased. Asthma diagnosis declined among schoolage but not preschool wheezers during 2003-2008.
Collapse
Affiliation(s)
- Michael B Anthracopoulos
- Respiratory Unit, Department of Paediatrics, University Hospital of Patras, School of Medicine of the University of Patras, Rion, Patras, Greece.
| | | | | | | | | | | |
Collapse
|
33
|
Affiliation(s)
- Göran Wennergren
- Department of Paediatrics and Krefting Research Centre, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden.
| |
Collapse
|
34
|
Abstract
PURPOSE OF REVIEW asthma is a common chronic disease with significant clinical impact worldwide. Sex-related disparities in asthma epidemiology and morbidity exist but debate continues regarding the mechanisms for these differences. There is a need to review the recent findings for asthma care providers and to highlight areas in need of additional research. RECENT FINDINGS recent data illustrate striking sex-related differences in asthma epidemiology and disease expression. Studies show an increased incidence of asthma in women. Data demonstrate that asthmatic women have a poorer quality of life and increased utilization of healthcare compared to their male counterparts despite similar medical treatment and baseline pulmonary function. Research continues to explore hypotheses for these differences including the potential influences of the female sex hormones, altered perception of airflow obstruction, increased bronchial hyper-responsiveness, and medication compliance and technique. However, no single explanation has been able to fully explain the disparities. SUMMARY women are more likely to be diagnosed with asthma and suffer greater morbidity than men. The physiologic mechanisms for these differences are not well understood. Understanding sex-related differences in asthma and providing patients with education geared toward these disparities are important in establishing effective, individualized asthma management strategies for all patients.
Collapse
|
35
|
Suh M, Kim HH, Sohn MH, Kim KE, Kim C, Shin DC. Prevalence of allergic diseases among Korean school-age children: a nationwide cross-sectional questionnaire study. J Korean Med Sci 2011; 26:332-8. [PMID: 21394299 PMCID: PMC3051078 DOI: 10.3346/jkms.2011.26.3.332] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Accepted: 12/27/2010] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study was to investigate the nationwide prevalence of childhood asthma, eczema and other allergic diseases in Korean school-age children (8-11 yr old) and to assess the difference between residential areas. Among 6,279 elementary schools, 427 schools were randomly selected according to residential area (metropolitan, provincial, rural, and industrial area) by the cluster sampling method. Parents of students completed a modified Korean version of a questionnaire formulated by the International Study of Asthma and Allergies in Childhood (ISAAC). Among 50,200 subjects, 31,026 (61.8%) responded, and 30,893 (99.6%) were analyzed. The 12-month prevalence of wheeze, flexural rash, and allergic rhinitis symptoms were 4.8%, 15.3%, and 32.9%, respectively. The prevalence of diagnosis of allergic diseases in boys was higher than that in girls, with the exception of eczema. In both boys and girls, the difference of the prevalence of allergic diseases among industrial, metropolitan and provincial areas was not statistically significant, but the differences between rural area and other areas were significant. Our results support the importance of contextual effect associated with residential area as causative agents of allergic diseases among Korean school-age children.
Collapse
Affiliation(s)
- Mina Suh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Hyun Kim
- Institute for Environmental Research, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Chun Shin
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
36
|
Ahn K, Kim J, Kwon HJ, Chae Y, Hahm MI, Lee KJ, Park YM, Lee SY, Han M, Kim WK. The prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in Korean children: Nationwide cross-sectional survey using complex sampling design. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2011. [DOI: 10.5124/jkma.2011.54.7.769] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kangmo Ahn
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jihyun Kim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Yoomi Chae
- Department of Occupational and Environmental Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Myung-Il Hahm
- Department of Health Administration and Management, Soonchunhyang University, Asan, Korea
| | - Kee-Jae Lee
- Department of Information and Statistics, Korea National Open University, Seoul, Korea
| | - Yong Mean Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Hallym University College of Medicine, Anyang, Korea
| | - Manyong Han
- Department of Pediatrics, CHA University College of Medicine, Seongnam, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University College of Medicine, Seoul, Korea
| |
Collapse
|
37
|
Gender differences in asthma development and remission during transition through puberty: the TRacking Adolescents' Individual Lives Survey (TRAILS) study. J Allergy Clin Immunol 2010; 126:498-504.e1-6. [PMID: 20816186 DOI: 10.1016/j.jaci.2010.06.018] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 06/17/2010] [Accepted: 06/21/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND During puberty, a gender shift in asthma prevalence occurs, with a preponderance of boys before puberty. The mechanisms underlying this gender shift are unclear. OBJECTIVES We assessed associations of pubertal stages and transition through puberty with (1) the prevalence, incidence, and remission of asthma in male and female subjects; (2) total IgE levels; and (3) peak expiratory flow (PEF) fall during a shuttle run test (SRT). METHODS In the TRacking Adolescents' Individual Lives Survey study (n = 2,230; 51% female subjects), associations between pubertal stages and the prevalence, incidence, and remission of asthma were tested by using logistic regression and generalized estimating equations at a mean age of 11.1 (SD, 0.6), 13.6 (SD, 0.5), and 16.3 (SD, 0.7) years. Multiple linear regression analyses were used to study log-transformed total IgE levels and PEF fall during a SRT dependent on early versus late pubertal stages at a mean age of 16.3 years. RESULTS The prevalence of asthma was similar in boys (7.7%) and girls (7.4%) at a mean age of 11.1 years. The prevalence of asthma was significantly higher in female (6.2%) than male (4.3%) subjects at 16.3 years of age. There were no significant associations between transition of pubertal stages and the presence of asthma, either cross-sectionally or longitudinally. Pubertal stages and log-transformed total IgE levels or PEF fall during a SRT at age 16.3 years were not correlated. CONCLUSIONS A shift in the prevalence of asthma occurs between 11.1 and 16.3 years, which is due to both an increased incidence and decreased remission of asthma in female compared with male subjects. Pubertal stages could not be proved to explain the gender shift in asthma prevalence.
Collapse
|
38
|
Anthracopoulos MB, Antonogeorgos G, Liolios E, Triga M, Panagiotopoulou E, Priftis KN. Increase in chronic or recurrent rhinitis, rhinoconjunctivitis and eczema among schoolchildren in Greece: three surveys during 1991-2003. Pediatr Allergy Immunol 2009; 20:180-6. [PMID: 18433422 DOI: 10.1111/j.1399-3038.2008.00752.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The prevalence of allergic rhinitis, hay fever and eczema has risen worldwide during the last four decades but may have reached a plateau in some westernized societies. We examined time trends in the prevalence of childhood chronic or recurrent rhinitis, rhinoconjunctivitis and eczema in urban Greece. Using identical methodology, three population-based cross-sectional parental questionnaire surveys on current (last two years) and lifetime allergic symptoms of the nose, eyes and skin were performed among 8-10-yr-old children in 1991, 1998 and 2003 in Patras, Greece. Exactly 2417, 3006 and 2725 questionnaires were completed in 1991, 1998 and 2003, respectively. Prevalence rates of current (lifetime) symptoms of chronic or recurrent rhinitis were 5.1% (6.0%) for 1991, 6.5% (8.0%) for 1998 and 8.0% (9.8%) for 2003. Respective values for rhinoconjunctivitis were 1.8% (2.1%), 2.7% (3.4%) and 3.6% (4.6%) and for eczema 2.5% (4.5%), 3.4% (6.3%) and 5.0% (9.5%) (p for trend <0.001). Among current asthmatics there was an increase in lifetime rhinitis (p = 0.038), current (p = 0.025) and lifetime rhinoconjunctivitis (p = 0.007) and current (p = 0.001) and lifetime eczema (p < 0.001); male predominance increased throughout the study. The proportion of atopic asthma (current asthma with chronic or recurrent rhinitis and/or rhinoconjunctivitis and/or eczema) increased during the same period (p < 0.001). In conclusion, there is a continuous increase in the prevalence of allergic manifestations among preadolescent children in Patras, Greece during the period 1991-2003. In our population, boys have contributed to this increase more than girls and the increase of atopy is, at least partially, responsible for the increase of asthma.
Collapse
|
39
|
Holditch-Davis D, Merrill P, Schwartz T, Scher M. Predictors of wheezing in prematurely born children. J Obstet Gynecol Neonatal Nurs 2008; 37:262-73. [PMID: 18507597 DOI: 10.1111/j.1552-6909.2008.00238.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To examine the degree to which neonatal illness severity, postneonatal health problems, child characteristics, parenting quality as measured by the HOME Inventory, and maternal characteristics are related to the development of wheezing in prematurely born children over the first 27 months after term. DESIGN Longitudinal predictive study. SETTING Infants were recruited from two neonatal intensive care units, one in southeast and one in Midwest. PARTICIPANTS One hundred thirteen preterm infants who weighed less than 1,500 g or required mechanical ventilation and their mothers. MAIN OUTCOME MEASURES The presence of wheezing was obtained from maternal report at 2, 6, 9, 13, 18, 22, and 27 months. Wheezing was considered to be medically significant if the child was using bronchodilators or pulmonary antiinflammatory medications. RESULTS Sixty-eight percent of the children had wheezing at least one or more ages; 47% of the children were also taking bronchodilators or pulmonary antiinflammatory medications and thus had medically significant wheezing. CONCLUSION Postneonatal health problems and the social environment appear to be more important in developing wheezing in prematurely born children than neonatal medical complications.
Collapse
|
40
|
Frank PI, Morris JA, Hazell ML, Linehan MF, Frank TL. Long term prognosis in preschool children with wheeze: longitudinal postal questionnaire study 1993-2004. BMJ 2008; 336:1423-6. [PMID: 18558639 PMCID: PMC2432172 DOI: 10.1136/bmj.39568.623750.be] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To follow a population of preschool children with and without parent reported wheeze over a period of 6-11 years to determine prognosis and its important predictive factors. DESIGN Longitudinal series of five postal surveys based on the international study of asthma and allergies in childhood questionnaire carried out between 1993 and 2004. SETTING Two general practice populations, south Manchester. PARTICIPANTS 628 children aged less than 5 years at recruitment and those with at least six years' follow-up data. MAIN OUTCOME MEASURES Parent completed questionnaire data for respiratory symptoms and associated features. RESULTS Of 628 children included in the study, 201 (32%) had parent reported wheeze at the first observation (baseline), of whom 27% also reported the symptom on the second occasion (persistent asthma). The only important baseline predictors of persistent asthma were exercise induced wheeze (odds ratio 3.94, 95% confidence interval 1.72 to 9.00) and a history of atopic disorders (4.44, 1.94 to 10.13). The presence of both predictors indicated a likelihood of 53.2% of developing asthma; if only one feature was present this decreased to 17.2%, whereas if neither was present the likelihood was 10.9%. Family history of asthma was not predictive of persistent asthma among children with preschool wheeze. CONCLUSION Using two simple predictive factors (baseline parent reported exercise induced wheeze and a history of atopic disorders), it is possible to estimate the likelihood of future asthma in children presenting with preschool wheeze. The absence of baseline exercise induced wheeze and a history of atopic disorders reduces the likelihood of subsequent asthma by a factor of five.
Collapse
Affiliation(s)
- Peter I Frank
- General Practice Research Unit, North West Lung Research Centre, Wythenshawe Hospital, Manchester M23 9LT
| | | | | | | | | |
Collapse
|
41
|
Bacharier LB, Boner A, Carlsen KH, Eigenmann PA, Frischer T, Götz M, Helms PJ, Hunt J, Liu A, Papadopoulos N, Platts-Mills T, Pohunek P, Simons FER, Valovirta E, Wahn U, Wildhaber J. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy 2008; 63:5-34. [PMID: 18053013 DOI: 10.1111/j.1398-9995.2007.01586.x] [Citation(s) in RCA: 367] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Asthma is the leading chronic disease among children in most industrialized countries. However, the evidence base on specific aspects of pediatric asthma, including therapeutic strategies, is limited and no recent international guidelines have focused exclusively on pediatric asthma. As a result, the European Academy of Allergy and Clinical Immunology and the American Academy of Allergy, Asthma and Immunology nominated expert teams to find a consensus to serve as a guideline for clinical practice in Europe as well as in North America. This consensus report recommends strategies that include pharmacological treatment, allergen and trigger avoidance and asthma education. The report is part of the PRACTALL initiative, which is endorsed by both academies.
Collapse
Affiliation(s)
- L B Bacharier
- Department of Pediatrics, Washington University, St Louis, MO, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
A number of studies have shown gender differences in the prevalence of wheeze and asthma. The aim of this review was to examine published results on gender differences in childhood and adolescent asthma incidence and prevalence, define current concepts and to identify new research needs. A Medline search was performed with the search words (gender OR sex) AND (child OR childhood OR adolescence) AND (asthma). Articles that reported on absence or presence of gender differences in asthma were included and reviewed, and cross-references were checked. Boys are consistently reported to have more prevalent wheeze and asthma than girls. In adolescence, the pattern changes and onset of wheeze is more prevalent in females than males. Asthma, after childhood, is more severe in females than in males, and is underdiagnosed and undertreated in female adolescents. Possible explanations for this switch around puberty in the gender susceptibility to develop asthma include hormonal changes and gender-specific differences in environmental exposures. This aspect needs consideration of the doctors and allergists who diagnose and treat asthmatic individuals. In conclusion, sex hormones are likely to play an important role in the development and outcome of the allergic immune response and asthma in particular. By obtaining functional data from appropriate models, the exact underlying mechanisms can be unravelled. To examine the effect of gender-specific differences in environmental exposures and changes of asthma prevalence and severity in puberty, larger populations may need to be investigated.
Collapse
Affiliation(s)
- C Almqvist
- Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
| | | | | |
Collapse
|
43
|
Becker KG. Autism, asthma, inflammation, and the hygiene hypothesis. Med Hypotheses 2007; 69:731-40. [PMID: 17412520 PMCID: PMC2048743 DOI: 10.1016/j.mehy.2007.02.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 02/07/2007] [Indexed: 11/20/2022]
Abstract
Inflammation and the genes, molecules, and biological pathways that lead to inflammatory processes influence many important and disparate biological processes and disease states that are quite often not generally considered classical inflammatory or autoimmune disorders. These include development, reproduction, aging, tumor development and tumor rejection, cardiovascular pathologies, metabolic disorders, as well as neurological and psychiatric disorders. This paper compares parallel aspects of autism and inflammatory disorders with an emphasis on asthma. These comparisons include epidemiological, morphometric, molecular, and genetic aspects of both disease types, contributing to a hypothesis of autism in the context of the immune based hygiene hypothesis. This hypothesis is meant to address the apparent rise in the prevalence of autism in the population.
Collapse
Affiliation(s)
- Kevin G Becker
- Gene Expression and Genomics Unit, RRB, TRIAD Technology Center, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA.
| |
Collapse
|