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Musakka ER, Ylilauri MPT, Jalanka J, Karvonen AM, Täubel M, Hantunen S, Lehto SM, Pekkanen J, Backman K, Keski-Nisula L, Kirjavainen PV. Maternal exercise during pregnancy is associated with reduced risk of asthma in the child: A prospective birth cohort study. MED 2024:S2666-6340(24)00370-2. [PMID: 39389054 DOI: 10.1016/j.medj.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/15/2024] [Accepted: 09/10/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND The means of primary prevention of asthma are limited. Maternal physical activity during pregnancy promotes fetal lung development and the newborn's lung function; thus, it could lower asthma risk and aid in asthma prevention. The objective of this study is to determine whether maternal physical activity during pregnancy is associated with asthma development in the child. METHODS The study population included 963 mother-infant pairs from the prospective Kuopio Birth Cohort study. Data on maternal physical activity during pregnancy, confounding factors, and children's asthma at 5 to 7 years of age were obtained from the Kuopio University Hospital birth registry and questionnaires. FINDINGS Maternal physical activity during pregnancy, when practiced three or more times per week, was associated with a reduced risk of asthma in the child, with an adjusted odds ratio of 0.54 (95% confidence interval 0.33-0.89; p = 0.02). The association was stable across a comprehensive set of adjustments, including length of gestation, mode of delivery, and maternal health indicators (e.g., asthma, smoking, pre-pregnancy body mass index and weight gain during pregnancy, infections, medication, healthy diet, stress), as well as various family environment variables. CONCLUSIONS Maternal physical activity during pregnancy may be associated with marked protection of asthma in childhood and should be studied further as an applicable measure for asthma prevention. FUNDING The study has been financially supported by grants from the Academy of Finland (no. 349427), the Emil Aaltonen Foundation, the Finnish Cultural Foundation, the Yrjö Jahnsson Foundation, the Juho Vainio Foundation (no. 202200461), the Kuopio Area Respiratory Foundation, and the Ida Montini Foundation.
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Affiliation(s)
- Emma-Reetta Musakka
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland.
| | - Maija Paula Tuulia Ylilauri
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Jonna Jalanka
- Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Anne Maarit Karvonen
- Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Martin Täubel
- Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland
| | - Sari Hantunen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Soili Marianne Lehto
- Division of Mental Health Services, Department of Research and Development, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry, University of Helsinki, Helsinki, Finland
| | - Juha Pekkanen
- Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Katri Backman
- Department of Pediatrics, Kuopio University Hospital, Kuopio, Finland; Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Leea Keski-Nisula
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland
| | - Pirkka Viljami Kirjavainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Department of Public Health, Finnish Institute for Health and Welfare, Kuopio, Finland
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Rodríguez-Martínez CE, Sossa-Briceño MP, Castro-Rodriguez JA. Single inhaler combination inhaled corticosteroid-formoterol as both maintenance and reliever (SMART) compared with a step up of treatment with fixed-dose inhaled corticosteroid-long-acting β2-agonist maintenance with a short-acting β2-agonist as reliever in adolescents and adults with poorly controlled asthma in Colombia: a cost-utility analysis. J Asthma 2024:1-8. [PMID: 39329257 DOI: 10.1080/02770903.2024.2410424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 09/07/2024] [Accepted: 09/25/2024] [Indexed: 09/28/2024]
Abstract
OBJECTIVE The aim of the present study was to determine the cost-utility of single inhaler combination inhaled corticosteroid and a long-acting β2-agonist (ICS/LABAs) as both maintenance and reliever (SMART) compared with a step-up maintenance treatment with a fixed medium to high dose of ICS combined with LABA and a short-acting β2-agonist (SABA) as reliever (ICS-LABA maintenance plus SABA) among patients aged 12 years or more with poorly controlled asthma in Colombia. METHODS A Markov-type model was developed to estimate the costs and health outcomes of a simulated cohort of patients aged 12 years or more with uncontrolled asthma treated for 12 months. The main effectiveness data were obtained from a recent meta-analysis. The main outcome was the variable ''quality-adjusted life-years'' (QALYs). RESULTS The base-case analysis showed that the budesonide/formoterol (BUD/FORM) SMART strategy was associated with lower overall treatment costs (US $3,062.37 vs. $4,462.02 average cost per patient over 12 months) and the greatest gain in QALYs (0.8511 vs. 0.8258 QALYs on average per patient over 12 months) compared with ICS-LABA maintenance plus SABA at step 4, thus leading to dominance. CONCLUSIONS In patients aged 12 years or more with uncontrolled asthma at GINA step 3 or 4, the BUD/FORM SMART strategy at either step 3 or 4 is cost-effective compared with the ICS-LABA maintenance plus SABA at step 4 strategy, because it shows a greater gain in QALYs at lower total treatment costs.
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Affiliation(s)
- Carlos E Rodríguez-Martínez
- Department of Pediatrics, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
- Department of Pediatric Pulmonology, School of Medicine, Universidad El Bosque, Bogota, Colombia
| | - Monica P Sossa-Briceño
- Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia
| | - Jose A Castro-Rodriguez
- Department of Pediatric Pulmonology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Ding W, Huang Y, Li G, Dong Y, Li X, Wu M, Song K, Li F. Higher risk of osteoporosis in adult-onset asthma than childhood-onset asthma: from genetic and prospective evidence. Osteoporos Int 2024; 35:659-668. [PMID: 38141141 DOI: 10.1007/s00198-023-07004-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
Both COA and AOA have a genetically causal effect on osteoporosis. COA and AOA were independently associated with incident osteoporosis, and the risk was greatly higher in AOA. Besides corticosteroids, the increased risk of osteoporosis among asthma patients should be attributed to genetic susceptibility and other asthma medications. PURPOSE/INTRODUCTION Childhood-onset asthma (COA) differs with adult-onset asthma (AOA) on genetic susceptibility, severity, and co-morbidities. Whether COA or AOA is independently associated with osteoporosis is unexplored. We aimed to determine the effects of COA and AOA on osteoporosis at genetic and individual level. METHODS We used two-sample Mendelian randomization analysis to explore the causal effects of COA and AOA on osteoporosis. In the UK Biobank cohort, we included 478,289 osteoporosis-free participants at baseline (2006-2010). Participants were classified as non-asthma, COA, and AOA at recruitment. Multivariate Cox regression analysis was used to evaluate the effects of COA, AOA, and multiple asthma medications on incident osteoporosis risk. RESULTS COA and AOA were causally related to osteoporosis, with odds ratio of 1.007 (95% confidence interval (CI), 1.0003-1.0132) and 1.012 (95% CI, 1.002-1.023), respectively. Multivariate Cox regression analysis suggested that COA (hazard ratio (HR), 1.46; 95% CI, 1.32-1.61) and AOA (HR, 1.70; 95% CI, 1.61-1.80) were independently associated with incident osteoporosis, and the risk was greatly higher in AOA (HR, 1.51; 95% CI, 1.34-1.70). In addition to corticosteroids, monotherapy with leukotriene modifiers (HR, 1.70; 95% CI, 1.20-2.42), long-acting beta agonists (HR, 1.49; 95% CI, 1.18-1.87), and short-acting beta agonists (HR, 1.72; 95% CI1.01-2.93) were independently associated with a higher risk of osteoporosis. CONCLUSIONS Both COA and AOA have a genetically causal effect on osteoporosis, and the risk of osteoporosis is greatly higher in AOA. Besides corticosteroids, the increased risk of osteoporosis among asthma patients should be attributed to genetic susceptibility and other asthma medications.
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Affiliation(s)
- Weizhong Ding
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yong Huang
- Department of Orthopedics, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Guanghui Li
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Yimin Dong
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiaochen Li
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minglong Wu
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Kehan Song
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
| | - Feng Li
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
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Jiang MY, Duan YP, Tong XL, Huang QR, Jia MM, Yang WZ, Feng LZ. Clinical manifestations of respiratory syncytial virus infection and the risk of wheezing and recurrent wheezing illness: a systematic review and meta-analysis. World J Pediatr 2023; 19:1030-1040. [PMID: 37531038 PMCID: PMC10533619 DOI: 10.1007/s12519-023-00743-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection in infants is a global health priority. We aimed to investigate the common manifestations of RSV infection by age group and human development index (HDI) level and to assess its association with the development of wheezing and recurrent wheezing illness. METHODS We searched the literature published between January 1, 2010 and June 2, 2022 in seven databases. Outcomes included common manifestations and long-term respiratory outcomes of RSV infection in children. Random- and fixed-effect models were used to estimate the effect size and their 95% confidence intervals. Subgroup analysis was conducted by age and HDI levels. This review was registered in PROSPERO (CRD42022379401). RESULTS The meta-analysis included 47 studies. The top five manifestations were cough (92%), nasal congestion (58%), rhinorrhea (53%), shortness of breath (50%), and dyspnea (47%). The clinical symptoms were most severe in infants. In our analysis, compared to very high and high HDI countries, fewer studies in medium HDI countries reported related manifestations, and no study in low HDI countries reported that. The RSV-infected infants were more likely to develop wheezing than the non-infected infants [odds ratio (OR), 3.12; 95% CI, 2.59-3.76] and had a higher risk of developing wheezing illnesses after recovery (OR, 2.60; 95% CI, 2.51-2.70). CONCLUSIONS Cough and shortness of breath are common manifestations of RSV infection. More attention should be given to infants and areas with low HDI levels. The current findings confirm an association between RSV infection and wheezing or recurrent wheezing illness.
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Affiliation(s)
- Ming-Yue Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, #9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
| | - Yu-Ping Duan
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, #9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
| | - Xun-Liang Tong
- Department of pulmonary and critical care medicine, Beijing Hospital/National Gerontology Center/Institute of Gerontology, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Qiang-Ru Huang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, #9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
| | - Meng-Meng Jia
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, #9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China
| | - Wei-Zhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, #9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China.
| | - Lu-Zhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, #9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China.
- State Key Laboratory of Respiratory Health and Multimorbidity, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
- Key Laboratory of Pathogen Infection Prevention and Control (Peking Union Medical College), Ministry of Education, Beijing, China.
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Wu S, Li C. Influence of Maternal Fish Oil Supplementation on the Risk of Asthma or Wheeze in Children: A Meta-Analysis of Randomized Controlled Trials. Front Pediatr 2022; 10:817110. [PMID: 35265563 PMCID: PMC8898822 DOI: 10.3389/fped.2022.817110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/19/2022] [Indexed: 12/17/2022] Open
Abstract
Background Previous studies evaluating the influences of maternal fish oil supplementation on the risk of asthma or wheeze in children showed inconsistent results. We performed a meta-analysis or randomized controlled trials (RCTs) to systematically evaluate the efficacy of maternal fish oil supplementation for asthma or wheeze. Methods Relevant RCTs were obtained by search of PubMed, Embase, and Cochrane's Library databases. A random-effects model incorporating the potential publication bias was used to pool the results. Results Ten RCTs with 3,676 infants were included. Compared to control, maternal supplementation with fish oil was not associated with a reduced risk of asthma or wheeze [odds ratio (OR): 0.91, 95% confidence interval (CI): 0.72-1.14, P = 0.40] with mild heterogeneity (I 2 = 28%). Subgroup analyses showed that maternal fish oil supplementation significantly reduced the risk of asthma (OR: 0.56, 95% CI: 0.35-0.91, P = 0.02; I 2 = 0%), but not the risk of wheeze (OR: 1.12, 95% CI: 0.90-1.41, P = 0.32; I 2 = 0%). In addition, maternal fish oil supplementation was associated with reduced risk of asthma or wheeze in high-dose studies (≥1,200 mg/d, OR: 0.65, 95% CI: 0.48-0.87, P = 0.003; I 2 = 0%), but not in low-dose studies (<1,200 mg/d, OR: 1.10, 95% CI: 0.88-1.38, P = 0.39; I 2 = 0%, P for subgroup difference = 0.005). Study characteristics such as the risk of the infants, timing of supplementation, and follow-up duration did not significantly affect the results. Conclusions Maternal fish oil supplementation may reduce the risk of clinically diagnosed asthma in children, particularly with high-dose fish oil.
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Affiliation(s)
- Shaojing Wu
- Department of Clinical Nutrition, Hainan Maternal and Children's Medical Center, Changbin Road Children's Hospital, Haikou, China
| | - Changhong Li
- Department of Obstetrics, Hainan Maternal and Children's Medical Center, Changbin Road Children's Hospital, Haikou, China
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Falah S, Mukhlif SF, Degan A. Prevalence of Recurrent Hospital Admission in Children with Recurrent Wheezing in Babylon Province. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Occurring of recurrent wheezing attacks signify a significant healthcare problem and considered one of the most common causes of emergency unit admission and hospitalizations.
AIM: The aim of study is to determine the associations of recurrent hospital admissions in children with recurrent wheezing.
METHODS: Cross-sectional descriptive study of 102 children with recurrent wheezy chest. Data collected from admitted patients with recurrent wheezing by direct interview with the patients’ families. Patients were 6 months to 5 years old. Data collected including age, gender, place of living whether urban or rural, prematurity, no. of people at home, history of NCU admission, history of ICU admission, exclusive breast feeding for 1st 6 months, anemia, GERD, history of atopy, exposure to smoking, inhaler use, and CXR findings.
RESULTS: About 79.41% of children have 1-3 times admission in hospital, significant association between the no. of hospitalization and History of ICU admission, children with more than 3 times admission to hospital present with GERD with significant association. Significant association with more than 3 times admission to hospital have previous history of exposure to smoking, inhaler use and X-ray finding.
CONCLUSION: One to three years old children is the most common age they have recurrent wheezing, most children with recurrent wheezy chest have more than 3 times hospitalization, most babies have previous history of ICU admission, GERD and exposure to smoking.
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Frost A, Bosquet Enlow M, Malin AJ, Bernard K, Wright RJ. Early Adverse Experiences and Repeated Wheezing From 6 to 30 Months of Age: Investigating the Roles of Hypothalamic-Pituitary-Adrenal Axis Functioning, Child Sex, and Caregiving Sensitivity. Child Dev 2021; 92:e1260-e1274. [PMID: 34128224 PMCID: PMC8599610 DOI: 10.1111/cdev.13606] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examined associations among early adversity, diurnal cortisol, child sex, and caregiver sensitivity at age 6 months in relation to wheezing in children (47% male) followed to 30 months. Analyses included 676 mother-child dyads, 393 of whom completed an observational caregiver sensitivity measure. Participants were primarily ethnic minorities (42.7% Black, 25.4% Hispanic); 22.1% of children had ≥ 1 wheezing episode. Higher adversity was associated with increased wheeze frequency and blunted diurnal cortisol slope. The indirect effect of adversity on wheezing through cortisol slope was significant for females, but not males. Higher caregiver sensitivity was protective against wheezing for males, but not females, with high cortisol. Findings suggest complex associations among adversity, cortisol, child sex, and caregiver sensitivity in predicting wheezing.
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Affiliation(s)
- Allison Frost
- Carolina Population Center, University of North Carolina, Chapel Hill, NC
| | - Michelle Bosquet Enlow
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA
| | - Ashley J. Malin
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Rosalind J. Wright
- Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA
- Institute for Exposomic Research, New York, NY
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Environmental exposure during pregnancy and the risk of childhood allergic diseases. World J Pediatr 2021; 17:467-475. [PMID: 34476758 DOI: 10.1007/s12519-021-00448-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/19/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Allergic diseases are one of the most common and important diseases that can exert hazardous effects on children's health. The prevalence of allergic diseases in childhood is gradually increasing all over the world in recent decades. Known causes of these diseases include anomalous immune responses and allergic inflammatory reactions, but the causes of allergic diseases in childhood are complex. DATA SOURCES PubMed, Cochrane Library, Embase and Web of Science were searched for articles focusing on environmental exposure during pregnancy and the risk of childhood allergic diseases, including asthma and atopic dermatitis, and the possible underlying mechanism. RESULTS In terms of environmental factors, allergic diseases in childhood are closely related to environmental chemical exposure during pregnancy, including bisphenols, phthalates acid esters, perfluorochemicals, polybrominated diphenyl ethers, and polychlorinated biphenyls. However, allergic diseases in childhood are also closely associated with maternal dietary nutrition, maternal intake of drugs, such as acetylsalicylic acid (aspirin), paracetamol and antibiotics, and maternal lifestyle. CONCLUSIONS Several harmful environmental factors during pregnancy can result in the interruption of the function of helper T cells (Th1/Th2), cytokines and immunoglobulins and may activate allergic reactions, which can lead to allergic diseases during childhood.
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Aydin M, Weisser C, Rué O, Mariadassou M, Maaß S, Behrendt AK, Jaszczyszyn Y, Heilker T, Spaeth M, Vogel S, Lutz S, Ahmad-Nejad P, Graf V, Bellm A, Weisser C, Naumova EA, Arnold WH, Ehrhardt A, Meyer-Bahlburg A, Becher D, Postberg J, Ghebremedhin B, Wirth S. The Rhinobiome of Exacerbated Wheezers and Asthmatics: Insights From a German Pediatric Exacerbation Network. FRONTIERS IN ALLERGY 2021; 2:667562. [PMID: 35386977 PMCID: PMC8974812 DOI: 10.3389/falgy.2021.667562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 03/23/2021] [Indexed: 12/17/2022] Open
Abstract
Although the nose, as a gateway for organism–environment interactions, may have a key role in asthmatic exacerbation, the rhinobiome of exacerbated children with asthma was widely neglected to date. The aim of this study is to understand the microbiome, the microbial immunology, and the proteome of exacerbated children and adolescents with wheeze and asthma. Considering that a certain proportion of wheezers may show a progression to asthma, the comparison of both groups provides important information regarding clinical and phenotype stratification. Thus, deep nasopharyngeal swab specimens, nasal epithelial spheroid (NAEsp) cultures, and blood samples of acute exacerbated wheezers (WH), asthmatics (AB), and healthy controls (HC) were used for culture (n = 146), 16 S-rRNA gene amplicon sequencing (n = 64), and proteomic and cytokine analyses. Interestingly, Proteobacteria were over-represented in WH, whereas Firmicutes and Bacteroidetes were associated with AB. In contrast, Actinobacteria commonly colonized HCs. Moreover, Staphylococcaceae, Enterobacteriaceae, Burkholderiaceae, Xanthobacteraceae, and Sphingomonadaceae were significantly more abundant in AB compared to WH and HC. The α-diversity analyses demonstrated an increase of bacterial abundance levels in atopic AB and a decrease in WH samples. Microbiome profiles of atopic WH differed significantly from atopic AB, whereby atopic samples of WH were more homogeneous than those of non-atopic subjects. The NAEsp bacterial exposure experiments provided a disrupted epithelial cell integrity, a cytokine release, and cohort-specific proteomic differences especially for Moraxella catarrhalis cultures. This comprehensive dataset contributes to a deeper insight into the poorly understood plasticity of the nasal microbiota, and, in particular, may enforce our understanding in the pathogenesis of asthma exacerbation in childhood.
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Affiliation(s)
- Malik Aydin
- Laboratory of Experimental Pediatric Pneumology and Allergology, Faculty of Health, Center for Biomedical Education and Research, School of Life Sciences, Witten/Herdecke University, Witten, Germany
- Center for Child and Adolescent Medicine, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
- *Correspondence: Malik Aydin
| | - Cornelius Weisser
- Center for Child and Adolescent Medicine, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Olivier Rué
- Université Paris-Saclay, INRAE, MaIAGE, Jouy-en-Josas, France
| | | | - Sandra Maaß
- Center of Functional Genomics of Microbes, Institute of Microbiology, University of Greifswald, Greifswald, Germany
| | - Ann-Kathrin Behrendt
- Pediatric Rheumatology and Immunology, Department of Pediatrics, University Medicine Greifswald, Greifswald, Germany
| | - Yan Jaszczyszyn
- Université Paris-Saclay, CEA, CNRS, Institute for Integrative Biology of the Cell, Gif-sur-Yvette, France
| | - Tatje Heilker
- Center for Child and Adolescent Medicine, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Maximilian Spaeth
- Center for Child and Adolescent Medicine, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Silvia Vogel
- Department of Pathology, Division of Molecular Pathology, Helios University Hospital Wuppertal, Center for Clinical and Translational Research, Witten/Herdecke University, Wuppertal, Germany
| | - Sören Lutz
- Children's Hospital, Helios Hospital Niederberg, Teaching Hospital of University Hospital Essen, Velbert, Germany
| | - Parviz Ahmad-Nejad
- Institute for Medical Laboratory Diagnostics, Center for Clinical and Translational Research, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Viktoria Graf
- Institute for Medical Laboratory Diagnostics, Center for Clinical and Translational Research, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Aliyah Bellm
- Helios Hospital Krefeld, Children's Hospital, Teaching Hospital of Rheinisch-Westfälische Technische Hochschule (RTWH) University Aachen, Krefeld, Germany
| | - Christoph Weisser
- Department of Economics and Center for Statistics, Georg-August University Göttingen, Göttingen, Germany
| | - Ella A. Naumova
- Department of Biological and Material Sciences in Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Wolfgang H. Arnold
- Department of Biological and Material Sciences in Dentistry, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Anja Ehrhardt
- Department of Human Medicine, Faculty of Health, Institute of Virology and Microbiology, Center for Biomedical Education and Research, Witten/Herdecke University, Witten, Germany
| | - Almut Meyer-Bahlburg
- Pediatric Rheumatology and Immunology, Department of Pediatrics, University Medicine Greifswald, Greifswald, Germany
| | - Dörte Becher
- Center of Functional Genomics of Microbes, Institute of Microbiology, University of Greifswald, Greifswald, Germany
| | - Jan Postberg
- Laboratory of Clinical Molecular Genetics and Epigenetics, Faculty of Health, Center for Biomedical Education and Research, School of Life Sciences, Witten/Herdecke University, Wuppertal, Germany
| | - Beniam Ghebremedhin
- Institute for Medical Laboratory Diagnostics, Center for Clinical and Translational Research, Helios University Hospital Wuppertal, Witten/Herdecke University, Wuppertal, Germany
| | - Stefan Wirth
- Laboratory of Experimental Pediatric Pneumology and Allergology, Faculty of Health, Center for Biomedical Education and Research, School of Life Sciences, Witten/Herdecke University, Witten, Germany
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10
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Chen CJ, Liu YH, Lin TY, Jan RH. Allergen detection and analysis in Eastern Taiwan area. Tzu Chi Med J 2021; 33:165-168. [PMID: 33912414 PMCID: PMC8059460 DOI: 10.4103/tcmj.tcmj_72_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/27/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022] Open
Abstract
Objective: Environmental factors, eating habits, and different ages might affect the profiles of allergy sensitization. The purpose of this study was to survey the different profiles of allergen sensitization in different ages in eastern Taiwan. Materials and Methods: We analyzed the allergic patients who had allergen sensitization examinations by the Phadiatop (atopy screen; IBT Laboratories, Lenexa, KS, USA) and the Pharmacia CAP System method at Haulien Tzu Chi Hospital from January 2010 to December 2015. Results were compared in different ages. Results: A total of 15,455 patients were analyzed. The food and aeroallergen screen sensitization rate of children was significantly higher than that of adults (44.0% vs. 9.9% and 61.9% vs. 52.2% P < 0.05). Children had statistically significantly higher cow milk allergen-specific sensitization rate than that of adults (32.9% vs. 5.8% P < 0.05). The higher sensitization of shrimp occurred in adults than children. (33.6% vs. 24.8% P < 0.05). Conclusion: Our data demonstrate that children have higher cow milk allergy sensitization and adults have higher sensitization of shrimp.
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Affiliation(s)
- Chia-Jung Chen
- Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yu-Hsien Liu
- Department of Laboratory Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Teng-Yi Lin
- Department of Laboratory Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Rong-Hwa Jan
- Institute of Medical Science, Tzu Chi University, Hualien, Taiwan.,Department of Pediatrics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
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11
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Freid RD, Qi Y(S, Espinola JA, Cash RE, Aryan Z, Sullivan AF, Camargo CA. Proximity to Major Roads and Risks of Childhood Recurrent Wheeze and Asthma in a Severe Bronchiolitis Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084197. [PMID: 33921001 PMCID: PMC8071463 DOI: 10.3390/ijerph18084197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/27/2021] [Accepted: 04/12/2021] [Indexed: 01/12/2023]
Abstract
Air pollution exposures have been suggested as risk factors for childhood respiratory diseases. We investigated proximity to major roads, an indicator of air pollution exposure, and its associations with childhood recurrent wheeze and asthma. We used data from a multicenter prospective cohort study of 921 infants hospitalized for bronchiolitis and recruited from 14 U.S. states. Primary exposure was residential proximity to the nearest major road at birth through age 3 years. Residential distance from nearest major road was divided into four categories: <100, 100–200, 201–300, and >300 m. Outcomes were parent-reported recurrent wheeze by age 3 years and asthma by age 5 years. Associations between residential proximity to major roads and respiratory outcomes were investigated using multivariable Cox proportional hazards modeling and logistic regression, adjusted for confounders. Out of 920 participants with home address data, pooled estimates identified 241 (26%) participants resided within 300 m of a major road, 296 (32%) developed recurrent wheeze by age 3, and 235 out of 858 participants (27%) developed asthma by 5 years. Participants who resided close to a major road had the highest risk of recurrent wheeze (adjusted hazards ratio for <100 m, 1.59, 95%CI: 1.08–2.33) and asthma (adjusted odds ratio for 201–300 m, 1.62, 95%CI: 1.16–2.25), compared to those residing >300 m from a major road. Proximity to major roads is associated with increased risks of recurrent wheeze and asthma in young children.
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12
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Bogdan RD, Rusu L, Toma AI, Nastase L. Significant Clinical Associations Between Exposure Type Factors and Recurrent Wheezing and Asthma in Children. J Med Life 2021; 13:600-611. [PMID: 33456612 PMCID: PMC7803326 DOI: 10.25122/jml-2020-0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The study aimed to identify certain factors related to family history, pathological conditions, or exposure-type that are significantly correlated with recurrent wheezing and/or asthma in children. One hundred nine children with recurrent wheezing and 44 children with asthma were studied in order to identify the degree of correlation of these conditions with familial history of asthma or atopy, child’s age group, gender, premature birth, perinatal asphyxia, neonatal infection, and antibiotic treatment during the neonatal period, history of atopy and obesity and histamine intolerance, nasopharyngeal bacterial colonization, pneumonia with bronchospasm. The clinical picture of these two diseases was also compared regarding the severity of exacerbations and their response to controller therapy. The medium age of children diagnosed with recurrent wheezing was significantly lower than those diagnosed with asthma (5.64 vs. 9.01 years; p<0.001). Inside the recurrent wheezing group, age distribution differed significantly from the asthma group (p-value <0.001). Atopy was the only pathological condition significantly associated with asthma (56.0%) when compared with the recurrent wheezing group (30.2%) with a relative risk value of 1.34 (p<0.004). For patients colonized with Staphylococcus aureus, the medium number of wheezing exacerbations was significantly higher (p<0.049). Approximately 91% of patients in the recurrent wheezing group and 71% from the asthma group responded to appropriate controller treatment. Our study showed a significant association between asthma and atopy, justifying the need to monitor asthma risk in a child with wheezing and atopy. Nasal carriage of Staphylococcus aureus proved to be significantly associated with the recurrence of wheezing in children.
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Affiliation(s)
| | - Lidia Rusu
- Regional Center of Public Health, Iasi, Romania
| | - Adrian Ioan Toma
- Department of Neonatology, Life Memorial Hospital, Bucharest, Romania.,Department of Medico-Surgical and Prophylactic Disciplines, Faculty of Medicine, "Titu Maiorescu" University, Bucharest, Romania
| | - Leonard Nastase
- Department of Neonatology, "Alessandrescu-Rusescu" National Institute of Mother and Child Health, Bucharest, Romania.,Department of Obstetrics-Gynecology and Neonatology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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13
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Medeiros D, Castro P, Bianca ACD, Sarinho E, Araújo JF, Correia Junior M, Rizzo JA. Impulse oscillometry: pulmonary function assessment in preschool children. Expert Rev Respir Med 2020; 14:1261-1266. [PMID: 32852224 DOI: 10.1080/17476348.2020.1813573] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES In contrast to spirometry, which requires active participation of the individual and is challenging for the preschool age group, the impulse oscillometry system comprises a test that minimizes the degree of coordination required. The study aimed to compare the results of Impulse Oscillometry System (IOS) in children with and without respiratory symptoms. METHODS A cross-sectional study was conducted in children aged between 3 and 6 years. A short version of the ATS-DLD-78-C questionnaire validated for Brazilian children was applied to identify two groups: children with and without respiratory symptoms. The IOS analysis was carried out measuring the following parameters in triplicate: resistance at 5 Hz (R5Hz) and 20 Hz (R20Hz), respiratory reactance at 5 Hz (X5Hz), and R5-R20Hz before and after bronchodilator application. RESULTS A total of 76 preschoolers were selected, 55 (72.4%) of whom had respiratory complaints. The coefficient of variability of R5Hz was ≤17% in 70/76 (92.1%) of the children. Resistances at R5Hz and R5-R20Hz in the children with respiratory complaints reached values higher than those of children without symptoms before bronchodilation. CONCLUSIONS The results obtained for resistance using IOS in children with respiratory symptoms were higher in the pre-bronchodilator examination for R5Hz and R5-R20Hz compared to those of children without respiratory symptoms. EXPERT OPINION Prospective investigations suggest that irreversible changes in lung function begin in infancy, before reaching school age. Pulmonary function follow-up in children with recurrent wheezing or asthma is important for confirmation of diagnosis and evaluation of the disease severity. The Impulse Oscillometry System (IOS) can be useful in assessing children's pulmonary function since it requires minimal patient cooperation and can be successfully applied to preschool children being an alternative to individuals who have difficulty performing spirometry.
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Affiliation(s)
- Décio Medeiros
- Department of Maternal-Child Health, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Pedro Castro
- Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Undergraduate Faculty Member in Medicine, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Ana Caroline Dela Bianca
- Department of Maternal-Child Health, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Emanuel Sarinho
- Department of Maternal-Child Health, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Jaqueline Figueirôa Araújo
- Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Master of Science in Health, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
| | - Marco Correia Junior
- Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Postgraduate Program in Hebiatrics and Physical Education, Universidade de Pernambuco (UPE) , Recife, Brazil
| | - Jose Angelo Rizzo
- Allergy and Immunology Research Center, Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil.,Department of Clinical Medicine, Universidade Federal de Pernambuco (UFPE) , Recife, Brazil
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14
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Alfonso J, Pérez S, Bou R, Amat A, Ruiz I, Mora A, Escolano S, Chofre L. Asthma prevalence and risk factors in school children: The RESPIR longitudinal study. Allergol Immunopathol (Madr) 2020; 48:223-231. [PMID: 31744641 DOI: 10.1016/j.aller.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 06/25/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To analyze the incidence of wheezing in the first six years of life; the prevalence of asthma at six years of age; and the associated risk factors, in a population from Valencia, Spain. METHODS A prospective longitudinal study was made of a cohort of 636 newborn infants, with follow-up of the clinical records and the completion of questionnaires up to the age of six years. RESULTS The prevalence of asthma at six years of age was 12.8%. Up until that age, 63% of the study population had experienced at least one episode of wheezing, and 35% had suffered recurrent wheezing (three or more episodes). Admission due to wheezing was associated to school asthma. The following risk factors were identified: atopic dermatitis (OR: 2.1; 95%CI: 1.2-3.5), the presence of at least one episode of wheezing in the first year (OR: 1.8; 95%CI: 1.1-2.9), prematurity (OR: 2.5; 95%CI: 1.2-5.1), and a family history of asthma (OR: 2.2; 95%CI: 1.2-4.1). CONCLUSIONS The prevalence of asthma at six years of age in our population is similar to that described in other longitudinal studies. An important increase is observed in the cumulative incidence of wheezing and of recurrent wheezing up to three years of age, followed by stabilization. The most relevant risk factors for developing asthma at six years were atopic dermatitis, wheezing during the first year, prematurity, and a family history of asthma. Full-term pregnancy and the minimization of respiratory infections at an early age could reduce the prevalence of asthma at six years of age in our population.
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15
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Higgins D, Karmaus W, Jiang Y, Banerjee P, Sulaiman IM, Arshad HS. Infant wheezing and prenatal antibiotic exposure and mode of delivery: a prospective birth cohort study. J Asthma 2020; 58:770-781. [PMID: 32141344 DOI: 10.1080/02770903.2020.1734023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: Assessments on whether prenatal antibiotic exposure and mode of delivery increase the risk of wheezing in infants and toddlers are inconsistent. Our goal is to evaluate the association between prenatal antibiotic use and Cesarean section with three subtypes of wheezing in infancy.Methods: An ongoing prospective three generations cohort study provides data on prenatal antibiotic use and mode of delivery. Respective questionnaire data was used to distinguish three subtypes of wheezing: any wheezing, infectious wheezing, and noninfectious wheezing. Repeated measurements of wheezing at 3, 6, and 12 months were analyzed using generalized estimation equations. Latent transition analysis assessed patterns of infant wheezing development in the first year of life.Results: The prevalence of any wheezing was highest at 12 months (40.1%). The prevalence of infectious wheezing was higher (3 months 23.8%, 6 months 33.5%, 12 months 38.5%) than of noninfectious wheezing (3 months 13.0%, 6 months 14.0%, 12 months 11.1%). About 11-13% of children had both infectious and noninfectious wheezing at 3, 6, and 12 months (3 months 10.7%, 6 months 13.9%, 12 months 13.1%). Children born via Cesarean section have approximately a 70-80% increase in the risk of any wheezing (RR = 1.83, 95% CI 1.29-2.60) and of infectious wheezing (RR = 1.72, 95% CI 1.18-2.50).Conclusions: Analyses of infectious and noninfectious wheezing subtypes suggests that children born by Cesarean sections may be more susceptible to infectious wheezing, warranting investigations into microbial factors of infectious wheezing. No significant associations were found between prenatal antibiotic exposure and wheezing types.
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Affiliation(s)
- Daleniece Higgins
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Yu Jiang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Pratik Banerjee
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA
| | - Irshad M Sulaiman
- Food and Drug Administration, Southeast Food and Feed Laboratory, Microbiological Sciences Branch, Atlanta, GA, USA
| | - Hasan S Arshad
- The David Hide Asthma and Allergy Research Centre, Newport, UK.,Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Hampshire, UK.,National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, Southhampton, UK
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16
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Underdal MO, Salvesen Ø, Henriksen AH, Andersen M, Vanky E. Impaired Respiratory Function in Women With PCOS Compared With Matched Controls From a Population-Based Study. J Clin Endocrinol Metab 2020; 105:5587980. [PMID: 31613965 DOI: 10.1210/clinem/dgz053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/20/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Increased prevalence of asthma has been reported from epidemiological studies in women with polycystic ovary syndrome (PCOS). OBJECTIVE To investigate respiratory function in women with PCOS compared with controls in a clinical setting. DESIGN An 8-year clinical follow-up study including self-reported asthma diagnoses and spirometry of women with PCOS randomized to metformin or placebo during pregnancy in the original studies (the Pilot and the PregMet-study), compared with matched controls from a population-based cohort study (The HUNT Study). SETTING Secondary and tertiary care centers. PARTICIPANTS A total of 145 women with PCOS (54% of original cohort) were matched 1:3 to controls, on gender, age, and smoking-status. MAIN OUTCOMES AND MEASURES Self-reported doctor-diagnosed asthma (DDA), percentage of predicted forced expiratory volume in the first second of expiration (FEV1 % predicted), percentage of predicted forced vital capacity (FVC % predicted). RESULTS Women with PCOS reported more DDA compared with controls (19% vs 9%; P < 0.01). Spirometry indicated a combined obstructive (FEV1 % predicted, 93.7 vs 102.0; P < 0.01) and restrictive (FVC % predicted, 94.5 vs 103.7; P < 0.01) respiratory impairment in PCOS compared with controls. Metformin in pregnancy did not affect respiratory function at follow-up. CONCLUSION Women with PCOS reported higher prevalence of DDA compared with controls matched for age and smoking status. In addition, respiratory function was decreased, with both obstructive and restrictive components. Further insight to the underlying pathogenesis of these observations is needed. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: The PregMet study: NCT00159536. The Pilot study: NCT03259919.
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Affiliation(s)
- Maria Othelie Underdal
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anne Hildur Henriksen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic and Occupational Medicine, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Marianne Andersen
- Department of Internal Medicine, Odense University Hospital, Odense, Denmark
| | - Eszter Vanky
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Obstetrics and Gynecology, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
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17
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Anderson WC, Stukus DR. Pediatric Asthma Masqueraders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 6:1083-1084.e9. [PMID: 29747972 DOI: 10.1016/j.jaip.2017.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/06/2017] [Accepted: 09/18/2017] [Indexed: 10/17/2022]
Affiliation(s)
- William C Anderson
- Department of Pediatrics, Section of Allergy and Immunology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colo
| | - David R Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
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18
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Khaleva E, Gridneva Z, Geddes DT, Oddy WH, Colicino S, Blyuss O, Boyle RJ, Warner JO, Munblit D. Transforming growth factor beta in human milk and allergic outcomes in children: A systematic review. Clin Exp Allergy 2019; 49:1201-1213. [PMID: 31058363 DOI: 10.1111/cea.13409] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/25/2019] [Accepted: 04/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Human milk (HM) transforming growth factor beta (TGF-β) is critical for inflammation regulation and oral tolerance promotion. Previous reports suggested that variations in HM TGF-β levels are associated with allergic outcomes. OBJECTIVE We undertook a systematic review (PROSPERO 2017 CRD42017069920) to reassess the evidence on the relationships between HM TGF-β and allergic outcomes in children. METHODS Electronic bibliographic databases (MEDLINE, EMBASE and Cochrane Library) were systematically searched. Two independent reviewers screened reference lists, extracted the data and assessed risk of bias using the National Institute for Clinical Excellence methodological checklist. RESULTS A total of 21 studies were identified. Sixteen studies assessed relationships between HM TGF-β and risk of eczema; 14, allergic sensitization; nine, wheezing/asthma; six, food allergy; three, allergic rhinitis/conjunctivitis. Five cohorts (5/18, 28%) reported a protective effect of TGF-β1, while 3 (3/10, 30%) suggested increased risk of allergic outcomes development and 1 (1/10, 10%), a protective effect of TGF-β2 on eczema. Meta-analysis was not possible due to significant heterogeneity in methodology, age of outcome assessment and differing statistical approaches. 71% (15/21) of studies carried a high risk of bias. CONCLUSION AND CLINICAL RELEVANCE In contrast with previous findings, we did not find strong evidence of associations between HM TGF-β and allergic outcomes. Differences in studies' methodology and outcomes do not allow unconditional rejection or acceptance of the hypothesis that HM TGF-β influences the risk of allergy development. Future studies on diverse populations employing standardized methods, accurate phenotyping of outcomes and evaluation of the effect of TGF-β in combination with other HM immune markers, microbiome and oligosaccharides are required.
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Affiliation(s)
- Ekaterina Khaleva
- University of Southampton, Southampton, UK.,inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey
| | - Zoya Gridneva
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Donna T Geddes
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,School of Molecular Sciences, The University of Western Australia, Perth, Western Australia, Australia
| | - Wendy H Oddy
- Nutritional Epidemiology, Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Silvia Colicino
- The National Heart and Lung Institute, Imperial College London, London, UK
| | - Oleg Blyuss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,Department of Applied Mathematics, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia.,Department of Pediatrics, Faculty of Pediatrics, Sechenov University, Moscow, Russia
| | - Robert J Boyle
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,Department of Paediatrics, Imperial College London, London, UK.,Centre of Evidence-based Dermatology, University of Nottingham, Nottingham, UK
| | - John O Warner
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,Department of Paediatrics, Imperial College London, London, UK.,Paediatrics and NIHR Collaboration for Leadership in Applied Health Research and Care for NW London, London, UK
| | - Daniel Munblit
- inVIVO Planetary Health, Research Group of the Worldwide Universities Network, West New York, New Jersey.,Department of Pediatrics, Faculty of Pediatrics, Sechenov University, Moscow, Russia.,Department of Paediatrics, Imperial College London, London, UK.,Healthcare Department of Moscow, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
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19
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Willis AL, Moss A, Torok M, Lowary M, Klein JD, Wilson KM. Smoke Exposure, Cytokine Levels, and Asthma Visits in Children Hospitalized for Bronchiolitis. Hosp Pediatr 2019; 9:46-50. [PMID: 30530718 DOI: 10.1542/hpeds.2018-0067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE To determine if cigarette smoke exposure, marijuana smoke exposure, or cytokine levels at admission to the hospital for bronchiolitis are associated with follow-up visits for asthma. METHODS We enrolled a cohort of children aged 31 days to 2 years who were hospitalized with bronchiolitis from January 2013 to April 2014. Data included the results of a baseline survey about children's health and demographics, nasal wash samples, the results of a 6-month postdischarge follow-up survey, and a chart review. Nasal wash samples were tested for interleukin (IL)-6, IL-13, and tumor necrosis factor α (TNF-α); values were categorized for analysis. χ2, Fisher's exact, and Wilcoxon rank tests were done to test bivariable differences; all analyses were done using SAS. RESULTS We approached 180 families for enrollment; 99 consented to participate, and 74% of these completed follow-up surveys. Half of those with high levels of IL-13 had follow-up visits for asthma, whereas only 4.2% of those with low levels had follow-up visits for asthma (P = .02). Marijuana exposure was reported for 12.5% (n = 7) of study participants. There was a significant association between marijuana exposure and TNF-α levels (P = .03). CONCLUSIONS Our study revealed an association between IL-13 and follow-up visits for asthma in children who were hospitalized with bronchiolitis. We found an association between family-reported marijuana smoke exposure and detectable but lower levels of TNF-α. Further research is needed to study these relationships.
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Affiliation(s)
| | - Angela Moss
- Department of Pediatric Hospital Medicine and
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, Colorado
| | - Michelle Torok
- Department of Pediatric Hospital Medicine and
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
- American Academy of Pediatrics Julius B Richmond Center of Excellence, Elk Grove Village, Illinois; and
| | - Karen M Wilson
- American Academy of Pediatrics Julius B Richmond Center of Excellence, Elk Grove Village, Illinois; and
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York
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20
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Riddell CA, Bhat N, Bont LJ, Dupont WD, Feikin DR, Fell DB, Gebretsadik T, Hartert TV, Hutcheon JA, Karron RA, Nair H, Reiner RC, Shi T, Sly PD, Stein RT, Wu P, Zar HJ, Ortiz JR. Informing randomized clinical trials of respiratory syncytial virus vaccination during pregnancy to prevent recurrent childhood wheezing: A sample size analysis. Vaccine 2018; 36:8100-8109. [PMID: 30473186 PMCID: PMC6288067 DOI: 10.1016/j.vaccine.2018.10.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/04/2018] [Accepted: 10/08/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Early RSV illness is associated with wheeze-associated disorders in childhood. Candidate respiratory syncytial virus (RSV) vaccines may prevent acute RSV illness in infants. We investigated the feasibility of maternal RSV vaccine trials to demonstrate reductions in recurrent childhood wheezing in general paediatric populations. METHODS We calculated vaccine trial effect sizes that depended on vaccine efficacy, allocation ratio, rate of early severe RSV illness, risk of recurrent wheezing at age 3, and increased risk of RSV infection on recurrent wheezing. Model inputs came from systematic reviews and meta-analyses. For each combination of inputs, we estimated the sample size required to detect the effect of vaccination on recurrent wheezing. RESULTS There were 81 scenarios with 1:1 allocation ratio. Risk ratios between vaccination and recurrent wheezing ranged from 0.9 to 1.0 for 70% of the scenarios. Among the 57 more plausible scenarios, the lowest sample size required to detect significant reductions in recurrent wheezing was 6196 mother-infant pairs per trial arm; however, 75% and 47% of plausible scenarios required >31,060 and >100,000 mother-infant pairs per trial arm, respectively. Studies with asthma endpoints at age 5 will likely need to be larger. DISCUSSION Clinical efficacy trials of candidate maternal RSV vaccines undertaken for licensure are unlikely to demonstrate an effect on recurrent wheezing illness due to the large sample sizes likely needed to demonstrate a significant effect. Further efforts are needed to plan for alternative study designs to estimate the impact of maternal RSV vaccine programs on recurrent childhood wheezing in general populations.
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Affiliation(s)
- Corinne A Riddell
- Division of Epidemiology & Biostatistics, University of California, Berkeley, 2121 Berkeley Way, Suite 5404, Berkeley, CA, USA
| | - Niranjan Bhat
- Center for Vaccine Innovation and Access, PATH, 2201 Westlake Ave, Seattle, WA, USA
| | - Louis J Bont
- Department of Paediatrics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Lundlaan 6, Utrecht, the Netherlands; The ReSViNET Foundation, Zeist, the Netherlands
| | - William D Dupont
- Department of Biostatistics, Vanderbilt University School of Medicine, Suite 1100, Room 11119, 2525 West End Ave., Nashville, TN 37203-1741, USA
| | - Daniel R Feikin
- Initiative for Vaccine Research, World Health Organization, 20 Avenue Appia, Geneva, Switzerland
| | - Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Children's Hospital of Eastern Ontario (CHEO) Research Institute, 401 Smyth Road, CPCR, Room L-1154, Ottawa, Ontario K1H 8L1, Canada
| | - Tebeb Gebretsadik
- Center for Asthma Research, Vanderbilt University School of Medicine, Department of Biostatistics, 2525 West End Ave, Suite 11000, Nashville, TN 37203, USA
| | - Tina V Hartert
- Center for Asthma Research, Allergy, Pulmonary & Critical Care Medicine, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
| | - Jennifer A Hutcheon
- Department of Obstetrics & Gynaecology, University of British Columbia, Shaughnessy C408A, British Columbia Children's & Women's Hospital, 4500 Oak Street, Vancouver, British Columbia V6H 3N1, Canada
| | - Ruth A Karron
- Center for Immunization Research, Johns Hopkins University, 624 N. Broadway, Suite 217, Baltimore, MD, 21205, USA
| | - Harish Nair
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, United Kingdom
| | - Robert C Reiner
- Department of Global Health, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA 98102, USA
| | - Ting Shi
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland, United Kingdom
| | - Peter D Sly
- Child Health Research Centre, University of Queensland, 62 Graham St., South Brisbane, QLD 4101, Australia
| | - Renato T Stein
- Pediatric Pulmonary Unit, Pontificia Univeridade Católica RS, Av. Ipiranga, 6690/420 Porto Alegre, Brazil
| | - Pingsheng Wu
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 1130, Nashville, TN, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; SA-Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, 5th Floor ICH Building, Klipfontein Road, Cape Town, South Africa
| | - Justin R Ortiz
- Center for Vaccine Development, University of Maryland School of Medicine, 685 W. Baltimore St, Suite 480, Baltimore, MD, USA.
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21
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Angurana SK, Kumar P. Only Oxygen for Acute Bronchiolitis. Chest 2017; 152:1093-1094. [DOI: 10.1016/j.chest.2017.08.1165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022] Open
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22
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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.
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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
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23
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Wang X, Gao X, Yang Q, Wang X, Li S, Jiang F, Zhang J, Ouyang F. Sleep disorders and allergic diseases in Chinese toddlers. Sleep Med 2017; 37:174-179. [PMID: 28899531 DOI: 10.1016/j.sleep.2017.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 02/10/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Optimal sleep is important for child growth, development, and immune function. We aimed to explore whether sleep disorders were associated with the risk of allergic diseases in Chinese toddlers. METHODS This study included 566 children (aged 23.9 ± 0.7 months; 51.1% boys) in Shanghai, China. Sleep parameters (total sleep time, sleep onset latency, nocturnal awaking and snoring) were assessed by an expanded version of the Brief Infant Sleep Questionnaire (BISQ-expanded). Information on four allergic diseases (wheeze, eczema, food allergy, and allergic rhinitis) in the past year was collected via standard questionnaire and judged by pediatricians. We used logistic regression to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for having any/and each of the four allergic diseases, based on sleep parameters, adjusting for children's age and gender, mode of delivery, any breastfeeding duration, children's body mass index (BMI), children's exposure to passive smoking, maternal education, family income, family allergic history, and children's antibiotic use. RESULTS There were 23.3% of children with at least one of the four allergic diseases. Snoring was significantly associated with increased odds of having any allergy (adjusted OR = 1.95; 95% CI: 1.17, 3.26), eczema (OR = 1.83, 95% CI: 1.03, 3.23) and food allergy (OR = 4.31, 95% CI: 1.23, 15.14), after adjustment for potential confounders. Nocturnal awaking ≥2 times per night was associated with higher risk of food allergy (OR = 3.92, 95% CI: 1.00, 15.35) and wheeze (OR = 6.16, 95% CI: 1.28, 29.74). CONCLUSION In this study, presence of certain sleep disorders was associated with higher risk of having allergic diseases in Chinese toddlers.
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Affiliation(s)
- Xu Wang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Gao
- Department of Nutritional Sciences, The Pennsylvania State University, PA, USA
| | - Qian Yang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Xia Wang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenghui Li
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; School of Public Health, Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Jiang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Developmental and Behavioral Pediatrics, Shanghai Pediatric Transitional Institution, Shanghai Children's Medical Center Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fengxiu Ouyang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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24
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Matok I, Elizur A, Perlman A, Ganor S, Levine H, Kozer E. Association of Acetaminophen and Ibuprofen Use With Wheezing in Children With Acute Febrile Illness. Ann Pharmacother 2016; 51:239-244. [PMID: 27794128 DOI: 10.1177/1060028016678006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Many infants and children receive acetaminophen and/or ibuprofen during febrile illness. Previously, some studies have linked acetaminophen and ibuprofen use to wheezing and exacerbation of asthma symptoms in infants and children. OBJECTIVE To assess whether acetaminophen or ibuprofen use are associated with wheezing in children presenting to the emergency department (ED) with febrile illness. METHODS This was a cross-sectional study of children who presented with fever to the pediatric ED between 2009 and 2013. The data were collected from questionnaires and from the children's medical files. Patients with wheezing in the ED were compared with nonwheezing patients. Associations between medication use and wheezing were assessed using univariate and multivariate analyses. The multivariate analysis adjusted for potential confounding variables (ie, age, atopic dermatitis, allergies, smoking, antibiotics use, etc) via propensity scores. RESULTS During the study period, 534 children admitted to the ED met our inclusion criteria, of whom 347 (65%) were included in the study. The use of acetaminophen was similar in children diagnosed with wheezing compared with those without wheezing (n = 39, 81.3%, vs n = 229, 82.7%, respectively). Ibuprofen use was significantly lower in children diagnosed with wheezing (n = 22, 52.4%, vs n = 168, 69.4%, respectively). In multivariate analysis, acetaminophen was not associated with a higher rate of wheezing during acute febrile illness (adjusted odds ratio [OR] = 0.76, 95% CI = 0.24- 2.39), whereas ibuprofen was associated with a lower risk of wheezing (adjusted OR = 0.36, 95% CI = 0.13-0.96). CONCLUSIONS Our study suggests that acetaminophen and ibuprofen are not associated with increased risk for wheezing during acute febrile illness.
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Affiliation(s)
- Ilan Matok
- 1 The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Arnon Elizur
- 2 Assaf-Harofeh Medical Center, Zerifin, Israel.,3 Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | | | - Shani Ganor
- 3 Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
| | - Hagai Levine
- 4 Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem, Israel
| | - Eran Kozer
- 2 Assaf-Harofeh Medical Center, Zerifin, Israel.,3 Sackler Faculty of Medicine,Tel Aviv University, Tel Aviv, Israel
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25
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Umławska W, Lipowicz A. Growth, Nutritional Status, and Pulmonary Function in Children with Chronic Recurrent Bronchitis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 885:1-9. [PMID: 26801150 DOI: 10.1007/5584_2015_192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Bronchitis is a common health problem in children. Frequent bronchitis in infancy increases the risk of developing chronic respiratory diseases. The aim of the study was to assess the level of growth and the nutritional status in children and youths with special regard to the level of body fatness assessed by measuring skin-fold thickness. Relationships between somatic development, pulmonary function and the course of the disease were also explored. The study was carried out using anthropometric and spirometric measurements and also information on the severity and course of the disease in 141 children with chronic or recurrent bronchitis. All of the subjects were patients of the Pulmonary Medicine and Allergology Center in Karpacz, Poland. The mean body height did not differ significantly between the children examined and their healthy peers. However, the infection-prone children had excessive body fatness and muscle mass deficiency. The increased level of subcutaneous adipose tissue occurred especially in children with short duration of the disease, i.e. a maximum of 1 year. The functional lung parameters were generally normal. The presence of atopic diseases such as allergic rhinitis or atopic dermatitis did not impair the course of the children's somatic development. Also, long-term disease or the presence of additional allergic diseases did not impair lung function in the examined children. Taking appropriate preventive measures is recommended to achieve and maintain normal body weight in children who receive therapy due to bronchitis.
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Affiliation(s)
- Wioleta Umławska
- Department of Human Biology, University of Wrocław, 35 Kuźnicza St, 50-138, Wrocław, Poland.
| | - Anna Lipowicz
- Department of Anthropology, Wrocław University of Environmental and Life Sciences, Wrocław, Poland
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26
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Reime B, Ratner PA, Seidenstücker S, Janssen PA, Novak P. Motives for Smoking Cessation are Associated with Stage of Readiness to Quit Smoking and Sociodemographics among German Industrial Employees. Am J Health Promot 2016; 20:259-66. [PMID: 16555799 DOI: 10.4278/0890-1171-20.4.259] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To test the relationships among particular motives for smoking cessation, stage of readiness to quit (preparation or contemplation), and sociodemographic characteristics. Design. A cross-sectional study to examine attitudes toward and use of health promotion at the worksite, using a self-administered questionnaire. Setting. Two German metal companies. Subjects. Of 1641 responding employees (response rate 65% in company A and 44% in company B), 360 smokers who intended to quit immediately (n = 105) or in the near future (n = 255) were analyzed. Measures. The questionnaire comprised of sociodemographic characteristics, smoking behavior, smoking history, readiness to quit smoking, motives to quit, such as coworkers' complaints and health-related or financial concerns. Chi-squared tests and multiple logistic regression analyses were performed. Results. Health-related reasons (94%) predominated financial (27%) or image-related (14%) reasons for smoking cessation. Participants in the cessation preparation group were more likely to report an awareness of being addicted (79.6% vs. 58.2%; p < .001) and the negative public image (22.5% vs. 11.6%; p < .01) as reasons for quitting compared with those in the contemplation group. In multivariable regression models, the motives for smoking cessation, including reduced performance, family's and coworkers' complaints, pregnancy/children, and negative public image, but not health-related and financial concerns, differed significantly by gender, age, marital status, education, and occupational status. Conclusions. Motives for smoking cessation vary according to the individual's level of readiness to quit and sociodemographic background.
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Affiliation(s)
- Birgit Reime
- NEXUS: Social Contexts of Health Behaviour Research, University of British Columbia, 302-6190 Agronomy Road, Vancouver BC V6T 1Z3, Canada.
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27
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Beamer PI, Lothrop N, Lu Z, Ascher R, Ernst K, Stern DA, Billheimer D, Wright AL, Martinez FD. Spatial clusters of child lower respiratory illnesses associated with community-level risk factors. Pediatr Pulmonol 2016; 51:633-42. [PMID: 26436763 PMCID: PMC5349765 DOI: 10.1002/ppul.23332] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/11/2015] [Accepted: 09/07/2015] [Indexed: 11/06/2022]
Abstract
Identifying geographic areas with increased incidence of disease may elucidate community-level risk factors for intervention development. Lower respiratory illnesses (LRIs) are the leading cause of death in children and are associated with other morbidities. We assessed geographic clustering of LRIs and evaluated if these spatial patterns and associated risk factors differed by phenotype. Participants enrolled at birth in the Tucson Children's Respiratory Study were followed through age three for physician diagnosed LRIs. Spatial clustering analysis, based upon each participant's birth address, was performed for four LRI phenotypes. We conducted principal component analysis at the census tract level to generate indices for lower socioeconomic status (SES), poorer housing conditions, and increased air pollution. Enrollment addresses were mapped for 812 subjects, of whom 58.4%, 33.5%, 34.2%, and 23.4% had any LRI, a wheezing LRI, a viral LRI, and a respiratory syncytial virus (RSV) LRI, respectively. Patterns of spatial clustering and associated risk factors differed by LRI phenotype. Multivariable regression analyses showed that wheezing LRI clusters were associated with increased air pollution (OR = 1.18, P = 0.01). Being in a viral cluster was associated with poorer housing conditions (OR = 1.28, P = 0.01), while being in a RSV cluster was associated with increased air pollution (OR = 1.14, P = 0.006), poorer housing conditions (OR = 1.54, P = 0.003), and higher SES (OR = 0.77, P = 0.001). Our use of social and environmental indices allowed us to identify broad contextual factors that may contribute to increased incidence of LRIs in specific geographic regions. To reduce LRI incidence, multifaceted interventions should be developed at the community level. Pediatr Pulmonol. 2016;51:633-642. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Paloma I Beamer
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona.,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.,Bio5 Institute, University of Arizona, Tucson, Arizona
| | - Nathan Lothrop
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Zhenqiang Lu
- Bio5 Institute, University of Arizona, Tucson, Arizona
| | - Rebecca Ascher
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Kacey Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Debra A Stern
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona
| | - Dean Billheimer
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona.,Bio5 Institute, University of Arizona, Tucson, Arizona
| | - Anne L Wright
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona
| | - Fernando D Martinez
- Arizona Respiratory Center, University of Arizona, Tucson, Arizona.,Bio5 Institute, University of Arizona, Tucson, Arizona
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28
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Farzan SF, Li Z, Korrick SA, Spiegelman D, Enelow R, Nadeau K, Baker E, Karagas MR. Infant Infections and Respiratory Symptoms in Relation to in Utero Arsenic Exposure in a U.S. Cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2016; 124:840-7. [PMID: 26359651 PMCID: PMC4892909 DOI: 10.1289/ehp.1409282] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 09/04/2015] [Indexed: 05/19/2023]
Abstract
BACKGROUND Arsenic has been linked to disrupted immune function and greater infection susceptibility in highly exposed populations. Well arsenic levels above the U.S. EPA limit occur in our U.S. study area and are of particular concern for pregnant women and infants. OBJECTIVES We investigated whether in utero arsenic exposure affects the risk of infections and respiratory symptoms over the first year of life. METHODS We prospectively obtained information on infant infections and symptoms, including their duration and treatment (n = 412) at 4, 8, and 12 months using a parental telephone survey. Using generalized estimating equation models adjusted for potential confounders, we evaluated the association between maternal pregnancy urinary arsenic and infant infections and symptoms over the first year. RESULTS Each doubling of maternal urinary arsenic was related to increases in the total number of infections requiring prescription medication in the first year [relative risk (RR) = 1.1; 95% CI: 1.0, 1.2]. Urinary arsenic was related specifically to respiratory symptoms (difficulty breathing, wheezing, and cough) lasting ≥ 2 days or requiring prescription medication (RR = 1.1; 95% CI: 1.0, 1.2; and RR = 1.2; 95% CI: 1.0, 1.5, respectively), and wheezing lasting ≥ 2 days, resulting in a doctor visit or prescription medication treatment (RR = 1.3; 95% CI: 1.0, 1.7; RR = 1.3; 95% CI: 1.0, 1.8, and RR = 1.5; 95% CI: 1.0, 2.2, respectively). Associations also were observed with diarrhea (RR = 1.4; 95% CI: 1.1, 1.9) and fever resulting in a doctor visit (RR = 1.2; 95% CI: 1.0, 1.5). CONCLUSIONS In utero arsenic exposure was associated with a higher risk of infection during the first year of life in our study population, particularly infections requiring medical treatment, and with diarrhea and respiratory symptoms. CITATION Farzan SF, Li Z, Korrick SA, Spiegelman D, Enelow R, Nadeau K, Baker E, Karagas MR. 2016. Infant infections and respiratory symptoms in relation to in utero arsenic exposure in a U.S. COHORT Environ Health Perspect 124:840-847; http://dx.doi.org/10.1289/ehp.1409282.
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Affiliation(s)
- Shohreh F. Farzan
- Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Zhigang Li
- Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Susan A. Korrick
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Donna Spiegelman
- Department of Biostatistics, and
- Department of Epidemiology, Global Health and Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Richard Enelow
- Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire, USA
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Kari Nadeau
- Division of Immunology and Allergy, Stanford Medical School and Lucile Packard Children’s Hospital, Stanford, California, USA
| | - Emily Baker
- Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Margaret R. Karagas
- Children’s Environmental Health and Disease Prevention Research Center at Dartmouth, Hanover, New Hampshire, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Address correspondence to M.R. Karagas, Department of Epidemiology, Geisel School of Medicine, One Medical Center Dr., 7927 Rubin, Lebanon, NH 03756 USA. Telephone: (603) 653-9010. E-mail:
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Wada K, Konishi K, Tamura T, Shiraki M, Iwasa S, Nagata C. Alcohol Intake During Pregnancy and Offspring's Atopic Eczema Risk. Alcohol Clin Exp Res 2016; 40:1037-43. [PMID: 27062380 DOI: 10.1111/acer.13048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 02/17/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although alcohol consumption has been suggested to have an effect on the immune system, it is unknown whether alcohol consumption has a role in developing allergic diseases. We aimed to examine the associations of total alcohol intake during pregnancy with the risks of childhood asthma and atopic eczema in a birth cohort in Japan. METHODS Pregnant women were recruited at a maternal clinic from May 2000 to October 2001. The children who were born to these mothers were followed until November 2007. Total alcohol intake, including alcohol as a cooking ingredient, was assessed using 5-day dietary records. Mother reports of physician-diagnosed asthma and atopic eczema were annually obtained from the questionnaires. Asthma assessed by the American Thoracic Society Division of Lung Diseases questionnaire and atopic eczema assessed by International Study of Asthma and Allergies in Childhood questions were also obtained in 2007. A total of 350 children participated in the follow-up survey. RESULTS Maternal total alcohol intake during pregnancy was associated with increased risks of atopic eczema before age 3. The positive association with atopic eczema was also observed when it was defined as before age 5. In the high versus the low tertile of maternal total alcohol intake, the estimated hazard ratios (HRs) of child's eczema were 1.90 (95% CI: 0.96 to 3.76) before age 3 and 1.74 (95% CI: 0.93 to 3.24) before age 5, respectively. The estimated HRs of child's asthma before age 3 was 1.61 (95% CI: 0.70 to 3.69) in the high versus the low of maternal total alcohol intake and 2.11 (95% CI: 0.93 to 4.81) among children having drinking mothers versus nondrinking mothers in pregnancy, although maternal alcohol intake during pregnancy was not significantly associated with the risk of asthma before age 5. CONCLUSIONS Alcohol consumption during pregnancy might have an effect on developing atopic eczema in offspring.
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Affiliation(s)
- Keiko Wada
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kie Konishi
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Tamura
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | | | | | - Chisato Nagata
- Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
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30
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Kim BJ, Bae KS, Kim HS, Chun YH, Yoon JS, Kim HH, Kim JT. Clinical characteristics of interferon-gamma-inducible protein of 10 kDa in children with wheezing. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.3.174] [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)
- Beom Joon Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kil Seong Bae
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwan Soo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Hong Chun
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong-Seo Yoon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Hee Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Tack Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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31
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Andersson NW, Hansen MV, Larsen AD, Hougaard KS, Kolstad HA, Schlünssen V. Prenatal maternal stress and atopic diseases in the child: a systematic review of observational human studies. Allergy 2016; 71:15-26. [PMID: 26395995 PMCID: PMC5054838 DOI: 10.1111/all.12762] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND A growing number of studies suggest that maternal stress during pregnancy promotes atopic disorders in the offspring. This is the first systematic review to address prenatal maternal stress (PNMS) and the subsequent risk of atopy-related outcomes in the child. METHODS The review was performed in accordance to the PRISMA criteria. We searched and selected studies in PubMed, Scopus, Embase and PsychINFO until November 2014. RESULTS Sixteen (with 25 analyses) of 426 identified articles met the review criteria. Five main PNMS exposures (negative life events, anxiety/depression, bereavement, distress and job strain) and five main atopic outcomes (asthma, wheeze, atopic dermatitis, allergic rhinitis and IgE) were assessed across the studies. Overall, 21 of the 25 analyses suggested a positive association between PNMS and atopic outcomes. Of the 11 exposure-response analyses reported, six found statistically significant trends. CONCLUSION This systematic review suggests a relationship between maternal stress during pregnancy and atopic disorders in the child. However, the existing studies are of diverse quality. The wide definitions of often self-reported stress exposures imply a substantial risk for information bias and false-positive results. Research comparing objective and subjective measures of PNMS exposure as well as objective measures for atopic outcome is needed.
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Affiliation(s)
- N. W. Andersson
- Department of Epidemiology Research Statens Serum Institut Copenhagen Denmark
- Sydney Medical School Faculty of Medicine University of Sydney Concord Hospital Sydney NSW Australia
- Department of Organic Psychiatric Disorders and Emergency Ward Aarhus University Hospital Risskov, Aarhus Denmark
| | - M. V. Hansen
- Department of Organic Psychiatric Disorders and Emergency Ward Aarhus University Hospital Risskov, Aarhus Denmark
| | - A. D. Larsen
- The National Research Centre for the Working Environment Copenhagen Denmark
| | - K. S. Hougaard
- The National Research Centre for the Working Environment Copenhagen Denmark
| | - H. A. Kolstad
- Department of Occupational Medicine Danish Ramazzini Centre Aarhus University Hospital Aarhus Denmark
| | - V. Schlünssen
- The National Research Centre for the Working Environment Copenhagen Denmark
- Department of Occupational Medicine Danish Ramazzini Centre Aarhus University Hospital Aarhus Denmark
- Section for Environment, Occupation and Health Department of Public Health Danish Ramazzini Centre Aarhus University Aarhus Denmark
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Ozdogan S, Tabakci B, Demirel AS, Atli B, Besli GE, Kose G. The evaluation of risk factors for recurrent hospitalizations resulting from wheezing attacks in preschool children. Ital J Pediatr 2015; 41:91. [PMID: 26577276 PMCID: PMC4650256 DOI: 10.1186/s13052-015-0201-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 11/11/2015] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND We aimed to evaluate the risk factors in preschool children admitted to inpatient services with a diagnosis of recurrent attacks of wheezing. METHOD The medical files of 44 preschool children with 2 or more recurrent hospitalizations resulting from wheezing between November 2011 and January 2012 were retrospectively investigated. RESULTS There were 28 males (64 %) and 16 females. The median age was 14 months (2.0-50). The median numbers of previous wheezing attacks and hospitalizations were 4 (2-10) and 2 (2-8), respectively. Fourteen patients (32 %) had been treated for gastroesophageal reflux (GER). The previous and recent hospital evaluations were investigated. Bronchopulmonary dysplasia and anemia were significantly more common in patients with 3 or more hospitalizations for wheezing than in those with 2 hospitalizations (p = 0.010 and p < 0.001, respectively). A review of the cases with 3 or more hospitalizations revealed that a history of GER and anemia were significant risk factors. CONCLUSION Anemia and GER are risk factors for recurrent hospitalizations resulting from wheezing and should be treated. If the history and physical examination suggest asthma, inhaler therapy treatment should be administered, with other investigations planned for patients who do not respond to treatment as expected.
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Affiliation(s)
- Sebnem Ozdogan
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
- Sinan Ercan Sok, Isiklar 1 Apt. No 34, Da: 23, 34742, Kozyataği, Istanbul, Turkey.
| | - Burcu Tabakci
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
| | | | - Bilge Atli
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
| | - Gulser Esen Besli
- Istanbul Medeniyet University, Faculty of Medicine, Goztepe, Turkey.
| | - Gulsen Kose
- Sisli Hamidiye Etfal Research and Training Hospital, Istanbul, Turkey.
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Shaikh U, Byrd RS. Population Health Considerations for Pediatric Asthma: Findings from the 2011-2012 California Health Interview Survey. Popul Health Manag 2015; 19:145-51. [PMID: 26103063 DOI: 10.1089/pop.2015.0015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Childhood asthma is a prevalent and costly chronic condition. Optimal management enables secondary and tertiary prevention. The goal was to identify population health considerations for pediatric asthma in California to inform the development of quality improvement interventions. California Health Interview Survey 2011-2012 is a random-digit dial telephone survey conducted in 5 languages. It includes 44,000 households from all 58 counties in California. This study assessed factors related to symptom control and health care use in children ages 2-11 years with asthma. An estimated 492,385 (9.6%) of children in California currently have asthma. Urban and rural residents face comparable asthma disease burdens. School-age male children as well as Asian and African American children are disproportionately affected. Asthma causes significant morbidity, with poorer health status, high utilization of emergency care, and the need for daily medication use. Only 38% of children with asthma have a recent asthma management plan. Half of all children with asthma did not receive influenza immunization in the past year, although this reflects the overall low rate of influenza vaccination. Parents of children with asthma frequently utilize the Internet for health information and communication with their child's health care provider. Children with asthma in California face several population-level challenges, including poor health status, low influenza vaccination rates, high use of emergency care, and suboptimal use of health literacy tools. Focusing on improved care coordination and preventive care for high-risk groups is especially urgent given the expansion of public health insurance and impending shortages in the primary care workforce. (Population Health Management 2016;19:145-151).
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Affiliation(s)
- Ulfat Shaikh
- 1 University of California Davis Institute for Population Health Improvement , California Department of Healthcare Services, Sacramento, California
| | - Robert S Byrd
- 2 University of California Davis School of Medicine , Sacramento, California
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Sá-Sousa A, Jacinto T, Azevedo LF, Morais-Almeida M, Robalo-Cordeiro C, Bugalho-Almeida A, Bousquet J, Fonseca JA. Operational definitions of asthma in recent epidemiological studies are inconsistent. Clin Transl Allergy 2014; 4:24. [PMID: 25136441 PMCID: PMC4136946 DOI: 10.1186/2045-7022-4-24] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 07/15/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The best combination of questions to define asthma in epidemiological asthma studies is not known. We summarized the operational definitions of asthma used in prevalence studies and empirically assess how asthma prevalence estimates vary depending on the definition used. METHODS We searched the Thomson Reuters ISI Web of knowledge and included (1) cross-sectional studies (2) on asthma prevalence (3) conducted in the general population and (4) containing an explicit definition of asthma. The search was limited to the 100 most-cited papers or published since January 2010. For each paper, we recorded the asthma definition used and other variables. Then we applied the definitions to the data of the Portuguese National Asthma survey (INAsma) and of the 2005-2006 National Health and Nutrition Examination Survey (NHANES) computing asthma prevalence estimates for the different definitions. RESULTS Of 1738 papers retrieved, 117 were included for analysis. Lifetime asthma, diagnosed asthma and current asthma were defined in 8, 12 and 29 different ways, respectively. By applying definitions of current asthma on INAsma and NHANES data, the prevalence ranged between 5.3%-24.4% and 1.1%-17.2%, respectively. CONCLUSIONS There is considerable heterogeneity in the definitions of asthma used in epidemiological studies leading to highly variable estimates of asthma prevalence. Studies to inform a standardized operational definition are needed. Meanwhile, we propose a set of questions to be reported when defining asthma in epidemiological studies.
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Affiliation(s)
- Ana Sá-Sousa
- Center for research in health technologies and information systems.– CINTESIS, Universidade do Porto, Porto, Portugal
| | - Tiago Jacinto
- Center for research in health technologies and information systems.– CINTESIS, Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- Center for research in health technologies and information systems.– CINTESIS, Universidade do Porto, Porto, Portugal
- Health Information and Decision Sciences Department – CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Mário Morais-Almeida
- Allergy and Clinical Immunology Department, Hospital CUF-Descobertas, Lisboa, Portugal
| | - Carlos Robalo-Cordeiro
- Allergy and Clinical Immunology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | | | - Jean Bousquet
- Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire Montpellier, Montpellier, France
- Centre de recherche en Epidémiologie et Santé des Populations, CESP Inserm U1018, Villejuif, France
| | - João Almeida Fonseca
- Center for research in health technologies and information systems.– CINTESIS, Universidade do Porto, Porto, Portugal
- Allergy Unit, Instituto CUF Porto e Hospital CUF Porto, Porto, Portugal
- Health Information and Decision Sciences Department – CIDES, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina da Universidade do Porto, Rua Dr. Plácido da Costa, s/n, 4200-450 Porto, Portugal
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Farzan SF, Korrick S, Li Z, Enelow R, Gandolfi AJ, Madan J, Nadeau K, Karagas MR. In utero arsenic exposure and infant infection in a United States cohort: a prospective study. ENVIRONMENTAL RESEARCH 2013; 126:24-30. [PMID: 23769261 PMCID: PMC3808159 DOI: 10.1016/j.envres.2013.05.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 04/22/2013] [Accepted: 05/03/2013] [Indexed: 05/19/2023]
Abstract
Arsenic (As), a ubiquitous environmental toxicant, has recently been linked to disrupted immune function and enhanced infection susceptibility in highly exposed populations. In drinking water, as levels above the EPA maximum contaminant level occur in our US study area and are a particular health concern for pregnant women and infants. As a part of the New Hampshire Birth Cohort Study, we investigated whether in utero exposure to As affects risk of infant infections. We prospectively obtained information on 4-month-old infants (n=214) using a parental telephone survey on infant infections and symptoms, including respiratory infections, diarrhea and specific illnesses, as well as the duration and severity of infections. Using logistic regression and Poisson models, we evaluated the association between maternal urinary As during pregnancy and infection risks adjusted for potentially confounding factors. Maternal urinary As concentrations were related to total number of infections requiring a physician visit (relative risk (RR) per one-fold increase in As in urine=1.5; 95% confidence interval (CI)=1.0, 2.1) or prescription medication (RR=1.6; 95% CI=1.1, 2.4), as well as lower respiratory infections treated with prescription medication (RR=3.3; 95% CI=1.2, 9.0). Associations were observed with respiratory symptoms (RR=4.0; 95% CI=1.0, 15.8), upper respiratory infections (RR=1.6; 95% CI=1.0, 2.5), and colds treated with prescription medication (RR=2.3; 95% CI=1.0, 5.2). Our results provide initial evidence that in utero As exposure may be related to infant infection and infection severity and provide insight into the early life impacts of fetal As exposure.
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Affiliation(s)
- Shohreh F. Farzan
- Children’s Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH 03755
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756
| | - Susan Korrick
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, 02115
- Department of Environmental Health, Harvard School of Public Health, Boston, MA 02115
| | - Zhigang Li
- Children’s Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH 03755
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756
| | - Richard Enelow
- Children’s Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH 03755
- Department of Microbiology and Immunology, Geisel School of Medicine at Dartmouth, Lebanon, NH 03756
| | - A. Jay Gandolfi
- Department of Pharmacology and Toxicology, University of Arizona, Tucson, AZ 85721
| | - Juliette Madan
- Children’s Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH 03755
- Division of Neonatology, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756
| | - Kari Nadeau
- Division of Immunology and Allergy, Stanford Medical School and Lucile Packard Children's Hospital, Stanford, CA, 94305
| | - Margaret R. Karagas
- Children’s Environmental Health & Disease Prevention Research Center at Dartmouth, Hanover, NH 03755
- Section of Biostatistics and Epidemiology, Department of Community and Family Medicine and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, 03756
- To whom correspondence should be addressed: Margaret R. Karagas, Section of Biostatistics and Epidemiology, Geisel School of Medicine, One Medical Center Drive, 7927 Rubin, Lebanon, NH, 03756, , telephone: (603) 653-9010, fax: (603) 653-9093
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Breastfeeding as a modifier of the respiratory effects of air pollution in children. Epidemiology 2013; 24:387-94. [PMID: 23429406 DOI: 10.1097/ede.0b013e3182877eb8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Breastfeeding and air pollution are both important factors for respiratory symptoms and asthma in children. Few studies have examined possible interaction between them on respiratory outcomes. METHODS We studied 31,049 Chinese children, ages 2-14 years old, from 25 elementary schools and 50 kindergartens in the Seven Northeastern Cities during 2008-2009. Parents or guardians completed questionnaires about the children's histories of respiratory conditions, risk factors, and feeding methods. Three-year average concentrations of particles with an aerodynamic diameter ≤ 10 µm, sulfur dioxide, nitrogen dioxides, and ozone were calculated from monitoring stations in 25 study districts. We used two-level logistic regressions to examine the effects of exposure, controlling for covariates. RESULTS Association of air pollution with childhood respiratory conditions was modified by breastfeeding. Compared with children who had been breastfed, those who were not exhibited consistently stronger effects of air pollution. Among non-breastfed children, odds ratios (ORs) per 10 µg/m increase in nitrogen dioxide were 1.40 (95% confidence interval = 1.19-1.64) for cough, 1.41 (1.16-1.71) for phlegm, 1.17 (1.00-1.36) for current wheeze, and 1.25 (1.07-1.46) for doctor-diagnosed asthma. For breastfed children, the ORs were 1.25 (1.09-1.43) for cough, 1.15 (0.99-1.34) for phlegm, 0.97 (0.87-1.08) for current wheeze, and 1.17 (1.05-1.32) for doctor-diagnosed asthma. Breastfeeding was more protective among younger children. Breastfeeding was also associated with reduced effects of passive smoke exposure in children. CONCLUSION Breastfeeding is associated with smaller associations between air pollution and respiratory conditions in children, suggesting that breastfeeding reduces susceptibility to the respiratory effects of pollutants.
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Graudenz GS, Ferreira DS. [Use of the ISAAC questionnaire in children under six years: asthma or transient wheezing?]. CAD SAUDE PUBLICA 2013; 28:1609-11. [PMID: 22892980 DOI: 10.1590/s0102-311x2012000800019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Moncayo AL, Vaca M, Oviedo G, Workman LJ, Chico ME, Platts-Mills TAE, Rodrigues LC, Barreto ML, Cooper PJ. Effects of geohelminth infection and age on the associations between allergen-specific IgE, skin test reactivity and wheeze: a case-control study. Clin Exp Allergy 2013; 43:60-72. [PMID: 23278881 PMCID: PMC3563216 DOI: 10.1111/cea.12040] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 08/19/2012] [Accepted: 09/24/2012] [Indexed: 01/15/2023]
Abstract
Background Most childhood asthma in poor populations in Latin America is not associated with aeroallergen sensitization, an observation that could be explained by the attenuation of atopy by chronic helminth infections or effects of age. Objective To explore the effects of geohelminth infections and age on atopy, wheeze, and the association between atopy and wheeze. Methods A case-control study was done in 376 subjects (149 cases and 227 controls) aged 7–19 years living in rural communities in Ecuador. Wheeze cases, identified from a large cross-sectional survey, had recent wheeze and controls were a random sample of those without wheeze. Atopy was measured by the presence of allergen-specific IgE (asIgE) and skin prick test (SPT) responses to house dust mite and cockroach. Geohelminth infections were measured in stools and anti-Ascaris IgE in plasma. Results The fraction of recent wheeze attributable to anti-Ascaris IgE was 45.9%, while those for SPT and asIgE were 10.0% and 10.5% respectively. The association between atopy and wheeze was greater in adolescents than children. Although Anti-Ascaris IgE was strongly associated with wheeze (adj. OR 2.24 (95% CI 1.33–3.78, P = 0.003) and with asIgE (adj. OR 5.34, 95% CI 2.49–11.45, P < 0.001), the association with wheeze was independent of asIgE. There was some evidence that the association between atopy and wheeze was greater in uninfected subjects compared with those with active geohelminth infections. Conclusions and clinical relevance Atopy to house dust mite and cockroach explained few wheeze cases in our study population, while the presence of anti-Ascaris IgE was an important risk factor. Our data provided only limited evidence that active geohelminth infections attenuated the association between atopy and wheeze in endemic areas or that age modified this association. The role of allergic sensitization to Ascaris in the development of wheeze, independent of atopy, requires further investigation.
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Affiliation(s)
- A-L Moncayo
- Instituto de Saude Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Association of breastfeeding with asthma in young Aboriginal children in Canada. Can Respir J 2013; 19:361-6. [PMID: 23248799 DOI: 10.1155/2012/402765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Few studies have investigated the factors associated with asthma in young Aboriginal children. OBJECTIVE To characterize the association of demographic, environmental and early life factors with asthma in young Aboriginal children in Canada. METHODS The 2006 Aboriginal Children's Survey was conducted among off-reserve Aboriginal children zero to six years of age to obtain information on Aboriginal children's development and well-being. The prevalence of asthma in Aboriginal children was obtained from the parental report of asthma as diagnosed by a health care professional. RESULTS The prevalence of reported asthma among off-reserve Aboriginal children zero to six years of age (n=14,170) was 9.4%. Asthma prevalence in both exclusively breastfed children (6.8%) and ever but not exclusively breastfed children (9.0%) was significantly lower than that in nonbreastfed children (11.0%). In the multiple logistic regression analysis, exclusive breastfeeding was protective of asthma compared with nonbreastfeeding (OR 0.59 [95% CI 0.44 to 0.78]). Older age groups, male sex, having two or more older siblings, low birth weight, day care attendance and ear infection were significant risk factors for asthma. CONCLUSIONS The prevalence of asthma among young Aboriginal children zero to six years of age living off reserve was slightly lower than that reported for all other Canadian children. Breastfeeding, especially exclusively breastfeeding, was protective of asthma in Aboriginal children, which is consistent with what has been observed in non-Aboriginal children in Canada. Public health interventions intended for reducing asthma incidence in young Aboriginal children should include breastfeeding promotion programs.
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Núñez-Enríquez JC, Fajardo-Gutiérrez A, Buchán-Durán EP, Bernáldez-Ríos R, Medina-Sansón A, Jiménez-Hernández E, Amador-Sanchez R, Peñaloza-Gonzalez JG, Paredes-Aguilera R, Alvarez-Rodriguez FJ, Bolea-Murga V, de Diego Flores-Chapa J, Flores-Lujano J, Bekker-Mendez VC, Rivera-Luna R, Del Carmen Rodriguez-Zepeda M, Rangel-López A, Dorantes-Acosta EM, Núñez-Villegas N, Velazquez-Aviña MM, Torres-Nava JR, Reyes-Zepeda NC, Cárdenas-Cardos R, Flores-Villegas LV, Martinez-Avalos A, Salamanca-Gómez F, Gorodezky C, Arellano-Galindo J, Mejía-Aranguré JM. Allergy and acute leukaemia in children with Down syndrome: a population study. Report from the Mexican inter-institutional group for the identification of the causes of childhood leukaemia. Br J Cancer 2013; 108:2334-8. [PMID: 23695017 PMCID: PMC3681010 DOI: 10.1038/bjc.2013.237] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/17/2013] [Accepted: 04/22/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Allergies have been described as protective factors against the development of childhood acute leukaemia (AL). Our objective was to investigate the associations between allergy history and the development of AL and acute lymphoblastic leukaemia (ALL) in children with Down syndrome (DS). METHODS A case-control study was performed in Mexico City. The cases (n=97) were diagnosed at nine public hospitals, and the controls (n=222) were recruited at institutions for children with DS. Odds ratios (OR) were calculated. RESULTS Asthma was positively associated with AL development (OR=4.18; 95% confidence interval (CI): 1.47-11.87), whereas skin allergies were negatively associated (OR=0.42; 95% CI: 0.20-0.91). CONCLUSION Our findings suggest that allergies and AL in children with DS share biological and immune mechanisms. To our knowledge, this is the first study reporting associations between allergies and AL in children with DS.
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Affiliation(s)
- J C Núñez-Enríquez
- Unidad de Investigación Médica en Epidemiologia Clínica, Hospital de Pediatría, Centro Médico Nacional (CMN) Siglo XXI, Instituto Mexicano del Seguro Social, Avenida Cuauhtémoc 330, Delegación Cuauhtémoc, México D.F. 06720, México.
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Lange NE, Celedón JC, Forno E, Ly NP, Onderdonk A, Bry L, Delaney ML, DuBois AM, Gold DR, Weiss ST, Litonjua AA. Maternal intestinal flora and wheeze in early childhood. Clin Exp Allergy 2013; 42:901-8. [PMID: 22909161 DOI: 10.1111/j.1365-2222.2011.03950.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Increasing evidence links altered intestinal flora in infancy to eczema and asthma. No studies have investigated the influence of maternal intestinal flora on wheezing and eczema in early childhood. OBJECTIVE To investigate the link between maternal intestinal flora during pregnancy and development of wheeze and eczema in infancy. METHODS A total of 60 pregnant women from the Boston area gave stool samples during the third trimester of their pregnancy and answered questions during pregnancy about their own health, and about their children's health when the child was 2 and 6 months of age. Quantitative culture was performed on stool samples and measured in log(10)colony-forming units (CFU)/gram stool. Primary outcomes included infant wheeze and eczema in the first 6 months of life. Atopic wheeze, defined as wheeze and eczema, was analysed as a secondary outcome. RESULTS In multivariate models adjusted for breastfeeding, day care attendance and maternal atopy, higher counts of maternal total aerobes (TA) and enterococci (E) were associated with increased risk of infant wheeze (TA: OR 2.32 for 1 log increase in CFU/g stool [95% CI 1.22, 4.42]; E: OR 1.57 [95% CI 1.06, 2.31]). No organisms were associated with either eczema or atopic wheeze. CONCLUSIONS AND CLINICAL RELEVANCE In our cohort, higher maternal total aerobes and enterococci were related to increased risk of infant wheeze. Maternal intestinal flora may be an important environmental exposure in early immune system development.
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Affiliation(s)
- N E Lange
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Darrow LA, Hess J, Rogers CA, Tolbert PE, Klein M, Sarnat SE. Ambient pollen concentrations and emergency department visits for asthma and wheeze. J Allergy Clin Immunol 2012; 130:630-638.e4. [PMID: 22840851 DOI: 10.1016/j.jaci.2012.06.020] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 05/14/2012] [Accepted: 06/18/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies report associations between aeroallergen exposure and asthma exacerbations. Aeroallergen burdens and asthma prevalence are increasing worldwide and are projected to increase further with climate change, highlighting the importance of understanding population-level relationships between ambient pollen concentrations and asthma. OBJECTIVE We sought to examine short-term associations between ambient concentrations of various pollen taxa and emergency department (ED) visits for asthma and wheeze in the Atlanta metropolitan area between 1993 and 2004. METHODS We assessed associations between the 3-day moving average (lag 0-1-2) of Betulaceae (except Alnus species), Cupressaceae, Quercus species, Pinaceae (except Tsuga species), Poaceae, and Ambrosia species pollen concentrations and daily asthma and wheeze ED visit counts, controlling for covarying pollen taxa and ambient pollutant concentrations. RESULTS We observed a 2% to 3% increase in asthma- and wheeze-related ED visits per SD increase in Quercus species and Poaceae pollen and a 10% to 15% increased risk on days with the highest concentrations (comparing the top 5% of days with the lowest 50% of days). An SD increase in Cupressaceae concentrations was associated with a 1% decrease in ED visits. The association for Quercus species pollen was strongest for children aged 5 to 17 years. Effects of Ambrosia species pollen on asthma exacerbations were difficult to assess in this large-scale temporal analysis because of possible confounding by the steep increase in circulating rhinoviruses every September. CONCLUSION Poaceae and Quercus species pollen contribute to asthma morbidity in Atlanta. Altered Quercus species and Poaceae pollen production caused by climate change could affect allergen-induced asthma morbidity in the southeastern United States.
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Affiliation(s)
- Lyndsey A Darrow
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Ga
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Medeiros D, Silva AR, Rizzo JÂ, Sarinho E, Mallol J, Solé D. [Prevalence of wheezing and associated risk factors among infants in Recife, Pernambuco State, Brazil]. CAD SAUDE PUBLICA 2012; 27:1551-9. [PMID: 21877003 DOI: 10.1590/s0102-311x2011000800010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 05/24/2011] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED The aim of this study was to verify the prevalence of wheezing in infants (< 1 year of age) in Recife, Pernambuco State, Brazil, and to identify associated risk factors. SAMPLE AND METHODS the study was performed according to the protocol of the International Study of Wheezing in Infants (EISL) in children ranging from 12 to 15 months of age. The sample was analyzed for presence or absence of wheezing. A total of 1,071 parents of children ranging from 12 to 15 months of age were interviewed. Prevalence of wheezing in the first year of life was 43%, with no difference between the sexes. Wheezing in the first year of life was associated with pneumonia, family history of asthma, more than nine episodes of upper airway infection, and the first cold before six months of age (p < 0.001). Prevalence of wheezing in the first year of life was high in Recife. Early onset (and high number) of colds, family history of asthma, and pneumonia were associated with wheezing in these children.
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Amat F, Vial A, Pereira B, Petit I, Labbe A, Just J. Predicting the long-term course of asthma in wheezing infants is still a challenge. ISRN ALLERGY 2011; 2011:493624. [PMID: 23724229 PMCID: PMC3658573 DOI: 10.5402/2011/493624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 06/05/2011] [Indexed: 12/04/2022]
Abstract
Background. In recurrent wheezing infants, it is important to identify those likely to remain asthmatic in order to propose appropriate long-term management.
Objective. To establish predictive factors for persistent asthma at adolescence in a population of recurrent wheezing infants.
Methods. Retrospective study of 227 infants. Inclusion criteria were age under 36 months, a history of at least three wheezing episodes assessed via a doctor-led ISAAC questionnaire and a standardized allergy testing programme. At 13 years, active asthma was assessed by questionnaire.
Results. Risk factors for asthma persisting into adolescence were allergic sensitization to multiple airborne allergens (OR 4.6, CI-95% (1.9–11.2) P = 0.001), initial atopic dermatitis (OR 3.4, CI-95% (1.9–6.3) P < 0.001), severe recurrent wheezing (OR 2.3, CI-95% (1.3–4.2) P = 0.007), and hypereosinophilia ≥470/mm3 (OR 2.2, CI-95% (1.07–4.7) P = 0.033).
Conclusion. While it is still difficult to predict the long-term course of asthma, atopy remains the major risk factor for persistent asthma.
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Affiliation(s)
- Flore Amat
- Asthma and Allergies Centre, Armand-Trousseau Children Hospital, University Pierre and Marie Curie-Paris 6, Paris, France
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Ozkaya E, Cambaz N, Kolsuz LD, Aycan N, Calis S, Samanci N. Vaccination coverage and risk factors for incomplete vaccination in children with recurrent wheeze. Allergol Immunopathol (Madr) 2011; 39:222-7. [PMID: 21208719 DOI: 10.1016/j.aller.2010.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Revised: 07/02/2010] [Accepted: 07/06/2010] [Indexed: 11/16/2022]
Abstract
AIM To determine the possible impact of recurrent wheeze on immunisation status in the first three years of life. METHOD A cross-sectional case control study of 288 children less than three years of age with a history of recurrent wheezing, hospitalised at a single centre for wheeze; and a control group of 190 children with no prior history of wheezing. Vaccination charts of all children were analysed according to the National Immunisation Schedule. Additionally, some associated data were collected through a questionnaire to the parents. RESULTS Children with recurrent wheezing during the first three years of life were less likely to be vaccinated against BCG (Bacillus-Calmette-Guerin), hepatitis B, Hib (Haemophilus influenza type B), and MMR (Measles, Mumps, Rubella) (p < 0.001). A significant inverse association was also found between the number of wheezy episodes and the number of vaccine doses received. The odds ratio of incomplete vaccination in children with recurrent wheeze was 10.6 (95% CI, 2.96 to 38.1). CONCLUSION Children under three years of age with recurrent wheeze run a high risk of incomplete immunisation. Efforts should be therefore made to insure that such children receive adequate vaccination.
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Affiliation(s)
- E Ozkaya
- Department of Pediatrics, Vakıf Gureba Education and Research Hospital, Istanbul, Turkey.
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Maselli DJ, Adams S, Peters J. The role of anti-infectives in the treatment of refractory asthma. Ther Adv Respir Dis 2011; 5:387-96. [PMID: 21459926 DOI: 10.1177/1753465811402534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Refractory asthma not only has a significant effect on quality of life, but also imposes an economic burden on society. Increasing evidence suggests that there is a pathophysiologic interaction between infection and allergic disease in patients with severe or refractory asthma. Therapeutic trials of macrolides and azoles are being utilized in some patients with refractory asthma who fail to respond to standard therapy. In this article we review the definition of refractory asthma and the potential pathophysiologic interactions between infection and allergic disease. Emerging data suggest that microorganisms and their byproducts may be a therapeutic target in the therapy of patients with severe or refractory asthma.
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Affiliation(s)
- Diego Jose Maselli
- Division of Pulmonary Diseases & Critical Care,University of Texas Health Science Center at San Antonio, TX, USA
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Lange NE, Bunyavanich S, Silberg JL, Canino G, Rosner BA, Celedón JC. Parental psychosocial stress and asthma morbidity in Puerto Rican twins. J Allergy Clin Immunol 2010; 127:734-40.e1-7. [PMID: 21194742 DOI: 10.1016/j.jaci.2010.11.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 11/02/2010] [Accepted: 11/09/2010] [Indexed: 01/12/2023]
Abstract
BACKGROUND Little is known about paternal psychosocial factors and childhood asthma. OBJECTIVE We sought to examine the link between maternal and paternal psychosocial stress and asthma outcomes in young children. METHODS Parents of 339 pairs of Puerto Rican twins were interviewed individually about their own psychosocial stress and about asthma in their children at age 1 year and again about their child's asthma at age 3 years. Fathers were asked about symptoms of posttraumatic stress disorder (PTSD), depression, and antisocial behavior. Mothers were asked about depressive symptoms. Outcomes assessed in children included recent asthma symptoms, oral steroid use and hospitalizations for asthma in the prior year, and asthma diagnosis. Generalized estimated equation models were used for the multivariate analysis of parental psychosocial stress and asthma morbidity in childhood. RESULTS After multivariable adjustment, paternal PTSD symptoms, depression, and antisocial behavior were each associated with increased asthma symptoms at age 1 year (eg, odds ratio, 1.08 for each 1-point increase in PTSD score; 95% CI, 1.03-1.14). Maternal depressive symptoms were associated with an increased risk of asthma hospitalizations at age 1 year. At age 3 years, maternal depressive symptoms were associated with asthma diagnosis and hospitalizations for asthma (odds ratio for each 1-point increase in symptoms, 1.16; 95% CI, 1.00-1.36). In an analysis combining 1- and 3-year outcomes, paternal depression was associated with oral steroid use, maternal depressive symptoms were associated with asthma hospitalizations and asthma diagnosis, and parental depression was associated with hospitalizations for asthma. CONCLUSIONS Both paternal and maternal psychosocial factors can influence asthma morbidity in young Puerto Rican children.
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Affiliation(s)
- Nancy E Lange
- Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA
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Alcântara-Neves NM, Badaró SJ, dos Santos MCA, Pontes-de-Carvalho L, Barreto ML. The presence of serum anti-Ascaris lumbricoides IgE antibodies and of Trichuris trichiura infection are risk factors for wheezing and/or atopy in preschool-aged Brazilian children. Respir Res 2010; 11:114. [PMID: 20731833 PMCID: PMC2939601 DOI: 10.1186/1465-9921-11-114] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2009] [Accepted: 08/23/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The elucidation of factors that trigger the development of transient wheezing in early childhood may be an important step toward understanding the pathogenesis of asthma and other allergic diseases later in life. Transient wheezing has been mainly attributed to viral infections, although sensitisation to aeroallergens and food allergens may occur at an early age. In developing countries, intestinal helminthic infections have also been associated with allergy or atopy-related disorders. OBJECTIVE The aim of this study was to explore the association of Trichuris trichiura and Ascaris lumbricoides infections with wheezing and atopy in early childhood. STUDY DESIGN A cross-sectional study using a Portuguese-language ISAAC phase I questionnaire, adapted for preschool-aged children, nested in a cohort study of childhood diarrhoea, was conducted on 682 children. Two faecal samples per child were examined for the presence of intestinal helminthic infection. IgE antibodies against three allergenic preparations (Dermatophagoides pteronyssinus, Blomia tropicalis and common child food), as well as against A. lumbricoides antigens, were measured in a sub-sample of these children, whose parents allowed the procedure. Atopy was defined by the presence of levels of serum IgE antibodies ≥0.35 kU/L against at least one of the three tested allergenic preparations. RESULTS Active T. trichiura infection but not A. lumbricoides infection was positively associated with wheezing in the total studied children population [adjusted OR = 2.60; CI = 1.54;4.38] and in the atopic children sub-population [adjusted OR = 3.07; CI = 1.00;9.43]. The association with atopy was also positive and statistically significant only in the brute analysis [OR = 2.13; CI = 1.03;4.40]. Anti-A. lumbricoides IgE antibodies, but not current A. lumbricoides infection, were positively associated with wheezing in atopic children [adjusted OR = 2.01; CI = 1.00;4.50] and in non-atopic children [adjusted OR = 3.07; CI = 1.13;8.35] and it was also associated with atopy [adjusted OR = 7.29; CI = 3.90; 13.4]. On the other hands, reports of wheezing were not significantly associated with atopy. CONCLUSIONS These data corroborate previous studies showing that wheezing is predominantly associated with infection in early childhood and shows that anti-A. lumbricoides IgE antibodies, but not active Ascaris infections, are associated with wheezing and atopy. Additionally, the data demonstrate that T. trichiura infection may play a role in the pathogenesis of atopic wheezing in early childhood.
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Affiliation(s)
- Neuza M Alcântara-Neves
- Departmento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Samuel J Badaró
- Departmento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Mariese CA dos Santos
- Departmento de Ciências da Biointeração, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador, Brazil
| | - Lain Pontes-de-Carvalho
- Laboratório de Patologia e Biologia Interativa, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Maurício L Barreto
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
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Fusco A, Vigliano I, Palamaro L, Cirillo E, Aloj G, Piscopo G, Giardino G, Pignata C. Altered signaling through IL-12 receptor in children with very high serum IgE levels. Cell Immunol 2010; 265:74-9. [PMID: 20696422 DOI: 10.1016/j.cellimm.2010.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Accepted: 07/16/2010] [Indexed: 01/16/2023]
Abstract
An alteration of Th1/Th2 homeostasis may lead to diseases in humans. In this study, we investigated whether an impaired IL-12R signaling occurred in children with elevated serum IgE levels divided on the basis of the IgE levels (group A: >2000kU/l; group B: <2000kU/l). We evaluated the integrity of the IL-12R signaling through the analysis of phosphorylation/activation of STAT4, and mRNA expression and membrane assembly of the receptor chains. At a functional level, a proliferative defect of lymphocytes from group A patients was observed. In these patients, an abnormal IL-12R signaling was documented, and this finding was associated with abnormal expression of the IL-12Rbeta2 chain. Our data indicate that in patients with very high IgE levels the generation of Th1 response is impaired, and that this abnormality associates with abnormal IL-12R signaling.
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Affiliation(s)
- Anna Fusco
- Department of Pediatrics, "Federico II" University, Naples, Italy
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Antenatal steroid therapy for fetal lung maturation and the subsequent risk of childhood asthma: a longitudinal analysis. J Pregnancy 2010; 2010:789748. [PMID: 21490744 PMCID: PMC3065803 DOI: 10.1155/2010/789748] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 04/06/2010] [Indexed: 11/22/2022] Open
Abstract
This study was designed to test the hypothesis that fetal exposure to corticosteroids in the antenatal period is an independent risk factor for the development of asthma in early childhood with little or no effect in later childhood. A population-based cohort study of all pregnant women who resided in Nova Scotia, Canada, and gave birth to a singleton fetus between 1989 and 1998
was undertaken. After a priori specified exclusions, 80,448 infants were available for analysis.
Using linked health care utilization records, incident asthma cases developed after 36 months of
age were identified. Extended Cox proportional hazards models were used to estimate hazard
ratios while controlling for confounders. Exposure to corticosteroids during pregnancy was
associated with a risk of asthma in childhood between 3–5 years of age: adjusted hazard ratio of
1.19 (95% confidence interval: 1.03, 1.39), with no association noted after 5 years of age:
adjusted hazard ratio for 5–7 years was 1.06 (95% confidence interval: 0.86, 1.30)
and for 8 or greater years was 0.74 (95% confidence interval: 0.54, 1.03). Antenatal steroid therapy appears to be an independent risk factor for the development of asthma between 3 and 5 years of age.
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