Prevalence of and risk factors for the development of atopic dermatitis in schoolchildren aged 12-14 in northwest Croatia

Prevalence of atopic eczema in adolescents from a very low prevalence area (Kosovo): role of wheezing, gender, exercise, and paracetamol

BACKGROUND

The epidemiology of atopic eczema in adolescents in Kosovo is virtually unknown, and the risk factors for the condition in very low-prevalence areas (as it was the case) are not well studied. The objective of the present study was to better know those factors and whether the presence of comorbid wheezing symptoms modifies the factors.

METHODS

The cross-sectional survey, Global Asthma Network-validated questionnaire, which includes questions on eczema symptoms and environmental factors (such as smoking, pet ownership, paracetamol usage, truck traffic, siblings, time spent using screens or watching television, and physical exercise), was administered to adolescents in the following main cities of Kosovo: Ferizaj, Gjakova, Gjilan, Peja, Prishtina, and Prizren. Additionally, height and weight were measured at school.

RESULTS

Prevalence of eczema symptoms ranged from 2.2% in Ferizaj to 5.5% in Gjakova. Severe symptoms were <1% in all cities. Eczema ever ranged from 3.0% in Ferizaj to 6.4% in Prizren. Factors significantly associated with the prevalence of current eczema symptoms in the meta-analysis were males (pooled adjusted odds ratio [aOR] 0.50, 95% Confidence Interval [95% CI] 0.37-0.66); physical exercise (pooled aOR 2.79, 95% CI 1.89-4.10); and paracetamol intake (pooled 1.86, 95% CI 1.32-2.64). The corresponding figures for eczema ever were as follows: pooled aOR: 0.68, 95% CI 0.44-1.06; pooled aOR 2.07, 95% CI 1.48-2.90; and pooled aOR 1.19, 95% CI 0.88-1.60. The associations tended to be higher in the subpopulation with eczema and wheezing comorbidity.

CONCLUSIONS

The prevalence of atopic eczema is very low in Kosovo and is associated with females, physical exercise, and paracetamol intake. These associations are higher when eczema and wheezing are comorbid conditions.

Helminth infections and allergic diseases: systematic review and meta-analysis of the global literature

INTRODUCTION

There is considerable research interest in the role of helminth infections in the development of allergic diseases. However, findings from previous studies are mixed. Existing systematic reviews of these studies are outdated. We performed a systematic review of the global literature on the association between helminth infections and development and clinical outcomes of allergic diseases.

METHODS

We searched Cochrane Library, MEDLINE, EMBASE, ISI Web of Science, PubMed, Global Index Medicus, Scielo, KoreaMed, Google Scholar, and Lilacs for studies published up to January 2020. We included observational epidemiological studies (cohort, case-control and cross-sectional studies) of children and adults reporting associations between helminth infections and asthma, allergic rhinitis, eczema and atopy. We performed random-effects meta-analysis to summarize the effect estimates.

RESULTS

We included 80 studies with 99,967 participants. In the meta-analyses, we did not observe an overall association between helminth infections and allergic diseases. There was, however, evidence that A. lumbricoides infections was associated with an increased risk of bronchial hyperreactivity in children (RR:1.41, 95%CI: 1.17-1.70; I²=50, p for I²=0.09), and was associated with an increased risk of atopy among helminth-infected adults (RR:1.37, 95%CI: 1.18-1.61; I²=52, p for I²=0.02). We found no study that addressed the association between helminth infection and clinical outcomes of allergic diseases. The overall strength of the underlying evidence was low to moderate.

CONCLUSION

Helminth infections may increase the risk of bronchial hyperreactivity in children and atopy in adults. Well-designed longitudinal cohorts may help clarify potential causal associations between chronic helminth infections and allergic diseases.

Allergic Diseases and Atopy Among Schoolchildren in Eastern Croatia

SUMMARY – A cross-sectional study was carried out in Brod-Posavina County, Croatia, to assess the prevalence of allergic diseases and atopy, as well as to investigate the possible etiologic factors for asthma, allergic rhinitis and eczema in childhood. The study included 1687 schoolchildren aged 10-11 years. Data were collected using standardized International Study of Asthma and Allergies in Childhood (ISAAC) Phase II written questionnaire. Skin prick tests were performed to provide an objective measure of atopy, defined as skin reactivity to one or more allergens. Lifetime prevalence of wheezing was 22.7%, rhinitis symptoms 22.5%, and eczema symptoms 17.9%. Period prevalence in the past 12 months was 7.9% for attacks of wheezing, 9.9% for rhinoconjunctivitis symptoms, and 10.1% for eczema symptoms. Of the children in which skin prick test was performed, 20.2% were positive for at least one of the allergens used, with house dust mite sensitization being the most frequent one. Risk factors for allergic disease include allergic disease in family, atopy, sensitization to indoor and outdoor allergens, and environmental tobacco smoke exposure at home. International comparison with the results of other ISAAC Phase II studies showed the Brod-Posavina County to be an area with moderate prevalence of atopy and current asthma symptoms.

Breastfeeding and asthma and allergies: a systematic review and meta-analysis

AIM

To systematically review the association between breastfeeding and childhood allergic disease.

METHODS

Predetermined inclusion/exclusion criteria identified 89 articles from PubMed, CINAHL and EMBASE databases. Meta-analyses performed for categories of breastfeeding and allergic outcomes. Meta-regression explored heterogeneity.

RESULTS

More vs. less breastfeeding (duration) was associated with reduced risk of asthma for children (5-18 years), particularly in medium-/low-income countries and with reduced risk of allergic rhinitis ≤5 years, but this estimate had high heterogeneity and low quality. Exclusive breastfeeding for 3-4 months was associated with reduced risk of eczema ≤2 years (estimate principally from cross-sectional studies of low methodological quality). No association found between breastfeeding and food allergy (estimate had high heterogeneity and low quality). Meta-regression found differences between study outcomes may be attributable to length of breastfeeding recall, study design, country income and date of study inception. Some of the protective effect of breastfeeding for asthma may be related to recall bias in studies of lesser methodological quality.

CONCLUSION

There is some evidence that breastfeeding is protective for asthma (5-18 years). There is weaker evidence for a protective effect for eczema ≤2 years and allergic rhinitis ≤5 years of age, with greater protection for asthma and eczema in low-income countries.