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Kamei JM, Maués RD, de Oliveira Silva G, Machado AH, Hoshino EM, Bacchiega FM, Sena LMF, Negrato CA. Prevalence of asthma in people with type 1 diabetes mellitus: a scoping review. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:12. [PMID: 38331806 PMCID: PMC10851526 DOI: 10.1186/s13223-024-00869-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/01/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND According to the Th1/Th2 paradigm, the expansion of Th1-type clones in individuals with type 1 diabetes results in reduced Th2-type clones, preventing the development of atopic diseases and vice versa. However, there is no consensus regarding the direct or inverse relationship between autoimmune and atopic diseases. OBJECTIVE The aim of this scoping review was to examine the knowledge gap about the possibility of coexistence of asthma and type 1 diabetes and determine the prevalence of this association. METHODS A scoping review was conducted, following the proposal of the Joanna Briggs Institute. The Population, Concept, and Context strategy was used to formulate the guiding question. The proposed question was: "What is the prevalence of asthma in people with T1DM?" After excluding duplicate articles, analyzing titles and abstracts, and excluding articles that did not answer the guiding question, 17 articles remained and were included in this review. RESULTS Most of the articles selected conformed to the Th1/Th2 hypothesis, as the prevalence of asthma was lower in individuals with T1DM. However, similar or higher prevalence of asthma was found between cases and controls in few articles. CONCLUSION The prevalence of asthma in people with T1DM ranged from 1.7% to 23.1%. Maybe the mechanisms that characterizes the Th1/Th2 paradigm aren't as simple as just the interaction of certain cytokines, since Th1-mediated autoimmune diseases and Th2- mediated atopy can coexist.
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Affiliation(s)
- Júlia Marchatto Kamei
- University of São Paulo - Bauru Campus (USP-Bauru), Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil.
| | - Raissa Dias Maués
- University of São Paulo - Bauru Campus (USP-Bauru), Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
| | - Gabriel de Oliveira Silva
- University of São Paulo - Bauru Campus (USP-Bauru), Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
| | - Alessandra Helena Machado
- University of São Paulo - Bauru Campus (USP-Bauru), Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
| | - Erika Megumi Hoshino
- University of São Paulo - Bauru Campus (USP-Bauru), Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
| | - Fabiana Menezes Bacchiega
- University of São Paulo - Bauru Campus (USP-Bauru), Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
| | - Laís Mota Furtado Sena
- University of São Paulo - Bauru Campus (USP-Bauru), Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
| | - Carlos Antonio Negrato
- University of São Paulo - Bauru Campus (USP-Bauru), Alameda Dr. Octávio Pinheiro Brisolla, 9-75, Bauru, 17012-901, Brazil
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D’Auria E, Minutoli M, Colombo A, Sartorio MUA, Zunica F, Zuccotti G, Lougaris V. Allergy and autoimmunity in children: non-mutually exclusive diseases. A narrative review. Front Pediatr 2023; 11:1239365. [PMID: 38027278 PMCID: PMC10652575 DOI: 10.3389/fped.2023.1239365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
In last decades a simultaneous increase in the prevalence of atopic and autoimmune disorders in pediatric population has been observed. Despite the Th1-Th2 paradigm, supporting the polarization of the immune system with Th1 response involved in autoimmune diseases and Th2 response leading to hypersensitivity reactions, recent evidence suggests a possible coexistence of common pathogenic pathways as result of shared immune dysregulation. Similar genes and other mechanisms such as epithelial barrier damage, gut microbiota dysbiosis and reduced number of T regs and IL-10 contribute to the onset of allergy and autoimmunity. IgA deficiency is also hypothesized to be the crosslink between celiac disease and allergy by lowering gut mucous membrane protection from antigens and allergens. The present narrative review aims to give an overview of the co-occurrence of allergic and autoimmune disorders (celiac disease, inflammatory bowel diseases, type 1 diabetes mellitus, thyroid disease, juvenile idiopathic arthritis) in pediatric population, based on the available evidence. We also highlighted the common pathogenic pathways that may underpin both. Our findings confirm that allergic and autoimmune diseases are commonly associated, and clinicians should therefore be aware of the possible coexistence of these conditions in order to ameliorate disease management and patient care. Particular attention should be paid to the association between atopic dermatitis or asthma and celiac disease or type 1 diabetes and vice versa, for therapeutic interventions. Further studies are needed to better clarify mechanisms involved in the pathogenesis and eventually identify new therapeutic strategies.
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Affiliation(s)
- Enza D’Auria
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Martina Minutoli
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Alessandra Colombo
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | | | - Fiammetta Zunica
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, Vittore Buzzi Children’s Hospital, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, ASST – Spedali Civili di Brescia, Paediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy
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Sgrazzutti L, Sansone F, Attanasi M, Di Pillo S, Chiarelli F. Coaggregation of Asthma and Type 1 Diabetes in Children: A Narrative Review. Int J Mol Sci 2021; 22:ijms22115757. [PMID: 34071190 PMCID: PMC8198343 DOI: 10.3390/ijms22115757] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 02/06/2023] Open
Abstract
Asthma and type 1 diabetes mellitus (T1DM) are two of the most frequent chronic diseases in children, representing a model of the atopic and autoimmune diseases respectively. These two groups of disorders are mediated by different immunological pathways, T helper (Th)1 for diabetes and Th2 for asthma. For many years, these two groups were thought to be mutually exclusive according to the Th1/Th2 paradigm. In children, the incidence of both diseases is steadily increasing worldwide. In this narrative review, we report the evidence of the potential link between asthma and T1DM in childhood. We discuss which molecular mechanisms could be involved in the link between asthma and T1DM, such as genetic predisposition, cytokine patterns, and environmental influences. Cytokine profile of children with asthma and T1DM shows an activation of both Th1 and Th2 pathways, suggesting a complex genetic-epigenetic interaction. In conclusion, in children, the potential link between asthma and T1DM needs further investigation to improve the diagnostic and therapeutic approach to these patients. The aim of this review is to invite the pediatricians to consider the potential copresence of these two disorders in clinical practice.
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Mameli C, Ghezzi M, Mari A, Cammi G, Macedoni M, Redaelli FC, Calcaterra V, Zuccotti G, D’Auria E. The Diabetic Lung: Insights into Pulmonary Changes in Children and Adolescents with Type 1 Diabetes. Metabolites 2021; 11:metabo11020069. [PMID: 33530418 PMCID: PMC7912250 DOI: 10.3390/metabo11020069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022] Open
Abstract
Historically, the lung was not listed and recognized as a major target organ of diabetic injury. The first evidence of diabetic lung involvement was published fifty years ago, with a study conducted in a population of young adults affected by type 1 diabetes (T1D). In recent years, there has been mounting evidence showing that the lung is a target organ of diabetic injury since the beginning of the disease—at the pediatric age. The deeply branched vascularization of the lungs and the abundance of connective tissue, indeed, make them vulnerable to the effects of hyperglycemia, in a way similar to other organs affected by microvascular complications. In this review, we focus on pulmonary function impairment in children and adolescents affected by T1D. We also cover controversial aspects regarding available studies and future perspectives in this field.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Department of Biomedical and Clinical Science “L. Sacco”, Università di Milano, 20157 Milan, Italy
- Correspondence: ; Tel.: +39-0263635324
| | - Michele Ghezzi
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Allergology and Pneumology Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Alessandra Mari
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
| | - Giulia Cammi
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
| | - Maddalena Macedoni
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
| | - Francesca Chiara Redaelli
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
| | - Valeria Calcaterra
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Department of Biomedical and Clinical Science “L. Sacco”, Università di Milano, 20157 Milan, Italy
| | - Enza D’Auria
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Allergology and Pneumology Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy
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Song BC, Jiang MM, Zhang S, Ma H, Liu M, Fu ZR, Wu R, Tong CY. Immunosuppressive activity of daphnetin on the humoral immune responses in ovalbumin-sensitized BALB/c mice. Immunopharmacol Immunotoxicol 2021; 43:171-175. [PMID: 33491523 DOI: 10.1080/08923973.2021.1872618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Most of the immunosuppressive drugs are used for the treatment of autoimmune disease, allergic diseases, and transplant rejection, but toxicity is the major obstacle for the potent drugs in the wide use of these immunosuppressive drugs. Daphnetin, a Chinese herbal product, has been reported that daphnetin possesses antimicrobial, anticoagulation, antimalarial, anticancer, and antioxidant activity. In a previous study, we found that daphnetin exhibited a potential immunosuppressive effect on LPS-induced B lymphocyte cells in vitro, therefore, in this research, we investigated the immunosuppressive effects of daphnetin in BALB/c mice use OVA as a prototype antigen. METHODS Sixty BALB/c mice were divided into six groups. The emulsion (100 μL containing 100 μg OVA) was injected subcutaneously with OVA + CFA into the shaved backs of the BALB/c mice on day 1, and a boosting injection was administered in OVA + IFA 2 weeks later. Beginning on the day of immunization, the immunized mice were administered intraperitoneally with daphnetin at a dose of 5, 10, and 20 mg/kg in saline solution for 28 consecutive days. We measured the effect of daphnetin on OVA-specific antibody, cytokine production, and Splenocyte proliferation in vivo. RESULTS The results revealed that daphnetin significantly suppressed serum immunoglobulin G levels (IgG), and the OVA-specific IgG subclasses IgG1 and IgG2b, daphnetin was also significantly decreased the Th1 and Th2 cytokine productions, inhibited the splenocytes proliferation rate in vivo. CONCLUSIONS It proved that daphnetin could suppress humoral response activity on OVA-sensitized mice, suggesting a potential role on daphnetin as a new immunosuppressive drug.
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Affiliation(s)
- Bo-Cui Song
- Department of Pharmaceutical Engineering, College of Life Science & Technology, Heilongjiang Bayi Agricultural University, Daqing, P. R. China
| | - Meng-Meng Jiang
- Department of Biological Engineering, College of Life Science & Technology, Heilongjiang Bayi Agricultural University, Daqing, P. R. China
| | - Shuang Zhang
- Animal Husbandry and Veterinary Station, Yongji Economic Development Zone, Jilin, P. R. China
| | - Hui Ma
- Department of Friendship Farm Husbandry and Veterinary, Friendship County, Shuangyashan, P. R. China
| | - Min Liu
- Department of Pharmaceutical Engineering, College of Life Science & Technology, Heilongjiang Bayi Agricultural University, Daqing, P. R. China
| | - Zhong-Ren Fu
- Department of Pharmaceutical Engineering, College of Life Science & Technology, Heilongjiang Bayi Agricultural University, Daqing, P. R. China
| | - Rui Wu
- Department of Clinical Veterinary Medicine, College of Animal Science and Veterinary Medicine, Heilongjiang Bayi Agricultural University, Daqing, P. R. China
| | - Chun-Yu Tong
- Department of Biological Science, College of Life Science & Technology, Heilongjiang Bayi Agricultural University, Daqing, P. R. China
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Jasser-Nitsche H, Varga EM, Borkenstein HM, Höntzsch J, Suppan E, Weinhandl G, Pieringer L, Avian A, Fröhlich-Reiterer E. Type 1 diabetes in children and adolescents is not associated with a reduced prevalence of atopy and allergic diseases. Pediatr Diabetes 2017; 18:890-894. [PMID: 28239959 DOI: 10.1111/pedi.12504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/09/2016] [Accepted: 12/28/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1D) as well as allergies in childhood have increased worldwide during the last 2 decades. The reasons for this increase are still unknown but early life origins are being discussed, such as dietary and hygiene factors that may play a role in the development of both diseases. The aim of this study was to compare the prevalence of allergies in children with and without T1D and to define potential influencing factors. MATERIALS AND METHODS Data were collected from 104 patients with T1D (n = 104; mean age 11.4 ± 4.4 years; m/f: 77/27) and 104 healthy controls (CG) (n = 104; mean age 11.4 ± 4.3 years; m/f: 77/27). A questionnaire on allergic symptoms was obtained from each individual. In parallel, ImmunoCAP tests to detect specific allergen sensitization were performed. RESULTS Allergen sensitization rates were not significantly different between both groups (T1D: 42% vs CG 38%; P = 0.625). In both groups, a comparable number of patients reported allergic symptoms in the questionnaire (T1D: 20% vs CG 26%; P = 0.43). Allergen sensitization and allergic symptoms were independent of breastfeeding, pets at home or diabetes duration. However, in T1D, fewer family members smoked (T1D: 10% vs CG 56%; P < 0.001). CONCLUSIONS The present cohort study shows the same prevalence of allergy and atopy in a pediatric diabetes population compared to healthy controls. Diabetes per se does not seem to influence the development of allergies.
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Affiliation(s)
- Hildegard Jasser-Nitsche
- Department of Pediatrics, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Eva-Maria Varga
- Department of Pediatrics, Division of Respiratory and Allergic Disease, Medical University of Graz, Graz, Austria
| | | | - Julia Höntzsch
- Department of Pediatrics, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Elisabeth Suppan
- Department of Pediatrics, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Gudrun Weinhandl
- Department of Pediatrics, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Lisa Pieringer
- Department of Pediatrics, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics, Division of General Pediatrics, Medical University of Graz, Graz, Austria
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Pols DHJ, Bohnen AM, Nielen MMJ, Korevaar JC, Bindels PJE. Risks for comorbidity in children with atopic disorders: an observational study in Dutch general practices. BMJ Open 2017; 7:e018091. [PMID: 29133326 PMCID: PMC5695444 DOI: 10.1136/bmjopen-2017-018091] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE This study aimed to investigate both atopic and non-atopic comorbid symptoms and diseases in children with physician-diagnosed atopic disorders (atopic eczema, asthma and allergic rhinitis). METHODS All children aged 0-18 years listed in a nationwide primary care database (the Netherlands Institute for Health Services Research-Primary Care Database) with routinely collected healthcare data in 2014 were selected. Children with atopic disorders were matched on age and gender with non-atopic controls within the same general practice. A total of 404 International Classification of Primary Care codes were examined. Logistic regression analyses were performed to examine the associations between the presence of atopic disorders and (non-)atopic symptoms and diseases by calculating ORs. RESULTS Having one of the atopic disorders significantly increased the risk of having other atopic-related symptoms, even if the child was not registered as having the related atopic disorder. Regarding non-atopic comorbidity, children with atopic eczema (n=15 530) were at significantly increased risk for (infectious) skin diseases (OR: 1.2-3.4). Airway symptoms or (infectious) diseases (OR: 2.1-10.3) were observed significantly more frequently in children with asthma (n=7887). Children with allergic rhinitis (n=6835) had a significantly distinctive risk of ear-nose-throat-related symptoms and diseases (OR: 1.5-3.9). Neither age nor gender explained these increased risks. CONCLUSION General practitioners are not always fully aware of relevant atopic and non-atopic comorbidity. In children known to have at least one atopic disorder, specific attention is required to avoid possible insufficient treatment and unnecessary loss of quality of life.
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Affiliation(s)
- David H J Pols
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arthur M Bohnen
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Mark M J Nielen
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Joke C Korevaar
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Ahmadizar F, Souverein PC, Arets HGM, de Boer A, Maitland-van der Zee AH. Asthma related medication use and exacerbations in children and adolescents with type 1 diabetes. Pediatr Pulmonol 2016; 51:1113-1121. [PMID: 27132537 DOI: 10.1002/ppul.23428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 02/11/2016] [Accepted: 02/23/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To investigate the use of asthma medication and occurrence of asthma exacerbations up to 5 years before and after the onset of type 1 diabetes mellitus (T1DM) in children and adolescents. METHODS Children and adolescents younger than 19 years with at least 2 insulin prescriptions between 1999 and 2009 classified as T1DM cohort (n = 915) and a 4 times larger reference cohort (n = 3,590) with the same age and gender were identified from the Dutch PHARMO Record Linkage System. The date of first insulin dispensing was selected as the index date. RESULTS The 5-year prevalence rate of asthma medication use in the T1DM cohort (23.2%) was significantly higher than the reference cohort (18.3%) after the onset of diabetes. No statistically significant difference between the two cohorts was observed in the use of specific types of asthma medication except for short acting muscarinic antagonists that were significantly more used in the T1DM cohort (5.5%) compared with the reference cohort (0.62%) after the onset of diabetes. The incidence rate of asthma medication use declined over time with a peak in the T1DM cohort the 1st year after the onset of diabetes. Furthermore, 1 year after the index date there was a peak in incidence rate of asthma exacerbations in both T1DM (7.8 per 1,000 person year) and reference (6.8 per 1,000 person year) cohorts. CONCLUSIONS T1DM is associated with statistically significantly higher asthma medication use after the onset of T1DM, especially in the 1st year after the onset of diabetes. Pediatr Pulmonol. 2016;51:1113-1121. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Fariba Ahmadizar
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Hubertus G M Arets
- Division of Paediatrics, Department of Paediatric Pulmonology and Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Anke H Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands.
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