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Xie X, Xuan L, Zhao Y, Wang X, Zhang L. Diverse Endotypes of Chronic Rhinosinusitis and Clinical Implications. Clin Rev Allergy Immunol 2023; 65:420-432. [PMID: 38175322 DOI: 10.1007/s12016-023-08976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
Chronic rhinosinusitis (CRS) is a highly heterogeneous disease characterized by inflammation in the nasal and sinus mucosa. The CRS phenotypes, based on the presence or absence of nasal polyps, are known as CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). However, this classification has limitations in fully capturing the mechanisms and clinical manifestations of CRS. To address the heterogeneity of CRS, there has been a growing focus on classifying the condition into distinct endotypes. Endotype classification involves grouping patients based on specific molecular, immunological, and clinical characteristics, allowing for more personalized and targeted treatment approaches.This review delves into the current state of endotype classifications for CRS. It explores the role of geographic factors, microbiome, and subphenotype in shaping different endotypes. Additionally, the review examines how various clinical features are associated with specific endotypes, providing valuable insights into tailoring treatment options for better outcomes and transitions between different endotypes.Overall, this review offers a comprehensive and up-to-date perspective on the intricate realm of CRS endotype classifications. By unraveling the molecular and clinical intricacies, this review lays the foundation for more precise, effective, and individualized treatment strategies in the management of CRS.
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Affiliation(s)
- Xiran Xie
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
| | - Lijia Xuan
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
- Beijing Municipal Education Commission and Beijing Key Laboratory of Nasal Diseases, Beijing Laboratory of Allergic Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China
| | - Yajuan Zhao
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China
- Department of Otolaryngology, Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital, Beijing, 101300, China
| | - Xiangdong Wang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.
- Beijing Municipal Education Commission and Beijing Key Laboratory of Nasal Diseases, Beijing Laboratory of Allergic Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China.
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, 100730, China.
- Beijing Municipal Education Commission and Beijing Key Laboratory of Nasal Diseases, Beijing Laboratory of Allergic Diseases, Beijing Institute of Otolaryngology, Beijing, 100005, China.
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Cao NW, Zhou HY, Du YJ, Li XB, Chu XJ, Li BZ. The effect of greenness on allergic rhinitis outcomes in children and adolescents: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 859:160244. [PMID: 36402344 DOI: 10.1016/j.scitotenv.2022.160244] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/14/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The relationship between greenness and health emerges as new public health concern. More published studies from multiple areas have explored the relationship between greenness and allergic rhinitis (AR) in children and adolescents. This study aims to determine the association between greenness and allergic rhinitis by systematic review and meta-analysis, in order to provide a more comprehensive assessment of the impact of greenness on AR in children and adolescents. METHODS The relative literature was systematically searched in PubMed, Embase, and Web of science lastly on September 25, 2022. Terms related to greenness and allergic rhinitis were used for searching. Summary effect estimates of greenness on AR in children and adolescents were calculated for per 10 % increase of greenness exposure with different buffer sizes by random-effects model. RESULTS A total of 579 studies were screened, and fourteen studies from Europe, Asia and North America were finally included. Most greenness exposure were measured by normalized difference vegetation index (NDVI). Enhanced vegetation index, outdoor-green environmental score and existed to measuring different greenness types. Greenness surrounding residences and schools were assessed. The overall effect of greenness on primary outcome was 1.00 (95%CI = 0.99-1.00). Most effect estimates of greenness were included in the NDVI-500 m group, and the pooled OR was 0.99 (95%CI = 0.97-1.01). No significant pooled estimates were found in analyses with study locations. CONCLUSION This study indicates no significant association between greenness exposure and AR in children and adolescents. Various exposure measures and conversion of data may affect the results of this meta-analysis. More precise assessment of personal greenness exposure in well-designed prospective studies are vital for drawing a definite association in future. Furthermore, greenness exposure surrounding schools should be paid considerable attention for its effect on AR in school-aged children and adolescents.
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Affiliation(s)
- Nv-Wei Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Hao-Yue Zhou
- Hospital-Acquired Infection Control Department, The First Hospital of Jiaxing & The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China
| | - Yu-Jie Du
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Xian-Bao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Xiu-Jie Chu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China
| | - Bao-Zhu Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China; Anhui Provincial Laboratory of Inflammatory and Immune Diseases, Hefei, Anhui, China.
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Wang X, Zhou N, Zhi Y. Association between exposure to greenness and atopic march in children and adults-A systematic review and meta-analysis. Front Public Health 2023; 10:1097486. [PMID: 36699899 PMCID: PMC9868616 DOI: 10.3389/fpubh.2022.1097486] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction Allergic diseases are a global public health problem. Food allergy, atopic dermatitis (AD), allergic rhinoconjunctivitis, allergic rhinitis (AR) and asthma represent the natural course of allergic diseases, also known as the "atopic march". In recent years, a large number of studies have been published on the association between greenness exposure and allergic diseases. However, systematic reviews on the association between greenness exposure and multiple allergic diseases or atopic march are lacking. Methods In this study, PubMed, EMBASE, ISI Web of Science, and Scopus were systematically searched. Meta-analyses were performed if at least three studies reported risk estimates for the same outcome and exposure measures. Results Of 2355 records, 48 studies were included for qualitative review. Five birth cohort studies, five cross-sectional studies, and one case-control study were included for asthma meta-analysis, respectively. Four birth cohort studies were included for AR meta-analysis. Our results support that exposure to a greener environment at birth reduces the risk of asthma and AR in childhood. In addition, higher greenness exposure was associated with decreased odds of current asthma in children. Discussion There was a large heterogeneity among the included studies and most of them did not specify the vegetation type and causative allergens. Therefore the study results need to be further validated. In addition, a small number of studies evaluated the association between greenness and food allergy, AD and allergic rhinoconjunctivitis. More research is needed to strengthen our understanding of the association between greenness and allergic diseases.
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Mueller W, Milner J, Loh M, Vardoulakis S, Wilkinson P. Exposure to urban greenspace and pathways to respiratory health: An exploratory systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 829:154447. [PMID: 35283125 DOI: 10.1016/j.scitotenv.2022.154447] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/OBJECTIVE Urban greenspace may have a beneficial or adverse effect on respiratory health. Our objective was to perform an exploratory systematic review to synthesise the evidence and identify the potential causal pathways relating urban greenspace and respiratory health. METHODS We followed PRISMA guidelines on systematic reviews and searched five databases for eligible studies during 2000-2021. We incorporated a broad range of urban greenspace and respiratory health search terms, including both observational and experimental studies. Screening, data extraction, and risk of bias, assessed using the Navigation Guide criteria, were performed independently by two authors. We performed a narrative synthesis and discuss suggested pathways to respiratory health. RESULTS We identified 108 eligible papers (n = 104 observational, n = 4 experimental). The most common greenspace indicators were the overall greenery or vegetation (also known as greenness), green land use/land cover of physical area classes (e.g., parks, forests), and tree canopy cover. A wide range of respiratory health indicators were studied, with asthma prevalence being the most common. Two thirds (n = 195) of the associations in these studies were positive (i.e., beneficial) with health, with 31% (n = 91) statistically significant; only 9% (n = 25) of reported associations were negative (i.e., adverse) with health and statistically significant. The most consistent positive evidence was apparent for respiratory mortality. There were n = 35 (32%) 'probably low' and n = 73 (68%) 'probably high' overall ratings of bias. Hypothesised causal pathways for health benefits included lower air pollution, more physically active populations, and exposure to microbial diversity; suggested mechanisms with poorer health included exposure to pollen and other aeroallergens. CONCLUSION Many studies showed positive association between urban greenspace and respiratory health, especially lower respiratory mortality; this is suggestive, but not conclusive, of causal effects. Results underscore the importance of contextual factors, greenspace metric employed, and the potential bias of subtle selection factors, which should be explored further.
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Affiliation(s)
- William Mueller
- Institute of Occupational Medicine, Edinburgh, UK; London School of Hygiene & Tropical Medicine, UK.
| | - James Milner
- London School of Hygiene & Tropical Medicine, UK
| | - Miranda Loh
- Institute of Occupational Medicine, Edinburgh, UK
| | - Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, Australian National University, Australia
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Dzhambov AM, Lercher P, Rüdisser J, Browning MHEM, Markevych I. Allergic symptoms in association with naturalness, greenness, and greyness: A cross-sectional study in schoolchildren in the Alps. ENVIRONMENTAL RESEARCH 2021; 198:110456. [PMID: 33188758 DOI: 10.1016/j.envres.2020.110456] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 05/16/2023]
Abstract
BACKGROUND Greenness may protect from or contribute to allergy risk by influencing air pollution and human-microbe interactions. However, existing research on the issue is heterogeneous and produced conflicting results. Less in known about the effects of greyness. This study investigated the association between different characteristics of residential and school environment and allergic symptoms in schoolchildren. METHODS The present cross-sectional survey was undertaken in 2004/2005 among 1251 schoolchildren (8-12 years old) in several alpine valleys in Austria and Italy. Children's mothers completed a questionnaire that asked about allergic symptoms (International Study of Asthma and Allergies in Childhood questionnaire), sociodemographic information, lifestyle, perinatal data, and housing conditions. We constructed four aggregate outcome variables: current asthma symptoms, ever asthma symptoms, ever allergic rhinitis (AR) symptoms, and ever eczema symptoms. We employed well-known greenness and greyness exposure indicators (Normalized Difference Vegetation Index, tree canopy cover, agricultural cover, imperviousness cover, and industrial cover), as well as an alternative naturalness index (Distance to Nature, D2N). Adjusted logistic regressions were used to explore associations between each exposure-outcome pair. Air pollution (NO2), traffic noise and time spent outdoors were tested as potential mediators in causal mediation analysis. RESULTS Decrease in naturalness in a 500-m buffer around the home was associated with higher prevalence of AR symptoms. Associations with asthma symptoms were in the same direction but marginally significant. Residential NDVI and tree cover were marginally associated with lower prevalence of asthma and AR symptoms. Having a domestic garden was associated with lower prevalence of asthma symptoms. School greenness in a 100-m buffer was associated with lower prevalence of AR symptoms. Residential greyness was associated with higher prevalence of AR and asthma symptoms. We observed stronger associations for greenness and greyness in non-movers and in children without a family history of allergies. Mediation by NO2 and time spent outdoors was present in some of the exposure-outcome pairs. CONCLUSIONS Schoolchildren residing in places with lower naturalness and higher greyness may be more likely to have allergic rhinitis and possibly asthma. Considering more comprehensive indicators than greenness and greyness and conducting research in children without a family history of allergic diseases may be key to better understanding who can profit from natural landscapes.
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Affiliation(s)
- Angel M Dzhambov
- Department of Hygiene, Faculty of Public Health, Medical University of Plovdiv, Plovdiv, Bulgaria; Institute for Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria.
| | - Peter Lercher
- Institute for Highway Engineering and Transport Planning, Graz University of Technology, Graz, Austria
| | | | - Matthew H E M Browning
- Department of Parks , Recreation, and Tourism Management, Clemson University, Clemson, USA
| | - Iana Markevych
- Institute of Psychology, Jagiellonian University, Krakow, Poland
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Eguiluz‐Gracia I, Mathioudakis AG, Bartel S, Vijverberg SJH, Fuertes E, Comberiati P, Cai YS, Tomazic PV, Diamant Z, Vestbo J, Galan C, Hoffmann B. The need for clean air: The way air pollution and climate change affect allergic rhinitis and asthma. Allergy 2020; 75:2170-2184. [PMID: 31916265 DOI: 10.1111/all.14177] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 02/06/2023]
Abstract
Air pollution and climate change have a significant impact on human health and well-being and contribute to the onset and aggravation of allergic rhinitis and asthma among other chronic respiratory diseases. In Westernized countries, households have experienced a process of increasing insulation and individuals tend to spend most of their time indoors. These sequelae implicate a high exposure to indoor allergens (house dust mites, pets, molds, etc), tobacco smoke, and other pollutants, which have an impact on respiratory health. Outdoor air pollution derived from traffic and other human activities not only has a direct negative effect on human health but also enhances the allergenicity of some plants and contributes to global warming. Climate change modifies the availability and distribution of plant- and fungal-derived allergens and increases the frequency of extreme climate events. This review summarizes the effects of indoor air pollution, outdoor air pollution, and subsequent climate change on asthma and allergic rhinitis in children and adults and addresses the policy adjustments and lifestyle changes required to mitigate their deleterious effects.
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Affiliation(s)
- Ibon Eguiluz‐Gracia
- Allergy Unit IBIMA‐Hospital Regional Universitario de Malaga‐UMA Malaga Spain
| | - Alexander G. Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine School of Biological Sciences The University of Manchester Manchester Academic Health Science Centre UK
- North West Lung Centre Wythenshawe Hospital Manchester University NHS Foundation Trust Southmoor Road Manchester UK
| | - Sabine Bartel
- Early Life Origins of Chronic Lung Disease, Research Center Borstel Leibniz Lung Center Member of the German Research Center for Lung Research (DZL) Borstel Germany
- Department of Pathology and Medical Biology University Medical Center Groningen GRIAC Research Institute University of Groningen Groningen The Netherlands
| | - Susanne J. H. Vijverberg
- Department of Respiratory Medicine Amsterdam UMC University of Amsterdam Amsterdam The Netherlands
| | - Elaine Fuertes
- National Heart and Lung Institute Imperial College London London UK
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology Sechenov University Moscow Russia
| | - Yutong Samuel Cai
- Department of Epidemiology and Biostatistics MRC Centre for Environment and Health School of Public Health Imperial College London London UK
- The George Institute for Global Health University of Oxford Oxford UK
| | - Peter Valentin Tomazic
- Department of General ORL, Head and Neck Surgery Medical University of Graz Graz Austria
| | - Zuzana Diamant
- Department of Respiratory Medicine & Allergology Institute for Clinical Science Skane University Hospital Lund University Lund Sweden
- Department of Respiratory Medicine First Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine School of Biological Sciences The University of Manchester Manchester Academic Health Science Centre UK
- North West Lung Centre Wythenshawe Hospital Manchester University NHS Foundation Trust Southmoor Road Manchester UK
| | - Carmen Galan
- Department of Botany, Ecology and Plant Physiology International Campus of Excellence on Agrifood (ceiA3) University of Córdoba Córdoba Spain
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine Medical Faculty University of Düsseldorf Düsseldorf Germany
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Di Cicco ME, Ferrante G, Amato D, Capizzi A, De Pieri C, Ferraro VA, Furno M, Tranchino V, La Grutta S. Climate Change and Childhood Respiratory Health: A Call to Action for Paediatricians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5344. [PMID: 32722291 PMCID: PMC7432234 DOI: 10.3390/ijerph17155344] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/13/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022]
Abstract
Climate change (CC) is one of the main contributors to health emergencies worldwide. CC appears to be closely interrelated with air pollution, as some pollutants like carbon dioxide (CO2), nitrogen oxides (NOx) and black carbon are naturally occurring greenhouse gases. Air pollution may enhance the allergenicity of some plants and, also, has an adverse effect on respiratory health. Children are a uniquely vulnerable group that suffers disproportionately from CC burden. The increasing global warming related to CC has a big impact on plants' lifecycles, with earlier and longer pollen seasons, as well as higher pollen production, putting children affected by asthma and allergic rhinitis at risk for exacerbations. Extreme weather events may play a role too, not only in the exacerbations of allergic respiratory diseases but, also, in favouring respiratory infections. Even though paediatricians are already seeing the impacts of CC on their patients, their knowledge about CC-related health outcomes with specific regards to children's respiratory health is incomplete. This advocates for paediatricians' increased awareness and a better understanding of the CC impact on children's respiratory health. Having a special responsibility for children, paediatricians should actively be involved in policies aimed to protect the next generation from CC-related adverse health effects. Hence, there is an urgent need for them to take action and successfully educate families about CC issues. This paper aims at reviewing the evidence of CC-related environmental factors such as temperature, humidity, rainfall and extreme events on respiratory allergic diseases and respiratory infections in children and proposing specific actionable items for paediatricians to deal with CC-related health issues in their clinical practice.
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Affiliation(s)
- Maria Elisa Di Cicco
- Department of Paediatrics, University Hospital of Pisa, via Roma 67, 56126 Pisa, Italy;
| | - Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy
| | - Doriana Amato
- Pediatric Medicine Unit and Pediatric Emergency Department, Pediatric Hospital Giovanni XXIII, via Giovanni Amendola 207, 70123 Bari, Italy; (D.A.); (V.T.)
| | - Antonino Capizzi
- Pediatrics Unit, S. Paolo and S. Corona Hospital, via Genova 30, 17100 Savona, Italy; (A.C.); (M.F.)
| | - Carlo De Pieri
- Pediatrics Clinic, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100 Udine, Italy;
| | - Valentina Agnese Ferraro
- Unit of Pediatric Allergy and Respiratory Medicine, Department of Women’s and Children’s Health, University of Padova, via Nicolò Giustiniani 2, 35128 Padova, Italy;
| | - Maria Furno
- Pediatrics Unit, S. Paolo and S. Corona Hospital, via Genova 30, 17100 Savona, Italy; (A.C.); (M.F.)
| | - Valentina Tranchino
- Pediatric Medicine Unit and Pediatric Emergency Department, Pediatric Hospital Giovanni XXIII, via Giovanni Amendola 207, 70123 Bari, Italy; (D.A.); (V.T.)
| | - Stefania La Grutta
- National Research Council of Italy, Institute for Research and Biomedical Innovation, IRIB, Via Ugo La Malfa 153, 90146 Palermo, Italy;
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Hu Y, Xu Z, Jiang F, Li S, Liu S, Wu M, Yan C, Tan J, Yu G, Hu Y, Yin Y, Tong S. Relative impact of meteorological factors and air pollutants on childhood allergic diseases in Shanghai, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 706:135975. [PMID: 31841850 DOI: 10.1016/j.scitotenv.2019.135975] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND Non-optimal weather conditions and air pollution pose a significant threat to children's health. However, the relative impact of different environmental exposures on childhood allergic diseases remains unclear. OBJECTIVES This study aimed to quantify the relative impact of meteorological factors and air pollutants on childhood allergic diseases in Shanghai, China. METHODS Data on clinical visits due to childhood asthma, allergic rhinitis (AR) and atopic dermatitis (AD) from 2007 to 2017 in Shanghai were collected from Shanghai Children's Medical Center and Xinhua Hospital. The meteorological data (i.e. daily mean temperature, temperature difference, air pressure, air pressure difference, precipitation, relative humidity, sunshine and wind speed) for the same period were obtained from the Shanghai Meteorological Center. Air pollution data (PM10, PM2.5, NO2, SO2 and O3) were provided by the Shanghai Environmental Protection Agency. Quasi-Poisson regression with distributed lag non-linear models and Poisson regression combined with generalized linear models were used to assess the relative impact of meteorological factors and air pollutants on childhood allergic diseases. RESULTS There were a total of 2,410,392 cases of childhood allergic diseases, including 975,771 asthma, 646,975 AR and 787,646 AD. Most of environmental factors were significantly associated with childhood allergic diseases. Daily mean temperature (standard β: -0.076 (95% confidence interval (CI): -0.086, -0.067)) and air pressure (standard β: 0.075 (95% CI: 0.068, 0.082)) seemed to play more important roles than other environmental factors in the occurrence of these allergic diseases. The numbers of these allergic diseases attributable to an interquartile range (IQR) change in meteorological factors also appeared to be greater than those attributable to an IQR change in air pollutants. CONCLUSIONS Both climatic variation and air pollution were associated with childhood allergic diseases, but the former appeared to play a more important role in the occurrence of these diseases. These findings may have significant implications for the development of tailored strategies to prevent these rapidly-increasing diseases worldwide.
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Affiliation(s)
- Yabin Hu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhiwei Xu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Fan Jiang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institution, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shenghui Li
- School of Public Health, Shanghai Jiaotong University, Shanghai, China
| | - Shijian Liu
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Meiqin Wu
- Shanghai Key Laboratory of Environmental and Child Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Chonghuai Yan
- Shanghai Key Laboratory of Environmental and Child Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | | | - Guangjun Yu
- Shanghai Children's Hospital, Shanghai, China
| | - Yi Hu
- Shanghai Children's Hospital, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Shilu Tong
- Department of Clinical Epidemiology and Biostatistics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China; School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia; School of Public Health, Institute of Environment and Population Health, Anhui Medical University, Hefei, China.
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Ferrante G, Asta F, Cilluffo G, De Sario M, Michelozzi P, La Grutta S. The effect of residential urban greenness on allergic respiratory diseases in youth: A narrative review. World Allergy Organ J 2020; 13:100096. [PMID: 32071664 PMCID: PMC7015834 DOI: 10.1016/j.waojou.2019.100096] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 11/01/2019] [Accepted: 12/06/2019] [Indexed: 01/26/2023] Open
Abstract
Background Environmental exposures across the life course may be a contributor to the increased worldwide prevalence of respiratory and allergic diseases occurring in the last decades. Asthma and rhinoconjunctivitis especially contribute to the global burden of disease. Greenness has been suggested to have beneficial effects in terms of reduction of occurrence of allergic respiratory diseases. However, the available evidence of a relationship between urban greenness and childhood health outcomes is not yet conclusive. The current review aimed at investigating the current state of evidence, exploring the relationship between children's exposure to residential urban greenness and development of allergic respiratory diseases, jointly considering health outcomes and study design. Methods The search strategy was designed to identify studies linking urban greenness exposure to asthma, rhinoconjunctivitis, and lung function in children and adolescents. This was a narrative review of literature following PRISMA guidelines performed using electronic search in databases of PubMed and Embase (Ovid) from the date of inception to December 2018. Results Our search strategy identified 2315 articles; after exclusion of duplicates (n = 701), 1614 articles were screened. Following review of titles and abstracts, 162 articles were identified as potentially eligible. Of these, 148 were excluded following full-text evaluation, and 14 were included in this review. Different methods for assessing greenness exposure were found; the most used was Normalized Difference Vegetation Index. Asthma, wheezing, bronchitis, rhinoconjunctivitis, allergic symptoms, lung function, and allergic sensitization were the outcomes assessed in the identified studies; among them, asthma was the one most frequently investigated. Conclusions The present review showed inconsistencies in the results mainly due to differences in study design, population, exposure assessment, geographic region, and ascertainment of outcome. Overall, there is a suggestion of an association between urban greenness in early life and the occurrence of allergic respiratory diseases during childhood, although the evidence is still inconsistent. It is therefore hard to draw a conclusive interpretation, so that the understanding of the impact of greenness on allergic respiratory diseases in children and adolescents remains difficult.
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Affiliation(s)
- Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, via del Vespro 129, 90127, Palermo, Italy
| | - Federica Asta
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Italy
| | - Giovanna Cilluffo
- National Research Council, Institute for Research and Biomedical Innovation (IRIB), via Ugo La Malfa 153, 90146, Palermo, Italy
| | - Manuela De Sario
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Italy
| | - Stefania La Grutta
- National Research Council, Institute for Research and Biomedical Innovation (IRIB), via Ugo La Malfa 153, 90146, Palermo, Italy
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Norbäck D, Lu C, Zhang Y, Li B, Zhao Z, Huang C, Zhang X, Qian H, Sun Y, Sundell J, Juan W, Liu W, Deng Q. Onset and remission of childhood wheeze and rhinitis across China - Associations with early life indoor and outdoor air pollution. ENVIRONMENT INTERNATIONAL 2019; 123:61-69. [PMID: 30496983 DOI: 10.1016/j.envint.2018.11.033] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Few longitudinal studies exist on childhood exposure to indoor and outdoor air pollution and respiratory illness in China. We studied associations between indoor and outdoor environment and prevalence, onset and remission of wheeze and rhinitis among children across China. METHODS Children (3-6 y) were recruited from randomized day care centres in six cities. The main data analysis was restricted to children not moving since birth (N = 17,679). Data on wheeze, rhinitis and the home environment were assessed by a parental questionnaire. Prevalence in the first two years of life (baseline) and the last year (follow-up) was used to calculate onset and remission. Outdoor PM2.5, PM10, and NO2 at the day care centre were modelled from monitoring station data. Associations were calculated by multilevel logistic regression. RESULTS Prenatal NO2 was associated with decreased remission of wheeze and increased prevalence and increased onset of rhinitis. Prenatal PM2.5 was associated with increased prevalence of wheeze. Postnatal NO2 and postnatal PM10 were associated with increased prevalence and lower remission of wheeze and rhinitis. Mould, window pane condensation, renovation and cockroaches at home were associated with increased prevalence and increased onset of wheeze and rhinitis. Gas cooking was associated with increased onset of rhinitis. Children of mothers with industrial work had more wheeze. CONCLUSIONS Outdoor PM2.5, PM10 and NO2 can increase childhood wheeze and rhinitis. Dampness and mould can increase onset and decrease remission. Crowdedness, cockroaches at home and emissions from new building materials and gas cooking can be risk factors for wheeze and rhinitis.
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Affiliation(s)
- Dan Norbäck
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China; School of Energy Science and Engineering, Central South University, Changsha, Hunan, China; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
| | - Chan Lu
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China; School of Energy Science and Engineering, Central South University, Changsha, Hunan, China
| | - Yinping Zhang
- School of Architecture, Tsinghua University, Beijing, China
| | - Baizhan Li
- Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Zhuohui Zhao
- Department of Environmental Health, Fudan University, Shanghai, China
| | - Chen Huang
- School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, China
| | - Xin Zhang
- Institute of Environmental Science, Shanxi University, Taiyuan, China
| | - Hua Qian
- School of Energy & Environment, Southeast University, Nanjing, China
| | - Yuexia Sun
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Jan Sundell
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China; School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Wang Juan
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Key Laboratory of Three Gorges Reservoir Region's Eco-Environment, Chongqing University, Chongqing, China
| | - Wei Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Qihong Deng
- XiangYa School of Public Health, Central South University, Changsha, Hunan, China; School of Energy Science and Engineering, Central South University, Changsha, Hunan, China.
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Associations of urban greenness with asthma and respiratory symptoms in Mexican American children. Ann Allergy Asthma Immunol 2018; 122:289-295. [PMID: 30557617 DOI: 10.1016/j.anai.2018.12.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Evidence on the association between residential surrounding greenness (RSG) in urban areas with asthma and asthma symptoms is inconsistent. OBJECTIVE To examine the association of RSG with respiratory outcomes in a sample of Mexican American children living in inner-city Chicago, Illinois. METHODS This study is based on parent-reported data on 1915 Mexican American children. We calculated RSG using the normalized difference vegetation index based on satellite imagery within buffers of 100, 250, and 500 m of each child's residence. Multivariable multilevel mixed-effect logistic regression was used to estimate adjusted odds ratios (aORs) for the effect of a 1-interquartile range increase in greenness. RESULTS In adjusted analyses, a protective effect of greenness within 100 m was observed for lifetime wheezing (aOR, 0.82; 95% CI, 0.69-0.96). Environmental tobacco smoke (ETS) exposure modified the association of RSG with lifetime asthma and current dry cough at night. For all buffer distances, increased greenness was associated with lower odds of lifetime asthma among children with current ETS exposure (100 m: aOR, 0.43; 95% CI, 0.22-0.87; 250 m: aOR, 0.39; 95% CI, 0.18-0.84; 500 m: aOR, 0.48; 95% CI, 0.26-0.90) and lower odds of current dry cough at night among children with perinatal ETS exposure (100 m: aOR, 0.53; 95% CI, 0.31-0.92; 250 m: aOR, 0.55; 95% CI, 0.31-0.98; 500 m: aOR, 0.55; 95% CI, 0.35-0.87). CONCLUSION Our results suggest inverse associations of urban greenness with respiratory outcomes, especially in children exposed to ETS. Further research is needed to examine the mechanisms through which RSG may be associated with the risk of asthma and contribute to health.
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Cilluffo G, Ferrante G, Fasola S, Montalbano L, Malizia V, Piscini A, Romaniello V, Silvestri M, Stramondo S, Stafoggia M, Ranzi A, Viegi G, La Grutta S. Associations of greenness, greyness and air pollution exposure with children's health: a cross-sectional study in Southern Italy. Environ Health 2018; 17:86. [PMID: 30518403 PMCID: PMC6282291 DOI: 10.1186/s12940-018-0430-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/23/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Due to the complex interplay among different urban-related exposures, a comprehensive approach is advisable to estimate the health effects. We simultaneously assessed the effect of "green", "grey" and air pollution exposure on respiratory/allergic conditions and general symptoms in schoolchildren. METHODS This study involved 219 schoolchildren (8-10 years) of the Municipality of Palermo, Italy. Data were collected through questionnaires self-administered by parents and children. Exposures to greenness and greyness at the home addresses were measured using the normalized difference vegetation index (NDVI), residential surrounding greyness (RSG) and the CORINE land-cover classes (CLC). RSG was defined as the percentage of buffer covered by either industrial, commercial and transport units, or dump and construction sites, or urban fabric related features. Two specific categories of CLC, namely "discontinuous urban fabric - DUF" - and "continuous urban fabric - CUF" - areas were found. Exposure to traffic-related nitrogen dioxide (NO2) was assessed using a Land-Use Regression model. A symptom score ranging from 0 to 22 was built by summing affirmative answers to twenty-two questions on symptoms. To avoid multicollinearity, multiple Logistic and Poisson ridge regression models were applied to assess the relationships between environmental factors and self-reported symptoms. RESULTS A very low exposure to NDVI ≤0.15 (1st quartile) had a higher odds of nasal symptoms (OR = 1.47, 95% CI [1.07-2.03]). Children living in CUF areas had higher odds of ocular symptoms (OR = 1.49, 95% CI [1.10-2.03]) and general symptoms (OR = 1.18, 95% CI [1.00-1.48]) than children living in DUF areas. Children living in proximity (≤200 m) to High Traffic Roads (HTRs) had increased odds of ocular (OR = 1.68, 95% CI [1.31-2.17]) and nasal symptoms (OR = 1.49, 95% CI [1.12-1.98]). A very high exposure to NO2 ≥ 60 μg/m3 (4th quartile) was associated with a higher odds of general symptoms (OR = 1.28, 95% CI [1.10-1.48]). No associations were found with RGS. A Poisson ridge regression model on the symptom score showed that children living in proximity to HTRs (≤200 m) had a higher symptoms score (RR = 1.09, 95% CI [1.02-1.17]) than children living > 200 m from HTRs. Children living in CUF areas had a higher symptoms score (RR = 1.11, 95% CI [1.03-1.19]) than children living in DUF areas. CONCLUSIONS Multiple exposures related to greenness, greyness (measured by CORINE) and air pollution within the urban environment are associated with respiratory/allergic and general symptoms in schoolchildren. No associations were found when considering the individual exposure to greyness measured using the RSG indicator.
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Affiliation(s)
- Giovanna Cilluffo
- National Research Council, Institute of Biomedicine and Molecular Immunology, via Ugo La Malfa 153, 90146, Palermo, Italy
- Department of Economics, Business and Statistical Science, University of Palermo, viale delle Scienze, Ed. 13, 90128 Palermo, Italy
| | - Giuliana Ferrante
- Department of Science for Health Promotion and Mother and Child Care, University of Palermo, via del Vespro 129, 90127 Palermo, Italy
| | - Salvatore Fasola
- National Research Council, Institute of Biomedicine and Molecular Immunology, via Ugo La Malfa 153, 90146, Palermo, Italy
- Department of Economics, Business and Statistical Science, University of Palermo, viale delle Scienze, Ed. 13, 90128 Palermo, Italy
| | - Laura Montalbano
- National Research Council, Institute of Biomedicine and Molecular Immunology, via Ugo La Malfa 153, 90146, Palermo, Italy
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, viale delle Scienze, Ed. 15, 90128 Palermo, Italy
| | - Velia Malizia
- National Research Council, Institute of Biomedicine and Molecular Immunology, via Ugo La Malfa 153, 90146, Palermo, Italy
| | - Alessandro Piscini
- National Institute of Geophysics and Volcanology, via di Vigna Murata 605, 00143 Rome, Italy
| | - Vito Romaniello
- National Institute of Geophysics and Volcanology, via di Vigna Murata 605, 00143 Rome, Italy
| | - Malvina Silvestri
- National Institute of Geophysics and Volcanology, via di Vigna Murata 605, 00143 Rome, Italy
| | - Salvatore Stramondo
- National Institute of Geophysics and Volcanology, via di Vigna Murata 605, 00143 Rome, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Latium Region Health Service, via Cristoforo Colombo, 112, 00147 Rome, Italy
| | - Andrea Ranzi
- Environmental Health Reference Centre, Regional Agency for Environmental Prevention of Emilia-Romagna, via Braghiroli 63, 41125 Modena, Italy
| | - Giovanni Viegi
- National Research Council, Institute of Biomedicine and Molecular Immunology, via Ugo La Malfa 153, 90146, Palermo, Italy
- National Research Council, Institute of Clinical Physiology, via Trieste 41, 56126 Pisa, Italy
| | - Stefania La Grutta
- National Research Council, Institute of Biomedicine and Molecular Immunology, via Ugo La Malfa 153, 90146, Palermo, Italy
- Department of Science for Health Promotion and Mother and Child Care, University of Palermo, via del Vespro 129, 90127 Palermo, Italy
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Food allergy trends at the crossing among socio-economics, history and geography. Curr Opin Allergy Clin Immunol 2018; 18:271-276. [DOI: 10.1097/aci.0000000000000437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Fuertes E, Flohr C, Silverberg JI, Standl M, Strachan DP. Global Associations between UVR Exposure and Current Eczema Prevalence in Children from ISAAC Phase Three. J Invest Dermatol 2017; 137:1248-1256. [DOI: 10.1016/j.jid.2017.02.966] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/30/2017] [Accepted: 02/12/2017] [Indexed: 11/16/2022]
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Kim DH, Park YS, Jang HJ, Kim JH, Lim DH. Prevalence and allergen of allergic rhinitis in Korean children. Am J Rhinol Allergy 2017; 30:72-8. [PMID: 27216339 DOI: 10.2500/ajra.2013.27.4317] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In recent decades, the amount of data about allergic rhinitis (AR) in Korean National Health Insurance Service has increased. OBJECTIVE To investigate the prevalence and quality of sensitized allergens of AR in Korean children and adolescents. METHODS This study obtained the results of the Korean International Study of Asthma and Allergies in Childhood questionnaires and the skin-prick test (SPT) results of 14,356 students who participated in a health screening from 2010 to 2014. AR was defined as one with current symptoms of AR with at least one or more positive results of an SPT with inhalant allergens. RESULTS The prevalence of AR in children was 20.8%. Positive rates of the allergen group were 87.3% for house-dust mites, 37.0% for pollen, 12.4% for mold, and 8.4% for pets. The common allergens in descending order were Dermatophagoides pteronyssinus, Dermatophagoides farinae, Betula, Humulus, Alnus, and Alternaria. As the children became older, pollen-sensitization rates tended to increase (p value for trends, <0.001). In metropolitan and middle inland areas, weed pollen was the most common pollen. The rates of tree-pollen sensitization were the highest at the seaside and in the southern inland. The most common comorbid allergic diseases associated with AR were pollen allergy and allergic conjunctivitis at 37.0% and 34.5%, respectively. CONCLUSIONS This was the first study conducted in Korea to investigate the prevalence of AR in the general population by using both questionnaires and SPTs. The allergens used for the SPTs were chosen based on the common allergens in this study, and this current pollen data will contribute to establish the cause of increasing AR prevalence in Korea.
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Affiliation(s)
- Dong Hyun Kim
- Department of Pediatrics, Inha University School of Medicine, Incheon, Republic of Korea
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Hicke-Roberts A, Åberg N, Wennergren G, Hesselmar B. Allergic rhinoconjunctivitis continued to increase in Swedish children up to 2007, but asthma and eczema levelled off from 1991. Acta Paediatr 2017; 106:75-80. [PMID: 27102081 DOI: 10.1111/apa.13433] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 03/14/2016] [Accepted: 04/12/2016] [Indexed: 01/22/2023]
Abstract
AIM This study investigated whether allergies among schoolchildren increased in Sweden between 1979 and 2007 and whether the geographical differences observed in previous studies remained. METHODS We collected questionnaire data on asthma, allergic rhinoconjunctivitis (ARC) and eczema in children aged seven to eight years from Mölndal, Gothenburg, in south-western Sweden and Kiruna in northern Sweden in 1979 (n = 4682), 1991 (n = 2481) and 2007 (n = 1029). The same regions and questions were used in all three studies, and extra questions on food allergy or intolerance were added in 2007. RESULTS In 1979, 1991 and 2007, the total prevalence of asthma was 2.5%, 5.7% and 7.1%, ARC was 5.5%, 8.1% and 11.1% and eczema was 7.1%, 18.3% and 19.7%, respectively. Asthma prevalence remained higher in Kiruna, but no significant regional differences were seen for ARC and eczema. Almost 20% reported a history of food allergy or intolerance, with a higher prevalence in Kiruna. The allergy risk was reduced if both parents were born outside Sweden. CONCLUSION The prevalence of ARC continued to increase between 1991 and 2007, but increases in asthma and eczema started to level off in 1991. Some geographical differences remained, but total allergy rates were similar in Kiruna and Mölndal in 2007.
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Affiliation(s)
- Anna Hicke-Roberts
- Paediatric Outpatient Clinic; Angered Hospital; Angered-Gothenburg Sweden
| | - Nils Åberg
- Department of Paediatrics; University of Gothenburg; Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Göran Wennergren
- Department of Paediatrics; University of Gothenburg; Queen Silvia Children's Hospital; Gothenburg Sweden
| | - Bill Hesselmar
- Department of Paediatrics; University of Gothenburg; Queen Silvia Children's Hospital; Gothenburg Sweden
- Data and Analysis Unit; Västra Götaland Health Care Department; Gothenburg Sweden
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Christiansen ES, Kjaer HF, Eller E, Bindslev-Jensen C, Høst A, Mortz CG, Halken S. The prevalence of atopic diseases and the patterns of sensitization in adolescence. Pediatr Allergy Immunol 2016; 27:847-853. [PMID: 27591739 DOI: 10.1111/pai.12650] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Atopic diseases are among the most common chronic diseases in adolescents, and it is uncertain whether the prevalence of atopic diseases has reached a plateau or is still increasing. The use of the ISAAC (International Study of Asthma and Allergy in Childhood) questionnaire has provided comparable prevalence rates from many countries, whereas studies including clinical examinations and strict diagnostic criteria are scarce. We aimed to investigate the prevalence of atopic diseases, the pattern of sensitization, and comorbidities at 14 years in a prospective birth cohort. METHODS The children were examined eight times from birth to 14 years. Visits included questionnaire-based interviews, clinical examination, skin prick test, and specific IgE. RESULTS Follow-up rate at 14 years was 66.2%. The 12-month prevalence of any atopic disease was high (40.3%) mostly due to a high prevalence of rhinoconjunctivitis (32.8%), whereas the prevalence of asthma was 12.9% and of atopic dermatitis 8.1%. In children with at least one atopic disease, 60% were sensitized, while only 16% of those without atopic diseases were sensitized. The frequency of sensitization depended on the phenotype. Among children with rhinoconjunctivitis only, rhinoconjunctivitis with concomitant asthma or atopic dermatitis or both 62.5%, 81.5%, 70%, and 100%, respectively, were sensitized, whereas it was 7.7% and 33.3% of children with only asthma or atopic dermatitis. CONCLUSION The prevalence of rhinoconjunctivitis was high in adolescence. Children with rhinoconjunctivitis with and without comorbidities were frequently sensitized. Children with asthma without concomitant allergic rhinoconjunctivitis were rarely sensitized.
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Affiliation(s)
- Elisabeth Soegaard Christiansen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense C, Denmark.,Hans Christian Andersen Children's Hospital, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Henrik Fomsgaard Kjaer
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Esben Eller
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Arne Høst
- Hans Christian Andersen Children's Hospital, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Charlotte Gotthard Mortz
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense C, Denmark
| | - Susanne Halken
- Hans Christian Andersen Children's Hospital, Odense University Hospital, University of Southern Denmark, Odense C, Denmark
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Fuertes E, Markevych I, Bowatte G, Gruzieva O, Gehring U, Becker A, Berdel D, von Berg A, Bergström A, Brauer M, Brunekreef B, Brüske I, Carlsten C, Chan-Yeung M, Dharmage SC, Hoffmann B, Klümper C, Koppelman GH, Kozyrskyj A, Korek M, Kull I, Lodge C, Lowe A, MacIntyre E, Pershagen G, Standl M, Sugiri D, Wijga A, Heinrich J. Residential greenness is differentially associated with childhood allergic rhinitis and aeroallergen sensitization in seven birth cohorts. Allergy 2016; 71:1461-71. [PMID: 27087129 DOI: 10.1111/all.12915] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND The prevalence of allergic rhinitis is high, but the role of environmental factors remains unclear. We examined cohort-specific and combined associations of residential greenness with allergic rhinitis and aeroallergen sensitization based on individual data from Swedish (BAMSE), Australian (MACS), Dutch (PIAMA), Canadian (CAPPS and SAGE), and German (GINIplus and LISAplus) birth cohorts (n = 13 016). METHODS Allergic rhinitis (doctor diagnosis/symptoms) and aeroallergen sensitization were assessed in children aged 6-8 years in six cohorts and 10-12 years in five cohorts. Residential greenness was defined as the mean Normalized Difference Vegetation Index (NDVI) in a 500-m buffer around the home address at the time of health assessment. Cohort-specific associations per 0.2 unit increase in NDVI were assessed using logistic regression models and combined in a random-effects meta-analysis. RESULTS Greenness in a 500-m buffer was positively associated with allergic rhinitis at 6-8 years in BAMSE (odds ratio = 1.42, 95% confidence interval [1.13, 1.79]) and GINI/LISA South (1.69 [1.19, 2.41]) but inversely associated in GINI/LISA North (0.61 [0.36, 1.01]) and PIAMA (0.67 [0.47, 0.95]). Effect estimates in CAPPS and SAGE were also conflicting but not significant (0.63 [0.32, 1.24] and 1.31 [0.81, 2.12], respectively). All meta-analyses were nonsignificant. Results were similar for aeroallergen sensitization at 6-8 years and both outcomes at 10-12 years. Stratification by NO2 concentrations, population density, an urban vs rural marker, and moving did not reveal consistent trends within subgroups. CONCLUSION Although residential greenness appears to be associated with childhood allergic rhinitis and aeroallergen sensitization, the effect direction varies by location.
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Abstract
PURPOSE OF REVIEW In this review, we summarize the latest publications on the genetic and environmental determinants of allergic rhinitis. RECENT FINDINGS Recent advances in genetic technology and bioinformatics have enabled simultaneous unbiased analysis of the entire genome regarding DNA sequence variants, epigenetic modifications and gene expression, providing functional correlates for DNA variants and phenotypes. As a result, new genes of mitochondrial and B-lymphocyte metabolism have been associated with allergic rhinitis phenotypes. Epidemiological studies recently showed an increased risk to develop allergic rhinitis in all age groups with reduction in farm exposure and in children with few older siblings. Climate changes seem to have also influenced pollen exposure and pollen-induced allergic disease. Lastly, occupational rhinitis has been increasingly recognized as a large burden to society. SUMMARY In summary, new high throughput genetics research technologies have pointed to new previously unsuspected pathways that may modulate the risk of developing allergic rhinitis such as mitochondrial metabolism. In addition, recent environmental factors found to influence the risk of developing allergic rhinitis include exposure to farm, pollution, occupational agents, and changes in climate.
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Montaño-Velázquez BB, Flores-Rojas EB, García-Vázquez FJ, Jurado-Hernandez S, Venancio Hernández MA, Alanis Flores AK, Jáuregui-Renaud K. Effect of cigarette smoke on counts of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa in young patients with perennial allergic rhinitis. Braz J Otorhinolaryngol 2016; 83:420-425. [PMID: 27287302 PMCID: PMC9442755 DOI: 10.1016/j.bjorl.2016.04.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 04/13/2016] [Accepted: 04/27/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction In teenagers with perennial allergic rhinitis, exposure to tobacco cigarette smoke increases the count of eosinophils in the nasal mucosa; the recruitment of eosinophils arises from the combined action of a number of cellular and molecular signals, including eotaxin. Objective To assess the effect of exposure to tobacco cigarette smoke on the count of immunoreactive cells to eotaxin-1 and eosinophils on the nasal mucosa of children and teenagers with perennial allergic rhinitis. Methods In a cross-sectional study, forty-four patients were evaluated (aged 7–19 years old): 22 with and 22 with no exposure to tobacco cigarette smoke. After replying to 2 validated questionnaires, on Asthma and Allergies in Childhood and on the severity of nasal symptoms, nasal mucosal samples were obtained by scraping the middle one-third of the inferior turbinates. Then counts of immunoreactive cells to eotaxin-1 and eosinophils were assessed by immunohistochemistry. Results Patients with exposure to tobacco cigarette smoke showed higher cell counts of both eotaxin-1 and eosinophils than patients with no exposure to the smoke, with no correlation between the two variables. However, both counts, of eotaxin-1 and eosinophils, were related to the cotinine/creatinine ratio. Conclusions Exposure to tobacco cigarette smoke can increase eotaxin-1 and the count of eosinophils in the nasal mucosa of young patients with perennial allergic rhinitis.
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Affiliation(s)
| | - Eulalia Beatriz Flores-Rojas
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Service of Otorhinolaryngology, Mexico City, Mexico
| | | | - Silvio Jurado-Hernandez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Service of Otorhinolaryngology, Mexico City, Mexico
| | - Marco Antonio Venancio Hernández
- Instituto Mexicano del Seguro Social, CMN La Raza, Hospital de Especialidades, Service of Immunology and Allergy, Mexico City, Mexico
| | - Angélica Kathya Alanis Flores
- Instituto Mexicano del Seguro Social, CMN La Raza, Hospital de Especialidades, Service of Immunology and Allergy, Mexico City, Mexico
| | - Kathrine Jáuregui-Renaud
- Instituto Mexicano del Seguro Social, Centro Médico Nacional sXXI, P.B. Edificio C Salud en el Trabajo, Medical Research Unit in Otoneurology, Mexico City, Mexico.
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Badran HS, Hussein A, Salah M, Lotfi WT. Identification and Prevalence of Allergic, Nonallergic, and Local Allergic Rhinitis Patients in Western Area, Saudi Arabia. Ann Otol Rhinol Laryngol 2016; 125:634-43. [PMID: 27067153 DOI: 10.1177/0003489416642785] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the diagnostic yield of skin prick test (SPT) and serum total immunoglobulin E (IgE) antibodies level in patients with allergic rhinitis (AR) and the role of nasal provocation test (NPT) for the determination of local allergic rhinitis (LAR) in patients with nonallergic rhinitis (NAR). METHODOLOGY This multi-center study included 1230 patients with clinical manifestations for ≥2 years. Patients were classified according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) and scored according to the quantitative Score for Allergic Rhinitis (SFAR). The SPT and total IgE antibody levels were done for all patients. Patients gave negative SPT underwent NPT, and its result was interpreted using Lebel Symptom Score Scale. RESULTS The SPT was positive in 77.8% of patients, mostly for grass pollen and dust mites. All patients were sensitive to multiple allergens. Median serum IgE antibody level for total study population was 162 IU/ml. Forty-two patients (3.4%) with negative SPT showed a weak response to NPT, while 231 patients (18.7%) with negative SPT had a high response to NPT and were considered to have LAR. CONCLUSION The SPT could discriminate between AR and NAR patients. The NPT could identify LAR in 84.6% of patients with rhinitis among those considered as NAR.
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Affiliation(s)
- Hatem S Badran
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
| | - Ahmed Hussein
- Department of Otorhinolaryngology, Faculty of Medicine, Cairo University, Egypt
| | - Mohamad Salah
- Department of Otorhinolaryngology, Faculty of Medicine, Zagazig University, Egypt
| | - Wassim T Lotfi
- Department of Otorhinolaryngology, Faculty of Medicine, Fayoum University, Egypt
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Klimek L, Bousquet J, Price D. Safety evaluation of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) for allergic rhinitis. Expert Opin Drug Saf 2015; 15:117-29. [PMID: 26581312 DOI: 10.1517/14740338.2016.1122755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION As a chronic disease, allergic rhinitis (AR) requires regular use of allergy medications for the effective management of symptoms. It is therefore imperative that AR treatments not only provide adequate symptom control but are also well tolerated. AREAS COVERED MP29-02 (Dymista, Meda, Solna, Sweden) is the first new class of AR medication (WHO ATC R01AD58) since the introduction of intranasal corticosteroids (INS) almost 50 years ago. It is a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate delivered in a single spray. Here we review all the safety information relevant to MP29-02, from the initial phase I bioavailability and disposition data, to the phase III 14-day and 52-week data and finally to phase IV safety data collected during MP29-02 use in routine clinical practice. EXPERT OPINION MP29-02 is the first real therapeutic advance in AR since the introduction of INS and has the potential to change the way this disease is managed, simplifying AR treatment regimens to a single puff in each nostril twice a day. Patients will benefit from superior symptom relief MP29-02 compared to INS with the added assurance that the safety of MP29-02 has been confirmed in the short term and long term as well as in real life.
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Affiliation(s)
- Ludger Klimek
- a Department of Otorhinolaryngology , Zentrum für Rhinologie und Allergologie , An den Quellen 10 D-65183 , Wiesbaden , Germany
| | - Jean Bousquet
- b Department of Pneumology , University of Montpellier - Hopital Arnaud de Villeneuve , Montpellier , France
| | - David Price
- c General Practice Airways Group Professor of Primary Care Respiratory Medicine, Department of General Practice and Primary Care, Foresterhill Health Centre , University of Aberdeen , Westburn Road, Aberdeen AB25 2AY , UK
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Ellis AK, Soliman M. Year in review: upper respiratory diseases. Ann Allergy Asthma Immunol 2015; 114:168-9. [PMID: 25744899 DOI: 10.1016/j.anai.2014.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Anne K Ellis
- Departments of Medicine and Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada; Allergy Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.
| | - Mena Soliman
- Departments of Medicine and Biomedical and Molecular Science, Queen's University, Kingston, Ontario, Canada
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Accurate prediction of severe allergic reactions by a small set of environmental parameters (NDVI, temperature). PLoS One 2015; 10:e0121475. [PMID: 25794106 PMCID: PMC4368791 DOI: 10.1371/journal.pone.0121475] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 02/16/2015] [Indexed: 11/21/2022] Open
Abstract
Severe allergic reactions of unknown etiology,necessitating a hospital visit, have an important impact in the life of affected individuals and impose a major economic burden to societies. The prediction of clinically severe allergic reactions would be of great importance, but current attempts have been limited by the lack of a well-founded applicable methodology and the wide spatiotemporal distribution of allergic reactions. The valid prediction of severe allergies (and especially those needing hospital treatment) in a region, could alert health authorities and implicated individuals to take appropriate preemptive measures. In the present report we have collecterd visits for serious allergic reactions of unknown etiology from two major hospitals in the island of Crete, for two distinct time periods (validation and test sets). We have used the Normalized Difference Vegetation Index (NDVI), a satellite-based, freely available measurement, which is an indicator of live green vegetation at a given geographic area, and a set of meteorological data to develop a model capable of describing and predicting severe allergic reaction frequency. Our analysis has retained NDVI and temperature as accurate identifiers and predictors of increased hospital severe allergic reactions visits. Our approach may contribute towards the development of satellite-based modules, for the prediction of severe allergic reactions in specific, well-defined geographical areas. It could also probably be used for the prediction of other environment related diseases and conditions.
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