The burden of allergic asthma in children: a landscape comparison based on data from Lithuanian, Latvian, and Taiwanese populations

Prevalence, associated factors, and impact of adolescent asthma in Taiwan: Global Asthma Network phase I survey

Background

The prevalence of asthma in Taiwan was increasing in the past 30 years, causing a great impact on adolescent health. This study aimed to investigate the current prevalence, impact, and associated factors of asthma in Taiwanese adolescents.

Material and methods

Parents or guardians provided passive consent at home prior to the survey. Adolescents aged 13-14 years completed a questionnaire survey in 2017 in Taipei, Taiwan. The prevalence, impact, and associated factors of asthma were analyzed. We also compared the asthma prevalence with the prevalence in 1995 and 2001.

Results

We analyzed 3474 validated questionnaires. The prevalence of physician-diagnosed asthma was 12.4%. The prevalence of current wheezing was 9.2% in 2017, which was 5.2% in 1995 and 7.0% in 2001. 3.3% of 13-14-year-old adolescents had severe asthma symptoms. Asthma significantly impacted the lives of adolescents. Of the students with asthma, 10.9% had school absenteeism, 16.5% urgently needed to see a doctor, 9.5% went to the emergency department, and 3.5% were admitted to hospitals within the preceding 12 months. The associated factors for physician-diagnosed asthma in Taiwanese adolescents were male (prevalence ratio [PR], 1.38; 95% confidence interval [CI], 1.05-1.83; p = 0.02), maternal history of asthma (PR, 2.61; 95% CI, 1.69-4.02; p < 0.01), and recent paracetamol use at least once per month (PR, 2.60; 95% CI, 1.24-5.42; p = 0.01). The associated factors for school absenteeism were nocturnal cough (PR, 1.99; 95% CI, 1.16-3.41; p = 0.01), current wheezing (PR, 7.52; 95% CI, 4.39-12.9; p < 0.01), and recent paracetamol use (at least once per month, PR, 3.16; 95% CI, 1.10-9.06; p = 0.03; at least once per year, PR, 2.19; 95% CI, 1.25-3.83; p < 0.01).

Conclusions

The prevalence of physician-diagnosed asthma was 12.4%. Asthma substantially impacted the lives of adolescents. Reducing nocturnal cough, wheezing frequency, and paracetamol usage might help decrease school absenteeism.

Interleukin-32 in Pathogenesis of Atopic Diseases: Proinflammatory or Anti-Inflammatory Role?

Atopic diseases, such as atopic dermatitis (AD), allergic asthma (AA), and allergic rhinitis (AR), are increasingly becoming a worldwide issue. This atopic triad originates at an early age and on a multifactorial basis, causing significant discomfort to susceptible individuals. The global case number is now reaching new highs, so exploring immune system regulation and its components is becoming critical. One cytokine, interleukin-32 (IL-32), is involved in inflammation and regulation of the immune system. It has nine isoforms that show varying degrees of expression, both intracellularly and extracellularly. IL-32 is secreted by immune cells, such as monocytes, macrophages, natural killer cells, and T cells, and by nonimmune cells, including fibroblasts, keratinocytes, and endothelial cells. Its production is regulated and augmented by microorganisms, mitogens, and other cytokines. Early studies demonstrated that IL-32 was an immune regulator that functioned to protect against inflammatory diseases, including AD, AA, and AR, and proposed a proinflammatory role for IL-32 in immune regulation and symptom exacerbation. However, several later reports suggested that IL-32 is downregulated in inflammatory diseases and exerts an anti-inflammatory effect. This review article focuses on recent findings regarding the detrimental and protective roles of IL-32 in development and management of inflammatory diseases. The exact role of IL-32 in AD, AA, and AR still remains to be elucidated. Future research should explore new avenues of IL-32 functionality in human inflammatory diseases.

Goat Milk Consumption Enhances Innate and Adaptive Immunities and Alleviates Allergen-Induced Airway Inflammation in Offspring Mice

Goat milk (GM), as compared to cow milk (CM), is easier for humans to digest. It also has antioxidant and anti-inflammatory effects and can improve minor digestive disorders and prevent allergic diseases in infants. It is unclear whether GM consumed in pregnant mothers has any protective effects on allergic diseases in infants. In this experimental study with mice, we found GM feeding enhanced immunoglobulin production, antigen-specific (ovalbumin, OVA) immune responses, and phagocytosis activity. The GM-fed mice had an increasing proportion of CD3⁺ T lymphocytes in the spleen. Splenocytes isolated from these animals also showed significantly increased production of cytokines IFN-γ and IL-10. More importantly, GM feeding during pregnancy and lactation periods can confer protective activity onto offspring by alleviating the airway inflammation of allergic asthma induced by mite allergens. There was a remarkably different composition of gut microbiota between offspring of pregnant mice fed with water or with milk (GM or CM). There was a greater proportion of beneficial bacterial species, such as Akkermansia muciniphila, Bacteroides eggerthii, and Parabacteroides goldsteinii in the gut microbiota of offspring from GM- or CM-fed pregnant mice compared to the offspring of water-fed pregnant mice. These results suggested that improving the nutrition of pregnant mice can promote immunological maturation and colonization of gut microbiota in offspring. This mother-to-child biological action may provide a protective effect on atopy development and alleviate allergen-induced airway inflammation in offspring.

Vitamin D plasma concentration and vitamin D receptor genetic variants confer risk of asthma: A comparison study of Taiwanese and Mongolian populations

Background

Recent reports have suggested that lower vitamin D serum levels are associated with susceptibility to and severity of asthma in different white populations, which may be due to a lack of sunlight exposure, genetic polymorphism of vitamin D pathway genes, and dietary intake. We investigated the associations between vitamin D concentration, genetic polymorphism of the vitamin D receptor (VDR), and asthma traits in Mongolian and Taiwanese populations that inhabited two different geographical areas.

Methods

In total, 328 Han Taiwanese subjects and 381 Mongolian subjects were enrolled, and their vitamin D serum levels assayed. Genomic DNA of 178 Han Taiwanese subjects and 90 Mongolian subjects was obtained from blood samples. Single-nucleotide polymorphisms (SNPs) of VDR, ApaI (rs7975232), TaqI (rs731236), BsmI (rs1544410) and FokI (rs2228570), were selected for genotyping. Logistic regression analyses were performed to detect an association between allergic asthma status and the interaction of the VDR SNP and serum vitamin D concentration in the case–control samples.

Results

We observed a significantly lower vitamin D level in the Mongolian subjects as compared with the Taiwanese population. In particular, in the population under 14 years of age, the serum vitamin D level was significantly higher in the Taiwanese population, in both non-asthmatic and asthmatic subjects, than in the Mongolian non-asthmatic and asthmatic subjects, respectively (P < 0.01). Moreover, the vitamin D level in the asthmatic children was significantly lower than that in the non-asthmatic children in both the Taiwanese and Mongolian populations (P < 0.01, respectively). Furthermore, we found that the rs2228570 genotype (OR, 3.763) of the VDR SNP and the vitamin D concentration (lower than 40 ng/ml, OR: 38.938) both contribute to increased susceptibility to bronchial asthma.

Conclusion

Our results demonstrated an association between vitamin D concentration and the risk of asthma in two populations of differing ethnicity living in different geographical areas. This information implies a potential role of vitamin D in the prevention and treatment of asthma worldwide.

High prevalence of IgE sensitization against house dust mites in pregnant women

There is an increase in prevalence and financial burden of childhood atopic disorders in recent years. Understanding allergic conditions of pregnant women is important for developing strategies for prevention and management of allergy-related diseases. However, little is currently known about the atopic conditions in pregnant women.The sera from 46 pregnant women were analyzed for allergen-specific IgE antibodies using the Optigen assay and SDS-PAGE immunoblot analysis.Results from the Optigen assay showed that 20 (43%) of the 46 serum samples analyzed demonstrated IgE reactivity against mite p (Dermatophagoides pteronyssinus) (95%), mite f (D farinae) (95%), house dust (60%), cat (25%), shrimp (20%), crab (15%), cockroach (10%), dog (5%), latex (5%), willow black (5%), and timothy grass (5%). Nineteen of the 20 Optigen-positive sera demonstrated IgE reactivity against both the house dust mites D pteronyssinus and D farina, with 10 of them having a high IgE CLA class value of 4. IgE reactivity to the house dust mite D pteronyssinus was confirmed in SDS-PAGE-immunoblots, which correlated well with the intensity of IgE-binding to the 15-kDa D pteronyssinus component and to the purified recombinant Der p 2 major house dust mite allergen.A high prevalence of IgE sensitization against house dust mites during pregnancy is noted, which is worthy of clinical attention. Children of IgE-sensitized mothers should be closely monitored for development of allergenic disorders.

Greenspace and Atopic Sensitization in Children and Adolescents-A Systematic Review

In the last decade, studies investigating greenspace have highlighted several benefits to human health. However, the effect of greenspace on allergies and atopic sensitization in children was not clear. While several studies have investigated this link, the evidence has not been systematically synthesized. We conducted a systematic search of eight databases. Study characteristics and findings were extracted from five articles covering 11 cohorts published between 2012 and 2016, and study quality assessments were performed. Due to significant heterogeneity, meta-analysis was not conducted. Findings were not consistent, possibly due to variations in exposure measurements, study populations and location, the specific allergens tested, and inclusion of confounders. Protective effects from greenspace were reported in four cohorts, while two cohorts showed an increase in sensitization related to greenspace. The other five cohorts found no significant effect of greenspace on atopic sensitization. There is limited understanding of the contributions of greenspace to specific allergens. Future research should consider amount and type of greenspace, as well as the specific allergens tested.

Helicobacter pylori Infection and Risk Factors in Relation to Allergy in Children

PURPOSE

To analyze presence of Helicobacter pylori infection and environmental risk factors among children with and without allergy.

METHODS

Parents of children at primary health care centres/kindergartens and allergologist consultation were asked to answer a questionnaire and to bring a faecal sample. H. pylori infection was detected by monoclonal stool antigen test. Prevalence of H. pylori infection and risk factors were compared between individuals with and without allergy using χ² test, ANOVA test and parameters and logistic regression.

RESULTS

Among 220 children (mean age, 4.7 years; ±standard deviation 2.3 years) H. pylori positivity was non-significantly lower among patients with allergy (n=122) compared to individuals without allergy (n=98): 13.9% (17/122) vs. 22.4% (22/98); p=0.106. In logistic regression analysis presence of allergy was significantly associated with family history of allergy (odds ratio [OR], 8.038; 95% confidence interval [CI], 4.067-15.886; p<0.0001), delivery by Caesarean section (OR, 2.980; 95% CI, 1.300-6.831; p=0.009), exclusive breast feeding for five months (OR, 2.601; 95% CI, 1.316-5.142; p=0.006), antibacterial treatment during the previous year (OR, 2.381; 95% CI, 1.186-4.782; p=0.015).

CONCLUSION

Prevalence of H. pylori infection did not differ significantly between children with and without allergy. Significant association of allergy with delivery by Caesarean section and antibacterial therapy possibly suggests the role of gastrointestinal flora in the development of allergy, while association with family history of allergy indicates the importance of genetic factors in the arise of allergy.

Evaluation of proteasomal gene polymorphisms in Lithuanian patients with asthma

OBJECTIVE

To investigate polymorphisms of proteasomal genes PSMA6 (rs1048990 and rs2277460), PSMC6 (rs2295826 and rs2295827) and PSMA3 (rs2348071) in Lithuanian patients with asthma.

METHODS

One-hundred forty-six asthma patients and 150 control subjects were studied. DNA was extracted from peripheral blood samples. Five single nucleotide polymorphisms (SNP's) of the three proteasomal genes were analyzed using allele-specific amplification or the cleaved amplified polymorphic sequence method.

RESULTS

While certain alleles and genotypes of PSMA6 rs2277460 and rs1048990 and PSMA3 rs2348071 SNP's occurred more frequently in asthma patients than in controls, no statistically significant differences in alleles or genotypes of PSMA6, PSMC6 or PSMA3 were observed between asthma patients and control subjects. However, when male and female study subjects were considered separately, we found that the CG genotype of PSMA6 rs1048990 is significantly more frequent in male asthma patients compared to male control subjects.

CONCLUSIONS

We found no significant differences in frequencies of selected five proteasomal gene PSMA6, PSMC6 and PSMA3 SNP's between asthma patients and control subjects overall. Among male subjects, however, the CG PSMA6 rs1048990 genotype was significantly more frequent in asthma patients compared with control subjects.

Integrated traditional Chinese medicine for childhood asthma in Taiwan: a Nationwide cohort study

Background

Traditional Chinese medicine (TCM) is the most commonly used alternative therapy in children with asthma, especially in the Chinese community. This study aimed to investigate the effects of the government-sponsored Outpatient’s Healthcare Quality Improvement (OHQI) project with integrated TCM treatment on childhood asthma.

Methods

This study used the Longitudinal Health Insurance Database 2000, which is a part of the Taiwan National Health Insurance Research Database (NHIRD). Children with diagnosed asthma and aged under 15 years from 2006–2010 were enrolled. They were collated into 3 groups: (1) subjects treated with non-TCM; (2) subjects treated with single TCM; and (3) subjects treated with integrative OHQI TCM. The medical visits and the cost of treatment paid by the Bureau of National Health Insurance (BNHI) to the outpatient, emergency room, and inpatient departments were evaluated for the study subjects within 1 year of the first asthma diagnosis during the study period.

Results

Fifteen multi-hospitals, including 7 medical centers, and 35 TCM physicians participated in OHQI during the study period. A total of 12850 children from the NHIRD database were enrolled in this study, and divided as follows: 12435 children in non-TCM group, 406 children in single TCM group, and 9 children in integrative OHQI TCM group. Although the total medical cost paid by the BNHI per patient in the integrative OHQI TCM group was greater than that in the non-OHQI groups, the patients in the integrative OHQI TCM group exhibited greater therapeutic effects, and did not require ER visits or hospitalization. In addition, ER visits and hospitalization among patients who received a combination of conventional therapy with integrated TCM were lower than those among patients who underwent conventional therapy alone or single TCM treatment.

Conclusions

Asthmatic children at partly controlled level under conventional therapy may benefit from adjuvant treatment with integrated TCM.

Report of a patient with complex composites of hepatitis B virus, allergic asthma and diabetes

HBV is a non-cytopathic virus and cell mediated immune response against this. Humoral mediated immune response are responsible for allergic diseases. Balance between these two subsets of Th CD4+ cells are result of the immune system response. A 56 year old woman presented with chronic HBV infection, allergic asthma, type 2 diabetes mellitus and high blood pressure and high blood lipid. Patients should be followed for the allergic and autoimmune diseases along with their viral reactivation.

Vitamin E and D regulation of allergic asthma immunopathogenesis

Asthma occurs as complex interactions of the environmental and genetics. Clinical studies and animal models of asthma indicate dietary factors such as vitamin E and vitamin D as protective for asthma risk. In this review, we discuss opposing regulatory functions of tocopherol isoforms of vitamin E and regulatory functions of vitamin D in asthma and how the variation in global prevalence of asthma may be explained, at least in part, by these dietary components.

Two faces of vitamin E in the lung

Asthma and allergic lung disease occur as complex environmental and genetic interactions. Clinical studies of asthma indicate a number of protective dietary factors, such as vitamin E, on asthma risk. However, these studies have had seemingly conflicting outcomes. In this perspective, we discuss opposing regulatory effects of tocopherol isoforms of vitamin E, mechanisms for tocopherol isoform regulation of allergic lung inflammation, association of vitamin E isoforms with outcomes in clinical studies, and how the variation in global prevalence of asthma may be explained, at least in part, by vitamin E isoforms.