Trends in the prevalence of asthma, rhinitis, and eczema in 15 year old adolescents over an 8 year period

Recent prevalence of allergic rhinitis caused by house dust mites among the pediatric population in Fukui, Japan

Background

Allergic rhinitis (AR) is an IgE-mediated type I allergic chronic nasal disease common among all age groups, including the pediatric population. House dust mites (HDMs) are globally ubiquitous and the most important indoor aeroallergen. However, the recent prevalence of HDM-caused AR (AR-HDM) in Japan remains unknown, especially after the COVID-19 pandemic.

Objective

The objective of this study was to investigate the current prevalence of AR-HDM, its clinical features, and the current status of medical examinations in elementary school students.

Methods

A survey of 41,000 elementary school students was conducted during July 2021 in Fukui Prefecture, Japan. Parents were asked to complete a questionnaire that examined allergic disease history and clinical background.

Results

A total of 17,974 subjects were analyzed in the study. The results showed that the current prevalence of AR-HDM in elementary school children is 18.8%. We found that AR-HDM had already developed before entrance into elementary school in 68.3% of affected subjects. Among these subjects, 82.3% had received some form of treatment, such as prescription medications, whereas 4.2% were treated by allergen immunotherapy. Multiple logistic regression analysis of the onset of AR-HDM revealed that male sex, being the first-born child, comorbidity of bronchial asthma, atopic dermatitis, food allergy, and allergic conjunctivitis are associated with development of AR-HDM.

Conclusions

The present study revealed the prevalence of AR-HDM in elementary school children. The results emphasize the importance of appropriate diagnosis and treatment from infancy through early childhood.

Is asthma in children still increasing? 20-year prevalence trends in northern Sweden

BACKGROUND

In the present study, we describe prevalence trends of asthma and investigate the association with asthma symptoms, use of asthma medication, and asthma severity among 8-year-old children in Norrbotten, Sweden in 1996, 2006, and 2017.

METHODS

Within the Obstructive Lung Disease in Northern Sweden (OLIN) studies, three pediatric cohorts were recruited in 1996, 2006, and 2017 respectively. Identical methods were used; all children in first and second grade (median age 8 years) in three municipalities were invited to a parental questionnaire survey, completed by n = 3430 in 1996 (97% participation), n = 2585 in 2006 (96%), and n = 2785 in 2017 (91%). The questionnaire included questions about respiratory symptoms and diagnosis, treatment, and severity of asthma.

RESULTS

The prevalence of wheezing was stable during the study, 10.1% in 1996; 10.8% in 2006; and 10.3% in 2017, p = .621, while physician-diagnosed asthma increased: 5.7%, 7.4%, and 12.2%, p < .001. The use of asthma medication in the last 12 months increased: 7.1%, 8.7%, and 11.5%, p < .001. Among children diagnosed with asthma, the prevalence of asthma symptoms, the impact on daily life, and severe asthma decreased, while the use of inhaled corticosteroids increased from 1996 until 2017.

CONCLUSION

The prevalence of wheezing was stable among 8-year-old in this area from 1996 to 2017, while the prevalence of physician-diagnosed asthma doubled but without an increase in asthma morbidity. The increase of physician-diagnosed asthma without a coincident increase in asthma morbidity can partly be explained by more and earlier diagnosis among those with mild asthma.

12-month prevalence of atopic dermatitis in resource-rich countries: a systematic review and meta-analysis

There is a lack of robust prevalence estimates of atopic dermatitis (AD) globally and trends over time due to wide variation of populations and age groups studied, different study methodologies and case definitions used. We sought to characterize 12-month AD prevalence across the life span and change over time in resource-rich countries focusing on population-based studies and using a standardized AD case definition. This systematic review was conducted according to PRISMA guidelines. Medline (Ovid), Embase, WOS core collection, Cinahl, and Popline were searched for studies published since inception through August 15, 2016. Studies were synthesized using random effects meta-analysis. Sources of heterogeneity were investigated using subgroup analyses and meta-regression. From 12,530 records identified, 45 studies met the inclusion criteria. Meta-analysis with random effects revealed the 12-month period prevalence of 9.2% (95% confidence interval 8.4-10.1%). The prevalence was significantly higher among 0-5-year-old children (16.2%; 95% confidence interval 14.2-18.7%) than in older age groups. Studies using a random sampling strategy yielded lower prevalence estimates than studies relying on other sampling methods. There was no clear time trend in AD prevalence over the period of 1992-2013.

Asthma in Youth and Early-onset Type 2 Diabetes: A Nationwide Study of 1.72 Million Israeli Adolescents

BACKGROUND

The prevalence of both asthma and early-onset diabetes is on the rise; however, the association between them remains unclear. We examined a possible association of asthma at adolescence with type 2 diabetes in young adulthood.

METHODS

This is a nationwide, population-based study of 1 718 541 Israeli adolescents (57% males; mean age 17.3 years; range 16-19 years), examined before compulsory military service between 1992 and 2016, with data linked to the Israeli National Diabetes Registry. Asthma diagnosis and severity were determined by a board-certified pulmonologist and based on spirometry tests.

RESULTS

Type 2 diabetes developed in 58/9090 (0.64%), 507/97 059 (0.52%), 114/23 332 (0.49%), and 7095/1 589 060 (0.44%) persons with moderate-to-severe, mild, inactive, and no history of asthma, respectively, during a mean follow-up >13 years. The respective odds ratios (ORs) were 1.33 (95% CI, 1.02-1.74), 1.17 (1.06-1.28), and 1.09 (0.9-1.31), considering those without asthma history as the reference, in a model adjusted for birth year, sex, body mass index, and other sociodemographic variables. The association persisted when the analysis accounted for coexisting morbidities, and when persons without asthma, individually matched by age, sex, birth year, and body mass index were the reference. Both mild and moderate-to-severe asthma were associated with type 2 diabetes before age 35 years: ORs 1.18 (1.05-1.34) and 1.44 (1.05-2.00), respectively. The strength of the association was accentuated over time. The effect was unchanged when adjusted for oral and inhaled glucocorticoid use.

CONCLUSION

Adolescents with active asthma have higher risk to develop type 2 diabetes. This seems related to disease severity, independent of adolescent obesity status, apparent before age 35 years, and more pronounced in recent years.

Models for estimating and projecting global, regional and national prevalence and disease burden of asthma: a systematic review

Background

Statistical models are increasingly being used to estimate and project the prevalence and burden of asthma. Given substantial variations in these estimates, there is a need to critically assess the properties of these models and assess their transparency and reproducibility. We aimed to critically appraise the strengths, limitations and reproducibility of existing models for estimating and projecting the global, regional and national prevalence and burden of asthma.

Methods

We undertook a systematic review, which involved searching Medline, Embase, World Health Organization Library and Information Services (WHOLIS) and Web of Science from 1980 to 2017 for modelling studies. Two reviewers independently assessed the eligibility of studies for inclusion and then assessed their strengths, limitations and reproducibility using pre-defined quality criteria. Data were descriptively and narratively synthesised.

Results

We identified 108 eligible studies, which employed a total of 51 models: 42 models were used to derive national level estimates, two models for regional estimates, four models for global and regional estimates and three models for global, regional and national estimates. Ten models were used to estimate the prevalence of asthma, 27 models estimated the burden of asthma – including, health care service utilisation, disability-adjusted life years, mortality and direct and indirect costs of asthma – and 14 models estimated both the prevalence and burden of asthma. Logistic and linear regression models were most widely used for national estimates. Different versions of the DisMod-MR- Bayesian meta-regression models and Cause Of Death Ensemble model (CODEm) were predominantly used for global, regional and national estimates. Most models suffered from a number of methodological limitations – in particular, poor reporting, insufficient quality and lack of reproducibility.

Conclusions

Whilst global, regional and national estimates of asthma prevalence and burden continue to inform health policy and investment decisions on asthma, most models used to derive these estimates lack the required reproducibility. There is a need for better-constructed models for estimating and projecting the prevalence and disease burden of asthma and a related need for better reporting of models, and making data and code available to facilitate replication.

The triad of current asthma, rhinitis and eczema is uncommon among adults: Prevalence, sensitization profiles, and risk factors

BACKGROUND

Coexistence of asthma, rhinitis, and eczema has been studied in children, but data are lacking in adults. As new treatments emerge, epidemiological data on the coexistence are needed.

AIMS

To study the prevalence of concomitant asthma, rhinitis and eczema in the general adult population and among those sensitized to aeroallergens, and to study associations between background characteristics and risks of phenotypes of asthma, rhinitis, and eczema.

METHODS

In the West Sweden Asthma Study, phenotypes and sensitization profiles of 1103 randomly selected adults (16-75 years) were assessed. The methods included measures of serum-IgE and structured interviews on asthma, rhinitis, eczema, their associated symptoms, and relevant risk factors.

RESULTS

Among all participants and in those sensitized, 2% and 6% had concomitant asthma, rhinitis, and eczema, respectively, and the condition did not differ by age or sex. Corresponding figures for asthma and rhinitis, but not eczema, was 8% and 19%, respectively. Determinants of coexistence of the three conditions were family history of asthma/allergy, body mass index, and occupational exposure to gas, dust and fumes. Allergic sensitization in those with asthma, rhinitis and eczema was found in 78%, in those with asthma and rhinitis but not eczema in 65%, in those with asthma and eczema but not rhinitis in 40%, while only 5% were sensitized among those having asthma only.

CONCLUSIONS

In the general adult population about 2% have concomitant asthma, rhinitis, and eczema. Of sensitized adults, about 6% has coexistence of the three conditions.

Impact of allergic rhinitis on the day-to-day lives of children: insights from an Australian cross-sectional study

STUDY DESIGN AND OBJECTIVE

Cross-sectional, observational survey to describe the impact of allergic rhinitis (AR) on Australian children (2 to 15 years).

METHODS

Participants (n=1541), parents of children aged 2 to 15 years, provided information on behalf of themselves and one eligible child in their household using a custom-built online questionnaire. Children were allocated to case (AR) or control (No AR) analysis groups based on a validated screening questionnaire.

STATISTICAL METHODS

The study sample was stratified on age: primary analysis population (6 to 15 years, n=1111; AR=797, No AR=314); exploratory population (2 to 5 years). The primary endpoint, parent-perceived burden, was quantified using a validated measure of health status and analysed via comparison of means.

RESULTS

The majority of AR cases were treated (730/797; 90.3%) and classified as having moderate-severe, intermittent AR (549/797; 68.9%). Half reported adequate symptom control in the prior 2 weeks (389/797; 48.8%; OR=4.04; 95% CI (CI) 2.24 to 7.31). Having AR was associated with worse overall health status (7.4 vs 8.4, mean difference (least squares mean difference (LSMD))=-0.99; 95% CI -1.18 to -0.79), fewer days being happy (22.2 vs 25.9, LSMD=-3.68; 95% CI -4.82 to -2.54) and more days of poor physical (2.82 vs 0.78, LSMD=2.04; 95% CI 1.61 to 2.47) and emotional (2.14 vs 0.67, LSMD=1.47; 95% CI 1.02 to -1.92) health compared with not having AR. All of these outcomes were significantly (p<0.05) worse in children who reported inadequate symptom control. Having AR negatively impacted on schoolwork, sleep and other activities, and increased the likelihood of having comorbidities.

CONCLUSION

The parent-perceived burden of AR in Australian children is high and it impacts many areas of day-to-day living. Inadequate symptom control is a key driver of the extent of this impact. Opportunities to optimise the management of AR in children include the adoption of self-assessment tools to gauge and monitor adequacy of symptom control.

Allergic rhinitis and allergic sensitisation are still increasing among Danish adults

BACKGROUND

Only a limited number of studies have included objective measures of allergic sensitisation (such as skin-prick test [SPT] and serum specific IgE [sIgE]) when studying time trends in allergic respiratory disease in adults within the current millennium.

METHODS

Five health examination studies of random samples of individuals aged 18-69 years resident in the Copenhagen region were conducted in 1990-1991, 2006-2008, 2010-2011, 2012-2015, and 2016-2017. Allergic sensitisation was defined by sIgE (in 1990-1991, 2006-2008, and, 2012-2015) or SPT (in 2006-2008, 2010-2011, and 2016-2017) to at least one of the allergens: birch, grass, house dust mite, or cat. Allergic rhinitis was defined as sensitisation and self-reported nasal symptoms.

RESULTS

The age- and sex-standardised prevalence of sIgE-defined sensitisation increased from 16% in 1990-1991, to 26% in 2006-2008, and to 29% in 2012-2015. The age- and sex-standardised prevalence of SPT-defined sensitisation increased from 27% in 2006-2008, to 28% in 2010-2011, and to 32% in 2016-2017. Changes in sIgE-defined and SPT-defined allergic rhinitis showed similar increasing trends.

CONCLUSION

The prevalence of allergic sensitisation and allergic rhinitis increased in a general adult Danish population over the last three decades and has thus continued to increase in the current millennium.

Asthma and allergic rhinitis risk depends on house dust mite specific IgE levels in PARIS birth cohort children

Background

The natural history of allergic sensitization in childhood, and its impact on allergic disease development, needs to be clarified. This study aims to identify allergic sensitization and morbidity patterns during the first 8 years of life.

Methods

The study was conducted in the on-going population-based prospective Pollution and Asthma Risk: an Infant Study (PARIS) birth cohort. Sensitization profiles were identified by k-means clustering based upon allergen-specific IgE levels measured at 18 months and 8/9 years. Allergic morbidity profiles were identified by latent class analysis based on symptoms, symptom severity, treatments, and lifetime doctor-diagnoses of asthma, allergic rhinitis, and atopic dermatitis and on lower respiratory infections before 2 years.

Results

Five sensitization and 5 allergic morbidity patterns were established in 714 children. Children not sensitized or with isolated and low allergen-specific sensitization were grouped together (76.8%). A profile of early and transient sensitization to foods that increased the risk of asthma later in childhood was identified (4.9%). Children strongly sensitized (≥3.5 kU_A/L) to house dust mite at 8/9 years (9.0%) had the highest risk of asthma and allergic rhinitis. Finally, timothy grass pollen at 8/9 years sensitization profile (5.3%) was related to respiratory allergic diseases, as was early onset and persistent sensitization profile (4.1%), this latter being also strongly associated with atopic dermatitis.

Conclusions & Clinical Relevance

We show that accurate assessment of the risk of allergic disease should rely on earliness and multiplicity of sensitization, involved allergens, and allergen-specific IgE levels, and not considering solely allergic sensitization as a dichotomous variable (allergen-specific IgE ≥0.35 kU_A/L), as usually done. This is particularly striking for house dust mite. We are hopeful that, pending further confirmation in other populations, our findings will improve clinical practice as part of an approach to allergic disease prevention.

Evaluation of eczema, asthma, allergic rhinitis and allergies among the grade-7 children of Iqaluit

Background

Little is known about the prevalence of asthma, allergic rhinitis, eczema and allergies among Canadian Inuit children, especially those living in the arctic and subarctic areas.

Methods

A cross-sectional study among grade seven students attending schools in Iqaluit, the capital city of Nunavut, was conducted during the 2016/2017 school year. We used the International Study of Allergy and Asthma in Children (ISAAC) questionnaire with added questions relevant to the population. In addition, skin prick tests (SPT) were conducted to test for sensitization to common food and environmental allergens.

Results

The prevalence of current asthma is 5.2%, all of them were males and 2/3 of them were Inuit and all had a previous respiratory hospitalization. Past asthma prevalence is 8.6%, 60% males and 60% Inuit. There was an inverse relationship to crowdedness possibly as a confounding factor because of getting a higher prevalence among the non-Inuit who usually live in less crowded houses. Current allergic rhinitis prevalence is 8.6%, 60% of the cases were among the mixed Inuit/Caucasian ethnicity while no cases among the non-Inuit, there was a female predominance 3:2. Past history of allergic rhinitis prevalence is 10.3%, half of the cases were among the mixed ethnicity (5.2% of that ethnicity) followed by Inuit (3.4%) and non-Inuit (1.7%), female: Male ratio 1:1. Current eczema prevalence was 27.6%, with half of the cases among the mixed ethnicity (13.8% of that group), followed by Inuit (8.6%). There was a female predominance with protective effect of exclusive breastfeeding. Past eczema prevalence 34.5%, with half of the cases were among the mixed ethnicity (17.2% of that group), followed by Inuit (10.3%). There was a female predominance. We noted a high rate of sensitization to Cat at 29.2%, most of the cases were among the mixed ethnicity, while absent sensitization to other common inhalant allergens.

Conclusion

While being cautious about firm conclusions due to the small sample size and power, the noticed variations in the prevalence and risk factors of asthma, allergic rhinitis and eczema among different ethnicities living at the same subarctic environment might be related to several possible explanations like genetic, gene-environment interaction and/or lifestyle factors, it was out of the scope of this study to determine the causality of such variation in prevalence, which emphasizes the need for further investigation.

Pain could negatively affect school grades - Swedish middle school students with low school grades most affected

Recurrent headache, abdominal and musculoskeletal pain are common in adolescents and it is therefore important to understand their impact on the transitional period from childhood to adulthood. However, studies of the prevalence over time and implications on educational outcomes are still limited, especially regarding multiple pain symptoms. The present study material consists of questionnaire surveys, completed in 2000 and 2008, including two study populations of 9th grade adolescents aged 15 living in West Sweden (n = 20 877). Pain symptoms and demographic variables were based on self-reports from the questionnaires, and school grades were obtained from Statistics Sweden after the student had finished their 9th grade. Between 2000 and 2008, the prevalence of abdominal pain increased among Swedish adolescents (largest increase in girls); the prevalence of headache increased only in girls; the prevalence of pain in upper body decreased only in boys. School grades were significantly lower among those with headache or abdominal pain. Among students with low school grades (10th percentile) the estimated difference between those having any of the symptoms or none were -27 school grade units (95% confidence interval for girls (-27.8; -26.0), for boys (-27.6; -25.5). Both symptoms being present pronounced the association. Low parental education increased the negative effect of symptoms on school grades, most pronounced in the group with the lowest grades. In conclusion, identification of pain symptoms may improve academic achievements, especially in students with multiple symptoms and with parents having low education. Further intervention studies are need.

The Southern Sweden Adolescent Allergy-Cohort: Prevalence of allergic diseases and cross-sectional associations with individual and social factors

OBJECTIVES

Asthma and allergic diseases are the most frequent chronic diseases in childhood worldwide, and considered a burden for the affected children and their families. The diseases impose an economic burden on society if not diagnosed and treated properly and management of and these diseases are challenging for healthcare professionals. The aim of the present investigation was to assess the prevalence of allergic diseases in an unselected cohort of adolescents in southern Sweden. Additionally, associations with sociodemographic factors were investigated, as well as impact on daily life.

METHODS

This cross-sectional study was based on a cohort of n = 1 530 school children, aged 13 to 14, from 13 municipalities in southern Sweden. Data were collected through web-based questionnaires.

RESULTS

Of all children 32% reported at least one allergic disease. 67% reported one allergic disease and 33% reported more than one. No allergy-related disease were reported by 68%. Current asthma was reported by 9.8% and current rhino-conjunctivitis was reported by 13%. The prevalence of food hypersensitivity was 12% and the prevalence of eczema was 11%. One to three wheezing attacks were reported from 55% and 40% reported more than four attacks of wheezing in the preceding year. The self-reported allergic diseases were diagnosed by a doctor in; 36% (food hypersensitivity) to 69% (rhinoconjunctivitis) of the cases.

CONCLUSIONS

A high number of affected children were identified. Some children being undiagnosed and some not receiving satisfactory treatment. These results suggest that additional studies to evaluate treatment procedures in order to improve healthcare for allergic children are warranted.

The burden of allergic rhinitis and allergic rhinoconjunctivitis on adolescents: A literature review

OBJECTIVE

To evaluate the literature regarding the burden of allergic rhinitis (AR) and allergic rhinoconjunctivitis (ARC) in adolescents (aged 10-19 years).

DATA SOURCES

Searches were performed in MEDLINE, Embase, Health Technology Assessment Database, and National Health Service Economic Evaluation Database for studies that evaluated concepts of symptoms, quality of life (QOL), daily activities, sleep, examination performance, school absenteeism and presenteeism, and treatment burden in adolescents with AR or ARC.

STUDY SELECTIONS

English-language journal articles indexed in the last 15 years describing noninterventional, population-based studies. Records were assessed by 2 independent reviewers.

RESULTS

A total of 27 articles were identified; outcomes evaluated were symptoms (n = 6 studies), QOL (n = 9), daily activities (n = 5), emotional aspects (n = 3), sleep (n = 6), education (n = 7), and treatment burden (n = 2). AR symptoms rated most bothersome were rhinorrhea, nasal congestion, and itchy eyes. QOL was worse in adolescents with AR vs controls regardless of QOL instrument used. Nasal symptoms and nasal obstruction were more likely to be associated with poor QOL in adolescents than in adults or younger children, respectively. Daily functioning and sleep were also negatively affected by AR. In addition, a detrimental effect on absenteeism, school productivity, and academic performance was reported.

CONCLUSION

Although AR and ARC are sometimes perceived as trivial conditions, this review indicates that their effect on adolescent life is negative and far-reaching. It is critical that clinicians gain a greater understanding of the unique burden of AR and ARC in adolescents to ensure they receive prompt and appropriate care and treatment to improve clinical and academic outcomes.

Early polysensitization is associated with allergic multimorbidity in PARIS birth cohort infants

BACKGROUND

Profiles of allergic sensitization are poorly documented in infancy. Relations between early sensitization and allergic morbidity need to be clarified.

METHODS

This study dealt with children involved in the Pollution and Asthma Risk: an Infant Study (PARIS), a population-based prospective birth cohort. Allergic sensitization to twelve food and four inhalant allergens was assessed at 18 months and defined by a specific immunoglobulin E (IgE) level ≥0.35 kU_A /l. Health data were collected by standardized questionnaires at 2 and 6 years. Early allergic profiles were identified by an unsupervised cluster analysis based on health data at 2 years and IgE measurements. Profiles were compared with regard to allergic morbidity and multimorbidity at 6 years.

RESULTS

Sensitization to any allergen concerned 13.6% of infants. By cluster analysis, 1525 infants were grouped into three profiles: 89.2% not or rarely sensitized (only 3.7% of sensitized), 9.2% mainly sensitized to one or few allergens (45.2% of monosensitized and 45.9% of paucisensitized) and 1.6% all polysensitized. The prevalence of doctor-diagnosed asthma, rhinitis, eczema, food allergy and multimorbidity at 2 years increased from profile one to profile three (p-trend <0.001). At 6 years, symptoms of current asthma, rhinitis, eczema and multimorbidity were significantly more frequent in the last two profiles.

CONCLUSIONS

This study highlights, as early as 18 months of age, three profiles of increasing severity with regard to allergic sensitization and diseases. These profiles also differ in terms of allergic morbidity at 6 years. Early sensitization can predict allergic multimorbidity in childhood, and in the case of early polysensitization, multimorbidity is more frequent as soon as infancy.

Impact of occupational exposures on exacerbation of asthma: a population-based asthma cohort study

Background

Asthma is a prevalent chronic disease and occupation contributes to approximately 15 % of cases among adults. However, there are still few studies on risk factors for work-exacerbated asthma. The current study investigated the association between asthma exacerbations and occupational exposures.

Methods

The study comprised all currently working adults (n = 1356) who reported ever asthma in prior population-based cohorts. All subjects completed a questionnaire about exposures, occupations and exacerbations of asthma. Exposure to high and low molecular weight agents, irritating agents and asthmagens were classified using the asthma-specific job exposure matrix for northern Europe (N-JEM). Severe exacerbation of asthma was defined as sought emergency care at a hospital, admitted to a hospital overnight, or made an urgent visit to a primary care physician or district medical office due to breathing problems during the last 12 months. Moderate exacerbation was defined as both being not severe exacerbation and an additional visit to a primary care physician or district medical office, or had extra treatments with corticosteroid tablets. Mild exacerbation was defined as being neither severe nor moderate exacerbation, and increasing usage of inhaled corticosteroids.

Multiple logistic regression was applied to investigate the association between exacerbation of asthma and occupational exposures while adjusting for potential confounders.

Results

Approximately 26 % of the working asthmatics reported exacerbation, and more than two-thirds of them had moderate or severe exacerbation. From 23 to 49 % of the asthmatics reported occupational exposure to a variety of different types of agents. Exposure to any gas, smoke or dust (OR 1.7[95 % CI 1.2–2.6]) was associated with severe exacerbation of asthma, as were organic dust (OR 1.7[1.2–2.5]), dampness and mold (OR 1.8[1.2–2.7]), cold conditions (OR 1.7[1.1–2.7]), and a physically strenuous job (OR 1.6[1.03–2.3]). Asthmagens and low molecular weight agents classified by the N-JEM were associated with mild exacerbation, with OR 1.6[1.1–2.5] and OR 2.2[1.1–4.4], respectively.

Conclusions

Self-reported exposure to any gas, smoke or dust, organic dust, dampness and mold, cold conditions and physically strenuous work, and jobs handling low molecular weight agents were associated with exacerbation of asthma. Reduction of these occupational exposures may help to reduce exacerbation of asthma.

Dietary intake, leisure time activities and obesity among adolescents in Western Sweden: a cross-sectional study

BACKGROUND

Overweight and obesity among adolescents are increasing worldwide. Risk factors include dietary intake characteristics and high levels of physical inactivity. In Sweden, few large comprehensive population-based surveys of dietary intake and lifestyle among adolescents have been carried out. Thus, the purpose of the current study was to describe dietary intake and food choices as well as leisure time activities in relation to overweight and obesity in a total sample of all schoolchildren aged 15 years in Western Sweden.

METHODS

In 2008, a questionnaire was sent to all 21,651 adolescents born in 1992 in Västra Götaland Region, Sweden. Participation rate was 54.3 % (50.7 % girls/49.3 % boys). The questionnaire included a 73-item semi-quantitative food frequency questionnaire and questions on lifestyle. Results were evaluated against the Nordic Nutrition Recommendations and Swedish indicators of healthy diet and exercise habits. Associations with concurrent overweight and obesity were evaluated in multiple linear regression analysis.

RESULTS

Among girls, 49.5 % reached the goal of consuming fruit and vegetables at least daily, whereas for boys the figure was 34.4 %. Among both sexes, 15 % reached the goal of consuming fish at least twice weekly. Two-thirds of both sexes reached the goal of regular moderate or vigorous physical activity weekly. In total, 12.4 % were overweight and 2.4 % were obese. More girls than boys were underweight, whereas more boys than girls were overweight or obese (p < 0.001). Boys exhibited a more frequent intake of sodas and concentrated fruit juices, milk 3 % fat, bread and potatoes and fast food (p < 0.001). Frequent intake of candies and chocolate was reported by both sexes. Among girls and boys, living in rural areas, living in apartments and reporting no frequent leisure time physical activity were significant risk factors for being overweight or obese, also when adjusted for other risk factors.

CONCLUSIONS

Dietary habits of adolescents in Western Sweden warrant improvements. Public health actions should be taken to increase consumption of fruit, vegetables and fish, and decrease consumption of sodas and candies and also to increase frequency of physical activity. These actions may be helpful in reducing risks for overweight and obesity.

Safety evaluation of MP29-02 (a novel intranasal formulation of azelastine hydrochloride and fluticasone propionate) for allergic rhinitis

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.

Fetal Growth, Obesity, and Atopic Disorders in Adolescence: a Retrospective Birth Cohort Study

BACKGROUND

Developmental status at birth and subsequent obesity have been implicated in the development of childhood atopic dermatitis (AD) and allergic rhinitis (AR).

METHODS

The current study analysed the cohort data of 74 688 junior high school students from a national retrospective birth cohort study in Taiwan. A random 10% sample was selected from singleton livebirths with complete data on the analytical variables of interest. Atopic disorders, including AD and AR, were assessed by questionnaires (International Study of Asthma and Allergies in Childhood). Logistic regression analyses were applied with adjustments for related risk factors.

RESULTS

Among subjects mainly 13-15 years of age, the estimated prevalence was 7.6% for AD and 22.4% for AR. While the role of fetal growth in allergic disorders was less evident, the risk of developing AD and AR were both influenced by a combination of fetal growth status and adolescent body mass index (BMI). Compared with those with normal fetal growth and school-aged BMI, the risk of developing AD increased 64% among adolescents with both restricted fetal growth and high BMI (odds ratio 1.64, 95% confidence interval 1.37, 1.97). The risk for this combination was higher than that for either restricted fetal growth or high BMI alone. Nevertheless, the overall interaction between BMI and fetal growth status on atopic disorders did not reach statistical significance.

CONCLUSIONS

Excessive weight gain could be an important risk factor related to developing atopic dermatitis and allergic rhinitis during adolescence, especially among infants born small for gestational age.

Association of atopic dermatitis with being overweight and obese: a systematic review and metaanalysis

BACKGROUND

Previous studies found conflicting results about whether atopic dermatitis (AD) is associated with overweight/obesity.

OBJECTIVE

We sought to examine the relationship between AD and overweight/obesity by performing a systematic review and metaanalysis.

METHODS

Observational studies of the relationship between AD and overweight/obesity were selected from PubMed, Embase, and the Cochrane Library. The quality of evidence was assessed using the Newcastle-Ottawa Scale. Fixed and random effects metaanalyses were performed to estimate pooled odds ratios (ORs). Sensitivity analyses were performed that compared results by location of study, study quality, and between studies in children and adults.

RESULTS

In total, 30 studies were included for review. Patients who were overweight (Cochrane-Mantel-Haenszel [CMH] OR, 1.27 [95% confidence interval {CI}: 1.19-1.36]; random effects OR, 1.23 [95% CI: 1.11-1.41]), obese (CMH OR, 1.68 [95% CI: 1.54-1.84]; random effects OR, 1.47 [95% CI: 1.21-1.79]), or overweight/obese (CMH OR, 1.42 [95% CI: 1.34-1.50]; random effects OR, 1.31 [95% CI: 1.16-1.48]) had higher odds of AD than normal weight patients. In sensitivity analyses, children who were overweight (random effects OR, 1.24 [95% CI: 1.08-1.43]), obese (random effects OR, 1.44 [95% CI: 1.12-1.86]), or overweight/obese (random effects OR, 1.32 [95% CI: 1.15-1.51]) and adults who were obese (random effects OR, 1.56 [95% CI: 1.24-1.95]) or overweight/obese (random effects OR, 1.29 [95% CI: 1.05-1.59]) had higher odds of AD. The association remained significant in North America and Asia but not Europe.

LIMITATIONS

Most studies were cross-sectional.

CONCLUSIONS

Overweight/obesity in North America and Asia is associated with an increased prevalence of AD.