Allergic conditions in 5-8-year-old Maltese schoolchildren: prevalence, severity, and associated risk factors [ISAAC]

A novel dose-adjustment protocol for interrupted subcutaneous immunotherapy in children with allergic rhinitis

Aim: To assess the effectiveness and safety of a new protocol for adjusting doses during interrupted subcutaneous immunotherapy maintenance, exceeding an 8-week interval, with mite allergen injections in children with allergic rhinitis.Patients & methods: 194 children with allergic rhinitis who underwent subcutaneous immunotherapy and experienced interruptions lasting more than 8 weeks during maintenance were enrolled. Following the adoption of a novel dose-adjustment protocol, a real-world study was conducted.Results: After 3 years of subcutaneous immunotherapy, the novel group exhibited a significant reduction in allergy symptoms compared with baseline. Systemic reactions related to the novel protocol did not significantly increase.Conclusion: The novel protocol was deemed safe and effective, offering advantages of time savings and reduced burdens.

Perinatal smoking exposure and risk of asthma in the first three years of life: A prospective prebirth cohort study

BACKGROUND

There is limited evidence on the association between prenatal smoking exposure and the risk of asthma in children. The aim of this prebirth cohort study was to investigate the association between prenatal and postnatal tobacco smoke exposure and the risk of asthma in Japanese children.

METHODS

Study subjects were 1304 mother-child pairs. Information on the variables under study was obtained using repeated questionnaires that were completed by mothers, first prior to delivery, then shortly after birth and subsequently around 4, 12, 24, and 36 months after delivery. Ever asthma was defined as a maternal report of physician-diagnosed asthma at any time since birth. Current asthma was defined as the use of asthma medication at the time of the sixth survey.

RESULTS

Logistic regression models revealed that maternal active smoking, either before pregnancy or during pregnancy, was not associated with the risk of ever asthma or current asthma. Further, no association was observed between postnatally living with at least one household smoker and the risk of asthma. Among children whose mothers are never smokers, maternal second-hand smoke (SHS) exposure at work and/or at home during pregnancy increased the risk of ever asthma and current asthma in children; adjusted odds ratio (95% confidence intervals) for ever asthma and current asthma were 2.41 (1.13-5.05) and 4.82 (1.68-13.43), respectively.

CONCLUSIONS

Our findings suggest that maternal SHS exposure during pregnancy might be associated with an increased risk of ever asthma and current asthma in young children whose mothers have never smoked.

Breastfeeding and childhood asthma: systematic review and meta-analysis

Asthma and wheezing disorders are common chronic health problems in childhood. Breastfeeding provides health benefits, but it is not known whether or how breastfeeding decreases the risk of developing asthma. We performed a systematic review and meta-analysis of studies published between 1983 and 2012 on breastfeeding and asthma in children from the general population. We searched the PubMed and Embase databases for cohort, cross-sectional, and case-control studies. We grouped the outcomes into asthma ever, recent asthma, or recent wheezing illness (recent asthma or recent wheeze). Using random-effects meta-analyses, we estimated pooled odds ratios of the association of breastfeeding with the risk for each of these outcomes. We performed meta-regression and stratified meta-analyses. We included 117 of 1,464 titles identified by our search. The pooled odds ratios were 0.78 (95% confidence interval: 0.74, 0.84) for 75 studies analyzing "asthma ever," 0.76 (95% confidence interval: 0.67, 0.86) for 46 studies analyzing "recent asthma," and 0.81 (95% confidence interval: 0.76, 0.87) for 94 studies analyzing recent wheezing illness. After stratification by age, the strong protective association found at ages 0-2 years diminished over time. We found no evidence for differences by study design or study quality or between studies in Western and non-Western countries. A positive association of breastfeeding with reduced asthma/wheezing is supported by the combined evidence of existing studies.

Risk factors for community-based reports of gastrointestinal, respiratory, and dermal symptoms: findings from a cohort study in Australia

Background

Although gastrointestinal (GI), respiratory, and dermal symptoms are common, few studies have conducted concurrent and comparative prospective analyses of risk factors for these 3 morbidity outcomes.

Methods

We used data from a community-based randomized controlled trial among 277 South Australian families to analyze GI (diarrhea, vomiting), respiratory (sore throat, runny nose, cough) and dermal (rash, generalized itch, dermal infection) symptoms.

Results

Log-binomial regression analysis revealed similar risks of GI (adjusted risk ratio [RR], 1.65; 95% CI, 1.05–2.58) and respiratory (RR, 1.68; 95% CI, 1.31–2.15) symptoms among childcare/kindergarten attendees. Swimming in public pools/spas in the current or previous week was associated with all 3 symptom complexes, conferring similar risk for each (RR for GI: 1.33; 95% CI, 0.99–1.77; respiratory: 1.20; 95% CI, 1.04–1.38; dermal: 1.41; 95% CI, 1.08–1.85). Pet ownership was not associated with symptoms. Household clustering of GI and respiratory symptoms was common, and clustering of respiratory symptoms correlated with number of individuals per household.

Conclusions

This simultaneous examination of risk factors for 3 health outcomes yielded new comparative data that are useful for developing prevention strategies.

The effect of cigarette smoking on allergic conditions in Maltese children (ISAAC)

Maltese children are frequently exposed to tobacco smoke through passive and personal smoking. In the phase 3 ISAAC study questionnaire, we enquired about passive smoking to the parents of 3816 (80% response rate) 5- to 8-yr-old children and about passive and personal smoking to 4139 (90% response rate) 13- to 15-yr-old participating children. Thirty-one percent of 5- to 8-yr olds were passive smokers with their father more likely to be the smoker (p < 0.0001). Maternal smoking in the first year of the child's life resulted in the children having an increased chance of wheezing 'ever' (p < 0.001), exercise-induced wheezing (p < 0.05) and being diagnosed with asthma (p < 0.0001). Current smoking by the mother also led to the child having current rhinitis (p < 0.001). Fifty-one percent of 13- to 15-yr olds were passive smokers again with the father more likely to be the smoker (p < 0.0001). Maternal (p < 0.0001) and paternal smoking (p < 0.05) resulted in the children having an increased chance of wheezing sometime in their life, exercise-induced wheezing, nocturnal cough, and being diagnosed with asthma. Current smoking by the mother was more common in children having current rhinitis (p < 0.05), while current smoking by both mother and/or father led to itchy/watery eyes accompanying rhinitis (p < 0.05). Recurrent itchy rashes were also more likely in passive smokers (p < 0.001). Personal smoking by the 13- to 15-yr olds (8.15% boys vs. 8.8% girls ns ) resulted in a higher cumulative prevalence of wheezing (p < 0.0001), rhinitis (p < 0.05), and recurrent itchy rash (p < 0.001) but only affected current prevalence of wheezing (p < 0.0001). These smokers were more likely to experience exercise-induced wheezing (p < 0.0001), nocturnal cough (p < 0.0001), and being diagnosed with asthma (p < 0.05) and eczema (p < 0.001). Children smoking more than 10 cigarettes/day persisted with wheezing (p = 0.04) had more frequent episodes of exercise-induced wheeze (p = 0.04), nocturnal cough (p < 0.0001), and rhinoconjunctivitis (p = 0.02) than milder smokers. Smoking seems to be affecting childhood allergies in Maltese children quite significantly.

Systematic review and meta-analysis investigating breast feeding and childhood wheezing illness

There is conflicting evidence concerning the relationship between breast feeding and wheezing illness. The objective of this study was to investigate whether there is any association between breast feeding and wheezing in children aged over 5 years and to discover possible sources of heterogeneity. An electronic search of MEDLINE and EMBASE databases was conducted from January 2000 to June 2010. In addition, reference lists from relevant publications were searched. Birth cohort, cross-sectional and case-control studies were included if they measured any breast feeding or exclusive breast feeding for 3 or 4 months. Wheezing illness, including asthma, was identified based on symptoms, reported diagnosis or objective criteria. Thirty-one publications were identified for meta-analysis. There was no association found between any or exclusive breast feeding and wheezing illness, although there was a high level of heterogeneity between the studies. Subgroup analysis revealed that any breast feeding slightly lowers the odds of wheeze (pooled odds ratio 0.92 [0.86, 0.98]) but slightly increases the odds of asthma defined by specific criteria (pooled odds ratio 1.10 [1.00, 1.22]). This meta-analysis does not provide evidence that breast feeding is protective against wheezing illness in children aged 5 years and over. The difference in the effects of breast feeding according to the nature of the wheezing illness highlights the importance of the heterogeneity of illness phenotypes.

A decrease in the prevalence and improved control of allergic conditions in 13- to 15-yr-old Maltese children (ISAAC)

The International Study of Asthma and Allergies in Childhood (ISAAC) has produced a reliable global map of childhood allergies through the use of a validated standardized questionnaire. Phase 1 of the study was carried out in the Maltese Islands in 1995 and repeated in 2002 in phase 3. To investigate the trends in prevalence and severity of childhood allergies in Maltese schoolchildren, in this article, we compare the data obtained from 4184 children, 13- to 15-yr-olds (88.7% response rate) in phase 1, to that of phase 3 when 4139 (90% response rate) children participated. The cumulative (27.9% vs. 27.4%: p=0.6) and current (16% vs. 14.6% p=0.08) prevalence rates of wheezing remained quite static but wheezers were more likely to be diagnosed with asthma in 2002 (11.1% vs. 14.1% p<0.0001). Along the 7 yrs, these asthmatics were better controlled with less wheezing attacks (p<0.01), less disturbed nights (p<0.05) and less acute severe episodes (p<0.05). Nasal problems were present in 52.7% of participants in 1995 and in 50.4% in 2002 (p<0.05), and 47.4% vs. 42.8% (p<0.0001) persisted with these symptoms and associated itchy eyes (29% vs. 21.8%: p<000001). Though prevalence decreased, the children were labelled as hayfever sufferers more often (32.3 vs. 40.7%: p<0.00001). Rhinitis symptoms seemed to interfere less with daily activities (p<0.01). In 2002, an itchy rash suggestive of eczema was also less present 'ever' (12.8% vs. 11.2%: p<0.05) or currently (10.1% vs. 8.5%: p<0.05) but again more likely to be diagnosed as eczema (p<0.001). This rash caused less sleepless nights in phase 3 of the study (p<0.05). These results indicate that asthma prevalence has reached a plateau between 1995 and 2002 while rhinitis and eczema are less common. All these allergic conditions are better controlled and more likely to be diagnosed in these schoolchildren by Maltese doctors in 2002 than in 1995.

Increasing prevalence of asthma, allergic rhinitis but not eczema in 5- to 8-yr-old Maltese children (ISAAC)

The International Study of Asthma and Allergies in Childhood (ISAAC) was the first worldwide study carried out with standardized questionnaires in order to create a reliable global map of childhood allergy. Phase 1 of the study was carried out in the Maltese Islands in 1994/95 while a similar study (phase 3) was repeated 7 yr later (2001/02). In this paper, the data obtained from 3816 5- to 8-yr-olds (80% response rate) in phase 3 were compared to that obtained from 3509 5- to 8-yr-olds (78.5% response rate) in phase 1 of the study in order to evaluate whether the problem of allergic conditions in Maltese schoolchildren was indeed changing. About 30.2% (phase 3) vs. 19.1% (phase 1) (p < 0.0001) of the participants were wheezers 'ever' while 14.8% vs. 8.8% (p < 0.0001) were current wheezers and 14.8% vs. 7.5% (p < 0.0001) were labelled as asthmatics. Of these wheezing children, 13.3% vs. 6.2% (p = 0.0002) had a wheezing episode severe enough to limit speech. Nasal problems were present in 28.8% of Maltese children in 2001 and in 23.4% in 1994 (p < 0.0001) and 24.4% vs. 20.7% (p < 0.0001) of all respondents persisted with these symptoms up to the year of answering the questionnaire. Hayfever had been diagnosed in 22.2% vs. 14.7% (p < 0.0001) of all the children. About 6.7% vs. 7.0% (p = 0.61) of respondents had an recurring itchy rash suggestive of eczema for at least 6 months of their lives and 5.4.% vs. 5.5% had it currently. In 1994, the prevalence of wheezing and eczema were slightly lower than the global mean, unlike the case of rhinitis, which in Malta was commoner than the world average, while in 2001 wheezing together with rhinitis surpassed the global mean as well. These results indicate a rising prevalence of wheezing and rhinitis but not eczema in Maltese children. Asthma seemed to be better controlled and all three allergic conditions more likely to be diagnosed.

Prevalence of Asthma and Wheeze in Relation to Passive Smoking in Japanese Children

PURPOSE

Evidence remains inconclusive as to whether environmental tobacco smoke is a risk factor for allergic disorders in childhood. The present large-scale cross-sectional study examined the relationship between passive smoking at home and the prevalence of allergic disorders in Japanese schoolchildren.

METHODS

Study subjects were 23,044 children aged 6 to 15 years in Okinawa. Outcomes were based on diagnostic criteria from the International Study of Asthma and Allergies in Childhood. Adjustment was made for sex, age, region of residence, number of siblings, paternal and maternal history of asthma, atopic eczema, or allergic rhinitis, as well as paternal and maternal educational level.

RESULTS

The prevalence of wheeze, asthma, atopic eczema, and allergic rhinoconjunctivitis in the previous 12 months was 10.7%, 7.6%, 6.8%, and 7.7%, respectively. Current heavy passive smoking and 7.0 or more pack-years of smoking in the household were independently related to an increased prevalence of wheeze and asthma, especially in children 6 to 10 years of age and children with a positive parental allergic history. There was no dose-response relationship between pack-years of smoking in the household and atopic eczema or allergic rhinoconjunctivitis.

CONCLUSIONS

Our findings suggested that environmental tobacco smoke might be associated with an increased prevalence of wheeze and asthma in Japanese children.

Feeding practices of babies and the development of atopic dermatitis in children after 12 months of age in Armenia: Is there a signal?

We investigated the influence of feeding practices on development of atopic dermatitis (AD) in Armenian children (n = 240). In multivariate models early introduction to solids, family history of atopy, and breastfeeding by a mother with atopic condition were associated with the development of AD after 12 months post-term. A prospective study in Armenia is recommended to confirm our findings.

Primary prevention of allergy and asthma is possible

Allergic diseases, such as asthma, are the result of complex gene-environment interactions. The focus for prevention of allergic disease has been on environmental control. Environmental exposures begin during the intrauterine period, during which a T-helper-2 immune phenotype is promoted. Food allergy frequently occurs during the first year of life, and avoidance of exposure must begin in early pregnancy and must be complete to be effective. Partial avoidance strategies have not been successful. Current data do not allow us to specifically recommend breastfeeding for the prevention of allergy and allergic diseases, but for other important reasons, breastfeeding (particularly exclusive breastfeeding) should be encouraged for at least the first 4 mo of life. Sensitization to allergens is one of the strongest determinants for subsequent development of asthma. There is a strong relationship between exposure to house dust mites, allergen sensitization, and asthma. However, exposure to pets and animals in a farming environment early in life may actually be protective for the development of allergy and asthma. Specific recommendations relating to these exposures requires additional research, but genetics clearly plays an important role in that process. To date, only a multifaceted intervention program has been successful as a primary prevention strategy for the development of asthma in young children. The specific components of the multifaceted intervention and the duration of protection have not yet been defined. It is increasingly clear that gene-directed environmental manipulation undertaken in a multifaceted manner during a "window of opportunity" is critical in the primary prevention of allergy and allergic diseases like asthma.

Changes in respiratory and allergic symptoms in schoolchildren from 1996 to 2002, results from the ISAAC surveys in Antwerp (Belgium)

Two cross sectional surveys (1995/1996 and 2001/2002) were carried out according to the ISAAC protocol among 6-7 and 13-14 year old schoolchildren in Antwerp, Belgium. A total of 8244 children participated in 1996 and 8159 children in 2002. No significant differences in current prevalence of asthma and asthma medication was found in 6-7 year olds and 13-14 year old girls. Significantly less asthma and asthma medication was reported by 13-14 year old boys in 2002. Symptoms of wheeze had lower occurrence in all groups in 2002, which was significant for older age group. Current prevalence of rash was significantly higher in the 6-7 year olds in 2002. No such increase was found for rash in the older age groups but they reported significantly more rhinitis. No differences were found between urban and suburban Antwerp in either survey. No clear changes in the occurrence of asthma were found for school children in Antwerp while wheeze was reported less in 2002 compared to 1996. Allergic disorders had higher occurrences in schoolchildren in 2002.

Comparison of local risk factors for children's atopic symptoms in Hanoi, Vietnam

BACKGROUND

A 1999 study in Hanoi, Vietnam using the International Study on Asthma and Allergies in Childhood (ISAAC) questionnaire showed a high prevalence of atopic symptoms. Identifying risk factors for symptoms in these children may help in understanding the causes for these high estimates.

METHODS

An ISAAC questionnaire with supplemental questions on environmental variables was distributed to 5495 school children in Hanoi and a suburban district, Dong Anh. The response rate was 65.7%.

RESULTS

In Dong Anh, the following were among the significant age and gender adjusted associations: pig ownership [odds ratio (OR) (95% confidence interval), OR = 1.79 (1.18-2.70) for doctor-diagnosed asthma (DDA), OR = 1.72 (1.08-2.78) for doctor diagnosed hay fever (DDHF)] and farming [OR = 1.67 (1.27-2.19) for ever asthma, OR = 1.51 (1.09-2.09) for DDHF]. In multivariate models, tuberculosis (TB) was a significant predictor of atopic symptoms [Hanoi: OR = 3.09 (1.10-8.70) for DDA, Dong Anh: OR = 3.71 (1.40-9.84) for DDA, OR = 4.66 (1.88-11.57) for DDHF].

CONCLUSIONS

These findings are contrary to the "hygiene hypothesis". Recent immunologic and epidemiologic studies refute the inverse association between allergy and TB and may be one explanation for the positive association in this study. The positive association with pig ownership and farming may be because of exposures on farms in a developing country that may be different from exposures in farms of developed countries.