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Eapen AA, Sitarik AR, Cheema G, Kim H, Ownby D, Johnson CC, Zoratti E. Effect of prenatal dog exposure on eczema development in early and late childhood. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3312-3314.e1. [PMID: 36229332 PMCID: PMC10278066 DOI: 10.1016/j.jaip.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/19/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Amy A Eapen
- Division of Allergy and Clinical Immunology, Department of Medicine, Henry Ford Health, Detroit, MI.
| | | | - Gagandeep Cheema
- Division of Allergy and Clinical Immunology, Department of Medicine, Henry Ford Health, Detroit, MI
| | - Haejin Kim
- Division of Allergy and Clinical Immunology, Department of Medicine, Henry Ford Health, Detroit, MI
| | - Dennis Ownby
- Department of Pediatrics, Augusta University, Augusta, Ga
| | | | - Edward Zoratti
- Division of Allergy and Clinical Immunology, Department of Medicine, Henry Ford Health, Detroit, MI
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Arshad SH, Holloway JW, Karmaus W, Zhang H, Ewart S, Mansfield L, Matthews S, Hodgekiss C, Roberts G, Kurukulaaratchy R. Cohort Profile: The Isle Of Wight Whole Population Birth Cohort (IOWBC). Int J Epidemiol 2019; 47:1043-1044i. [PMID: 29547889 DOI: 10.1093/ije/dyy023] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - John W Holloway
- Human Development and Health, University of Southampton, Southampton, UK
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis, Memphis, TN, USA
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, University of Memphis, Memphis, TN, USA
| | - Susan Ewart
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
| | - Linda Mansfield
- Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, MI, USA
| | - Sharon Matthews
- The David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, UK
| | - Claire Hodgekiss
- The David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, UK
| | - Graham Roberts
- The David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK.,Human Development and Health, University of Southampton, Southampton, UK
| | - Ramesh Kurukulaaratchy
- The David Hide Asthma and Allergy Research Centre, Newport, Isle of Wight, UK.,Clinical and Experimental Sciences, University of Southampton, Southampton, UK.,NIHR Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
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Persistence of atopic dermatitis (AD): A systematic review and meta-analysis. J Am Acad Dermatol 2016; 75:681-687.e11. [PMID: 27544489 DOI: 10.1016/j.jaad.2016.05.028] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous studies found conflicting results about whether childhood atopic dermatitis (AD) persists into adulthood. OBJECTIVE We sought to determine persistence rates and clinical factors associated with prolonged AD. METHODS A systematic review was performed in MEDLINE, EMBASE, Scopus, GREAT, LILACS, Web of Science, Academic Search Complete, and Cochrane Library. Meta-analysis was performed using Kaplan-Meier plots and random-effects proportional hazards regression. RESULTS In total, 45 studies including 110,651 subjects spanning 434,992 patient-years from 15 countries were included. In pooled analysis, 80% of childhood AD did not persist by 8 years and less than 5% persisted by 20 years after diagnosis (mean ± SE: 6.1 ± 0.02 years). Children with AD that persisted already for more than 10 years (8.3 ± 0.08 years) had longer persistence than those with 3 (3.2 ± 0.02 years) or 5 (6.8 ± 0.06 years) years of persistence. Children who developed AD by age 2 years had less persistent disease (P < .0001). Persistence was greater in studies using patient-/caregiver-assessed versus physician-assessed outcomes, female versus male patients (P ≤ .0006), but not in those with sensitivity to allergens (P = .90). Three studies found prolonged persistence with more severe AD. LIMITATIONS Some studies did not capture recurrences later in life. CONCLUSIONS Most childhood AD remitted by adulthood. However, children with already persistent disease, later onset, and/or more severe disease have increased persistence.
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Pickett K, Loveman E, Kalita N, Frampton GK, Jones J. Educational interventions to improve quality of life in people with chronic inflammatory skin diseases: systematic reviews of clinical effectiveness and cost-effectiveness. Health Technol Assess 2016; 19:1-176, v-vi. [PMID: 26502807 DOI: 10.3310/hta19860] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Inflammatory skin diseases include a broad range of disorders. For some people, these conditions lead to psychological comorbidities and reduced quality of life (QoL). Patient education is recommended in the management of these conditions and may improve QoL. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of educational interventions to improve health-related quality of life (HRQoL) in people with chronic inflammatory skin diseases. DATA SOURCES Twelve electronic bibliographic databases, including The Cochrane Library, MEDLINE and EMBASE, were searched to July 2014. Bibliographies of retrieved papers were searched and an Advisory Group contacted. REVIEW METHODS Systematic reviews were conducted following standard methodologies. Clinical effectiveness studies were included if they were undertaken in people with a chronic inflammatory skin condition. Educational interventions that aimed to, or could, improve HRQoL were eligible. Studies were required to measure HRQoL, and other outcomes such as disease severity were also included. Randomised controlled trials (RCTs) or controlled clinical trials were eligible. For the review of cost-effectiveness, studies were eligible if they were full economic evaluations, cost-consequence or cost analyses. RESULTS Seven RCTs were included in the review of clinical effectiveness. Two RCTs focused on children with eczema and their carers. Five RCTs were in adults. Of these, two were of people with psoriasis, one was of people with acne and two were of people with a range of conditions. There were few similarities in the interventions (e.g. the delivery mode, the topics covered, the duration of the education), which precluded any quantitative synthesis. Follow-up ranged from 4 weeks to 12 months, samples sizes were generally small and, overall, the study quality was poor. There appeared to be positive effects on HRQoL in participants with psoriasis in one trial, but no difference between groups in another trial in which participants had less severe psoriasis. Carers of children in one RCT of eczema showed improvement in HRQoL; however, in a RCT evaluating a website intervention there were no demonstrable effects on HRQoL. Neither the RCT in those adults with acne nor the RCT in those adults with mixed skin conditions demonstrated an effect on HRQoL. One RCT reported subgroups with atopic dermatitis or psoriasis and education was effective for psoriasis only. Other outcomes also showed mixed results. It is unclear how clinically meaningful any of the observed improvements are. Three studies of cost-effectiveness were included. The interventions, comparators and populations varied across the studies and, overall, the studies provided limited information on cost-effectiveness. The studies did provide detailed information on resources and costs that could be useful to inform a future cost-effectiveness evaluation in this area. LIMITATIONS The application of the inclusion criterion around whether the interventions were aimed at improving HRQoL or the inference that they could improve HRQoL was difficult as information was rarely reported. CONCLUSIONS There is uncertainty regarding whether educational interventions addressing issues that could improve HRQoL in people with chronic skin conditions are effective. Tentative conclusions about the best approach to delivering these kinds of interventions are that face-to-face, group, sessions may be beneficial; however, text messages may also be effective. Delivery over a period of time and by a multidisciplinary team may also be associated with positive outcomes. There is uncertainty over whether or not educational interventions are cost-effective. STUDY REGISTRATION This study is registered as PROSPERO CRD42014007426. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Emma Loveman
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Neelam Kalita
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Geoff K Frampton
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
| | - Jeremy Jones
- Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK
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Edwards AM, Bibawy D, Matthews S, Tongue N, Arshad SH, Lødrup Carlsen K, Øymar K, Pollock I, Clifford R, Thomas A, Gamanya R, Vyas J, Stevens MT, Carlsen KH. Long-term use of a 4% sodium cromoglicate cutaneous emulsion in the treatment of moderate to severe atopic dermatitis in children. J DERMATOL TREAT 2015; 26:541-7. [PMID: 25909369 DOI: 10.3109/09546634.2015.1034077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Sodium cromoglicate (SCG), a chromone with anti-inflammatory, anti-itch and anti-allergic properties. We report a long-term study of a 4% aqueous solution of SCG in children with moderate to severe atopic dermatitis (AD). MATERIALS AND METHODS Children aged 1 to 12 years with AD were entered into a 12-week randomised clinical trial (RCT), followed by 12 months open treatment with known 4% SCG emulsion (Altocrom®). Primary endpoint was change in SCORAD score. Secondary endpoints included symptom severity, Quality of Life, concomitant treatment usage, global assessments. RESULTS One hundred and seventy-seven subjects entered, 118 treated with 4% SCG emulsion and 59 with vehicle: 128 completed 12 months in open study. SCORAD score reduced during RCT by -15.3 (-33%) on 4% SCG emulsion and -18.0 (-39%) on vehicle: p = 0.2331. After 12 months reduction was 56%. No secondary endpoint showed differences between treatments during RCT. Thirty-two subjects reported treatment related events during RCT and open trial. Eleven (7%) reported application site discomfort. Most were reported as mild and most resolved without intervention and the study drug was stopped in one case only. CONCLUSIONS SCG 4% cutaneous emulsion was well tolerated in children treated for 15 months.
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Affiliation(s)
- Alan Martin Edwards
- a The David Hide Asthma and Allergy Research Centre , St Mary's Hospital , Newport, Isle of Wight , UK
| | - Dalia Bibawy
- a The David Hide Asthma and Allergy Research Centre , St Mary's Hospital , Newport, Isle of Wight , UK
| | - Sharon Matthews
- a The David Hide Asthma and Allergy Research Centre , St Mary's Hospital , Newport, Isle of Wight , UK
| | - Nicky Tongue
- a The David Hide Asthma and Allergy Research Centre , St Mary's Hospital , Newport, Isle of Wight , UK
| | - Syed Hasan Arshad
- a The David Hide Asthma and Allergy Research Centre , St Mary's Hospital , Newport, Isle of Wight , UK
| | - Karin Lødrup Carlsen
- b Department of Paediatrics , Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Knut Øymar
- c Pediatric Department , Stavanger University Hospital , Stavanger , Norway
| | - Ian Pollock
- d Department of Paediatrics , Barnet and Chase Farm Hospitals NHS Trust, Barnet , Hertfordshire , UK
| | - Rollo Clifford
- e Children's Centre , Dorset County Hospital , Dorchester , UK
| | - Anne Thomas
- f Department of Dermatology , Cardiff University , Wales , UK , and
| | - Rufaro Gamanya
- f Department of Dermatology , Cardiff University , Wales , UK , and
| | - Jui Vyas
- f Department of Dermatology , Cardiff University , Wales , UK , and
| | | | - Kai-Håkon Carlsen
- b Department of Paediatrics , Institute of Clinical Medicine, University of Oslo , Oslo , Norway
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Sahiner UM, Buyuktiryaki B, Cavkaytar O, Arik Yılmaz E, Soyer O, Sackesen C, Tuncer A, Sekerel BE. Recurrent wheezing in the first three years of life: short-term prognosis and risk factors. J Asthma 2013; 50:370-5. [PMID: 23363237 DOI: 10.3109/02770903.2013.770013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE It is difficult to determine if preschool children with recurrent wheezing are suffering from asthma or will suffer from asthma in the future. The aim of this study was to investigate the prognosis and risk factors of recurrent wheezing in children, beginning in the first 3 years of life. METHOD Children who were referred because of recurrent wheezing episodes during the first 3 years of life were evaluated for the presence of asthma over a 4-year period. A child without any symptoms within the last 12 months was considered to be in remission. RESULTS The study included 529 (male/female: 2.17) children with a median (inter-quartile) age of 0.6 years (0.3-1.0) at symptom onset. The median follow-up and symptom durations were 2.93 years (1.74-4.76) and 4.30 years (2.91-5.97), respectively. Remission/recovery was achieved in 1.7%, 8.0%, and 14.4% of the children within 12, 24, and 36 months, respectively. A negative "stringent asthma predictive index" (API) significantly shortened the time to recovery of wheezing compared to the positive API (p = .036). Maternal smoking during pregnancy (OR = 4.35; 95% CI = 1.29-14.63); p = .018) and the number of emergency room admissions within the first 3 years of life (OR = 1.10; 95% CI = 1.01-1.19); p = .031) were found to be independent risk factors for the persistence of wheezing symptoms. CONCLUSION Most of the children who were referred with frequent wheezing remain symptomatic 3 years after the initial wheezing episodes. A negative API is related to a shorter wheezing duration. Maternal smoking during pregnancy and the severity of the wheezing episodes appeared to be significant risk factors for the persistence of wheezing symptoms.
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Affiliation(s)
- Umit Murat Sahiner
- Pediatric Allergy and Asthma Department, School of Medicine, Hacettepe University, Ankara, Turkey
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Bousquet J, Anto J, Sunyer J, Nieuwenhuijsen M, Vrijheid M, Keil T. Pooling birth cohorts in allergy and asthma: European Union-funded initiatives - a MeDALL, CHICOS, ENRIECO, and GA²LEN joint paper. Int Arch Allergy Immunol 2012; 161:1-10. [PMID: 23258290 DOI: 10.1159/000343018] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Long-term birth cohort studies are essential to understanding the life course and childhood predictors of allergy and the complex interplay between genes and the environment (including lifestyle and socioeconomic determinants). Over 100 cohorts focusing on asthma and allergy have been initiated in the world over the past 30 years. Since 2004, several research initiatives funded under the EU Framework Program for Research and Technological Development FP6-FP7 have attempted to identify, compare, and evaluate pooling data from existing European birth cohorts (GA(2)LEN: Global Allergy and European Network, FP6; ENRIECO: Environmental Health Risks in European Birth Cohorts, FP7; CHICOS: Developing a Child Cohort Research Strategy for Europe, FP7; MeDALL: Mechanisms of the Development of ALLergy, FP7). However, there is a general lack of knowledge about these initiatives and their potentials. The aim of this paper is to review current and past EU-funded projects in order to make a summary of their goals and achievements and to suggest future research needs of these European birth cohort networks.
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Affiliation(s)
- Jean Bousquet
- University Hospital, Hôpital Arnaud de Villeneuve, Montpellier, France.
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Experiences of carers managing childhood eczema and their views on its treatment: a qualitative study. Br J Gen Pract 2012; 62:e261-7. [PMID: 22520913 DOI: 10.3399/bjgp12x636083] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Childhood eczema causes significant impact on quality of life for some families, yet non-concordance with treatment is common. AIM To explore parents' and carers' views of childhood eczema and its treatment. DESIGN AND SETTING Qualitative interview study in primary care in the south of England. METHOD Carers of children aged ≤5 years with a recorded diagnosis of eczema, who reported that eczema was still a problem, were invited to participate. Thirty-one parents were interviewed from 28 families. RESULTS Many parents expressed frustration with both medical care and prescribed treatments. They felt their child's suffering was not 'taken seriously', and experienced messages about a 'trial and error' prescribing approach and assurance that their child would 'grow out of it' as a further 'fobbing off', or dismissal. Many carers were ambivalent about eczema treatments, mainly topical corticosteroids but also emollients. Dietary exclusions as a potential cure were of interest to most families, although they perceived healthcare professionals as uninterested in this. Families varied in the extent to which they felt able to manage eczema and the length of time taken to gain control. In some instances, this was linked to not understanding advice or receiving conflicting advice from different healthcare providers. CONCLUSION Poor concordance with treatments seems unsurprising in the presence of such dissonance between carers' and healthcare providers' agendas. Acknowledging the impact of the condition, greater attention to how key messages are delivered and addressing carers' treatment beliefs are likely to improve engagement with effective self-care.
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9
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Skypala I. Adverse Food Reactions—An Emerging Issue for Adults. ACTA ACUST UNITED AC 2011; 111:1877-91. [DOI: 10.1016/j.jada.2011.09.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 05/20/2011] [Indexed: 01/03/2023]
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Biagini Myers JM, Khurana Hershey GK. Eczema in early life: genetics, the skin barrier, and lessons learned from birth cohort studies. J Pediatr 2010; 157:704-14. [PMID: 20739029 PMCID: PMC2957505 DOI: 10.1016/j.jpeds.2010.07.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 04/22/2010] [Accepted: 07/06/2010] [Indexed: 12/17/2022]
Abstract
Eczema is a chronic inflammatory disorder of the skin that affects up to 30% of children. It often afflicts infants in the first few months of life and can be the first indicator of the atopic march. Recent results from birth cohort studies have uncovered novel information regarding genetic and environmental factors that promote the development of eczema. Birth cohort studies provide an optimal study design to elucidate these associations and prospectively track longitudinal data including exposure assessment and health outcomes from birth into early life and childhood. This is especially relevant for eczema given the age specific emergence of this disease. In this review, we will provide a general overview of pediatric eczema and discuss the important findings in the literature with respect to genetics and environmental exposures, highlighting those derived from birth cohort studies. Additionally, we will review how these relate to the atopic march, the hygiene hypothesis and the integrity of the skin barrier.
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Affiliation(s)
| | - Gurjit K. Khurana Hershey
- Division of Asthma Research, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Belyhun Y, Amberbir A, Medhin G, Erko B, Hanlon C, Venn A, Britton J, Davey G. Prevalence and risk factors of wheeze and eczema in 1-year-old children: the Butajira birth cohort, Ethiopia. Clin Exp Allergy 2010; 40:619-26. [PMID: 20447078 DOI: 10.1111/j.1365-2222.2010.03479.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The rising global prevalence of asthma and other allergic conditions has been linked to potential aetiological factors influencing the developing immune system. OBJECTIVE To investigate the prevalence and associated risk factors for wheeze and eczema in 1-year-old children in a birth cohort from Butajira, Ethiopia. METHODS In 2005/6, a population-based cohort of 1065 pregnant women was established. At 1 year of age, data on wheeze and eczema in the children were collected from the mother via an interview-administered questionnaire, along with numerous demographic and lifestyle factors. A stool sample was also obtained from the child for geohelminth analysis. RESULTS The prevalence of wheeze was 11.5% (103/899) and eczema 8.6% (77/899). Independent predictors of wheeze were maternal allergic history [adjusted OR (AOR)=3.00, 95% CI 1.23-7.36], paternal allergic history (AOR=2.59, 95% CI 1.08-6.25), increasing household size (P for trend=0.023; AOR=3.54, 95% CI 1.31-9.56 for 7+ vs. 1-3 individuals) and paracetamol use by the child (overall P<0.001; AOR 11.04, 95% CI 4.30-28.31 for 4+ tablets in past month vs. never). Factors independently associated with eczema were maternal allergic history (AOR=3.68, 95% CI 1.54-8.77), household size (overall P=0.035; AOR=0.45, 95% CI 0.23-0.87 for 4-6 individuals relative to 1-3) and place of sleeping (overall P<0.001; AOR=0.29, 95% CI 0.10-0.82 for floor vs. bed/platform). CONCLUSION These findings support the hypothesis that eczema in early life in these children is a manifestation of allergy, while wheezing is probably due to infection as well as allergy.
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Affiliation(s)
- Y Belyhun
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia
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12
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Musharrafieh U, Al-Sahab B, Zaitoun F, El-Hajj MA, Ramadan F, Tamim H. Prevalence of asthma, allergic rhinitis and eczema among Lebanese adolescents. J Asthma 2009; 46:382-7. [PMID: 19484674 DOI: 10.1080/02770900902777775] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Studies on allergic diseases remain scarce in Lebanon. The aim of the present study was to determine prevalence and characteristics of asthma, allergic rhinitis and eczema among Lebanese school children. METHODS The study was cross-sectional in design performed on a convenient sample of 3,115 students (13-14 yr) selected from 13 schools in 5 Lebanese provinces. Students were asked to complete the Arabic version of the International Study of Asthma and Allergies in Childhood questionnaire. Logistic regression was performed to assess the characteristics of having asthma, allergic rhinitis and eczema in the past year. RESULTS The prevalence of ever having asthma, rhinitis and eczema was 8.3%, 45.2% and 12.8% respectively, while the prevalence of the symptoms of these diseases in the past year was 24.1%, 38.6% and 20.9%, respectively. Residing in the South and the North provinces of Lebanon and living in a busy area increased the likelihood of developing asthma and rhinitis. Higher rates of asthma and eczema, however, was noted among students going to private schools (Odds Ratio (OR) = 1.6, 95% confidence interval (CI): 1.3-2.1 and OR = 1.3, 95% CI: 1.0-1.7, respectively). Passive smoking was significantly associated with asthma only (OR = 1.3, 95% CI: 1.1-1.7). In addition to the above, the odds of having any of the three outcomes increases to at least 2.4-fold when accompanied by another allergic disease. CONCLUSIONS Allergic diseases are highly prevalent in Lebanon and are catching up with the rates of developed countries. Moreover, the role of each of the three diseases in the existence of the other two had the greatest impact on their prevalence.
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Affiliation(s)
- Umayya Musharrafieh
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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13
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Punekar YS, Sheikh A. Establishing the incidence and prevalence of clinician-diagnosed allergic conditions in children and adolescents using routinely collected data from general practices. Clin Exp Allergy 2009; 39:1209-16. [PMID: 19400899 DOI: 10.1111/j.1365-2222.2009.03248.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There remains a need to better characterize the epidemiology of allergic disorders, particularly in relation to describing the incidence, natural history and co-morbidity of allergic conditions. OBJECTIVES To estimate the incidence and prevalence of clinician-diagnosed eczema, asthma and rhinitis, alone and in combination, in children and adolescents in the United Kingdom. METHODS Using the national General Practice Research Database (GPRD) - one of the largest validated databases of routinely collected healthcare data in the world aggregating 3.6 million individuals - we constructed a retrospective birth cohort of 43,473 children born in the year 1990 and registered with a UK general practice within a year of birth. The cohort was followed until 2008 or the longest available follow-up period to determine the cumulative and age-specific incidence and prevalence rates of clinician-diagnosed eczema, asthma and rhinitis, and an 18-year prevalence of these conditions, alone and in combination. RESULTS Eczema had the highest incidence density of 226.9 per 10,000 person-years [95% confidence interval (CI): 225.8-228.0] followed by asthma [136.6;(95% CI: 135.7-137.5)] and rhinitis [61.4;(95% CI: 60.8-62.0)], by the age of 18 years. The incidence densities of suffering from one, two or all three allergic conditions were 323.2 (95% CI: 322.0-324.4), 206.4 (95% CI: 205.7-207.1) and 141.9 (95% CI: 141.4-142.4) per 10,000 person-years, respectively. Among the 24 112 children with a complete 18-year follow-up, eczema had the highest 18-year prevalence of clinician-diagnosed condition at 36.5% (95% CI: 35.9-37.2%) followed by asthma [22.9;(95% CI: 22.3-23.4%)] and rhinitis[11.4;(95% CI: 11.0-11.8%)]. The 18-year prevalence of more than one and all three conditions was 16.1% (95% CI: 15.6-16.6%) and 2.5% (95% CI: 2.4-2.8%), respectively. CONCLUSIONS This is one of the first studies to provide national estimates on the age-specific incidence and age-specific prevalence of the major allergic disorders showing clinician-diagnosed eczema, asthma and rhinitis to have high incidence rates in early childhood. A significant proportion of children experience and are diagnosed with multiple allergic conditions in early childhood.
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Affiliation(s)
- Y S Punekar
- Schering-Plough Ltd., Welwyn Garden City, Hertfordshire, UK
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Waked M, Salameh P. Risk factors for asthma and allergic diseases in school children across Lebanon. J Asthma Allergy 2008; 2:1-7. [PMID: 21437138 PMCID: PMC3048605 DOI: 10.2147/jaa.s3844] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: Childhood asthma is one of important diseases of childhood. There is no known prevalence of asthma and allergic diseases in Lebanon. This study was conducted with a secondary objective of finding the odds of exposure to asthma, allergic rhinitis and eczema potential risk factors in Lebanese children. Material and methods: It is a cross-sectional study on children in public and private schools. A sample of 22 schools participated, where standardized written core questionnaires were distributed. 5–12 year old students completed the questionnaires at home, while 13–14 year old students filled it in class. Results: 5522 children were evaluated for asthma, allergic rhinitis and atopic eczema prevalence and their associated factors. These diseases seem to be similarly affected by parental respiratory problems, parental smoking, infancy gastroesophageal reflux, recurrent otitis, and previous pertussis. Humidity on the bedroom walls is associated with both asthma and allergic rhinitis, a spongy pillow with both allergic rhinitis and eczema, animal possession with asthma, and noncotton mattress with atopic eczema. The adjusted odds ratios for significant associations varied between 1.25 and 3 (0.0001 < p-value < 0.01). Conclusion: These factors are preventable, thus permitting a possible reduction of the prevalence of these diseases.
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Jordan S, Storey M, Morgan G. Antibiotics and allergic disorders in childhood. Open Nurs J 2008; 2:48-57. [PMID: 19319220 PMCID: PMC2582823 DOI: 10.2174/1874434600802010048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 05/02/2008] [Accepted: 05/05/2008] [Indexed: 12/28/2022] Open
Abstract
AIM This paper explores the possible association between antibiotics prescribed in infancy and allergic disorders, mainly eczema and asthma, in childhood. BACKGROUND No-one fully understands why childhood asthma and eczema have become so common. Some authorities suggest that there may be an association between eczema and asthma and antibiotics prescribed in childhood; however, others disagree. METHOD/EVALUATION: The available literature was reviewed to examine the links between prescribed antibiotics and childhood eczema and asthma. FINDINGS/KEY ISSUE: Some, but not all, research indicates that antibiotic administration in pregnancy, childbirth or infancy may be linked to childhood asthma and eczema, but much uncertainty remains. None of the papers identified stated the doses of antibiotics prescribed. In addition, we were unable to locate studies reporting the interactions between antibiotics and the developing immune system. CONCLUSION Health care professionals should be selective when prescribing antibiotics. Further prospective work is needed to guide the prescribing of antibiotics in childbirth and infancy.
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Affiliation(s)
- Sue Jordan
- School of Health Science, Swansea University, Swansea, SA2 8PP, UK
| | - Mel Storey
- School of Medicine, Swansea University, Swansea, SA2 8PP, UK
| | - Gareth Morgan
- School of Medicine, Swansea University, Swansea, SA2 8PP, UK
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Perkin MR, Strachan DP, Williams HC, Lack G, Golding J. The predictive value of early life total immunoglobulin E measurement in identifying atopic children in a population-based birth cohort study. Pediatr Allergy Immunol 2006; 17:118-24. [PMID: 16618361 DOI: 10.1111/j.1399-3038.2005.00364.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atopy is common and the prevalence amongst children is rising. Measurements in early childhood that can predict subsequent development of atopy could be clinically useful for targeting preventive measures. We used the Children in Focus (CiF) subgroup of a large population-based birth cohort study (the Avon Longitudinal Study of Parents and Children) to investigate whether total immunoglobulin E (IgE) measured at 12 and 18 months could predict subsequent development of atopy at 5 yr of age. Atopy was determined by positive skin prick test (> or = 3 mm wheal) to one or more of 14 inhalant and food allergens. Prevalence of skin prick positivity to any allergen was 14.5% (104 of 715; 95% CI: 12.0-17.1%). Total IgE levels were significantly higher at 12 months of age (p < 0.0005) but not 18 months of age in those children subsequently atopic. The highest positive predictive value was 41% with an IgE measurement of >51 kU/l, with a sensitivity of 13.5% and a specificity of 95.8%. Although significant differences in early life IgE measurements were seen, the extent of overlap was great, such that the overall performance of IgE at 12 months as a screening test for atopy was poor.
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Affiliation(s)
- Michael R Perkin
- Department of Child Health, St George's, University of London, London, UK.
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Kurukulaaratchy RJ, Matthews S, Arshad SH. Defining childhood atopic phenotypes to investigate the association of atopic sensitization with allergic disease. Allergy 2005; 60:1280-6. [PMID: 16134995 DOI: 10.1111/j.1398-9995.2005.00890.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Although atopic sensitization is common in childhood, its relationship to clinical allergic disease remains incompletely understood. We therefore sought to explore this relationship by defining sensitization based atopic phenotypes. METHODS Children were recruited at birth (n = 1456) and reviewed at 1, 2, 4 and 10 years. Skin prick testing (SPT) to common allergens was done at 4 (n = 980) and 10 years (n = 1036) with lung function (n = 981), bronchial challenge (n = 784) and serum IgE (n = 953) testing at 10. Atopic phenotypes were defined, by sensitization pattern, for children with SPT at both 4 and 10 years (n = 823). RESULTS Of phenotyped children, 68.0% were never atopic, 4.3% early childhood atopic (only atopic at age 4), 16.5% chronic childhood atopics (at 4 and 10 years) and 11.2% delayed childhood atopics (only at 10). Never atopics showed small but identifiable prevalence of allergic diseases such as asthma, eczema and rhinitis. Amongst allergen-sensitized subjects, aeroallergen predominated over food sensitization throughout childhood. Chronic childhood atopics showed highest prevalence of lifetime plus persistent wheeze, eczema and rhinitis, increased prevalence of aeroallergen sensitization, some evidence of persistent food sensitization, significantly greater cord IgE than never atopics (P = 0.006), plus higher total IgE (P < 0.001) and bronchial hyper-responsiveness (P < 0.001) at 10 years than other phenotypes. CONCLUSION A proportion of childhood eczema, rhinitis and asthma is nonatopic. The commonest childhood pattern of atopy is chronic sensitization, associated with early, persisting and clinically significant allergic disease. The currently accepted childhood 'Allergic March' may oversimplify the natural history of childhood atopy and allergic disease.
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Affiliation(s)
- R J Kurukulaaratchy
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK
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Rancé F. Quelle est l’utilité des examens complémentaires pour le diagnostic et la prise en charge de la dermatite atopique ? Ann Dermatol Venereol 2005. [DOI: 10.1016/s0151-9638(05)86139-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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