Increasing prevalence of allergic rhinitis but not asthma among children in Hong Kong from 1995 to 2001 (Phase 3 International Study of Asthma and Allergies in Childhood)

Objective monitoring tools for improved management of childhood asthma

Asthma is a common chronic disease amongst children. Epidemiological studies showed that the mortality rate of asthma in children is still high worldwide. Asthma control is therefore essential to minimize asthma exacerbations, which can be fatal if the condition is poorly controlled. Frequent monitoring could help to detect asthma progression and ensure treatment effectiveness. Although subjective asthma monitoring tools are available, the results vary as they rely on patients' self-perception. Emerging evidence suggests several objective tools could have the potential for monitoring purposes. However, there is no consensus to standardise the use of objective monitoring tools. In this review, we start with the prevalence and severity of childhood asthma worldwide. Then, we detail the latest available objective monitoring tools, focusing on their effectiveness in paediatric asthma management. Publications of spirometry, fractional exhaled nitric oxide (FeNO), hyperresponsiveness tests and electronic monitoring devices (EMDs) between 2016 and 2023 were included. The potential advantages and limitations of each tool were also discussed. Overall, this review provides a summary for researchers dedicated to further improving objective paediatric asthma monitoring and provides insights for clinicians to incorporate different objective monitoring tools in clinical practices.

Improvements in Gut Microbiome Composition Predict the Clinical Efficacy of a Novel Synbiotics Formula in Children with Mild to Moderate Atopic Dermatitis

Atopic dermatitis (AD) is a common chronic inflammatory skin disease with a significant association with various type-2 inflammation-related comorbidities. Ongoing research suggests the crucial involvement of gut microbiome, especially in childhood onset AD, and hence, probiotics have emerged as a potential non-steroid-based therapeutics option to complement existing AD management plans. In order to delineate the impact of probiotics in the gut microbiome of pediatric AD patients from southern China, targeted 16S rRNA sequencing and thorough bioinformatic analysis were performed to analyze the gut microbiome profiles of 24 AD children after taking an orally administered novel synbiotics formula with triple prebiotics for 8 weeks. A notable improvement in Eczema Area and Severity Index (EASI) (p = 0.008) was observed after taking an 8-week course of probiotics, with no adverse effects observed. The relative abundances of key microbial drivers including Bacteroides fragilis and Lactobacillus acidophilus were significantly increased at week 8. We also found that the positive responsiveness towards an 8-week course of probiotics was associated with improvements in the gut microbiome profile with a higher relative abundance of probiotic species. Over-represented functional abundance pathways related to vitamin B synthesis and peptidoglycan recycling may imply the underlying mechanism. In summary, our study suggests how the gut microbial landscape shifts upon probiotic supplementation in AD children, and provides preliminary evidence to support targeted probiotic supplementation for the management of childhood AD.

The Spectrum and Age-Sex Patterns Among Outpatients with Allergic Diseases - Yichang City, Hubei Province, China, 2018-2021

What is already known about this topic?

Allergic diseases have affected an estimated 40% of the population in China. However, our understanding of the full spectrum of these diseases remains insufficient.

What is added by this report?

Between 2018 and 2021, Yichang City documented 625,929 outpatient visits mainly related to skin and mucous membrane allergies (77.90%) and allergic respiratory conditions (19.64%). In 2021, the occurrence of outpatient visits for conditions such as allergic rhinitis, acute atopic conjunctivitis, and atopic dermatitis increased. The demographic analysis revealed that male patients comprised the majority of the under 18 age bracket (56.05%), while female patients were predominantly represented in the 18 to 65 age bracket (61.79%).

What are the implications for public health practice?

This constitutes the first analysis of the spectrum of allergic diseases, utilizing regional outpatient data, which has substantial implications for understanding the disease burden.

Impact of comorbid allergic diseases on health-related quality of life of Hong Kong schoolchildren

BACKGROUND

Studies on the relationship between childhood allergic disease and health-related quality of life (HRQOL) have mostly been confined to a single allergic condition. Therefore, a composite allergic score (CAS) was derived to assess the accumulated effect of eczema, asthma, and allergic rhinitis on HRQOL in Hong Kong schoolchildren.

METHODS

Parents of grade one/two or grade eight/nine schoolchildren completed a questionnaire assessing the prevalence and severity of eczema (POEM), asthma (C-ACT/ACT), and allergic rhinitis (VAS) and schoolchildren's HRQOL (PedsQL). Three rounds of recruitment were conducted. A total of 19 primary and 25 secondary schools agreed to participate.

RESULTS

Data from 1140 caregivers of grade one/two schoolchildren and 1048 grade eight/nine schoolchildren were imputed and analyzed. The proportion of female respondents were lower in grade one/two (37.7%) but higher in grade eight/nine (57.3%). 63.8% of grade one/two and 58.1% of grade eight/nine schoolchildren reported having at least one allergic disease. In general, greater disease severity was significantly associated with lower HRQOL. After controlling for age, gender, and allergic comorbidity in hierarchical regressions, CAS significantly predicted all HRQOL outcomes in both grade one/two and grade eight/nine schoolchildren. Female grade eight/nine schoolchildren reported lower HRQOL outcomes.

CONCLUSION

Composite allergic score may be a practical tool to evaluate allergic comorbidity and the effectiveness of treatments targeting common pathological mechanisms of allergic diseases. Non-pharmaceutical approaches should be considered, especially for patients with more than one allergic disease and greater severity.

Early life exposure to outdoor air pollution and indoor environmental factors on the development of childhood allergy from early symptoms to diseases

BACKGROUND

The prevalence of childhood allergies has increased during past decades leading to serious hospitalization and heavy burden worldwide, yet the key factors responsible for the onset of early symptoms and development of diagnosed diseases are unclear.

OBJECTIVE

To explore the role of early life exposure to ambient air pollution and indoor environmental factors on early allergic symptoms and doctor diagnosed allergic diseases.

METHODS

A retrospective cohort study of 2598 preschool children was conducted at 36 kindergartens in Changsha, China from September of 2011 to February of 2012. A questionnaire was developed to survey each child's early onset of allergic symptoms (wheeze and rhinitis-like symptoms) and doctor diagnosis of allergic diseases (asthma and rhinitis) as well as home environments. Each mother's and child's exposures to ambient air pollutants (PM₁₀, SO₂, and NO₂) and temperature were estimated for in utero and postnatal periods. The associations of early symptoms and diagnosed diseases with outdoor air pollution and indoor environmental variables were examined by logistic regression models.

RESULTS

Childhood early allergic symptoms (33.9%) including wheeze (14.7%) and rhinitis-like symptoms (25.4%) before 2 years old were not associated with outdoor air pollution exposure but was significantly associated with maternal exposure of window condensation at home in pregnancy with ORs (95% CI) of 1.33 (1.11-1.59), 1.30 (1.01-1.67) and 1.27 (1.04-1.55) respectively, and was associated with new furniture during first year after birth with OR (95% CI) of 1.43 (1.02-2.02) for early wheeze. Childhood diagnosed allergic diseases (28.4%) containing asthma (6.7%) and allergic rhinitis (AR) (7.2%) were significantly associated with both outdoor air pollutants (mainly for SO₂ and NO₂) during first 3 years and indoor new furniture, redecoration, and window condensation. We found that sex, age, parental atopy, maternal productive age, environmental tobacco smoke (ETS), antibiotics use, economic stress, early and late introduction of complementary foods, and outdoor air pollution modified the effects of home environmental exposure in early life on early allergic symptoms and diagnosed allergic diseases.

CONCLUSION

Our study indicates that early life exposure to indoor environmental factors plays a key role in early onset of allergic symptoms in children, and further exposure to ambient air pollution and indoor environmental factors contribute to the later development of asthma and allergic rhinitis.

Childhood Wheeze, Allergic Rhinitis, and Eczema in Hong Kong ISAAC Study from 1995 to 2015

BACKGROUND

The prevalence of allergic diseases has been increasing in developing areas but has reached a plateau in many developed areas. Regular surveys are imperative to assess the disease burden for the prioritization of resource allocation.

OBJECTIVES

We examined the change in the prevalence of wheezing, allergic rhinitis (AR), and eczema in school-aged children with possible associative factors and possible health effects of school air quality.

METHODS

This was the third repeated cross-sectional study conducted in 2015-2016 using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. Our first and second surveys were conducted in 1994-1995 and 2000-2001, respectively. Regarding the third survey, we recruited 3698 children aged 6-7 from 33 local schools in 18 districts. Air quality, temperature, and humidity were also measured. The changes in prevalence, multiple regression, and GLIMMIX procedure were analyzed.

RESULTS

From our first survey to our third survey, the increased prevalences for lifetime wheeze, current wheeze, lifetime rhinitis, current rhinitis, current rhinoconjunctivitis, lifetime chronic rash, and current chronic rash were 4.2%, 2.1%, 12.5%, 12.6%, 14.2%, 3.9%, and 4.1%, respectively. Increased prevalence of parental atopy had the strongest association with an increased prevalence of each of these seven health outcomes. There was no significant association between school air pollutant levels and the prevalence of health outcomes.

CONCLUSIONS

There was an increase in the prevalence of wheezing, allergic rhinitis, and eczema across the surveys. The most important associated risk factor identified was the increased prevalence of a parental history of atopy.

Time-trends for eczema prevalences among children and adults from 1985 to 2015 in China: a systematic review

Background

Several studies have reported that childhood prevalence of eczema has been increasing worldwide. However, none study quantitatively evaluated prevalence trends of eczema among children and adults in the last 30 years in China.

Methods and Findings

Via a systematic review of literature databases in English and Chinese, we summarized all studies reporting eczema prevalences from 1985 to 2015 in China as well as diagramed prevalence and eczematous population trends against year for different age groups. A total of 93 studies and 17 studies (16 for children and one for adults) were selected for qualitative and quantitative synthesis, respectively. Childhood lifetime-ever eczema prevalences ranged from 10.0% to 30.0%. Prevalences among 3-12-year-olds children showed increasing trends in most specific cities, but national lifetime-ever eczema prevalences among 13-14-year-olds children decreased from 10.6% in 2001 to 8.6% in 2009 in mainland China. We estimated that about 1.5 million children aged 13-14-year-olds in 2009 and 15.5 million children aged 3-6-year-olds in 2012 had lifetime-ever eczema in mainland China. Similar studies were too few to ascertain time-trends of eczema prevalence among adults. About 39.4, 20.0, and 11.6 million adults aged 15-86-year-olds in 2010 had contact dermatitis, seborrheic dermatitis, and atopic dermatitis in the mainland China, respectively.

Conclusions

The burden of eczema became heavier in young children, whereas perhaps had been reduced in adolescent in China. More studies for eczema prevalence in adults are warranted.

Maternal exposure to PM2.5/BC during pregnancy predisposes children to allergic rhinitis which varies by regions and exclusive breastfeeding

BACKGROUND

Increasing prevalence of childhood allergic rhinitis(AR) needs a deeper understanding on the potential adverse effects of early life exposure to air pollution.

OBJECTIVES

The main aim was to evaluate the effects of maternal exposure to PM_2.5 and chemical constituents during pregnancy on preschool children's AR, and further to explore the modification effects of regions and exclusive breastfeeding.

METHODS

A multi-center population-based study was performed in 6 cities from 3 regions of China in 2011-2012. Maternal exposure to ambient PM_2.5 and main chemical constituents(BC, OM, SO₄^2-, NO₃^-, NH₄⁺) during pregnancy was assessed and a longitudinal prospective analysis was applied on preschool children's AR. The modification effects of regions and exclusive breastfeeding were investigated.

RESULTS

A total of 8.8% and 9.8% of children reported doctor-diagnosed allergic rhinitis(DDAR) and current hay fever, respectively, and 48.6% had less than 6 months of exclusive breastfeeding. The means of PM_2.5 during pregnancy were 52.7 μg/m³, 70.3 μg/m³ and 76.4 μg/m³ in the east, north and central south of China, respectively. Multilevel log-binomial model regression showed that each interquartile range(IQR) increase of PM_2.5 during pregnancy was associated with an average increase in prevalence ratio (PR) of DDAR by 1.43(95% confidence interval(CI): 1.11, 1.84) and current hay fever by 1.79(95% CI: 1.26, 2.55), respectively. Among chemical constituents, black carbon (BC) had the strongest associations. Across 3 regions, the eastern cities had the highest associations, followed by those in the central south and the north. For those equal to or longer than 6 months of exclusive breastfeeding, the associations were significantly reduced.

CONCLUSIONS

Children in east of China had the highest risks of developing AR per unit increase of maternal exposure to PM_2.5 during pregnancy, especially BC constituent. Remarkable decline was found in association with an increase in breastfeeding for ≥6 months, in particular in east of China.

Association between Concentration of Air Pollutants and Prevalence of Inflammatory Sinonasal Diseases: A Nationwide Cross-sectional Study

BACKGROUND

Air pollution is a serious health concern and affects inflammatory sinonasal diseases such as allergic rhinitis (AR) and chronic rhinosinusitis (CRS). Clarifying the relationship between air pollutants and upper respiratory diseases could help the patients.

OBJECTIVE

To evaluate the association between the concentration of air pollutants and the prevalence of AR and CRS among South Koreans.

METHODS

In this cross-sectional study, nationwide data were reviewed for participants of the Korean National Health and Nutrition Examination Survey (KNHANES) 2008 to 2012. Participants were surveyed with health questionnaires, examined with endoscopies by otolaryngologists, and tested with serum immunoglobulin E levels. The concentrations of sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and particulate matter with aerodynamic diameters ≤10 µm (PM₁₀) were measured in 16 areas of South Korea. Air pollutant concentrations of geographic districts were matched to each participant's residence. Logistic regression analysis was performed.

RESULTS

Among 27 863 eligible adults, 3359 and 1606 participants had AR or CRS, respectively. In multivariable logistic regression analysis for AR, PM₁₀ showed statistically significant results (odds ratio [OR] = 1.145, 95% confidence interval [CI] = 1.042-1.258). No air pollutants showed statistically significant differences in the prevalence of CRS. In AR, PM₁₀ (OR = 1.458, 95% CI = 1.201-1.770) was associated with endoscopic findings of watery rhinorrhea, whereas SO₂ (OR = 1.202, 95% CI = 1.100-1.313) was associated with pale mucosa.

CONCLUSION

The prevalence of AR was significantly associated with PM₁₀ concentration. In patients with AR, endoscopic findings of watery rhinorrhea were associated with PM₁₀. However, CRS was not associated with the air pollutant concentrations. Lower concentration of PM₁₀ might help managing the clinical symptoms in patients of AR.

Childhood food allergy and food allergen sensitisation are associated with adult airways disease: A birth cohort study

BACKGROUND

Childhood food allergy (FA) and food allergen sensitization (FAS) are associated with allergic airway disease(s) [AAD] (asthma and rhinitis) in childhood. However, the associations between childhood FA/FAS and AAD in adulthood are not well described.

METHODS

We investigated the longitudinal relationship between childhood FA/FAS to common food allergens and AAD at 18 and 26 years, in the Isle of Wight birth cohort. Study subjects (N = 1456) were followed up at fixed time points from ages 1-26 years for FA/FAS status. AAD were evaluated from 4 years onwards. The associations between FA/FAS and AAD were assessed with univariate analyses and then multivariable logistic regression, adjusting for clinically relevant co-variates.

RESULTS

Food allergy at 4 years was significantly associated with asthma at 18 years [adjusted odds ratio (aOR): 2.75, 95% CI: 1.53-4.92, p = .001] and 26 years (aOR: 2.62, 95% CI: 1.32-5.20, p = .006). Conversely, childhood FA was not associated with adulthood rhinitis whatsoever. While FAS at ages 4 and 10 were associated with both AAD, the associations between FAS and rhinitis were less robust relative to asthma.

CONCLUSION

Childhood FA increased the odds of asthma during adulthood by nearly threefold. Additionally, childhood FAS was also associated with increased odds of asthma in adulthood. Conversely, FAS but not FA in childhood was associated with rhinitis in adulthood. We suggest that children with FA/FAS should be followed up to facilitate early detection and intervention of subsequent AAD, particularly asthma.

Oxidative Stress and Antioxidant Pathway in Allergic Rhinitis

Oxidative stress is the cause and consequence of redox metabolism in various physiological and pathological conditions. Understanding the molecular pathways underlying oxidative stress and the role of antioxidants could serve as the key to helping treat associated diseases. Allergic rhinitis is a condition that deteriorates the daily function and quality of life of afflicted individuals and is associated with a high socioeconomic burden and prevalence. Recent studies have focused on the role of oxidative stress and antioxidants in allergic rhinitis. This review discusses animal and clinical studies on oxidative markers and the potential therapeutic dietary antioxidants for allergic rhinitis.

The role of the environment in shaping the trends of childhood asthma - An Asian perspective

Asthma has now become one of the most common atopic disorders not only in developed countries but also in many developing countries. The etiology is likely due to a complex interaction between genetic and environmental factors. In many Asian countries, the prevalence of asthma has also been documented by validated instruments to be increasing rapidly over the past two decades. However, studies in rural areas in Asia with a traditional farming environment revealed markedly lower asthma prevalence when compared with residents in nearby cities despite having similar genetic background. Among the environmental factors implicated in the pathogenesis of asthma, air pollution, dietary patterns, viral infections, and early microbial exposure have been studied extensively around the world. Asia provides many opportunities to study these potential factors as there are many ethnic groups living in distinctly different environments. The understanding of the roles of these factors in affecting the early immune system and subsequent development of asthma will enable us to develop potential primary preventive strategies against a disease which affects millions worldwide.

Unlocking the Non-IgE-Mediated Pseudo-Allergic Reaction Puzzle with Mas-Related G-Protein Coupled Receptor Member X2 (MRGPRX2)

Mas-related G-protein coupled receptor member X2 (MRGPRX2) is a class A GPCR expressed on mast cells. Mast cells are granulated tissue-resident cells known for host cell response, allergic response, and vascular homeostasis. Immunoglobulin E receptor (FcεRI)-mediated mast cell activation is a well-studied and recognized mechanism of allergy and hypersensitivity reactions. However, non-IgE-mediated mast cell activation is less explored and is not well recognized. After decades of uncertainty, MRGPRX2 was discovered as the receptor responsible for non-IgE-mediated mast cells activation. The puzzle of non-IgE-mediated pseudo-allergic reaction is unlocked by MRGPRX2, evidenced by a plethora of reported endogenous and exogenous MRGPRX2 agonists. MRGPRX2 is exclusively expressed on mast cells and exhibits varying affinity for many molecules such as antimicrobial host defense peptides, neuropeptides, and even US Food and Drug Administration-approved drugs. The discovery of MRGPRX2 has changed our understanding of mast cell biology and filled the missing link of the underlying mechanism of drug-induced MC degranulation and pseudo-allergic reactions. These non-canonical characteristics render MRGPRX2 an intriguing player in allergic diseases. In the present article, we reviewed the emerging role of MRGPRX2 as a non-IgE-mediated mechanism of mast cell activation in pseudo-allergic reactions. We have presented an overview of mast cells, their receptors, structural insight into MRGPRX2, MRGPRX2 agonists and antagonists, the crucial role of MRGPRX2 in pseudo-allergic reactions, current challenges, and the future research direction.

Differential Correlations among Allergy Tests According to Indoor Allergens in Allergic Rhinitis

OBJECTIVES

Several allergy tests are used for the diagnosis of allergic rhinitis; however, few studies have reported a direct comparison of the skin prick test (SPT), multiple allergen simultaneous test (MAST), and ImmunoCAP according to specific allergens. This study aimed to evaluate the correlations between each test and allergic rhinitis symptoms and to evaluate the correlations of the MAST and ImmunoCAP with the SPT for representative indoor allergens in Korea.

METHODS

Electronic medical charts were retrospectively reviewed, and 698 patients with allergic rhinitis who had performed SPT, MAST, and ImmunoCAP were enrolled. Correlations between each allergy test for 4 representative indoor allergens and the symptoms of allergic rhinitis were analyzed. Agreements of the MAST and ImmunoCAP with the SPT were compared according to each allergen.

RESULTS

The SPT showed higher correlations with allergic rhinitis symptoms for 4 indoor allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, cat, and dog allergens) than the MAST or ImmunoCAP. In comparison between the MAST and SPT, the least correlation was observed for the dog allergen, whereas between the ImmunoCAP and SPT, the least correlation was observed for the cat allergen. The correlation between the ImmunoCAP and SPT was higher than that between the MAST and SPT for the dog allergen, whereas no significant differences were noted for other allergens.

CONCLUSIONS

Overall, the SPT showed a higher correlation with allergic rhinitis symptoms than the MAST or ImmunoCAP for 4 indoor allergens. ImmunoCAP showed similar reactivity to MAST; however, it showed better positivity with dog allergen in patients who were reactive to the allergen in the SPT. Care should be taken while evaluating dog allergen sensitization using the MAST.

Potential Co-Factors of an Intraoral Contact Allergy-A Cross-Sectional Study

The aim of this cross-sectional study was to evaluate the frequency of dental allergens and potential co-factors, especially hypothyroidism, for patients with an intraoral contact allergy. From 2015 to 2016, patients with confirmed symptoms of an intraoral contact allergy (study group SG n = 50) were recruited in the dental clinic of the University of Leipzig. The participants of the control group (CG n = 103) were patients without oral diseases or intraoral symptoms of a contact allergy. For the data collection, a new "Allergy questionnaire" was developed. Information on allergies and general diseases were collected. The statistical analysis was carried out with SPSS 23.0. Sensitizations/allergies to metals and composites were higher in SG compared to CG. Of all study participants (n = 148), 14.2% (n = 21) had a nickel allergy. In 18% (n = 8) of the SG a cobalt allergy based on all metal allergens could be seen. In addition, an association between a nickel and cobalt allergy was found. Hypothyroidism occurred significantly more frequently (p = 0.049) in SG than in CG. Sensitizations and allergies can occur to metals in dental alloys. Hypothyroidism increased the risk of having an allergy threefold.

Research on allergic rhinitis improvement in asthmatic children after dust mite exposure reduction: a randomized, double-blind, cross-placebo study protocol

Background

Allergic rhinitis (AR) in children is a major respiratory inflammatory disease with a high incidence that is increasing yearly. In China, 54.93% of children with asthma have AR, which often requires synchronous treatment. House dust mites (HDMs) are common allergens that often cause attacks of AR and asthma. Reducing allergen exposure is one of the most important measures to control and treat AR and asthma attacks. Hestelia Mite Bait, containing 0.1% emamectin, is a new tool for trapping and killing dust mites, reducing the number of dust mites on mattresses and thereby potentially reducing stimulation by allergens and ultimately improving asthma and rhinitis symptoms. This single-centre, randomized, double-blind, cross-placebo trial will explore the improvement in AR in asthmatic children after dust mite exposure reduction.

Methods

We will recruit 60 children (aged 3–12 years) who have been diagnosed with AR and asthma and are allergic to dust mites as confirmed by a serum allergen test. Participants will randomly receive the Hestelia Mite Bait intervention for 8 weeks and the placebo intervention for 8 weeks. There will be a 4-week washout period between the two interventions. The primary outcome is the visual analogue scale (VAS) score of AR symptoms; the secondary outcomes include the Rhinitis Control Assessment Test (RCAT) score, Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score, changes in the dust mite level, drug usage for asthma and AR, Asthma Control Questionnaire-5 (ACQ-5) score, and frequencies of acute asthma attacks, emergency visits, and hospitalizations.

Discussion

This study aims to scientifically and objectively evaluate the effects of mite bait on rhinitis and asthma improvement after dust mite exposure reduction and provides a convenient means for future prevention and treatment of allergic diseases involving the airways in children.

Trial registration

www.chictr.org.cn ChiCTR1900024688. Registered on July 21, 2019

Cluster Analysis of Inhalant Allergens in South Korea: A Computational Model of Allergic Sensitization

Objectives.

Sensitization to specific inhalant allergens is a major risk factor for the development of atopic diseases, which impose a major socioeconomic burden and significantly diminish quality of life. However, patterns of inhalant allergic sensitization have yet to be precisely described. Therefore, to enhance the understanding of aeroallergens, we performed a cluster analysis of inhalant allergic sensitization using a computational model.

Methods.

Skin prick data were collected from 7,504 individuals. A positive skin prick response was defined as an allergen-to-histamine wheal ratio ≥1. To identify the clustering of inhalant allergic sensitization, we performed computational analysis using the four-parameter unified-Richards model.

Results.

Hierarchical cluster analysis grouped inhalant allergens into three clusters based on the Davies-Bouldin index (0.528): cluster 1 (Dermatophagoides pteronyssinus and Dermatophagoides farinae), cluster 2 (mugwort, cockroach, oak, birch, cat, and dog), and cluster 3 (Alternaria tenus, ragweed, Candida albicans, Kentucky grass, and meadow grass). Computational modeling revealed that each allergen cluster had a different trajectory over the lifespan. Cluster 1 showed a high level (>50%) of sensitization at an early age (before 19 years), followed by a sharp decrease in sensitization. Cluster 2 showed a moderate level (10%–20%) of sensitization before 29 years of age, followed by a steady decrease in sensitization. However, cluster 3 revealed a low level (<10%) of sensitization at all ages.

Conclusion.

Computational modeling suggests that allergic sensitization consists of three clusters with distinct patterns at different ages. The results of this study will be helpful to allergists in managing patients with atopic diseases.

Important Role of Immunological Responses to Environmental Exposure in the Development of Allergic Asthma

Allergic asthma is a public health problem that affects human health and socioeconomic development. Studies have found that the prevalence of asthma has significantly increased in recent years, which has become particularly pronounced in developed countries. With rapid urbanization in China in the last 3 decades, the prevalence of asthma has increased significantly in urban areas. As changes in genetic backgrounds of human populations are limited, environmental exposure may be a major factor that is responsible for the increased prevalence of asthma. This review focuses on environmental components of farms and rural areas that may have protective effects in reducing the development of asthma. Farm and rural related microorganism- and pathogen-associated molecular patterns are considered to be important environmental factors that modulate host's innate and adaptive immune system to induce protection effects later in life. Environmental microbial-related immunotherapy will also be discussed as the future research direction for the prevention of allergic asthma.

How does parental history of atopic disease predict the risk of atopic dermatitis in a child? A systematic review and meta-analysis

BACKGROUND

Parental history of atopic disease is a well-established risk factor for the development of atopic dermatitis (AD), but several aspects of this association remain unclear.

OBJECTIVE

We sought to determine the association of parental history of atopic disease with AD in offspring.

METHODS

We searched PubMed and EMBASE through June 2018 for relevant records and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled odds ratios (ORs) with 95% CI were calculated using random-effects models.

RESULTS

A total of 163 records covering 149 unique studies were included. Of these, 119 studies were included in the meta-analysis. Individuals with parental history of atopic disease had increased odds of AD (OR, 1.81; 95% CI, 1.65-1.99). Parental asthma (OR, 1.56; 95% CI, 1.18-2.05) and allergic rhinitis (OR, 1.68; 95% CI, 1.34-2.11) had a smaller effect than AD (OR, 3.30; 95% CI, 2.46-4.42). The effect of maternal and paternal history was comparable for all atopic diseases. An increase in odds was observed when comparing the effect of having 1 (OR, 1.30; 95% CI, 1.15-1.47) or 2 atopic parents (OR, 2.08; 95% CI, 1.83-2.36), as well as having a parent with 1 (OR, 1.49; 95% CI, 1.28-1.74) or more atopic diseases (OR, 2.32; 95% CI, 1.92-2.81).

CONCLUSIONS

This study provides evidence-based risk estimates that may guide physicians who counsel parents with a history of atopic disease about their children's risk of AD. This information is of particular importance for future efforts toward establishing prophylactic interventions for AD on a general population level.

Filaggrin mutations increase allergic airway disease in childhood and adolescence through interactions with eczema and aeroallergen sensitization

BACKGROUND

Filaggrin loss-of-function (FLG-LOF) mutations are an established genetic cause of eczema. These mutations have subsequently been reported to increase the risk of aeroallergen sensitization and allergic airway disease. However, it is unclear whether FLG variants require both eczema and aeroallergen sensitization to influence airway disease development long-term outcomes.

OBJECTIVE

To examine the effects of FLG-LOF mutations on allergic airway disease outcomes, with eczema and aeroallergen sensitization as intermediate variables, using the Isle of Wight birth cohort.

METHODS

Study participants were evaluated at ages 1, 2, 4, 10 and 18 years to ascertain the development of allergic diseases (eczema, asthma and allergic rhinitis) and aeroallergen sensitization (determined by skin prick tests). FLG-LOF mutations were genotyped in 1150 subjects. To understand the complex associations between FLG mutations, intermediate variables (eczema and aeroallergen sensitization) and airway disease, path analysis was performed.

RESULTS

There were significant total effects of FLG-LOF mutations on both asthma and allergic rhinitis at all ages as well as on aeroallergen sensitization up till 10 years old. In the filaggrin-asthma analysis, a direct effect of FLG-LOF mutations was observed on early childhood eczema (age 1 and 2 years) (relative risk (RR) 2.01, 95% CI: 1.74-2.31, P < .001), and all significant indirect pathways on asthma outcomes passed through eczema at these ages. In contrast, for the filaggrin-rhinitis model, FLG-LOF mutations exerted significant direct effects on early eczema as well as rhinitis at 10 years (RR 1.99; 95% CI: 1.72-2.29, P = .002).

CONCLUSION

FLG-LOF mutations are a significant risk factor for later childhood asthma and rhinitis. However, the pathway to asthma is only through early childhood eczema while a direct effect was observed for childhood rhinitis.

Dog and Cat Allergies: Current State of Diagnostic Approaches and Challenges

Allergies to dogs and cats affect 10%-20% of the population worldwide and is a growing public health concern as these rates increase. Given the prevalence of detectable dog and cat allergens even in households without pets, there is a critical need to accurately diagnose and treat patients to reduce morbidity and mortality from exposure. The ability to diagnose cat sensitization is good, in contrast to dogs. Component resolved diagnostics of sensitization to individual allergenic proteins will dramatically improve diagnosis. This review focuses on the current state of knowledge regarding allergies to dogs and cats, recent advances, therapies such as subcutaneous immunotherapy, and discusses important areas to improve diagnosis and therapy.

International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis

BACKGROUND

Critical examination of the quality and validity of available allergic rhinitis (AR) literature is necessary to improve understanding and to appropriately translate this knowledge to clinical care of the AR patient. To evaluate the existing AR literature, international multidisciplinary experts with an interest in AR have produced the International Consensus statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR).

METHODS

Using previously described methodology, specific topics were developed relating to AR. Each topic was assigned a literature review, evidence-based review (EBR), or evidence-based review with recommendations (EBRR) format as dictated by available evidence and purpose within the ICAR:AR document. Following iterative reviews of each topic, the ICAR:AR document was synthesized and reviewed by all authors for consensus.

RESULTS

The ICAR:AR document addresses over 100 individual topics related to AR, including diagnosis, pathophysiology, epidemiology, disease burden, risk factors for the development of AR, allergy testing modalities, treatment, and other conditions/comorbidities associated with AR.

CONCLUSION

This critical review of the AR literature has identified several strengths; providers can be confident that treatment decisions are supported by rigorous studies. However, there are also substantial gaps in the AR literature. These knowledge gaps should be viewed as opportunities for improvement, as often the things that we teach and the medicine that we practice are not based on the best quality evidence. This document aims to highlight the strengths and weaknesses of the AR literature to identify areas for future AR research and improved understanding.

Epidemiological trends of allergic diseases in adolescents

Objective:

To assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in adolescents in the city of Belo Horizonte, Brazil, in 2012 by administering the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, as well as to compare the observed prevalences with those found in studies performed 10 years earlier and employing the same methodology used here.

Methods:

This was a cross-sectional study conducted between May and December of 2012 and involving adolescents in the 13- to 14-year age bracket. Participants were randomly selected from among adolescents studying at public schools in Belo Horizonte and completed the ISAAC questionnaire. Proportions were calculated in order to assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in the sample as a whole, and the chi-square goodness-of-fit test was used in order to compare the prevalences observed in 2012 with those found in 2002.

Results:

The prevalences of symptoms of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in 2012 were 19.8%, 35.3%, and 16.3%, respectively, being significantly higher than those found in 2002 (asthma, p = 0.006; allergic rhinitis, p < 0.01; and allergic rhinoconjunctivitis, p = 0.002).

Conclusions:

The prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis among adolescents in 2012 were found to be high, having increased in comparison with those found 10 years earlier, despite efforts in prevention, diagnosis, and treatment.

Prevalence of and Risk Factors for Childhood Asthma, Rhinitis, and Eczema in Hong Kong: Proposal for a Cross-Sectional Survey

BACKGROUND

Previous studies have shown that particulate matter is a major problem in indoor air quality in Hong Kong schools, but little has been done to assess its relationship with health indicators in the children attending those schools. Our study aims to address this research gap by collecting aerosol data in schools to examine the link between different air pollutants with childhood respiratory health. It is important to explore whether or not the prevalence of asthma, allergic rhinoconjunctivitis, and eczema are increasing in local children.

OBJECTIVE

Our aim is to (1) examine the prevalence of asthma, allergic rhinitis, and eczema in school children aged 6-7 years in Hong Kong between 2001 and 2017, and (2) measure air quality at primary schools and explore its relationship with health outcomes measured by the International Study of Asthma and Allergies in Childhood (ISAAC) survey.

METHODS

This is a cross-sectional study consisting of an ISAAC questionnaire and aerosol data collection. We have recruited over 2000 parents of primary school students aged 6-7 years old for the questionnaire, and so far 19 schools have completed aerosol data collection.

RESULTS

The study is expected to be completed this year.

CONCLUSIONS

We predict that our study will show a significant change in the prevalence of asthma, allergic rhinitis, and eczema in school children aged 6-7 years old in recent years. In addition, we expect to show a significant association between air quality at school and health outcomes measured by the ISAAC survey.

The relationship between allergic status and adenotonsillar regrowth: a retrospective research on children after adenotonsillectomy

Adenotonsillar regrowth in children after adenotonsillectomy (T&A) for obstructive sleep apnea (OSA) is often seen in clinical treatment, however, the relationship between allergic disease and adenotonsillar regrowth remains unclear. In this retrospective study, children were assigned to either the recurrence or control group, and subdivided by age at operation. Among children over 36 months, those in the recurrence group had more allergic disease and higher IgE, IL-4, and IL-5 levels than the same-aged children in control group. The Paediatric Allergic Disease Quality of Life Questionnaire (PADQLQ) scores for nasal symptoms and activity were higher in children older than 36 months in recurrence group. The results of immunohistochemistry and immunofluorescence showed that FoxP3+ cells (Tregs) were less, while GATA3+ cells (Th2 cells) were more in recurrence group for all ages. Allergic status and low levels of FoxP3 were proved as independent risk factors for adenotonsillar regrowth by multivariate logistic regression. These results indicate that allergic disease is a risk factor for adenotonsillar regrowth in children following T&A for OSA, and this risk increases with age. The decreased level of Tregs and subsequent changes in immune function play an important role in the pathogenesis of adenotonsillar regrowth.

Cross-sectional study about impact of parental smoking on rhinitis symptoms in children

OBJECTIVE

Assess the prevalence of rhinitis and exposure to environmental tobacco smoke (ETS) of children in our community and its relationship with symptoms of rhinitis METHODS (DESIGN, SETTING, PARTICIPANTS, MAIN OUTCOME MEASURES): Cross-sectional study using questionnaire on rhinitis of the International Study of Asthma and Allergies in Childhood, in children (6-7 years) and adolescents (13-14 years). Categories: "rhinitis ever", "recent rhinitis", "recent rhinoconjunctivitis", "severe rhinoconjunctivitis". Parental smoking: (i) neither parent smokes; (ii) only the mother smokes; (iii) only the father smokes; and (iv) both parents smoke. Odds ratio of the prevalence of symptoms of rhinitis according to ETS exposure was calculated using logistic regression.

RESULTS

10 690 children and 10 730 adolescents. The prevalence of "rhinitis ever" in children: 29.4%, "recent rhinitis" 24%, "recent rhinoconjunctivitis" 11.5% and "severe rhinoconjunctivitis" 0.1%. In adolescents: 46.2%, 34.5%, 16.2% and 0.2%, respectively. Environmental tobacco smoke exposure in the home occurred in 51% of cases. Parental smoking was associated with a higher prevalence of forms of rhinitis in adolescents when only the mother was a smoker. In children when both parents were smokers.

CONCLUSION

Rhinitis is highly prevalent in our community. Environmental tobacco smoke exposure is still very common. The relationship between ETS and rhinitis symptoms in children of this community is not as robust as that found for asthma.

Is Gianotti-Crosti Syndrome Associated with Atopy? A Case-Control Study and a Postulation on the Intrinsic Host Factors in Gianotti-Crosti Syndrome

OBJECTIVES

To investigate whether Gianotti-Crosti syndrome (GCS) in children is associated with atopy.

METHODS

The setting was two outpatient clinic. Diagnoses of asthma and atopic dermatitis (AD) were made according to internationally accepted diagnostic criteria. Allergic rhinitis, atopic urticaria, and allergic conjunctivitis were diagnosed clinically. Participants were children with GCS diagnosed over the previous 5 years. For any child with GCS, we extracted the record of the subsequent age and sex pair-matched child seen for problems unrelated to the skin as controls.

RESULTS

We retrieved the records of 37 pairs of study and control subjects; 28 (76%) children with GCS and 9 (24%) controls had AD (risk ratio [RR] = 3.11[95% confidence interval {CI} 1.73, 5.73]), 31 (84%) children with GCS and 19 (51%) controls had at least one atopic condition (RR = 1.63 [95% CI 1.13, 2.18]) and 11 (30%) children with GCS and 2 (5%) controls had at least three atopic conditions (RR = 5.50 [95% CI 1.29, 35.35]).

CONCLUSION

GCS is significantly associated with AD and the presence of atopic conditions.

Prevalence of otitis media with effusion in children with allergic rhinitis, a cross sectional study

OBJECTIVES

Otitis media with effusion (OME) may be caused by various factors including Eustachian tube dysfunction, inflammatory response as well as atopy. Allergic rhinitis (AR), a common chronic disorder in children, is associated with swelling of the mucosa and can therefore result in Eustachian tube dysfunction. This study aims to compare the prevalence of OME in subjects with and without AR.

METHOD

Children aged 4-12 were recruited from the clinics at Kwong Wah Hospital, Hong Kong. Subjects recruited were interviewed and a questionnaire filled in regarding nasal obstruction, rhinorrhea, sneezing, itching of the nose and/or post nasal discharge (ARIR document). The children were then examined by a doctor using a pneumatic otoscopy and a portable tympanometer. Children found to have OME were offered a follow-up visit 3 months later.

RESULTS

12 out of 159 (7.5%) of the AR group were found to have OME compared with 3 out of 185 (1.6%) in the non-AR group, p=0.016. During the 2nd visit at 3 months, 85.7% of the AR subjects showed resolution of their OME.

CONCLUSIONS

Our data showed a significant difference in the prevalence of OME between AR and non-AR subjects. Of the 185 non AR subjects (Control group), 3 was found to have OME, suggesting a point prevalence of OME of 1.6% in the community in Hong Kong. OME is more likely to occur in children with allergic rhinitis and it may be wiser to manage OME in these individuals differently.

Relationship Between Allergic Rhinitis and Mental Health in the General Korean Adult Population

PURPOSE

This study was conducted to evaluate the association between AR and mental health status in the general Korean adult population and to investigate the relative burden of AR on mental health using the Allergic Rhinitis and Its Impact on Asthma (ARIA) classification.

METHODS

A cross-sectional study was performed by using data from 11,154 individuals, 19 years old or older in the Korean National Health and Nutrition Examination Survey 2011-2012. Univariate analysis was conducted in the healthy AR groups with weighted prevalence of demographic characteristics, socioeconomic status, and comorbid diseases. Subanalysis that classified AR severity according to the ARIA classification was carried out to evaluate the relationship of AR severity with mental health. The odds ratios (ORs) for each component representing mental health status were estimated by multiple logistic regression analysis with confounder adjustment.

RESULTS

Univariate analysis with the chi-square test after adjustment for age, sex, body mass index, smoking status, alcohol use status, and exercise status, components representing mental health status showed a linear relationship with the severity of AR according to the ARIA classification. Stress, depressive mood, suicidal thoughts, and psychological consultation factors were correlated with AR after adjustment for demographic characteristics and socioeconomic status. Even after adjustment for comorbid allergic diseases, the correlation remained significant with stress, depressive mood, and psychological consultation factors (OR [95% CI]; 1.227 [1.042, 1.445], 1.368 [1.095, 1.71], 1.804 [1.096, 2.969], respectively).

CONCLUSIONS

Patients with AR appear to be at higher risk of mental disorders in the general Korean adult population. Moreover, persistent or severe AR was correlated with poor mental health. Therefore, better control of AR may be conducive to better mental health, and more attention should be paid to the psychological status of AR patients.

Environmental Exposure and Genetic Predisposition as Risk Factors for Asthma in China

Asthma is the most common chronic pulmonary disease worldwide and places a considerable economic burden on society. China is the world's largest developing country and has the largest population. China has undergone dramatic changes in the past few decades. The traditional lifestyle and living environment have changed in ways that directly affect the prevalence of asthma. The prevalence of asthma is lower in Chinese children and adults than in developed countries, but the prevalence has been on the rise during the past 30 years. The prevalence significantly varies among different parts of China. Polymorphisms of multiple genes, outdoor air pollution caused by PM2.5, PM10, SO₂, NO₂, environmental tobacco smoke, and coal, indoor pollution, and inhaled allergens, such as house dust mites, pollen, and cockroach particles, are risk factors for asthma.

Effect modification by gender and smoking status on the association between obesity and atopic sensitization in Chinese adults: a hospital-based case-control study

BACKGROUND

There is an ongoing debate on the potential association between obesity and atopy. However, no previous studies have investigated whether this relationship depends on sex and smoking status in Chinese adults.

METHODS

In this hospital-based, case-control study, we recruited 1150 atopic cases aged 18 years or older and 1245 healthy control participants during April 2009 and December 2012 in Harbin, China. We conducted structured questionnaire interviews, anthropometry measurements and serum allergen-specific immunoglobulin E (IgE) testing. Univariate and multivariate logistic regression models were used to explore the relationship between obesity and atopy risk stratified by sex and smoking status.

RESULTS

There was an association between obesity and an increased risk of atopic sensitization after adjusting for age, educational, family history, smoking and alcohol consumption (OR: 2.61, 3.25; 95% CI: 1.57-4.33,1.91-5.56 in males and females, respectively). The association between BMI and allergic sensitization depended on smoking status. In both genders, the association of obesity with atopic sensitization risk was stronger in non-smokers than in current smokers. In males, ORs of atopic sensitization for obesity were 3.15 (95% CI, 1.46-6.68) for non-smokers and 2.22 (95% CI, 1.10-4.48) for current smokers. The corresponding ORs in females were 3.51 (95% CI, 1.98-6.24) and 2.22 (95% CI, 0.46-10.68) for non-smokers and current smokers, respectively. After excluding those subjects who with pre-existing allergic conditions, the same relationship still remained.

CONCLUSIONS

Obesity is positively and significantly associated with the risk of atopy in both men and women as well in both smokers and non-smokers in China. In addition, the relationship between obesity and atopic sensitization is stronger in non-smokers than in current smokers.

Significant rise of the prevalence and clinical features of childhood asthma in Qingdao China: cluster sampling investigation of 10,082 children

Background

Recent investigations suggested that the trend of childhood asthma has been stabilizing or even reversing in some countries. The observation provides contrast to our experience. Thus, the study aimed to investigate the prevalence and clinical features of asthma in children aged 0–14 years in Qingdao China, determine the changes of childhood asthma in China, and discover evidence that can allow better diagnosis and treatment of childhood asthma.

Methods

A cluster sampling method was used. We randomly extracted the investigation clusters from schools, kindergartens, and communities in Qingdao. Subsequently, we interviewed the members of the clusters using a questionnaire from the International Study of Asthma and Allergies in Childhood (ISAAC) to find children with asthmatic symptoms. After determination by the doctors, more details on the asthmatic children were obtained by asking questions from the National Epidemiology Study of Asthma and Allergies in China questionnaire to obtain more details. We intended to survey 10,800 children. However, the actual number of children was 10,082.

Results

The prevalence of asthma in Qingdao children aged 0–14 years was 3.69%. The prevalence among male children was higher than in female (χ2 = 24.53,P < 0.01). Among the asthmatic children, 68.0% had their first attack when they were less than three years old. Moreover, 71.2% once suffered respiratory tract infections. For 95.7% of asthmatic children, the asthma attack was first manifested as cough. Asthmatic children who used inhaled corticosteroids (ICS) only accounted for 46%.

Conclusions

The prevalence of asthma in children aged 0–14 years in Qingdao China increased significantly based on data obtained ten years ago (2000). Respiratory tract infections were the most important precursors of asthma attack. The attack was most commonly manifested as cough. The treatment, especially the use of ICS, was more rational. However, a certain difference was found, which has yet to be contrasted with the Global Initiative for Asthma (GINA) project.

Changes in allergen sensitization over the last 30 years in Korea respiratory allergic patients: a single-center

PURPOSE

Determining the culprit allergen is important for the diagnosis and management of allergic diseases. The skin prick test (SPT) has been widely used to identify culprit allergens. Skin reactivity to allergens has changed due to changes in lifestyle and outdoor environments. Therefore, the aim of the present paper was to examine changes in allergen sensitization in Korea.

METHODS

We enrolled 1,135 patients with respiratory allergic diseases who were diagnosed at Severance Hospital from January 2010 to December 2011. SPTs were performed with inhalant allergens, and were compared to our previous studies of the SPTs in the 1980s and the 1990s.

RESULTS

In the 2010s, the SPT positive rate of allergic rhinitis or allergic conjunctivitis was higher than asthma without allergic rhinitis or allergic conjunctivitis. The SPT positive rate was decreased by increments of age (P value <0.01). Skin reactivity to tree pollens was significantly increased to 36.4% in the 2010s from 19.0% in the 1990s and 8.8% in the 1980s. Among tree pollens, skin reactivity to oak (4.7%->14.4%), birch (7.1%->13.6%), alder (6.3%->13.4%) and pine (2.9%->14.3%) was significantly increased in the 2010s compared with the 1990s, respectively. Current skin reactivity to grass pollens (13.9%) and weed pollens (27.0%) has significantly decreased since the 1990s (20.3%, 40.9%, respectively). Skin reactivity to house dust mites showed no difference between the 1990s (55.2%) and the 2010s (55.6%). Skin reactivity to dog (27.3%->20.7%) and cockroach (25.3%->12.3%) have significantly decreased in the 2010s in comparison with the 1990s.

CONCLUSIONS

In light of the above results, we revealed the changes in skin reactivity to inhalant allergens that have occurred in Korean allergic patients over the past three decades. Since outdoor environmental factors such as the amount of pollen, global warming and plant distribution causes the changes in skin reactivity, further study and continuous close observation will be needed.

The prevalence of asthma diagnosis and symptoms is still increasing in early adolescents in Turkey

BACKGROUND

This study was performed to evaluate the time trends in prevalence of asthma and related factors in Denizli, Turkey.

METHODS

Two cross-sectional surveys were performed, 6 years apart (2002 and 2008) using the ISAAC protocol, in the 13-14 age groups and comparisons were made between the results.

RESULTS

Lifetime prevalence of wheeze, 12 month prevalence of wheeze, and the prevalence of wheeze after exercise in the previous 12 months were significantly increased respectively from 10.2% to 13.4% (POR = 1.37, 95%CI = 1.18-1.58, p < 0.001), from 5.0% to 6.2% (POR = 1.26, 95%CI = 1.02-1.55, p = 0.016) and from 9% to 10.2% (POR = 1.15, 95%CI = 0.98-1.35, p = 0.046) in 2008 study. Doctor diagnosed asthma prevalence also increased significantly from 2.1% to 12.9 (POR = 6.80, 95%CI = 5.22-8.85, p < 0.001). Prevalence of sleep disturbed by wheeze in the last 12 months; but, never woken with wheezing (POR = 1.62, 95%CI = 1.26-2.09, p = < 0.001) and less than one night per week (POR = 1.58, 95%CI = 1.06-2.36, p = 0.013) were significantly increased in 2008 study. Severe attacks of wheeze limiting speech in the last year was increased from 1.3% to 2.2% (POR = 1.67, 95%CI = 1.14-2.43, p = 0.004). The number of wheeze attacks in the previous 12 months was increased significantly for 4-to-12 attacks (POR = 1.54, 95%CI = 1.03-2.32, p = 0.02) in 2008 study. However, prevalence of waking with cough in the last 12 months did not change. While history of family atopy and domestic animal at home were found as significant risk factors for asthma in 2002 study, male gender, history of family atopy and stuffed toys were found significant in 2008.

CONCLUSIONS

The prevalence of asthma symptoms were increased in Denizli. History of family atopy, male gender and stuffed toys were important risk factors for asthma in 2008.

Active or passive exposure to tobacco smoking and allergic rhinitis, allergic dermatitis, and food allergy in adults and children: a systematic review and meta-analysis

BACKGROUND

Allergic rhinitis, allergic dermatitis, and food allergy are extremely common diseases, especially among children, and are frequently associated to each other and to asthma. Smoking is a potential risk factor for these conditions, but so far, results from individual studies have been conflicting. The objective of this study was to examine the evidence for an association between active smoking (AS) or passive exposure to secondhand smoke and allergic conditions.

METHODS AND FINDINGS

We retrieved studies published in any language up to June 30th, 2013 by systematically searching Medline, Embase, the five regional bibliographic databases of the World Health Organization, and ISI-Proceedings databases, by manually examining the references of the original articles and reviews retrieved, and by establishing personal contact with clinical researchers. We included cohort, case-control, and cross-sectional studies reporting odds ratio (OR) or relative risk (RR) estimates and confidence intervals of smoking and allergic conditions, first among the general population and then among children. We retrieved 97 studies on allergic rhinitis, 91 on allergic dermatitis, and eight on food allergy published in 139 different articles. When all studies were analyzed together (showing random effects model results and pooled ORs expressed as RR), allergic rhinitis was not associated with active smoking (pooled RR, 1.02 [95% CI 0.92-1.15]), but was associated with passive smoking (pooled RR 1.10 [95% CI 1.06-1.15]). Allergic dermatitis was associated with both active (pooled RR, 1.21 [95% CI 1.14-1.29]) and passive smoking (pooled RR, 1.07 [95% CI 1.03-1.12]). In children and adolescent, allergic rhinitis was associated with active (pooled RR, 1.40 (95% CI 1.24-1.59) and passive smoking (pooled RR, 1.09 [95% CI 1.04-1.14]). Allergic dermatitis was associated with active (pooled RR, 1.36 [95% CI 1.17-1.46]) and passive smoking (pooled RR, 1.06 [95% CI 1.01-1.11]). Food allergy was associated with SHS (1.43 [1.12-1.83]) when cohort studies only were examined, but not when all studies were combined. The findings are limited by the potential for confounding and bias given that most of the individual studies used a cross-sectional design. Furthermore, the studies showed a high degree of heterogeneity and the exposure and outcome measures were assessed by self-report, which may increase the potential for misclassification.

CONCLUSIONS

We observed very modest associations between smoking and some allergic diseases among adults. Among children and adolescents, both active and passive exposure to SHS were associated with a modest increased risk for allergic diseases, and passive smoking was associated with an increased risk for food allergy. Additional studies with detailed measurement of exposure and better case definition are needed to further explore the role of smoking in allergic diseases.

The natural course of allergic rhinitis: a 32-year follow-up study

CONCLUSION

Early intervention may change the natural course of allergic rhinitis, preventing the progression to asthma. In particular, immunotherapy guarantees remission of local symptoms and valid protection against local and bronchial complications. Symptomatic treatment represents a valid alternative; it is always to be preferred to abstention from any treatment.

OBJECTIVES

Data emerging from various studies on the increase of the prevalence of allergic rhinitis in recent decades appear to be widely dishomogeneous. Another point that needs clarification is the relationship between allergic rhinitis and lower airways pathologies such as asthma or bronchitis.

METHODS

We followed the evolution of allergic rhinitis in a group of patients for the last 30 years to highlight the efficacy of different treatments in the prevention of complications, specifically asthma. After 32 years (1980-2012), 46/73 (63%) patients completed the follow-up.

RESULTS

Symptomatic drugs exhibited maximum efficacy from the third to the eighth year, with 13 of 15 patients reporting an improvement of symptoms; immunotherapy achieved the best efficacy starting from the sixth to the tenth year (8 of 10 patients recovered). Subsequently, improvements decreased in the two groups, to a steady level of 11 of 15 and 6 of 10 recovered patients. Asthma developed in 3 of 46 patients and only among patients that were not treated.

Allergic rhinitis in adolescence increases the risk of depression in later life: a nationwide population-based prospective cohort study

BACKGROUND

Many cross-sectional studies have suggested an association between allergic rhinitis (AR) and depression, but the timing relationship was not determined. Using a nationwide population-based prospective cohort study (1:4, age-/gender-matched), we hypothesized that AR in adolescence would increase the risk of depression in later life.

METHODS

In all, 1673 adolescents aged 12-15 that had AR between 1996 and 2000 were recruited for our study. Cases of major depressive disorder and any depressive disorder that occurred to the end of follow-up (December 31, 2010) were identified.

RESULT

Adolescents with AR had a higher prevalence of major depression (2.5% vs. 1.2%, p<0.001) and any depressive disorder (4.9% vs. 2.8%, p<0.001) and an earlier onset of major depression (19.31 ± 2.91 vs. 20.43 ± 2.71 years, p=0.038) and any depressive disorder (19.35 ± 2.63 vs. 20.43 ± 2.62 years, p=0.002) compared with the controls. The Cox regression model showed that adolescents with AR had increased HRs of major depression (HR: 1.59, 95% CI: 1.02-2.50) and any depressive disorder (HR: 1.42, 95% CI: 1.04-1.93) after controlling residence location and comorbid allergic diseases.

LIMITATIONS

The prevalence of depressive disorder may be underestimated because only those who had medicine-seeking behaviors were enrolled.

CONCLUSIONS

This first cohort case-control study showed an association between AR in early adolescence and depression in late adolescence and early adulthood. Our results suggested that allergic responses played important roles in the development of depression.

Role of skin prick test in allergic disorders: a prospective study in kashmiri population in light of review

Background:

Skin prick test (SPT) is the most effective diagnostic test to detect IgE mediated type I allergic reactions like allergic rhinitis, atopic asthma, acute urticaria, food allergy etc. SPTs are done to know allergic sensitivity and applied for devising immunotherapy as the therapeutic modality.

Materials and Methods:

This prospective study was conducted in the department of Immunology and Molecular medicine at SKIMS. A total of 400 patients suffering from allergic rhinitis, asthma and urticaria were recruited in this study. SPT was performed with panel of allergens including house dust mite, pollens, fungi, dusts, cockroach, sheep wool and dog epithelia. Allergen immunotherapy was given to allergic rhinitis and asthmatic patients as therapeutic modality.

Results:

In our study, age of patients ranged from 6 to 65 years. Majority of patients were in the age group of 20-30 years (72%) with Male to female ratio of 1:1.5. Of the 400 patients, 248 (62%) had urticaria, 108 (27%) patients had allergic rhinitis and 44 (11%) patients had asthma. SPT reaction was positive in 38 (86.4%) with allergic asthma, 74 (68.5%) patients with allergic rhinitis and 4 (1.6%) patient with urticaria, respectively. Allergen immunotherapy was effective in 58% patients with allergic rhinitis and 42% allergic asthma.

Conclusion:

Identifiable aeroallergen could be detected in 86.4% allergic asthma and 68.5% allergic rhinitis patients by SPT alone. Pollens were the most prevalent causative allergen. There was significant relief in the severity of symptoms, medication intake with the help of allergen immunotherapy.

Chronic health problems and health-related quality of life in Chinese children and adolescents: a population-based study in Hong Kong

OBJECTIVE

We examined the association of different chronic physical and mental conditions, individually or comorbidly on health-related quality of life (QoL) in Chinese children aged ≤14 years in Hong Kong.

DESIGN

Population-based cross-sectional survey.

PARTICIPANTS

Approximately 7500 Chinese children aged <14 years in Hong Kong.

INTERVENTIONS

Nil.

PRIMARY AND SECONDARY OUTCOME MEASURES

Various health concepts of validated Chinese version of Child Health Questionnaire (CHQ), a health-related QoL questionnaire in children.

RESULT

There was significant association of physical and mental health conditions, either individually or comorbidly, on the various concepts of CHQ. Children with mental health problems were apparently more affected than those with physical health problems. Chronic renal disease and congenital malformation were the physical health conditions associated with the lowest scores in CHQ concepts in children aged 5-10 years and aged 10-14 years, respectively. Behavioural problem was the mental health condition associated with the lowest score in CHQ concepts in both age groups.

CONCLUSIONS

Our study shows important information concerning the prevalence of different health conditions and its association, either individually or comorbidly on the QoL in a representative sample of Chinese children in HK.

Interaction between IL13 genotype and environmental factors in the risk for allergic rhinitis in Korean children

BACKGROUND

The prevalence of allergic rhinitis (AR) is increasing worldwide. Allergic diseases develop in susceptible subjects when they are exposed to specific environmental factors.

OBJECTIVE

We analyzed changes in the prevalence of AR and identified genetic and environmental factors in early childhood that affect risk.

METHODS

We used the International Study of Asthma and Allergies in Childhood questionnaire to collect data on AR, allergies, and environmental exposures from 4554 elementary school students from 5 areas of Seoul, Korea, in 2008. We also obtained DNA from 1050 subjects from 1 area of Seoul for genotype analysis of IL13.

RESULTS

We identified genetic and environmental factors during infancy and early childhood that increased the risk for current AR (resulting in a diagnosis of AR and AR symptoms in the past 12 months) in elementary school-aged children. These included allergic disease in parents and antibiotic use in infants, allergic disease in parents and exposure of infants to mold, and allergic disease in parents and moving an infant to a newly built house. The risk of current AR also increased in subjects with GA or AA at nucleotide 2044 in IL13 who had been exposed to mold in the home during infancy (adjusted odds ratio, 3.27; 95% CI, 1.75-6.11) compared with subjects who had GG at this position and had not been exposed to mold (adjusted odds ratio, 3.27; 95% CI, 1.75-6.11).

CONCLUSION

The prevalence of AR is increasing in Korean children. Children with a family history of allergic disease and exposure to specific environmental risk factors during infancy are more likely to have AR. Children with GA or AA at IL13(+2044) are at increased risk for AR when exposed to mold in the home during the first year of life.

The prevalence of childhood asthma in China: a systematic review

BACKGROUND

It is well known that the prevalence of asthma has been reported to increase in many places around the world during the last decades. Therefore, the aim of this study was to identify and review studies of asthma prevalence among children in China and address time trends and regional variation in asthma.

METHODS

A systematic literature search was performed using PubMed and China National Knowledge Infrastructure (CNKI) databases. Selected articles had to describe an original study that showed the prevalence of asthma among children aged 0-14 years.

RESULTS

A total of 74 articles met the inclusion criteria. The lifetime prevalence of asthma varied between 1.1% in Lhasa (Tibet) and 11.0% in Hong Kong in studies following the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. The prevalence was 3% or lower in most articles following Chinese diagnostic criteria. One article reported the results from two national surveys and showed that the current average prevalence of asthma for the total study population had increased from 1990 to 2000 (0.9% to 1.5%). The lowest current prevalence was found in Lhasa (0.1% in 1990, 0.5% in 2000).

CONCLUSIONS

The prevalence of childhood asthma was generally low, both in studies following the ISAAC and Chinese diagnostic criteria. Assessment of time trends and regional variations in asthma prevalence was difficult due to insufficient data, variation in diagnostic criteria, difference in data collection methods, and uncertainty in prevalence measures. However, the findings from one large study of children from 27 different cities support an increase in current prevalence of childhood asthma from 1990 to 2000. The lowest current prevalence of childhood asthma was found in Tibet.

Foetal exposure to maternal passive smoking is associated with childhood asthma, allergic rhinitis, and eczema

Objective. We examined the hypothesis that foetal exposure to maternal passive smoking is associated with childhood asthma, allergic rhinitis, and eczema. Methods. The study was a population-based cross-sectional survey of Hong Kong Chinese children aged ≤14 years carried out in 2005 to 2006. Results. Foetal exposure to maternal passive smoking was significantly associated with wheeze ever (OR 2.05; 95% CI 1.58–2.67), current wheeze (OR 2.06; 95% CI 1.48–2.86), allergic rhinitis ever (OR 1.22; 95% CI 1.09–1.37), and eczema ever (OR 1.61; 95% CI 1.38–1.87). Foetal exposure to maternal active smoking was significantly associated with asthma ever (OR 2.10; 95% CI 1.14–3.84), wheeze ever (OR 2.46; 95% CI 1.27–4.78), and current wheeze (OR 2.74; 95% CI 1.24–6.01) but not with allergic rhinitis ever (OR 1.01; 95% CI 0.70–1.46) or eczema ever (OR 1.38; 95% CI 0.87–2.18). The dose response relationship between wheeze ever and current wheeze with increasing exposure, from no exposure to maternal passive smoking and then to maternal active smoking, further supports causality. Conclusion. There is significant association between foetal exposure to maternal passive smoking and maternal active smoking with childhood asthma and related atopic illnesses. Further studies are warranted to explore the potential causal relationship.

Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies

The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner.

Rhinoconjunctivitis prevalence and associated factors in school children aged 6-7 and 13-14 years old in Bogota, Colombia

OBJECTIVE

Allergic rhinitis is one of the most frequent chronic diseases among children. The objective of the study was to assess the prevalence of rhinoconjunctivitis and determine clinical, social and environmental associated factors, among school children aged 6-7 years and adolescents aged 13-14 years in Bogotá, Colombia.

METHODS

We used ISAAC (International Study of Asthma and Allergies in Childhood) phase III study methodology and questionnaire for design and data collection, and we did a secondary analysis of these data. The sample consisted of 3830 registers from adolescents between 13 and 14 years old and 3256 registers from children between 6 and 7 years.

RESULTS

The prevalence of rhinoconjunctivitis symptoms in the last year was 17.2% (95% CI, 15.9-18.5) in children vs. 24.9% (95% CI, 23.6-26.3) in adolescents. In both groups there was a female predominance in children (17.8% vs. 16.5%), and in the teenagers group (28.0% vs. 21.4%), though the differences were not statistically significant. The factors associated with rhinoconjunctivitis in the group of 6-7 years where: asthma [OR 3.9; (95% CI, 2.8-5.4)], atopic dermatitis [OR 2.3; (95% CI, 1.7-3.1)], use of acetaminophen in the last year [OR 2.6; (95% CI, 1.4-4.9)], use of antibiotics in the first year of live [OR 1.7; (95% CI, 1.3-2.3)], higher maternal education [OR 1.5; (95% CI, 1.0-2.3)] and cesarean delivery [OR 1.6; (95% CI, 1.2-2.1)]. Among the 13-14 year age-group, factors associated with rhinoconjunctivitis included: asthma [OR 2.6; (95% CI, 2.0-3.4)], atopic dermatitis [OR 1.8; (95% CI, 1.4-2.3)], use of acetaminophen in the last year [OR 1.8; (95% CI, 1.4-2.4)], consumption of fast-food three times or more per week [OR 1.5; (95% CI, 1.2-2.0), ever smoked [OR 1.4; (95% CI, 1.2-1.7)] and meat consumption was protective factor [OR 0.7; (95% CI, 0.5-0.9)].

CONCLUSION

In both studied groups, the estimated prevalence of rhinoconjunctivitis symptoms was relatively high. Future in-depth research is needed to assess the complex interactions between allergic rhinoconjunctivitis symptoms and social and environmental factors.

Association between maternal allergic rhinitis and asthma on the prevalence of atopic disease in offspring

BACKGROUND

Asthma is a common co-morbidity of allergic rhinitis (AR). The prevalence of these two allergic diseases has increased in China and has been shown to cluster in families independently. This study evaluated the association between maternal AR (presenting with or without asthma) and the allergic conditions in offspring.

METHODS

Women (n = 592) diagnosed with AR were recruited for this study; 379 patients presented with AR and 213 presented with both AR and asthma. Total serum IgE levels and nasal eosinophil counts were analyzed and correlated with disease presentation.

RESULTS

The prevalence of allergic conditions in offspring of mothers diagnosed with AR and asthma was significantly higher than the prevalence observed in children born to mothers presenting with AR only. Maternal total serum IgE and eosinophil counts were predictive of atopy in offspring. Children born to mothers presenting with persistent moderate-to-severe AR had the highest risk of developing atopic conditions (OR 6.26, 95% CI 3.26-12.02). Maternal age of 25-30 years at delivery was also associated with a higher risk for the allergic disease in offspring compared to maternal age of 36-40 (OR 2.13, 95% CI 1.31-3.47).

CONCLUSIONS

The severity of maternal AR, asthma co-morbidity, elevated serum IgE levels and nasal eosinophilia were all associated with an increased risk of offspring developing allergic conditions. Children born to older mothers were protected against developing atopic disease.

Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America

BACKGROUND

There is comparatively little information in the public domain on the diversity in prevalence and triggers/factors associated with allergic rhinitis (AR) or allergic rhinoconjunctivitis (AR/C) in countries beyond western-Europe and North America.

OBJECTIVE

To review the prevalence and the sensitizing agents/triggers and factors associated with AR/C in several countries in Africa, the Asia-Pacific region, Australia, Eastern Europe, Latin America, Middle East and Turkey.

METHODS

Articles published in English in peer-reviewed journals were assessed and selected for further review, following an extensive literature search using the Medline database.

RESULTS

This review demonstrated that prevalence of AR and AR/C in these regions has predominantly been investigated in children; with studies indicating wide inter- and intra-regional variations ranging from 2.9% AR and 3.8% AR/C in 10-18-years-old children from one region in Turkey to 54.1% AR and 39.2% AR/C in 13-14-years-old children in one region in Nigeria. Moreover, the prevalence of AR and AR/C has increased markedly over the last decade particularly in some of the more affluent African countries, China-Taiwan and several Middle East countries, likely as a consequence of improved living standards leading to increased exposure to multiple traditional and non-traditional sensitizing agents and risk factors similar to those noted in western-Europe and North America.

CONCLUSIONS AND CLINICAL RELEVANCE

Our findings suggest that the greater diversity in prevalence of AR or AR/C in populations in these regions is in contrast to the lower diversity of AR or AR/C in the 'western populations (USA and Europe), which tend to be more uniform. This review provides a comprehensive database of the important allergens and triggers which are likely to influence the prevalence of allergic rhinitis in these diverse regions, where the prevalence of allergic rhinitis is increasing and its adverse impact on the quality of life of affected individuals is increasingly recognised.