Trends in the prevalence of asthma symptoms and allergic diseases in Israeli adolescents: results from a national survey 2003 and comparison with 1997

Maternal Exposure to Polychlorinated Biphenyls and Asthma, Allergic Rhinitis and Atopic Dermatitis in the Offspring: The Environmental Health Fund Birth Cohort

Background: Polychlorinated biphenyls (PCBs) are persistent organic pollutants banned for use worldwide. Due to their biodegradation resistance, they accumulate along the food chain and in the environment. Maternal exposure to PCBs may affect the fetus and the infant. PCBs are immunotoxic and may damage the developing immune system. PCBs are associated with elevated IgE antibodies in cord blood and are considered to be predictive of atopic reactions. Several studies on the association between prenatal exposure to PCBs and atopic reactions were previously published, albeit with conflicting results. Objectives: To examine the association between maternal PCBs levels and atopic reactions in their offspring. Methods: During the years 2013-2015, a prospective birth cohort was recruited at the delivery rooms of Shamir Medical Center (Assaf Harofeh) and "Dana Dwek" Children's Hospital. Four PCBs congeners were investigated: PCBs 118, 138, 153, and 180. In 2019, when children reached the age of 4-6 years, mothers were interviewed using the ISAAC questionnaire to assess symptoms of atopic reactions, including asthma, allergic rhinitis, and atopic dermatitis. Results: One hundred and fifty mother-child dyads were analyzed. No significant differences were found in the median serum PCBs concentrations of each studied congener or total PCBs for asthma, allergic rhinitis, atopic dermatitis diagnosis, or parent-reported symptoms. No association was found between exposure to total PCBs and the risk for asthma symptoms or diagnosis, adjusted to maternal age and family member with atopic condition: aOR = 0.94, 95%CI: (0.88; 0.99). No association was observed between each studied PCB congener and asthma symptoms or diagnosis. The same results were found also for other studied outcomes-allergic rhinitis and atopic dermatitis. Conclusion: Our study joins a series of previous studies that attempt to shed light on environmental exposures in utero as influencing factors for atopic conditions in children. Our results reflect the complexity of the pathophysiology of these phenomena. No relationship between maternal serum PCBs levels was demonstrated for asthma, allergic rhinitis, or atopic dermatitis. However, additional multi-participant studies, with longer, spanning into later pediatric age follow up are needed.

Childhood Asthma - The Effect of Asthma Specialist Intervention on Asthma Control: A Retrospective Review

Background

Childhood asthma is the most common chronic disease throughout the western world. Improving asthma control is a leading health management goal.

Purpose

To evaluate the effect of an intervention by a visit to an asthma specialist on asthma control in children.

Materials and Methods

This retrospective study was conducted using the electronic database of Maccabi Health Services. All members ages 5-16 with an asthma diagnosis during 2000-2016, and at least one visit to a specialist were included. Asthma outcomes during the 2 years before and after the visit to the asthma specialist were compared.

Results

A total of 37,066 children were diagnosed with asthma. Among them, 13,533 (36.5%) had at least one visit to an asthma specialist and were included. Children with asthma visited their primary care physician more often in the period before the specialist visit (4.4± 4.4 vs 3.16± 3.9 visits, respectively; p<0.01). After visiting a specialist, average number of visits to emergency departments (0.52± 1.3 vs 0.45±1), all cause hospitalizations (0.13±0.45 vs 0.08±0.4) and hospitalizations due to asthma exacerbations (0.08±0.345 vs 0.05±0.3) decreased (p<0.01 for all comparisons). Prescription of short-acting beta agonists decreased (2.85±3.6 vs 2.2 ±3.7, p<0.01) and inhaled steroid prescriptions increased (1.9±2.9 vs 2.7±3.7, p<0.01), respectively, after the intervention. A substantial reduction in the prescription of corticosteroids (0.81±1.9 vs 0.43±1.4, p<0.01) after specialist visit was also noted.

Conclusion

We found significant positive outcomes after a single consultation with an asthma specialist. Referring pediatric asthma patients to an asthma specialist should be one of the goals of an asthma management plan.

Pneumococcal Conjugated Vaccines Decreased Acute Otitis Media Burden: A Population-Based Study in Israel

OBJECTIVE

To study time trends in all-cause acute otitis media (AOM) burden by calculating incidence rates of AOM episodes and recurrent acute otitis media (rAOM) cases in highly immunized pediatric population during the pre- and post-pneumococcal conjugated vaccine (PCV) years.

STUDY DESIGN

In this population-based study, AOM episodes and rAOM cases were identified in Clalit Health Services-insured Israeli children aged 0-10 years between 2005 and 2018 by using a data-sharing platform. Because a near-sequential implementation of PCV-7/PCV-13 occurred within a 1-year period (2009/2010), we compared AOM visits before (2005-July 2009) and after (August 2009-2018) the introduction of PCVs. We focused on children younger than 2 years of age, who are the target population of PCVs and are at AOM peak age.

RESULTS

We identified 805 389 AOM episodes contributed by 270 137 children. The median number of AOM episodes was 2 (IQR 1-4). A downward trend of incidence rates of AOM episodes was observed during the post-PCV years in children younger than age 9 years (P < .001). The largest decrease (21%) was observed in children younger than 1 year, from 807/1000 children during the pre-PCV years to 640/1000 during the post-PCV years (P < .001). An average annual decrease of ∼14/1000 AOM episodes was calculated in children younger than 1 year old (β = -13.39, 95% CI -16.25 to -10.53, P < .001). Of rAOM cases, documented in 84 237 (31.2%) children, 74% were in children younger than 2 years, and 55% were in boys. The risk to develop rAOM significantly decreased during the post-PCV years in children younger than 2 years (hazard ratio 0.893, 95% CI 0.878-0.908; P < .001).

CONCLUSIONS

AOM burden significantly decreased following PCVs introduction in highly immunized children.

Chronic urticaria in children - New insights from a large cohort

BACKGROUND

Chronic spontaneous urticaria is well-described in adults, but less so in children. The aim of this study is to describe the demographics, clinical characteristics, comorbidities, and outcomes of children with chronic, spontaneous urticaria.

METHODS

This retrospective study followed children up to 18 years old, diagnosed with chronic spontaneous urticaria, between the years 2002-2018, and treated in a tertiary referral allergy and clinical immunology center. Data including demographics, clinical characteristics, comorbidities, treatments, and outcomes were extracted from electronic medical records.

RESULTS

Records of 380 children coded to have chronic urticaria were reviewed, of which 250 (65.8%) fulfilled the diagnostic criteria for chronic spontaneous urticaria. There were 136 females (54.4%). Mean age at diagnosis was 11.4 years, and 122 (48%) were adolescents. The average duration of chronic spontaneous urticaria was 12.25 ± 15.2 months. The urticaria in 208 children )83.2%) resolved within 24 months. Eighty-seven patients (34.8%) had at least one atopic disease. Atopic comorbidities included atopic dermatitis in 17.2%, allergic rhinitis in 16%, asthma in 13.2%, and food allergy in 3.2%. Eighteen patients (7.2%) had a concomitant autoimmune disease. Nine (3.6%) had thyroid disease.

CONCLUSIONS AND CLINICAL RELEVANCE

Chronic spontaneous urticaria in children is a self-limited disease with favorable prognosis. Atopic diseases are more prevalent in children with chronic spontaneous urticaria than in the general pediatric population, increasing the possibility of a special subgroup of TH2-related chronic urticaria in children.

A practical algorithm for topical treatment of atopic dermatitis in the Middle East emphasizing the importance of sensitive skin areas

Background There is a need for safe, effective treatment for atopic dermatitis (AD) in the Middle East. Objective To propose a practical algorithm for the treatment of AD throughout the Middle East. Methods An international panel of six experts from the Middle East and one from Europe developed the algorithm. The practical treatment guide was based on a review of published guidelines on AD, an evaluation of relevant literature published up to August 2016 and local treatment practices. Results Patients with an acute mild-to-moderate disease flare on sensitive body areas should apply the topical calcineurin inhibitor (TCI), pimecrolimus 1% cream twice daily until clearance. For other body locations, a TCI, either pimecrolimus 1% cream, tacrolimus 0.03% ointment in children or 0.1% ointment in adults, should be applied twice daily until clearance. Emollients should be used as needed. Patients experiencing acute severe disease flares should apply a topical corticosteroid (TCS) according to their label for a few days to reduce inflammation. After clinical improvement, pimecrolimus for sensitive skin areas or TCIs for other body locations should be used until there is a complete resolution of lesions. Conclusions These recommendations are expected to optimize AD management in patients across the Middle East.

Asthma severity and heterogeneity: Insights from prevalence trends and associated demographic variables and anthropometric indices among Israeli adolescents

OBJECTIVES

While asthma presents various clinical forms with different levels of severity, it is unclear whether asthma severities are a consequence of disease management or varied etiologies. We sought to investigate this question.

METHODS

This paper presents a cross-sectional study of 113,671 Israeli adolescents. Prevalence rates of mild and moderate-to-severe asthma over a 24-year period were calculated and multivariate regression models (outcomes: different asthma severity, reference: subjects without asthma) were performed to analyze associations with anthropometric indices and socio-demographic variables, in males and females separately.

RESULTS

The prevalence of mild asthma increased until birth years 1976-1980 and then steadily decreased. In contrast, the prevalence of moderate-to-severe asthma was relatively stable until birth years 1976-1980, then rose steeply until 1986-1990 and subsequently plateaued in the early 1990s. Obesity was positively associated with both mild and moderate-to-severe asthma in males (Odds Ratio (OR) [95%CIs]: 1.61 [1.37-1.89] and 1.63 [1.34-1.98], respectively) and females (1.54 [1.10-2.16] and 1.54 [1.20-1.98], respectively). Family size greater than three siblings was negatively associated with both mild and moderate-to-severe asthma in males (0.62 [0.56-0.68] and 0.59 [0.52-0.68]) and females (0.71 [0.60-0.83] and 0.73 [0.63-0.83]). In contrast, in males, underweight was only associated with mild asthma (1.54 [1.22-1.94]) but not with moderate-to-severe asthma. In females, overweight was only associated with moderate-to-severe asthma (1.21 [1.00-1.46]) and rural residence was only associated with mild asthma (1.26 [1.09-1.47]).

CONCLUSIONS

The differences between mild and moderate-to-severe asthma enhance asthma phenotype characterization, with respect to secular trends and associated variables, and indicate varied etiologies.

From Population Databases to Research and Informed Health Decisions and Policy

Background

In the era of big data, the medical community is inspired to maximize the utilization and processing of the rapidly expanding medical datasets for clinical-related and policy-driven research. This requires a medical database that can be aggregated, interpreted, and integrated at both the individual and population levels. Policymakers seek data as a lever for wise, evidence-based decision-making and information-driven policy. Yet, bridging the gap between data collection, research, and policymaking, is a major challenge.

The model

To bridge this gap, we propose a four-step model: (A) creating a conjoined task force of all relevant parties to declare a national program to promote collaborations; (B) promoting a national digital records project, or at least a network of synchronized and integrated databases, in an accessible transparent manner; (C) creating an interoperative national research environment to enable the analysis of the organized and integrated data and to generate evidence; and (D) utilizing the evidence to improve decision-making, to support a wisely chosen national policy. For the latter purpose, we also developed a novel multidimensional set of criteria to illuminate insights and estimate the risk for future morbidity based on current medical conditions.

Conclusion

Used by policymakers, providers of health plans, caregivers, and health organizations, we presume this model will assist transforming evidence generation to support the design of health policy and programs, as well as improved decision-making about health and health care, at all levels: individual, communal, organizational, and national.

Adolescent versus parent reports on asthma and asthma symptoms

PURPOSE

Epidemiological studies of asthma in adolescence commonly rely on self-reports. This study aimed to compare adolescent and parent reports regarding the presence of asthma and asthma symptoms in two ethnic groups, Jews and Arabs, living in the same country.

METHODS

Eighth-grade pupils attending five schools in Tel Aviv and four schools in two Arab cities in Israel were asked to complete the self-report International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire in the classroom. Their parents were interviewed by telephone using the parental ISAAC questionnaire. We assessed prevalence rates of asthma and asthma symptoms according to adolescent and parent responses. Agreement between adolescents and parents was assessed by Cohen's kappa coefficient.

RESULTS

Adolescents reported more asthma and asthma symptoms than their parents in both the Jewish (327 adolescent-parent pairs) and the Arab (335 adolescent-parent pairs) groups. Both groups showed moderate adolescent-parent chance-corrected agreement for current asthma (kappa 0.59 in Jews, 0.52 in Arabs, P = 0.60) and lifetime asthma (kappa 0.53 Jews, 0.44 in Arabs, P = 0.33); and slight to fair chance-corrected agreement for asthma symptoms. There were no statistically significant differences between the Jewish and Arab populations in chance-corrected agreement for any of the parameters assessed.

CONCLUSIONS

Jewish and Arab adolescents more often report asthma and asthma symptoms than do their parents. This seems to be a cross-cultural phenomenon. Therefore, particular attention should be paid to the source of information when comparing prevalence of asthma and asthma symptoms across studies. Pediatr Pulmonol. 2017;52:154-159. © 2016 Wiley Periodicals, Inc.

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.

Investigational drugs for the treatment of allergic rhinitis

INTRODUCTION

Allergic rhinitis is characterized by paroxysms of sneezing, rhinorrhea and nasal obstruction. Its prevalence is increasing in industrialized countries worldwide and imposes a significant economic burden as a result of reduced school performance, work productivity and medical expenses. Allergic rhinitis impairs the quality of life of those affected, and current treatment regimens are inadequate for those whose symptoms are severe or refractory to standard drug therapies. They mainly include symptom control with intranasal glucocorticoids, oral and intranasal antihistamines.

AREAS COVERED

This article provides a review of the most current literature on research that has focused on improving the efficacy of current treatment regimens and developing new drugs. It also provides the reader with an improved understanding of the pathogenesis of allergic rhinitis, including the inflammatory mediators and cell types involved, which has led to novel treatment options that are under investigation. These new drugs aim to alter the immunologic response to allergens in order to achieve greater clinical efficacy.

EXPERT OPINION

It is our opinion that despite developments in new therapies, a multidrug approach is vital for successful treatment of allergic rhinitis. Furthermore, immunotherapy in the form of sublingual immunotherapy is a promising additional therapeutic approach that will potentially make immunotherapy available to a wider selection of eligible patients with allergic rhinitis.

Pediatric allergy and immunology in Israel

After the geographic and sociodemographic settings as well as the health care in Israel are briefly described, the scope of pediatric allergy and immunology in Israel is presented. This includes specific disorders commonly encountered, the environment that induces symptoms, the specialists who treat them, and the common challenges of patients, parents, doctors, and allied health personnel who collaborate to manage the maladies and patient care. Allergies usually affect some overall 15-20% of the pediatric population. The main allergens are inhaled, ingested, or injected (insects stings). Generally, the incidence of the various allergens affecting children in Israel, is similar to other parts of the Western world. Owing to the high consanguinity rate in the Israeli population, the prevalence of the various immunodeficiency conditions (in the adaptive as well as the innate system) is higher than that reported worldwide. Pediatric allergists/immunologists also treat autoimmune disorders affecting the pediatric group. Pediatric allergy and clinical immunology are not separate specialties. The 25 specialists who treat children with allergic/immunologic diseases have undergone a basic training in Pediatrics. They also received an additional 2-yr training in allergy and clinical immunology and then have to pass the board examinations. They work mainly in pediatric allergy units, in several hospitals that are affiliated to the five medical schools in the country. Aside from clinical work, most of the centers are also heavily involved in clinical and basic research in allergy and immunology.

Encouraging pulmonary outcome for surviving, neurologically intact, extremely premature infants in the postsurfactant era

OBJECTIVE

The aim of this study was to determine the long-term pulmonary outcome of extreme prematurity at a single tertiary-care center from 1997 to 2001 in the postsurfactant era.

METHODS

We assessed symptoms, exhaled nitric oxide, spirometry, methacholine challenge (provocative concentration of methacholine required to decrease FEV₁ by 20% [PC(20)]), lung volumes, diffusion, and cardiopulmonary exercise tolerance.

RESULTS

Of 279 infants born, 192 survived to discharge, and 79 of these developed bronchopulmonary dysplasia (BPD) (65 mild, 12 moderate, two severe). We studied a subgroup of 53 neurologically intact preterm subjects aged 10 ± 1.5 years (28 with BPD [born, 26.2 ± 1.4 weeks; birth weight, 821 ± 164 g] and 25 without BPD [born, 27.2 ± 1 weeks; birth weight, 1,050 ± 181 g]) and compared them with 23 term control subjects. Of the BPD cases, 21 were mild, seven were moderate, and none was severe; 77.4% of subjects received antenatal steroids, and 83% received postnatal surfactant. Sixty percent of the preterm subjects wheezed at age < 2 years compared with 13% of the control subjects (P < .001), but only 13% wheezed in the past year compared with 0% of control subjects (not significant). For preterm and control subjects, respectively (mean ± SD), FEV₁ % predicted was 85% ± 10% and 94% ± 10% (P < .001), with limited reversibility; residual volume/total lung capacity was 29.3% ± 5.5% and 25% ± 8% (P < .05); diffusing capacity/alveolar volume was 89.6% ± 9.2% and 97% ± 10% (P < .005); and PC(20) was 6.5 ± 5.8 mg/mL and 11.7 ± 5.5 mg/mL (P < .001). PC(20) was < 4 mg/mL in 49% of preterm subjects despite normal exhaled nitric oxide. Most measurements were similar in premature subjects with and without BPD. Peak oxygen consumption and breathing reserve were normal, but % predicted maximal load (measured in Watts) was 69% ± 15% for subjects with BPD compared with 88% ± 23% for subjects without and 86% ± 20% for control subjects (P < .01).

CONCLUSIONS

Pulmonary outcome was encouraging at mid-childhood for neurologically intact survivors in the postsurfactant era. Despite mechanical ventilation and oxygen therapy, most had no or mild BPD. Changes found probably reflect the hypoplastic lungs of prematurity.

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.

Self-reported seafood intake and atopy in Japanese school-aged children

BACKGROUND

The effects of fish consumption and n-3 poly-unsaturated fatty acid (PUFA) levels on atopic disorders are inconsistent in previous reports, but few studies have investigated the effects of both fish and n-3 PUFA. The aim of the present study was to investigate whether erythrocyte fatty acids and the consumption of fish are associated with atopic diseases in pre- and early adolescents.

METHODS

A total of 135 students with eczema, 136 students with asthma, and 137 healthy control students were selected from fifth and eighth grades in Shunan, Japan. Atopic disorders and dietary intake were evaluated with questionnaires, and total serum IgE was measured using an enzyme-linked immunosorbent assay. In addition, erythrocyte membrane levels of PUFA were assessed via gas chromatography.

RESULTS

Total IgE was significantly elevated in the atopic subjects (P < 0.001). The intake of fatty and dried fish or seafood was significantly associated with eczema (odds ratios of the highest quartiles: 0.46, 95% confidence interval (95%CI): 0.22-0.94; 0.34, 95%CI: 0.16-0.71, respectively). Additionally, only erythrocyte eicosapentaenoic acid (EPA) level had a negative association with eczema (P= 0.048). For asthma, the effect of fish consumption was not significant.

CONCLUSIONS

Fish consumption was related to a low prevalence of eczema, but not asthma in Japanese pre- and early adolescents. EPA may be involved in this mechanism.

Gender differences in comorbidity of conduct disorder among adolescents in Northern Finland

Objectives

Conduct disorder (CD) refers to a pattern of severe antisocial and aggressive behaviour manifested in childhood or adolescence, with heavy costs to society. Though CD is a common psychiatric diagnosis among adolescents of both genders, gender differences in comorbidity of CD have been little studied. In this study we examined gender differences among adolescents with CD in causes for hospitalization, comorbid psychiatric diagnoses and somatic conditions.

Study design

The original study sample consisted of 508 inpatient adolescents in Northern Finland (age 12–17); 155 of them (65 girls, 92 boys) fulfilled the DSM-IV criteria for CD.

Methods

Diagnosis of CD and psychiatric comorbidities were obtained from the K-SADS-PL and somatic conditions from the EuropAsi.

Results

As compared to boys with CD, suicidality (including suicidal ideation and behaviour) was significantly more commonly the cause of hospitalization among girls with CD (43% vs. 24%, p=0.013). Among somatic conditions, there was a significant predominance in self-reported allergies among girls (60% vs. 25%, p<0.001). Girls had more often diagnosed comorbid post-traumatic stress disorder (13% vs. 3%, p=0.025) and marginally significantly more major depressive disorder (36% vs. 23%, p=0.086).

Conclusions

Girls with CD seem to have an increased tendency to develop both comorbid psychiatric and somatic conditions as well as suicidality. New clinical aspects in treatment of CD and comorbid disorders among girls are discussed.

Vitamin D serum levels in allergic rhinitis: any difference from normal population?

Background

Recently it has been suggested that, the worldwide increase in allergic diseases such as asthma, allergic rhinitis and food allergy is associated with low vitamin D intake.

Objective

This study measured the vitamin D levels in patients with allergic rhinitis and compared the results with the general population.

Methods

Vitamin D levels were assessed in 50 patients with allergic rhinitis diagnosed clinically by Allergic Rhinitis and its Impact on Asthma 2008 criteria and the result of skin prick test for aeroallergens. There was no control group, and the study results were compared with the results of another study evaluating vitamin D status in the 5,329 people of normal population of Iran.

Results

The prevalence of severe vitamin D deficiency was significantly higher in patients with allergic rhinitis than the normal population, 30% and 5.1% respectively (p = 0.03). Also women with allergic rhinitis had lower vitamin D levels.

Conclusion

Measuring vitamin D serum levels could be helpful in the routine assessment of patients with allergic rhinitis in Iran.

High prevalence of childhood asthma in Northern Israel is linked to air pollution by particulate matter: evidence from GIS analysis and Bayesian Model Averaging

The medical records of 3922 school children residing in the Greater Haifa Metropolitan Area in Northern Israel were analyzed. Individual exposure to ambient air pollution (SO(2) and PM(10)) for each child was estimated using Geographic Information Systems tools. Factors affecting childhood asthma risk were then investigated using logistic regression and the more recently developed Bayesian Model Averaging (BMA) tools. The analysis reveals that childhood asthma in the study area appears to be significantly associated with particulate matter of less than 10 μm in aerodynamic diameter (PM(10)) (Odds Ratio (OR) = .11; P<0.001). However, no significant association with asthma prevalence was found for SO(2) (P >0.2), when PM(10) and SO(2) were introduced into the models simultaneously. When considering a change in PM(10) between the least and the most polluted parts of the study area (9.4 μg/m(3)), the corresponding OR, calculated using the BMA analysis, is 2.58 (with 95% posterior probability limits of OR ranging from 1.52 to 4.41), controlled for gender, age, proximity to main roads, the town of a child's residence, and family's socio-economic status. Thus, it is concluded that exposure to airborne particular matter, even at relatively low concentrations (40-50 μg/m(3)), generally below international air pollution standards (55-70 μg/m(3)), appears to be a considerable risk factor for childhood asthma in urban areas. This should be a cause of concern for public health authorities and environmental decision-makers.

[Risk factors and prevalence of asthma and rhinitis among primary school children in Lisbon]

AIMS

A cross-sectional study was carried out with the objective of identifying nutrition habits and housing conditions as risk factors for respiratory problems in schoolchildren in Lisbon.

MATERIAL AND METHODS

Between October and December 2008, parents of 900 students of the basic schools of Lisbon were invited to answer a questionnaire of the International Study of Asthma and Allergies in Childhood Program (ISAAC). The response rate was 40%. Logistic regression was used in the analysis of results.

RESULTS

The prevalence of asthma, allergic rhinitis and wheeze was 5.6%, 43.0% and 43.3%, respectively. Risk factors independently associated with asthma were wheezing attacks, and dry cough at night not related to common cold in the last 12 months. Wheezing crises were found to affect children daily activities. Risk factors for wheeze were hay fever and the presence of a pet at home. A risk factor for rhinitis was cough at night. The frequent consumption of egg was also associated with increased risk of rhinitis.

CONCLUSION

Contrarily to asthma, the prevalence of allergic rhinitis and wheeze increased in comparison with previous ISAAC studies. Wheezing attacks were associated with asthma and hay fever was identified as a risk factor of manifesting wheezing symptoms. Having pets at home was pointed out as a significant risk factor for rhinitis, but not smoking exposure, mould, plush toys, diet (except egg consumption), breastfeeding or other conditions.

Is the prevalence of asthma declining? Systematic review of epidemiological studies

Asthma prevalence has increased very considerably in recent decades such that it is now one of the commonest chronic disorders in the world. Recent evidence from epidemiological studies, however, suggests that the prevalence of asthma may now be declining in many parts of the world, which, if true is important for health service planning and also because this offers the possibility of generating and testing new aetiological hypotheses. Our objective was to determine whether the prevalence of asthma is declining worldwide. We undertook a systematic search of EMBASE, Medline, Web of Science and Google Scholar, for high quality reports of cohort studies, repeat cross-sectional studies and analyses of routine healthcare datasets to examine international trends in asthma prevalence in children and adults for the period 1990-2008. There were 48 full reports of studies that satisfied our inclusion criteria. The large volume of data identified clearly indicate that there are, at present, no overall signs of a declining trend in asthma prevalence; on the contrary, asthma prevalence is in many parts of the world still increasing. The reductions in emergency healthcare utilization being reported in some economically developed countries most probably reflect improvements in quality of care. There remain major gaps in the literature on asthma trends in relation to Africa and parts of Asia. There is no overall global downward trend in the prevalence of asthma. Healthcare planners will for the foreseeable future, therefore, need to continue with high levels of anticipated expenditure in relation to provision of asthma care.

Prevalence of asthma symptoms and atopic disorders in preschool children and the trend over a decade

OBJECTIVES

Over the last few decades, there have been substantial publications on the prevalence and trends of asthma in school-age children and adolescents. There has been a scarcity of reports on asthma prevalence and trends in preschool children. This study was performed to measure the prevalence of symptoms of asthma, allergic rhinitis, and eczema in preschool (4- and 5-year-old) children and the trend over a decade.

STUDY DESIGN

A cross-sectional questionnaire based survey using the International Study of Asthma and Allergy in Childhood (ISAAC) was performed on South Australian preschool children in 2006. The results were compared to a previous survey conducted in 1993.

RESULTS

The 12-month period prevalence of reported wheeze, allergic rhinitis, and eczema was 23.7%, 20.8%, and 18.8%, respectively. The prevalence of wheeze symptoms was higher in males than females. There was a decline in the prevalence of "wheeze in the last 12 months" (25.2% to 23.7%) and in "asthma ever" (22.5% to 19.0%, p < 0.05) from 1993 to 2006.

CONCLUSION

There is a burden in the symptoms of asthma, allergic rhinitis, and eczema in preschool children. There is a declining trend in the prevalence of "current wheeze" and "asthma ever" in South Australian preschool children over a decade.