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Rutter CE, Silverwood RJ, Pearce N, Strachan DP. Potential asthma risk factors do not account for global asthma symptom prevalence patterns and time trends in children and adolescents. World Allergy Organ J 2024; 17:100917. [PMID: 38974946 PMCID: PMC11227011 DOI: 10.1016/j.waojou.2024.100917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/29/2024] [Accepted: 05/21/2024] [Indexed: 07/09/2024] Open
Abstract
Background The International Study of Asthma and Allergies in Childhood (ISAAC) and the Global Asthma Network (GAN) conducted a series of global asthma prevalence surveys, between 1990 and 2020, in adolescents aged 13-14 and children aged 6-7 years. We used them to assess whether potential asthma risk factors explain global asthma symptom prevalence trends over this period. Method We fitted mixed-effects linear regression models to estimate associations between centre-level risk factor prevalence and both the mid-point asthma symptom prevalence and the change per decade. We also estimated the 2019 asthma symptom prevalence across all included centres. Results For adolescents, across 50 centres in 26 countries there was weak evidence that decreasing asthma prevalence over time was associated with regular fast-food consumption and frequent television viewing. However, frequent television viewing, along with heavy truck traffic, were associated with higher prevalence of asthma symptoms at the study mid-point. For children, across 41 centres in 21 countries, no risk factors were associated with time trends in asthma symptom prevalence, but truck traffic and paracetamol in the first year of life were associated with higher mid-point prevalence.We estimated the 2019 asthma symptom prevalence, across a total of 124 centres, to be 12.8% (11.4%, 14.2%) with little evidence of a difference by age. Low-income countries had lower prevalence (children 5.2% [2.5%, 7.8%], adolescents 5.3% [2.8%, 7.8%]), than lower-middle-, upper-middle- and high-income countries (all approximately 14-15%). Including risk factors in the models did not change the estimates. Conclusion Potential asthma risk factors do not seem to explain the global prevalence patterns or time trends. Country income accounts for some of the differences, but the unexplained variation is very high.
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Affiliation(s)
- Charlotte E. Rutter
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
| | - Richard J. Silverwood
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
- Centre for Longitudinal Studies, UCL Social Research Institute, University College London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, UK
| | - David P. Strachan
- Population Health Research Institute, St George's University of London, UK
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Yasaratne D, Idrose NS, Dharmage SC. Asthma in developing countries in the Asia-Pacific Region (APR). Respirology 2023; 28:992-1004. [PMID: 37702387 DOI: 10.1111/resp.14590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023]
Abstract
There is growing interest in the epidemiology of asthma in developing countries, especially in the Asia-Pacific Region (APR). A number of reviews have been published in this field, but a comprehensive synthesis of overall data has not been reported. Here, we summarized the burden, risk factors and challenges of asthma management in developing countries with a specific emphasis on the APR by consolidating evidence from both systematic and narrative reviews published up until February 2023. We found that although asthma prevalence in low and low-middle-income countries (LMICs) is known to be generally lower compared to high-income countries, the burden is substantially greater. Studies conducted in APR LMIC have reported a range of risk factors, including pre- and post-natal factors, environmental considerations, lifestyle measures, individual features and genetics. The low and inequitable distribution of quality preventive and curative health care, a lack of advanced diagnostic measures, non-availability and non-affordability of novel therapeutics, cultural beliefs and practices, and diverse disease phenotypes make it challenging to achieve optimal asthma control in the region. Hence, we call for the development of a region-specific blueprint for action to mitigate this challenging situation, to help reduce the burden of asthma in APR LMIC.
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Affiliation(s)
- Duminda Yasaratne
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - N Sabrina Idrose
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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3
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Ghatee MA, Kanannejad Z, Nikaein K, Fallah N, Sabz G. Geo-climatic risk factors for chronic rhinosinusitis in southwest Iran. PLoS One 2023; 18:e0288101. [PMID: 37406025 DOI: 10.1371/journal.pone.0288101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease associated with some environmental factors. In this study, we evaluated the effect of geo-climatic factors on CRS in a region of southwest Iran. The study mapped the residency addresses of 232 patients with CRS who lived in Kohgiluyeh and Boyer-Ahmad province and had undergone sinus surgery from 2014 to 2019. The effects of Mean Annual Humidity (MAH), Mean Annual Rainfall (MAR), Mean Annual Temperature (MAT), maximum MAT (maxMAT), minimum MAT (minMAT), Mean Annual Evaporation (MAE), wind, elevation, slope, and land cover were assessed on the occurrence of CRS using Geographical Information System (GIS). Statistical analysis was performed using univariate and multivariate binary logistic regression. Patients came from 55 points including villages, towns, and cities. In univariate analysis, climatic factors including MAT (OR = 0.537), minMAT (OR = 0.764), maxMAT (OR = 0.63), MAR (OR = 0.994), and MAH (OR = 0.626) were significantly related to CRS occurrence. Elevation (OR = 0.999), slope (OR = 0.9), and urban setting (OR = 24.667) were the significant determinants among geographical factors when analyzed independently. The multivariate analysis found maxMAT (OR = 0.5), MAR (OR = 0.994), elevation (OR = 0.998), and urban (OR = 16.8) as significant factors affecting CRS occurrence. The urban setting is the most critical factor affecting CRS disease. Cold and dry areas and low attitude are the other risk factors for CRS in Kohgiluyeh and Boyer-Ahmad province, southwest Iran.
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Affiliation(s)
- Mohammad Amin Ghatee
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
- Department of Parasitology, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Zahra Kanannejad
- Allergy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Koorosh Nikaein
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Niloufar Fallah
- Student Research Committee, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Gholamabbas Sabz
- Cellular and Molecular Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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4
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Barne M, Singh S, Mangal DK, Singh M, Awasthi S, Mahesh PA, Kabra SK, Mohammed S, Sukumaran TU, Ghoshal AG, Sinha S, Kochar SK, Singh N, Singh U, Patel KK, Sharma AK, Girase B, Madas S, Chauhan A, Sit N, Siddaiah JB, Singh V, Salvi S. Global Asthma Network Phase I, India: Results for allergic rhinitis and eczema in 127,309 children and adults. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2022; 1:51-60. [PMID: 37780584 PMCID: PMC10509898 DOI: 10.1016/j.jacig.2022.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 10/03/2023]
Abstract
Background The Global Asthma Network phase I study in India aimed to study the prevalence, time trends, and associated risk factors of allergic rhinitis and eczema among 6-7-year-old, and 13-14-year-old school children and their parents. Objectives: The objective of the study was to understand the current prevalence and associated risk factors of Allergic Rhinitis and Eczema in India among 6-7-year-olds, 13-14-year-olds and in their parents/guardians for newer directions to health care providers, policy makers and academicians. Methods Cross-sectional, multicenter study using self- and parent-administered questionnaire among randomly selected school children aged 6 to 7 years from 8 centers and 13 to 14 years from 9 centers and their respective parents/guardians across India. Results Prevalence of allergic rhinitis (AR) (%, 95% CI) among 20,084 6-7-year-olds (children), 25,887 13-14-year-olds (adolescents), and 81,296 adults/parents was 7.7% (7.4%-8.1%), 23.5% (23.0%-24.1%), and 9.8% (9.55%-9.96%) and that of eczema was 2.5% (2.3%-2.7%), 3.5% (3.27%-3.71%), and 9.9% (9.7%-10.1%), respectively. Among 6-7-year-olds, AR and eczema showed a significantly (P < .001) declining time trend since the International Study of Asthma and Allergies in school children phase III in 2002-2003. Among 13-14-year-olds, AR (P < .01) but not eczema showed a significant temporal decline. Coexisting atopic condition, parental history of atopy, and some environmental factors consistent with previous studies were significant risk factors among children and adolescents. AR or eczema in either parent strongly predicted the same atopic condition among their adolescent offspring. Among adults, coexisting atopic condition was the strongest predictor of either AR or eczema. Conclusions There is a slight declining time trend of AR and eczema in India over 2 decades among children and adolescents. Nearly 10% of Indian adults suffer from AR and eczema. Although genetic factors had the strongest association for AR and eczema among all age groups, certain early-life and environmental exposures need consideration to devise preventative strategies.
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Affiliation(s)
- Monica Barne
- Chest Research Foundation, Pune, India
- Pulmocare Research and Education Foundation, Pune, India
| | - Sheetu Singh
- Department of Pulmonary Medicine, Rajasthan Hospital, Jaipur, India
| | - Daya Krishan Mangal
- Department of Public Health and Epidemiology, IIHMR University, Jaipur, India
| | - Meenu Singh
- Department of Advanced Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Shally Awasthi
- Department of Pediatrics, King George’s Medical University, Lucknow, India
| | - Padkuduru A. Mahesh
- Department of Pulmonary Medicine, Jagadguru Sri Shivarathreeshwara Medical College, JSSAHER, Mysuru, India
| | - Sushil K. Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sabir Mohammed
- Department of Medicine, Sardar Patel Medical College, Bikaner, India
| | | | - Aloke G. Ghoshal
- Department of Respiratory Medicine, National Allergy Asthma Bronchitis Institute, Kolkata, India
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay K. Kochar
- Department of Medicine, Sardar Patel Medical College, Bikaner, India
| | - Nishtha Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, India
| | | | | | - Arvind Kumar Sharma
- Department of Community Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Bhushan Girase
- Chest Research Foundation, Pune, India
- PATH India, New Delhi, India
| | - Sapna Madas
- Chest Research Foundation, Pune, India
- Pulmocare Research and Education Foundation, Pune, India
| | - Anil Chauhan
- Department of Public Health and Epidemiology, IIHMR University, Jaipur, India
| | - Niranjan Sit
- Department of Respiratory Medicine, National Allergy Asthma Bronchitis Institute, Kolkata, India
| | | | - Virendra Singh
- Department of Respiratory Medicine, Asthma Bhawan, Jaipur, India
| | - Sundeep Salvi
- Chest Research Foundation, Pune, India
- Pulmocare Research and Education Foundation, Pune, India
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5
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Primary Prevention of Food Allergy-Environmental Protection beyond Diet. Nutrients 2021; 13:nu13062025. [PMID: 34204606 PMCID: PMC8231128 DOI: 10.3390/nu13062025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023] Open
Abstract
A food allergy is a potentially life-threatening disease with a genetic and environmental background. As its prevalence has increased significantly in recent years, the need for its effective prevention has been emphasized. The role of diet modifications and nutrients in food allergy reduction has been extensively studied. Much less is known about the role of other environmental factors, which can influence the incidence of this disease. Changes in neonates gut microbiome by delivery mode, animal contact, inhalant allergens, oral and then cutaneous allergen exposure, air pollution, smoking, infections and vaccinations can be the potential modifiers of food allergy development. There is some data about their role as the risk or preventive factors, but yet the results are not entirely consistent. In this paper we present the current knowledge about their possible role in primary prevention of food allergies. We discuss the mechanisms of action, difficulties in designing accurate studies about food allergy and the potential biases in interpreting the connection between environmental factors and food allergy prevention. A better understanding of the role of environmental factors in food allergies development may help in implementing practical solutions for food allergy primary prevention in the future.
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6
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Wjst M. Allergy protection at farms-just a myth? IMMUNITY INFLAMMATION AND DISEASE 2020; 9:74-75. [PMID: 33200546 PMCID: PMC7860597 DOI: 10.1002/iid3.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Matthias Wjst
- Institute of Lung Biology and Disease, Helmholtz Zentrum Muenchen, German Research Center for Environmental Health (GmbH), München, Germany.,Institut für Medizinische Informatik, Statistik und Epidemiologie, Technische Universität München, München, Germany
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7
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Mpairwe H, Nkurunungi G, Tumwesige P, Akurut H, Namutebi M, Nambuya I, Nnaluwooza M, Apule B, Onen C, Katongole T, Niwagaba E, Mukasa M, Webb EL, Elliott AM, Pearce N. Risk factors associated with rhinitis, allergic conjunctivitis and eczema among schoolchildren in Uganda. Clin Exp Allergy 2020; 51:108-119. [PMID: 33098716 PMCID: PMC7612100 DOI: 10.1111/cea.13769] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/31/2020] [Accepted: 10/19/2020] [Indexed: 01/19/2023]
Abstract
Background The prevalence of allergy-related diseases (ARDs), including rhinitis, allergic conjunctivitis and eczema, is on the increase globally. The causes of this increase are not well established. Objectives To investigate the risk factors associated with ARDs among schoolchildren in Uganda. Methods We conducted a secondary data analysis of a large asthma case–control study involving 1700 schoolchildren, 5–17 years, in urban Uganda. ARDs were defined according to the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Skin prick testing (SPT) was conducted using standard procedures and allergen-specific IgE (asIgE) using ImmunoCAP®. We employed inverse probability weighted analysis to generate estimated prevalence data and weighted odds ratios. Results The lifetime estimated weighted prevalence of reported rhinitis, allergic conjunctivitis and eczema was 43.3%, 39.5% and 13.5%; weighted prevalence in 12 months was 10.1%, 9.1% and 2.3%, respectively. There was overlap of ARDs, with 66.3% of 1193 schoolchildren who reported having ever an ARDs (including asthma) reporting two or more. Risk factors associated with reported rhinitis in the last 12 months were city residence at birth [adjusted odds ratio (95% confidence interval) 2.66 (1.42–4.99) compared to rural]; father’s [2.62 (1.79–3.83)] and mother’s history of allergic disease [2.12 (1.48–3.02)]; frequent de-worming in the last 12 months [2.01 (1.30–3.11), ≥2 versus none]; current high frequency of ‘trucks passing on the street near home’ [2.59 (1.48–4.52), ‘almost all the time’ versus rarely] and positive SPT [1.54 (1.09–2.18)] but not asIgE [1.38 (0.60–3.15)]. The same pattern of risk factors was observed for allergic conjunctivitis and eczema. Conclusion We found extensive multi-morbidity of, and overlap in the risk factors for, rhinitis, conjunctivitis and eczema—similar to asthma risk factors—among schoolchildren in urban Uganda. This suggests a similar underlying cause for all ARDs, associated with exposure to urban lifestyles and environment in Uganda.
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Affiliation(s)
- Harriet Mpairwe
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Gyaviira Nkurunungi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Pius Tumwesige
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Hellen Akurut
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Milly Namutebi
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Irene Nambuya
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Marble Nnaluwooza
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Barbara Apule
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Caroline Onen
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Tonny Katongole
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emmanuel Niwagaba
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Mike Mukasa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Emily L Webb
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Alison M Elliott
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
| | - Neil Pearce
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, London, UK
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Rutter CE, Silverwood RJ, Asher MI, Ellwood P, Pearce N, Garcia-Marcos L, Strachan DP. Comparison of individual-level and population-level risk factors for rhinoconjunctivitis, asthma, and eczema in the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. World Allergy Organ J 2020; 13:100123. [PMID: 32642022 PMCID: PMC7334817 DOI: 10.1016/j.waojou.2020.100123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background Symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in children cluster at both the individual and population levels. Objectives To assess individual-level and school-level risk factors for symptoms of rhinoconjunctivitis and compare them to corresponding associations with symptoms of asthma and eczema in Phase Three of the International Study of Asthma and Allergies in Childhood. Methods We studied 116,863 children aged 6–7 years from 2163 schools in 59 centres and 22 countries and 224,436 adolescents aged 13–14 years from 2037 schools in 97 centres in 41 countries. Multilevel logistic regression models were fitted with random intercepts for school, centre, and country, adjusting for sex and maternal education at the child level. Associations between symptoms and a range of lifestyle and environmental risk factors were assessed for both the child's exposure and mean exposure at the school. Models were fitted for rhinoconjunctivitis, asthma, and eczema singly (unimorbidity) and for combinations of these conditions (multimorbidity). Results Generally, associations between symptoms and exposures at the school level were similar in direction and magnitude to those at the child level. Associations with multimorbidity were stronger than for unimorbidity, particularly in individuals with symptoms of all three diseases, but risk factor associations found in conventional single disease analyses persisted among children with only one condition, after excluding multimorbid groups. Comparisons of individuals with only one disease showed that many risk factor associations were consistent across the three conditions. More strongly associated with asthma were low birthweight, cat exposure in infancy, and current maternal smoking. Current paracetamol use was more strongly associated with asthma and rhinoconjunctivitis than eczema. Breastfeeding was more strongly associated with eczema than asthma or rhinoconjunctivitis. The direction and magnitude of most risk factor associations were similar in affluent and non-affluent countries, although notable exceptions include farm animal contact in infancy and larger sibships, which were associated with increased risk of rhinoconjunctivitis in non-affluent countries but reduced risk in affluent countries. In both age groups, current paracetamol use increased risk of each disease to a greater extent in affluent countries than in non-affluent countries. Effects of paracetamol and antibiotics in infancy were more consistent between richer and poorer settings. Conclusions Most of the environmental and lifestyle correlates of rhinoconjunctivitis, asthma and eczema in childhood display similarity across the three conditions, even in less affluent settings where allergic sensitisation is less likely to explain the concordant epidemiological patterns. Trial registration Not applicable.
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Affiliation(s)
- Charlotte E Rutter
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard J Silverwood
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre for Longitudinal Studies, Department of Social Science, University College London, London, United Kingdom
| | - M Innes Asher
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Luis Garcia-Marcos
- Pediatric Allergy and Pulmonology Units, 'Virgen de La Arrixaca' University Children's Hospital, University of Murcia, ARADyAL Network and IMIB Bioresearch Institute, Murcia, Spain
| | - David P Strachan
- Population Health Research Institute, St George's University of London, London, United Kingdom
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9
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Abstract
Over the last few decades, advances in our understanding of microbial ecology have allowed us to appreciate the important role of microbial communities in maintaining human health. While much of this research has focused on gut microbes, microbial communities in other body sites and from the environment are increasingly recognized in human disease. Here, we discuss recent advances in our understanding of host-microbiota interactions in the development and manifestation of asthma focusing on three distinct microbial compartments. First, environmental microbes originating from house dust, pets, and farm animals have been linked to asthma pathogenesis, which is often connected to their production of bioactive molecules such as lipopolysaccharide. Second, respiratory microbial communities, including newly appreciated populations of microbes in the lung have been associated with allergic airway inflammation. Current evidence suggests that the presence of particular microbes, especially Streptococcus, Haemophilus, and Morexella species within the airway may shape local immune responses and alter the severity and manifestations of airway inflammation. Third, the gut microbiota has been implicated in both experimental models and clinical studies in predisposing to asthma. There appears to be a "critical window" of colonization that occurs during early infancy in which gut microbial communities shape immune maturation and confer susceptibility to allergic airway inflammation. The mechanisms by which gut microbial communities influence lung immune responses and physiology, the "gut-lung axis," are still being defined but include the altered differentiation of immune cell populations important in asthma and the local production of metabolites that affect distal sites. Together, these findings suggest an intimate association of microbial communities with host immune development and the development of allergic airway inflammation. Improved understanding of these relationships raises the possibility of microbiota-directed therapies to improve or prevent asthma.
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Affiliation(s)
- Aaron Ver Heul
- Division of Allergy and Immunology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph Planer
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew L Kau
- Division of Allergy and Immunology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.
- Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, MO, USA.
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10
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Rutter CE, Silverwood RJ, Williams HC, Ellwood P, Asher I, Garcia-Marcos L, Strachan DP, Pearce N, Langan SM. Are Environmental Factors for Atopic Eczema in ISAAC Phase Three due to Reverse Causation? J Invest Dermatol 2019; 139:1023-1036. [PMID: 30521836 PMCID: PMC6478380 DOI: 10.1016/j.jid.2018.08.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/26/2022]
Abstract
Some previously described environmental associations for atopic eczema may be due to reverse causation. We explored the role of reverse causation by comparing individual- and school-level results for multiple atopic eczema risk factors. The International Study of Asthma and Allergies in Childhood (i.e, ISAAC) Phase Three surveyed children in schools (the sampling unit) regarding atopic eczema symptoms and potential risk factors. We assessed the effect of these risk factors on atopic eczema symptoms using mixed-effect logistic regression models, first with individual-level exposure data and second with school-level exposure prevalence. Overall, 546,348 children from 53 countries were included. At ages 6-7 years, the strongest individual-level associations were with current paracetamol use (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.37-1.54), which persisted at school-level (OR = 1.55, 95% CI = 1.10-2.21), early-life antibiotics (OR = 1.41, 95% CI = 1.34-1.48), and early-life paracetamol use (OR = 1.28, 95% CI = 1.21-1.36), with the former persisting at the school level, whereas the latter was no longer observed (OR = 1.35, 95% CI = 1.00-1.82 and OR = 0.94, 95% CI = 0.69-1.28, respectively). At ages 13-14 years, the strongest associations at the individual level were with current paracetamol use (OR = 1.57, 95% CI = 1.51-1.63) and open-fire cooking (OR = 1.46, 95% CI = 1.33-1.62); both were stronger at the school level (OR = 2.57, 95% CI = 1.84-3.59 and OR = 2.38, 95% CI = 1.52-3.73, respectively). Association with exposure to heavy traffic (OR = 1.31, 95% CI = 1.27-1.36) also persisted at the school level (OR = 1.40, 95% CI = 1.07-1.82). Most individual- and school-level effects were consistent, tending to exclude reverse causation.
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Affiliation(s)
- Charlotte E Rutter
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hywel C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Luis Garcia-Marcos
- Pediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia and IMIB Bioresearch Institute, Murcia, Spain
| | - David P Strachan
- Population Health Research Institute, St George's University of London, London, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Red de Asma, Reacciones Adversas y Alérgicas, Madrid, Spain; Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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11
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Silverwood RJ, Rutter CE, Mitchell EA, Asher MI, Garcia‐Marcos L, Strachan DP, Pearce N. Are environmental risk factors for current wheeze in the International Study of Asthma and Allergies in Childhood (ISAAC) phase three due to reverse causation? Clin Exp Allergy 2019; 49:430-441. [PMID: 30508327 PMCID: PMC6487816 DOI: 10.1111/cea.13325] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/19/2018] [Accepted: 11/04/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence of symptoms of asthma in children. We undertook comprehensive analyses addressing risk factors for asthma symptoms in combination, at both the individual and the school level, to explore the potential role of reverse causation due to selective avoidance or confounding by indication. OBJECTIVE To explore the role of reverse causation in risk factors of asthma symptoms. METHODS We compared two sets of multilevel logistic regression analyses, using (a) individual level exposure data and (b) school level average exposure (ie prevalence), in two different age groups. In individual level analyses, reverse causation is a possible concern if individual level exposure statuses were changed as a result of asthma symptoms or diagnosis. School level analyses may suffer from ecologic confounding, but reverse causation is less of a concern because individual changes in exposure status as a result of asthma symptoms would only have a small effect on overall school exposure levels. RESULTS There were 131 924 children aged 6-7 years (2428 schools, 25 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (odds ratio = 2.06; 95% confidence interval 1.97-2.16), early life antibiotic use (1.65; 1.58-1.73) and open fire cooking (1.44; 1.26-1.65). In school level analyses, these risk factors again showed increased risks. There were 238 586 adolescents aged 13-14 years (2072 schools, 42 countries) with complete exposure, outcome and confounder data. The strongest associations in individual level analyses (fully adjusted) were for current paracetamol use (1.80; 1.75-1.86), cooking on an open fire (1.32; 1.22-1.43) and maternal tobacco use (1.23; 1.18-1.27). In school level analyses, these risk factors again showed increased risks. CONCLUSIONS & CLINICAL RELEVANCE These analyses strengthen the potentially causal interpretation of previously reported individual level findings, by providing evidence against reverse causation.
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Affiliation(s)
- Richard J. Silverwood
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Charlotte E. Rutter
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
| | - Edwin A. Mitchell
- Department of Paediatrics: Child and Youth HealthFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - M. Innes Asher
- Department of Paediatrics: Child and Youth HealthFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Luis Garcia‐Marcos
- Pediatric Allergy and Pulmonology Units‘Virgen de la Arrixaca’ University Children's HospitalUniversity of Murcia and IMIB Bioresearch InstituteMurciaSpain
| | - David P. Strachan
- Population Health Research InstituteSt George's University of LondonLondonUK
| | - Neil Pearce
- Department of Medical StatisticsLondon School of Hygiene and Tropical MedicineLondonUK
- Centre for Global NCDsLondon School of Hygiene and Tropical MedicineLondonUK
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12
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Rychlik KA, Sillé FCM. Environmental exposures during pregnancy: Mechanistic effects on immunity. Birth Defects Res 2019; 111:178-196. [PMID: 30708400 DOI: 10.1002/bdr2.1469] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/16/2019] [Indexed: 12/21/2022]
Abstract
In human studies, it is well established that exposures during embryonic and fetal development periods can influence immune health. Coupled with genetic predisposition, these exposures can alter lifetime chronic and infectious disease trajectory, and, ultimately, life expectancy. Fortunately, as research advances, mechanisms governing long-term effects of prenatal exposures are coming to light and providing the opportunity for intervention and risk reduction. For instance, human association studies have provided a foundation for the association of prenatal exposure to particulate matter with early immunosuppression and later allergic disease in the offspring. Only recently, the mechanisms mediating this response have been revealed and there is much we have yet to discover. Although cellular immune response is understood for many exposure scenarios, molecular pathways are still unidentified. This review will provide commentary and synthesis of the current literature regarding environmental exposures during pregnancy and mechanisms determining immune outcomes. Shared mechanistic features and current gaps in the state of the science are identified and discussed. To such purpose, we address exposures by their immune effect type: immunosuppression, autoimmunity, inflammation and tissue damage, hypersensitivity, and general immunomodulation.
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Affiliation(s)
- Kristal A Rychlik
- Department of Environmental Health and Engineering, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Fenna C M Sillé
- Department of Environmental Health and Engineering, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
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13
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Associations of urban greenness with asthma and respiratory symptoms in Mexican American children. Ann Allergy Asthma Immunol 2018; 122:289-295. [PMID: 30557617 DOI: 10.1016/j.anai.2018.12.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Evidence on the association between residential surrounding greenness (RSG) in urban areas with asthma and asthma symptoms is inconsistent. OBJECTIVE To examine the association of RSG with respiratory outcomes in a sample of Mexican American children living in inner-city Chicago, Illinois. METHODS This study is based on parent-reported data on 1915 Mexican American children. We calculated RSG using the normalized difference vegetation index based on satellite imagery within buffers of 100, 250, and 500 m of each child's residence. Multivariable multilevel mixed-effect logistic regression was used to estimate adjusted odds ratios (aORs) for the effect of a 1-interquartile range increase in greenness. RESULTS In adjusted analyses, a protective effect of greenness within 100 m was observed for lifetime wheezing (aOR, 0.82; 95% CI, 0.69-0.96). Environmental tobacco smoke (ETS) exposure modified the association of RSG with lifetime asthma and current dry cough at night. For all buffer distances, increased greenness was associated with lower odds of lifetime asthma among children with current ETS exposure (100 m: aOR, 0.43; 95% CI, 0.22-0.87; 250 m: aOR, 0.39; 95% CI, 0.18-0.84; 500 m: aOR, 0.48; 95% CI, 0.26-0.90) and lower odds of current dry cough at night among children with perinatal ETS exposure (100 m: aOR, 0.53; 95% CI, 0.31-0.92; 250 m: aOR, 0.55; 95% CI, 0.31-0.98; 500 m: aOR, 0.55; 95% CI, 0.35-0.87). CONCLUSION Our results suggest inverse associations of urban greenness with respiratory outcomes, especially in children exposed to ETS. Further research is needed to examine the mechanisms through which RSG may be associated with the risk of asthma and contribute to health.
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14
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Santos CBD, Pilatti LA, Pedroso B, Carvalho DR, Guimarães AM. Previsão do Índice de Desenvolvimento Humano e da expectativa de vida nos países da América Latina por meio de técnicas de mineração de dados. CIENCIA & SAUDE COLETIVA 2018. [DOI: 10.1590/1413-812320182311.26142016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo A previsibilidade de indicadores epidemiológicos pode contribuir na projeção de variáveis dependentes, auxiliar em tomadas de decisões para sustentar ou não políticas públicas e justificar o cenário vivido pelos países e o mundo. O artigo tem por objetivo predizer o Índice de Desenvolvimento Humano e a expectativa de vida nos países latino-americanos no período de 2015 a 2020, utilizando técnicas de mineração de dados. Foram percorridas as etapas do processo Descoberta de Conhecimento em Base Dados. Adotaram-se para previsões modelos desenvolvidos com séries multivariadas através do algoritmo de mineração de dados SMOReg, que apresentaram melhor desempenho em testes desenvolvidos durante o experimento. As médias do Índice de Desenvolvimento Humano e da expectativa de vida nos países latino-americanos tendem a aumentar no período analisado, respectivamente, 4,99 ± 3,90 % e 2,65 ± 0,06 anos. Experiências multivariadas possibilitam maior aprendizagem dos algoritmos, aumentando sua precisão. As técnicas de mineração de dados apresentaram melhor qualidade nas previsões em relação à técnica mais popular, ARIMA. As previsões sugerem média de crescimento do IDH e EV dos países latino-americanos maiores que a mundial.
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15
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Serra-Baldrich E, de Frutos J, Jáuregui I, Armario-Hita J, Silvestre J, Herraez L, Martín-Santiago A, Valero A, Sastre J. Changing perspectives in atopic dermatitis. Allergol Immunopathol (Madr) 2018; 46:397-412. [PMID: 29031890 DOI: 10.1016/j.aller.2017.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 07/29/2017] [Indexed: 01/25/2023]
Abstract
Atopic dermatitis (AD) is a multifaceted disease that involves a complex interplay between the skin and the immune system. The course of the disease depends strongly on the genetic background of the patient and on yet poorly-defined environmental factors. Changes in lifestyle could be behind the dramatic rise in the prevalence of AD across continents; including hygienic conditions, food, social habits, skin microbiome or exposure to a number of allergens. Although AD typically develops in childhood and disappears after a few years, in a relatively large number of patients it continues into adulthood. Adult AD can also appear de novo but it is often underdiagnosed and its treatment can be challenging. New, highly effective drugs are being developed to manage moderate and severe forms of the disease in adults. In this review, we highlight the most recent developments in diagnostic tools, current insights into the mechanistic basis of this disease, and therapeutic innovations.
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16
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Christoforidou Z, Burt R, Mulder I, Gill BP, Pluske J, Kelly D, Stokes CR, Bailey M, Lewis MC. Development of Immune Cells in the Intestinal Mucosa Can Be Affected by Intensive and Extensive Farm Environments, and Antibiotic Use. Front Immunol 2018; 9:1061. [PMID: 29868021 PMCID: PMC5964130 DOI: 10.3389/fimmu.2018.01061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/27/2018] [Indexed: 12/30/2022] Open
Abstract
Epidemiological studies have demonstrated that exposure to farm environments during childhood can be linked to reductions in the incidence of immune disorders, but generating an appropriate model is difficult. 108 half-sibling piglets were born on either extensive (outdoor) or intensive (indoor) farms: at 1 day old, a subset of piglets from each litter were transferred to a high-hygiene isolator facility to create differences in rearing environment either during birth/first day or during the subsequent 56 days of life. Interactions between CD14, CD16, MHCIIDR, and capillary endothelium were assessed using four-color quantitative fluorescence immunohistology. Effects of birth and rearing environment on the antigen-presenting microenvironment of the proximal and distal jejunum (professional and stromal) were apparent at 5, 28, and 56 days after birth However, effects on CD4+CD25+Foxp3+ regulatory T-cells (Tregs) in the intestinal mucosa were apparent around weaning at 28 days but had disappeared by 56 days. These Tregs were reduced in the isolator piglets compared to their farm-reared siblings, but this effect was less marked in piglets born on the extensive farm and required administration of antibiotics. Our results suggest that there may be at least two windows of opportunity in which different farm environments were influencing immune development: one during the perinatal period (up to the first day of life), and one during later infancy. Furthermore, the differences on Tregs suggest that the effects of early life influences may be particularly critical around weaning.
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Affiliation(s)
- Zoe Christoforidou
- Infection and Immunity, School of Veterinary Science, University of Bristol, Langford, United Kingdom
| | - Rachel Burt
- Infection and Immunity, School of Veterinary Science, University of Bristol, Langford, United Kingdom
| | - Imke Mulder
- Gut Immunology Group, Rowett Institute, University of Aberdeen, Aberdeen, United Kingdom
| | - Bhupinder P Gill
- Agricultural and Horticultural Development Board, Milton Keynes, United Kingdom
| | - John Pluske
- School of Veterinary and Life Sciences, Murdoch University, Murdoch, WA, Australia
| | - Denise Kelly
- Gut Immunology Group, Rowett Institute, University of Aberdeen, Aberdeen, United Kingdom
| | - Christopher R Stokes
- Infection and Immunity, School of Veterinary Science, University of Bristol, Langford, United Kingdom
| | - Michael Bailey
- Infection and Immunity, School of Veterinary Science, University of Bristol, Langford, United Kingdom
| | - Marie C Lewis
- Food and Nutritional Sciences, School of Chemistry, Food and Pharmacy, University of Reading, Reading, United Kingdom
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17
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Prevalence and Determinants of Sinus Problems in Farm and Non-Farm Populations of Rural Saskatchewan, Canada. SINUSITIS 2018. [DOI: 10.3390/sinusitis3010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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18
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Vuillermin PJ, Macia L, Nanan R, Tang ML, Collier F, Brix S. The maternal microbiome during pregnancy and allergic disease in the offspring. Semin Immunopathol 2017; 39:669-675. [PMID: 29038841 PMCID: PMC5711986 DOI: 10.1007/s00281-017-0652-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 09/04/2017] [Indexed: 12/27/2022]
Abstract
There is substantial epidemiological and mechanistic evidence that the increase in allergic disease and asthma in many parts of the world in part relates to changes in microbial exposures and diet acting via the composition and metabolic products of the intestinal microbiome. The majority of research in this field has focused on the gut microbiome during infancy, but it is increasingly clear that the maternal microbiome during pregnancy also has a key role in preventing an allergy-prone immune phenotype in the offspring. The mechanisms by which the maternal microbiome influences the developing fetal immune system include alignment between the maternal and infant regulatory immune status and transplacental passage of microbial metabolites and IgG. Interplay between microbial stimulatory factors such as lipopolysaccharides and regulatory factors such as short-chain fatty acids may also influence on fetal immune development. However, our understanding of these pathways is at an early stage and further mechanistic studies are needed. There are also no data from human studies relating the composition and metabolic activity of the maternal microbiome during pregnancy to the offspring's immune status at birth and risk of allergic disease. Improved knowledge of these pathways may inform novel strategies for tackling the increase in allergic disorders in the modern world.
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Affiliation(s)
- Peter J Vuillermin
- Deakin University, Geelong, Australia. .,Barwon Health, Geelong, Australia. .,Murdoch Childrens Research Institute, Parkville, Australia. .,Centre for Food and Allergy Research, Parkville, Australia.
| | - Laurence Macia
- Charles Perkins Centre, Discipline of Pathology, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Ralph Nanan
- Charles Perkins Centre, Discipline of Pathology, School of Medical Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Mimi Lk Tang
- Murdoch Childrens Research Institute, Parkville, Australia.,The Royal Children's Hospital, Melbourne, Parkville, Australia
| | - Fiona Collier
- Deakin University, Geelong, Australia.,Barwon Health, Geelong, Australia.,Murdoch Childrens Research Institute, Parkville, Australia
| | - Susanne Brix
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Kongens Lyngby, Denmark
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19
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Gray LEK, O'Hely M, Ranganathan S, Sly PD, Vuillermin P. The Maternal Diet, Gut Bacteria, and Bacterial Metabolites during Pregnancy Influence Offspring Asthma. Front Immunol 2017; 8:365. [PMID: 28408909 PMCID: PMC5374203 DOI: 10.3389/fimmu.2017.00365] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/14/2017] [Indexed: 01/04/2023] Open
Abstract
This review focuses on the current evidence that maternal dietary and gut bacterial exposures during pregnancy influence the developing fetal immune system and subsequent offspring asthma. Part 1 addresses exposure to a farm environment, antibiotics, and prebiotic and probiotic supplementation that together indicate the importance of bacterial experience in immune programming and offspring asthma. Part 2 outlines proposed mechanisms to explain these associations including bacterial exposure of the fetoplacental unit; immunoglobulin-related transplacental transport of gut bacterial components; cytokine signaling producing fetomaternal immune alignment; and immune programming via metabolites produced by gut bacteria. Part 3 focuses on the interplay between diet, gut bacteria, and bacterial metabolites. Maternal diet influences fecal bacterial composition, with dietary microbiota-accessible carbohydrates (MACs) selecting short-chain fatty acid (SCFA)-producing bacteria. Current evidence from mouse models indicates an association between increased maternal dietary MACs, SCFA exposure during pregnancy, and reduced offspring asthma that is, at least in part, mediated by the induction of regulatory T lymphocytes in the fetal lung. Part 4 discusses considerations for future studies investigating maternal diet-by-microbiome determinants of offspring asthma including the challenge of measuring dietary MAC intake; limitations of the existing measures of the gut microbiome composition and metabolic activity; measures of SCFA exposure; and the complexities of childhood respiratory health assessment.
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Affiliation(s)
- Lawrence E K Gray
- Barwon Infant Study, School of Medicine, Deakin University, Geelong, VIC, Australia.,Child Health Research Unit, Barwon Health, Geelong, VIC, Australia
| | - Martin O'Hely
- Barwon Infant Study, School of Medicine, Deakin University, Geelong, VIC, Australia.,Respiratory Diseases, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Sarath Ranganathan
- Respiratory Diseases, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Peter David Sly
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Peter Vuillermin
- Barwon Infant Study, School of Medicine, Deakin University, Geelong, VIC, Australia.,Child Health Research Unit, Barwon Health, Geelong, VIC, Australia
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20
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Eldeirawi K, Kunzweiler C, Combs AMT, Persky VW. In utero exposure to pets is associated with asthma and wheezing in Mexican American children. J Asthma 2016; 53:374-81. [PMID: 26797097 DOI: 10.3109/02770903.2015.1104693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To examine the associations of in utero and early life exposure to cats/dogs and birds with the risk of lifetime doctor-diagnosed asthma and other respiratory conditions in a sample of Mexican American (MA) children 4-18 years of age. METHODS This study is a population-based cross-sectional investigation of 1816 MA children. We conducted multiple logistic models examining the relationship of asthma and wheezing with exposures to cats/dogs and birds in utero, infancy and at the time of the survey adjusted for country of birth, family history of asthma/allergies, antibiotics use in infancy and other covariates. RESULTS In adjusted analyses, in utero exposure to cats/dogs and birds jointly was associated with increased odds of asthma (adjusted odds ratio (aOR): 2.89; 95% confidence interval (CI): 1.34-6.23), ever wheezing (aOR: 1.96; 95% CI: 1.11-3.46) and current exercise-induced wheezing (aOR: 3.16; 95% CI: 1.27-7.85) compared to children not exposed to these pets in utero. Children who were exposed to both cats/dogs and birds in utero had an elevated, albeit statistically non-significant, odds of current wheezing. Exposures in infancy and at the time of the survey to cats/dogs and birds were not associated with asthma or wheezing. CONCLUSIONS In utero exposure to pets might be associated with an increased risk of asthma and respiratory conditions in a sample of non-affluent MA children.
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Affiliation(s)
- Kamal Eldeirawi
- a Department of Health Systems Science , College of Nursing and
| | - Colin Kunzweiler
- b Division of Epidemiology and Biostatistics , School of Public Health, University of Illinois at Chicago , Chicago , IL , USA
| | | | - Victoria W Persky
- b Division of Epidemiology and Biostatistics , School of Public Health, University of Illinois at Chicago , Chicago , IL , USA
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21
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Wang X, Liu W, Hu Y, Zou Z, Shen L, Huang C. Home environment, lifestyles behaviors, and rhinitis in childhood. Int J Hyg Environ Health 2015; 219:220-31. [PMID: 26712524 DOI: 10.1016/j.ijheh.2015.11.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/05/2015] [Accepted: 11/25/2015] [Indexed: 11/24/2022]
Abstract
The prevalence of children allergic rhinitis has been increasing in China and associated factors still are not clear. In the present paper, we selected 13,335 parent-reported questionnaires of 4-6 years-old children, in a cross-sectional study from April 2011 to April 2012 in Shanghai city, and investigated associations of various factors with parent-reported allergic rhinitis (doctor-diagnosed) and rhinitis symptoms in childhood. After adjusted by age, sex, family history of atopy, and respondent of questionnaire, we find that no siblings, mother in older age during pregnancy, shorter breastfeeding, using antibiotics in the first year, and home dampness-related exposures, had significant associations with increased prevalence of the studied diseases. Location, type, building area, decoration materials and construction period of the residence, also had significant associations with these diseases. Current parental smoking and pet-keeping had no significant associations with the studied diseases. Incense-burning and using mosquito coils had significant associations with reduced risk of allergic rhinitis and with increased risk of rhinitis symptoms. Using air cleaner and cleaning the residence in high frequency had associations with increased risk, but eating fast food and ice cream often had associations with the reduced risk, of the studied diseases. Families with children being diagnosed allergic rhinitis likely change their lifestyle behaviors. In conclusion, childhood rhinitis could be influenced by heredity and many "environmental exposures". Avoidance behaviors and reverse causation in parental smoking, pet-keeping, and dietary habits for childhood rhinitis should be carefully considered.
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Affiliation(s)
- Xueying Wang
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Wei Liu
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Yu Hu
- Tongji Architectural Design (Group) Company Limited (TJAD), Shanghai, PR China
| | - Zhijun Zou
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China
| | - Li Shen
- R&B Technology (Shanghai) Company Limited, Shanghai, PR China
| | - Chen Huang
- Department of Building Environment and Energy Engineering, School of Environment and Architecture, University of Shanghai for Science and Technology, Shanghai, PR China.
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22
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Martikainen MV, Kääriö H, Karvonen A, Schröder PC, Renz H, Kaulek V, Dalphin JC, von Mutius E, Schaub B, Pekkanen J, Hirvonen MR, Roponen M. Farm exposures are associated with lower percentage of circulating myeloid dendritic cell subtype 2 at age 6. Allergy 2015; 70:1278-87. [PMID: 26119336 DOI: 10.1111/all.12682] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Early life farm exposures have been shown to decrease the risk of allergic diseases. Dendritic cells (DCs) may mediate asthma-protective effect of farm exposures as they play an important role in the development of immunity and tolerance. Our aim was to investigate whether the numbers and phenotypes of circulating DCs at age 6 are associated with farming, asthma, and atopy in a selected sample of French and Finnish children from the PASTURE study. METHODS We studied 82 farm and 86 nonfarm children with and without asthma. Using flow cytometry, BDCA1+ CD11c+ myeloid DC1s (mDC1), BDCA3+(high) mDC2s and BDCA2+ plasmacytoid DCs (pDCs) were identified and expressions of CD86, immunoglobulin-like transcript 3 (ILT3) and ILT4 were analyzed. Questionnaires were used to assess prenatal and lifetime patterns of farm exposures and to define asthma. Atopic sensitization was defined by specific IgE measurements. RESULTS The percentage of mDC2 cells was lower in farm children (0.033 ± 0.001) than in nonfarm children (0.042 ± 0.001; P = 0.008). Similar associations were found between mDC2 percentage and prenatal (P = 0.02) and lifetime exposure to farm milk (P = 0.03) and stables (P = 0.003), but these associations were not independent from farming. Asthma was positively associated with ILT4 + mDCs (P = 0.04) and negatively with CD86 + pDCs (P = 0.048) but only in nonfarm children. CONCLUSIONS Inverse association between farm exposure and mDC2 percentage suggest that this DC subset may play a role in farm-related immunoregulation.
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Affiliation(s)
- M.-V. Martikainen
- Department of Environmental Science; University of Eastern Finland; Kuopio Finland
| | - H. Kääriö
- Department of Environmental Science; University of Eastern Finland; Kuopio Finland
| | - A. Karvonen
- Department of Health Protection; National Institute for Health and Welfare; Kuopio Finland
| | - P. C. Schröder
- Department of Allergy and Pulmonary; University Children's Hospital; Dr. von Hauner Children's Hospital; LMU Munich; Munich Germany
- Member of the German Center for Lung Research (DZL); Munich; Germany
| | - H. Renz
- Institute of Laboratory Medicine, Pathobiochemistry and Molecular Diagnostics; Philipps University; Marburg Germany
| | - V. Kaulek
- Department of Respiratory Disease; UMR/CNRS 6249 Chrono-Environment; University Hospital of Besançon; Besançon France
| | - J.-C. Dalphin
- Department of Respiratory Disease; UMR/CNRS 6249 Chrono-Environment; University Hospital of Besançon; Besançon France
| | - E. von Mutius
- Department of Allergy and Pulmonary; University Children's Hospital; Dr. von Hauner Children's Hospital; LMU Munich; Munich Germany
- Member of the German Center for Lung Research (DZL); Munich; Germany
| | - B. Schaub
- Department of Allergy and Pulmonary; University Children's Hospital; Dr. von Hauner Children's Hospital; LMU Munich; Munich Germany
- Member of the German Center for Lung Research (DZL); Munich; Germany
| | - J. Pekkanen
- Department of Public Health; University of Helsinki; Helsinki Finland
| | - M.-R. Hirvonen
- Department of Environmental Science; University of Eastern Finland; Kuopio Finland
- Department of Health Protection; National Institute for Health and Welfare; Kuopio Finland
| | - M. Roponen
- Department of Environmental Science; University of Eastern Finland; Kuopio Finland
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Herrant M, Loucoubar C, Boufkhed S, Bassène H, Sarr FD, Baril L, Mercereau-Puijalon O, Mécheri S, Sakuntabhai A, Paul R. Risk factors associated with asthma, atopic dermatitis and rhinoconjunctivitis in a rural Senegalese cohort. Allergy Asthma Clin Immunol 2015; 11:24. [PMID: 26306096 PMCID: PMC4547418 DOI: 10.1186/s13223-015-0090-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/10/2015] [Indexed: 11/25/2022] Open
Abstract
Background The World Allergy Organization estimates that 40 % of the world’s population is affected by allergic diseases. The International Study of Asthma and Allergies in Childhood has completed Phase III and it has now become clear that these diseases have increased in developing countries, especially Africa, where prevalence rates were formerly low. Despite an increase in studies in Africa, few sub-Saharan West African countries are represented; the focus has remained on urban populations and little attention has been paid to rural sub-Saharan Africa. Methods We performed an allergy survey in a birth cohort of children aged less than 15 years in rural Senegal and implemented an ISAAC questionnaire. We carried out a complete blood count and serological analyses for IgE levels against common allergens and mosquito saliva. Results The prevalence rates of asthma, rhinoconjunctivitis (RC) and
atopic dermatitis (AD) were 12.8, 12.5 and 12.2 % respectively. Specific IgE (sIgE) levels against mosquito spp. salivary gland antigens were significantly associated with AD; sIgE levels against selected true grasses (Poaceae) were significantly associated with RC. sIgE levels against house dust mite spp. were not associated with asthma, but were significantly correlated with mosquito IgE levels. Such cross-reactivity may blur the association between HDM sIgE and asthma. Consumption of seafood, storing whey cream, using plant fibre bedding and presence of carpet were significantly associated with increased risk of RC. The association of seafood may be the result of histamine intoxication from molluscs prepared by putrefaction. Cat presence and dog contact were associated with increased risk of asthma. Cow contact was associated with increased risk of AD. Conclusions Our allergy study in rural West Africa revealed lower prevalence rates than the majority of African urban settings. Although several associated known risk factors were identified, there were associations specific to the region. The identification of probable artefactual dietary phenomena is a challenge for robust diagnosis of allergic disease. The association AD with mosquito saliva, a common allergen in rural settings, warrants specific attention. Further studies in rural Africa are needed to address the aetiology of allergy in a non-urban environment. Electronic supplementary material The online version of this article (doi:10.1186/s13223-015-0090-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magali Herrant
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, 75724 Paris Cedex 15, France.,Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Cheikh Loucoubar
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, 75724 Paris Cedex 15, France.,Institut Pasteur de Dakar, Group of Biostatistics, Bioinformatics and Modeling, Dakar, Senegal
| | - Sabah Boufkhed
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Hubert Bassène
- Institut de Recherche pour le Développement (IRD), Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, URMITE CNRS-IRD 198 UMR 6236, Dakar, Senegal
| | - Fatoumata Diene Sarr
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | - Laurence Baril
- Institut Pasteur de Dakar, Unité d'Epidémiologie des Maladies Infectieuses, Dakar, Senegal
| | | | - Salaheddine Mécheri
- Institut Pasteur, Unité de Biologie des Interactions Hôte Parasite, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 2581, 75724 Paris Cedex 15, France
| | - Anavaj Sakuntabhai
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, 75724 Paris Cedex 15, France
| | - Richard Paul
- Institut Pasteur, Unité de la Génétique Fonctionnelle des Maladies Infectieuses, 28 rue du Docteur Roux, 75724 Paris Cedex 15, France.,Centre National de la Recherche Scientifique, Unité de Recherche Associée 3012, 75724 Paris Cedex 15, France
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Solé D, Camelo-Nunes IC, Wandalsen GF, Mallozi MC. Asthma in children and adolescents in Brazil: contribution of the International Study of Asthma and Allergies in Childhood (ISAAC). ACTA ACUST UNITED AC 2015; 32:114-25. [PMID: 24676199 PMCID: PMC4182995 DOI: 10.1590/s0103-05822014000100018] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 05/22/2013] [Indexed: 11/23/2022]
Abstract
Objective: To assess asthma among Brazilian pediatric population applying the International
Study of Asthma and Allergies in Childhood (ISAAC), an internationally
standardized and validated protocol. Data sources: ISAAC was conceived to maximize the value of epidemiologic studies on asthma and
allergic diseases, establishing a standardized method (self-applicable written
questionnaire and/or video questionnaire) capable to facilitate the international
collaboration. Designed to be carried out in three successive and dependent
phases, the ISAAC gathered a casuistic hitherto unimaginable in the world and in
Brazil. This review included data gathered from ISAAC official Brazilian centers
and others who used this method. Data synthesis: At the end of the first phase, it has been documented that the prevalence of
asthma among Brazilian schoolchildren was the eighth among all centers
participating all over the world. Few centers participated in the second phase and
investigated possible etiological factors, especially those suggested by the first
phase, and brought forth many conjectures. The third phase, repeated seven years
later, assessed the evolutionary trend of asthma and allergic diseases prevalence
in centers that participated simultaneously in phases I and III and in other
centers not involved in phase I. Conclusions: In Brazil, the ISAAC study showed that asthma is a disease of high prevalence and
impact in children and adolescents and should be seen as a Public Health problem.
Important regional variations, not well understood yet, and several risk factors
were found, which makes us wonder: is there only one or many asthmas in Brazil?
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Affiliation(s)
- Dirceu Solé
- Departamento de Pediatria, Escola Paulista de Medicina, Unifesp, Sao Paulo, SP, Brasil
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Sundaresan AS, Hirsch AG, Storm M, Tan BK, Kennedy TL, Greene JS, Kern RC, Schwartz BS. Occupational and environmental risk factors for chronic rhinosinusitis: a systematic review. Int Forum Allergy Rhinol 2015; 5:996-1003. [PMID: 26077513 DOI: 10.1002/alr.21573] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/07/2015] [Accepted: 05/14/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND Chronic rhinosinusitis (CRS) is a prevalent and disabling paranasal sinus disease, with a likely multifactorial etiology potentially including hazardous occupational and environmental exposures. We completed a systematic review of the occupational and environmental literature to evaluate the quality of evidence of the role that hazardous exposures might play in CRS. METHODS We searched PubMed for studies of CRS and following exposure categories: occupation, employment, work, industry, air pollution, agriculture, farming, environment, chemicals, roadways, disaster, and traffic. We abstracted information from the final set of articles across 6 primary domains: study design; population; exposures evaluated; exposure assessment; CRS definition; and results. RESULTS We identified 41 articles from 1080 manuscripts: 37 occupational risk papers, 1 environmental risk paper, and 3 papers studying both categories of exposures. None of the 41 studies used a CRS definition consistent with current diagnostic guidelines. Exposure assessment was generally dependent on self-report or binary measurements of exposure based on industry of employment. Only grain, dairy, and swine operations among farmers were evaluated by more than 1 study using a common approach to defining CRS, but employment in these settings was not consistently associated with CRS. The multiple other exposures did not meet quality standards for reporting associations or were not evaluated by more than 1 study. CONCLUSION The current state of the literature allows us to make very few conclusions about the role of hazardous occupational or environmental exposures in CRS, leaving a critical knowledge gap regarding potentially modifiable risk factors for disease onset and progression.
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Affiliation(s)
| | | | - Margaret Storm
- Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD
| | - Bruce K Tan
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Thomas L Kennedy
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Health System, Danville, PA
| | - J Scott Greene
- Department of Otolaryngology-Head and Neck Surgery, Geisinger Health System, Danville, PA
| | - Robert C Kern
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Brian S Schwartz
- Center for Health Research, Geisinger Health System, Danville, PA.,Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Uphoff E, Cabieses B, Pinart M, Valdés M, Antó JM, Wright J. A systematic review of socioeconomic position in relation to asthma and allergic diseases. Eur Respir J 2014; 46:364-74. [PMID: 25537562 DOI: 10.1183/09031936.00114514] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 11/24/2014] [Indexed: 01/11/2023]
Abstract
The role of socioeconomic position (SEP) in the development of asthma and allergies is unclear, with some pointing to the risks of low SEP and other research pointing in the direction of higher SEP being associated with higher prevalence rates. The aim of this systematic review is to clarify associations between SEP and the prevalence of asthma and allergies. Out of 4407 records identified, 183 were included in the analysis. Low SEP was associated with a higher prevalence of asthma in 63% of the studies. Research on allergies, however, showed a positive association between higher SEP and illness in 66% of studies. Pooled estimates for the odds ratio of disease for the highest compared with the lowest SEP confirmed these results for asthma (unadjusted OR 1.38, 95% CI 1.37-1.39), allergies in general (OR 0.67, 95% CI 0.62-0.72), atopic dermatitis (unadjusted OR 0.72, 95% CI 0.61-0.83) and allergic rhinoconjunctivitis (unadjusted OR 0.52, 95% CI 0.46-0.59). Sensitivity analyses with a subsample of high-quality studies led to the same conclusion. Evidence from this systematic review suggests that asthma is associated with lower SEP, whereas the prevalence of allergies is associated with higher SEP.
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Affiliation(s)
- Eleonora Uphoff
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK. Dept of Health Sciences, University of York, York, UK.
| | - Báltica Cabieses
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK. Dept of Health Sciences, University of York, York, UK. Universidad del Desarrollo, Clínica Alemana, Santiago, Chile
| | - Mariona Pinart
- Centre for Research in Environmental Epidemiology, Barcelona, Spain. IMIM (Hospital del Mar Research Institute), Barcelona, Spain. CIBER Epidemiología y Salud Pública, Barcelona, Spain. Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - Macarena Valdés
- PhD in Public Health Programme, Universidad de Chile, Santiago, Chile
| | - Josep Maria Antó
- Centre for Research in Environmental Epidemiology, Barcelona, Spain. IMIM (Hospital del Mar Research Institute), Barcelona, Spain. CIBER Epidemiología y Salud Pública, Barcelona, Spain. Departament de Ciències Experimentals i de la Salut, Universitat Pompeu Fabra, Barcelona, Spain
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
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Liu F, Zhao Y, Liu YQ, Liu Y, Sun J, Huang MM, Liu Y, Dong GH. Asthma and asthma related symptoms in 23,326 Chinese children in relation to indoor and outdoor environmental factors: the Seven Northeastern Cities (SNEC) Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2014; 497-498:10-17. [PMID: 25112820 DOI: 10.1016/j.scitotenv.2014.07.096] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Both the levels and patterns of outdoor and indoor air pollutants have changed dramatically during the last decade in China. However, few studies have evaluated the effects of the present air pollution on the health of Chinese children. This study examines the association between outdoor and indoor air pollution and respiratory diseases among children living in Liaoning, a heavy industrial province of China. METHODS A cross-sectional study of 23,326 Chinese children aged 6 to 13 years was conducted in 25 districts of 7 cities in Northeast China during 2009. Three-year (2006-2008) average concentrations of particles with an aerodynamic diameter of ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxides (NO2), and ozone (O3) were calculated from monitoring stations in each of the 25 districts. We used two-level logistic regression models to examine the effects of yearly variations in exposure to each pollutant, controlling for important covariates. RESULTS The prevalence of respiratory symptoms was higher for those dwelling close to a busy road, those living near smokestacks or factories, those living with smokers, those living in one-story houses typically with small yards, and those with home renovation, bedroom carpet or pets. Ventilation device use was associated with decreased odds of asthma in children. The adjusted odds ratio for diagnosed-asthma was 1.34 (95% confidence interval [CI], 1.24-1.45) per 31 μg/m(3) increase in PM10, 1.23 (95%CI, 1.14-1.32) per 21 μg/m(3) increase in SO2, 1.25 (95%CI, 1.16-1.36) per 10 μg/m(3) increase in NO2, and 1.31 (95%CI, 1.21-1.41) per 23 μg/m(3) increase in O3, respectively. CONCLUSION Outdoor and indoor air pollution was associated with an increased likelihood of respiratory morbidity among Chinese children.
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Affiliation(s)
- Fan Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Yang Zhao
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Yu-Qin Liu
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Yang Liu
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Jing Sun
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Mei-Meng Huang
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Yi Liu
- Department of Orthodontics, School of Stomatology, China Medical University, Shenyang, Liaoning Province 110001, PR China.
| | - Guang-Hui Dong
- Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong Province 510080, PR China.
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on childhood asthma specifically related to the underlying genetic background and pathophysiology of asthma and their interaction with environmental stimuli. We will also discuss emerging data in the field of disease phenotyping. RECENT FINDINGS The field of genetics is continuously evolving to expand our knowledge on the cause of disease. Childhood onset asthma has been related to atopy and exposure to early-life infections. More recently, phenotypes have been used to classify asthma as transient and persistent, but the association of each phenotype with the genetic origin of asthma is not clearly understood. SUMMARY This review covers the topics of genetics, epigenetics, pathophysiology, phenotypes and treatment as they relate to childhood asthma. Overall, it provides a basis for the future of asthma treatment through description of the current research.
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Can economic deprivation protect health? Paradoxical multilevel effects of poverty on Hispanic children's wheezing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:7856-73. [PMID: 25101769 PMCID: PMC4143837 DOI: 10.3390/ijerph110807856] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/23/2014] [Accepted: 07/29/2014] [Indexed: 11/17/2022]
Abstract
Prior research suggests that economic deprivation has a generally negative influence on residents’ health. We employ hierarchical logistic regression modeling to test if economic deprivation presents respiratory health risks or benefits to Hispanic children living in the City of El Paso (Texas, USA) at neighborhood- and individual-levels, and whether individual-level health effects of economic deprivation vary based on neighborhood-level economic deprivation. Data come from the US Census Bureau and a population-based survey of El Paso schoolchildren. The dependent variable is children’s current wheezing, an established respiratory morbidity measure, which is appropriate for use with economically-deprived children with an increased likelihood of not receiving a doctor’s asthma diagnosis. Results reveal that economic deprivation (measured based on poverty status) at both neighborhood- and individual-levels is associated with reduced odds of wheezing for Hispanic children. A sensitivity analysis revealed similar significant effects of individual- and neighborhood-level poverty on the odds of doctor-diagnosed asthma. Neighborhood-level poverty did not significantly modify the observed association between individual-level poverty and Hispanic children’s wheezing; however, greater neighborhood poverty tends to be more protective for poor (as opposed to non-poor) Hispanic children. These findings support a novel, multilevel understanding of seemingly paradoxical effects of economic deprivation on Hispanic health.
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30
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Lim A, Asher MI, Ellwood E, Ellwood P, Exeter DJ. How are 'urban' and 'rural' defined in publications regarding asthma and related diseases? Allergol Immunopathol (Madr) 2014; 42:157-61. [PMID: 23735168 DOI: 10.1016/j.aller.2013.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 02/02/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Global variations in the prevalence of asthma and related diseases have suggested that environmental factors are causative, and that factors associated with urbanisation are of particular interest. A range of definitions for 'urban' and 'rural' have been used in articles on asthma and related diseases, making it difficult to assess their importance as aetiological factors. This study sets out to examine such definitions used in the literature. METHODS Medical and social science databases were searched for articles that made distinctions of 'urban' and/or 'rural' in the context of asthma and related diseases. RESULTS The search identified 73 articles and categorised four types of definitions. A specific definition of urban or rural was used in 19 (26%) articles. Nine (12%) articles used non-specific and/or administrative definitions. There were 23 (32%) articles that described locations as 'urban' or 'rural' but did not indicate if the description defined 'urban' or 'rural'. Distinctions were made between urban and rural locations without a description or definition in 22 (30%) articles. CONCLUSIONS There is substantial variation in the definitions of 'urban' and 'rural' in articles regarding asthma and related diseases. It would be advantageous to have clearer and more precise definitions of 'urban' and 'rural' which could facilitate aetiological research and also comparisons between locations, especially in international studies.
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Affiliation(s)
- A Lim
- Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand.
| | - M I Asher
- Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand
| | - E Ellwood
- Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand
| | - P Ellwood
- Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand
| | - D J Exeter
- Epidemiology & Biostatistics, School of Population Health, The University of Auckland, New Zealand
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Kim YA, Collins TW, Grineski SE. Neighborhood context and the Hispanic health paradox: differential effects of immigrant density on children׳s wheezing by poverty, nativity and medical history. Health Place 2014; 27:1-8. [PMID: 24509419 DOI: 10.1016/j.healthplace.2014.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/04/2014] [Accepted: 01/19/2014] [Indexed: 01/16/2023]
Abstract
Prior research suggests that immigrant enclaves provide respiratory health benefits for US Hispanic residents. We test if immigrant enclaves provide differential respiratory health benefits for Hispanic children in El Paso (Texas) based on individual-level factors. Results reveal that higher neighborhood immigrant density is associated with reduced odds of wheezing, but that the protective immigrant enclave effect is modified by poverty, general health status, body mass index (BMI), and caretaker nativity. Higher immigrant density is significantly more protective for poor children and those with foreign-born caretakers; conversely, it is significantly less protective for children in worse health and those with higher BMI. These findings foster a novel understanding of how immigrant enclaves may be differentially protective for Hispanic children based on individual-level factors.
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Affiliation(s)
- Young-An Kim
- Department of Sociology & Anthropology, University of Texas at El Paso, 500 West University Ave, El Paso, Texas 79968, USA.
| | - Timothy W Collins
- Department of Sociology & Anthropology, University of Texas at El Paso, 500 West University Ave, El Paso, Texas 79968, USA.
| | - Sara E Grineski
- Department of Sociology & Anthropology, University of Texas at El Paso, 500 West University Ave, El Paso, Texas 79968, USA.
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Solis-Soto MT, Patiño A, Nowak D, Radon K. Association between environmental factors and current asthma, rhinoconjunctivitis and eczema symptoms in school-aged children from Oropeza Province--Bolivia: a cross-sectional study. Environ Health 2013; 12:95. [PMID: 24192069 PMCID: PMC4228317 DOI: 10.1186/1476-069x-12-95] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 10/30/2013] [Indexed: 05/09/2023]
Abstract
BACKGROUND In recent years, the prevalence of asthma, rhinoconjunctivitis and eczema symptoms in childhood has considerably increased in developing countries including Bolivia, possibly due to changes in lifestyle, environmental and domestic factors. This study aimed to assess the association between environmental factors and asthma, rhinoconjuctivitis and eczema symptoms in school-aged children from Oropeza Province in Chuquisaca, Bolivia. METHODS A cross-sectional study was performed in 2340 children attending the fifth grade in 36 randomly selected elementary schools in Oropeza province. The prevalence of symptoms was determined using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. Environmental factors were assessed by the ISAAC environmental questionnaire including questions related to exposure to pets, farm animals, indoor and outdoor pollution, presence of disease vectors at home and precarious household conditions. Generalized linear mixed-effects models were adjusted for age, sex and place of living. RESULTS Thirty seven percent of children reported that at least one of their parents smoked at home. Wood or coal was used as cooking fuel in 19% of the homes and 29% reported intense truck traffic on the street where they lived. With respect to hygiene conditions, 86% reported exposure to dogs, 59% exposure to cats and 36% regular contact to farm animals. More than one precarious household condition was reported by 8% of children. In the adjusted model exposure to dog (adjusted OR 1.4; CI 95% 1.0-1.9), cat (1.2; 1.0-1.5), farm animals (1.5; 1.2-1.8); intense truck traffic (1.3; 1.0-1.6), parents smoking at home (1.2; 1.0-1.5), presence of disease vectors at home (fourth quartile vs. first quartile: 1.6; 1.2-2.3) and two or more precarious household conditions (1.5; 1.0-2.2) were significantly associated with rhinoconjunctivitis symptoms. The associations were similar for asthma and eczema symptoms; however it did not reach the level of statistical significance for all items. CONCLUSION Our results support previous findings reported for poor communities especially in Latin America, showing that lower hygiene conditions did not have protective effect against asthma and rhinoconjunctivitis and eczema symptoms.
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Affiliation(s)
| | - Armando Patiño
- Departmental Service of Health (SEDES) - Chuquisaca, Bolivia, South America
| | - Dennis Nowak
- Institute for Occupational, Social and Environmental Medicine, Occupational and Environmental Epidemiology & Net Teaching Unit, University Hospital Munich (LMU), Munich, Germany
| | - Katja Radon
- Institute for Occupational, Social and Environmental Medicine, Occupational and Environmental Epidemiology & Net Teaching Unit, University Hospital Munich (LMU), Munich, Germany
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Morais-Almeida M, Santos N, Pereira AM, Branco-Ferreira M, Nunes C, Bousquet J, Fonseca JA. Prevalence and classification of rhinitis in preschool children in Portugal: a nationwide study. Allergy 2013; 68:1278-88. [PMID: 24053488 DOI: 10.1111/all.12221] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND Information on rhinitis epidemiology in preschool children is scarce. OBJECTIVES To estimate, in children with 3-5 years of age, current rhinitis prevalence, to describe rhinitis symptoms and associated sociodemographic characteristics, and to report allergic rhinitis and its impact on asthma (ARIA) classification. METHODS Cross-sectional, nationwide, population-based study including children aged 3-5 years. A multistep selection strategy was used to obtain a representative sample. Data were collected at kindergartens and parish centers by face-to-face interview to caregivers, using an adapted ISAAC questionnaire. 'Current rhinitis' (CR) was defined as the presence of ≥1 rhinitis symptom (repeated sneezing and/or itchy nose, blocked nose for >1 h, or runny nose without having a cold/flu) in the last year. Rhinitis lasting ≥4 days/week and ≥4 consecutive weeks was classified as persistent. Moderate-severe disease interfered 'a moderate amount' or 'a lot' in daily activities. RESULTS Five thousand and eighteen children were included. CR prevalence was 43.4% [95% CI (42.0-44.8%); n = 2179] and that of physician-diagnosed rhinitis was 11.7% [95% CI (10.8-12.6%); n = 588]. Of children with CR, 67% reported blocked nose, 48% rhinorrhea, and 46% sneezing/itchy nose. Considering ARIA classification, 30% of the population had mild intermittent, 3% mild persistent, 7% moderate-severe intermittent, and 3% moderate-severe persistent rhinitis. Children with CR had more current wheezing, physician-diagnosed asthma, self-reported food allergy, and family history of allergic disease. These characteristics were also associated with persistent and moderate-severe rhinitis. CONCLUSIONS This is the first nationwide population-based study reporting rhinitis prevalence and ARIA classification in preschool children. In this age-group, rhinitis is frequent and underdiagnosed. About 25% children with rhinitis presented moderate-severe disease.
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Affiliation(s)
| | | | | | | | | | - J. Bousquet
- Department of Allergy and Respiratory Diseases; University Hospital and INSERM; Montpellier; France
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Affiliation(s)
- Debbie Jarvis
- National Heart and Lung Institute and MRC-HPA Centre for Environment and Health, Imperial College, London, SW3 6LR, UK.
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35
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Sozańska B, Pearce N, Dudek K, Cullinan P. Consumption of unpasteurized milk and its effects on atopy and asthma in children and adult inhabitants in rural Poland. Allergy 2013; 68:644-50. [PMID: 23534445 DOI: 10.1111/all.12147] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Consumption of unpasteurized cow's milk has been identified as a possible protective factor for atopy and asthma. Most studies have been conducted among children and in farming populations. We investigated the effects of consumption of unpasteurized milk in early life on atopy, asthma, and rhinitis in village and town inhabitants in a region of Poland and assessed whether any protective effects of milk consumption differed according to place of residence and farming status. METHODS We surveyed the inhabitants (aged >5 years) of a small town and seven nearby villages in southwest Poland (n = 1700, response rate 88%). Participants (or their parents for those <16 years of age) completed a questionnaire on farm exposures and symptoms of asthma and rhinitis. In particular, information was collected on unpasteurized milk consumption in early life. Atopy was assessed using skin prick tests. RESULTS Consumption of unpasteurized milk in the first year of life was inversely associated with atopy and asthma both among town and village inhabitants - town: adjusted odds ratio (aOR) for atopy 0.46 [95% confidence interval (CI) 0.37-0.52] asthma 0.51 (0.32-0.74); villages: atopy 0.59 (0.44-0.70) and asthma 0.59 (0.42-0.74). For atopy, the protective effect was more clearly seen among nonfarmers (0.42; 0.34-0.46) than in farmers (0.82; 0.54-1.11). For doctor-diagnosed hay fever and current rhinitis symptoms, the protective effect was only observed among town inhabitants and/or nonfarmers. CONCLUSIONS Early-life exposure to unpasteurized milk may protect against atopy, asthma, and related conditions, independently of place of residence and farming status, and in both children and adults.
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Affiliation(s)
- B. Sozańska
- 1st Department of Pediatrics, Allergology and Cardiology; Wroclaw Medical University; Wroclaw; Poland
| | | | - K. Dudek
- Institute of Machines Design and Operation; Technical University of Wroclaw; Wroclaw; Poland
| | - P. Cullinan
- Imperial College (NHLI) and Royal Brompton Hospital; London; UK
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Risks of new-onset allergic sensitization and airway inflammation after early age swimming in chlorinated pools. Int J Hyg Environ Health 2013; 217:38-45. [PMID: 23601779 DOI: 10.1016/j.ijheh.2013.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 03/08/2013] [Accepted: 03/12/2013] [Indexed: 02/06/2023]
Abstract
RATIONALE Irritant chlorination products in swimming pools can cause respiratory problems in swimmers but their possible implication in allergies development is still unclear. OBJECTIVES To assess prospectively whether early-life attendance at chlorinated pools increases the risks of IgE sensitization and of airways inflammation later during childhood. METHODS We conducted a two-year prospective study among 196 kindergarten children (mean age of 5.7 years, 54% of boys). We measured exhaled nitric oxide (eNO) and aeroallergen-specific IgE in nasal mucosa. Parents completed a questionnaire about the child's health, chlorinated pool attendance and potential confounders. MAIN RESULTS Ever swimming at indoor or outdoor chlorinated pools before the age of three years was associated with higher odds for new-onset IgE sensitization to house dust mite (adjusted odds ratio [aOR] 2.93, 95% confidence interval [CI] 1.14-7.55) and for new-onset increased eNO (>15 ppb; aOR, 4.54, 95% CI 1.48-13.9). For both outcomes, aORs increased dose-dependently with time spent in chlorinated pools with values reaching, respectively, 3.60 (95% CI 1.21-10.7) and 5.92 (95% CI 1.72-20.5) when the cumulative pool attendance exceeded 60 h These risks appeared independently of each other, of parental history of allergies and of pre-existing diseases, including eczema, which at baseline was more prevalent in early swimmers (aOR, 2.91; 95% CI 1.23-6.89). Such associations were not seen with IgE sensitization to pollen or cat allergens. CONCLUSION Attendance at chlorinated swimming pools in early life is associated with higher risks of new-onset airways inflammation and IgE sensitization to house dust mite, independently of other risk factors.
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Tischer CG, Gref A, Standl M, Bauer M, Bergström A, Brauer M, Carlsten C, Gehring U, Granell R, Henderson J, Kerkhof M, MacNutt M, Melén E, Wickman M, Heinrich J. Glutathione-S-transferase P1, early exposure to mould in relation to respiratory and allergic health outcomes in children from six birth cohorts. A meta-analysis. Allergy 2013; 68:339-46. [PMID: 23330922 DOI: 10.1111/all.12093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are conflicting study results regarding the association of exposure to visible mould and fungal components in house dust with respiratory and allergic diseases in children. It has been suggested that functional polymorphisms of the GSTP1 gene may influence the risk for allergic disorders through an impaired defence against oxidant injury. METHODS We examined in six birth cohorts of over 14 000 children whether the association between early exposure to reported mould at home in relation to respiratory and allergic diseases is modified by a single nucleotide polymorphism of the GSTP1 gene. RESULTS We observed a positive association of mould exposure with nasal symptoms (2-10 year) aOR: 1.19 (1.02-11.38). Further, there was a borderline significant increased risk of rhinoconjunctivitis (6-8 year) in children homozygous for the minor allele Val/Val, aOR: 1.25 (0.98-1.60). In stratified analyses, subjects homozygous for the minor allele and exposed to mould at home were at increased risk for early wheezing aOR: 1.34 (1.03-1.75), whereas the major allele may confer susceptibility for later nasal outcomes, (6-8 year) aOR: 1.20 (1.00-1.45) and (2-10 year) aOR: 1.30 (1.04-1.61), respectively. For none of the health outcomes studied, we found gene by environment interactions. CONCLUSION A genetic influence of the GSTP1 gene cannot be ruled out, but the magnitude of the effect is a matter of further research. In conclusion, the interplay between gene and environments is complex and remains subject of further study.
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Affiliation(s)
- C. G. Tischer
- Helmholtz Centre Munich; German Research Centre for Environmental Health; Institute of Epidemiology I; Neuherberg; Germany
| | - A. Gref
- Institute of Environmental Medicine; Centre for Allergy Research; Karolinska Institutet; Stockholm; Sweden
| | - M. Standl
- Helmholtz Centre Munich; German Research Centre for Environmental Health; Institute of Epidemiology I; Neuherberg; Germany
| | - M. Bauer
- Department of Environmental Immunology; UFZ - Helmholtz Centre for Environmental Research; Leipzig; Germany
| | - A. Bergström
- Institute of Environmental Medicine; Centre for Allergy Research; Karolinska Institutet; Stockholm; Sweden
| | - M. Brauer
- School of Population and Public Health & Department of Medicine - Atmospheric Science Programme; Faculty of Medicine; University of British Columbia; Vancouver; BC; Canada
| | - C. Carlsten
- Respiratory Medicine Division; University of British Columbia; Vancouver; BC; Canada
| | - U. Gehring
- Institute for Risk Assessment Sciences; Utrecht University; Utrecht; the Netherlands
| | - R. Granell
- School of Social and Community Medicine; University of Bristol; Bristol; UK
| | - J. Henderson
- School of Social and Community Medicine; University of Bristol; Bristol; UK
| | - M. Kerkhof
- Department of Epidemiology; University Medical Centre Groningen; University of Groningen; Groningen; the Netherlands
| | - M. MacNutt
- Respiratory Medicine Division; University of British Columbia; Vancouver; BC; Canada
| | - E. Melén
- Institute of Environmental Medicine; Centre for Allergy Research; Karolinska Institutet; Stockholm; Sweden
| | - M. Wickman
- Institute of Environmental Medicine; Centre for Allergy Research; Karolinska Institutet; Stockholm; Sweden
| | - J. Heinrich
- Helmholtz Centre Munich; German Research Centre for Environmental Health; Institute of Epidemiology I; Neuherberg; Germany
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Lung dendritic cell developmental programming, environmental stimuli, and asthma in early periods of life. J Allergy (Cairo) 2012; 2012:176468. [PMID: 23209481 PMCID: PMC3503332 DOI: 10.1155/2012/176468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 09/29/2012] [Accepted: 09/30/2012] [Indexed: 12/22/2022] Open
Abstract
Dendritic cells (DCs) are important cells of our innate immune system. Their role is critical in inducing adaptive immunity, tolerance, or allergic response in peripheral organs—lung and skin. The lung DCs are not developed prenatally before birth. The DCs develop after birth presumably during the first year of life; exposures to any foreign antigen or infectious organisms during this period can significantly affect DC developmental programming and generation of distinct DC phenotypes and functions. These changes can have both short-term and long-term health effects which may be very relevant in childhood asthma and predisposition for a persistent response in adulthood. An understanding of DC development at molecular and cellular levels can help in protecting neonates and infants against problematic environmental exposures and developmental immunotoxicity. This knowledge can eventually help in designing novel pharmacological modulators to skew the DC characteristics and immune responses to benefit the host across a lifetime.
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Feehley T, Stefka AT, Cao S, Nagler CR. Microbial regulation of allergic responses to food. Semin Immunopathol 2012; 34:671-88. [PMID: 22941410 PMCID: PMC3874145 DOI: 10.1007/s00281-012-0337-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/17/2012] [Indexed: 02/07/2023]
Abstract
The incidence of food allergy in developed countries is rising at a rate that cannot be attributed to genetic variation alone. In this review, we discuss the environmental factors that may contribute to the increasing prevalence of potentially fatal anaphylactic responses to food. Decreased exposure to enteric infections due to advances in vaccination and sanitation, along with the adoption of high-fat (Western) diets, antibiotic use, Cesarean birth, and formula feeding of infants, have all been implicated in altering the enteric microbiome away from its ancestral state. This collection of resident commensal microbes performs many important physiological functions and plays a central role in the development of the immune system. We hypothesize that alterations in the microbiome interfere with immune system maturation, resulting in impairment of IgA production, reduced abundance of regulatory T cells, and Th2-skewing of baseline immune responses which drive aberrant responses to innocuous (food) antigens.
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Affiliation(s)
- Taylor Feehley
- Committee on Immunology and Department of Pathology, University of Chicago, Chicago, IL, USA
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Svanes C. Commentary: a step towards understanding asthma in low- and middle-income countries. Int J Epidemiol 2012; 41:761-3. [PMID: 22523200 DOI: 10.1093/ije/dys051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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