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Uraguchi K, Matsumoto N, Mitsuhashi T, Takao S, Makihara S, Ando M, Yorifuji T. Association Between Clinical Remission of Infantile-Onset Allergic Rhinitis During the School-Age Period and the Type of Housing: A Longitudinal Population-Based Japanese Study. J Pediatr Health Care 2024; 38:629-636. [PMID: 38127044 DOI: 10.1016/j.pedhc.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
This study investigated the association between housing type and clinical remission of infantile-onset allergic rhinitis (AR) in 53,575 children born in 2001 in Japan. Infantile-onset AR was defined as the presence of AR symptoms reported between ages 1.5 and 4.5 years, and remission was assessed between ages 10 and 12. The type of housing was categorized into detached houses and multi-unit residential buildings with 1-2, 3-5, or ≥6 floors. Among the 4,352 infantile-onset AR, 42.9% experienced remission. Notably, living in multi-unit residential buildings, particularly those with 1-2 and ≥6 floors, was positively associated with AR remission.
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Lisik D, Ermis SSÖ, Ioannidou A, Milani GP, Nyassi S, Spolidoro GCI, Kankaanranta H, Goksör E, Wennergren G, Nwaru BI. Is sibship composition a risk factor for childhood asthma? Systematic review and meta-analysis. World J Pediatr 2023; 19:1127-1138. [PMID: 36997765 PMCID: PMC10590346 DOI: 10.1007/s12519-023-00706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/12/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Following the "hygiene hypothesis", the role of sibship composition in asthma and wheezing has been extensively studied, but the findings are inconsistent. For the first time, this systematic review and meta-analysis synthesized evidences from studies investigating the association of sibship size and birth order with risk of asthma and wheezing. METHODS Fifteen databases were searched to identify eligible studies. Study selection and data extraction were performed independently by pairs of reviewers. Meta-analysis with robust variance estimation (RVE) was used to produce pooled risk ratio (RR) effect estimates from comparable numerical data. RESULTS From 17,466 identified records, 158 reports of 134 studies (> 3 million subjects) were included. Any wheezing in the last ≤ 1.5 years occurred more frequently in infants with ≥ 1 sibling [pooled RR 1.10, 95% confidence interval (CI) 1.02-1.19] and ≥ 1 older sibling (pooled RR 1.16, 95% CI 1.04-1.29). The pooled effect sizes for asthma were overall statistically nonsignificant, although having ≥ 1 older sibling was marginally protective for subjects aged ≥ 6 years (pooled RR 0.93, 95% CI 0.88-0.99). The effect estimates weakened in studies published after 2000 compared with earlier studies. CONCLUSIONS Being second-born or later and having at least one sibling is associated with a slightly increased risk of temporary wheezing in infancy. In contrast, being second-born or later is associated with marginal protection against asthma. These associations appear to have weakened since the turn of the millennium, possibly due to lifestyle changes and socioeconomic development. Video Abstract.
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Affiliation(s)
- Daniil Lisik
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Medicinaregatan 1F, 413 90, Göteborg, Sweden.
| | - Saliha Selin Özuygur Ermis
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Medicinaregatan 1F, 413 90, Göteborg, Sweden
- Department of Respiratory Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Athina Ioannidou
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Medicinaregatan 1F, 413 90, Göteborg, Sweden
| | - Gregorio Paolo Milani
- Department of Clinical Science and Community Health, University of Milan, 20122, Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
| | - Sungkutu Nyassi
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Medicinaregatan 1F, 413 90, Göteborg, Sweden
| | | | - Hannu Kankaanranta
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Medicinaregatan 1F, 413 90, Göteborg, Sweden
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Emma Goksör
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Göran Wennergren
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Medicinaregatan 1F, 413 90, Göteborg, Sweden
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bright Ibeabughichi Nwaru
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Medicinaregatan 1F, 413 90, Göteborg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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Ilmarinen P, Julkunen-Iivari A, Lundberg M, Luukkainen A, Nuutinen M, Karjalainen J, Huhtala H, Pekkanen J, Kankaanranta H, Toppila-Salmi S. Cluster Analysis of Finnish Population-Based Adult-Onset Asthma Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3086-3096. [PMID: 37268268 DOI: 10.1016/j.jaip.2023.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Phenotypes of adult asthma have been identified in previous studies but rarely in population-based settings. OBJECTIVE To identify clusters of adult-onset asthma in a Finnish population-based study on subjects born before 1967. METHODS We used population-based data from 1350 asthmatics with adult-onset asthma (Adult Asthma in Finland) from Finnish national registers. Twenty-eight covariates were selected based on literature. The number of covariates was reduced by using factor analysis before cluster analysis. RESULTS Five clusters (CLU1-CLU5) were identified, 3 clusters with late-onset adult asthma (onset ≥40 years) and 2 clusters with onset at earlier adulthood (<40 years). Subjects in CLU1 (n = 666) had late-onset asthma and were nonobese, symptomatic, and predominantly female with few respiratory infections during childhood. CLU2 (n = 36) consisted of subjects who had earlier-onset asthma, were predominantly female, obese with allergic asthma, and had recurrent respiratory infections. Subjects in CLU3 (n = 75) were nonobese, older, and predominantly men with late-onset asthma, smoking history, comorbidities, severe asthma, least allergic diseases, low education, many siblings, and childhood in rural areas. CLU4 (n = 218) was a late-onset cluster consisting of obese females with comorbidities, asthma symptoms, and low education level. Subjects in CLU5 (n = 260) had earlier onset asthma, were nonobese, and predominantly allergic females. CONCLUSIONS Our population-based adult-onset asthma clusters take into account several critical factors such as obesity and smoking, and identified clusters that partially overlap with clusters identified in clinical settings. Results give us a more profound understanding of adult-onset asthma phenotypes and support personalized management.
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Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anna Julkunen-Iivari
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Marie Lundberg
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Annika Luukkainen
- Inflammation Center, Department of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikko Nuutinen
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland
| | - Jussi Karjalainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Juha Pekkanen
- Department of Public Health, University of Helsinki, Helsinki, Finland; Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Internal Medicine and Clinical Nutrition, Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Sanna Toppila-Salmi
- Department of Allergy, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Haartman Institute, Medicum, University of Helsinki, Helsinki, Finland; Department of Pulmonary Medicine, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Lisik D, Ermis SSÖ, Ioannidou A, Milani GP, Nyassi S, Spolidoro GCI, Kankaanranta H, Goksör E, Wennergren G, Nwaru BI. Siblings and risk of allergic rhinitis: A systematic review and meta-analysis. Pediatr Allergy Immunol 2023; 34:e13991. [PMID: 37492922 DOI: 10.1111/pai.13991] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023]
Abstract
Following the "hygiene hypothesis" and the increase in the prevalence of atopic diseases such as allergic rhinitis, a plethora of studies have investigated the role of sibship composition as a protective factor, but findings are conflicting. The aim of this study was to synthesize the global literature linking birth order and sibship size (number of siblings) to the risk of allergic rhinitis. Fifteen databases were systematically searched, with no restrictions on publication date or language. Observational studies with defined sibship composition (birth order or sibship size) as exposure and allergic rhinitis or allergic rhinoconjunctivitis (self-reported or clinically diagnosed) as outcome were eligible. Study selection, data extraction, and quality assessment were performed independently in pairs. Relevant data were summarized in tables. Comparable numerical data were analyzed using meta-analysis with robust variance estimation (RVE). Seventy-six reports with >2 million subjects were identified. Being second- or later-born child was associated with protection against both current (pooled risk ratio [RR] 0.79, 95% CI 0.73-0.86) and ever (RR 0.77, 95% CI 0.68-0.88) allergic rhinitis. Having siblings, regardless of birth order, was associated with a decreased risk of current allergic rhinitis (RR 0.89, 95% CI 0.83-0.95) and allergic rhinoconjunctivitis (RR 0.92, 95% CI 0.86-0.98). These effects were unchanged across age, time period, and geographical regions. Our findings thus indicate that primarily, a higher birth order, and to a lesser extent the number of siblings, is associated with a lower risk of developing allergic rhinitis.
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Affiliation(s)
- Daniil Lisik
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Saliha Selin Özuygur Ermis
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Respiratory Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Athina Ioannidou
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Gregorio Paolo Milani
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sungkutu Nyassi
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Hannu Kankaanranta
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Tampere University Respiratory Research Group, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Emma Goksör
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Göran Wennergren
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bright Ibeabughichi Nwaru
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
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Sakihara T, Otsuji K, Arakaki Y, Hamada K, Matsui T, Sugiura S, Ito K. Effects of regular soy formula intake between 1 and 2 months of age on food sensitization in infancy. Pediatr Allergy Immunol 2022; 33:e13898. [PMID: 36564877 DOI: 10.1111/pai.13898] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 11/09/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effects of regular soy formula (SF) intake on the development of food sensitization in infancy remain unclear. This study aimed to assess the effects of regular SF intake between 1 and 2 months of age on food sensitization development by 6 months of age. METHODS Using data from a randomized controlled trial of a birth cohort from four Japanese hospitals that assessed cow's milk allergy development, we performed a retrospective cohort study of 235 infants who avoided cow's milk formula and supplemented breastfeeding with SF as required between 1 and 2 months of age. Regular SF intake was defined as SF consumption of ≥14 days per month and ≥1350 ml per month. Food sensitization was defined as positive skin prick test reactions to hen's egg, cow's milk, wheat, and/or soy. Using multivariable logistic regression models that adjusted for parental, perinatal, and environmental factors, we calculated the adjusted odds ratios of regular SF intake for food, hen's egg, and cow's milk sensitization by 6 months of age. RESULTS From the 235 participants, 114 (48.5%) had regular SF intake. The adjusted odds ratios of regular SF intake for food, hen's egg, and cow's milk sensitization were 0.32 (95% confidence interval: 0.16-0.62, p = .0007), 0.42 (0.20-0.88, p = .02), and 0.33 (0.14-0.81, p = .02), respectively. CONCLUSION Regular SF intake between 1 and 2 months of age in infants avoiding cow's milk formula was significantly associated with a reduced risk of food sensitization in infancy.
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Affiliation(s)
| | - Kenta Otsuji
- Department of Pediatrics, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Yohei Arakaki
- Department of Pediatrics, Naha City Hospital, Okinawa, Japan
| | - Kazuya Hamada
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Teruaki Matsui
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Shiro Sugiura
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
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Hou W, Guan F, Xia L, Xu Y, Huang S, Zeng P. Investigating the influence of breastfeeding on asthma in children under 12 years old in the UK Biobank. Front Immunol 2022; 13:967101. [PMID: 36248866 PMCID: PMC9559182 DOI: 10.3389/fimmu.2022.967101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/13/2022] [Indexed: 01/28/2023] Open
Abstract
Background Childhood-onset asthma (COA) has become a major and growing problem worldwide and imposes a heavy socioeconomic burden on individuals and families; therefore, understanding the influence of early-life experiences such as breastfeeding on COA is of great importance for early prevention. Objectives To investigate the impact of breastfeeding on asthma in children under 12 years of age and explore its role at two different stages of age in the UK Biobank cohort. Methods A total of 7,157 COA cases and 158,253 controls were obtained, with information regarding breastfeeding, COA, and other important variables available through questionnaires. The relationship between breastfeeding and COA were examined with the logistic regression while adjusting for available covariates. In addition, a sibling analysis was performed on 398 pairs of siblings to explain unmeasured family factors, and a genetic risk score analysis was performed to control for genetic confounding impact. Finally, a power evaluation was conducted in the sibling data. Results In the full cohort, it was identified that breastfeeding had a protective effect on COA (the adjusted odds ratio (OR)=0.875, 95% confidence intervals (CIs): 0.831~0.922; P=5.75×10-7). The impact was slightly pronounced in children aged 6-12 years (OR=0.852, 95%CIs: 0.794~0.914, P=7.41×10-6) compared to those aged under six years (OR=0.904, 95%CIs: 0.837~0.975, P=9.39×10-3), although such difference was not substantial (P=0.266). However, in the sibling cohort these protective effects were no longer significant largely due to inadequate samples as it was demonstrated that the power was only 23.8% for all children in the sibling cohort under our current setting. The protective effect of breastfeeding on COA was nearly unchanged after incorporating the genetic risk score into both the full and sibling cohorts. Conclusions Our study offered supportive evidence for the protective effect of breastfeeding against asthma in children less than 12 years of age; however, sibling studies with larger samples were warranted to further validate the robustness our results against unmeasured family confounders. Our findings had the potential to encourage mothers to initiate and prolong breastfeeding.
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Affiliation(s)
- Wenyan Hou
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Fengjun Guan
- Department of Pediatrics, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Lei Xia
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Yue Xu
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Shuiping Huang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China,Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, China,Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, China,Key Laboratory of Environment and Health, Xuzhou Medical University, Xuzhou, China,*Correspondence: Shuiping Huang, ; Ping Zeng,
| | - Ping Zeng
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, China,Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, China,Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, China,Key Laboratory of Environment and Health, Xuzhou Medical University, Xuzhou, China,Engineering Research Innovation Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, China,*Correspondence: Shuiping Huang, ; Ping Zeng,
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Prevalence of infantile wheezing and eczema in a metropolitan city in Japan: A complete census survey. PLoS One 2022; 17:e0268092. [PMID: 35511893 PMCID: PMC9070868 DOI: 10.1371/journal.pone.0268092] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 04/21/2022] [Indexed: 12/04/2022] Open
Abstract
Infantile wheezing and eczema are associated with the subsequent onset of asthma and other atopic diseases. However, there are no large population-based surveys on infantile allergic symptoms in Japan. The objective of the study was to determine the prevalence of wheezing and asthma in infants in Nagoya, Japan. This population-based cross-sectional study was performed in the metropolitan city of Nagoya, Japan. We surveyed parents to ascertain the prevalence of wheezing and eczema in infants who attended group health checkups at 3, 18, and 36 months of age. Their parents completed modified questionnaires from the International Study of Asthma and Allergies in Childhood. More than 90% of the approximately 40,000 children in each study group living in the target area were included in the survey. The prevalence of wheezing was 8%, 17%, and 13% at 3, 18, and 36 months, respectively, and was characterized by birth season. The prevalence of eczema was 24%, 30%, and 31%, at 3, 18, and 36 months, respectively. Participants born in autumn and winter had a higher incidence of eczema in each age group. Three-quarters of the children had a parental history of allergic conditions. Parental allergic diseases and male gender are risk factors for wheezing and eczema in children. This survey had a high response rate and covered almost the entire population of the target age groups in a large city. We believe that the results of this study, therefore, provide a much higher level of confidence regarding the prevalence of allergies in infants in Japan than that in previous studies with limited cohorts.
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Sakihara T, Yasuki D, Otsuji K, Arakaki Y, Hamada K, Sugiura S, Ito K. Effects of delivery mode and labor duration on the development of food sensitization in infancy. Ann Allergy Asthma Immunol 2022; 129:212-219.e2. [PMID: 35460868 DOI: 10.1016/j.anai.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/24/2022] [Accepted: 04/07/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The effects of delivery mode and labor duration on the development of food sensitization (FS) in infancy remain unclear. OBJECTIVE To elucidate the potential effects of delivery mode and labor duration on FS development by 6 months of age. METHODS Using data from a randomized controlled trial of a birth cohort from 4 Japanese hospitals that assessed cow's milk allergy development by 6 months of age, we performed a nested case-control trial of 462 participants who had undergone the final assessment at 6 months of age. FS was defined as positive skin prick test reactions to hen's egg, cow's milk, wheat, or soy. For the primary outcome, we calculated the adjusted odds ratio of vaginal delivery (VD) relative to cesarean delivery for FS development by 6 months of age using a multivariable logistic regression analysis. For the secondary outcome, we compared labor durations between participants with and without FS using the Mann-Whitney U test. RESULTS The adjusted odds ratio of VD for FS development was 2.54 (95% confidence interval, 1.32-4.87; P = .005). The median labor duration was significantly longer in participants with FS (5.7 hours, interquartile range, 2.7-10.1) than in participants without FS (4.5 hours, 1.1-8.2) (P = .01). CONCLUSION VD was considerably associated with an increased risk of FS in infancy, and longer labor durations may promote FS development.
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Affiliation(s)
| | - Daichi Yasuki
- Department of Pediatrics, Heartlife Hospital, Okinawa, Japan
| | - Kenta Otsuji
- Department of Pediatrics, Okinawa Kyodo Hospital, Okinawa, Japan
| | - Yohei Arakaki
- Department of Pediatrics, Naha City Hospital, Okinawa, Japan
| | - Kazuya Hamada
- Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shiro Sugiura
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
| | - Komei Ito
- Department of Allergy, Aichi Children's Health and Medical Center, Aichi, Japan
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Matsumoto N, Kubo T, Nakamura K, Mitsuhashi T, Takeuchi A, Tsukahara H, Yorifuji T. Trajectory of body mass index and height changes from childhood to adolescence: a nationwide birth cohort in Japan. Sci Rep 2021; 11:23004. [PMID: 34837002 PMCID: PMC8626480 DOI: 10.1038/s41598-021-02464-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 11/17/2021] [Indexed: 11/09/2022] Open
Abstract
To investigate the dynamics of body mass index (BMI) and height changes in childhood leading to obesity in adolescents. BMI Z-scores were calculated using the LMS (lambda-mu-sigma) method based on yearly height and weight information (age 1.5-15 years) from a nationwide Japanese birth cohort that started in 2001 (n = 26,711). We delineated the trajectories of BMI and height changes leading to obesity at age 15 years using mixed effect models. Children who became obese at the age of 15 years kept relatively high BMI z-scores through childhood for both genders, and had an increasing trend over time as opposed to the normal weight group, with an increasing slope during puberty. Early adiposity rebound was associated with overweight or obesity at the age of 15 years. Age at peak height velocity (APHV) occurred earlier in the obese/overweight group at age 15 years than in the normal weight group, and occurred later in the underweight group. Obese adolescents experienced early adiposity rebound timing and maintained a serial BMI z-score increase throughout childhood, with a greater slope at puberty. An earlier peak in height gain during puberty may have contributed to the observed patterns of BMI change.
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Affiliation(s)
- Naomi Matsumoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Toshihide Kubo
- Department of Pediatrics, National Hospital Organization, Okayama Medical Center, Okayama, Japan
| | - Kazue Nakamura
- Department of Pediatrics, National Hospital Organization, Okayama Medical Center, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Akihito Takeuchi
- Department of Pediatrics, National Hospital Organization, Okayama Medical Center, Okayama, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Toppila-Salmi S, Lemmetyinen R, Chanoine S, Karjalainen J, Pekkanen J, Bousquet J, Siroux V. Risk factors for severe adult-onset asthma: a multi-factor approach. BMC Pulm Med 2021; 21:214. [PMID: 34238263 PMCID: PMC8268541 DOI: 10.1186/s12890-021-01578-4] [Citation(s) in RCA: 9] [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: 12/13/2020] [Accepted: 06/29/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The aim was to identify risk factors for severe adult-onset asthma. METHODS We used data from a population-based sample (Adult Asthma in Finland) of 1350 patients with adult-onset asthma (age range 31-93 years) from Finnish national registers. Severe asthma was defined as self-reported severe asthma and asthma symptoms causing much harm and regular impairment and ≥ 1 oral corticosteroid course/year or regular oral corticosteroids or waking up in the night due to asthma symptoms/wheezing ≥ a few times/month. Sixteen covariates covering several domains (personal characteristics, education, lifestyle, early-life factors, asthma characteristics and multiple morbidities) were selected based on the literature and were studied in association with severe asthma using logistic regressions. RESULTS The study population included 100 (7.4%) individuals with severe asthma. In a univariate analysis, severe asthma was associated with male sex, age, a low education level, no professional training, ever smoking, ≥ 2 siblings, ≥ 1 chronic comorbidity and non-steroidal anti-inflammatory drug (NSAID)-exacerbated respiratory disease (NERD) (p < 0.05), and trends for association (p < 0.2) were observed for severe childhood infection, the presence of chronic rhinosinusitis with nasal polyps, and being the 1st child. The 10 variables (being a 1st child was removed due to multicollinearity) were thus entered in a multivariate regression model, and severe asthma was significantly associated with male sex (OR [95% CI] = 1.96 [1.16-3.30]), ever smoking (1.98 [1.11-3.52]), chronic comorbidities (2.68 [1.35-5.31]), NERD (3.29 [1.75-6.19]), and ≥ 2 siblings (2.51 [1.17-5.41]). There was a dose-response effect of the total sum of these five factors on severe asthma (OR [95% CI] = 2.30 [1.81-2.93] for each one-unit increase in the score). CONCLUSIONS Male sex, smoking, NERD, comorbidities, and ≥ 2 siblings were independent risk factors for self-reported severe asthma. The effects of these factors seem to be cumulative; each additional risk factor gradually increases the risk of severe asthma.
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Affiliation(s)
- Sanna Toppila-Salmi
- Haartman Institute, Medicum, University of Helsinki, Haartmaninkatu 3, PO Box 21, 00014 Helsinki, Finland
- Skin and Allergy Hospital, Hospital District of Helsinki and Uusimaa, Helsinki University Hospital and University of Helsinki (HUS), Meilahdentie 2, PO Box 160, 00029 Helsinki, Finland
| | - Riikka Lemmetyinen
- Haartman Institute, Medicum, University of Helsinki, Haartmaninkatu 3, PO Box 21, 00014 Helsinki, Finland
- Skin and Allergy Hospital, Hospital District of Helsinki and Uusimaa, Helsinki University Hospital and University of Helsinki (HUS), Meilahdentie 2, PO Box 160, 00029 Helsinki, Finland
| | - Sebastien Chanoine
- UGA/Inserm U 1209/CNRS UMR 5309 Joint Research Centre Team of Environmental Epidemiology Applied To Reproduction and Respiratory Health, Institute for Advanced Biosciences, Site Santé - Allée Des Alpes, 38700 La Tronche, France
- Pôle Pharmacie, CHU Grenoble Alpes, 38000 Grenoble, France
- Université Grenoble Alpes, 38000 Grenoble, France
| | - Jussi Karjalainen
- Allergy Centre, Tampere University Hospital, Teiskontie 35, PO Box 2000, 33521 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere University, 33014 Tampere, Finland
| | - Juha Pekkanen
- Department of Public Health, University of Helsinki, Tukholmankatu 8 B, PO Box 20, 00014 Helsinki, Finland
- Environmental Health, National Institute for Health and Welfare, PO Box 95, 70701 Kuopio, Finland
| | - Jean Bousquet
- Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Charité, Universitätsmedizin Berlin, Berlin, Germany
- University Hospital Montpellier, MACVIA-France, Montpellier, France
| | - Valérie Siroux
- UGA/Inserm U 1209/CNRS UMR 5309 Joint Research Centre Team of Environmental Epidemiology Applied To Reproduction and Respiratory Health, Institute for Advanced Biosciences, Site Santé - Allée Des Alpes, 38700 La Tronche, France
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11
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Modelling maternal and perinatal risk factors to predict poorly controlled childhood asthma. PLoS One 2021; 16:e0252215. [PMID: 34043705 PMCID: PMC8158992 DOI: 10.1371/journal.pone.0252215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Abstract
Asthma is the most common non-communicable pulmonary condition, affecting prepubertal boys more often than girls. This study explored how maternal and perinatal risk factors are linked to poorly controlled childhood asthma in a sex dependent manner. This single centre study was performed at a metropolitan teaching hospital in Western Sydney, Australia, using electronical obstetric records from 2000 to 2017 and electronical pediatric records from 2007 to 2018. The data of 1694 children with complete entries were retrospectively analysed. Risk factors for multiple hospital admission for asthma were selected by backward-eliminated Poisson regression modelling. Selection stability of these parameters was independently confirmed using approximated exhaustive search. Sex-specific regression models indicated that most notably parity (RR[95%CI] for parity = 3; 1.85[1.22-2.81]), birth length z-score (1.45[1.23-1.70]) and birth weight z-score (0.77[0.65-0.90]) contributed to multiple asthma admissions in girls, while boys were affected most prominently by maternal BMI (e.g. BMI 35-39.9; 1.92[1.38-2.67]) and threatened preterm labor (1.68[1.10-2.58]). Allergic status was a risk factors for both boys and girls (1.47[1.18-1.83] and 1.46[1.13-1.89]). Applying ROC analysis, the predictive modelling of risk factors for hospital admissions showed an incremental increase with an AUC of 0.84 and 0.75 for girls and boys respectively for >3 hospital admissions. Multiple hospital admissions for asthma are associated with maternal and perinatal risk factors in a sex and birth order dependent manner. Hence, prospective risk stratification studies aiming to improve childhood asthma control are warranted to test the clinical utility of these parameters. Furthermore, the influence of the early in utero environment on male-female differences in other communicable and non-communicable respiratory conditions should be considered.
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12
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Venter C, Palumbo MP, Sauder KA, Glueck DH, Starling AP, Ringham BM, O'Mahony L, Moore BF, Yang IV, Dabelea D. Examining Associations Between Dietary Inflammatory Index in Pregnancy, Pro-inflammatory Cytokine and Chemokine Levels at Birth, and Offspring Asthma and/or Wheeze by Age 4 Years. J Acad Nutr Diet 2021; 121:2003-2012.e3. [PMID: 33744233 DOI: 10.1016/j.jand.2021.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/14/2021] [Accepted: 02/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have demonstrated associations between maternal dietary inflammatory index (DII) during pregnancy and offspring asthma and/or wheeze. OBJECTIVE The study aimed to assess associations between maternal DII during pregnancy and 1) offspring cord sera pro-inflammatory cytokines (interleukin [IL]-1β, IL-4, IL-6, IL-10, tumor necrosis factor-α) and chemokines (IL-8, monocyte chemoattractant protein-1) at birth and 2) offspring asthma and/or wheeze at age 4 years. DESIGN The Healthy Start study is a prospective prebirth longitudinal study that recruited pregnant women in Denver, Colorado and tracked their offspring. PARTICIPANTS AND SETTING This study used data from 1228 mother-child dyads enrolled in the Healthy Start study. Pregnant women were recruited in Denver, Colorado, between 2009 and 2014, and offspring tracked until age 4 years. MAIN OUTCOME MEASURES Cord sera cytokines and chemokines were analyzed with multiplex panel immunoassays. Offspring diagnosis of asthma and/or wheeze by age 4 years was extracted from electronic medical records. STATISTICAL ANALYSES PERFORMED Unadjusted and adjusted linear and logistic regression models were used to assess associations. Covariates included factors such as nulliparity, race/ethnicity, gestational smoking, and maternal history of asthma. RESULTS Unadjusted analysis showed that increasing maternal DII scores were associated with increased odds of child asthma and/or wheeze by 4 years (odds ratio = 1.17; 95% CI: 1.07-1.27), but the association was attenuated and no longer statistically significant in the adjusted model (odds ratio = 1.15; 95% CI: 0.99-1.33). There were no significant associations between DII scores and cord sera cytokine or chemokine levels. CONCLUSIONS The study showed that the inflammatory profile of the maternal diet was not associated with cytokines and chemokine levels at birth. The results suggested that a more inflammatory maternal diet was associated with increased odds of offspring asthma and/or wheeze by age 4 years, which could be considered of clinical relevance but the finding was not statistically significant at the .05 level.
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13
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Sugiura S, Hiramitsu Y, Futamura M, Kamioka N, Yamaguchi C, Umemura H, Ito K, Camargo CA. Development of a prediction model for infants at high risk of food allergy. Asia Pac Allergy 2021; 11:e5. [PMID: 33604275 PMCID: PMC7870367 DOI: 10.5415/apallergy.2021.11.e5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background Identification of risk factors for food allergy (FA) in infants is an active research area. An important reason is to identify optimal target infants for early introduction of specific food antigens. Although eczema has been used for this purpose, multivariable prediction scores have not been reported. Objective The aim of this research is to develop a multivariable prediction score for infants at high risk of FA. Methods We performed a cross-sectional analysis of a self-administered questionnaire for the parents of 18-month-old children at well-child visits between April 2016 and March 2017 (development dataset) and between April 2017 and March 2018 (validation dataset). We developed and validated the prediction score. Results The questionnaire collection rate was 18,549 of 20,198 (92%) in the development dataset and 18,620 of 19,977 (93%) in the validation dataset. Risk factors for FA were being born in August–December, first child, eczema, atopic dermatitis in father and mother, and FA in mother and sibling(s). For identifying infants with FA, the developed multivariable prediction score showed higher discrimination ability (area under the curve [AUC] = 0.75) than focusing on eczema (AUC = 0.70) in the validation dataset. The score was also useful for identifying infants with a history of anaphylaxis (AUC = 0.73) than focusing on eczema (AUC = 0.67) in the validation dataset. Conclusion The new prediction score enables more efficient identification of infants at high risk of FA, who may be the optimal target group for the early introduction of specific antigens.
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Affiliation(s)
- Shiro Sugiura
- Committee for the Prevention of Pediatric Allergic Disease, Nagoya City, Japan.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Aichi Children's Health and Medical Center, Obu, Japan
| | - Yoshimichi Hiramitsu
- Committee for the Prevention of Pediatric Allergic Disease, Nagoya City, Japan.,Nagoya City Public Health Research Institute, Nagoya City, Japan
| | - Masaki Futamura
- Committee for the Prevention of Pediatric Allergic Disease, Nagoya City, Japan.,Division of Pediatrics, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Naomi Kamioka
- Committee for the Prevention of Pediatric Allergic Disease, Nagoya City, Japan.,Department of Pediatrics, Nagoya City West Medical Center, Nagoya, Japan
| | - Chikae Yamaguchi
- Committee for the Prevention of Pediatric Allergic Disease, Nagoya City, Japan.,Nagoya City University Graduate School of Nursing, Nagoya City, Japan
| | - Harue Umemura
- Committee for the Prevention of Pediatric Allergic Disease, Nagoya City, Japan.,Department of Nutrition, Nagoya University of Arts and Sciences, Nissin, Japan
| | - Komei Ito
- Committee for the Prevention of Pediatric Allergic Disease, Nagoya City, Japan.,Aichi Children's Health and Medical Center, Obu, Japan
| | - Carlos A Camargo
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Roberts G, Almqvist C, Boyle R, Crane J, Hogan SP, Marsland B, Saglani S, Woodfolk JA. Developments in the field of clinical allergy in 2018 through the eyes of Clinical and Experimental Allergy, Part II. Clin Exp Allergy 2020; 49:1550-1557. [PMID: 31833123 DOI: 10.1111/cea.13535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this article, we describe developments in the field of clinical allergy as described by Clinical and Experimental Allergy in 2018; epidemiology, asthma and rhinitis, clinical allergy and allergens are all covered.
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Affiliation(s)
- Graham Roberts
- Clinical and Experimental Sciences and Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - R Boyle
- Department of Paediatrics, Imperial College London, London, UK
| | - J Crane
- Department of Medicine, University of Otago Wellington, Wellington, New Zealand
| | - S P Hogan
- Department of Pathology, Mary H Weiser Food Allergy Center, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - B Marsland
- Department of Immunology and Pathology, Monash University, Melbourne, Vic., Australia
| | - S Saglani
- National Heart & Lung Institute, Imperial College London, London, UK
| | - J A Woodfolk
- Division of Asthma, Allergy and Immunology, Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
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15
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Matsumoto N, Yorifuji T, Nakamura K, Ikeda M, Tsukahara H, Doi H. Breastfeeding and risk of food allergy: A nationwide birth cohort in Japan. Allergol Int 2020; 69:91-97. [PMID: 31540813 DOI: 10.1016/j.alit.2019.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/10/2019] [Accepted: 08/21/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Although breastfeeding has been well-established as the preferred method for infant nutrition, its prophylactic effects on food allergy remain controversial. Infantile eczema has been linked to food allergy via percutaneous sensitization; however, this relationship has not been considered in previous studies. We aimed to uncover the prophylactic effects of breastfeeding on food allergy, focusing on eczema-mediated percutaneous sensitization. METHODS This retrospective cohort study was based on 46,616 children from the Longitudinal Survey of Newborns in the 21st Century in Japan, begun in 2001. We classified participants into three groups based on infant feeding practices (exclusive breastfeeding, partial breastfeeding including only colostrum, and formula feeding only) and used information from at least one outpatient visit for food allergy during two observation periods (age 6-18 months and age 6-66 months) as health outcomes. We performed log-binomial regression analysis adjusted for potential confounders and stratified analysis according to infantile eczema status. RESULTS Compared with formula feeding, partial breastfeeding including only colostrum reduced the risk of food allergy only in children with infantile eczema, (RR = 0.66, 95% CI: 0.46, 0.96 for age 6-66 months), whereas exclusive breastfeeding increased this risk in those without infantile eczema (RR = 2.41, 95% CI: 1.40, 4.15, age 6-66 months). The prophylactic effects of breastfeeding on food allergy in the infantile eczema group increased with shorter breastfeeding duration. CONCLUSIONS Our results showed that breastfeeding, especially colostrum, had prophylactic effects on food allergy only among high-risk children with infantile eczema whereas prolonged breastfeeding increased the risk of food allergy.
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Affiliation(s)
- Naomi Matsumoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kazue Nakamura
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Masanori Ikeda
- Department of Pediatric Acute Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hirokazu Tsukahara
- Department of Pediatrics, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroyuki Doi
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Ziyab AH. Prevalence of food allergy among schoolchildren in Kuwait and its association with the coexistence and severity of asthma, rhinitis, and eczema: A cross-sectional study. World Allergy Organ J 2019; 12:100024. [PMID: 30976380 PMCID: PMC6441753 DOI: 10.1016/j.waojou.2019.100024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/25/2018] [Accepted: 03/11/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Food allergy (FA) is a common public health problem that affects both children and adults. Empirical knowledge of the burden of FA in Kuwait is limited. This study sought to estimate the prevalence of FA among schoolchildren in Kuwait and assess associations between FA and the coexistence and severity of asthma, rhinitis, and eczema. METHODS Schoolchildren aged 11-14 years (n = 3,864) were enrolled in a cross-sectional study. Parents completed questionnaires regarding their children's early life exposures and clinical history of FA and allergic diseases. Study-defined FA was ascertained by a convincing clinical history. Associations were assessed using Poisson regression with robust variance estimation, and adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) were estimated. RESULTS The 12-month prevalence of study-defined FA was estimated to be 4.1% (154/3,738), with more girls being affected than boys (aPR = 1.44, 95% CI: 1.04-1.99). Egg (2.7%), fish (1.6%), shellfish (1.3%), peanut (1.3%), and tree nut (1.2%) were the most reported offending food allergens. Underweight and adiposity, cesarean section delivery, exposure to household dogs during infancy, and parental history of doctor-diagnosed FA were associated with an increased prevalence of study-defined FA. However, later birth order was associated with a reduced prevalence of study-defined FA. The prevalence of eczema only was higher in children with study-defined FA than in those without study-defined FA (aPR = 3.49, 95% CI: 2.37-5.14). In contrast, this association was not pronounced for children who had asthma only (aPR = 1.56, 95% CI: 0.94-2.57) or rhinitis only (aPR = 1.40, 95% CI: 0.86-2.28). Study-defined FA was associated with a 9.20-fold (95% CI: 4.50-18.78) higher prevalence of coexisting asthma, rhinitis, and eczema. Moreover, study-defined FA was associated with increased severity of symptoms of asthma, rhinitis, and eczema. CONCLUSIONS FA affects a considerable proportion of schoolchildren in Kuwait, and the most reported offending food allergens are similar to those reported in Western countries. Study-defined FA was associated with the coexistence and increased severity of asthma, rhinitis, and eczema, indicating that FA may link the comanifestations of allergic diseases and contribute to their chronicity and severity.
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