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Pulmonary disorders in pregnancy: Bronchiectasis, cystic fibrosis, sarcoidosis and interstitial diseases. Best Pract Res Clin Obstet Gynaecol 2022; 85:114-126. [PMID: 36244873 DOI: 10.1016/j.bpobgyn.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/03/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
This chapter aims to provide expert guidance to obstetricians, general practitioners, allied health staff and women with lung disease about the interactions between pregnancy and different lung diseases. This chapter will cover other airway diseases such as bronchiectasis and cystic fibrosis (CF) together with sarcoidosis and interstitial lung disease (ILD), noting that another chapter covers asthma. The physiological changes which occur in pregnancy, such as the changes in airway physiology, resting ventilation and sleep, are summarised in another chapter. This chapter extends the evidence-based approach and clinical expertise of the recent European Respiratory Society/Thoracic Society of Australia and New Zealand (ERS/TSANZ) taskforce. The papers selected were based on the population (pregnant women with lung disease other than asthma) and the effects of these diseases on risks of pregnancy-associated complications and miscarriages, breastfeeding, nutritional considerations, lung function, long-term maternal outcomes and management considerations during pregnancy. As there are very few randomised control trials in the area, the majority of the literature consists of observational studies (prospective or retrospective), cross-sectional surveys and case series. Other guidelines have also recently been published, which may be helpful to the reader.
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Berlin M, Flor-Hirsch H, Kohn E, Brik A, Keidar R, Livne A, Marom R, Ovental A, Mandel D, Lubetzky R, Factor-Litvak P, Tovbin J, Betser M, Moskovich M, Hazan A, Britzi M, Gueta I, Berkovitch M, Matok I, Hamiel U. Maternal Exposure to Polychlorinated Biphenyls and Asthma, Allergic Rhinitis and Atopic Dermatitis in the Offspring: The Environmental Health Fund Birth Cohort. Front Pharmacol 2022; 13:802974. [PMID: 35462915 PMCID: PMC9019472 DOI: 10.3389/fphar.2022.802974] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/07/2022] [Indexed: 01/04/2023] Open
Abstract
Background: Polychlorinated biphenyls (PCBs) are persistent organic pollutants banned for use worldwide. Due to their biodegradation resistance, they accumulate along the food chain and in the environment. Maternal exposure to PCBs may affect the fetus and the infant. PCBs are immunotoxic and may damage the developing immune system. PCBs are associated with elevated IgE antibodies in cord blood and are considered to be predictive of atopic reactions. Several studies on the association between prenatal exposure to PCBs and atopic reactions were previously published, albeit with conflicting results. Objectives: To examine the association between maternal PCBs levels and atopic reactions in their offspring. Methods: During the years 2013–2015, a prospective birth cohort was recruited at the delivery rooms of Shamir Medical Center (Assaf Harofeh) and “Dana Dwek” Children’s Hospital. Four PCBs congeners were investigated: PCBs 118, 138, 153, and 180. In 2019, when children reached the age of 4–6 years, mothers were interviewed using the ISAAC questionnaire to assess symptoms of atopic reactions, including asthma, allergic rhinitis, and atopic dermatitis. Results: One hundred and fifty mother-child dyads were analyzed. No significant differences were found in the median serum PCBs concentrations of each studied congener or total PCBs for asthma, allergic rhinitis, atopic dermatitis diagnosis, or parent-reported symptoms. No association was found between exposure to total PCBs and the risk for asthma symptoms or diagnosis, adjusted to maternal age and family member with atopic condition: aOR = 0.94, 95%CI: (0.88; 0.99). No association was observed between each studied PCB congener and asthma symptoms or diagnosis. The same results were found also for other studied outcomes—allergic rhinitis and atopic dermatitis. Conclusion: Our study joins a series of previous studies that attempt to shed light on environmental exposures in utero as influencing factors for atopic conditions in children. Our results reflect the complexity of the pathophysiology of these phenomena. No relationship between maternal serum PCBs levels was demonstrated for asthma, allergic rhinitis, or atopic dermatitis. However, additional multi-participant studies, with longer, spanning into later pediatric age follow up are needed.
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Affiliation(s)
- Maya Berlin
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hadar Flor-Hirsch
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Elkana Kohn
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Anna Brik
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rimona Keidar
- Department of Neonatology, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ayelet Livne
- Department of Neonatology, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ronella Marom
- Departments of Neonatology and Pediatrics, Dana Dwek Children’s Hospital, Tel Aviv Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Amit Ovental
- Departments of Neonatology and Pediatrics, Dana Dwek Children’s Hospital, Tel Aviv Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Dror Mandel
- Departments of Neonatology and Pediatrics, Dana Dwek Children’s Hospital, Tel Aviv Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ronit Lubetzky
- Departments of Neonatology and Pediatrics, Dana Dwek Children’s Hospital, Tel Aviv Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Josef Tovbin
- Division of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Moshe Betser
- Division of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Miki Moskovich
- Division of Obstetrics and Gynecology, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ariela Hazan
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Malka Britzi
- Residues Lab, Kimron Veterinary Institute, Beit-Dagan, Israel
| | - Itai Gueta
- The Institute of Clinical Pharmacology and Toxicology, Department of Medicine, Sheba Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Matitiahu Berkovitch
- Clinical Pharmacology and Toxicology Unit, Shamir Medical Center (Assaf Harofeh), Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Matitiahu Berkovitch,
| | - Ilan Matok
- Division of Clinical Pharmacy, Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Uri Hamiel
- Department of Pediatrics, Shamir Medical Center (Assaf Harofeh), Zerifin, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Time-Specific Factors Influencing the Development of Asthma in Children. Biomedicines 2022; 10:biomedicines10040758. [PMID: 35453508 PMCID: PMC9025817 DOI: 10.3390/biomedicines10040758] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 02/01/2023] Open
Abstract
Susceptibility to asthma is complex and heterogeneous, as it involves both genetic and environmental insults (pre- and post-birth) acting in a critical window of development in early life. According to the Developmental Origins of Health and Disease, several factors, both harmful and protective, such as nutrition, diseases, drugs, microbiome, and stressors, interact with genotypic variation to change the capacity of the organism to successfully adapt and grow in later life. In this review, we aim to provide the latest evidence about predictive risk and protective factors for developing asthma in different stages of life, from the fetal period to adolescence, in order to develop strategic preventive and therapeutic interventions to predict and improve health later in life. Our study shows that for some risk factors, such as exposure to cigarette smoke, environmental pollutants, and family history of asthma, the evidence in favor of a strong association of those factors with the development of asthma is solid and widely shared. Similarly, the clear benefits of some protective factors were shown, providing new insights into primary prevention. On the contrary, further longitudinal studies are required, as some points in the literature remain controversial and a source of debate.
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A Critical Review of Statistical Methods for Twin Studies Relating Exposure to Early Life Health Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312696. [PMID: 34886424 PMCID: PMC8657152 DOI: 10.3390/ijerph182312696] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/20/2021] [Accepted: 11/30/2021] [Indexed: 11/21/2022]
Abstract
When investigating disease etiology, twin data provide a unique opportunity to control for confounding and disentangling the role of the human genome and exposome. However, using appropriate statistical methods is fundamental for exploiting such potential. We aimed to critically review the statistical approaches used in twin studies relating exposure to early life health conditions. We searched PubMed, Scopus, Web of Science, and Embase (2011–2021). We identified 32 studies and nine classes of methods. Five were conditional approaches (within-pair analyses): additive-common-erratic (ACE) models (11 studies), generalized linear mixed models (GLMMs, five studies), generalized linear models (GLMs) with fixed pair effects (four studies), within-pair difference analyses (three studies), and paired-sample tests (two studies). Four were marginal approaches (unpaired analyses): generalized estimating equations (GEE) models (five studies), GLMs with cluster-robust standard errors (six studies), GLMs (one study), and independent-sample tests (one study). ACE models are suitable for assessing heritability but require adaptations for binary outcomes and repeated measurements. Conditional models can adjust by design for shared confounders, and GLMMs are suitable for repeated measurements. Marginal models may lead to invalid inference. By highlighting the strengths and limitations of commonly applied statistical methods, this review may be helpful for researchers using twin designs.
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García-Serna AM, Martín-Orozco E, Hernández-Caselles T, Morales E. Prenatal and Perinatal Environmental Influences Shaping the Neonatal Immune System: A Focus on Asthma and Allergy Origins. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083962. [PMID: 33918723 PMCID: PMC8069583 DOI: 10.3390/ijerph18083962] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 01/04/2023]
Abstract
It is suggested that programming of the immune system starts before birth and is shaped by environmental influences acting during critical windows of susceptibility for human development. Prenatal and perinatal exposure to physiological, biological, physical, or chemical factors can trigger permanent, irreversible changes to the developing immune system, which may be reflected in cord blood of neonates. The aim of this narrative review is to summarize the evidence on the role of the prenatal and perinatal environment, including season of birth, mode of delivery, exposure to common allergens, a farming environment, pet ownership, and exposure to tobacco smoking and pollutants, in shaping the immune cell populations and cytokines at birth in humans. We also discuss how reported disruptions in the immune system at birth might contribute to the development of asthma and related allergic manifestations later in life.
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Affiliation(s)
- Azahara María García-Serna
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain; (A.M.G.-S.); (E.M.-O.); (T.H.-C.)
- Department of Biochemistry and Molecular Biology B and Immunology, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
| | - Elena Martín-Orozco
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain; (A.M.G.-S.); (E.M.-O.); (T.H.-C.)
- Department of Biochemistry and Molecular Biology B and Immunology, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
- Network of Asthma and Adverse and Allergic Reactions (ARADyAL), 28029 Madrid, Spain
| | - Trinidad Hernández-Caselles
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain; (A.M.G.-S.); (E.M.-O.); (T.H.-C.)
- Department of Biochemistry and Molecular Biology B and Immunology, Faculty of Medicine, University of Murcia, 30100 Murcia, Spain
- Network of Asthma and Adverse and Allergic Reactions (ARADyAL), 28029 Madrid, Spain
| | - Eva Morales
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain; (A.M.G.-S.); (E.M.-O.); (T.H.-C.)
- Department of Public Health Sciences, University of Murcia, 30100 Murcia, Spain
- Correspondence: ; Tel.: +34-868883691
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Richards M, Ferber J, Chen H, Swor E, Quesenberry CP, Li D, Darrow LA. Caesarean delivery and the risk of atopic dermatitis in children. Clin Exp Allergy 2020; 50:805-814. [DOI: 10.1111/cea.13668] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/10/2020] [Accepted: 05/10/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Megan Richards
- School of Community Health Sciences University of Nevada Reno NV USA
| | - Jeannette Ferber
- Division of Research Kaiser Permanente Northern California Oakland CA USA
| | - Hong Chen
- Division of Research Kaiser Permanente Northern California Oakland CA USA
| | - Erin Swor
- Department of Obstetrics, Gynecology, and Reproductive Medicine University of California San Diego CA USA
| | | | - De‐Kun Li
- Division of Research Kaiser Permanente Northern California Oakland CA USA
| | - Lyndsey A. Darrow
- School of Community Health Sciences University of Nevada Reno NV USA
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Richards M, Ferber J, Li DK, Darrow LA. Cesarean delivery and the risk of allergic rhinitis in children. Ann Allergy Asthma Immunol 2020; 125:280-286.e5. [PMID: 32387533 DOI: 10.1016/j.anai.2020.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cesarean delivery (C-section) may influence the infant microbiome and affect immune system development and subsequent risk for allergic rhinitis (AR). OBJECTIVE To investigate the association between C-section and AR at ages 6, 8, and 10 years. METHODS Data were collected prospectively through Kaiser Permanente Northern Californias (KPNC) integrated healthcare system. Children were eligible if they were born in a KPNC hospital and remained in the KPNC system for minimum 6 years (n = 117,768 age 6; n = 75,115 age 8; n = 40,332 age 10). Risk ratios (RR) for C-section and AR were estimated at each follow-up age and adjusted for important covariates, including intrapartum antibiotics, pre-pregnancy body mass index, maternal allergic morbidities, and breastfeeding. Subanalyses considered information on C-section indication, labor, and membrane rupture. RESULTS After adjusting for confounders, we did not observe an association between C-section and AR at follow-up ages 6, 8, or 10 years (RR [CI]: 6 years, 0.98 [0.91, 1.04]; 8 years, 1.00 [0.95, 1.07]; 10 years, 1.03 [0.96, 1.10]). In stratified analyses, there was limited evidence that C-section increases the risk of AR in certain subgroups (eg, children of non-atopic mothers, second or higher birth order children), but most estimated risk ratios were consistent with no association. Estimated associations were unaffected by participant attrition, missing data, or intrapartum antibiotics. CONCLUSION C-section delivery was not associated with AR at follow-up ages of 6, 8, or 10 years in a large contemporary US cohort.
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Affiliation(s)
- Megan Richards
- School of Community Health Sciences, University of Nevada, Reno, Nevada.
| | - Jeannette Ferber
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - De-Kun Li
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Lyndsey A Darrow
- School of Community Health Sciences, University of Nevada, Reno, Nevada
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Middleton PG, Gade EJ, Aguilera C, MacKillop L, Button BM, Coleman C, Johnson B, Albrechtsen C, Edenborough F, Rigau D, Gibson PG, Backer V. ERS/TSANZ Task Force Statement on the management of reproduction and pregnancy in women with airways diseases. Eur Respir J 2020; 55:13993003.01208-2019. [PMID: 31699837 DOI: 10.1183/13993003.01208-2019] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 08/30/2019] [Indexed: 11/05/2022]
Abstract
This European Respiratory Society/Thoracic Society of Australia and New Zealand statement outlines a review of the literature and expert opinion concerning the management of reproduction and pregnancy in women with airways diseases: asthma, cystic fibrosis (CF) and non-CF bronchiectasis. Many women with these diseases are now living into reproductive age, with some developing moderate-to-severe impairment of lung function in early adulthood. The statement covers aspects of fertility, management during pregnancy, effects of drugs, issues during delivery and the post-partum period, and patients' views about family planning, pregnancy and parenthood. The statement summarises current knowledge and proposes topics for future research, but does not make specific clinical recommendations.
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Affiliation(s)
- Peter G Middleton
- CF Research Group, Ludwig Engel Centre for Respiratory Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Elisabeth J Gade
- Dept of Gynecology and Obstetrics, Rigshospitalet, Copenhagen, Denmark
| | - Cristina Aguilera
- Dept of Clinical Pharmacology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Lucy MacKillop
- Oxford University Hospitals NHS Foundation Trust, Nuffield Dept of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Brenda M Button
- Dept of Medicine, Nursing and Health Sciences, Monash Institute of Medical Research, Monash University, Melbourne Australia
| | | | | | | | - Frank Edenborough
- Sheffield Adult Cystic Fibrosis Centre, Northern General Hospital, Sheffield, UK
| | - David Rigau
- Iberoamerican Cochrane Centre, Barcelona, Spain
| | - Peter G Gibson
- Centre for Asthma and Respiratory Diseases, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
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Calov M, Alinaghi F, Hamann CR, Silverberg J, Egeberg A, Thyssen JP. The Association Between Season of Birth and Atopic Dermatitis in the Northern Hemisphere: A Systematic Review and Meta-Analysis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 8:674-680.e5. [PMID: 31678290 DOI: 10.1016/j.jaip.2019.10.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cold and dry climate negatively affects skin barrier functions. This could explain the higher incidence of atopic dermatitis (AD) in Northern countries distant from the equator, as well as the general worsening of AD in Northern European winter months. Although it has been suggested that fall and winter birth is associated with AD, this remains unknown. OBJECTIVES To examine whether the prevalence of AD is associated with season of birth. METHODS We conducted a systematic review and meta-analysis. Two reviewers independently searched 3 databases. Study quality was assessed using a Newcastle-Ottawa scale. Study heterogeneity was assessed with Cochrane Q and I2 statistics. Odds ratios with 95% CIs were calculated. Publication bias was assessed using funnel plots. RESULTS The systematic review identified 23 relevant articles of which 9 articles were included in the meta-analysis. Among a total of 726,378 children aged 0 to 12 years, the overall pooled prevalence of AD was 12.9%. The pooled prevalence of AD was 15.4% (95% CI, 12.1%-19.1%), 14.9% (95% CI, 12.0%-18.1%), 12.7% (95% CI, 10.2%-15.4%), and 13.7% (95% CI, 10.8%-17.0%), among children born in the fall, winter, spring, and summer, respectively. AD was significantly associated with fall (odds ratio, 1.16; 95% CI, 1.06-1.28; P = .0018) and winter (odds ratio, 1.15; 95% CI, 1.04-1.27; P = .0076) birth compared with spring birth. CONCLUSIONS Although a positive and significant association was observed between being born in fall and winter and developing AD on the Northern hemisphere, there is a need for additional and better-designed studies to understand the effect of seasonal changes on the risk of AD.
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Affiliation(s)
- Monika Calov
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Farzad Alinaghi
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Carsten Robert Hamann
- Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark; Section of Dermatology, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Jonathan Silverberg
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark
| | - Jacob Pontoppidan Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark; Copenhagen Research Group for Inflammatory Skin (CORGIS), Hellerup, Denmark.
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Gerlich J, Benecke N, Peters-Weist AS, Heinrich S, Roller D, Genuneit J, Weinmayr G, Windstetter D, Dressel H, Range U, Nowak D, von Mutius E, Radon K, Vogelberg C. Pregnancy and perinatal conditions and atopic disease prevalence in childhood and adulthood. Allergy 2018; 73:1064-1074. [PMID: 29193127 DOI: 10.1111/all.13372] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Previous studies showed controversial results for the influence of pregnancy-related and perinatal factors on subsequent respiratory and atopic diseases in children. The aim of this study was to assess the association between perinatal variables and the prevalence of asthma, bronchial hyperreactivity (BHR), flexural eczema (FE), allergic rhinitis, and sensitization in childhood and early adulthood. METHODS The studied population was first examined in Munich and Dresden in 1995/1996 at age 9-11 years. Participants were followed until age 19-24 years using questionnaires and clinical examinations. Associations between perinatal data and subsequent atopic diseases were examined using logistic regression analyses adjusting for potential confounders. RESULTS Cesarean section was statistically significantly associated with BHR in early adulthood (odds ratio 4.8 [95% confidence interval 1.5-15.2]), while assisted birth was associated with presence of asthma symptoms in childhood (2.2 [1.2-3.9]), FE symptoms (2.2 [1.2-4.3]) and doctor's diagnosis of atopic dermatitis (1.9 [1.0-3.4]) in childhood, and sensitization in early adulthood (2.2 [1.1-4.3]). Lower birth length (1.9 [1.1-3.2]), lower birthweight (0.5 [0.3-0.9]), and higher birthweight (0.6 [0.4-1.0]) were predictive of sensitization in early adulthood compared to average birth length and birthweight, respectively. None of the other perinatal factors showed statistically significant associations with the outcomes. CONCLUSIONS Our results indicate that children who are born by cesarean section and especially by assisted birth, might be at greater risk for developing asthma, FE, and sensitization and should hence be monitored. Prenatal maternal stress might partly explain these associations, which should be further investigated.
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Affiliation(s)
- J. Gerlich
- Institute and Clinic for Occupational, Social, and Environmental Medicine; University Hospital, LMU Munich; Munich Germany
- Comprehensive Pneumology Center Munich; German Center for Lung Research; Munich Germany
| | - N. Benecke
- Paediatric Department; University Hospital Carl Gustav Carus, TU Dresden; Dresden Germany
| | - A. S. Peters-Weist
- Institute and Clinic for Occupational, Social, and Environmental Medicine; University Hospital, LMU Munich; Munich Germany
| | - S. Heinrich
- Institute and Clinic for Occupational, Social, and Environmental Medicine; University Hospital, LMU Munich; Munich Germany
| | - D. Roller
- Paediatric Department; University Hospital Carl Gustav Carus, TU Dresden; Dresden Germany
| | - J. Genuneit
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm Germany
| | - G. Weinmayr
- Institute of Epidemiology and Medical Biometry; Ulm University; Ulm Germany
| | - D. Windstetter
- Institute and Clinic for Occupational, Social, and Environmental Medicine; University Hospital, LMU Munich; Munich Germany
| | - H. Dressel
- Institute and Clinic for Occupational, Social, and Environmental Medicine; University Hospital, LMU Munich; Munich Germany
- Institute for Epidemiology, Biostatistics and Prevention; Zürich University; Zürich Switzerland
| | - U. Range
- Institute for Medical Informatics and Biometry; Medical Faculty; “Carl Gustav Carus”, TU; Dresden Germany
| | - D. Nowak
- Institute and Clinic for Occupational, Social, and Environmental Medicine; University Hospital, LMU Munich; Munich Germany
- Comprehensive Pneumology Center Munich; German Center for Lung Research; Munich Germany
| | - E. von Mutius
- Comprehensive Pneumology Center Munich; German Center for Lung Research; Munich Germany
- Dr v Haunersches Kinderspital; University Hospital, LMU Munich; Munich Germany
| | - K. Radon
- Institute and Clinic for Occupational, Social, and Environmental Medicine; University Hospital, LMU Munich; Munich Germany
- Comprehensive Pneumology Center Munich; German Center for Lung Research; Munich Germany
| | - C. Vogelberg
- Paediatric Department; University Hospital Carl Gustav Carus, TU Dresden; Dresden Germany
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Jõgi NO, Svanes C, Siiak SP, Logan E, Holloway JW, Igland J, Johannessen A, Levin M, Real FG, Schlunssen V, Horsnell WGC, Bertelsen RJ. Zoonotic helminth exposure and risk of allergic diseases: A study of two generations in Norway. Clin Exp Allergy 2017; 48:66-77. [PMID: 29117468 DOI: 10.1111/cea.13055] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/01/2017] [Accepted: 10/27/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Animal and human studies indicate that definitive host helminth infections may confer protection from allergies. However, zoonotic helminths, such as Toxocara species (spp.), have been associated with increased allergies. OBJECTIVE We describe the prevalence of Toxocara spp. and Ascaris spp. seropositivity and associations with allergic diseases and sensitization, in 2 generations in Bergen, Norway. METHODS Serum levels of total IgG4, anti-Toxocara spp. IgG4 and Ascaris spp. IgG4 were established by ELISA in 2 cohorts: parents born 1945-1972 (n = 171) and their offspring born 1969-2003 (n = 264). Allergic outcomes and covariates were recorded through interviews and clinical examinations including serum IgEs and skin prick tests. RESULTS Anti-Ascaris spp. IgG4 was detected in 29.2% of parents and 10.3% of offspring, and anti-Toxocara spp. IgG4 in 17.5% and 8.0% of parents and offspring, respectively. Among offspring, anti-Toxocara spp. IgG4 was associated with pet keeping before age 15 (OR = 6.15; 95% CI = 1.37-27.5) and increasing BMI (1.16[1.06-1.25] per kg/m2 ). Toxocara spp. seropositivity was associated with wheeze (2.97[1.45- 7.76]), hayfever (4.03[1.63-9.95]), eczema (2.89[1.08-7.76]) and cat sensitization (5.65[1.92-16.6]) among offspring, but was not associated with allergic outcomes among parents. Adjustment for childhood or current pet keeping did not alter associations with allergies. Parental Toxocara spp. seropositivity was associated with increased offspring allergies following a sex-specific pattern. CONCLUSIONS & CLINICAL RELEVANCE Zoonotic helminth exposure in Norway was less frequent in offspring than parents; however, Toxocara spp. seropositivity was associated with increased risk of allergic manifestations in the offspring generation, but not among parents. Changes in response to helminth exposure may provide insights into the increase in allergy incidence in affluent countries.
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Affiliation(s)
- N O Jõgi
- University of Tartu, Tartu, Estonia.,Centre for International Health, University of Bergen, Bergen, Norway
| | - C Svanes
- Centre for International Health, University of Bergen, Bergen, Norway.,Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - E Logan
- University of Cape Town, Cape Town, South Africa
| | - J W Holloway
- Human Development & Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - J Igland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - A Johannessen
- Centre for International Health, University of Bergen, Bergen, Norway
| | - M Levin
- University of Cape Town, Cape Town, South Africa
| | - F G Real
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - V Schlunssen
- Aarhus University, Aarhus, Denmark.,National Research Centre for the Working Environment, Copenhagen, Denmark
| | - W G C Horsnell
- Institute of Infectious Disease and Molecular Medicine/Division of Immunology, University of Cape Town, Cape Town, South Africa.,Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK.,Laboratory of Molecular and Experimental Immunology and Neurogenetics, UMR 7355, CNRS-University of Orleans and Le Studium Institute for Advanced Studies, Orléans, France
| | - R J Bertelsen
- Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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12
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Bertelsen RJ, Rava M, Carsin AE, Accordini S, Benediktsdóttir B, Dratva J, Franklin KA, Heinrich J, Holm M, Janson C, Johannessen A, Jarvis DL, Jogi R, Leynaert B, Norback D, Omenaas ER, Raherison C, Sánchez‐Ramos JL, Schlünssen V, Sigsgaard T, Dharmage SC, Svanes C. Clinical markers of asthma and IgE assessed in parents before conception predict asthma and hayfever in the offspring. Clin Exp Allergy 2017; 47:627-638. [PMID: 28199764 PMCID: PMC5447870 DOI: 10.1111/cea.12906] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 01/23/2017] [Accepted: 02/01/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mice models suggest epigenetic inheritance induced by parental allergic disease activity. However, we know little of how parental disease activity before conception influences offspring's asthma and allergy in humans. OBJECTIVE We aimed to assess the associations of parental asthma severity, bronchial hyperresponsiveness (BHR), and total and specific IgEs, measured before conception vs. after birth, with offspring asthma and hayfever. METHODS The study included 4293 participants (mean age 34, 47% men) from the European Community Respiratory Health Survey (ECRHS) with information on asthma symptom severity, BHR, total and specific IgEs from 1991 to 1993, and data on 9100 offspring born 1972-2012. Adjusted relative risk ratios (aRRR) for associations of parental clinical outcome with offspring allergic disease were estimated with multinomial logistic regressions. RESULTS Offspring asthma with hayfever was more strongly associated with parental BHR and specific IgE measured before conception than after birth [BHR: aRRR = 2.96 (95% CI: 1.92, 4.57) and 1.40 (1.03, 1.91), respectively; specific IgEs: 3.08 (2.13, 4.45) and 1.83 (1.45, 2.31), respectively]. This was confirmed in a sensitivity analysis of a subgroup of offspring aged 11-22 years with information on parental disease activity both before and after birth. CONCLUSION & CLINICAL RELEVANCE Parental BHR and specific IgE were associated with offspring asthma and hayfever, with the strongest associations observed with clinical assessment before conception as compared to after birth of the child. If the hypothesis is confirmed in other studies, parental disease activity assessed before conception may prove useful for identifying children at risk for developing asthma with hayfever.
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Affiliation(s)
- R. J. Bertelsen
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Department of Occupational MedicineHaukeland University HospitalBergenNorway
| | - M. Rava
- INSERM U1168, VIMA: Aging and Chronic DiseasesEpidemiological and Public Health ApproachesVillejuifFrance
- UMR‐S 1168Univ Versailles St‐Quentin‐en‐YvelinesMontigny le BretonneuxFrance
- Genetic and Molecular Epidemiology GroupSpanish National Cancer Research Center (CNIO)MadridSpain
| | - A. E. Carsin
- ISGlobalCentre for Research in Environmental Epidemiology (CREAL)BarcelonaSpain
- Universitat Pompeu FabraBarcelonaSpain
- CIBER de Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
| | - S. Accordini
- Unit of Epidemiology and Medical StatisticsDepartment of Diagnostics and Public HealthUniversity of VeronaVeronaItaly
| | | | - J. Dratva
- Department of Epidemiology and Public HealthSwiss Tropical and Public Health InstituteBaselSwitzerland
| | - K. A. Franklin
- Department of Surgical and Perioperative SciencesUmeå UniversityUmeåSweden
| | - J. Heinrich
- Helmholtz Zentrum MünchenGerman Research Center for Environmental HealthInstitute of Epidemiology INeuherbergGermany
- Institute and Outpatient Clinic for Occupational, Social, and Environmental MedicineLudwig Maximilians University MunichMunchenGermany
| | - M. Holm
- Department of Occupational and Environmental MedicineSahlgrenska University HospitalGothenburgSweden
| | - C. Janson
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - A. Johannessen
- Centre for International HealthDepartment of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Centre for Clinical ResearchHaukeland University HospitalBergenNorway
| | - D. L. Jarvis
- Respiratory Epidemiology, Occupational Medicine and Public HealthNational Heart and Lung InstituteImperial CollegeLondonUK
| | - R. Jogi
- Tartu University HospitalLung ClinicTartuEstonia
| | - B. Leynaert
- Inserm, UMR 1152Pathophysiology and Epidemiology of Respiratory Diseases, Epidemiology TeamParisFrance
- UMR 1152University Paris Diderot Paris 7ParisFrance
| | - D. Norback
- Department of Medical SciencesUppsala UniversityUppsalaSweden
| | - E. R. Omenaas
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Centre for Clinical ResearchHaukeland University HospitalBergenNorway
| | - C. Raherison
- INSERM U897 Bordeaux UniversityBordeaux CedexFrance
| | | | - V. Schlünssen
- Department of Public HealthAarhus UniversityAarhusDenmark
- National Research Centre for the Working EnvironmentCopenhagenDenmark
| | - T. Sigsgaard
- Department of Public HealthAarhus UniversityAarhusDenmark
| | - S. C. Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population HealthThe University of MelbourneMelbourneVic.Australia
| | - C. Svanes
- Department of Occupational MedicineHaukeland University HospitalBergenNorway
- Centre for International HealthDepartment of Global Public Health and Primary CareUniversity of BergenBergenNorway
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13
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Bauer SM. Atopic Eczema: Genetic Associations and Potential Links to Developmental Exposures. Int J Toxicol 2017; 36:187-198. [DOI: 10.1177/1091581817701075] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Atopic eczema (AE), or atopic dermatitis (AD), is a common inflammatory skin disease with a disrupted epidermal barrier and an allergic immune response. AD/AE is prominently characterized by a symptomatic itch and transient skin lesions. Infants compose a significant percentage affected. Two models have been proposed to explain AD/AE skin pathology: the gut microbiome-focused inside-outside model and the outside-inside model concentrating on the disrupted skin barrier/skin microbiome. Gene disruptions contributing to epidermal structure, as well as those in immune system genes, are implicated. Over 30 genes have been linked to AD/AE with Flg and Tmem79/Matt alterations being common. Other linked disruptions are in the interleukin-1 family of cytokines/receptors and the TH2 gene family of cytokines. Inheritable epigenetic modifications of the genes or associated proteins may also be involved. Skin barrier disruption and the allergic immune response have been the main foci in mechanistic studies of AD/AE, but the role of the environment is becoming more apparent. Thus, an examination of in utero exposures could be very helpful in understanding the heterogeneity of AD/AE. Although research is limited, there is evidence that developmental exposure to environmental tobacco smoke or phthalates may impact disease. Management for AD/AE includes topical corticosteroids and calcineurin inhibitors, which safely facilitate improvements in select individuals. Disease heterogeneity warrants continued research not only into elucidating disease mechanism(s), via identification of contributing genetic alterations, but also research to understand how/when these genetic alterations occur. This may lead to the cure that those affected by AD/AE eagerly await.
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Affiliation(s)
- Stephen M. Bauer
- Assistant Professor of Biology, Department of Biology, Belmont Abbey College, Belmont, NC, USA
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14
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Stemmler S, Hoffjan S. Trying to understand the genetics of atopic dermatitis. Mol Cell Probes 2016; 30:374-385. [PMID: 27725295 DOI: 10.1016/j.mcp.2016.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 02/07/2023]
Abstract
Atopic dermatitis (AD) is a common and complex skin disease associated with both genetic and environmental factors. Loss-of-function mutations in the filaggrin gene, encoding a structural protein with an important role in epidermal barrier function, constitutes a well recognised susceptibility locus for AD. Further, genome-wide association studies (GWAS), including large meta-analyses, have discovered 38 additional susceptibility loci with genome-wide significance. However, the reported variations only explain a fraction of the overall heritability of AD. Here, we summarize the current knowledge of the role of filaggrin and the epidermal differentiation complex as well as the results of GWAS, with an emphasis on novel findings and observations made in the past two years. Additionally, we present first results of exome sequencing for AD and discuss novel therapeutic strategies.
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Affiliation(s)
| | - Sabine Hoffjan
- Department of Human Genetics, Ruhr-University, Bochum, Germany
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15
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Centenary Celebration for Scottish Missionary Mary Slessor: A Lasting Legacy for Twins/Twin Research: Twins With Kleinfelter's Syndrome; Twin Research on Atopic Diseases; Twin Study of Autism; Psychotherapy with Twins / General Interest: Female Twin Pole-Vaulters; Longest Twin Birth Interval; Pair of Franco-Cuban Vocalists; Croatian Twin Models. Twin Res Hum Genet 2015; 18:328-33. [PMID: 25906830 DOI: 10.1017/thg.2015.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The centenary celebration for Scottish missionary, Mary Slessor, took place on February 14, 2015 in Melle, Belgium. Slessor saved many newborn twins and their mothers from death and disownment by members of their community, including their families, who believed twins harbored evil spirits. The events of this unusual and significant gathering are described. Next, twin research and reports concerning Kleinfelter's disease, atopic diseases, autism and psychotherapy are presented. General interest subjects include identical female twin pole-vaulters, the longest twin birth interval, Franco-Cuban twin vocalists, and Croatian twin models.
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16
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Dietert RR, Dietert JM. The Microbiome and Sustainable Healthcare. Healthcare (Basel) 2015; 3:100-29. [PMID: 27417751 PMCID: PMC4934527 DOI: 10.3390/healthcare3010100] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/09/2015] [Accepted: 02/16/2015] [Indexed: 12/19/2022] Open
Abstract
Increasing prevalences, morbidity, premature mortality and medical needs associated with non-communicable diseases and conditions (NCDs) have reached epidemic proportions and placed a major drain on healthcare systems and global economies. Added to this are the challenges presented by overuse of antibiotics and increased antibiotic resistance. Solutions are needed that can address the challenges of NCDs and increasing antibiotic resistance, maximize preventative measures, and balance healthcare needs with available services and economic realities. Microbiome management including microbiota seeding, feeding, and rebiosis appears likely to be a core component of a path toward sustainable healthcare. Recent findings indicate that: (1) humans are mostly microbial (in terms of numbers of cells and genes); (2) immune dysfunction and misregulated inflammation are pivotal in the majority of NCDs; (3) microbiome status affects early immune education and risk of NCDs, and (4) microbiome status affects the risk of certain infections. Management of the microbiome to reduce later-life health risk and/or to treat emerging NCDs, to spare antibiotic use and to reduce the risk of recurrent infections may provide a more effective healthcare strategy across the life course particularly when a personalized medicine approach is considered. This review will examine the potential for microbiome management to contribute to sustainable healthcare.
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Affiliation(s)
- Rodney R Dietert
- Department of Microbiology and Immunology, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
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17
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Abstract
This thesis explores the contribution of twin studies, particularly those studies originating from the Danish Twin Registry, to the understanding of the aetiology of asthma. First, it is explored how twin studies have established the contribution of genetic and environmental factors to the variation in the susceptibility to asthma, and to the variation in several aspects of the clinical expression of the disease such as its age at onset, its symptomatology, its intermediate phenotypes, and its relationship with other atopic diseases. Next, it is explored how twin studies have corroborated theories explaining asthma's recent increase in prevalence, and last, how these fit with the explanations of the epidemiological trends in other common chronic diseases of modernity.
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