1
|
Khalkhali HR, Oshnouei S, Salarilak S, Rahimi Rad M, Karamyar M, Khashabi J. Effects of antibiotic consumption on children 2-8 years of age developing asthma. Epidemiol Health 2014; 36:e2014006. [PMID: 25045578 PMCID: PMC4101990 DOI: 10.4178/epih/e2014006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/07/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Antibiotic exposure in children is a possible contributor to the increasing asthma prevalence in several countries. The present study aimed to investigate the association between antibiotic exposure and the risk of developing childhood asthma at 2-8 years of age. METHODS A case-control study was undertaken among children aged 2-8 years old between March and September 2010 in the Urmia district in the northwest of Iran. The cases were doctor-diagnosed asthmatic children based on Global Initiative for Asthma criteria (n=207), and the controls were children without respiratory symptoms (n=400) selected by frequency matching by age and gender. Clinical data including antibiotic exposure was collected by a validated and reliable questionnaire, which was completed by interviewing parents/guardians. RESULTS Antibiotic consumption during the first year of life increased the odds ratio [OR] of asthma symptoms at 2-8 years of age (crude OR, 2.26; 95% confidence interval [CI], 1.53-3.35; p<0.01), and the strength of association was similar after adjusting for a family history of asthma or atopic disorder, preterm delivery, birth order, and delivery method (adjusted OR, 1.91; 95% CI, 1.27-2.88; p=0.03). CONCLUSIONS Our study suggests that antibiotic consumption in children was associated with an increased risk of childhood asthma, and an additional confirmative study is needed.
Collapse
Affiliation(s)
- Hamid Reza Khalkhali
- Inpatient Safety Research Center, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran ; Department of Biostatistics and Epidemiology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Sima Oshnouei
- Reproductive Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Shaker Salarilak
- Department of Public Health, Faculty of Medicine, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Mohammadhossein Rahimi Rad
- Department of Respiratory Medicine, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohammad Karamyar
- Department of Pediatrics, Motahari Hospital, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Javad Khashabi
- Department of Pediatrics, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
2
|
Jerschow E, McGinn AP, de Vos G, Vernon N, Jariwala S, Hudes G, Rosenstreich D. Dichlorophenol-containing pesticides and allergies: results from the US National Health and Nutrition Examination Survey 2005-2006. Ann Allergy Asthma Immunol 2012; 109:420-5. [PMID: 23176881 PMCID: PMC10576446 DOI: 10.1016/j.anai.2012.09.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 09/06/2012] [Accepted: 09/09/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Epidemiologic studies support the hypothesis that reduced microbial exposure in westernized societies promotes atopy. Dichlorophenols are widely used as pesticides and for chlorination of water. They have a strong bactericidal effect that could affect microflora in the environment. However, it is unknown whether their use is associated with a higher prevalence of allergies. OBJECTIVE To test the association between exposure to environmental pesticides represented by dichlorophenols and allergic sensitization measured by allergen-specific serum IgE levels in a US nationally representative sample of 2,211 persons 6 years and older in the National Health and Nutrition Examination Survey 2005-2006. METHODS Exposure to dichlorophenols was defined as high if their levels in urine were present at the 75th percentile and above. Association of the high exposure to dichlorophenols with sensitization to food and environmental allergens was assessed in logistic regression models after adjustment for sample weights and potential confounders. RESULTS Sensitizations to 1 or more food allergens were more common in those with exposure to 2 dichlorophenol metabolites. After multivariable adjustment, urine dichlorophenol levels at the 75th percentile and above were associated with the presence of sensitization to foods (odds ratio, 1.8; 95% confidence interval, 1.2-2.5; P = .003). No significant association was found between dichlorophenol exposure and sensitization to aeroallergens alone. CONCLUSION High urine levels of dichlorophenols are associated with the presence of sensitization to foods in a US population. Excessive use of dichlorophenols may contribute to the increasing incidence of food allergies in westernized societies.
Collapse
Affiliation(s)
- Elina Jerschow
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA.
| | | | | | | | | | | | | |
Collapse
|
3
|
Peakman M. Broadening the translational immunology landscape. Clin Exp Immunol 2012; 170:249-53. [DOI: 10.1111/j.1365-2249.2012.04671.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SummaryIt is just over 5 years sinceClinical and Experimental Immunology came under the direction of a new team of Editors and made a concerted effort to refresh its approach to promoting clinical and applied immunology through its pages. There were two major objectives: to foster papers in a field which, at the time, we loosely termed ‘translational immunology’; and to create a forum for the presentation and discussion of immunology that is relevant to clinicians operating in this space. So, how are we doing with these endeavours? This brief paper aims to summarize some of the key learning points and successes and highlight areas in which translational gaps remain.
Collapse
Affiliation(s)
- M Peakman
- Department of Immunobiology, King's College London
- NIHR Comprehensive Biomedical Research Centre, Guy's and St Thomas’ NHS Foundation Trust and King's College London, London, UK
| |
Collapse
|
4
|
Antó JM, Pinart M, Akdis M, Auffray C, Bachert C, Basagaña X, Carlsen KH, Guerra S, von Hertzen L, Illi S, Kauffmann F, Keil T, Kiley JP, Koppelman GH, Lupinek C, Martinez FD, Nawijn MC, Postma DS, Siroux V, Smit HA, Sterk PJ, Sunyer J, Valenta R, Valverde S, Akdis CA, Annesi-Maesano I, Ballester F, Benet M, Cambon-Thomsen A, Chatzi L, Coquet J, Demoly P, Gan W, Garcia-Aymerich J, Gimeno-Santos E, Guihenneuc-Jouyaux C, Haahtela T, Heinrich J, Herr M, Hohmann C, Jacquemin B, Just J, Kerkhof M, Kogevinas M, Kowalski ML, Lambrecht BN, Lau S, Lødrup Carlsen KC, Maier D, Momas I, Noel P, Oddie S, Palkonen S, Pin I, Porta D, Punturieri A, Rancière F, Smith RA, Stanic B, Stein RT, van de Veen W, van Oosterhout AJM, Varraso R, Wickman M, Wijmenga C, Wright J, Yaman G, Zuberbier T, Bousquet J. Understanding the complexity of IgE-related phenotypes from childhood to young adulthood: a Mechanisms of the Development of Allergy (MeDALL) seminar. J Allergy Clin Immunol 2012; 129:943-54.e4. [PMID: 22386796 DOI: 10.1016/j.jaci.2012.01.047] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 12/22/2011] [Accepted: 01/12/2012] [Indexed: 12/18/2022]
Abstract
Mechanisms of the Development of Allergy (MeDALL), a Seventh Framework Program European Union project, aims to generate novel knowledge on the mechanisms of initiation of allergy. Precise phenotypes of IgE-mediated allergic diseases will be defined in MeDALL. As part of MeDALL, a scientific seminar was held on January 24, 2011, to review current knowledge on the IgE-related phenotypes and to explore how a multidisciplinary effort could result in a new integrative translational approach. This article provides a summary of the meeting. It develops challenges in IgE-related phenotypes and new clinical and epidemiologic approaches to the investigation of allergic phenotypes, including cluster analysis, scale-free models, candidate biomarkers, and IgE microarrays; the particular case of severe asthma was reviewed. Then novel approaches to the IgE-associated phenotypes are reviewed from the individual mechanisms to the systems, including epigenetics, human in vitro immunology, systems biology, and animal models. The last chapter deals with the understanding of the population-based IgE-associated phenotypes in children and adolescents, including age effect in terms of maturation, observed effects of early-life exposures and shift of focus from early life to pregnancy, gene-environment interactions, cohort effects, and time trends in patients with allergic diseases. This review helps to define phenotypes of allergic diseases in MeDALL.
Collapse
Affiliation(s)
- Josep M Antó
- Centre for Research in Environmental Epidemiology, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Björkstén B. Diverse microbial exposure - consequences for vaccine development. Vaccine 2011; 30:4336-40. [PMID: 22079075 DOI: 10.1016/j.vaccine.2011.10.074] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 10/17/2011] [Accepted: 10/26/2011] [Indexed: 01/08/2023]
Abstract
Numerous epidemiological studies suggest that there is an inverse relationship between "immunologically mediated diseases of affluence", such as allergy, diabetes and inflammatory bowel disease on one hand and few infections encountered in early childhood, on the other hand. Careful analysis of the epidemiological, clinical and animal studies taken together, however, suggests that the protection is mediated by broad exposure to a wealth of commensal, non-pathogenic microorganisms early in life, rather than by infections. Microbial exposure has little relationship with "hygiene" in the usual meaning of the word and the term "hygiene hypothesis" is therefore misleading. A better term would be "microbial deprivation hypothesis". The suggestion that childhood infections would protect against allergic disease led to unfortunate speculations that vaccinations would increase the risk for allergies and diabetes. Numerous epidemiological studies have therefore been conducted, searching for a possible relationship between various childhood vaccinations on one hand and allergy on the other hand. It is reasonable from these studies to conclude that vaccinations against infectious agents neither significantly increase, nor reduce the likelihood of immunologically mediated diseases. It is established that the postnatal maturation of immune regulation is largely driven by exposure to microbes. Germ free animals manifest excessive immune responses when immunised and they do not develop normal immune regulatory function. The gut is by far the largest source of microbial exposure, as the human gut microbiome contains up to 1014 bacteria, i.e. ten times the number of cells in the human body. Several studies in recent years have shown differences in the composition of the gut microbiota between allergic and non-allergic individuals and between infants living in countries with a low and a high prevalence of immune mediated diseases. The administration of probiotic bacteria to pregnant mothers and postnatal to their infants has immune modulatory effects. So far, however, probiotic bacteria do not seem to significantly enhance immune responses to vaccines. The potential to improve vaccine responses by modifying the gut microbiota in infants and the possibility to employ probiotic bacteria as adjuvants and/or delivery vehicles, is currently explored in several laboratories. Although to date few clinical results have been reported, experimental studies have shown some encouraging results.
Collapse
Affiliation(s)
- Bengt Björkstén
- Institute of Environmental Medicine, Karolinska Institutet Stockholm, and School of Health and Medical Sciences, Örebro University, Sweden.
| |
Collapse
|
6
|
Wingender G, Rogers P, Batzer G, Lee MS, Bai D, Pei B, Khurana A, Kronenberg M, Horner AA. Invariant NKT cells are required for airway inflammation induced by environmental antigens. ACTA ACUST UNITED AC 2011; 208:1151-62. [PMID: 21624935 PMCID: PMC3173256 DOI: 10.1084/jem.20102229] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
House dust contains antigens capable of activating mouse and human iNKT cells, contributing to allergen-induced airway inflammation. Invariant NKT cells (iNKT cells) are a unique subset of T lymphocytes that rapidly carry out effector functions. In this study, we report that a majority of sterile house dust extracts (HDEs) tested contained antigens capable of activating mouse and human iNKT cells. HDEs had adjuvant-like properties in an ovalbumin (OVA)-induced asthma model, which were dependent on Vα14i NKT cells, as vaccinated animals deficient for iNKT cells displayed significantly attenuated immune responses and airway inflammation. Furthermore, the administration of HDEs together with OVA mutually augmented the synthesis of cytokines by Vα14i NKT cells and by conventional CD4+ T cells in the lung, demonstrating a profound immune response synergy for both Th2 cytokines and IL-17A. These data demonstrate that iNKT cell antigens are far more widely dispersed in the environment than previously anticipated. Furthermore, as the antigenic activity in different houses varied greatly, they further suggest that iNKT cell responses to ambient antigens, particular to certain environments, might promote sensitization to conventional respiratory allergens.
Collapse
Affiliation(s)
- Gerhard Wingender
- Division of Developmental Immunology, La Jolla Institute for Allergy and Immunology, La Jolla, CA 92037, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Risnes KR, Belanger K, Murk W, Bracken MB. Antibiotic exposure by 6 months and asthma and allergy at 6 years: Findings in a cohort of 1,401 US children. Am J Epidemiol 2011; 173:310-8. [PMID: 21190986 DOI: 10.1093/aje/kwq400] [Citation(s) in RCA: 196] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Many studies have reported that antibiotic use may be associated with increased risk of childhood asthma. Respiratory tract infections in small children may be difficult to distinguish from early symptoms of asthma, and studies may have been confounded by "protopathic" bias, where antibiotics are used to treat early symptoms of asthma. These analyses of a cohort including 1,401 US children assess the association between antibiotic use within the first 6 months of life and asthma and allergy at 6 years of age between 2003 and 2007. Antibiotic exposure was associated with increased risk of asthma (adjusted odds ratio = 1.52, 95% confidence interval (CI): 1.07, 2.16). The odds ratio if asthma was first diagnosed after 3 years of age was 1.66 (95% CI: 0.99, 2.79) and, in children with no history of lower respiratory infection in the first year of life, the odds ratio was 1.66 (95% CI: 1.12, 3.46). The adverse effect of antibiotics was particularly strong in children with no family history of asthma (odds ratio = 1.89, 95% CI: 1.00, 3.58) (P(interaction) = 0.03). The odds ratio for a positive allergy blood or skin test was 1.59 (95% CI: 1.10, 2.28). The results show that early antibiotic use was associated with asthma and allergy at 6 years of age, and that protopathic bias was unlikely to account for the main findings.
Collapse
Affiliation(s)
- Kari R Risnes
- Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale University Schools of Public Health and Medicine, New Haven, Connecticut, USA
| | | | | | | |
Collapse
|
8
|
Bibliography. Genetics. Current world literature. Curr Opin Pediatr 2010; 22:833-5. [PMID: 21610333 DOI: 10.1097/mop.0b013e32834179f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
9
|
BCG vaccination and allergy: a systematic review and meta-analysis. J Allergy Clin Immunol 2010; 127:246-53, 253.e1-21. [PMID: 20933258 DOI: 10.1016/j.jaci.2010.07.039] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 06/14/2010] [Accepted: 07/19/2010] [Indexed: 01/21/2023]
Abstract
BACKGROUND There is conflicting evidence on whether BCG vaccination might represent an effective primary preventative strategy against the development of allergic sensitization and disease. OBJECTIVES We sought to systematically review the relationship between BCG vaccination and the risk of sensitization, eczema/atopic dermatitis, allergic rhinoconjunctivitis, asthma, and other allergic conditions, such as food allergy and anaphylaxis. METHODS Four international databases were searched for published epidemiologic or interventional studies. Additional online study databases were searched and vaccine manufacturers and a panel of international experts were contacted in an attempt to locate unpublished or ongoing studies. Quality assessment was undertaken by using internationally established criteria. Meta-analyses were undertaken by using fixed- or random-effects modeling. Funnel plots were used to assess for the risk of publication bias. RESULTS We identified 767 articles, of which 17 satisfied our inclusion criteria; there was only 1 randomized controlled trial, with the remaining studies being epidemiologic investigations. Meta-analyses did not show any protective effect of vaccination against the risk of sensitization, as judged by specific IgE tests (odds ratio [OR], 1.31; 95% CI, 1.07-1.60) or skin prick testing (OR, 0.87; 95% CI, 0.67-1.13); the risk of atopic eczema/dermatitis (OR, 0.84; 95% CI, 0.64-1.09); or the risk of allergic rhinoconjunctivitis (OR, 1.07; 95% CI, 0.89-1.28). BCG vaccination was associated with a protective effect against the risk of asthma (OR, 0.73; 95% CI, 0.56-0.95), although this might be explained by publication bias. CONCLUSIONS BCG vaccination is unlikely to be associated with protection against the risk of allergic sensitization and disease. The observed possible benefit in relation to the development of asthma is unlikely to be due to allergic sensitization.
Collapse
|
10
|
Ewald PW. 99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: symbionts and immunopathology in chronic diseases: insights from evolution. Clin Exp Immunol 2010; 160:27-34. [PMID: 20415848 DOI: 10.1111/j.1365-2249.2010.04127.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Immunological aetiologies of disease are not generally well understood, but have been attributed to intrinsic immunological imbalances, infectious triggers or persistent infections. Evolutionary considerations lead to the formulation of three feasible categories of immunopathology for common diseases. One category of hypotheses presumes that the immune system is exposed to environmental conditions to which the individual is not well adapted. One hypothesis within this category, often referred to as the hygiene hypothesis, proposes that new more hygienic environmental conditions have generated compositions of symbionts that differ from those to which humans have been adapted. A second category of hypotheses proposes that infectious agents act as triggers of immunopathology by shifting the immune system into a self-destructive state. A third category proposes that infectious agents keep the immune in a self-destructive state by causing persistent infections. To evaluate disease causation rigorously and to determine the appropriate interventions, these three categories of causation need to considered for every disease that involves immunopathology. Assessment of the progress in understanding oncogenesis and other chronic diseases emphasizes the value of such integrated assessments.
Collapse
Affiliation(s)
- P W Ewald
- Department of Biology and the Program on Disease Evolution, University of Louisville, Louisville, KY 40204, USA.
| |
Collapse
|
11
|
Ehlers S, Kaufmann SHE. 99th Dahlem conference on infection, inflammation and chronic inflammatory disorders: lifestyle changes affecting the host-environment interface. Clin Exp Immunol 2010; 160:10-4. [PMID: 20415845 PMCID: PMC2841829 DOI: 10.1111/j.1365-2249.2010.04120.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
In industrialized nations and high-income regions of the world, the decline of infectious diseases is paralleled by an increase in allergic, autoimmune and chronic inflammatory diseases (AACID). Changes in lifestyle in westernized societies, which impact individually and collectively on intestinal microbiota, may – at least in part – account for the AACID pandemic. Many disease genes that contribute to AACID encode pattern recognition and signalling molecules in barrier-associated cells. Interactions between gene products and environmental factors depend highly upon the host's state of maturation, the composition of the skin and gut microflora, and exposure to pollutants, antibiotics and nutrients. Inflammatory stress responses, if regulated appropriately, ensure immunity, health and relative longevity; when they are dysregulated, they can no longer be terminated appropriately and thus precipitate AACID. The 99th Dahlem Conference brought together experts of various disciplines (genetics, evolution biology, molecular biology, structural biology, cell biology, immunology, microbiology, nutrition science, epidemiology and clinical medicine) to discuss the multi-faceted relationships between infection, immunity and inflammation in barrier organs and the development of AACID. In Clinical and Experimental Immunology we are presenting a compilation of background papers that formed the basis of discussions. Controversial viewpoints and gaps in current knowledge were examined and new concepts for prevention and treatment of CID were formulated.
Collapse
Affiliation(s)
- S Ehlers
- Cluster of Excellence Inflammation at Interfaces, Research Center Borstel, Borstel, Germany.
| | | |
Collapse
|