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Biagioni B, Annesi-Maesano I, D'Amato G, Cecchi L. The rising of allergic respiratory diseases in a changing world: from climate change to migration. Expert Rev Respir Med 2020; 14:973-986. [PMID: 32662693 DOI: 10.1080/17476348.2020.1794829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The rising of allergic respiratory diseases (ARDs) suggests a decisive role of environmental factors, that have dramatically changed in the last decades. AREAS COVERED This review addresses various aspects of the external exposome acting on the development, progression, clinical presentation and severity of ARDs. Climate change, air pollution and biodiversity loss act directly and through their complex interactions on atopic risk: reacent foundings on these aspects are discussed herein. The review also focuses on migration studies, underling the possible role of migrant status as an experimental model to study environment effects on atopy onset and progression. EXPERT OPINION Future perspective on this topic include prevention and mitigation strategies in regard to pollution and climate change, improvement of environmental monitoring methods, implementation of public health policies, further advances in 'omics' research and knowledge, prospective and immunological research on migrant populations and new policies to face human mobility.
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Affiliation(s)
- Benedetta Biagioni
- Allergy Unit, Department of Pediatric Medicine, Anna Meyer Childrens University Hospital , Florence, Italy
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Department, Institute Pierre Louis of Epidemiology and Public Health, INSERM and Sorbonne Université , Paris, France
| | - Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Speciality A. Cardarelli Hospital , Napoli, Italy.,Medical School of Specialization in Respiratory Diseases, University on Naples Federico II , Naples, Italy
| | - Lorenzo Cecchi
- SOS Allergy and Clinical Immunology - Prato, USL Toscana Centro , Florence, Italy.,Centre of Bioclimatology, University of Florence , Florence, Italy
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2
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Li L, Spengler JD, Cao SJ, Adamkiewicz G. Prevalence of asthma and allergic symptoms in Suzhou, China: Trends by domestic migrant status. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2019; 29:531-538. [PMID: 29269755 DOI: 10.1038/s41370-017-0007-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 10/27/2017] [Indexed: 06/07/2023]
Abstract
Rapid urbanization in developing countries, with significant rural-to-urban and between-urban areas migration, presents a natural epidemiological model to better understand population-level trends in asthma and allergy prevalance without confounding by genetic factors. This cross-sectional study, conducted November 2014 to January 2015 in Suzhou, China, investigated differences in asthma and allergic symptoms between domestic migrant residents and long-term residents and their children. Using multivariate logistic regression, the odds ratios for children in migrant families compared to those in long-term resident families in Suzhou for doctor-diagnosed asthma, pneumonia, rhinitis, and eczema were 0.56 (95% CI: 0.42.0.73), 0.60 (95% CI: 0.49, 0.72), 0.63 (95% CI:0.52, 0.77), and 0.73 (95% CI: 0.60, 0.89), respectively. While there was a lower prevalence of asthma and allergic symptoms for domestic migrants (children and parents) compared to the local population in Suzhou, migrant children had a higher asthma rate than their parents. This follows the trend of increasing asthma rates for children in the urban local population, suggesting an environmental component. Parental migration plays a role in both parental and children's health but further investigations are needed to determine how these results may be shaped by early life exposures, lifestyle differences, and other environmental factors.
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Affiliation(s)
- Linyan Li
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - John D Spengler
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shi-Jie Cao
- Department of Civil and Environmental Engineering, Soochow University, Suzhou, China
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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3
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Rowan-Nash AD, Korry BJ, Mylonakis E, Belenky P. Cross-Domain and Viral Interactions in the Microbiome. Microbiol Mol Biol Rev 2019; 83:e00044-18. [PMID: 30626617 PMCID: PMC6383444 DOI: 10.1128/mmbr.00044-18] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The importance of the microbiome to human health is increasingly recognized and has become a major focus of recent research. However, much of the work has focused on a few aspects, particularly the bacterial component of the microbiome, most frequently in the gastrointestinal tract. Yet humans and other animals can be colonized by a wide array of organisms spanning all domains of life, including bacteria and archaea, unicellular eukaryotes such as fungi, multicellular eukaryotes such as helminths, and viruses. As they share the same host niches, they can compete with, synergize with, and antagonize each other, with potential impacts on their host. Here, we discuss these major groups making up the human microbiome, with a focus on how they interact with each other and their multicellular host.
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Affiliation(s)
- Aislinn D Rowan-Nash
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, USA
| | - Benjamin J Korry
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, USA
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Peter Belenky
- Department of Molecular Microbiology and Immunology, Brown University, Providence, Rhode Island, USA
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Tham EH, Loo EXL, Zhu Y, Shek LPC. Effects of Migration on Allergic Diseases. Int Arch Allergy Immunol 2018; 178:128-140. [PMID: 30466080 DOI: 10.1159/000494129] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/01/2018] [Indexed: 11/19/2022] Open
Abstract
Studies in migrant populations provide vital opportunities to investigate the role of environmental factors in the pathogenesis of allergic disorders. Differences in allergy prevalence have been observed between migrants and native-born subjects living in the same geographical location. Immigrants who migrate from less affluent countries with lower allergy prevalence tend to have a lower prevalence of allergic disorders compared to native-born residents of the more affluent host country. The patterns of allergic disease prevalence also differ between first- and second-generation migrants. The timing of migration in relation to birth, age at migration, and duration of residence in the host country also influence one's atopic risk. A complex interplay of multiple environmental, socioeconomic, and cultural factors is likely responsible for these observed differences. Further research into the roles of various risk factors in modulating differences in allergic disease prevalence between migrant and native populations will enhance our understanding of the complex gene-environment interactions involved in the pathogenesis of allergic disorders.
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Affiliation(s)
- Elizabeth Huiwen Tham
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS), Singapore, Singapore, .,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore,
| | - Evelyn Xiu Ling Loo
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Yanan Zhu
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Lynette Pei-Chi Shek
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System (NUHS), Singapore, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
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Machluf Y, Farkash R, Fink D, Chaiter Y. Asthma severity and heterogeneity: Insights from prevalence trends and associated demographic variables and anthropometric indices among Israeli adolescents. J Asthma 2017; 55:826-836. [PMID: 28872935 DOI: 10.1080/02770903.2017.1373809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES While asthma presents various clinical forms with different levels of severity, it is unclear whether asthma severities are a consequence of disease management or varied etiologies. We sought to investigate this question. METHODS This paper presents a cross-sectional study of 113,671 Israeli adolescents. Prevalence rates of mild and moderate-to-severe asthma over a 24-year period were calculated and multivariate regression models (outcomes: different asthma severity, reference: subjects without asthma) were performed to analyze associations with anthropometric indices and socio-demographic variables, in males and females separately. RESULTS The prevalence of mild asthma increased until birth years 1976-1980 and then steadily decreased. In contrast, the prevalence of moderate-to-severe asthma was relatively stable until birth years 1976-1980, then rose steeply until 1986-1990 and subsequently plateaued in the early 1990s. Obesity was positively associated with both mild and moderate-to-severe asthma in males (Odds Ratio (OR) [95%CIs]: 1.61 [1.37-1.89] and 1.63 [1.34-1.98], respectively) and females (1.54 [1.10-2.16] and 1.54 [1.20-1.98], respectively). Family size greater than three siblings was negatively associated with both mild and moderate-to-severe asthma in males (0.62 [0.56-0.68] and 0.59 [0.52-0.68]) and females (0.71 [0.60-0.83] and 0.73 [0.63-0.83]). In contrast, in males, underweight was only associated with mild asthma (1.54 [1.22-1.94]) but not with moderate-to-severe asthma. In females, overweight was only associated with moderate-to-severe asthma (1.21 [1.00-1.46]) and rural residence was only associated with mild asthma (1.26 [1.09-1.47]). CONCLUSIONS The differences between mild and moderate-to-severe asthma enhance asthma phenotype characterization, with respect to secular trends and associated variables, and indicate varied etiologies.
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Affiliation(s)
| | | | - Daniel Fink
- b Shaarei Zedek Medical Center , Jerusalem , Israel
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Machluf Y, Tal O, Navon A, Chaiter Y. From Population Databases to Research and Informed Health Decisions and Policy. Front Public Health 2017; 5:230. [PMID: 28983476 PMCID: PMC5613084 DOI: 10.3389/fpubh.2017.00230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022] Open
Abstract
Background In the era of big data, the medical community is inspired to maximize the utilization and processing of the rapidly expanding medical datasets for clinical-related and policy-driven research. This requires a medical database that can be aggregated, interpreted, and integrated at both the individual and population levels. Policymakers seek data as a lever for wise, evidence-based decision-making and information-driven policy. Yet, bridging the gap between data collection, research, and policymaking, is a major challenge. The model To bridge this gap, we propose a four-step model: (A) creating a conjoined task force of all relevant parties to declare a national program to promote collaborations; (B) promoting a national digital records project, or at least a network of synchronized and integrated databases, in an accessible transparent manner; (C) creating an interoperative national research environment to enable the analysis of the organized and integrated data and to generate evidence; and (D) utilizing the evidence to improve decision-making, to support a wisely chosen national policy. For the latter purpose, we also developed a novel multidimensional set of criteria to illuminate insights and estimate the risk for future morbidity based on current medical conditions. Conclusion Used by policymakers, providers of health plans, caregivers, and health organizations, we presume this model will assist transforming evidence generation to support the design of health policy and programs, as well as improved decision-making about health and health care, at all levels: individual, communal, organizational, and national.
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Affiliation(s)
| | - Orna Tal
- The Israeli Center for Emerging Technologies (ICET) in Hospitals and Hospital-Based Health Technology Assessment (HB-HTA), Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Israeli Center for Technology Assessment in Health Care (ICTAHC), The Gertner Institute for Epidemiology and Health Policy, Tel Aviv, Israel
| | - Amir Navon
- The School of Social Sciences and Humanities, Kinneret College, Sea of Galilee, Jordan Valley, Israel
| | - Yoram Chaiter
- The Israeli Center for Emerging Technologies (ICET) in Hospitals and Hospital-Based Health Technology Assessment (HB-HTA), Assaf Harofeh Medical Center, Zerifin, Israel
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Alavinezhad A, Boskabady MH. The prevalence of asthma and related symptoms in Middle East countries. CLINICAL RESPIRATORY JOURNAL 2017; 12:865-877. [PMID: 28544458 DOI: 10.1111/crj.12655] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 04/11/2017] [Accepted: 05/09/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Asthma is a chronic inflammatory airway disease characterized by reversible airway constriction and airway hyperresponsiveness. Asthma is a worldwide problem and its prevalence varies among different parts of the world. There are insufficient data about the prevalence and risk factors of this disease in Middle East countries. DATA SOURCE The objective of this review article was to determine the prevalence of asthma in Middle East countries by searching EMBASE, Medline, Web of Science and Google Scholar for articles about asthma prevalence in children and adults in this region. STUDY SELECTION The prevalence of asthma in different countries and different cities of each country in the Middle East was reviewed in children and adults of both sexes. The possible risk factors for asthma in different areas were also reviewed from 1985 to 2012. RESULTS The highest asthma prevalence in children and adults was 35.4% in Tehran, Iran by ISAAC phase I and 15% in Kuwait by self-designed questionnaire and the lowest prevalence was 1% in Kermanshah, Iran by ISAAC and 2% in Tehran, Iran by ECRHS questionnaire, respectively. Most studies showed that the prevalence of this common disease declines with increasing age. CONCLUSION The data showed that the prevalence of asthma varies among different countries and even among different cities of the same country. The common risk factors for this disease were genetic predisposition, cigarette smoking, family history of asthma and allergic diseases.
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Affiliation(s)
- Azam Alavinezhad
- Neurogeneeic Inflammation Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Hossein Boskabady
- Neurogeneeic Inflammation Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Barr RG, Avilés-Santa L, Davis SM, Aldrich TK, Gonzalez F, Henderson AG, Kaplan RC, LaVange L, Liu K, Loredo JS, Mendes ES, Ni A, Ries A, Salathe M, Smith LJ. Pulmonary Disease and Age at Immigration among Hispanics. Results from the Hispanic Community Health Study/Study of Latinos. Am J Respir Crit Care Med 2016; 193:386-95. [PMID: 26451874 PMCID: PMC4803083 DOI: 10.1164/rccm.201506-1211oc] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/09/2015] [Indexed: 12/19/2022] Open
Abstract
RATIONALE Asthma has been reported to be more prevalent among Hispanics of Puerto Rican heritage than among other Hispanics and among Hispanics born in the United States or who immigrated as children than among those who came as adults; however, direct comparisons across Hispanic groups are lacking. OBJECTIVES To test whether asthma is more prevalent among Hispanics of Puerto Rican heritage than among other Hispanic groups, whether asthma is associated with age of immigration, and whether chronic obstructive pulmonary disease varies by heritage in a large, population-based cohort of Hispanics in the United States. METHODS The Hispanic Community Health Study/Study of Latinos researchers recruited a population-based probability sample of 16,415 Hispanics/Latinos, 18-74 years of age, in New York City, Chicago, Miami, and San Diego. Participants self-reported Puerto Rican, Cuban, Dominican, Mexican, Central American, or South American heritage; birthplace; and, if relevant, age at immigration. A respiratory questionnaire and standardized spirometry were performed with post-bronchodilator measures for those with airflow limitation. MEASUREMENTS AND MAIN RESULTS The prevalence of physician-diagnosed asthma among Puerto Ricans (36.5%; 95% confidence interval, 33.6-39.5%) was higher than among other Hispanics (odds ratio, 3.9; 95% confidence interval, 3.3-4.6). Hispanics who were born in the mainland United States or had immigrated as children had a higher asthma prevalence than those who had immigrated as adults (19.6, 19.4, and 14.1%, respectively; P < 0.001). Current asthma, bronchodilator responsiveness, and wheeze followed similar patterns. Chronic obstructive pulmonary disease prevalence was higher among Puerto Ricans (14.1%) and Cubans (9.8%) than among other Hispanics (<6.0%), but it did not vary across Hispanic heritages after adjustment for smoking and prior asthma (P = 0.22), by country of birth, or by age at immigration. CONCLUSIONS Asthma was more prevalent among Puerto Ricans, other Hispanics born in the United States, and those who had immigrated as children than among other Hispanics. In contrast, the higher prevalence of chronic obstructive pulmonary disease among Puerto Ricans and Cubans was largely reflective of differential smoking patterns and asthma.
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Affiliation(s)
- R. Graham Barr
- Department of Medicine and
- Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - Larissa Avilés-Santa
- Division of Cardiovascular Sciences, NHLBI, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - Ashley G. Henderson
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Robert C. Kaplan
- Department of Epidemiology, Albert Einstein College of Medicine, Bronx, New York
| | | | - Kiang Liu
- Department of Preventative Medicine and
| | - Jose S. Loredo
- Department of Medicine, University of California, San Diego, La Jolla, California; and
| | | | - Ai Ni
- Department of Biostatistics and
| | - Andrew Ries
- Department of Medicine, University of California, San Diego, La Jolla, California; and
| | | | - Lewis J. Smith
- Department of Medicine, Northwestern University, Chicago, Illinois
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Gordon B, Hassid A, Bar-Shai A, Derazne E, Tzur D, Hershkovich O, Afek A. Association between asthma and body mass index and socioeconomic status: A cross-sectional study on 849,659 adolescents. Respirology 2015; 21:95-101. [PMID: 26390812 DOI: 10.1111/resp.12645] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 06/03/2015] [Accepted: 07/07/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Asthma is associated with body mass index (BMI), but its association with socioeconomic status (SES) is controversial. The combined effect of SES and BMI on asthma prevalence is undetermined. METHODS Seventeen-year-old pre-recruits to the Israeli Defense Forces underwent routine physical examinations. SES was determined according to established criteria based on place of residence. The study population was divided according to classic weight groups and three SES groups (low, medium and high). Univariable and multivariable logistic regression models were applied to assess odds ratios (OR) of BMI and SES groups for asthma prevalence. The combined effect of BMI and SES was also calculated. RESULTS The 849,659 subjects included 480,993 males (9.5% asthma prevalence) and 368,666 females (6.7% asthma prevalence). Increased BMI were associated with increased OR for asthma in females (1.44, 95% CI 1.36-1.52 for obese vs normal weight). Males had a J-shaped curve (OR 1.24 95% CI 1.2-1.29 for obese, 1.12, 95% CI 1.08-1.16 for underweight, both vs normal weight). OR adjusted to SES did not change significantly. All SES groups produced a linear curve (1.59 95% CI 1.53-1.66 for females and 1.79 95% CI 1.74-1.84 for males). Adjustment of SES to BMI produced no significant change in OR. When all groups were compared with the normal weight/lower SES group, the highest OR was for the obese/higher SES group (2.32 95% CI 2.05-2.64 for females and 1.99 95% CI 1.83-2.13 for males). CONCLUSIONS Both BMI and SES are co-independently associated with asthma in adolescent males and females.
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Affiliation(s)
- Barak Gordon
- Medical Corps, Israeli Defense Forces, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviad Hassid
- Medical Corps, Israeli Defense Forces, Tel Hashomer, Israel
| | - Amir Bar-Shai
- Pulmonology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Estela Derazne
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorit Tzur
- Medical Corps, Israeli Defense Forces, Tel Hashomer, Israel
| | - Oded Hershkovich
- Medical Corps, Israeli Defense Forces, Tel Hashomer, Israel.,Orthopedic Department, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Arnon Afek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Respiratory allergy in immigrants to a highly industrialised area in Italy according to area of origin and time period. Allergol Immunopathol (Madr) 2015; 43:461-8. [PMID: 25456530 DOI: 10.1016/j.aller.2014.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 07/10/2014] [Accepted: 07/31/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Migrants from developing to Western countries tend to become more sensitised to host than to origin country allergens, although substantial changes in migration patterns have occurred in recent decades. METHODS We investigated adult immigrants with respiratory allergy, first tested for allergic sensitisation between 1985 and 2012 in a highly industrialised area in Italy. A comparison was made of the sensitisation pattern between immigrants and a random sample of native-born subjects affected by a respiratory allergy, and among immigrants according to macro-region of origin and time period. RESULTS Between 1985 and 2012, 480 immigrants with respiratory allergy had a first positive allergy test. Immigrants were sensitised mainly to grass (67.1%), house dust mites (HDM) (38.5%) and birch (27.5%), with a pattern of sensitisation very similar to that observed in Italians (native-born). An increase in the proportion of subjects with asthma and of subjects with polysensitisation was observed from the first (1985-2002) to the middle (2003-2007) and the most recent period (2008-2012). In recent years, the proportion of subjects with polysensitisation in immigrants is higher than in Italians (native-born) (53.3% vs. 40.1%). Among immigrants, the risk of sensitisation to grass was higher in those from Sub-Saharan Africa (odds ratio, OR=2.76) and Latin America (OR=2.49), whereas risk of sensitisation to HDM was higher among immigrants from South Asia (OR=2.71), compared to immigrants from Eastern Europe. CONCLUSIONS Immigrants develop multiple sensitisations more frequently than native-born people, and are especially sensitised to local allergens; the country of origin seems to play a role.
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Influences of large sets of environmental exposures on immune responses in healthy adult men. Sci Rep 2015; 5:13367. [PMID: 26306804 PMCID: PMC4549790 DOI: 10.1038/srep13367] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/13/2015] [Indexed: 11/19/2022] Open
Abstract
Environmental factors have long been known to influence immune responses. In particular, clinical studies about the association between migration and increased risk of atopy/asthma have provided important information on the role of migration associated large sets of environmental exposures in the development of allergic diseases. However, investigations about environmental effects on immune responses are mostly limited in candidate environmental exposures, such as air pollution. The influences of large sets of environmental exposures on immune responses are still largely unknown. A simulated 520-d Mars mission provided an opportunity to investigate this topic. Six healthy males lived in a closed habitat simulating a spacecraft for 520 days. When they exited their “spacecraft” after the mission, the scenario was similar to that of migration, involving exposure to a new set of environmental pollutants and allergens. We measured multiple immune parameters with blood samples at chosen time points after the mission. At the early adaptation stage, highly enhanced cytokine responses were observed upon ex vivo antigen stimulations. For cell population frequencies, we found the subjects displayed increased neutrophils. These results may presumably represent the immune changes occurred in healthy humans when migrating, indicating that large sets of environmental exposures may trigger aberrant immune activity.
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Rook GAW, Raison CL, Lowry CA. Microbiota, immunoregulatory old friends and psychiatric disorders. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2014; 817:319-56. [PMID: 24997041 DOI: 10.1007/978-1-4939-0897-4_15] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Regulation of the immune system is an important function of the gut microbiota. Increasing evidence suggests that modern living conditions cause the gut microbiota to deviate from the form it took during human evolution. Contributing factors include loss of helminth infections, encountering less microbial biodiversity, and modulation of the microbiota composition by diet and antibiotic use. Thus the gut microbiota is a major mediator of the hygiene hypothesis (or as we prefer, "Old Friends" mechanism), which describes the role of organisms with which we co-evolved, and that needed to be tolerated, as crucial inducers of immunoregulation. At least partly as a consequence of reduced exposure to immunoregulatory Old Friends, many but not all of which resided in the gut, high-income countries are undergoing large increases in a wide range of chronic inflammatory disorders including allergies, autoimmunity and inflammatory bowel diseases. Depression, anxiety and reduced stress resilience are comorbid with these conditions, or can occur in individuals with persistently raised circulating levels of biomarkers of inflammation in the absence of clinically apparent peripheral inflammatory disease. Moreover poorly regulated inflammation during pregnancy might contribute to brain developmental abnormalities that underlie some cases of autism spectrum disorders and schizophrenia. In this chapter we explain how the gut microbiota drives immunoregulation, how faulty immunoregulation and inflammation predispose to psychiatric disease, and how psychological stress drives further inflammation via pathways that involve the gut and microbiota. We also outline how this two-way relationship between the brain and inflammation implicates the microbiota, Old Friends and immunoregulation in the control of stress resilience.
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Affiliation(s)
- Graham A W Rook
- Centre for Clinical Microbiology, UCL (University College London), Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK,
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13
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Garcia-Marcos L, Robertson CF, Ross Anderson H, Ellwood P, Williams HC, Wong GW. Does migration affect asthma, rhinoconjunctivitis and eczema prevalence? Global findings from the international study of asthma and allergies in childhood. Int J Epidemiol 2014; 43:1846-54. [PMID: 25056339 DOI: 10.1093/ije/dyu145] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Immigrants to Westernized countries adopt the prevalence of allergic diseases of native populations, yet no data are available on immigrants to low-income or low-disease prevalence countries. We investigated these questions using data from the International Study of Asthma and Allergies in Childhood. METHODS Standardized questionnaires were completed by 13-14-year-old adolescents and by the parent/guardians of 6-7-year-old children. Questions on the symptom prevalence of asthma, rhinoconjunctivitis and eczema, and a wide range of factors postulated to be associated with these conditions, including birth in or not in the country and age at immigration, were asked. Odds ratios for risk of the three diseases according to immigration status were calculated using generalized linear mixed models. These were adjusted for: world region; language and gross national income; and individual risk factors including gender, maternal education, antibiotic and paracetamol use, maternal smoking, and diet. Effect modification by gross national income and by prevalence was examined. RESULTS There were 326 691 adolescents from 48 countries and 208 523 children from 31 countries. Immigration was associated with a lower prevalence of asthma, rhinoconjunctivitis and eczema in both age groups than among those born in the country studied, and this association was mainly confined to high-prevalence/affluent countries. This reduced risk was greater in those who had lived fewer years in the host country. CONCLUSIONS Recent migration to high prevalence/affluent countries is associated with a lower prevalence of allergic diseases. The protective pre-migration environment quickly decreases with increasing time in the host country.
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Affiliation(s)
- Luis Garcia-Marcos
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - Colin F Robertson
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - H Ross Anderson
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - Philippa Ellwood
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - Hywel C Williams
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
| | - Gary Wk Wong
- Respiratory Medicine and Allergy Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain, Murdoch Children's Research Institute, Melbourne, Australia, MRC Centre for Environment and Health, St George's, University of London, London, UK, Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand, Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK and Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China. The ISAAC Phase Three Study group are listed under Supplementary data at IJE online
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14
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Chang M, Kelvin EA. Differing asthma prevalence by gross national index of country of birth among New York City residents. Allergy 2014; 69:494-500. [PMID: 24475906 DOI: 10.1111/all.12367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The hygiene hypothesis suggests that higher exposure to infectious agents may be one reason for regional differences in asthma. This would suggest that immigrants from less developed countries, where infections are more common, to highly developed countries will have lower risk of asthma compared with natives, as has been found in a number of studies. We expand the research on immigrants to look at the level of development in country of origin as a predictor of asthma in New York City residents. METHODS Data came from the 2009 cross-sectional Community Health Survey. We used logistic regression to assess the relationship of country of birth and the gross national income (GNI), an indicator of the level of development, of country of birth with asthma among immigrants and US-born New York City residents. RESULTS Those who were foreign born had lower odds of having asthma compared with those US born (OR = 0.43, P < 0.001). There was a dose relationship between GNI and asthma with decreasing odds of having asthma associated with lower GNI in country of birth (low GNI country: OR = 0.26, P = 0.014; middle GNI country: OR = 0.36, P < 0.001; and high GNI country = reference). CONCLUSIONS These findings lend support to the hygiene hypothesis in that the odds of having asthma among New York City residents was lowest among people born in the least developed countries, as indicated by GNI, where infections are likely the most common.
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Affiliation(s)
- M. Chang
- Epidemiology & Biostatistics Program; CUNY School of Public Health; Hunter College; New York NY USA
| | - E. A. Kelvin
- Epidemiology & Biostatistics Program; CUNY School of Public Health; Hunter College; New York NY USA
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15
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Regulation of the immune system by biodiversity from the natural environment: an ecosystem service essential to health. Proc Natl Acad Sci U S A 2013; 110:18360-7. [PMID: 24154724 DOI: 10.1073/pnas.1313731110] [Citation(s) in RCA: 366] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Epidemiological studies suggest that living close to the natural environment is associated with long-term health benefits including reduced death rates, reduced cardiovascular disease, and reduced psychiatric problems. This is often attributed to psychological mechanisms, boosted by exercise, social interactions, and sunlight. Compared with urban environments, exposure to green spaces does indeed trigger rapid psychological, physiological, and endocrinological effects. However, there is little evidence that these rapid transient effects cause long-term health benefits or even that they are a specific property of natural environments. Meanwhile, the illnesses that are increasing in high-income countries are associated with failing immunoregulation and poorly regulated inflammatory responses, manifested as chronically raised C-reactive protein and proinflammatory cytokines. This failure of immunoregulation is partly attributable to a lack of exposure to organisms ("Old Friends") from mankind's evolutionary past that needed to be tolerated and therefore evolved roles in driving immunoregulatory mechanisms. Some Old Friends (such as helminths and infections picked up at birth that established carrier states) are almost eliminated from the urban environment. This increases our dependence on Old Friends derived from our mothers, other people, animals, and the environment. It is suggested that the requirement for microbial input from the environment to drive immunoregulation is a major component of the beneficial effect of green space, and a neglected ecosystem service that is essential for our well-being. This insight will allow green spaces to be designed to optimize health benefits and will provide impetus from health systems for the preservation of ecosystem biodiversity.
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Rook GAW, Lowry CA, Raison CL. Microbial 'Old Friends', immunoregulation and stress resilience. EVOLUTION MEDICINE AND PUBLIC HEALTH 2013; 2013:46-64. [PMID: 24481186 PMCID: PMC3868387 DOI: 10.1093/emph/eot004] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Chronic inflammatory diseases (autoimmunity, allergy and inflammatory bowel diseases) are increasing in prevalence in urban communities in high-income countries. One important factor is reduced exposure to immunoregulation-inducing macro- and microorganisms and microbiota that accompanied mammalian evolution (the hygiene hypothesis or 'Old Friends' mechanism). Reduced exposure to these organisms predisposes to poor regulation of inflammation. But inflammation is equally relevant to psychiatric disorders. Inflammatory mediators modulate brain development, cognition and mood, and accompany low socioeconomic status and some cases of depression in developed countries. The risk of all these conditions (chronic inflammatory and psychiatric) is increased in urban versus rural communities, and increased in immigrants, particularly if they move from a low- to a high-income country during infancy, and often the prevalence increases further in second generation immigrants, suggesting that critical exposures modulating disease risk occur during pregnancy and infancy. Diminished exposure to immunoregulation-inducing Old Friends in the perinatal period may enhance the consequences of psychosocial stressors, which induce increased levels of inflammatory mediators, modulate the microbiota and increase the risk for developing all known psychiatric conditions. In later life, the detrimental effects of psychosocial stressors may be exaggerated when the stress occurs against a background of reduced immunoregulation, so that more inflammation (and therefore more psychiatric symptoms) result from any given level of psychosocial stress. This interaction between immunoregulatory deficits and psychosocial stressors may lead to reduced stress resilience in modern urban communities. This concept suggests novel interpretations of recent epidemiology, and novel approaches to the increasing burden of psychiatric disease.
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Affiliation(s)
- Graham A W Rook
- Centre for Clinical Microbiology, Department of Infection, University College London (UCL), London, UK; Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO 80309-0354, USA and Department of Psychiatry, College of Medicine and Norton School of Family and Consumer Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, USA
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17
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Shani M, Band Y, Kidon MI, Segel MJ, Rosenberg R, Nakar S, Vinker S. The second generation and asthma: Prevalence of asthma among Israeli born children of Ethiopian origin. Respir Med 2013; 107:519-23. [PMID: 23333066 DOI: 10.1016/j.rmed.2012.12.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Revised: 12/09/2012] [Accepted: 12/10/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Immigrant populations moving from undeveloped countries with low asthma prevalence have shown increased asthma prevalence in their new Westernized environment. We compared the prevalence of asthma among Israeli born children of Ethiopian origin to that in non-Ethiopian children. METHODS Cross sectional study. Data was retrieved for children aged 6-18 years in four clinics with a large proportion of patients of Ethiopian origin. For each Israeli born child from Ethiopian origin we matched an Israeli born child of any other origin of the same age and gender, receiving primary care from the same physician at the same clinic. Asthma was defined as any visit to a primary care physician, emergency room or hospitalization related to asthma symptoms or subsequent purchasing of any asthma medication during 2008. RESULTS 1217 children of Ethiopian origin and 1217 matched controls were studied. More Ethiopian children came from families with a low socioeconomic status (23.9% vs. 17%, p < 0.001), and with significantly lower parental smoking (5.1% vs. 40.1%, p < 0.001). The prevalence of asthma was 92/1217 (7.5%) among children of Ethiopian origin, compared to 122/1217 (10.0%) among the control group (OR = 0.74, 95% CI: 0.56-0.98, p = 0.032). When adjusted for tobacco exposure, the OR for risk of asthma in the Ethiopian children was 0.80 (95% CI: 0.59-1.09, p = 0.16). CONCLUSION Asthma prevalence in the second generation of Israeli born children of Ethiopian origin does not seem to differ from other children in their community. This observation supports the theory that environmental exposures, rather than genetic factors, dictated the increase in asthma in this immigrant population.
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Affiliation(s)
- Michal Shani
- Department of Family Medicine Central District, Clalit Health Service, Israel.
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Izbicki G, Grosman A, Weiler Z, Shulimzon T, Laxer U, Fink G. National asthma observational survey of severe asthmatics in Israel: the no-air study. Allergy Asthma Clin Immunol 2012; 8:8. [PMID: 22656244 PMCID: PMC3444925 DOI: 10.1186/1710-1492-8-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 06/01/2012] [Indexed: 11/21/2022] Open
Abstract
Background Asthma is considered a global public health issue requiring a significant medical expenditure as a result of its high prevalence and the low rate of disease control. Objective This is the first nationwide survey of severe asthma patients carried out in Israel. In this study we aimed to assess health resources utilization, compliance with treatment and disease-control in a subgroup of patients with severe asthma in Israel. Material and method One hundred and twenty-three patients with a diagnosis of asthma for more then one year, as well as a hospitalization during the last 12 months due to asthma exacerbation or maintenance systemic steroids therapy, were included in this non-interventional observational study. Results Asthma was uncontrolled in 43.9%, partly controlled in 50.4% and well controlled in only 5.7%. The majority of the patients (83%) were compliant with drug treatment. Conclusion The fact that 83% of the asthma patients included in this study were compliant with their asthma therapy was not manifested in asthma control. Therefore concrete tools are required for achieving and maintaining asthma control, especially in the treatment of the most severe asthmatic patients.
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Affiliation(s)
- Gabriel Izbicki
- Pulmonary Institute, Shaare Zedek Medical Center, affiliated with the Hebrew University-Hadassah School of Medicine, Jerusalem, 91031, Israel.
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Personal and parental nativity as risk factors for food sensitization. J Allergy Clin Immunol 2011; 129:169-75.e1-5. [PMID: 22075329 DOI: 10.1016/j.jaci.2011.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/28/2011] [Accepted: 10/03/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND Immigrants to developed countries have low rates of aeroallergen sensitization and asthma, but less is known about both food allergy and the role of parental immigration status. OBJECTIVE We sought to evaluate the relationship between personal and parental nativity and the risk of food sensitization. METHODS Three thousand five hundred fifty subjects less than 21 years old from the Nation Health and Examination Survey 2005-2006 were included. Odds ratios (ORs) were generated by using logistic regression, which adjusted for race/ethnicity, sex, age, and household income and accounted for the complex survey design. Nativity was classified as US-born or foreign-born, and the age of immigration was estimated. Head-of-household nativity was used as a proxy for parental nativity. Food sensitization was defined as at least 1 specific IgE level of 0.35 kU/L or greater to milk, egg, or peanut. Aeroallergen-specific sensitizations and the presence of asthma, allergic rhinitis, or eczema were also assessed. RESULTS Compared with those born outside the United States (US), US-born children and adolescents had higher odds of sensitization to any food (OR, 2.05; 95% CI, 1.49-2.83; P < .001). Among the foreign-born group, those who arrived before 2 years of age had higher odds of food sensitization than those who arrived later (OR, 2.68; 95% CI, 1.19-6.08; P = .02). Within the US-born group, in contrast, children of immigrants were at the highest risk (OR, 1.53; 95% CI, 1.05-2.24; P = .02). CONCLUSION Although foreign-born children and adolescents are at lower risk of food sensitization compared with those born in the US, among those born in the US, the children of immigrants are at the highest risk.
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Eldeirawi K, McConnell R, Furner S, Freels S, Stayner L, Hernandez E, Amoruso L, Torres S, Persky VW. Associations of Doctor-Diagnosed Asthma with Immigration Status, Age at Immigration, and Length of Residence in the United States in a Sample of Mexican American School Children in Chicago. J Asthma 2009. [DOI: 10.1080/02770900903114572] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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