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Jung WS, Kim SH, Lee H. Missed Diagnosis of Anaphylaxis in Patients With Pediatric Urticaria in the Emergency Department. Pediatr Emerg Care 2021; 37:199-203. [PMID: 30281553 DOI: 10.1097/pec.0000000000001617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study was to determine the characteristics of missed diagnosis of pediatric anaphylaxis that were registered as urticaria only at the emergency department (ED) by comparing those who had only urticaria symptoms with those who had both anaphylaxis and urticaria symptoms. METHODS Subjects were classified into missed anaphylaxis and urticaria group according to whether satisfied anaphylaxis diagnostic criteria or not. Anaphylaxis group, those who were initially registered as anaphylaxis with urticaria and anaphylaxis symptoms simultaneously, were further investigated. RESULTS The missed anaphylaxis group included 37 patients of 1051 pediatric urticaria patients. The anaphylaxis group included 11 patients. The time from symptom onset to ED arrival in the missed anaphylaxis group was shorter than the urticaria group. More patients in the missed anaphylaxis group had a history of past food allergy. Seafood, egg, and milk were more common causes of allergy in the missed anaphylaxis group; however, idiopathic causes were more common in the urticaria group. Symptom was more severe in the missed anaphylaxis group than the urticaria group. More treatments except antihistamine were performed at ED in the missed anaphylaxis group. Cardiovascular symptoms were more common in the anaphylaxis group than the missed anaphylaxis group. CONCLUSIONS Of all pediatric urticaria patients, 3.5% of patients were not registered as anaphylaxis although they had anaphylaxis symptoms. Missed diagnosis of anaphylaxis in pediatric urticaria patients at ED was associated with a history of past food allergy, milk, egg, and seafood as causes of allergy, treated with fluid administration, steroid, and epinephrine.
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Affiliation(s)
- Woo Sung Jung
- From the Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
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2
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Gunaratne AW, Makrides M, Collins CT, Gibson RA, McPhee AJ, Sullivan TR, Gould JF, Green TJ, Doyle LW, Davis PG, French NP, Colditz PB, Simmer K, Morris SA, Best KP. Docosahexaenoic acid supplementation of preterm infants and parent-reported symptoms of allergic disease at 7 years corrected age: follow-up of a randomized controlled trial. Am J Clin Nutr 2019; 109:1600-1610. [PMID: 31070712 DOI: 10.1093/ajcn/nqz010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/17/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Docosahexaenoic acid (DHA, 22:6n-3) supplementation in the prenatal period is associated with a reduction in the incidence of some symptoms of allergic disease. Infants born preterm are at increased risk of allergic disease, but it is unknown if DHA supplementation reduces the risk of childhood allergies. OBJECTIVES The aim of this study was to determine if supplementation of infants born at <33 wk gestation with high-DHA compared with standard-DHA enteral feeds decreases the incidence and severity of parent-reported allergic disease symptoms at a corrected age (CA) of 7 y. METHODS This study was a follow-up of an Australian multicenter randomized controlled trial. Infants were given high-DHA (∼1% total fatty acids) or standard-DHA (∼0.3% total fatty acids) enteral feeds from 2-4 d of postnatal age until 40 wk postmenstrual age. Parent-reported incidence of respiratory allergic disease symptoms including wheeze and rhinitis at 7 y CA were the main outcomes. Other outcomes included the incidence of eczema symptoms; severity of any symptoms; and the incidence of wheeze, rhinitis, rhinoconjunctivitis, and eczema from birth to 7 y CA. RESULTS Data were available for 569 of 657 (87%) children originally randomized. Symptoms of wheeze or rhinitis at 7 y CA did not differ between high- and standard-DHA groups [wheeze: RR: 1.10; 95% CI: 0.73, 1.65; P = 0.66; rhinitis: RR: 1.09; 95% CI: 0.81, 1.46; P = 0.59]. There was no difference in other allergic disease symptoms at 7 y CA or in the severity of symptoms. Parent-reported symptoms of wheeze, rhinitis, rhinoconjunctivitis, or eczema from birth to 7 y CA did not differ between the groups. CONCLUSIONS High-dose DHA supplementation of infants born at <33 wk gestation did not alter allergic disease symptoms or severity at 7 y CA, or from birth to 7 y CA compared with standard-dose DHA. This trial was registered with the Australian New Zealand Clinical Trials Registry as ANZCTR 12606000327583 (http://www.anzctr.org.au).
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Affiliation(s)
- Anoja W Gunaratne
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Maria Makrides
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Carmel T Collins
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Robert A Gibson
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,School of Agriculture, Food and Wine
| | - Andrew J McPhee
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Department of Neonatal Medicine, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - Thomas R Sullivan
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jacqueline F Gould
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Tim J Green
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
| | - Lex W Doyle
- Clinical Sciences, The Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Peter G Davis
- Clinical Sciences, The Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Noel P French
- Centre of Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia.,King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Paul B Colditz
- Perinatal Research Centre, University of Queensland Centre for Clinical Research, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Karen Simmer
- Centre of Neonatal Research and Education, The University of Western Australia, Perth, Western Australia, Australia.,King Edward Memorial Hospital and Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia
| | - Scott A Morris
- Department of Neonatal Perinatal Medicine, Flinders Medical Centre and College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Karen P Best
- Healthy Mothers, Babies and Children, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.,Adelaide Medical School
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3
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Yrjänä JMS, Koski T, Törölä H, Valkama M, Kulmala P. Very early introduction of semisolid foods in preterm infants does not increase food allergies or atopic dermatitis. Ann Allergy Asthma Immunol 2018; 121:353-359. [PMID: 29981439 DOI: 10.1016/j.anai.2018.06.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/21/2018] [Accepted: 06/28/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The optimal age for the introduction of solid foods for infants has long been a controversial issue. OBJECTIVE To determine whether the early introduction of semisolid foods influences the incidence of food allergy or atopic dermatitis among preterm infants. METHODS Retrospective data from 464 preterm infants born in Oulu University Hospital between 2008 and 2012 were analyzed. Age- and sex-matched full-term control children from the general population were identified. The primary outcome of the study was the difference in timing of the introduction of complementary feeding between preterm and full-term infants. The secondary outcomes were the incidences of food allergies and atopic dermatitis by the ages of 1 and 2 years. RESULTS Semisolid food was introduced at the median corrected age of 1.4 months for all preterm infants, at 1.9 months for late preterm, at 0.9 months for very preterm, and at 0.1 months for extremely preterm infants. The cumulative incidence, either of food allergies or of atopic dermatitis, did not differ significantly between preterm infants and controls by the ages of 1 and 2 years. CONCLUSION The very early introduction of complementary foods into the diet of preterm babies did not increase the incidence of food allergies or atopic dermatitis even among the most preterm infants. This finding supports the hypothesis that the gut-associated lymphoid tissue of preterm infants is ready to encounter food proteins and to begin the maturation process within 3 to 6 months of birth, regardless of gestational age.
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Affiliation(s)
- Jaakko M S Yrjänä
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Teppo Koski
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Helena Törölä
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Marita Valkama
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Petri Kulmala
- PEDEGO Research Unit and MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Biomedicine Research Unit, Medical Microbiology and Immunology, University of Oulu, Oulu, Finland
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4
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Gaspar-Marques J, Carreiro-Martins P, Papoila AL, Caires I, Pedro C, Araújo-Martins J, Virella D, Rosado-Pinto J, Leiria-Pinto P, Neuparth N. Food allergy and anaphylaxis in infants and preschool-age children. Clin Pediatr (Phila) 2014; 53:652-7. [PMID: 24647697 DOI: 10.1177/0009922814527502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Food allergy (FA) prevalence data in infants and preschool-age children are sparse, and proposed risk factors lack confirmation. In this study, 19 children's day care centers (DCC) from 2 main Portuguese cities were selected after stratification and cluster analysis. An ISAAC's (International Study of Asthma and Allergies in Childhood) derived health questionnaire was applied to a sample of children attending DCCs. Outcomes were FA parental report and anaphylaxis. Logistic regression was used to explore potential risk factors for reported FA. From the 2228 distributed questionnaires, 1217 were included in the analysis (54.6%). Children's median age was 3.5 years, and 10.8% were described as ever having had FA. Current FA was reported in 5.7%. Three (0.2%) reports compatible with anaphylaxis were identified. Reported parental history of FA, personal history of atopic dermatitis, and preterm birth increased the odds for reported current FA. A high prevalence of parental-perceived FA in preschool-age children was identified. Risk factor identification may enhance better prevention.
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Affiliation(s)
- João Gaspar-Marques
- Hospital de Dona Estefânia, Lisbon, Portugal CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Pedro Carreiro-Martins
- Hospital de Dona Estefânia, Lisbon, Portugal CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Ana Luísa Papoila
- Departamento de Bioestatística e Informática, CEAUL, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Iolanda Caires
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Catarina Pedro
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - José Araújo-Martins
- CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | | | | | - Paula Leiria-Pinto
- Hospital de Dona Estefânia, Lisbon, Portugal CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Nuno Neuparth
- Hospital de Dona Estefânia, Lisbon, Portugal CEDOC, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
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5
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Saulyte J, Regueira C, Montes-Martínez A, Khudyakov P, Takkouche B. Active or passive exposure to tobacco smoking and allergic rhinitis, allergic dermatitis, and food allergy in adults and children: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001611. [PMID: 24618794 PMCID: PMC3949681 DOI: 10.1371/journal.pmed.1001611] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 01/22/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Allergic rhinitis, allergic dermatitis, and food allergy are extremely common diseases, especially among children, and are frequently associated to each other and to asthma. Smoking is a potential risk factor for these conditions, but so far, results from individual studies have been conflicting. The objective of this study was to examine the evidence for an association between active smoking (AS) or passive exposure to secondhand smoke and allergic conditions. METHODS AND FINDINGS We retrieved studies published in any language up to June 30th, 2013 by systematically searching Medline, Embase, the five regional bibliographic databases of the World Health Organization, and ISI-Proceedings databases, by manually examining the references of the original articles and reviews retrieved, and by establishing personal contact with clinical researchers. We included cohort, case-control, and cross-sectional studies reporting odds ratio (OR) or relative risk (RR) estimates and confidence intervals of smoking and allergic conditions, first among the general population and then among children. We retrieved 97 studies on allergic rhinitis, 91 on allergic dermatitis, and eight on food allergy published in 139 different articles. When all studies were analyzed together (showing random effects model results and pooled ORs expressed as RR), allergic rhinitis was not associated with active smoking (pooled RR, 1.02 [95% CI 0.92-1.15]), but was associated with passive smoking (pooled RR 1.10 [95% CI 1.06-1.15]). Allergic dermatitis was associated with both active (pooled RR, 1.21 [95% CI 1.14-1.29]) and passive smoking (pooled RR, 1.07 [95% CI 1.03-1.12]). In children and adolescent, allergic rhinitis was associated with active (pooled RR, 1.40 (95% CI 1.24-1.59) and passive smoking (pooled RR, 1.09 [95% CI 1.04-1.14]). Allergic dermatitis was associated with active (pooled RR, 1.36 [95% CI 1.17-1.46]) and passive smoking (pooled RR, 1.06 [95% CI 1.01-1.11]). Food allergy was associated with SHS (1.43 [1.12-1.83]) when cohort studies only were examined, but not when all studies were combined. The findings are limited by the potential for confounding and bias given that most of the individual studies used a cross-sectional design. Furthermore, the studies showed a high degree of heterogeneity and the exposure and outcome measures were assessed by self-report, which may increase the potential for misclassification. CONCLUSIONS We observed very modest associations between smoking and some allergic diseases among adults. Among children and adolescents, both active and passive exposure to SHS were associated with a modest increased risk for allergic diseases, and passive smoking was associated with an increased risk for food allergy. Additional studies with detailed measurement of exposure and better case definition are needed to further explore the role of smoking in allergic diseases.
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Affiliation(s)
- Jurgita Saulyte
- Department of Preventive Medicine, University
of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de
Epidemiología y Salud Pública (CIBER-ESP), Barcelona, Spain
| | - Carlos Regueira
- Department of Preventive Medicine, University
of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de
Epidemiología y Salud Pública (CIBER-ESP), Barcelona, Spain
| | - Agustín Montes-Martínez
- Department of Preventive Medicine, University
of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de
Epidemiología y Salud Pública (CIBER-ESP), Barcelona, Spain
| | - Polyna Khudyakov
- Departments of Epidemiology and Biostatistics,
Harvard School of Public Health, Boston, Massachusetts, United States of
America
| | - Bahi Takkouche
- Department of Preventive Medicine, University
of Santiago de Compostela, Santiago de Compostela, Spain
- Centro de Investigación Biomédica en Red de
Epidemiología y Salud Pública (CIBER-ESP), Barcelona, Spain
- * E-mail:
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Flohr C. Following in the footsteps of David Barker: the association between extreme prematurity and atopic dermatitis risk. Br J Dermatol 2013; 169:1175-6. [DOI: 10.1111/bjd.12708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- C. Flohr
- Department of Paediatric Dermatology; St John's Institute of Dermatology; Guy's & St Thomas’ Hospital NHS Foundation Trust and King's College London; Westminster Bridge Road London SE1 7EH U.K
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7
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Barbarot S, Gras-Leguen C, Colas H, Garrot E, Darmaun D, Larroque B, Roze J, Ancel P. Lower risk of atopic dermatitis among infants born extremely preterm compared with higher gestational age. Br J Dermatol 2013; 169:1257-64. [DOI: 10.1111/bjd.12581] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2013] [Indexed: 11/27/2022]
Affiliation(s)
- S. Barbarot
- Department of Pediatric Dermatology; UMR 1280 Nantes University Hospital; Nantes France
| | - C. Gras-Leguen
- Department of Neonatal Medicine and INSERM CIC 004; UMR 1280 Nantes University Hospital; Nantes France
| | - H. Colas
- Department of Neonatal Medicine and INSERM CIC 004; UMR 1280 Nantes University Hospital; Nantes France
| | - E. Garrot
- Department of Neonatal Medicine and INSERM CIC 004; UMR 1280 Nantes University Hospital; Nantes France
| | - D. Darmaun
- French National Institute for Agricultural Research; UMR 1280 Nantes University Hospital; Nantes France
| | - B. Larroque
- INSERM; UMR S953; IFR 69; Epidemiological Research on Perinatal Health and Women's and Children's Health; Paris France
- UPMC University Paris 06; UMR S953; Paris France
| | - J.C. Roze
- Department of Neonatal Medicine and INSERM CIC 004; UMR 1280 Nantes University Hospital; Nantes France
| | - P.Y. Ancel
- INSERM; UMR S953; IFR 69; Epidemiological Research on Perinatal Health and Women's and Children's Health; Paris France
- UPMC University Paris 06; UMR S953; Paris France
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Räsänen M, Kaprio J, Laitinen T, Winter T, Koskenvuo M, Laitinen LA. Perinatal Risk Factors for Hay Fever — A Study Among 2550 Finnish Twin Families. ACTA ACUST UNITED AC 2012. [DOI: 10.1375/twin.4.5.392] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractPrevious studies have suggested that perinatal factors influence the risk for asthma but population studies on perinatal factors and risk for hay fever are few. We studied the effect of perinatal factors on the risk for hay fever among adolescent twins by a questionnaire study involving five consecutive nation-wide birth cohorts of 16-year-old twins and their parents. The risk for parent-reported, doctor-diagnosed hay fever in the adolescents associated with several perinatal characteristics was assessed with logistic regression analysis among individuals and by a discordant pair analysis. In the univariate analysis of the birth factors, the risk for hay fever increased with increasing birth weight (p for trend = 0.048, OR for those ≥ 3000g 1.35, 95% CI 0.91–2.02 compared to those < 2000g) and gestational age (p for trend = 0.04, OR for those born after 40 weeks of gestation 2.24, 95% CI 1.03–4.86, compared to those born before 33 weeks of gestation) and was lower in those subjects hospitalised in the neonatal period (OR 0.74, 95% CI 0.58–0.93). Because of significant interactions between parental hay fever status and birth factors (ponderal index, p = 0.03 and maternal age p = 0.04), stratified analysis were performed. The positive association between birth weight and hay fever was most obvious among adolescents with no parental history of hay fever (p for trend = 0.03). Similar, though not significant, trends were found with other birth factors among these families, whereas no such trend was found among adolescents with parental hay fever, suggesting that gestational maturity increases the risk for hay fever in the absence of genetic predisposition. However, of the perinatal factors only neonatal hospitalisation (OR 0.75, 95% CI 0.59–0.96) remained a significant risk factor for the development of hay fever, when adjusted for non-perinatal factors.
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9
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Zachariassen G, Faerk J, Esberg BH, Fenger-Gron J, Mortensen S, Christesen HT, Halken S. Allergic diseases among very preterm infants according to nutrition after hospital discharge. Pediatr Allergy Immunol 2011; 22:515-20. [PMID: 21332800 DOI: 10.1111/j.1399-3038.2010.01102.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To determine whether a cow's milk-based human milk fortifier (HMF) added to mother's milk while breastfeeding or a cow's milk-based preterm formula compared to exclusively mother's milk after hospital discharge, increases the incidence of developing allergic diseases among very preterm infants (VPI) during the first year of life. Of a cohort of 324 VPI (gestational age 24-32 wk), the exclusively breastfed VPI were shortly before discharge randomized to breastfeeding without fortification or supplementing with a fortifier. Those not breastfed were fed a preterm formula. The intervention period was from discharge until 4 months corrected age (CA). Follow-up was performed at 4 and 12 months CA including specific IgE to a panel of allergens at 4 months CA. The incidence during and prevalence at 12 months CA of recurrent wheezing (RW) was 39.2% and 32.7%, while atopic dermatitis (AD) was 18.0% and 12.1%, respectively. Predisposition to allergic disease increased the risk of developing AD (p=0.04) [OR 2.6 (95% CI 1.0-6.4)] and the risk of developing RW (p=0.02) [OR 2.7 (95% CI 1.2-6.3)]. Boys had an increased risk of developing RW (p=0.003) [OR 3.1 (95% CI 1.5-6.5)]. No difference was found between nutrition groups. None developed food allergy. Compared to exclusively breastfed, VPI supplemented with HMF or fed exclusively a preterm formula for 4 months did not have an increased risk of developing allergic diseases during the first year of life.
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Affiliation(s)
- Gitte Zachariassen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense C, Denmark.
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10
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Siltanen M, Wehkalampi K, Hovi P, Eriksson JG, Strang-Karlsson S, Järvenpää AL, Andersson S, Kajantie E. Preterm birth reduces the incidence of atopy in adulthood. J Allergy Clin Immunol 2011; 127:935-42. [PMID: 21333345 DOI: 10.1016/j.jaci.2010.12.1107] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 12/12/2010] [Accepted: 12/16/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Immunologic pathways are primed in early life. Preterm birth can influence this process and thereby affect whether a person will have atopy later in life. Previous studies on the effects of preterm birth on atopy in adulthood have been inconclusive and limited to children or subjects born moderately preterm. OBJECTIVE Our aim was to compare the incidence of atopy among young adults who were born preterm and at very low birth weight (≤ 1500 g) with that of term-born young adults (control subjects). METHODS The study comprised 166 adults who were born preterm and at very low birth weight and 172 control subjects, all of whom were from the Helsinki Study of Very Low Birth Weight Adults. We assessed atopic predisposition at ages 18 to 27 years using skin prick tests for 6 common aeroallergens and measurements of serum concentrations of total IgE and 3 types of allergen-specific (cat, birch, and timothy) IgE. We asked the subjects whether they had been given a diagnosis of asthma or allergic rhinitis or had atopic eczema and analyzed data by using logistic or linear regression, adjusting for potential confounding factors. RESULTS The risk for having at least 1 positive reaction on a skin prick test was reduced (adjusted odds ratio, 0.43; 95% CI, 0.23-0.79, P = .007), and the concentration of cat-specific IgE was less (25% less; 95% CI, 43% to 2.3% less; P = .033) in sera from very-low-birth-weight subjects compared with that seen in sera from control subjects. Within the very-low-birth-weight group, those born at an earlier gestational age were less likely to have positive skin prick test reactions (adjusted odds ratio for 1 week, 0.82; 95% CI, 0.68-0.98, P = .029) and less likely to have high levels of allergen-specific IgE. Cumulative incidences of atopic disease were similar between adults of very low birth weight and control subjects. CONCLUSIONS Young adults born prematurely and at very low birth weight have a lower incidence of atopy than adults who were born full term. This finding supports the hypothesis that the risk for atopy is determined during early stages of development.
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Affiliation(s)
- Mirjami Siltanen
- Division of Welfare and Health Promotion, Department of Chronic Disease Prevention, Diabetes Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
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11
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Jones LL, Hashim A, McKeever T, Cook DG, Britton J, Leonardi-Bee J. Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis. Respir Res 2011; 12:5. [PMID: 21219618 PMCID: PMC3022703 DOI: 10.1186/1465-9921-12-5] [Citation(s) in RCA: 197] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 01/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Passive smoke exposure increases the risk of lower respiratory infection (LRI) in infants, but the extensive literature on this association has not been systematically reviewed for nearly ten years. The aim of this paper is to provide an updated systematic review and meta-analysis of studies of the association between passive smoking and LRI, and with diagnostic subcategories including bronchiolitis, in infants aged two years and under. METHODS We searched MEDLINE and EMBASE (to November 2010), reference lists from publications and abstracts from major conference proceedings to identify all relevant publications. Random effect pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated. RESULTS We identified 60 studies suitable for inclusion in the meta-analysis. Smoking by either parent or other household members significantly increased the risk of LRI; odds ratios (OR) were 1.22 (95% CI 1.10 to 1.35) for paternal smoking, 1.62 (95% CI 1.38 to 1.89) if both parents smoked, and 1.54 (95% CI 1.40 to 1.69) for any household member smoking. Pre-natal maternal smoking (OR 1.24, 95% CI 1.11 to 1.38) had a weaker effect than post-natal smoking (OR 1.58, 95% CI 1.45 to 1.73). The strongest effect was on bronchiolitis, where the risk of any household smoking was increased by an OR of 2.51 (95% CI 1.96 to 3.21). CONCLUSIONS Passive smoking in the family home is a major influence on the risk of LRI in infants, and especially on bronchiolitis. Risk is particularly strong in relation to post-natal maternal smoking. Strategies to prevent passive smoke exposure in young children are an urgent public and child health priority.
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Affiliation(s)
- Laura L Jones
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
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12
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Kase JS, Pici M, Visintainer P. Risks for common medical conditions experienced by former preterm infants during toddler years. J Perinat Med 2009; 37:103-8. [PMID: 19143576 DOI: 10.1515/jpm.2009.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To identify associations between reactive airway disease (RAD), eczema, and gastroesophageal reflux (GERD) and antenatal/neonatal variables. METHODS This is a retrospective observational cohort analysis of former preterm (PT) infants evaluated at the Regional Neonatal Follow-up Program in the Lower Hudson Valley Region of New York. Subjects <2 years evaluated between January 2005 and December 2007 were included. Patient demographics, antenatal factors and co-morbidities of prematurity were correlated with each medical condition. RESULTS A total of 727 subjects were analyzed: 12.8% had RAD, 10.5% had eczema; and 26.7% had GERD. RAD and GERD correlated inversely with gestational age. RAD was more prevalent in singletons and African Americans; GERD in Caucasians; and eczema in singletons and males. Respiratory disease in the newborn period increased the incidence of RAD and GERD. Toddlers who had RAD were likely to have eczema or GERD; no association between GERD and eczema existed. CONCLUSIONS These three medical conditions were strongly associated. Their association may be the result of a common element developing each condition, or due to one condition exacerbating another. Respiratory problems in the newborn were strong predictors of GERD and RAD.
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Affiliation(s)
- Jordan S Kase
- The Division of Newborn Medicine, The Department of Pediatrics, NYMC, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA.
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Thavagnanam S, Fleming J, Bromley A, Shields MD, Cardwell CR. A meta-analysis of the association between Caesarean section and childhood asthma. Clin Exp Allergy 2008; 38:629-33. [PMID: 18352976 DOI: 10.1111/j.1365-2222.2007.02780.x] [Citation(s) in RCA: 439] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children born by Caesarean section have modified intestinal bacterial colonization and consequently may have an increased risk of developing asthma under the hygiene hypothesis. The results of previous studies that have investigated the association between Caesarean section and asthma have been conflicting. OBJECTIVE To review published literature and perform a meta-analysis summarizing the evidence in support of an association between children born by Caesarean section and asthma. METHODS MEDLINE, Web Science, Google Scholar and PubMed were searched to identify relevant studies. Odds ratio (OR) and 95% confidence interval (CI) were calculated for each study from the reported prevalence of asthma in children born by Caesarean section and in control children. Meta-analysis was then used to derive a combined OR and test for heterogeneity in the findings between studies. RESULTS Twenty-three studies were identified. The overall meta-analysis revealed an increase in the risk of asthma in children delivered by Caesarean section (OR=1.22, 95% CI 1.14, 1.29). However, in this analysis, there was evidence of heterogeneity (I(2)=46%) that was statistically significant (P<0.001). Restricting the analysis to childhood studies, this heterogeneity was markedly decreased (I(2)=32%) and no longer attained statistical significance (P=0.08). In these studies, there was also evidence of an increase (P<0.001) in the risk of asthma after Caesarean section (OR=1.20, 95% CI 1.14, 12.6). CONCLUSION In this meta-analysis, we found a 20% increase in the subsequent risk of asthma in children who had been delivered by Caesarean section.
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Affiliation(s)
- S Thavagnanam
- Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
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14
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Ram FSF, Ducharme FM, Scarlett J. WITHDRAWN: Cow's milk protein avoidance and development of childhood wheeze in children with a family history of atopy. Cochrane Database Syst Rev 2007; 2007:CD003795. [PMID: 17636737 PMCID: PMC10680424 DOI: 10.1002/14651858.cd003795.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In infants with a family history of atopy, food allergen avoidance has been advocated as means of preventing the development of atopic disease, when breast-feeding is not possible or supplemental feeding is needed. Most infant formulas are based on cow's milk protein. Alternative choices include soya based and hydrolysed cows milk formulas. OBJECTIVES To estimate the effect of dietary avoidance of cow's milk protein on the development of asthma or wheeze in children. SEARCH STRATEGY We searched the Cochrane database for eligible trials until February 2002. We obtained the full text papers of all abstracts identified as RCTs and two reviewers independently reviewed them. SELECTION CRITERIA We included randomised controlled trials involving children with a family history of atopy in at least one first degree relative, if feeding with cow's milk based standard formula was compared to dietary avoidance of cow's milk protein, using soya or other hypoallergenic formula during the initial four months of life or longer. DATA COLLECTION AND ANALYSIS Two reviewers extracted data independently. A priori defined subgroups were the types of hypoallergenic artificial feed and dietary restrictions on mother and/or child's diet. MAIN RESULTS Six trials used hydrolysed formula for at least four months, in addition to dietary restrictions and in some cases dust-mite reduction measures. The risk of infants experiencing asthma or wheeze during the first year of life was reduced compared to standard cow's milk based formula (Relative Risk 0.40, 95% Confidence Intervals 0.19 to 0.85). Feeding soya-based formula as opposed to standard cow's milk formula did not reduce the risk of having asthma or wheeze at any age. AUTHORS' CONCLUSIONS Breast-milk should remain the feed of choice for all babies. In infants with at least one first degree relative with atopy, hydrolysed formula for a minimum of four months combined with dietary restrictions and environment measures may reduce the risk of developing asthma or wheeze in the first year of life. There is insufficient evidence to suggest that soya-based milk formula has any benefit.
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Affiliation(s)
- F S F Ram
- Massey University - Albany, School of Health Sciences, Private Bag 102 904, North Shore Mail Centre, Auckland, New Zealand.
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Liem JJ, Kozyrskyj AL, Huq SI, Becker AB. The risk of developing food allergy in premature or low-birth-weight children. J Allergy Clin Immunol 2007; 119:1203-9. [PMID: 17379288 DOI: 10.1016/j.jaci.2006.12.671] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2006] [Revised: 12/17/2006] [Accepted: 12/19/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Premature or low-birth-weight children have increased gut permeability compared with term or normal-birth-weight children. OBJECTIVE To determine whether premature or low-birth-weight children have an increased risk of developing food allergy compared with term or normal-birth-weight children. METHODS The 1995 Manitoba Birth Cohort was studied using the Manitoba Health Services Insurance Plan (MHSIP) database. This database is a population-based, health care administrative and prescription database. It has records of every child born and subsequent utilization of the provincial health care system. The diagnosis of food allergy (ICD-9-CM code of 693 in hospital/medical claims or a prescription of injectable epinephrine excluding a sole diagnosis of venom allergy) was obtained up until the year 2002. The relative risks of food allergy in premature or low-birth-weight children compared with term or normal-birth-weight children were determined. RESULTS A total of 13,980 children were born in 1995 and continue to live in the province of Manitoba. Of these, 592 children (4.23%) were found to have food allergy and epinephrine was prescribed in 316 (2.26%) children. No gestational age or birth weight group had a statistically significant increased risk for food allergy. CONCLUSION Prematurity and low birth weight are not associated with a change in risk for development of food allergy in childhood. CLINICAL IMPLICATIONS Immaturity of the gastrointestinal tract or immune response does not seem to change the risk for development of food allergies. We ask whether early exposure to food antigens may protect premature children by increasing immune tolerance to those antigens.
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Affiliation(s)
- Joel J Liem
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
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16
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Osborn DA, Sinn J. Formulas containing hydrolysed protein for prevention of allergy and food intolerance in infants. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2006. [PMID: 17054180 DOI: 10.1002/14651858.cd003664.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Allergies and food reactions are common and may be associated with foods including adapted cow's milk formula. Formulas containing hydrolysed proteins have been used to treat infants with allergy or food intolerance. However, it is unclear whether hydrolysed formula can be advocated for prevention of allergy and food intolerance in infants without evidence of allergy or food intolerance. OBJECTIVES To determine the effect of feeding hydrolysed formulas on allergy and food intolerance in infants and children compared to adapted cow's milk or human breast milk. If hydrolysed formulas are effective, to determine what type of hydrolysed formula is most effective including extensively and partially hydrolysed formulas. To determine which infants benefit, including infants at low or high risk of allergy and infants receiving early, short term or prolonged formula feeding. SEARCH STRATEGY The standard search strategy of the Cochrane Neonatal Review Group was used. The review was updated with searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2006), MEDLINE (1966-March 2006), EMBASE (1980-March 2006) and CINAHL (1982-March 2006) and previous reviews including cross references. SELECTION CRITERIA Randomised and quasi-randomised trials that compare the use of a hydrolysed infant formula to human milk or cow's milk formula. Trials with >80% follow up of participants were eligible for inclusion. DATA COLLECTION AND ANALYSIS Eligibility of studies for inclusion, methodological quality and data extraction were assessed independently by each review author. Primary outcomes included clinical allergy, specific allergies and food intolerance. Meta-analysis was conducted using a fixed effects model. MAIN RESULTS Two trials compared early, short term hydrolysed formula to human milk feeding. No significant difference in infant allergy or childhood cow's milk allergy (CMA) were reported. No eligible trial compared prolonged hydrolysed formula to human milk feeding. Two trials compared early, short term hydrolysed formula to cow's milk formula feeding. No significant benefits were reported. One large quasi-random study reported a reduction in infant CMA of borderline significance in low risk infants (RR 0.62, 95% CI 0.38, 1.00). Ten eligible studies compared prolonged feeding with hydrolysed formula versus cow's milk formula in high risk infants. Meta-analysis found a significant reduction in infant allergy (seven studies, 2514 infants; typical RR 0.79, 95% CI 0.66, 0.94), but not in the incidence of childhood allergy (two studies, 950 infants; typical RR 0.85, 95% CI 0.69, 1.05). There was no significant difference in infant eczema (eight studies, 2558 infants, typical RR 0.84, 95% CI 0.68, 1.04), childhood eczema incidence (two studies, 950 infants, typical RR 0.83, 95% CI 0.63, 1.10), childhood eczema prevalence (one study, 872 infants; RR 0.66, 95% CI 0.43, 1.02), or infant or childhood asthma, rhinitis and food allergy. One study reported a significant reduction in infants with CMA with confirmed atopy (RR 0.36, 95% CI 0.15, 0.89). Subgroup analysis of trials blinded to formula found no significant difference in infant allergy (four studies, 2156 infants; typical RR 0.87, 95% CI 0.69, 1.08) or childhood allergy incidence (one study, 872 infants; RR 0.91, 95% CI 0.73, 1.14). No eligible trial examined the effect of prolonged hydrolysed formula feeding on allergy beyond early childhood. There is evidence that preterm or low birthweight infants fed a hydrolysed preterm formula have significantly reduced weight gain, but not in other growth parameters (head circumference or length). Studies in term infants report no adverse effects on growth. Subgroup analysis of trials of partially hydrolysed versus cow's milk formula found a significant reduction in infant allergy (six studies, 1391 infants; typical RR 0.79, 95% CI 0.65, 0.97) but not childhood allergy, or infant or childhood asthma, eczema or rhinitis. Methodological concerns were the same as for the overall analysis. Analysis of trials of extensively hydrolysed formula versus cow's milk formula found no significant differences in allergy or food intolerance. Infants fed extensively hydrolysed formula compared with partially hydrolysed formula had a significant reduction in food allergy (two studies, 341 infants; typical RR 0.43, 95% CI 0.19, 0.99), but there was no significant difference in all allergy or any other specific allergy incidence. Comparing extensively hydrolysed casein containing formula with cow's milk formula, one study (431 infants) reported a significant reduction in childhood allergy incidence (RR 0.72, 95% CI 0.53, 0.97). Meta-analysis found a significant reduction in infant eczema (three studies, 1237 infants; typical RR 0.71, 95% CI 0.51, 0.97). One study reported a significant reduction in childhood eczema incidence (RR 0.66, 95% CI 0.44, 0.98) and prevalence (RR 0.50, 95% CI 0.27, 0.92). AUTHORS' CONCLUSIONS There is no evidence to support feeding with a hydrolysed formula for the prevention of allergy compared to exclusive breast feeding. In high risk infants who are unable to be completely breast fed, there is limited evidence that prolonged feeding with a hydrolysed formula compared to a cow's milk formula reduces infant and childhood allergy and infant CMA. In view of methodological concerns and inconsistency of findings, further large, well designed trials comparing formulas containing partially hydrolysed whey, or extensively hydrolysed casein to cow's milk formulas are needed.
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Affiliation(s)
- D A Osborn
- Westmead Hospital, Neonatal Unit, Hawkesbury Road, Westmead, New South Wales, Australia
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Snibson KJ, Bischof RJ, Koumoundouros E, McMurtrie LS, Cock M, Harding R. Altered airway responsiveness in adult sheep born prematurely: effects of allergen exposure. Exp Lung Res 2006; 32:215-28. [PMID: 16908448 DOI: 10.1080/01902140600817499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The aim of this study was to determine the effects of preterm birth per se on airway function in adult sheep. Preterm birth was induced at approximately 0.89 of term. At approximately 1 year of age the authors measured pulmonary resistance (RL) and airway responsiveness before and after house dust mite (HDM) challenge. Mature preterm sheep tended to have greater baseline RL than controls (P = .12): the smaller preterm sheep showed significantly greater RL than controls following bronchoconstrictor challenge. Preterm animals tended to have greater baseline total blood leukocyte count (P = .06). It was concluded that preterm sheep, especially with low postnatal growth, have greater airway responsiveness to bronchoconstrictor and higher baseline RL.
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Affiliation(s)
- Kenneth J Snibson
- Centre for Animal Biotechnology, Department of Veterinary Science, The University of Melbourne, Parkville, Victoria, Australia.
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18
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Agosti M, Tandoi F, Mosca F. What is the role of the prevention of allergy in the first period of life? Acta Paediatr 2005; 94:106-9. [PMID: 16214775 DOI: 10.1111/j.1651-2227.2005.tb02164.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The widespread increase in the prevalence of allergic disease, which has occurred over the last 20 y, has created general concern in Europe and in the rest of the world. The reason for this increase is still partially unknown. In this period, despite a greater understanding of the pathogenesis and risk factors of allergies plus the greater efficacy of drugs to control the symptoms, the cost of intervention and the socio-economic impact are still very high. For these reasons, prevention in the first period of life represents a goal for both developed and developing countries in order to reduce this upward trend.
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Affiliation(s)
- Massimo Agosti
- Neonatal Intensive Care Unit, Del Ponte Hospital, Varese, Italy.
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19
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Siltanen M, Savilahti E, Pohjavuori M, Kajosaari M. Respiratory symptoms and lung function in relation to atopy in children born preterm. Pediatr Pulmonol 2004; 37:43-9. [PMID: 14679488 DOI: 10.1002/ppul.10402] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Respiratory morbidity is a major health problem among children. The aim of this study was to compare the background of respiratory problems of children born preterm with that of children born full-term, with special reference to atopy. The study comprised two cohorts of 10-year-old children: a group of 72 children born preterm with birth weights of less than 1,501 g, and a group of 65 children born full-term with birth weights of over 2,500 g. Histories of respiratory and atopic symptoms, and of risk factors for atopy, were collected with a questionnaire. Predisposition to atopy was verified by skin-prick testing and by measuring serum total and antigen-specific IgEs. Lung function was evaluated by spirometry testing. Children born preterm had significantly more wheezing. In them, the lifetime prevalence of wheezing was 43%, vs. 17% in children born full-term (P = 0.001; odds ratio, 3.71; 95% confidence interval, 1.67-8.25). In the full-term group, wheezing was associated with atopy: 64% of wheezers were atopic; in the preterm group, 23% of wheezers were atopic (difference between groups, P = 0.024). Children born preterm expired significantly lower spirometry values of forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1), FEV1/FVC ratio, forced expiratory flow after 50% of vital capacity has been exhaled (FEF50), and forced expiratory flow during middle half of FVC (FEF25-75). In the preterm group, wheezing, asthma, and low gestational age, but not atopy, were significantly associated with lower lung function values. Wheezers of the preterm group who still wheezed at age 10 were significantly more often atopic than those who no longer wheezed (62% vs. 9%, P = 0.006). In conclusion, we demonstrated a significant difference between groups in the association of atopy with respiratory problems. However, although atopy was not associated with a lifetime prevalence of respiratory symptoms in prematurely born children, an atopic predisposition in them was found to associate with persistence of wheezing.
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Affiliation(s)
- Mirjami Siltanen
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
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20
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Agosti M, Vegni C, Gangi S, Benedetti V, Marini A. Allergic manifestations in very low-birthweight infants: a 6-year follow-up. Acta Paediatr 2003; 91:44-7. [PMID: 14599041 DOI: 10.1111/j.1651-2227.2003.tb00645.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The incidence of allergic manifestations was evaluated from birth until 6 y of age in 83 very low-birthweight infants (VLBWIs). In the same period 98 full-term babies were followed from birth to 24 mo of life. All the subjects were examined by paediatricians to establish the presence of atopic dermatitis (AD), gastrointestinal disturbances (GD) and asthma (AS). The incidence of total allergic manifestations (31.3%) in VLBWIs was significantly lower than that (52%) in 24-mo-old infants, born at full term. The incidence of allergies in VLBWIs did not differ at all at the subsequent checks, up to 6 y of age. AD (33.7%) was the most common symptom, statistically higher in full-term infants than in VLBWIs (7.2%). GD had a similar distribution (8.2% in full-term infants vs 7.2% in VLBWIs). AS (16.8%) was significantly higher in VLBWIs than in those born full term (10.2%). In the various VLBWI subgroups analysed, AD was more prevalent in babies weighing >1000 g and in babies >30 wk of age; the incidence of GD was higher in infants weighing <1000 g and in SGA infants, and AS was more prevalent in infants weighing <1000 g, in infants <30 wk of age and in babies appropriate for gestational age. A family history of allergy was related to a major incidence of allergies.
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Affiliation(s)
- M Agosti
- Istituto Pediatria-Neonatologia, University of Milan, Italy.
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21
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Ram FS, Ducharme FM, Scarlett J. Cow's milk protein avoidance and development of childhood wheeze in children with a family history of atopy. Cochrane Database Syst Rev 2002:CD003795. [PMID: 12137717 DOI: 10.1002/14651858.cd003795] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In infants with a family history of atopy, food allergen avoidance has been advocated as means of preventing the development of atopic disease when breast-feeding is not possible or supplemental feeding is needed. Most infant formulas are based on cow's milk protein. Alternative choices include soya based and hydrolysed cows milk formulas. OBJECTIVES To estimate the effect of dietary avoidance of cow's milk protein on the development of asthma or wheeze in children. SEARCH STRATEGY The Cochrane database was searched for eligible trials until February 2002. The full text papers of all abstracts identified as RCTs were obtained and reviewed independently by two reviewers. SELECTION CRITERIA Randomised controlled trials involving children with a family history of atopy in at least one first degree relative were considered if feeding with cow's milk based standard formula was compared to dietary avoidance of cow's milk protein using soya or other hypoallergenic formula during the initial four months of life or longer. DATA COLLECTION AND ANALYSIS Two reviewers extracted data independently. A priori defined subgroups were the types of hypoallergenic artificial feed and dietary restrictions on mother and/or child's diet. MAIN RESULTS Six trials used hydrolysed formula for at least 4 months in addition to dietary restrictions and in some cases dust-mite reduction measures. The risk of infants experiencing asthma or wheeze during the first year of life was reduced compared to standard cow's milk based formula (Relative Risk =0.40, 95% Confidence Intervals 0.19, 0.85). Feeding soya-based formula as opposed to standard cow's milk formula did not reduce the risk of having asthma or wheeze at any age. REVIEWER'S CONCLUSIONS Breast-milk should remain the feed of choice for all babies. In infants with at least one first degree relative with atopy, hydrolysed formula for a minimum of 4 months combined with dietary restrictions and environment measures may reduce the risk of developing asthma or wheeze in the first year of life. There is insufficient evidence to suggest that soya-based milk formula has any benefit.
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Affiliation(s)
- F S Ram
- Department of Physiological Medicine, St George's Hospital Medical School, Level 0, Jenner Wing, Cranmer Terrace, London, UK, SW17 0RE.
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Abstract
BACKGROUND The infant with persistent or recurrent wheezing during the first 2 years of life poses a diagnostic dilemma, which can be a source of anxiety to both physicians and parents. A suggested diagnostic approach to the causes of infantile wheezing is outlined. OBJECTIVES 1. To review the physiologic considerations of the infant's airways that predispose to wheezing. 2. To discuss the key physical findings, family history, and risk factors associated with wheezing in infants. 3. To develop a rational approach to the differential diagnosis and management of infantile wheezing. DATA SOURCES The MEDLINE database as well as our clinical experience pertaining to infantile wheezing. CONCLUSIONS This review discusses the diagnostic evaluation and treatment of the wheezing infant. We suggest that infant pulmonary function testing may be used as one diagnostic aid in the workup of the wheezing infant.
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Affiliation(s)
- R L Morton
- Pediatric Pulmonary Medicine, Department of Pediatrics University of Louisville School of Medicine, Kentucky, USA
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Siltanen M, Kajosaari M, Pohjavuori M, Savilahti E. Prematurity at birth reduces the long-term risk of atopy. J Allergy Clin Immunol 2001; 107:229-34. [PMID: 11174187 DOI: 10.1067/mai.2001.112128] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Antigen exposure in early life has long-lasting effects on atopic sensitization. Thus the predisposition to atopy of children born preterm can be assumed to differ from that of children born at term. OBJECTIVE The aim of this study was to evaluate the association between premature birth and atopy. METHODS At an outpatient clinic, we examined 2 groups of 10-year-old children, 72 who were born preterm (birth weight < 1500 g) and 65 who were born at term (birth weight > 2500 g). The atopy data were collected with a questionnaire, by performing skin prick testing, and by measuring the serum total IgE level, 3 allergen-specific IgE levels, the eosinophil cationic protein level, and the blood eosinophil level. The data on perinatal and neonatal events affecting the preterm children were collected from the hospital records. RESULTS By the age of 10 years, the children born preterm had significantly less atopy than the children born at term: 15% versus 31% of children in the 2 groups were defined as having had obvious atopy (P = .03, odds ratio 0.41, 95% CI 0.18-0.93). The mean value of total IgE level was significantly higher in the term group, 74 kU/L versus 41 kU/L (P = .02). By skin prick testing, the children born at term had positive reactions 2 to 3 times more often; 37% versus 17% of children in the groups had at least 1 positive reaction (P = .007). CONCLUSION Our data show that prematurity at birth is linked with a decreased long-term risk of atopic sensitization.
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Affiliation(s)
- M Siltanen
- Hospital for Children and Adolescents, University of Helsinki, Finland
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Høst A, Koletzko B, Dreborg S, Muraro A, Wahn U, Aggett P, Bresson JL, Hernell O, Lafeber H, Michaelsen KF, Micheli JL, Rigo J, Weaver L, Heymans H, Strobel S, Vandenplas Y. Dietary products used in infants for treatment and prevention of food allergy. Joint Statement of the European Society for Paediatric Allergology and Clinical Immunology (ESPACI) Committee on Hypoallergenic Formulas and the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition. Arch Dis Child 1999; 81:80-4. [PMID: 10373144 PMCID: PMC1717972 DOI: 10.1136/adc.81.1.80] [Citation(s) in RCA: 248] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A Høst
- European Society for Paediatric Allergology and Clinical Immunology, Hepatology and Nutrition
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Affiliation(s)
- P J Merkus
- Department of Physiology, Leiden University, The Netherlands
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Elder DE, Hagan R, Evans SF, Benninger HR, French NP. Recurrent wheezing in very preterm infants. Arch Dis Child Fetal Neonatal Ed 1996; 74:F165-71. [PMID: 8777678 PMCID: PMC2528342 DOI: 10.1136/fn.74.3.f165] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS To document the prevalence of, and identify risk factors for, recurrent wheezing treated with bronchodilators in the first year of life. METHODS Parental history and neonatal data were collected prospectively in a regional cohort of very preterm infants (< 33 weeks). Data on maternal smoking, siblings at home, breast feeding, respiratory symptoms, and hospital re-admissions were documented at 12 months. RESULTS Outcome data were available for 525/560 (95%) of survivors. The incidence of recurrent wheeze was 76/525 (14.5%) in very preterm infants and 20/657 (3%) in a cohort of term newborns. Significant risk factors for recurrent wheeze in very preterm infants were parental history of asthma, maternal smoking, siblings at home, neonatal oxygen supplementation at 28 days, 36, and 40 weeks of gestation. CONCLUSIONS Wheezing respiratory illnesses are common in very preterm infants. The factors involved are similar to those in more mature infants, with the addition of immaturity and neonatal lung injury.
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Affiliation(s)
- D E Elder
- Department of Paediatrics, Wellington Clinical School of Medicine, New Zealand
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Abstract
It seems clear that parental smoking is harmful, although the magnitude of its effect may be smaller than sometimes suggested. However, smoking and other behaviours detrimental to health must be seen within a social and historical context. Individuals are not 'free choosing actors' and their behaviour is determined, at least in part, by their social and environmental circumstances. Smoking might better be regarded as a 'proximal' cause. 'Proximal' causes such as infectious or toxic agents are themselves subject to 'causes of causes' which are the determinants of exposure to these agents. Smoking may act as the 'proximal' cause, directly harming the fetus, but is itself caused by factors in the social and environmental circumstances. The complexity of the relationship between social and environmental circumstances, health related behaviours, and adverse outcomes cannot be resolved by the search for single causative agents. As Rutter points out, in order to begin to understand causal complexity 'it is necessary to examine distal causal relationships in the form of chains and of linked sequences involving several different, relatively short-term effects or operations' (p 2). Health promotion programmes sensitive to social context avoid 'victim blaming' and acknowledge that it is not enough to exhort mothers to 'stop smoking before and during pregnancy because this will harm your baby' (p 99). Mothers know that smoking can harm themselves and their babies and the vast majority want to give up. Their choice is limited by their social circumstances, and failure to recognise this has ensured the failure of health promotion initiatives aimed at smoking reduction during pregnancy. There are limitations in the techniques available to control for confounding in multivariate analysis and results must be interpreted with caution. Misinterpretation can lead to overemphasis of the role of single factors, diverting attention from complex pathways. While health related behaviours may be a 'proximal' cause of ill health, there is a duty on researchers, health promoters, and health policy makers to take account of the complex causal pathways in which these 'proximal' causes lie.
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Affiliation(s)
- S Logan
- Department of Epidemiology and Biostatistics, Institute of Child Health, London
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30
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de Winter JP, van Sonderen L, van den Anker JN, Merth IT, Brand R, van Bel F, Zonderland HM, Quanjer PH. Respiratory illness in families of preterm infants with chronic lung disease. Arch Dis Child Fetal Neonatal Ed 1995; 73:F147-52. [PMID: 8535870 PMCID: PMC2528477 DOI: 10.1136/fn.73.3.f147] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIMS--To examine the relation, based on two types of questionnaires, between (1) chronic lung disease of the newborn (CLDN) and lower respiratory illness (LRI) in siblings, and between (2) CLDN and asthma, chronic obstruction pulmonary disease (COPD), or allergy in parents and grandparents. METHODS--Data from 209 children born before 32 weeks of gestation were randomly taken from the records of three neonatal units. Taking into account age and gender, the excess of LRI was calculated for each family compared with the average of all families. Subsequently whether CLDN was associated with an excess of LRI in the family was tested. RESULTS--Thirty one (14.8%) children were diagnosed as having CLDN. The family probability index for LRI did not differ between children with or without CLDN. The prevalence of COPD, asthma, and allergy in parents of children with CLDN was similar to that of children without CLDN. The prevalence of LRI was 18.1% in study children, 29.6% in children with CLDN, and 16.9% in children without CLDN (P < 0.01). These prevalences were higher compared with that of a group of term siblings (9.3%) (P = 0.05). CONCLUSIONS--These findings suggest that CLDN in preterm children is not related to a genetic or familial predisposition towards asthma, COPD, or allergy.
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Affiliation(s)
- J P de Winter
- Leiden University, Department of Paediatrics, The Netherlands
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31
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Rylander E, Pershagen G, Eriksson M, Nordvall L. Parental smoking and other risk factors for wheezing bronchitis in children. Eur J Epidemiol 1993; 9:517-26. [PMID: 8307137 DOI: 10.1007/bf00209530] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A population-based case-control study was performed to investigate etiologic factors for wheezing bronchitis and asthma in children up to four years of age. A total of 199 children hospitalized for the first time with these diagnoses at a major hospital in Stockholm in 1986-1988 constituted the cases, 351 children from the catchment area of the hospital were used as controls. Information on known and suspected risk factors was obtained through home interviews with a parent. Parental smoking was associated with a relative risk of 1.8 (95% confidence interval 1.3-2.6) corresponding to a population attributable proportion of 27%. The strongest association was seen for maternal smoking and children below 18 months of age. Other major risk factors included atopic heredity, recurrent upper respiratory tract infections and breast-feeding less than 3 months, which appeared to interact multiplicatively with parental smoking. The environmental factors had a stronger influence in the youngest age group, and the overall attributable proportion associated with parental smoking, short breast-feeding period and exposure to pets in the household was 43%. It is clear that successful primary prevention could dramatically reduce the incidence of wheezing bronchitis in children.
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Affiliation(s)
- E Rylander
- Department of Epidemiology, Karolinska Institute, Stockholm, Sweden
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