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Arabi V, Sasanfar B, Toorang F, Nafei Z, Behniafard N, Salehi-Abargouei A. Association between DASH diet and asthma symptoms among a large sample of adolescents: a cross-sectional study. BMC Nutr 2024; 10:92. [PMID: 38937858 PMCID: PMC11210139 DOI: 10.1186/s40795-024-00884-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 05/09/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND The Dietary Approaches to Stop Hypertension (DASH) diet, which has a lot of emphasis on the consumption of fruits, vegetables, and whole grains, and on the other hand, the consumption of red meat and sodium is limited, due to its anti-inflammatory properties, which can be related to reducing the risk of asthma. OBJECTIVES The aim of this study was to determine the relationship between the DASH diet and asthma symptoms among children and adolescents. METHODS This cross-sectional study was conducted among7667 children (3414 boys and 4253 girls) aged 6-7 and 13-14 years living in central Iran. Dietary food consumption was assessed using a multiple-choice questionnaire. Logistic regression was used to obtain odds ratios for the association between the DASH-like diet with current asthma and asthma symptoms. RESULTS Our findings revealed that higher adherence to a DASH-like diet resulted in lower odds of asthma confirmed by a doctor among the whole population (OR = 0.53; 95%CI: 0.36-0.76) and also in females (OR = 0.47; 95%CI: 0.29-0.78). Moreover, the higher adherence to the DASH-like diet was inversely associated with the chance of wheezing in the past 12 months in all subjects (OR = 0.67; 95%CI: 0.51-0.86) and in boys (OR = 0.57; 95%CI: 0.38-0.85). CONCLUSION The findings of the present study showed that following the DASH diet can be associated with the improvement of asthma symptoms in children and adolescents. However, more research is needed to improve dietary recommendations for asthma prevention.
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Affiliation(s)
- Vahid Arabi
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Bahareh Sasanfar
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Toorang
- Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
- Departments of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Zahra Nafei
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
- Shahid Sadoughi Hospital, Ebne Sina Boulevard, Yazd, Iran.
| | - Nasrin Behniafard
- Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Allergy and Clinical Immunology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Amin Salehi-Abargouei
- Research Center for Food Hygiene and Safety, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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2
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Chiang BM, Ye M, Chattopadhyay A, Halezeroglu Y, Van Blarigan EL, Abuabara K. Sodium Intake and Atopic Dermatitis. JAMA Dermatol 2024:2819233. [PMID: 38837130 PMCID: PMC11154362 DOI: 10.1001/jamadermatol.2024.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/12/2024] [Indexed: 06/06/2024]
Abstract
Importance The association of diet with atopic dermatitis (AD) remains poorly understood and could help explain heterogeneity in disease course. Objective To determine the extent to which a higher level of dietary sodium intake, estimated using urine sodium as a biomarker, is associated with AD in a large, population-based cohort. Design, Setting, and Participants This cross-sectional study of adult participants (aged 37-73 years) from the UK Biobank examined 24-hour urine sodium excretion, which was estimated using a single spot urine sample collected between March 31, 2006, and October 1, 2010, and calculations from the sex-specific International Cooperative Study on Salt, Other Factors, and Blood Pressure equation, incorporating body mass index; age; and urine concentrations of potassium, sodium, and creatinine. The data were analyzed between February 23, 2022, and March 20, 2024. Exposure The primary exposure was 24-hour urinary sodium excretion. Main Outcome and Measure The primary outcome was AD or active AD based on diagnostic and prescription codes from linked electronic medical records. Multivariable logistic regression models adjusted for age, sex, race and ethnicity, Townsend Deprivation Index, and education were used to measure the association. Results The analytic sample comprised 215 832 participants (mean [SD] age, 56.52 [8.06] years; 54.3% female). Mean (SD) estimated 24-hour urine sodium excretion was 3.01 (0.82) g per day, and 10 839 participants (5.0%) had a diagnosis of AD. Multivariable logistic regression revealed that a 1-g increase in estimated 24-hour urine sodium excretion was associated with increased odds of AD (adjusted odds ratio [AOR], 1.11; 95% CI, 1.07-1.14), increased odds of active AD (AOR, 1.16; 95% CI, 1.05-1.28), and increased odds of increasing severity of AD (AOR, 1.11; 95% CI, 1.07-1.15). In a validation cohort of 13 014 participants from the National Health and Nutrition Examination Survey, a 1 g per day higher dietary sodium intake estimated using dietary recall questionnaires was associated with a higher risk of current AD (AOR, 1.22; 95% CI, 1.01-1.47). Conclusions and Relevance These findings suggest that restriction of dietary sodium intake may be a cost-effective and low-risk intervention for AD.
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Affiliation(s)
- Brenda M. Chiang
- Department of Dermatology, University of California, San Francisco
| | - Morgan Ye
- Department of Dermatology, University of California, San Francisco
| | | | | | - Erin L. Van Blarigan
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- Department of Urology, University of California, San Francisco
| | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco
- Division of Epidemiology and Biostatistics, University of California, Berkeley
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Al Meslamani AZ. Insights into the immunological links between dietary habits and asthma. Expert Rev Clin Immunol 2024; 20:245-248. [PMID: 37897370 DOI: 10.1080/1744666x.2023.2277864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/27/2023] [Indexed: 10/30/2023]
Affiliation(s)
- Ahmad Z Al Meslamani
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
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Antonogeorgos G, Kogias C, Douros K, Panagiotakos D. Greater fruit and vegetables consumption, and adherence to a Mediterranean type of diet reduces the risk for asthma in children; a systematic review and meta-analysis. Int J Food Sci Nutr 2024; 75:4-30. [PMID: 37933707 DOI: 10.1080/09637486.2023.2276033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023]
Abstract
The objective of this study was to explore the relationship between the consumption of fruits, vegetables and adherence to the Mediterranean diet with childhood asthma development and severity. A systematic literature search and synthesis of the results was performed throughout the last two decades. A total of 45 studies were analysed and 392,797 children were included. Greater adherence to a Mediterranean type of diet was inversely associated with asthmatic outcomes (OR:0.71,95% CI:0.54,0.88). Regarding fruits, vegetables consumption, a significant inverse association between increased fruits or vegetable intake and asthma was found (OR:0.82,95% CI:0.77,0.86; 0.84,95% CI:0.77,0.91, respectively). Fruits and vegetables consumption combined was also inversely related to all asthmatic outcomes (OR:0.65,95% CI:0.49,0.78). The level of heterogeneity was moderate-to-high (30%-97%). The present review and meta-analysis show a trend to an inverse association between adherence to the Mediterranean diet or a healthy diet rich in fruits and vegetables and the occurrence of childhood asthma but with a low level of certainty.
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Affiliation(s)
- George Antonogeorgos
- Allergology and Pulmonology Unit, 3rd Pediatric Department, National and Kapodistrian University of Athens, Athens, Greece
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
| | - Christos Kogias
- Allergology and Pulmonology Unit, 3rd Pediatric Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Douros
- Allergology and Pulmonology Unit, 3rd Pediatric Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, Athens, Greece
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5
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Jeong S, Choi YJ. Association between household income levels and nutritional intake of allergic children under 6 years of age in Korea: 2019 Korea National Health and Nutrition Examination Survey and application of machine learning. Front Public Health 2024; 11:1287085. [PMID: 38274515 PMCID: PMC10808989 DOI: 10.3389/fpubh.2023.1287085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/21/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction This study investigated the prevalence of allergic diseases in Korean children aged 6 and below, focusing on the interplay between nutritional status, household income levels, and allergic disease occurrence. Methods This study used data from the 2019 Korea National Health and Nutrition Examination Survey, a nationwide comprehensive survey, and included a representative sample of 30,382 children under the age of 6 to investigate in detail the relationship between allergic diseases, nutritional intake, and socioeconomic factors. Logistic regression analysis was performed to identify factors associated with allergic diseases, including gender, BMI, eating habits, dietary supplement intake, and nutrient consumption. To predict childhood asthma, 14 machine learning models were compared using the 'pycaret' package in Python. Results We discerned that 24.7% were diagnosed with allergic conditions like atopic dermatitis, asthma, and allergic rhinitis. Notably, household income exhibited a significant influence, with the lowest income quartile exhibiting higher prevalence rates of asthma, allergic rhinitis, and multiple allergic diseases. In contrast, the highest income quartile displayed lower rates of allergic rhinitis. Children diagnosed with allergic diseases demonstrated compromised intake of essential nutrients such as energy, dietary fiber, vitamin B1, sodium, potassium, and iron. Particularly noteworthy were the deficits in dietary fiber, vitamin A, niacin, and potassium intake among children aged 3-5 with allergies. Logistic regression analysis further elucidated that within low-income families, female children with higher BMIs, frequent dining out, dietary supplement usage, and altered consumption of vitamin B1 and iron faced an elevated risk of allergic disease diagnosis. Additionally, machine learning analysis pinpointed influential predictors for childhood asthma, encompassing BMI, household income, subjective health perception, height, and dietary habits. Discussion Our findings underscore the pronounced impact of income levels on the intricate nexus between allergic diseases and nutritional status. Furthermore, our machine learning insights illuminate the multifaceted determinants of childhood asthma, where physiological traits, socioeconomic circumstances, environmental factors, and dietary choices intertwine to shape disease prevalence. This study emphasizes the urgency of tailored nutritional interventions, particularly in socioeconomically disadvantaged populations, while also underscoring the necessity for comprehensive longitudinal investigations to unravel the intricate relationship between allergic diseases, nutritional factors, and socioeconomic strata.
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Affiliation(s)
- Seungpil Jeong
- Department of Medical Informatics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Yean Jung Choi
- Department of Food and Nutrition, Sahmyook University, Seoul, Republic of Korea
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Losol P, Sokolowska M, Hwang YK, Ogulur I, Mitamura Y, Yazici D, Pat Y, Radzikowska U, Ardicli S, Yoon JE, Choi JP, Kim SH, van de Veen W, Akdis M, Chang YS, Akdis CA. Epithelial Barrier Theory: The Role of Exposome, Microbiome, and Barrier Function in Allergic Diseases. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:705-724. [PMID: 37957791 PMCID: PMC10643858 DOI: 10.4168/aair.2023.15.6.705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/18/2023] [Accepted: 10/07/2023] [Indexed: 11/15/2023]
Abstract
Allergic diseases are a major public health problem with increasing prevalence. These immune-mediated diseases are characterized by defective epithelial barriers, which are explained by the epithelial barrier theory and continuously emerging evidence. Environmental exposures (exposome) including global warming, changes and loss of biodiversity, pollution, pathogens, allergens and mites, laundry and dishwasher detergents, surfactants, shampoos, body cleaners and household cleaners, microplastics, nanoparticles, toothpaste, enzymes and emulsifiers in processed foods, and dietary habits are responsible for the mucosal and skin barrier disruption. Exposure to barrier-damaging agents causes epithelial cell injury and barrier damage, colonization of opportunistic pathogens, loss of commensal bacteria, decreased microbiota diversity, bacterial translocation, allergic sensitization, and inflammation in the periepithelial area. Here, we review scientific evidence on the environmental components that impact epithelial barriers and microbiome composition and their influence on asthma and allergic diseases. We also discuss the historical overview of allergic diseases and the evolution of the hygiene hypothesis with theoretical evidence.
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Affiliation(s)
- Purevsuren Losol
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Medical Research Center, Seoul National University, Seoul, Korea
- Department of Molecular Biology and Genetics, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yu-Kyoung Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yasutaka Mitamura
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yagiz Pat
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Urszula Radzikowska
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Sena Ardicli
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Jeong-Eun Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jun-Pyo Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Medical Research Center, Seoul National University, Seoul, Korea
| | - Willem van de Veen
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Medical Research Center, Seoul National University, Seoul, Korea.
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
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Clemente-Suárez VJ, Mielgo-Ayuso J, Ramos-Campo DJ, Beltran-Velasco AI, Martínez-Guardado I, Navarro Jimenez E, Redondo-Flórez L, Yáñez-Sepúlveda R, Tornero-Aguilera JF. Basis of preventive and non-pharmacological interventions in asthma. Front Public Health 2023; 11:1172391. [PMID: 37920579 PMCID: PMC10619920 DOI: 10.3389/fpubh.2023.1172391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
Asthma is one of the most common atopic disorders in all stages of life. Its etiology is likely due to a complex interaction between genetic, environmental, and lifestyle factors. Due to this, different non-pharmacological interventions can be implemented to reduce or alleviate the symptoms caused by this disease. Thus, the present narrative review aimed to analyze the preventive and non-pharmacological interventions such as physical exercise, physiotherapy, nutritional, ergonutritional, and psychological strategies in asthma treatment. To reach these aims, an extensive narrative review was conducted. The databases used were MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. Asthma is an immune-mediated inflammatory condition characterized by increased responsiveness to bronchoconstrictor stimuli. Different factors have been shown to play an important role in the pathogenesis of asthma, however, the treatments used to reduce its incidence are more controversial. Physical activity is focused on the benefits that aerobic training can provide, while physiotherapy interventions recommend breathing exercises to improve the quality of life of patients. Nutritional interventions are targeted on implement diets that prioritize the consumption of fruits and vegetables and supplementation with antioxidants. Psychological interventions have been proposed as an essential non-pharmacological tool to reduce the emotional problems associated with asthma.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Madrid, Spain
- Studies Centre in Applied Combat (CESCA), Toledo, Spain
| | - Juan Mielgo-Ayuso
- Department of Health Sciences, Faculty of Health Sciences, University of Burgos, Burgos, Spain
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Ismael Martínez-Guardado
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, Universidad Camilo José Cela, Madrid, Spain
| | | | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | | | - Jose Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Madrid, Spain
- Studies Centre in Applied Combat (CESCA), Toledo, Spain
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Zhang J, He M, Yu Q, Xiao F, Zhang Y, Liang C. The Effects of a Healthy Diet on Asthma and Wheezing in Children and Adolescents: A Systematic Review and Meta-Analysis. J Asthma Allergy 2023; 16:1007-1024. [PMID: 37780080 PMCID: PMC10541225 DOI: 10.2147/jaa.s423884] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/18/2023] [Indexed: 10/03/2023] Open
Abstract
Background Asthma is a public health problem requiring focused attention. This study aimed to systematically evaluate the association between dietary structure and asthma or wheezing in children. Methods The study protocol of this meta-analysis has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with the registration code CRD42023390191. A total of 8397 articles were retrieved, searching PubMed, Medline, Embase, Web of Science, and Scopus databases as of November 21, 2022. Two independent authors were responsible for independently conducting the literature screening process. Effect-size estimates were expressed as odds ratio (OR) in cross-sectional studies and risk ratio (RR) in cohort studies with a 95% confidence interval (CI). Summary effect estimates were evaluated with random-effect models. Meanwhile, subgroup and sensitivity analyses were performed to assess the potential sources of heterogeneity and the robustness of the pooled estimation. Results A total of 65 studies, including 567,426 subjects had been analyzed. Overall analyses of cross-sectional studies revealed that a healthy diet was protective against asthma (adjusted OR=0.85, 95% CI: 0.80-0.89, P <0.001, I2=69.8%, Tau2=0.026) and wheezing (adjusted OR=0.85, 95% CI: 0.81-0.89, P <0.001, I2=66.8%, Tau2=0.015) in children and adolescents. Conversely, unhealthy diets can exacerbate asthma (adjusted OR=1.28, 95% CI: 1.20-1.36, P <0.001, I2=64.9%, Tau2=0.019) and wheeze (adjusted OR=1.09, 95% CI: 1.02-1.16, P =0.006, I2=75.2%, Tau2=0.023) in children and adolescents. The same trend was found in cohort studies (adjusted RR=0.72, 95% CI: 0.58-0.90, P =0.003, I2=83.5%, Tau2=0.105). A clear trend was observed between high-frequency healthy diets (OR=0.80; 95% CI: 0.71-0.89; P <0.001) is more protective against asthma than low-frequency healthy diets (OR=0.81; 95% CI: 0.70-0.94; P =0.007). Conclusion Our findings highlight the protective effects of a healthy diet on asthma and wheezing in children, including fruit, seafood, cereals, and the Mediterranean diet.
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Affiliation(s)
- Jin Zhang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Mengyang He
- Graduate School, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Qiduo Yu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Fei Xiao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People’s Republic of China
| | - Yongming Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital; National Clinical Research Center for Respiratory Diseases, Beijing, People’s Republic of China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People’s Republic of China
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Lim JJ, Reginald K, Say YH, Liu MH, Chew FT. A dietary pattern of frequent plant-based foods intake reduced the associated risks for atopic dermatitis exacerbation: Insights from the Singapore/Malaysia cross-sectional genetics epidemiology cohort. BMC Public Health 2023; 23:1818. [PMID: 37726698 PMCID: PMC10508008 DOI: 10.1186/s12889-023-16736-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND The prevalence of atopic dermatitis (AD) has been increasing in recent years, especially in Asia. There is growing evidence to suggest the importance of dietary patterns in the development and management of AD. Here, we seek to understand how certain dietary patterns in a Singapore/Malaysia population are associated with various risks of AD development and exacerbation. METHODS A standardized questionnaire following the International Study of Asthma and Allergies in Childhood (ISAAC) guidelines was investigator-administered to a clinically and epidemiology well-defined allergic cohort of 13,561 young Chinese adults aged 19-22. Information on their sociodemographic, lifestyle, dietary habits, and personal and family medical atopic histories were obtained. Allergic sensitization was assessed by a skin prick test to mite allergens. Spearman's rank-order correlation was used to assess the correlation between the intake frequencies of 16 food types. Dietary patterns were identified using principal component analysis. Four corresponding dietary scores were derived to examine the association of identified dietary patterns with allergic sensitization and AD exacerbations through a multivariable logistic regression that controlled for age, gender, parental eczema, BMI, and lifestyle factors. RESULTS The correlation is the strongest between the intake of butter and margarine (R = 0.65). We identified four dietary patterns, "high-calorie foods", "plant-based foods", "meat and rice", and "probiotics, milk and eggs", and these accounted for 47.4% of the variance in the dietary habits among the subjects. Among these patterns, moderate-to-high intake of "plant-based foods" conferred a negative association for chronic (Adjusted odds ratio (AOR): 0.706; 95% confidence interval (CI): 0.589-0.847; p < 0.001) and moderate-to-severe AD (AOR: 0.756; 95% CI: 0.638-0.897; p < 0.01). "Meat and rice" and "probiotics, milk and eggs" were not significantly associated with AD exacerbation. While frequent adherence to "high-calorie foods" increased the associated risks for ever AD and moderate-to-severe AD, having a higher adherence to "plant-based foods" diminished the overall associated risks. CONCLUSIONS Frequent adherence to "plant-based foods" was associated with reduced risks for AD exacerbation in young Chinese adults from Singapore/Malaysia. This provides the initial evidence to support the association between dietary factors and AD. Further research is needed to better understand the pathomechanisms underlying diet and AD exacerbations.
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Affiliation(s)
- Jun Jie Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, 117543 Singapore
| | - Kavita Reginald
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, 117543 Singapore
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, 47500 Petaling Jaya, Selangor, Malaysia
| | - Yee-How Say
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, 117543 Singapore
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, 47500 Petaling Jaya, Selangor, Malaysia
- Department of Biomedical Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR), 31900 Kampar, Perak, Malaysia
| | - Mei Hui Liu
- Department of Food Science & Technology, Faculty of Science, National University of Singapore, Singapore, 117543 Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, 117543 Singapore
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10
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Lee H, Sim N, Fotouhi A, Daveluy S. Vegan Diet in Dermatology: A Review. J Clin Med 2023; 12:5800. [PMID: 37762741 PMCID: PMC10531971 DOI: 10.3390/jcm12185800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 08/29/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Diet is known to play a role in the development of skin disorders. While a vegan diet is frequently described as a risk factor for skin disease secondary to nutritional deficiency, this risk may be overestimated. This review aims to debunk myths and provide information on skin disorders and inflammatory skin conditions that have associations with specific nutritional deficiencies in the context of a vegan diet. A literature search was performed for each nutrient and inflammatory skin disease using the PubMed/MEDLINE database and public health website pages concerning a vegan diet. The literature has individual cases reporting skin disease due to deficiencies in vitamin B2 and vitamin A in patients following a vegan diet. The recommended daily amounts of nutrients and vitamins can be fulfilled on a vegan diet. Vegan diets also avoid food groups such as dairy and other animal-based products, which holds benefits in inflammatory skin diseases including acne, psoriasis, hidradenitis suppurativa, and atopic dermatitis. Overall, the risk of skin disease secondary to nutritional deficiency in patients following a vegan diet is very low and likely over-emphasized. A well-balanced and conscientiously planned vegan diet can adequately provide the necessary amounts of proteins, vitamins, and minerals to support skin health.
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Affiliation(s)
- Hannah Lee
- School of Medicine, Wayne State University, Detroit, MI 48201, USA; (H.L.); (N.S.)
| | - Nathan Sim
- School of Medicine, Wayne State University, Detroit, MI 48201, USA; (H.L.); (N.S.)
| | - Audrey Fotouhi
- Department of Dermatology, Wayne State University, Detroit, MI 48201, USA;
| | - Steven Daveluy
- Department of Dermatology, Wayne State University, Detroit, MI 48201, USA;
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Olejnik A, Gornowicz-Porowska J, Jenerowicz D, Polańska A, Dobrzyńska M, Przysławski J, Sansone A, Ferreri C. Fatty Acids Profile and the Relevance of Membranes as the Target of Nutrition-Based Strategies in Atopic Dermatitis: A Narrative Review. Nutrients 2023; 15:3857. [PMID: 37686888 PMCID: PMC10489657 DOI: 10.3390/nu15173857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/26/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Recently, the prevalence of atopic dermatitis has increased drastically, especially in urban populations. This multifactorial skin disease is caused by complex interactions between various factors including genetics, environment, lifestyle, and diet. In eczema, apart from using an elimination diet, the adequate content of fatty acids from foods (saturated, monounsaturated, and polyunsaturated fatty acids) plays an important role as an immunomodulatory agent. Different aspects regarding atopic dermatitis include connections between lipid metabolism in atopic dermatitis, with the importance of the MUFA levels, as well as of the omega-6/omega-3 balance that affects the formation of long-chain (C20 eicosanoic and C22 docosaenoic) fatty acids and bioactive lipids from them (such as prostaglandins). Impair/repair of the functioning of epidermal barrier is influenced by these fatty acid levels. The purpose of this review is to drive attention to membrane fatty acid composition and its involvement as the target of fatty acid supplementation. The membrane-targeted strategy indicates the future direction for dermatological research regarding the use of nutritional synergies, in particular using red blood cell fatty acid profiles as a tool for checking the effects of supplementations to reach the target and influence the inflammatory/anti-inflammatory balance of lipid mediators. This knowledge gives the opportunity to develop personalized strategies to create a healthy balance by nutrition with an anti-inflammatory outcome in skin disorders.
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Affiliation(s)
- Anna Olejnik
- Faculty of Chemistry, Adam Mickiewicz University in Poznań, Uniwersytetu Poznańskiego 8, 61-614 Poznań, Poland;
- Centre for Advanced Technology, Adam Mickiewicz University in Poznań, Uniwersytetu Poznańskiego 10, 61-614 Poznań, Poland
| | - Justyna Gornowicz-Porowska
- Department and Division of Practical Cosmetology and Skin Diseases Prophylaxis, Poznan University of Medicinal Sciences, Rokietnicka 3, 60-806 Poznań, Poland
| | - Dorota Jenerowicz
- Department of Dermatology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-356 Poznań, Poland; (D.J.); (A.P.)
| | - Adriana Polańska
- Department of Dermatology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-356 Poznań, Poland; (D.J.); (A.P.)
| | - Małgorzata Dobrzyńska
- Department of Bromatology, Poznan University of Medical Sciences, Rokietnica 3, 60-806 Poznań, Poland; (M.D.); (J.P.)
| | - Juliusz Przysławski
- Department of Bromatology, Poznan University of Medical Sciences, Rokietnica 3, 60-806 Poznań, Poland; (M.D.); (J.P.)
| | - Anna Sansone
- Istituto per la Sintesi Organica e la Fotoreattività, Consiglio Nazionale Delle Ricerche, Via Piero Gobetti 101, 40129 Bologna, Italy;
| | - Carla Ferreri
- Istituto per la Sintesi Organica e la Fotoreattività, Consiglio Nazionale Delle Ricerche, Via Piero Gobetti 101, 40129 Bologna, Italy;
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12
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Lim JJ, Lim YYE, Ng JY, Malipeddi P, Ng YT, Teo WY, Wong QYA, Matta SA, Sio YY, Wong YR, Teh KF, Rawanan Shah SM, Reginald K, Say YH, Liu MH, Chew FT. Burgers, Fast Foods, and Increased Associated Risk for Atopic Dermatitis: A Cross-Sectional Study of Dietary Habits among Young Chinese Adults in Singapore/Malaysia. Dermatology 2023; 240:77-84. [PMID: 37666213 DOI: 10.1159/000533942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/29/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND We see increasing evidence that dietary and nutrients factors play a pivotal role in allergic diseases and recent global findings suggest that dietary habits influence the pathogenesis of atopic dermatitis (AD). Frequent consumption of fast food diets is associated with AD development. Despite the rising prevalence of AD in Asia, efforts in investigating the role of dietary habits and AD in adults are still lacking. METHODS We evaluated the association between the dietary intake of 16 food types and AD manifestations using our Singapore/Malaysia Cross-sectional Genetics Epidemiology Study (SMCGES) population. Dietary habits profiles of 11,494 young Chinese adults (1,550 AD cases/2,978 non-atopic controls/6,386 atopic controls) were assessed by an investigator-administered questionnaire. AD cases were further evaluated for their chronicity (550 chronic) and severity (628 moderate-to-severe). Additionally, we derived a novel food index, Quality of Diet based on Glycaemic Index Score (QDGIS), to examine the association between dietary intake of glycaemic index (GI) and various AD phenotypes. RESULTS The majority of AD subjects are distributed in the good (37.1%) and moderate (36.2%) QDGIS classes. From the multivariable analyses for age and gender, a moderate QDGIS class was significantly associated with a lower odds of AD (adjusted odds ratio (AOR): 0.844; 95% confidence interval (CI): 0.719-0.991; p < 0.05) and moderate-to-severe AD (AOR: 0.839; 95% CI: 0.714-0.985; p < 0.05). A good QDGIS class was only significantly associated with a lower odds of chronic AD (AOR: 0.769; 95% CI: 0.606-0.976; p < 0.05). Among high GI foods, frequent consumption of burgers/fast food was strongly associated with an increased risk of chronic and moderate-to-severe AD. Among low GI foods, increased intake frequencies of fruits, vegetables, and pulses decreased the odds of AD. Finally, we identified significant associations between frequent seafood, margarine, butter, and pasta consumption with an increased odds of AD despite them having little GI values. CONCLUSION While genetic components are well-established in their risks associated with increased AD prevalence, there is still a lack of a focus epidemiology study associating dietary influence with AD. Based on the first allergic epidemiology study conducted here in Singapore and Malaysia, it laid the groundwork to guide potential dietary interventions from changing personal dietary habits.
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Affiliation(s)
- Jun Jie Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore,
| | - Yi Ying Eliza Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Jun Yan Ng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Praneeth Malipeddi
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Ting Ng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Wei Yi Teo
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Qi Yi Ambrose Wong
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Sri Anusha Matta
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yang Yie Sio
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yi Ru Wong
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Keng Foo Teh
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Smyrna Moti Rawanan Shah
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Kavita Reginald
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Yee-How Say
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
- Department of Biomedical Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR), Kampar, Malaysia
| | - Mei Hui Liu
- Department of Food Science and Technology, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
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13
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Brigham E, Hashimoto A, Alexis NE. Air Pollution and Diet: Potential Interacting Exposures in Asthma. Curr Allergy Asthma Rep 2023; 23:541-553. [PMID: 37440094 DOI: 10.1007/s11882-023-01101-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE OF REVIEW To provide a review of emerging literature describing the impact of diet on the respiratory response to air pollution in asthma. RECENT FINDINGS Asthma phenotyping (observable characteristics) and endotyping (mechanistic pathways) have increased the specificity of diagnostic and treatment pathways and opened the doors to the identification of subphenotypes with enhanced susceptibility to exposures and interventions. Mechanisms underlying the airway immune response to air pollution are still being defined but include oxidative stress, inflammation, and activation of adaptive and innate immune responses, with genetic susceptibility highlighted. Of these, neutrophil recruitment and activation appear prominent; however, understanding neutrophil function in response to pollutant exposures is a research gap. Diet may play a role in asthma pathogenesis and morbidity; therefore, diet modification is a potential target opportunity to protect against pollutant-induced lung injury. In particular, in vivo and in vitro data suggest the potential for diet to modify the inflammatory response in the airways, including impacts on neutrophil recruitment and function. Murine models provide compelling results in regard to the potential for dietary components (including fiber, antioxidants, and omega-3 fatty acids) to buffer against the inflammatory response to air pollution in the lung. Precision lifestyle approaches to asthma management and respiratory protection in the context of air pollution exposures may evolve to include diet, pending the results of further epidemiologic and causal investigation and with neutrophil recruitment and activation as a candidate mechanism.
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Affiliation(s)
- Emily Brigham
- Division of Respirology, University of British Columbia, Vancouver, BC, Canada.
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
| | - Alisa Hashimoto
- Faculty of Science, University of British Columbia, BC, Vancouver, Canada
| | - Neil E Alexis
- Center for Environmental Medicine, Asthma and Lung Biology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Pediatrics, Division of Allergy, Immunology, Rheumatology and Infectious Disease, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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14
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Lim JJ, Reginald K, Say YH, Liu MH, Chew FT. A Dietary Pattern for High Estimated Total Fat Amount Is Associated with Enhanced Allergy Sensitization and Atopic Diseases among Singapore/Malaysia Young Chinese Adults. Int Arch Allergy Immunol 2023; 184:975-984. [PMID: 37393903 DOI: 10.1159/000530948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/28/2023] [Indexed: 07/04/2023] Open
Abstract
INTRODUCTION Frequent dietary patterns for fast food diets are suggested to be a risk factor for atopic disease development. Excessive dietary fats in fast foods are postulated to promote low-grade chronic inflammation. However, no studies in Asia have yet to characterize the dietary pattern for high-fat foods with atopic diseases. Thus, this study aims to assess the association between dietary fats with the prevalence of atopic diseases in an allergic cohort. METHODS Through an investigator-administered questionnaire that follows the International Study of Asthma and Allergies in Childhood (ISAAC) protocol, we evaluated the eating habits, lifestyle behaviours, sociodemographics, and atopic symptoms, and history among 11,494 young Chinese adults in Singapore and Malaysia. A skin prick test (SPT) for common house dust mites was also conducted to determine the atopic (allergic) status. We identified 1,550 atopic dermatitis (AD), 1,301 allergic asthma (AS), and 3,757 allergic rhinitis (AR) atopic cases. We derived a novel dietary index, Diet Quality based on Total Fat Amount (DQTFA), to examine the association between eating patterns for estimated total fat amount with various atopic outcomes. RESULTS There was a preponderance of subjects having positive SPT reaction (69.0%) with the prevalence of AR being the highest (32.7%), then AD (13.5%), and AS (11.3%). Additionally, there is a significantly higher proportion of subjects with an atopy background and atopic diseases consume diets with a high estimated mean fat amount. The adherence to a dietary pattern of the higher estimated total fat amount was shown to be strongly associated with all atopic diseases and exhibited dose-dependent responses in the univariate analysis. These associations remained significant even with the adjustments for age, gender, body mass index, use of alcohol, sedentary lifestyles, and physical activity. A dietary pattern for high-fat amount is more strongly associated with AS (adjusted odds ratio [AOR]: 1.524; 95% confidence interval [CI]: 1.216-1.725; p < 0.001) and AR (AOR: 1.294; 95% CI: 1.107-1.512; p < 0.001) compared to AD (AOR: 1.278; 95% CI: 1.049-1.559; p < 0.05). Finally, it was shown that having either one of the atopic comorbidities was strongly associated with a dietary pattern of high-fat amounts (AOR: 1.360; 95% CI: 1.161-1.594; p < 0.001). CONCLUSION Our findings altogether provide initial evidence that the dietary pattern of a diet high in fat amount is associated with an increased risk of atopy and atopic diseases in young Chinese adults in Singapore and Malaysia. Balancing the consumption of dietary fats and changing personal dietary habits by choosing foods of the lower fat amount may reduce the associated odds of atopic diseases.
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Affiliation(s)
- Jun Jie Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore,
| | - Kavita Reginald
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
| | - Yee-How Say
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, Petaling Jaya, Malaysia
- Department of Biomedical Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR), Kampar, Malaysia
| | - Mei Hui Liu
- Department of Food Science & Technology, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore, Singapore
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15
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Gu Z, Wei P, Kou W, Tang XY, Yao HB, Liu EM. Analysis of Multimorbidity of Moderate to Severe Allergic Rhinitis in Children: A Real-World Study. Int Arch Allergy Immunol 2023; 184:882-892. [PMID: 37290409 DOI: 10.1159/000530842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Allergic rhinitis (AR) in children is associated with various comorbidities, posing challenges for treatment and management. There have been few investigations of these multimorbidities in Chinese children with AR. Here, we investigated the prevalence of multimorbidities in children with moderate to severe AR and analyzed the influencing factors using real-world data. METHODS In total, 600 children who visited the outpatient clinic of our hospital and were diagnosed with moderate-severe AR were prospectively enrolled. All children underwent allergen detection and electronic nasopharyngoscopy. Parents or guardians completed a questionnaire that included age, sex, mode of delivery, feeding pattern, and familial history of allergy. The multimorbidities investigated included atopic dermatitis (AD), asthma, allergic conjunctivitis (AC), chronic rhinosinusitis (CRS), adenoid hypertrophy (AH), tonsil hypertrophy (TH), recurrent epistaxis, and recurrent respiratory tract infections (RRTIs). RESULTS The AR multimorbidities reported in children were as follows: recurrent epistaxis (46.5%), AC (46.3%), AD (40.7%), asthma (22.5%), RRIs (21.3%), CRS (20.5%), AH (19.7%), and TH (12.5%). In univariate logistic regression analysis, age (<6 years), birth mode, familial history of allergy, and single dust mite allergy were associated with AR multimorbidity (p < 0.05). Multivariate logistic regression revealed that a familial history of allergy was an independent risk factor for AC (odds ratio [OR] = 1.539, 95% confidence interval [CI]: 1.104-2.145) and AH (OR = 1.506, 95% CI: 1.000-2.267) (p < 0.05). Age (<6 years) was independently associated with the risk of AD (OR = 1.405, 95% CI: 1.003-1.969) and RRTIs (OR = 1.869, 95% CI: 1.250-2.793) (p < 0.05), cesarean section with AR and CRS risk (OR = 1.678, 95% CI: 1.100-2.561), and single dust mite allergy with asthma (OR = 1.590, 95% CI: 1.040-2.432) and CRS (OR = 1.600, 95% CI: 1.018-2.515) risk (p < 0.05). Further, non-dust mite allergy was independently associated with AR and CRS (OR = 2.056, 95% CI: 1.084-3.899). CONCLUSION AR was found to be accompanied by different comorbidities, including both allergic and non-allergic comorbidities, complicating disease treatment. These findings demonstrated that age (<6 years), familial history of allergy, types of allergens, and cesarean section were risk factors for different multimorbidities associated with AR.
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Affiliation(s)
- Zheng Gu
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China,
| | - Ping Wei
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Wei Kou
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Xin-Ye Tang
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - Hong-Bing Yao
- Department of Otolaryngology Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
| | - En-Mei Liu
- Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Child Infection and Immunity, Chongqing, China
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Kang M, Jung JH, Kim JY, Hong SH, Her Y. Therapeutic and Preventive Effect of Orally Administered Prebiotics on Atopic Dermatitis in a Mouse Model. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2023; 15:303-315. [PMID: 37075794 DOI: 10.4168/aair.2023.15.3.303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/04/2022] [Accepted: 10/04/2022] [Indexed: 05/17/2023]
Abstract
PURPOSE Recently, interest is increasing in using prebiotics, which are nutrient ingredients of live microorganism that improve the intestinal environments by promoting the growth of beneficial gut microflora. Although numerous studies have demonstrated the beneficial effects of probiotics on atopic dermatitis (AD) development, few have examined preventive and therapeutic effects of prebiotics on the onset and progression of AD. METHODS In this study, we investigated therapeutic and preventive effect of prebiotics, including β-glucan and inulin, using an oxazolone (OX)-induced AD-like mouse model. Prebiotics were orally administered 2 weeks after the end of sensitization period (therapeutic study) and 3 weeks before the initial sensitization (prevention study). The physiological and histological alterations in the skin and gut of the mice were investigated. RESULTS In the therapeutic study, the severity of skin lesions and inflammatory responses were effectively reduced after administering β-glucan and inulin, respectively. The expression level of calprotectin was significantly decreased by approximately 2-fold (P < 0.05) in the skin and gut of prebiotics-treated mice compared to the control. In addition, epidermal thickness and the number of infiltrated immune cells were markedly reduced in the dermis of prebiotics-treated mice compared <strike>with</strike> to those in the OX-induced mice (P < 0.05). These findings were same as in the prevention study. Importantly, pre-administration of β-glucan and inulin prevented the progression of AD by promoting the growth of good bacteria in the gut of OX-induced AD mice. However, the co-administration of β-glucan and inulin did not show enhanced preventive effects on these alterations. CONCLUSIONS Prebiotics has a therapeutic effect on AD in OX-induced AD mouse model. Moreover, our study suggests that prebiotics prevents the development of AD and this effect is associated with a change in gut microbiome.
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Affiliation(s)
- Minje Kang
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Ji-Hye Jung
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Ji-Young Kim
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Seok-Ho Hong
- Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea.
| | - Young Her
- Department of Dermatology, Kangwon National University Hospital, School of Medicine, Kangwon National University, Chuncheon, Korea.
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17
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Vitamin D and Omega-3 (Fatty Acid) Supplementation in Pregnancy for the Primary Prevention of Food Allergy in Children-Literature Review. CHILDREN 2023; 10:children10030468. [PMID: 36980026 PMCID: PMC10047068 DOI: 10.3390/children10030468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/19/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
During the last decades the prevalence of food allergy (FA), an adverse immune response to a specific food antigen, has risen, with negative effects on the quality of life (QoL) of many children and their families. The pathogenesis of FA is complex, involving both genetic and environmental factors. SPINK5, STAT6, HLA and FOXP3 are some of the genes that are reported to be implicated in FA development. Regarding environmental factors, particular interest has been focused on modification of the dietary habits of pregnant women for the primary prevention of FA. Specifically, Vitamin D and omega-3 (Ω-3) fatty acid supplementation during pregnancy may influence the development of FA in the offspring. Vitamin D is a hormone with various actions, including mediation of the immune system, reducing the production of inflammatory cytokines and promoting tolerance. Vitamin D deficiency in pregnancy suppresses T-regulatory cells in the fetus, and Vitamin D supplementation might protect against FA development. Dietary Ω-3 fatty acids are found mainly in fish and vegetable oils. They are beneficial for human health, playing a role in the immune system as anti-inflammatory agents, and providing cell membrane stabilization with inhibition of antigen presentation. It is documented that maternal supplementation with Ω-3 during pregnancy may protect from allergic sensitization in the children. The aim of this literature review was to explore the potential preventive role of maternal supplementation during pregnancy with Vitamin D and Ω-3 in the development of FA in the offspring. With the prevalence of FA rising, all the possible protective mechanisms and measures for FA prevention need to be explored, starting with those that can be modified.
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18
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Dietary fiber and SCFAs in the regulation of mucosal immunity. J Allergy Clin Immunol 2023; 151:361-370. [PMID: 36543697 DOI: 10.1016/j.jaci.2022.11.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
Gut bacterial metabolites such as short-chain fatty acids (SCFAs) have important effects on immune cells and the gut. SCFAs derive from the fermentation of dietary fiber by gut commensal bacteria. Insufficient fiber intake thus compromises SCFA production and, as a consequence, the host's physiology (particularly immune functions). We propose that many Western diseases, including those associated with impaired mucosal responses such as food allergy and asthma, may be affected by insufficient fiber intake and reduced SCFA levels in the gut and blood. Insufficient fiber intake is 1 alternative, or contributor, on top of the "hygiene hypothesis" to the rise of Western lifestyle diseases, and the 2 ideas need to be reconciled. The mechanisms by which SCFAs influence immunity and gut homeostasis are varied; they include stimulation of G protein-coupled receptors (GPCRs), such as GPR43 or GPR41; inhibition of histone deacetylases (and hence, gene transcription changes); and induction of intracellular metabolic changes. SCFAs modulate at many different levels to alter mucosal homeostasis, including changes to gut epithelial integrity, increases in regulatory T-cell numbers and function, and decreased expression of numerous inflammatory cytokines. There is scope for preventing and/or treating diseases by using diets that alter SCFA levels.
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19
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Lunjani N, Walsh LJ, Venter C, Power M, MacSharry J, Murphy DM, O'Mahony L. Environmental influences on childhood asthma-The effect of diet and microbiome on asthma. Pediatr Allergy Immunol 2022; 33:e13892. [PMID: 36564884 PMCID: PMC10107834 DOI: 10.1111/pai.13892] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022]
Abstract
Early life dietary patterns and timely maturation of mucosa-associated microbial communities are important factors influencing immune development and for establishing robust immune tolerance networks. Microbial fermentation of dietary components in vivo generates a vast array of molecules, some of which are integral components of the molecular circuitry that regulates immune and metabolic functions. These in turn protect against aberrant inflammatory processes and promote effector immune responses that quickly eliminate pathogens. Multiple studies suggest that changes in dietary habits, altered microbiome composition, and microbial metabolism are associated with asthma risk and disease severity. While it remains unclear whether these microbiome alterations are a cause or consequence of dysregulated immune responses, there is significant potential for using diet in targeted manipulations of the gut microbiome and its metabolic functions in promoting immune health. In this article, we will summarize our knowledge to date on the role of dietary patterns and microbiome activities on immune responses within the airways. Given the malleability of the human microbiome, its integration into the immune system, and its responsiveness to diet, this makes it a highly attractive target for therapeutic and nutritional intervention in children with asthma.
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Affiliation(s)
- Nonhlanhla Lunjani
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,Department of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Laura J Walsh
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Carina Venter
- Section of Allergy and Immunology, University of Colorado School of Medicine, Colorado, USA.,Children's Hospital Colorado, Colorado, USA
| | - Matthew Power
- School of Microbiology, University College Cork, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - John MacSharry
- School of Microbiology, University College Cork, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
| | - Desmond M Murphy
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,Clinical Research Facility, University College Cork, Cork, Ireland
| | - Liam O'Mahony
- APC Microbiome Ireland, University College Cork, Cork, Ireland.,School of Microbiology, University College Cork, Cork, Ireland.,Department of Medicine, University College Cork, Cork, Ireland
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20
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Topalušić I, Stipić Marković A, Artuković M, Dodig S, Bucić L, Lugović Mihić L. Divergent Trends in the Prevalence of Children's Asthma, Rhinitis and Atopic Dermatitis and Environmental Influences in the Urban Setting of Zagreb, Croatia. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121788. [PMID: 36553232 PMCID: PMC9777289 DOI: 10.3390/children9121788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Previous studies have reported that the allergy epidemic in developed countries has reached its plateau, while a rise is expected in developing ones. Our aim was to compare the prevalence of allergic diseases among schoolchildren from the city of Zagreb, Croatia after sixteen years. METHODS Symptoms of asthma, allergic rhinitis (AR) and atopic dermatitis (AD) and risk factors were assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. An allergic profile was determined by a skin prick test. RESULTS The prevalence of current, ever-in-a-lifetime and diagnosed AR of 35.7%, 42.5% and 14.9% and AD of 18.1%, 37.1% and 31.1% demonstrated a significant increase. The asthma prevalence has remained unchanged. The allergen sensitivity rate has remained similar, but pollens have become dominant. Mould and dog exposure are risks for asthma (OR 14.505, OR 2.033). Exposure to cat allergens is protective in AR (OR 0.277). Parental history of allergies is a risk factor in all conditions. CONCLUSION Over sixteen years, the prevalence of AR and AD, but not of asthma, have increased. The proportion of atopy has remained high. The AR/AD symptom rise is probably a consequence of increased pollen sensitisation united with high particulate matter concentrations. The stable asthma trend could be a result of decreasing exposures to indoor allergens.
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Affiliation(s)
- Iva Topalušić
- Division of Pulmology, Immunology, Allergology and Rheumatology, Department of Paediatrics, University Children’s Hospital Zagreb, 10 000 Zagreb, Croatia
- Correspondence: ; Tel.: +385-98-1857-599
| | - Asja Stipić Marković
- Department of Pulmology, Special Hospital for Pulmonary Diseases, 10 000 Zagreb, Croatia
| | - Marinko Artuković
- Department of Pulmology, Special Hospital for Pulmonary Diseases, 10 000 Zagreb, Croatia
| | - Slavica Dodig
- Faculty of Pharmacy and Biochemistry, University of Zagreb, 10 000 Zagreb, Croatia
| | - Lovro Bucić
- Division for Environmental Health, Croatian Institute for Public Health, 10 000 Zagreb, Croatia
| | - Liborija Lugović Mihić
- Department of Dematology, School of Dental Medicine, Clinical Hospital Center Sisters of Mercy, 10 000 Zagreb, Croatia
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21
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Rey-Mariño A, Francino MP. Nutrition, Gut Microbiota, and Allergy Development in Infants. Nutrients 2022; 14:nu14204316. [PMID: 36297000 PMCID: PMC9609088 DOI: 10.3390/nu14204316] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
The process of gut microbiota development in infants is currently being challenged by numerous factors associated with the contemporary lifestyle, including diet. A thorough understanding of all aspects of microbiota development will be necessary for engineering strategies that can modulate it in a beneficial direction. The long-term consequences for human development and health of alterations in the succession pattern that forms the gut microbiota are just beginning to be explored and require much further investigation. Nevertheless, it is clear that gut microbiota development in infancy bears strong associations with the risk for allergic disease. A useful understanding of microbial succession in the gut of infants needs to reveal not only changes in taxonomic composition but also the development of functional capacities through time and how these are related to diet and various environmental factors. Metagenomic and metatranscriptomic studies have started to produce insights into the trends of functional repertoire and gene expression change within the first year after birth. This understanding is critical as during this period the most substantial development of the gut microbiota takes place and the relations between gut microbes and host immunity are established. However, further research needs to focus on the impact of diet on these changes and on how diet can be used to counteract the challenges posed by modern lifestyles to microbiota development and reduce the risk of allergic disease.
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Affiliation(s)
- Alejandra Rey-Mariño
- Genomics and Health Department, Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 València, Spain
| | - M. Pilar Francino
- Genomics and Health Department, Foundation for the Promotion of Health and Biomedical Research of the Valencia Region (FISABIO), 46020 València, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), 28001 Madrid, Spain
- Correspondence:
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22
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Wong QYA, Lim JJ, Ng JY, Malipeddi P, Teo WY, Lim YYE, Ng YT, Sio YY, Matta SA, Wong YR, Teh KF, Rawanan Shah SM, Reginald K, Say YH, Chew FT. Allergic rhinitis in Chinese young adults from the Singapore/Malaysia cross-sectional genetics epidemiology study (SMCGES) cohort: Prevalence, patterns, and epidemiology of allergic rhinitis. World Allergy Organ J 2022; 15:100704. [PMID: 36267097 PMCID: PMC9554817 DOI: 10.1016/j.waojou.2022.100704] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/01/2022] [Accepted: 09/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Allergic rhinitis (AR) is characterized by the occurrence of at least 2 symptoms of nasal itching, nasal blockage, rhinorrhea, and sneezing, when not afflicted with a cold or flu, with defined atopic sensitization demonstrated by skin prick test or specific IgE responses. Besides the detriment to standard of living and economic burden of AR, both multicentre and single-cohort studies have observed an increase in AR prevalence in Asia over time. Methods In total, 12 872 individuals, with mean age 22.1 years (SD = 4.8), were recruited from universities in Singapore and Malaysia. Each participant provided epidemiological data based on an investigator-administered questionnaire adapted from the validated International Study of Allergies and Asthma in Childhood (ISAAC) protocol, and atopy status was determined using a skin prick test (SPT) performed by qualified staff. AR was diagnosed according to Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines and a positive SPT result. Results Sensitization (determined by SPT) to either Blomia tropicalis or Dermatophagoides pteronyssinus was prevalent in 66.5% of the cohort. Current rhinitis (manifesting ≥2 rhinitis symptoms, within the past 12 months) was observed in 48.9% of our population, while AR, which included atopy status, was estimated at 39.4%. Sneezing and rhinorrhea were the most common symptoms among AR cases. AR prevalence decreased with increasing age (OR: 0.979; 95% CI: 0.969-0.989), while male gender (OR: 2.053; 95% CI: 1.839-2.294), and a parental history of allergic diseases (OR: 2.750; 95% CI: 2.284-3.316) were significant risk factors for AR. Upon adjustment for age, gender, and parental history, housing type (OR: 0.632; 95% CI: 0.543-0.736) and income level (>$6000 vs <$2000; OR: 2.461; 95% CI: 2.058-2.947) remained as significant risk factors for AR, while ever having kept a pet (OR: 1.167; 95% CI: 1.025-1.328) emerged as a risk factor. Conflicting results were obtained for indicators of sedentary lifestyle: frequent physical activity (OR: 1.394; 95% CI: 1.150-1.694) and increased duration spent using the TV/computer (OR: 1.224; 95% CI: 1.006-1.489) both increased the risk of AR. Lastly, we used the Quality of Diet based on Glycaemic Index Score (QDGIS) to assess the Glycaemic Index (GI) level of overall diet. We identified lower GI level of overall diet as a protective factor against AR manifestation (OR: 0.682; 95% CI: 0.577-0.807). Conclusion While the previously established non-modifiable risk factors for AR were present in our study population, the identification of modifiable risk factors, such as TV/computer usage, and dietary habits, opens a new area for research, both in the areas of gene-environment interaction, and management of AR.
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Affiliation(s)
- Qi Yi Ambrose Wong
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Jun Jie Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Jun Yan Ng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Praneeth Malipeddi
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Wei Yi Teo
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Yi Ying Eliza Lim
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Yu Ting Ng
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Yang Yie Sio
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Sri Anusha Matta
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore
| | - Yi Ru Wong
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, 47500 Petaling Jaya, Selangor, Malaysia
| | - Keng Foo Teh
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, 47500 Petaling Jaya, Selangor, Malaysia
| | - Smyrna Moti Rawanan Shah
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, 47500 Petaling Jaya, Selangor, Malaysia
| | - Kavita Reginald
- Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, 47500 Petaling Jaya, Selangor, Malaysia
| | - Yee How Say
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore,Department of Biological Sciences, School of Medicine and Life Sciences, Sunway University, 47500 Petaling Jaya, Selangor, Malaysia,Department of Biomedical Science, Faculty of Science, Universiti Tunku Abdul Rahman (UTAR), 31900 Kampar, Perak, Malaysia
| | - Fook Tim Chew
- Department of Biological Sciences, Faculty of Science, National University of Singapore, 117543, Singapore,Corresponding author. Department of Biological Sciences; Vice Dean, Faculty of Science Department of Biological Sciences, Faculty of Science, National University of Singapore, Allergy and Molecular Immunology Laboratory, Lee Hiok Kwee Functional Genomics Laboratories, Block S2, Level 5, 14 Science Drive 4, Lower Kent Ridge Road, 117543, Singapore
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23
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Liao M, Su J, Li J, Tao J, Kang X, Wu B, Shan S, Wang X, Chen X, Xiao Y, Shen M. Consumption of Red Meat and Atopic Dermatitis: A Cross-Sectional Study in Chinese College Students. Dermatitis 2022; 33:e48-e51. [PMID: 35849694 DOI: 10.1097/der.0000000000000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Lin H, Zhao Y, Zhu Y, Li C, Xu W, Chen X, Huang H, Jin L. Maternal High-Fat Diet Aggravates Allergic Asthma in Offspring via Modulating CD4 + T-Cell Differentiation. Nutrients 2022; 14:nu14122508. [PMID: 35745240 PMCID: PMC9230034 DOI: 10.3390/nu14122508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/12/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
Abstract
Maternal improper nutrition has been reported to trigger respiratory disorders in offspring. Here, we characterized the effects of high-fat environment in the fetal period on mice and human cord blood CD4+ T-lymphocytes, and investigated their roles in susceptibility to asthma. Mice born to mothers that consumed a high-fat diet (HFD) throughout the gestation period were sensitized by ovalbumin to establish an experimental asthma model. To further extrapolate to humans, we collected cord blood from neonates of hypercholesterolemic (HC) mothers (n = 18) and control mothers (n = 20). In mice, aggravated airway hyperresponsiveness and inflammation revealed that maternal high-fat diet could lead to exacerbated allergic asthma in adult offspring. It was partially due to augmented activation and proliferation of CD4+ T-cells, where upregulated klf2 mRNA levels may be potentially involved. Notably, naïve HFD CD4+ T-cells had enhanced TH2-based immune response both in vivo and in vitro, resulting from DNA hypomethylation of the Il-4 promoter region. Moreover, in human, TH2 cytokines transcripts were enhanced in CD4+ T-cells of the HC group, which was associated with an increased risk of developing allergic diseases at 3 years old. Together, our study indicated that early life improper nutrition-triggered epigenetic changes in T-cells may contribute to long-lasting alterations in allergic diseases.
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Affiliation(s)
- Hui Lin
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; (H.L.); (C.L.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China; (Y.Z.); (Y.Z.)
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China
| | - Yiran Zhao
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China; (Y.Z.); (Y.Z.)
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Yajie Zhu
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China; (Y.Z.); (Y.Z.)
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Cheng Li
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; (H.L.); (C.L.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China; (Y.Z.); (Y.Z.)
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China
| | - Wei Xu
- Department of Immunology, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China;
| | - Xi Chen
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China; (Y.Z.); (Y.Z.)
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China
- International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
- Correspondence: (X.C.); (H.H.); (L.J.)
| | - Hefeng Huang
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; (H.L.); (C.L.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China; (Y.Z.); (Y.Z.)
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China
- Key Laboratory of Reproductive Genetics (Ministry of Education), Zhejiang University, Hangzhou 310006, China
- Correspondence: (X.C.); (H.H.); (L.J.)
| | - Li Jin
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai 200011, China; (H.L.); (C.L.)
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China; (Y.Z.); (Y.Z.)
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences, Shanghai 200030, China
- Correspondence: (X.C.); (H.H.); (L.J.)
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25
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Juskiene I, Prokopciuk N, Franck U, Valiulis A, Valskys V, Mesceriakova V, Kvedariene V, Valiulyte I, Poluzioroviene E, Sauliene I, Valiulis A. Indoor air pollution effects on pediatric asthma are submicron aerosol particle-dependent. Eur J Pediatr 2022; 181:2469-2480. [PMID: 35312840 DOI: 10.1007/s00431-022-04443-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/08/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023]
Abstract
The school environment is crucial for the child's health and well-being. On the other hand, the data about the role of school's aerosol pollution on the etiology of chronic non-communicable diseases remain scarce. This study aims to evaluate the level of indoor aerosol pollution in primary schools and its relation to the incidence of doctor's diagnosed asthma among younger school-age children. The cross-sectional study was carried out in 11 primary schools of Vilnius during 1 year of education from autumn 2017 to spring 2018. Particle number (PNC) and mass (PMC) concentrations in the size range of 0.3-10 µm were measured using an Optical Particle Sizer (OPS, TSI model 3330). The annual incidence of doctor's diagnosed asthma in each school was calculated retrospectively from the data of medical records. The total number of 6-11 years old children who participated in the study was 3638. The incidence of asthma per school ranged from 1.8 to 6.0%. Mean indoor air pollution based on measurements in classrooms during the lessons was calculated for each school. Levels of PNC and PMC in schools ranged between 33.0 and 168.0 particles/cm3 and 1.7-6.8 µg/m3, respectively. There was a statistically significant correlation between the incidence of asthma and PNC as well as asthma and PMC in the particle size range of 0.3-1 µm (r = 0.66, p = 0.028) and (r = 0.71, p = 0.017) respectively. No significant correlation was found between asthma incidence and indoor air pollution in the particle size range of 0.3-2.5 and 0.3-10 µm. Conclusion: We concluded that the number and mass concentrations of indoor air aerosol pollution in primary schools in the particle size range of 0.3-1 µm are primarily associated with the incidence of doctor's diagnosed asthma among younger school-age children. What is Known: • Both indoor and outdoor aerosol pollution is associated with bronchial asthma in children. What is New: • The incidence of bronchial asthma among younger school age children is related to indoor air quality in primary schools. • Aerosol pollutants in the size range of 0.3-1 µm in contrast to larger size range particles can play major role in the etiology of bronchial asthma in children.
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Affiliation(s)
- Izabele Juskiene
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Antakalnio Str. 57, Vilnius, LT-10207, Lithuania
| | - Nina Prokopciuk
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Antakalnio Str. 57, Vilnius, LT-10207, Lithuania. .,Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, Vilnius, Lithuania.
| | - Ulrich Franck
- Department of Environmental Immunology, Helmholtz Centre for Environmental Research-UFZ, Leipzig, Germany
| | - Algirdas Valiulis
- Department of Rehabilitation, Physical and Sports Medicine, Institute of Health Sciences, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Vaidotas Valskys
- Center of Life Sciences, Institute of Biosciences, Vilnius University, Vilnius, Lithuania
| | | | - Violeta Kvedariene
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, Vilnius, Lithuania.,Clinic of Chest Diseases and Allergology, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Indre Valiulyte
- Vilnius University Faculty of Medicine, Vilnius, Lithuania.,Kantonsspital Thurgau, Frauenfeld, Switzerland
| | - Edita Poluzioroviene
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Antakalnio Str. 57, Vilnius, LT-10207, Lithuania
| | | | - Arunas Valiulis
- Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Antakalnio Str. 57, Vilnius, LT-10207, Lithuania.,Department of Public Health, Institute of Health Sciences, Vilnius University Faculty of Medicine, Vilnius, Lithuania
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26
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Scadding GK, Smith PK, Blaiss M, Roberts G, Hellings PW, Gevaert P, Mc Donald M, Sih T, Halken S, Zieglmayer PU, Schmid-Grendelmeier P, Valovirta E, Pawankar R, Wahn U. Allergic Rhinitis in Childhood and the New EUFOREA Algorithm. FRONTIERS IN ALLERGY 2022; 2:706589. [PMID: 35387065 PMCID: PMC8974858 DOI: 10.3389/falgy.2021.706589] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/11/2021] [Indexed: 12/25/2022] Open
Abstract
Allergic rhinitis in childhood has been often missed, mistreated and misunderstood. It has significant comorbidities, adverse effects upon quality of life and educational performance and can progress to asthma or worsen control of existing asthma. Accurate diagnosis and effective treatment are important. The new EUFOREA algorithm provides a succinct but wide- ranging guide to management at all levels, based on previous guidelines with updated evidence and has been adjusted and approved by experts worldwide.
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Affiliation(s)
- Glenis Kathleen Scadding
- Ear, Nose and Throat Department, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom.,Faculty of Medical Sciences, University College London, London, United Kingdom
| | | | - Michael Blaiss
- Department of Paediatrics, Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Graham Roberts
- National Institute of Health Research Biomedical Research Centre, Southampton General Hospital, Southampton, United Kingdom.,The David Hide Asthma and Allergy Research Centre, Newport, United Kingdom.,Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Peter William Hellings
- Department of Microbiology and Immunology, Department of Otorhinolaryngology, Katholieke Universiteit Leuven, Leuven, Belgium.,Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, Netherlands
| | - Philippe Gevaert
- Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | | | - Tania Sih
- Medical School, University of São Paulo, São Paulo, Brazil
| | - Suzanne Halken
- Paediatric Allergy, University of Southern Denmark, Odense, Denmark
| | - Petra Ursula Zieglmayer
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria.,Vienna Challenge Chamber, Vienna, Austria
| | - Peter Schmid-Grendelmeier
- Allergy Unit, Dermatology Department, University Hospital of Zurich, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo Allergy Clinic, Turku, Finland
| | - Ruby Pawankar
- Division of Allergy, Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Ulrich Wahn
- Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Charite-Berlin, Berlin, Germany
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27
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Venter C, Smith PK, Arshad H. Dietary strategies for the prevention of asthma in children. Curr Opin Allergy Clin Immunol 2022; 22:123-131. [PMID: 35197434 DOI: 10.1097/aci.0000000000000805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review summarizes information relating to dietary intake during pregnancy, lactation and early life that may prevent childhood asthma. This review also summarizes how future studies may be improved. RECENT FINDINGS Recent findings from observational studies suggest that eating according to certain dietary patterns during pregnancy, such as the dietary inflammatory index, Mediterranean diet and Maternal diet index, may reduce asthma and or wheeze in the child. Vitamin D supplementation with higher doses than recommended during pregnancy may be associated with reduced early transient childhood wheezing in the offspring. Higher levels of omega-3 fatty acids in breast milk may be protective against childhood asthma. Breastfeeding infants has been shown to offer many benefits to mother and child but a direct relationship between breastfeeding and the development of asthma has not been established. During childhood, infants and children may need to reduce their intake of advanced glycation end products, increase their food intake according to the traditional Mediterranean diet and increase the diversity of foods eaten. SUMMARY Current evidence provides limited suggestions regarding dietary changes for preventing early transient childhood wheezing. In order to harmonize methods for future data collection and reporting, it is important to harmonize relevant definitions and other important factors. The aim of the considerations described here is to enable a better comparison of future studies and provide better guidance to patients and families.
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Affiliation(s)
- Carina Venter
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, Denver, Aurora, Colorado, USA
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Peter K Smith
- Griffith University Department of Clinical Medicine
- Qld Allergy Services, Southport, Queensland, Australia
| | - Hasan Arshad
- University of Southampton, Southampton
- The David Hide Asthma and Allergy Center, Isle of Wight, UK
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28
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Singh S, Salvi S, Mangal DK, Singh M, Awasthi S, Mahesh PA, Kabra SK, Mohammed S, Sukumaran TU, Ghoshal AG, Barne M, Sinha S, Kochar SK, Singh N, Singh U, Patel KK, Sharma AK, Girase B, Chauhan A, Sit N, Siddaiah JB, Singh V. Prevalence, time trends and treatment practices of asthma in India: the Global Asthma Network study. ERJ Open Res 2022; 8:00528-2021. [PMID: 35651368 PMCID: PMC9149387 DOI: 10.1183/23120541.00528-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/05/2022] [Indexed: 11/05/2022] Open
Abstract
Objective The objective of this subanalysis of data from centres across urban areas in India of the Global Asthma Network (GAN) was to study 1) the prevalence of symptoms of asthma in children and adults, 2) the change in prevalence of asthma and its trigger factors since the International Study of Asthma and Allergies in Childhood (ISAAC), and 3) current asthma treatment practice. Methods In this cross-sectional, multicentre, school-based and self-administered questionnaire, responses from children aged 6-7 years and 13-14 years, and their respective parents, were analysed. Results The GAN Phase I study included 20 084 children in the 6-7-year age group, 25 887 children in the 13-14-year age group and 81 296 parents. The prevalence of wheeze in the previous 12 months was 3.16%, 3.63% and 3.30% in the three groups, respectively. In comparison to the ISAAC studies, there was a significant reduction in the prevalence of current wheeze (p<0.001). Bivariate analysis revealed a significant reduction in the prevalence of trigger factors. Almost 82% of current wheezers and 70% of subjects with symptoms of severe asthma were not clinically diagnosed as having asthma. The daily use of inhaled corticosteroids (ICS) was less than 2.5% in subjects with current wheeze and those with symptoms of severe asthma but less than 1% used daily ICS when asthma remained undiagnosed. Conclusion The prevalence of current wheeze and its causal factors showed a significant reduction compared to previous ISAAC studies. Among subjects with current wheeze and symptoms of severe asthma, the problem of under-diagnosis and under-treatment was widespread.
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Affiliation(s)
- Sheetu Singh
- Dept of Pulmonary Medicine, Rajasthan Hospital, Jaipur, India
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | | | - Meenu Singh
- Dept of Pediatrics, Postgraduate Institute of Medical Education and Research, Changdigarh, India
| | - Shally Awasthi
- Dept of Pediatrics, King George's Medical University, Lucknow, India
| | - Padukudru Anand Mahesh
- Dept of Respiratory Medicine, Jagadguru Sri Shivarathreeshwara Medical College, JSSAHER, Mysuru, India
| | - Sushil K. Kabra
- Dept of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Sabir Mohammed
- Dept of Pulmonary Medicine, Kothari Medical College and Research Institute, Bikaner, India
| | | | | | - Monica Barne
- Pulmocare Research and Education Foundation, Pune, India
| | - Sanjeev Sinha
- Dept of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjay K. Kochar
- Dept of Pulmonary Medicine, Kothari Medical College and Research Institute, Bikaner, India
| | - Nishtha Singh
- Dept of Respiratory Medicine, Asthma Bhawan, Jaipur, India
| | | | | | - Arvind Kumar Sharma
- Dept of Community Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | | | - Anil Chauhan
- Dept of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Sit
- National Allergy Asthma Bronchitis Institute, Kolkata, India
| | - Jayaraj B. Siddaiah
- Dept of Respiratory Medicine, Jagadguru Sri Shivarathreeshwara Medical College, JSSAHER, Mysuru, India
| | - Virendra Singh
- Dept of Respiratory Medicine, Asthma Bhawan, Jaipur, India
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Association between Diet Quality and Adolescent Wheezing: Effect Modification by Environmental Tobacco Smoke Exposure. Ann Am Thorac Soc 2022; 19:1328-1337. [PMID: 35263245 DOI: 10.1513/annalsats.202107-837oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Protective effects of a high quality diet on respiratory health, particularly among youths exposed to environmental tobacco smoke (ETS), are unknown. OBJECTIVES To assess if a higher quality diet is associated with improved respiratory symptoms and lung function among adolescents, and if these associations are modified by ETS exposure. METHODS This was a cross-sectional study on 7,026 nonsmoking adolescents of the 2003-2012 National Health and Nutrition Examination Survey. Diet quality was assessed using the Healthy Eating Index-2010 score (HEI-2010), categorized into quintiles. ETS exposure was measured using serum cotinine, dichotomized as high (>2.99 ng/ml) or low (≤2.99 ng/ml). Outcomes included the presence of wheezing and cough symptoms in the past 12 months, and in a sub-group, spirometric lung function. Survey-design adjusted logistic and linear models evaluated associations between diet and 1) respiratory symptoms and 2) lung function, respectively, and assessed the interaction between HEI-2010 and serum cotinine. RESULTS While there were no significant associations between diet quality and respiratory symptoms, there was a significant interaction between HEI-2010 and serum cotinine on wheezing (pint = 0.011). In models stratified by serum cotinine, adolescents with high serum cotinine and the healthiest diet (5th quintile HEI-2010) experienced lower wheezing odds (OR, 0.10; 95% CI, 0.02-0.61), compared to those with the poorest diet (1st quintile HEI-2010). In contrast, among adolescents with low serum cotinine, there were no significant differences in any respiratory symptoms between those with the highest, compared to the lowest diet quality. Of the sub-group with spirometry data (n = 3,166), there was a trend towards better lung function with improving diet quality, although this did not achieve statistical significance. There was no effect modification by ETS exposure on the relationship between diet quality and lung function. CONCLUSIONS Consuming a higher quality diet was associated with lower wheezing odds in adolescents with substantial ETS exposure. While longitudinal studies are needed, public health interventions to improve diet quality in vulnerable, environmentally-exposed populations merit consideration.
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Primary Prevention of Pediatric Asthma through Nutritional Interventions. Nutrients 2022; 14:nu14040754. [PMID: 35215404 PMCID: PMC8875095 DOI: 10.3390/nu14040754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Asthma is the most common chronic non-communicable disease in children, the pathogenesis of which involves several factors. The increasing burden of asthma worldwide has emphasized the need to identify the modifiable factors associated with the development of the disease. Recent research has focused on the relationship between dietary factors during the first 1000 days of life (including pregnancy)—when the immune system is particularly vulnerable to exogenous interferences—and allergic outcomes in children. Specific nutrients have been analyzed as potential targets for the prevention of childhood wheeze and asthma. Recent randomized controlled trials show that vitamin D supplementation during pregnancy, using higher doses than currently recommended, may be protective against early childhood wheezing but not school-age asthma. Omega-3 fatty acid supplementation during pregnancy and infancy may be associated with a reduced risk of childhood wheeze, although the evidence is conflicting. Data from observational studies suggest that some dietary patterns during pregnancy and infancy might also influence the risk of childhood asthma. However, the quality of the available evidence is insufficient to allow recommendations regarding dietary changes for the prevention of pediatric asthma. This review outlines the available high-quality evidence on the role of prenatal and perinatal nutritional interventions for the primary prevention of asthma in children and attempts to address unmet areas for future research in pediatric asthma prevention.
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Potential Role of Omega-3 Polyunsaturated Fatty Acids in Pediatric Food Allergy. Nutrients 2021; 14:nu14010152. [PMID: 35011028 PMCID: PMC8746967 DOI: 10.3390/nu14010152] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Polyunsaturated fatty acids (PUFAs) are involved both in immune system regulation and inflammation. In particular, within the PUFAs category, omega-3 (ω-3) may reduce inflammation, whereas omega-6 (ω-6) PUFAs are generally considered to have a proinflammatory effect. Recent evidence highlights an imbalance in the ω-3:ω-6 ratio with an increased intake of ω-6, as a consequence of the shift towards a westernized diet. In critical age groups such as infants, toddlers and young children, as well as pregnant and lactating women or fish allergic patients, ω-3 intake may be inadequate. This review aims to discuss the potential beneficial effects of PUFAs on pediatric food allergy prevention and treatment, both at prenatal and postnatal ages. Data from preclinical studies with PUFAs supplementation show encouraging effects in suppressing allergic response. Clinical studies results are still conflicting about the best timing and dosages of supplementation and which individuals are most likely to benefit; therefore, it is still not possible to draw firm conclusions. With regard to food-allergic children, it is still debated whether PUFAs could slow disease progression or not, since consistent data are lacking. In conclusion, more data on the effects of ω-3 PUFAs supplementation alone or in combination with other nutrients are warranted, both in the general and food allergic population.
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32
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Narla S, Silverberg JI. Dermatology for the internist: optimal diagnosis and management of atopic dermatitis. Ann Med 2021; 53:2165-2177. [PMID: 34787024 PMCID: PMC8604464 DOI: 10.1080/07853890.2021.2004322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Internists are front-line health care providers that commonly provide the first encounter to patients for dermatological conditions, especially atopic dermatitis (AD). Internists need to be comfortable with managing mild-moderate AD in their practices. Criteria and guidelines established in dermatology literature are available to help the general practitioner diagnose and treat AD. AD is a systemic disease associated with multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions. Environmental factors may play a role in the development or worsening of AD; however, there is currently no strong evidence to guide specific population- or clinic-based interventions for their avoidance. While food allergies are common in AD patients, the role of food allergens as an exacerbating factor for AD is controversial. Before starting any dietary modifications, careful evaluation should be performed by an allergist. If the patient is not well-controlled despite adequate topical therapies or is experiencing severe/worsening disease, early referral to dermatology is warranted to rule out confounding diagnoses and/or escalation to systemic therapies. Finally, it is important to recognise the racial disparities present in AD and address these when formulating treatment plans.Key messages:Confounding dermatoses, either instead of or in addition to AD, should be considered in treatment-refractory AD, and the appropriate workup may be initiated while awaiting dermatology referral.AD patients have multiple cutaneous and extra-cutaneous comorbidities that warrant screening by internists, especially mental health conditions.
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Affiliation(s)
- Shanthi Narla
- Department of Dermatology, St. Luke’s University Health Network, Easton, PA, USA
| | - Jonathan I. Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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33
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Venter C, Pickett K, Starling A, Maslin K, Smith PK, Palumbo MP, O'Mahony L, Ben Abdallah M, Dabelea D. Advanced glycation end product intake during pregnancy and offspring allergy outcomes: A Prospective cohort study. Clin Exp Allergy 2021; 51:1459-1470. [PMID: 34610188 DOI: 10.1111/cea.14027] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 05/24/2021] [Accepted: 09/28/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Associations have been shown between concurrent assessment of dietary intake of advanced glycation end products (AGEs) and childhood allergic outcomes. We examined the association between maternal AGEs intake and development of offspring asthma, wheeze, atopic dermatitis, allergic rhinitis and food allergies, and sought to determine whether the intake of AGEs was associated with cord sera cytokines/chemokines. METHODS Pregnant women ≥16 years were recruited in the Healthy Start study, a prospective pre-birth cohort from Colorado (N = 1410). The analysis included 962 dyads with adequate diet (≥2 recalls) and allergy outcome details. AGEs intake was estimated for each mother by matching intakes reported using 24-h dietary recalls during pregnancy to a reference database of commonly consumed foods' AGEs values. Child diagnoses of asthma and allergies up to 8 years were obtained from electronic medical records. Cord sera cytokines and chemokines were analysed in a subset (N = 462) of children. RESULTS The median [IQR] AGEs intake for the overall sample was 11,919 kU/day [8293, 16,573]. Unadjusted analysis showed a positive association between maternal AGEs intake in pregnancy and rhinitis up to 8 years of age (HR = 1.03; 95% CI: 1.01, 1.06), but the association was attenuated and no longer significant in adjusted models (HR = 1.01; 95% CI: 0.98, 1.04). Both adjusted and unadjusted models showed no associations between AGEs intake in pregnancy and any of the other outcomes (p > .05). There were no significant associations between any cytokine or chemokine measured and AGEs intake or any of the outcomes studied (p > .05). CONCLUSION The study showed that maternal AGEs intake was not associated with offspring asthma and allergy outcomes. AGEs exposure during pregnancy may not have the same impact on child development as postnatal exposure.
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Affiliation(s)
- Carina Venter
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Kaci Pickett
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Anne Starling
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
| | | | - Pete K Smith
- Qld Allergy Services, Southport, Queensland, Australia.,Department of Clinical Medicine, Griffith University, Southport, Queensland, Australia
| | - Michaela P Palumbo
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, USA
| | - Liam O'Mahony
- Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Miriam Ben Abdallah
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA
| | - Dana Dabelea
- Department of Pediatrics, University of Colorado School of Medicine, University of Colorado Denver, Aurora, Colorado, USA.,Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, University of Colorado Denver, Aurora, Colorado, USA.,Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA
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Carucci L, Coppola S, Luzzetti A, Voto L, Giglio V, Paparo L, Nocerino R, Berni Canani R. Immunonutrition for Pediatric Patients With Cow's Milk Allergy: How Early Interventions Could Impact Long-Term Outcomes. FRONTIERS IN ALLERGY 2021; 2:676200. [PMID: 35386962 PMCID: PMC8974760 DOI: 10.3389/falgy.2021.676200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/18/2021] [Indexed: 12/25/2022] Open
Abstract
Cow's milk allergy (CMA) is one of the most common food allergies and one of the main causes of food-induced anaphylaxis in the pediatric age. Moreover, up to 45% of CMA children develop other atopic manifestations later in life, a phenomenon commonly named atopic march. Thus, CMA imposes a significant cost to health care systems as well as to families, and has emerged as one of the most expensive allergic diseases. The immunonutrition strategy builds its foundation on the ability of selected dietary factors to modulate immune system development and function. Recent studies highlighted the potential of immunonutrition in the management of CMA. This review is focused on the mechanisms and long-term clinical outcomes of the immunonutrition approach in children with CMA.
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Affiliation(s)
- Laura Carucci
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
- *Correspondence: Laura Carucci
| | - Serena Coppola
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Anna Luzzetti
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Luana Voto
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Veronica Giglio
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Lorella Paparo
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Rita Nocerino
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
| | - Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- ImmunonutritionLab at the CEINGE Advanced Biotechnologies Research Center, University of Naples Federico II, Naples, Italy
- European Laboratory for the Investigation of Food-Induced Diseases, University of Naples Federico II, Naples, Italy
- Task Force for Microbiome Studies, University of Naples Federico II, Naples, Italy
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35
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Di Costanzo M, De Paulis N, Biasucci G. Butyrate: A Link between Early Life Nutrition and Gut Microbiome in the Development of Food Allergy. Life (Basel) 2021; 11:life11050384. [PMID: 33922797 PMCID: PMC8146414 DOI: 10.3390/life11050384] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 12/11/2022] Open
Abstract
Increased prevalence of food allergies in the last thirty years has been attributed to lifestyle changes in Westernized countries. Among the environmental factors, nutritional factors and their interaction with the gut microbiome in early life are thought to have an important role in the observed epidemiological change. The gut microbiome synthesizes bacterial metabolites, which represent a link among gut microbiome, nutrition, and immune system. The main metabolites produced by gut microbiome are short-chain fatty acids (SCFAs). SCFAs have multiple beneficial effects on human health including protective effects in autoimmune and inflammatory diseases. Among SCFAs, butyrate is essential for maintaining gut immune homeostasis and exerts a pivotal role in immune tolerance with strong anti-inflammatory effects in allergic diseases. Recent findings suggest that butyrate takes part in the development of immunological tolerance to food, especially in the first 1000 days of life. Herein, we provide a critical review of the scientific literature on the role of butyrate for prevention and treatment of food allergies with focus on the complex interplay among early life nutrition, gut microbiome, and immune system.
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Affiliation(s)
- Margherita Di Costanzo
- Pediatrics and Neonatology Unit, Department of Maternal and Child Health, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (N.D.P.); (G.B.)
- Department of Translational Medical Science—Pediatric Section, University “Federico II”, 80131 Naples, Italy
- Correspondence:
| | - Nicoletta De Paulis
- Pediatrics and Neonatology Unit, Department of Maternal and Child Health, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (N.D.P.); (G.B.)
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Department of Maternal and Child Health, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (N.D.P.); (G.B.)
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36
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Alwarith J, Kahleova H, Crosby L, Brooks A, Brandon L, Levin SM, Barnard ND. The role of nutrition in asthma prevention and treatment. Nutr Rev 2021; 78:928-938. [PMID: 32167552 PMCID: PMC7550896 DOI: 10.1093/nutrit/nuaa005] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Asthma is a chronic respiratory condition characterized by airway inflammation and hyperreactivity. Prevalence has continued to rise in recent decades as Western dietary patterns have become more pervasive. Evidence suggests that diets emphasizing the consumption of plant-based foods might protect against asthma development and improve asthma symptoms through their effects on systemic inflammation, oxidation, and microbial composition. Additionally, increased fruit and vegetable intake, reduced animal product consumption, and weight management might mediate cytokine release, free radical damage, and immune responses involved in the development and course of asthma. The specific aim of this review paper is to examine the current literature on the associations between dietary factors and asthma risk and control in children and adults. Clinical trials examining the mechanism(s) by which dietary factors influence asthma outcomes are necessary to identify the potential use of nutritional therapy in the prevention and management of asthma.
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Affiliation(s)
- Jihad Alwarith
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Hana Kahleova
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Lee Crosby
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Alexa Brooks
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | | | - Susan M Levin
- Physicians Committee for Responsible Medicine, Washington, DC, USA
| | - Neal D Barnard
- George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Application of Metabolomics in Pediatric Asthma: Prediction, Diagnosis and Personalized Treatment. Metabolites 2021; 11:metabo11040251. [PMID: 33919626 PMCID: PMC8072856 DOI: 10.3390/metabo11040251] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022] Open
Abstract
Asthma in children remains a significant public health challenge affecting 5–20% of children in Europe and is associated with increased morbidity and societal healthcare costs. The high variation in asthma incidence among countries may be attributed to differences in genetic susceptibility and environmental factors. This respiratory disorder is described as a heterogeneous syndrome of multiple clinical manifestations (phenotypes) with varying degrees of severity and airway hyper-responsiveness, which is based on patient symptoms, lung function and response to pharmacotherapy. However, an accurate diagnosis is often difficult due to diversities in clinical presentation. Therefore, identifying early diagnostic biomarkers and improving the monitoring of airway dysfunction and inflammatory through non-invasive methods are key goals in successful pediatric asthma management. Given that asthma is caused by the interaction between genes and environmental factors, an emerging approach, metabolomics—the systematic analysis of small molecules—can provide more insight into asthma pathophysiological mechanisms, enable the identification of early biomarkers and targeted personalized therapies, thus reducing disease burden and societal cost. The purpose of this review is to present evidence on the utility of metabolomics in pediatric asthma through the analysis of intermediate metabolites of biochemical pathways that involve carbohydrates, amino acids, lipids, organic acids and nucleotides and discuss their potential application in clinical practice. Also, current challenges on the integration of metabolomics in pediatric asthma management and needed next steps are critically discussed.
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38
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Urrutia-Pereira M, Chong-Neto H, Mocellin LP, Ellwood P, Garcia-Marcos L, Simon L, Rinelli P, Solé D. Prevalence of asthma symptoms and associated factors in adolescents and adults in southern Brazil: A Global Asthma Network Phase I study. World Allergy Organ J 2021; 14:100529. [PMID: 33850603 PMCID: PMC8010518 DOI: 10.1016/j.waojou.2021.100529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 12/22/2022] Open
Abstract
Background The Global Asthma Network (GAN) aims to find out the current status of the prevalence and severity of asthma, rhinitis, and eczema using global surveillance to achieve worldwide recognition and improve the management of asthma, especially in low- and middle-income countries. The aim of this study was to verify the associated factors for asthma in adolescents and their respective parents/caregivers. Methods Adolescents (13–14 years old; n = 1058) and their respective parents/caregivers (mean age = 42.1 years, n = 896) living in the town of Uruguaiana, Southern Brazil fulfilled the standardized questionnaire. Results Although the prevalence of wheezing in the past 12 months was higher among adults than adolescents (18.4% vs. 15.8%, respectively), adolescents showed more severe wheezing and worse control over the disease revealed by higher consumption of short-acting beta-2 agonists; going to the emergency room; hospitalization in the last year and dry night cough. Smoking and paracetamol use were associated with risk for developing asthma symptoms and consuming seafood/fish was protective. For the adults smoking (10 or more cigarettes/day) and exposure to mould in the house were associated with risk for asthma symptoms. Conclusions Adolescents have a high prevalence of asthma symptoms and few have an action plan. Adults do not have their disease under control and they use more relief than preventive medication. Differences in associated factors could determine the outcomes in asthma control among adolescents and their parents.
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Affiliation(s)
| | | | - Lucas Pitrez Mocellin
- Department of Collective Health, Faculty of Medicine, Federal University of Pampa, Brazil
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, The University of Auckland, New Zealand
| | - Luis Garcia-Marcos
- Pediatric Allergy and Pulmonology Units, Arrixaca University Children's Hospital, University of Murcia, IMIB Bio-health Research Institute of Murcia (IMIB), ARADyAL Network, Spain
| | - Laura Simon
- Department of Pediatrics, Federal University of Pampa (Unipampa), Brazil
| | - Pietro Rinelli
- Department of Pediatrics, Federal University of Pampa (Unipampa), Brazil
| | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, Brazil
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39
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[Diet and asthma: Better eating for better breathing?]. Rev Mal Respir 2021; 38:278-288. [PMID: 33676796 DOI: 10.1016/j.rmr.2021.02.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
Inhaled therapies are the cornerstone of asthma treatment. However, according to national and international guidelines, non-pharmacological interventions should not be neglected in asthma. It has been demonstrated that a healthy diet is beneficial to general health. Recently, the effect of diet on asthma has been highlighted in many studies. Two diets have been particularly studied: the Mediterranean diet (high in fruits and vegetables and low in fat) and the Western diet (high in saturated fat and low in fruits and vegetables). A beneficial effect of the Mediterranean diet and deleterious effect of the Western diet on the development or control of asthma has been shown in some studies even after adjustment for overweight. Study findings have not been unanimous, probably related to the complexity of conducting studies on a diet that may change from day to day for any individual subject. In addition, the effect of physical exercise, which is known to be beneficial in asthma, is rarely taken into account in these studies. However, studies on diet are becoming more complex with the use of specific dietary indices, which should bring interesting data in the future.
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40
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Environnement microbiologique, confinement et risque allergique. REVUE FRANCAISE D ALLERGOLOGIE 2021. [DOI: 10.1016/j.reval.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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McLoughlin RF, Berthon BS, Wood LG. Weight loss in obese children with asthma - is it important? Paediatr Respir Rev 2021; 37:10-14. [PMID: 32303450 DOI: 10.1016/j.prrv.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/28/2020] [Indexed: 12/12/2022]
Abstract
Obesity is a significant public health problem worldwide, and it has been identified as an independent risk factor for asthma in both adults and children. Not only does obesity increase asthma risk, but it is also associated with decreased asthma-related quality of life, worsened symptoms and asthma control, increased frequency and severity of asthma exacerbations and reduced response to asthma medications. In this review we examine the epidemiology and implications of obesity in both children and adults with asthma, and how the obesogenic "western" diet contributes to asthma prevalence and progression. Finally, we summarise the current evidence on the impact of weight loss on asthma outcomes in both adults and children, highlighting the need for further research to be conducted in the paediatric population.
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Affiliation(s)
- Rebecca F McLoughlin
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, NSW, Australia.
| | - Bronwyn S Berthon
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, NSW, Australia.
| | - Lisa G Wood
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, NSW, Australia.
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Ribeiro WR, Queiroz AG, Mendes E, Casaro MB, Nascimento CM, Coelho LSSF, Martins FS, Leite-Silva VR, Ferreira CM. Preventive oral supplementation with Bifidobacterium longum 5 1A alleviates oxazolone-induced allergic contact dermatitis-like skin inflammation in mice. Benef Microbes 2021; 12:199-209. [PMID: 33573507 DOI: 10.3920/bm2020.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Allergic contact dermatitis (ACD) is a common allergic skin disease that affects individuals subjected to different antigen exposure conditions and significantly impacts the quality of life of those affected. Numerous studies have demonstrated that probiotics suppress inflammation through immunomodulatory effects. In this study, we aimed to evaluate the effect of the probiotic Bifidobacterium longum 51A as a preventive treatment for ACD using an oxazolone-induced murine model. We demonstrated that B. longum 51A exerted a prophylactic effect on oxazolone-induced ACD-like skin inflammation via reductions in ear and dermal thickness and leucocyte infiltration. The administration of inactivated B. longum 51A did not affect oxazolone-induced ACD-like skin inflammation, suggesting that the bacteria must be alive to be effective. Given that B. longum 51A is an acetate producer, we treated mice with acetate intraperitoneally, which also prevented ear and dermal thickening. Moreover, the tissue levels of the inflammatory cytokines and chemokines interleukin (IL)-10, IL-33, tumour necrosis factor-α, chemokine (C-C motif) ligand 2/monocyte chemoattractant protein-1 and chemokine (C-C motif) ligand 5/RANTES were significantly reduced after probiotic treatment, but only IL-33 and IL-10 were reduced when the mice were treated with acetate. These results show that B. longum 51A exerted a potential prophylactic effect on skin inflammation and that acetate represents one potential mechanism. However, other factors are likely involved since these two treatments do not yield the same results.
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Affiliation(s)
- W R Ribeiro
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemistry and Pharmaceutical Sciences, Federal University of São Paulo, R. São Nicolau, 210, Diadema, SP 09913-030, Brazil
| | - A G Queiroz
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemistry and Pharmaceutical Sciences, Federal University of São Paulo, R. São Nicolau, 210, Diadema, SP 09913-030, Brazil
| | - E Mendes
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemistry and Pharmaceutical Sciences, Federal University of São Paulo, R. São Nicolau, 210, Diadema, SP 09913-030, Brazil
| | - M B Casaro
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemistry and Pharmaceutical Sciences, Federal University of São Paulo, R. São Nicolau, 210, Diadema, SP 09913-030, Brazil
| | - C M Nascimento
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemistry and Pharmaceutical Sciences, Federal University of São Paulo, R. São Nicolau, 210, Diadema, SP 09913-030, Brazil
| | - L S S F Coelho
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemistry and Pharmaceutical Sciences, Federal University of São Paulo, R. São Nicolau, 210, Diadema, SP 09913-030, Brazil
| | - F S Martins
- Department of Microbiology, Institute of Biological Sciences, Federal University of Minas Gerais, Avenida Presidente Antônio Carlos 6627, Campus Pampulha UFMG Belo Horizonte, MG 31970201, Brazil
| | - V R Leite-Silva
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemistry and Pharmaceutical Sciences, Federal University of São Paulo, R. São Nicolau, 210, Diadema, SP 09913-030, Brazil.,Therapeutics Research Centre, Translational Research Institute, Diamantina Institute, University of Queensland, 37 Kent St, Woolloongabba, QLD 4102, Australia
| | - C M Ferreira
- Department of Pharmaceutical Sciences, Institute of Environmental, Chemistry and Pharmaceutical Sciences, Federal University of São Paulo, R. São Nicolau, 210, Diadema, SP 09913-030, Brazil
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Del-Río-Navarro BE, Berber A, Reyes-Noriega N, Navarrete-Rodríguez EM, García-Almaraz R, Ellwood P, Garcia-Marcos L, Saucedo-Ramírez OJ, Mérida-Palacio VJ, Ramos-García BDC, Escalante-Domínguez AJ, Linares-Zapién FJ, Moreno-Gardea HL, Ochoa-López G, Hernández-Mondragón LO, Lozano-Sáenz JS, Sacre-Hazouri JA, Juan-Pineda Á, Sánchez-Coronel MG, Rodríguez-Pérez N, Ambriz-Moreno MDJ. Global Asthma Network Phase I study in Mexico: prevalence of asthma symptoms, risk factors and altitude associations-a cross-sectional study. BMJ Open Respir Res 2020; 7:7/1/e000658. [PMID: 33268340 PMCID: PMC7713197 DOI: 10.1136/bmjresp-2020-000658] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/16/2022] Open
Abstract
Background Global Asthma Network (GAN) was established in 2012 as a development to the International Study of Asthma and Allergies in Childhood to improve asthma care globally. Objective To survey asthma, allergic rhinitis and atopic dermatitis in primary and secondary school children and to investigate and evaluate its prevalence, severity, management and risk factors in Mexico. Methods GAN Phase I is a cross-sectional, multicentre survey carried out in 15 centres corresponding to 14 Mexican cities throughout 2016–2019 using the validated Spanish language version of the GAN Phase I questionnaires. The questionnaires were completed by parents of 6–7-year-old primary school pupils (school children) and by 13–14-year-old adolescents. Results A total of 35 780 school children and 41 399 adolescents participated. Wheezing ever prevalence was 26.2% (95% CI 25.8% to 26.7%) in school children and 23.9% (95% CI 23.4% to 24.3%) in adolescents. The corresponding frequencies for current wheeze were 10.2% (95% CI 9.9% to 10.5%) and 11.6% (95% CI 11.2% to 11.9%). In school children, the risk factors for current wheeze were rhinitis (OR 4.484; 95% CI 3.915% to 5.134%) and rash symptoms (OR 1.735; 95% CI 1.461% to 2.059%). For adolescents, rhinitis symptoms (OR 3.492; 95% CI 3.188% to 3.825%) and allergic rhinitis diagnosis (OR 2.144; 95% CI 1.787% to 2.572%) were the most significant. For both groups, there was a negative relation with centres’ sea level altitude higher than 1500 m above mean sea level (p<0.005). Conclusions The most important risk factors for asthma symptoms in both age groups were the presence of rhinitis and rash symptoms or diagnosis. On the other hand, sea level altitude higher than 1500 metres was a protective factor.
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Affiliation(s)
| | - Arturo Berber
- Allergy and Immunology, Hospital Infantil de México Federico Gomez, Mexico City, Mexico
| | - Nayely Reyes-Noriega
- Allergy and Immunology, Hospital Infantil de México Federico Gomez, Mexico City, Mexico
| | | | | | - Philippa Ellwood
- Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Luis Garcia-Marcos
- Paediatric Allergy and Pulmonology Units 'Virgen de la Arrixaca' University Children's Hospital, University of Murcia, Universidad de Murcia, Murcia, Spain
| | | | | | | | | | - Francisco Javier Linares-Zapién
- Allergy and Immunology, Centro de Investigación, Diagnóstico y Tratamiento de Asma y Alergias, Toluca, Estado de México, Mexico
| | | | | | | | | | | | | | | | - Noel Rodríguez-Pérez
- Allergy and Immunology, Benemérita Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
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Energy-drink consumption is associated with asthma, allergic rhinitis, and atopic dermatitis in Korean adolescents. Eur J Clin Nutr 2020; 75:1077-1087. [PMID: 33257845 DOI: 10.1038/s41430-020-00812-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND/OBJECTIVES Few studies have evaluated the effects of energy drinks on allergic diseases. The purpose of this investigation was to evaluate the association between energy drinks and various allergic diseases, including asthma, allergic rhinitis, and atopic dermatitis, in a large representative Korean adolescent population. SUBJECTS/METHODS This cross-sectional study used data from the Korea Youth Risk Behavior Web-based Survey collected from 2015 to 2016. A total of 129,809 participants (n = 67,056 for males; n = 62,753 for females) aged 12-18 years were included and were asked about their frequency of consumption of energy drinks such as Hot6®, Redbull®, and Bacchus®. Their history of asthma, allergic rhinitis, and atopic dermatitis throughout life and in the last 12 months were obtained. The association between the frequency of energy-drink consumption and allergic diseases was analyzed using multiple logistic regression with adjustment for various covariates. RESULTS Age, sex, physical activity, obesity, region of residence, economic level, paternal and maternal educational level, smoking, and alcohol consumption differed significantly according to the frequency of energy-drink consumption (each P < 0.001). Frequent energy-drink consumption (≥7 times a week) was significantly associated with asthma throughout life (odds ratio [OR] = 1.30, 95% confidence interval (CI) = 1.03-1.64, P = 0.025), asthma within the last 12 months (OR = 1.65, 95% CI = 1.16-2.35, P = 0.006), allergic rhinitis within the last 12 months (OR = 1.21, 95% CI = 1.02-1.44, P = 0.030), and atopic dermatitis within the last 12 months (OR = 1.49, 95% CI = 1.17-1.90, P = 0.001) compared to no energy-drink consumption in the full-adjusted model. CONCLUSIONS Frequent energy-drink consumption is associated with allergic diseases, including asthma, allergic rhinitis, and atopic dermatitis, in Korean adolescents.
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Ng YT, Chew FT. A systematic review and meta-analysis of risk factors associated with atopic dermatitis in Asia. World Allergy Organ J 2020; 13:100477. [PMID: 33204388 PMCID: PMC7645284 DOI: 10.1016/j.waojou.2020.100477] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/01/2020] [Accepted: 10/01/2020] [Indexed: 12/18/2022] Open
Abstract
Background Atopic dermatitis (AD) is a chronic, inflammatory skin disorder characterised by intense itch and eczematous lesions. Rising prevalence of AD has been observed worldwide including in Asia. Understanding the risk factors associated with AD may explain its pathogenicity and identify new preventive strategies and treatments. However, AD-associated risk factors and comorbidities specific to Asia have not been systematically reviewed. Methods We performed a systematic review in accordance with the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines and summarised epidemiological studies investigating personal, family, and environmental factors and comorbidities associated with AD in Asia. Significant factors were assessed if they can be altered through lifestyle practices and further classified into non-modifiable and modifiable factors. Meta-analysis using the random-effect model was also conducted to provide an overall estimate for several significant factors. Results We identified a total of 162 epidemiological studies conducted in Asia. Among non-modifiable factors, a family history of atopic diseases was the most reported, suggesting the involvement of genetics in AD pathogenesis. Among modifiable factors, the results of meta-analyses revealed maternal smoking as the strongest risk factor with a pooled odds ratio (OR) of 2.95 (95% CI, 2.43-3.60), followed by active smoking (pooled OR, 1.91, 95% CI, 1.41-2.59). Conclusion While a family history may aid clinicians in identifying high-risk individuals, literature has long suggested the importance of gene-environment interaction. This review identified several modifiable factors including medical treatments, indoor and outdoor environmental exposure, and personal and family lifestyle specific to Asia. Based on the meta-analyses performed, prevention strategies against AD may start from changing personal and family lifestyle choices, especially smoking habits.
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Key Words
- AD, atopic dermatitis
- Asia
- Atopic dermatitis
- CI, Confidence interval
- Eczema
- FLG, Filaggrin
- HR, Hazard ratio
- I2, Inconsistency index
- ISAAC, International Study of Asthma and Allergies in Childhood
- NO2, nitrogen dioxide
- OR, Odds ratio
- PR, Prevalence ratio
- PRISMA, Preferred Reporting Item for Systematic Review and Meta-Analyses
- PUFAs, polyunsaturated fatty acids
- RR, Relative risk
- Risk factors
- TCM, traditional chinese medicine
- Th, T helper cell
- VOCs, Volatile organic compounds
- p, p-value
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Affiliation(s)
- Yu Ting Ng
- Department of Biological Sciences, National University of Singapore, Singapore
| | - Fook Tim Chew
- Department of Biological Sciences, National University of Singapore, Singapore
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Oh HY, Lee SY, Yoon J, Cho HJ, Kim YH, Suh DI, Yang SI, Kwon JW, Jang GC, Sun YH, Woo SI, Youn YS, Park KS, Cho HJ, Kook MH, Yi HR, Chung HL, Kim JH, Kim HY, Jung S, Jung JA, Woo HO, Koo KO, Kwon SO, Lee JK, Chang WS, Kim E, Lee J, Kim S, Hong SJ. Vegetable dietary pattern may protect mild and persistent allergic rhinitis phenotype depending on genetic risk in school children. Pediatr Allergy Immunol 2020; 31:920-929. [PMID: 32524629 DOI: 10.1111/pai.13308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/16/2020] [Accepted: 05/25/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The effect of diet on allergic rhinitis (AR), its severity in children, and whether it modifies AR depending on genetic susceptibility are unknown. We investigated the association between dietary patterns and AR in school children and the influence of diet on AR according to a genetic risk score (GRS). METHODS Totally, 435 7-year-old school children were recruited from the Panel Study on Korean Children. We used dietary patterns (vegetable, sugar, and meat) and dietary inflammatory index (DII) as dietary parameters. AR and its severity were defined by questionnaires about treatment in the previous 12 months and the Allergic Rhinitis and its Impact on Asthma (ARIA) guideline, respectively. A GRS was calculated using 6 single nucleotide polymorphisms for allergic diseases. RESULTS A vegetable diet containing a lot of anti-inflammatory nutrients and higher vitamin D level in blood were negatively correlated, while DII was positively correlated with triglyceride level and triglyceride/HDL cholesterol. Vegetable diet (aOR, 95% CI = 0.73, 0.58-0.94) and DII (1.13, 1.01-1.28) were associated with AR risk. In particular, a high-vegetable diet resulted in a lower risk of mild and persistent AR (aOR, 95% CI = 0.24, 0.10-0.56) while a high DII represented a higher risk (2.33, 1.06-5.10). The protective effect of vegetable diet on AR appeared only among children with a lower GRS (adjusted P = .018). CONCLUSIONS A vegetable dietary pattern characterized by high intake of anti-inflammatory nutrients and higher vitamin D level in blood might be associated with a lower risk of mild and persistent AR. This beneficial effect is modified by a genetic factor.
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Affiliation(s)
- Hea Young Oh
- Department of Medicine, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jisun Yoon
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun-Ju Cho
- Department of Pediatrics, International St. Mary's Hospital, Catholic Kwandong University, Incheon, Korea
| | - Young-Ho Kim
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Song-I Yang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Chuncheon-si, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang-si, Korea
| | - Yong Han Sun
- Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung-Il Woo
- Department of Pediatrics, Chungbuk National University Hospital and College of Medicine, Cheongju, Korea
| | - You-Sook Youn
- Department of Pediatrics, The Catholic University of Korea, Daejeon St. Mary's Hospital, Daejeon, Korea
| | - Kang Seo Park
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
| | - Hwa Jin Cho
- Department of Pediatrics, Chonnam National University Children's Hospital and Medical School, Gwangju, Korea
| | - Myung-Hee Kook
- Department of Pediatrics, Gwangju Veterans Hospital, Gwangju, Korea
| | - Hye Ryoung Yi
- Department of Pediatrics, Gwangju Veterans Hospital, Gwangju, Korea
| | - Hai Lee Chung
- Department of Pediatrics, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Ja Hyeong Kim
- Department of Pediatrics, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jin-A Jung
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea
| | - Hyang-Ok Woo
- Department of Pediatrics, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Kyeong Ok Koo
- Department of Food and Nutrition, Kyunghee University, Seoul, Korea
| | - Sung-Ok Kwon
- Biomedical Research Institute, Kangwon National University Hospital, Chuncheon, Korea
| | - Jeom-Kyu Lee
- Division of Allergy and Chronic Respiratory Diseases, Center for Biomedical Sciences Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Woo-Sung Chang
- Division of Allergy and Chronic Respiratory Diseases, Center for Biomedical Sciences Korea National Institute of Health, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Eunseol Kim
- Korea Institute of Child Care and Education, Seoul, Korea
| | - Jeongrim Lee
- Korea Institute of Child Care and Education, Seoul, Korea
| | - Sangrok Kim
- Department of Medical Science, Asan Medical Institute of Convergence Science and Technology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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The Role of Environmental Exposures in Atopic Dermatitis. Curr Allergy Asthma Rep 2020; 20:74. [PMID: 33047271 DOI: 10.1007/s11882-020-00971-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Although genetic factors clearly play a role in the development of atopic dermatitis (AD), the recent dramatic increase in the prevalence of AD in low- and middle-income countries is not consistent with only a role of genetic factors. These findings strongly suggest that environmental factors may play an important role in the pathogenesis of AD. RECENT FINDINGS We reviewed the role of gene-environment studies; in utero exposures including tobacco smoke, alcohol, maternal stress, various digestive supplements, and gestational diabetes; early-life exposures including diet, gut microbiota, antibiotics, and breastfeeding; climate including temperature, ultraviolet radiation exposure, and air pollution; and household products, indoor allergens, water hardness, pH, and skin microbiota and their effects on AD. Environmental factors definitely play a role in the pathogenesis of AD. However, identifying definitive factors continues to be difficult in the setting of conflicting evidence and the complex interactions between genotypes and the environment resulting in a multitude of AD phenotypes. All of the different environmental interactions discussed highlight the importance of intervening on multiple levels in a patient's environment to improve or even prevent AD symptoms. Further, the importance of modifying environmental factors early on in a person's life is demonstrated. When possible, all of these environmental factors should be considered in treating a patient with AD and the appropriate modifications should be made at population and individual levels.
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He Z, Wu H, Zhang S, Lin Y, Li R, Xie L, Li Z, Sun W, Huang X, Zhang CJP, Ming WK. The association between secondhand smoke and childhood asthma: A systematic review and meta-analysis. Pediatr Pulmonol 2020; 55:2518-2531. [PMID: 32667747 DOI: 10.1002/ppul.24961] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 07/10/2020] [Accepted: 07/12/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure can trigger asthma exacerbations in children. Different studies have linked increased asthma symptoms and even deaths in children with SHS, but the risk has not been quantified uniformly across studies. We aimed to investigate the role of SHS exposure as a risk factor of asthma among children. METHODS We performed a systematic review in PubMed, Scopus, and Google Scholar from June 1975 to 10 March 2020. We included cohort, case-control, and cross-sectional studies reporting odds ratio (OR) or relative risk estimates and confidence intervals of all types of SHS exposure and childhood asthma. RESULTS Of the 26 970 studies identified, we included 93 eligible studies (42 cross-sectional, 41 cohort, and 10 case-control) in the meta-analysis. There were significantly positive associations between SHS exposure and doctor-diagnosed asthma (OR = 1.24; 95% confidence interval (CI) = 1.20-1.28), wheezing (OR = 1.27; 95% CI = 1.23-1.32) and asthma-like syndrome (OR = 1.34; 95% CI = 1.34-1.64). The funnel plots of all three outcomes skewed to the right, indicating that the studies generally favor a positive association of the disease with tobacco exposure. Subgroup analysis demonstrated that younger children tended to suffer more from developing doctor-diagnosed asthma, but older children (adolescents) suffered more from wheezing. There was no evidence of significant publication or small study bias using Egger's and Begg's tests. CONCLUSION The results show a positive association between prenatal and postnatal secondhand smoking exposure and the occurrence of childhood asthma, asthma-like syndrome, and wheezing. These results lend support to continued efforts to reduce childhood exposure to secondhand smoke.
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Affiliation(s)
- Zonglin He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Huailiang Wu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Siyu Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Yuchen Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Rui Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Lijie Xie
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Zibo Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Weiwei Sun
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Xinyu Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China
| | - Casper J P Zhang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China.,Faculty of Medicine, International School, Jinan University, Guangzhou, Guangdong, China.,School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.,Harvard Medical School, Harvard University, Boston, Massachusetts
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49
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Dietary patterns and allergy in children aged 5-12 years in Australia: Findings from the Mothers and Their Children's Health study. Allergol Int 2020; 69:628-629. [PMID: 32457021 DOI: 10.1016/j.alit.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 11/20/2022] Open
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50
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Rutter CE, Silverwood RJ, Asher MI, Ellwood P, Pearce N, Garcia-Marcos L, Strachan DP. Comparison of individual-level and population-level risk factors for rhinoconjunctivitis, asthma, and eczema in the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. World Allergy Organ J 2020; 13:100123. [PMID: 32642022 PMCID: PMC7334817 DOI: 10.1016/j.waojou.2020.100123] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/08/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
Background Symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema in children cluster at both the individual and population levels. Objectives To assess individual-level and school-level risk factors for symptoms of rhinoconjunctivitis and compare them to corresponding associations with symptoms of asthma and eczema in Phase Three of the International Study of Asthma and Allergies in Childhood. Methods We studied 116,863 children aged 6–7 years from 2163 schools in 59 centres and 22 countries and 224,436 adolescents aged 13–14 years from 2037 schools in 97 centres in 41 countries. Multilevel logistic regression models were fitted with random intercepts for school, centre, and country, adjusting for sex and maternal education at the child level. Associations between symptoms and a range of lifestyle and environmental risk factors were assessed for both the child's exposure and mean exposure at the school. Models were fitted for rhinoconjunctivitis, asthma, and eczema singly (unimorbidity) and for combinations of these conditions (multimorbidity). Results Generally, associations between symptoms and exposures at the school level were similar in direction and magnitude to those at the child level. Associations with multimorbidity were stronger than for unimorbidity, particularly in individuals with symptoms of all three diseases, but risk factor associations found in conventional single disease analyses persisted among children with only one condition, after excluding multimorbid groups. Comparisons of individuals with only one disease showed that many risk factor associations were consistent across the three conditions. More strongly associated with asthma were low birthweight, cat exposure in infancy, and current maternal smoking. Current paracetamol use was more strongly associated with asthma and rhinoconjunctivitis than eczema. Breastfeeding was more strongly associated with eczema than asthma or rhinoconjunctivitis. The direction and magnitude of most risk factor associations were similar in affluent and non-affluent countries, although notable exceptions include farm animal contact in infancy and larger sibships, which were associated with increased risk of rhinoconjunctivitis in non-affluent countries but reduced risk in affluent countries. In both age groups, current paracetamol use increased risk of each disease to a greater extent in affluent countries than in non-affluent countries. Effects of paracetamol and antibiotics in infancy were more consistent between richer and poorer settings. Conclusions Most of the environmental and lifestyle correlates of rhinoconjunctivitis, asthma and eczema in childhood display similarity across the three conditions, even in less affluent settings where allergic sensitisation is less likely to explain the concordant epidemiological patterns. Trial registration Not applicable.
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Affiliation(s)
- Charlotte E Rutter
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Richard J Silverwood
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre for Longitudinal Studies, Department of Social Science, University College London, London, United Kingdom
| | - M Innes Asher
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Centre for Global NCDs, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Luis Garcia-Marcos
- Pediatric Allergy and Pulmonology Units, 'Virgen de La Arrixaca' University Children's Hospital, University of Murcia, ARADyAL Network and IMIB Bioresearch Institute, Murcia, Spain
| | - David P Strachan
- Population Health Research Institute, St George's University of London, London, United Kingdom
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