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Korpela K, Hurley S, Ford SA, Franklin R, Byrne S, Lunjani N, Forde B, Neogi U, Venter C, Walter J, Hourihane J, O'Mahony L. Association between gut microbiota development and allergy in infants born during pandemic-related social distancing restrictions. Allergy 2024. [PMID: 38419554 DOI: 10.1111/all.16069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/05/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Several hypotheses link reduced microbial exposure to increased prevalence of allergies. Here we capitalize on the opportunity to study a cohort of infants (CORAL), raised during COVID-19 associated social distancing measures, to identify the environmental exposures and dietary factors that contribute to early life microbiota development and to examine their associations with allergic outcomes. METHODS Fecal samples were sequenced from infants at 6 (n = 351) and repeated at 12 (n = 343) months, using 16S sequencing. Published 16S data from pre-pandemic cohorts were included for microbiota comparisons. Online questionnaires collected epidemiological information on home environment, healthcare utilization, infant health, allergic diseases, and diet. Skin prick testing (SPT) was performed at 12 (n = 343) and 24 (n = 320) months of age, accompanied by atopic dermatitis and food allergy assessments. RESULTS The relative abundance of bifidobacteria was higher, while environmentally transmitted bacteria such as Clostridia was lower in CORAL infants compared to previous cohorts. The abundance of multiple Clostridia taxa correlated with a microbial exposure index. Plant based foods during weaning positively impacted microbiota development. Bifidobacteria levels at 6 months of age, and relative abundance of butyrate producers at 12 months of age, were negatively associated with AD and SPT positivity. The prevalence of allergen sensitization, food allergy, and AD did not increase over pre-pandemic levels. CONCLUSIONS Environmental exposures and dietary components significantly impact microbiota community assembly. Our results also suggest that vertically transmitted bacteria and appropriate dietary supports may be more important than exposure to environmental microbes alone for protection against allergic diseases in infancy.
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Affiliation(s)
- Katri Korpela
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Sadhbh Hurley
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland
- Children's Health Ireland, Dublin, Ireland
| | | | - Ruth Franklin
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Susan Byrne
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland
- Children's Health Ireland, Dublin, Ireland
| | | | - Brian Forde
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
| | - Ujjwal Neogi
- The Systems Virology Lab, Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Carina Venter
- Section of Allergy & Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jens Walter
- APC Microbiome Ireland, University College Cork, Cork, Ireland
- School of Microbiology, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Jonathan Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland
- Children's Health Ireland, Dublin, 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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2
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Chen J, Liu X, Liu Z, Zhou Y, Xie L, Zhang J, Tan J, Yang Y, Tian M, Dong Y, Li J. Early exposure to infections increases the risk of allergic rhinitis-a systematic review and meta-analysis. BMC Pediatr 2023; 23:96. [PMID: 36859178 PMCID: PMC9976500 DOI: 10.1186/s12887-023-03870-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/30/2023] [Indexed: 03/03/2023] Open
Abstract
OBJECTIVE The purpose of this study was to provide evidence for early life care by meta-analyzing the relationship between infection during pregnancy and up to 2 years of age and the risk of subsequent allergic rhinitis (AR). METHODS Published studies up to April 2022 were systematically searched in PubMed, Embase, Web of Science, Cochrane Library, SinoMed, CNKI, Wanfang Database, and VIP. Literature screening, including quality assessment, was performed, and the effect values (OR, HR, RR) and 95% confidence intervals (95% CI) of infection during pregnancy and up to 2 years of age and allergic rhinitis were extracted from each qualified study. RESULTS In total, 5 studies with a sample size of 82,256 reported the relationship between infection during pregnancy and offspring AR. Meta-analysis showed that maternal infection during pregnancy was associated with an increased risk of childhood AR in offspring (OR = 1.34, 95% CI: 1.08-1.67). Altogether, 13 studies with a sample size of 78,426 reported evidence of an association between infection within 2 years of age and subsequent AR in children. A pooled meta-analysis of all studies showed that early infection within 2 years of age was closely associated with childhood AR (OR = 1.25, 95% CI: 1.12-1.40), especially upper respiratory tract infection (OR = 1.32, 95% CI: 1.06-1.65) and gastrointestinal infections (OR = 1.37, 95% CI: 1.01-1.86), but ear infection showed similar results in the cohort study (OR = 1.13, 95% CI: 1.04-1.22). CONCLUSION Current evidence suggests that infection during pregnancy, early upper respiratory infection, gastrointestinal infections and ear infection within 2 years of age would increase the risk of AR in children. Therefore, the prevention of infection during pregnancy and in infancy and young children needs to be emphasized.
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Affiliation(s)
- JunRong Chen
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Xiaohua Liu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China.,Changsha Woman and Children Health Care Hospital Affilated to Hunan Normal University, NO. 416 Chengnan East Road, Changsha, 410007, Hunan, China
| | - Zixin Liu
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China.,Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, China
| | - Yaqian Zhou
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China.,Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China
| | - Li Xie
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Jialin Zhang
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Jin Tan
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Yide Yang
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410081, China
| | - Mei Tian
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China
| | - Yunpeng Dong
- Department of Otolatyngoloty-Head and Neck Surgery, the First College of Clinical Medical Science, Yichang Central People's Hospital, Three Gorges University, Hubei, 443000, China.
| | - Jian Li
- Key Laboratory of Study and Discovery of Small Targeted Molecules of Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China. .,Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Hunan, 410013, China.
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3
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Liu X, Wu R, Fu Y, Chen W, Chen Y, Yan Y, Bi J, Liu J. Meta-analysis of early-life antibiotic use and allergic rhinitis. Open Med (Wars) 2022; 17:1760-1772. [PMID: 36407870 PMCID: PMC9635271 DOI: 10.1515/med-2022-0459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 07/26/2023] Open
Abstract
This meta-analysis aimed to investigate the correlation between early-life antibiotic use and allergic rhinitis. PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for available studies. Eighteen studies covering 1,768,874 children were included. Early-life antibiotics were associated with an increased incidence of allergic rhinitis (effect size (ES) = 5.00, 95% confidence interval [CI]: 4.88-5.13; I 2 = 95.7%, P heterogeneity <0.001). In Asia, Europe, and the USA, the incidence of allergic rhinitis in the antibiotic group was higher than that in the no medication group (Asia: ES = 3.68, 95% CI: 3.38-4.01; Europe: ES = 3.20, 95% CI: 3.00-3.42; USA: ES = 3.68, 95% CI: 2.74-4.95). Compared with the no medication group, children who received antibiotics in the first 1 week of life (ES = 5.75, 95% CI: 2.18-15.18), first 1 year of life (ES = 3.37, 95% CI: 3.20-3.55; I 2 = 64.2%, P heterogeneity = 0.001), or first 3 years of life (ES = 5.21, 95% CI: 2.42-11.19) had a higher incidence of allergic rhinitis. No individual study influenced the estimates of the meta-analysis. The funnel plot showed moderate symmetry and low publication bias. In conclusion, the use of antibiotics in early life was associated with allergic rhinitis. Still, most included studies analyzed antibiotic exposure as a dichotomous variable, without information on the type and dosage of antibiotics.
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Affiliation(s)
- Xiang Liu
- Department of ENT and Head & Neck Surgery, Hangzhou First Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, 310003, Zhejiang, China
| | - Rongrong Wu
- Department of ENT and Head & Neck Surgery, The Children’s Hospital Zhejiang University School of Medicine, 3333 Bingsheng Road, Hangzhou, 310051, Zhejiang, China
| | - Yong Fu
- Department of ENT and Head & Neck Surgery, The Children’s Hospital Zhejiang University School of Medicine, 3333 Bingsheng Road, Hangzhou, 310051, Zhejiang, China
| | - Wenxin Chen
- Department of ENT and Head & Neck Surgery, The Children’s Hospital Zhejiang University School of Medicine, 3333 Bingsheng Road, Hangzhou, 310051, Zhejiang, China
| | - Yang Chen
- Department of ENT and Head & Neck Surgery, The Children’s Hospital Zhejiang University School of Medicine, 3333 Bingsheng Road, Hangzhou, 310051, Zhejiang, China
| | - Yangyan Yan
- Department of ENT and Head & Neck Surgery, The Children’s Hospital Zhejiang University School of Medicine, 3333 Bingsheng Road, Hangzhou, 310051, Zhejiang, China
| | - Jing Bi
- Department of ENT and Head & Neck Surgery, The Children’s Hospital Zhejiang University School of Medicine, 3333 Bingsheng Road, Hangzhou, 310051, Zhejiang, China
| | - Jia Liu
- Department of ENT and Head & Neck Surgery, The Children’s Hospital Zhejiang University School of Medicine, 3333 Bingsheng Road, Hangzhou, 310051, Zhejiang, China
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4
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Hurley S, Franklin R, McCallion N, Byrne AM, Fitzsimons J, Byrne S, White M, O'Mahony L, Hourihane JO. Allergy-related outcomes at 12 months in the CORAL birth cohort of Irish children born during the first COVID 19 lockdown. Pediatr Allergy Immunol 2022; 33:e13766. [PMID: 35338733 PMCID: PMC9115474 DOI: 10.1111/pai.13766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/17/2022]
Affiliation(s)
- Sadhbh Hurley
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
| | - Ruth Franklin
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Naomi McCallion
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Rotunda Maternity Hospital, Dublin, Ireland
| | - Aideen M Byrne
- Children's Health Ireland, Dublin, Ireland.,Trinity College, Dublin, Ireland
| | | | - Susan Byrne
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
| | - Martin White
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Coombe Hospital, Dublin, Ireland
| | - Liam O'Mahony
- APC Microbiome Institute, University College Cork, Cork, Ireland
| | - Jonathan O'B Hourihane
- Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.,Children's Health Ireland, Dublin, Ireland
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5
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Duong QA, Pittet LF, Curtis N, Zimmermann P. Antibiotic exposure and adverse long-term health outcomes in children: a systematic review and meta-analysis. J Infect 2022; 85:213-300. [PMID: 35021114 DOI: 10.1016/j.jinf.2022.01.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antibiotics are among the most commonly used drugs in children. In addition to inducing antibiotic resistance, antibiotic exposure has been associated with long-term adverse health outcomes. METHODS A systematic search using PRISMA Guidelines to identify original studies reporting associations between antibiotic exposure and long-term adverse health outcomes in children. Overall pooled estimates of the odds ratios (ORs) were obtained using fixed or random-effects models. RESULTS We identified 160 observational studies investigating 21 outcomes in 22,103,129 children. Antibiotic exposure was associated with an increased risk of atopic dermatitis (OR 1.40, 95% confidence interval (CI) 1.30-1.52, p<0.01), allergic symptoms (OR 1.93, 95%CI 1.66-2.26, p<0.01), food allergies (OR 1.35, 95%CI 1.20-1.52, p<0.01), allergic rhinoconjunctivitis (OR 1.66, 95%CI 1.51-1.83, p<0.01), wheezing (OR 1.81, 95%CI 1.65-1.97, p<0.01), asthma (OR 1.96, 95%CI 1.76-2.17, p<0.01), increased weight gain or overweight (OR 1.18, 95%CI 1.11-1.26, p<0.01), obesity (OR 1.21, 95%CI 1.05-1.40, p<0.01), juvenile idiopathic arthritis (OR 1.74, 95%CI 1.21-2.52, p<0.01), psoriasis (OR 1.75, 95%CI 1.44-2.11, p<0.01), autism spectrum disorders (OR 1.19, 95%CI 1.04-1.36, p=0.01) and neurodevelopment disorders (OR 1.29, 95%CI 1.09-1.53, p<0.01). Dose-response effects and stronger effects with broad-spectrum antibiotic were often reported. Antibiotic exposure was not associated with an altered risk of allergic sensitisation, infantile colic, abdominal pain, inflammatory bowel disease, celiac disease, type 1 diabetes, fluorosis, and attention deficit hyperactivity disorder. CONCLUSION Although a causal association cannot be determined from these studies, the results support the meticulous application of sound antibiotic stewardship to avoid potential adverse long-term health outcomes.
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Affiliation(s)
- Quynh Anh Duong
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Laure F Pittet
- Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Unit of Pediatric Infectious Diseases, Department of Pediatrics, Gynecology & Obstetrics, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland
| | - Nigel Curtis
- Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland; Infectious Diseases Research Group, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland.
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6
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Effect of probiotic supplementation in pregnant women: a meta-analysis of randomised controlled trials. Br J Nutr 2019; 123:870-880. [PMID: 31856928 DOI: 10.1017/s0007114519003374] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Probiotics are being used increasingly in pregnant women, whereas the efficiency on pregnancy outcomes is yet lacking. PubMed, Embase and the Cochrane Library were searched. Relative risks (RR) or weighted mean differences (WMD) with 95 % CI were employed to calculate the summary outcomes. A total of eighteen randomised controlled trials (RCT) including 4356 pregnant women were eligible. The summary RR indicated that probiotic supplementation was associated with a significant decrease in the risk of atopic eczema (RR 0·68; 95 % CI 0·58, 0·81; P < 0·001) and eczema (RR 0·79; 95 % CI 0·68, 0·91; P = 0·002) without significant heterogeneity. Probiotic supplementation was associated with a prolonged gestational age (WMD 0·09; 95 % CI 0·04, 0·15; P = 0·001) with insignificant heterogeneity, whereas no significant effect was exerted on birth weight (P = 0·851). The risks of death (RR 0·34; 95 % CI 0·13, 0·91; P = 0·031) and necrotising enterocolitis (NEC) (RR 0·38; 95 % CI 0·18, 0·81; P = 0·012) were significantly reduced in pregnant women receiving probiotics without evidence of heterogeneity. These findings suggested that probiotics in pregnant women were beneficial for atopic eczema, eczema, gestational age, death and NEC.
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7
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Ahmadizar F, Vijverberg SJH, Arets HGM, de Boer A, Lang JE, Garssen J, Kraneveld A, Maitland-van der Zee AH. Early-life antibiotic exposure increases the risk of developing allergic symptoms later in life: A meta-analysis. Allergy 2018; 73:971-986. [PMID: 29105784 DOI: 10.1111/all.13332] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 01/01/2023]
Abstract
This study systematically reviewed and quantified the relationship between exposure to antibiotics during the first 2 years of life and the risk of allergies/atopies including hay fever, eczema, food allergy, positive skin prick testing (SPT), or elevated allergen-specific serum/plasma immunoglobulin (Ig) E levels later in life. PubMed and Web of Science databases were searched for observational studies published from January 1966 through November 11, 2015. Overall pooled estimates of the odds ratios (ORs) were obtained using fixed or random-effects models. Early-life exposure to antibiotics appears to be related to an increased risk of allergic symptoms of hay fever, eczema, and food allergy later in life. The summary OR for the risk of hay fever (22 studies) was 1.23, 95% confidence interval (CI):1.13-1.34; I2 : 77.0%. The summary OR for the risk of eczema (22 studies) was 1.26, 95% CI: 1.15-1.37; I2 : 74.2%, and the summary OR for food allergy (3 studies) was 1.42, 95% CI: 1.08-1.87; I2 : 80.8%. However, no association was found for antibiotics exposure early in life and objective atopy measurements including positive SPT or elevated allergen-specific serum/plasma IgE levels.
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Affiliation(s)
- F. Ahmadizar
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
| | - S. J. H. Vijverberg
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
- Department of Respiratory Medicine; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
| | - H. G. M. Arets
- Department of Pediatric Pulmonology and Allergology; Department of Pediatrics; University Medical Centre Utrecht; Utrecht The Netherlands
| | - A. de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
| | - J. E. Lang
- Division of Pulmonary and Sleep Medicine; Nemours Children's Hospital; Orlando FL USA
| | - J. Garssen
- Division of Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
- Nutricia Research; Utrecht The Netherlands
| | - A. Kraneveld
- Division of Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
| | - A. H. Maitland-van der Zee
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht Institute for Pharmaceutical Sciences (UIPS); Utrecht University; Utrecht The Netherlands
- Department of Respiratory Medicine; Academic Medical Centre; University of Amsterdam; Amsterdam The Netherlands
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8
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Kikkawa T, Yorifuji T, Fujii Y, Yashiro M, Okada A, Ikeda M, Doi H, Tsukahara H. Birth order and paediatric allergic disease: A nationwide longitudinal survey. Clin Exp Allergy 2018; 48:577-585. [PMID: 29368358 DOI: 10.1111/cea.13100] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 11/24/2017] [Accepted: 12/21/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND Environmental factors seem to be related to the incidence of allergic disease. Children with a later birth order are often exposed to environments, where pathogens and endotoxins can be found, and thus have a higher risk of developing infectious diseases. Therefore, birth order is regarded as an indicator that reflects post-natal environment. However, longitudinal studies are limited on this subject. This study sought to elucidate the relationships between birth order and allergic disease. METHODS From a nationwide longitudinal study that followed children born in 2001 (n = 47 015), we selected doctors' visits for 3 types of allergic disease-bronchial asthma, food allergy and atopic dermatitis-from infancy to 12 years of age and conducted binomial log-linear regression analysis to evaluate the associations between birth order and these diseases. We adjusted for the child and parental factors and estimated risk ratio (RR) and 95% confidence interval (CI) for each outcome. RESULTS The associations between birth order and bronchial asthma were diverse; later birth order increased the risk in early childhood, but decreased the risks during school age. For example, the adjusted RR comparing third-born or higher and first-born children was 1.19 (95% CI, 1.05-1.35) between 30 and 42 months of age, but was 0.76 (95% CI, 0.65-0.89) between 10 and 11 years. Later birth order was generally protective for food allergy but increased the risk of atopic dermatitis. CONCLUSION The influence of birth order depended on the type of allergic disease and the childhood period. Childhood is unique in terms of physical and immunological development, and the immune response to the post-natal environment in childhood appears to be heterogeneous.
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Affiliation(s)
- T Kikkawa
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan.,Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - T Yorifuji
- Department of Human Ecology, Okayama University Graduate School of Environmental and Life Science, Okayama, Japan
| | - Y Fujii
- Department of Pediatric Acute Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - M Yashiro
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan
| | - A Okada
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - M Ikeda
- Department of Pediatric Acute Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - H Doi
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - H Tsukahara
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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9
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Francino MP. Antibiotics and the Human Gut Microbiome: Dysbioses and Accumulation of Resistances. Front Microbiol 2016; 6:1543. [PMID: 26793178 PMCID: PMC4709861 DOI: 10.3389/fmicb.2015.01543] [Citation(s) in RCA: 447] [Impact Index Per Article: 55.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/21/2015] [Indexed: 12/12/2022] Open
Abstract
The human microbiome is overly exposed to antibiotics, due, not only to their medical use, but also to their utilization in farm animals and crops. Microbiome composition can be rapidly altered by exposure to antibiotics, with potential immediate effects on health, for instance through the selection of resistant opportunistic pathogens that can cause acute disease. Microbiome alterations induced by antibiotics can also indirectly affect health in the long-term. The mutualistic microbes in the human body interact with many physiological processes, and participate in the regulation of immune and metabolic homeostasis. Therefore, antibiotic exposure can alter many basic physiological equilibria, promoting long-term disease. In addition, excessive antibiotic use fosters bacterial resistance, and the overly exposed human microbiome has become a significant reservoir of resistance genes, contributing to the increasing difficulty in controlling bacterial infections. Here, the complex relationships between antibiotics and the human microbiome are reviewed, with focus on the intestinal microbiota, addressing (1) the effects of antibiotic use on the composition and function of the gut microbiota, (2) the impact of antibiotic-induced microbiota alterations on immunity, metabolism, and health, and (3) the role of the gut microbiota as a reservoir of antibiotic resistances.
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Affiliation(s)
- M P Francino
- Unitat Mixta d'Investigació en Genòmica i Salut, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)-Salud Pública/Institut Cavanilles de Biodiversitat i Biologia Evolutiva, Universitat de ValènciaValència, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud PúblicaMadrid, Spain
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10
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Prince BT, Mandel MJ, Nadeau K, Singh AM. Gut Microbiome and the Development of Food Allergy and Allergic Disease. Pediatr Clin North Am 2015; 62:1479-92. [PMID: 26456445 PMCID: PMC4721650 DOI: 10.1016/j.pcl.2015.07.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The impact of gut microbiome on human development, nutritional needs, and disease has become evident with advances in the ability to study these complex communities of microorganisms, and there is growing appreciation for the role of the microbiome in immune regulation. Several studies have examined associations between changes in the commensal microbiota and the development of asthma, allergic rhinitis, and asthma, but far less have evaluated the impact of the microbiome on the development of food allergy. This article reviews the human gastrointestinal microbiome, focusing on the theory and evidence for its role in the development of IgE-mediated food allergy and other allergic diseases.
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Affiliation(s)
- Benjamin T. Prince
- Department of Pediatrics, Division of Allergy and Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, Illinois,Department of Medicine, Division of Allergy and Immunology, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Mark J. Mandel
- Department of Microbiology-Immunology, Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kari Nadeau
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine, Stanford, California
| | - Anne Marie Singh
- Division of Allergy and Immunology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, 225 East Chicago Avenue, #60, Chicago, IL 60611, USA; Division of Allergy and Immunology, Department of Medicine, Northwestern Feinberg School of Medicine, Northwestern University, 225 East Chicago Avenue, #60, Chicago, IL 60611, USA.
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11
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Pitter G, Ludvigsson JF, Romor P, Zanier L, Zanotti R, Simonato L, Canova C. Antibiotic exposure in the first year of life and later treated asthma, a population based birth cohort study of 143,000 children. Eur J Epidemiol 2015; 31:85-94. [PMID: 25957084 DOI: 10.1007/s10654-015-0038-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/25/2015] [Indexed: 12/16/2022]
Abstract
Several epidemiological studies reported an association between antibiotic consumption in the first year of life and later asthma, but results are conflicting and affected by potential biases. We examined this controversial issue in a population-based birth cohort. Using administrative data, we identified 143,163 children born in 1995-2011 in Friuli-Venezia Giulia (Italy) (median follow-up 5.25 years, 927,350 person-years). Antibiotic prescriptions in the first year of life and subsequent treated asthma (defined as ≥2 anti-asthmatic drug prescriptions within a 12-month period) were retrieved from drug prescription records. We estimated incidence rate ratios (IRR) using Poisson regression models, adjusted for perinatal variables and for hospitalizations for infections in the first year of life. We identified 34,957 new-onset asthma cases. Antibiotic consumption in the first year of life increased the risk of new-onset asthma [IRR 1.51, 95% confidence interval (CI) 1.48-1.54] with a dose-response relationship (p-trend <0.001). The risk was highest for asthma identified at 13-35 months of life (IRR 2.07, 95% CI 2.00-2.14), but remained statistically significant for asthma identified at 36-71 months (IRR 1.17, 95% CI 1.14-1.21) and at ≥72 months (IRR 1.15, 95% CI 1.08-1.22). Antibiotics increased the risk of current asthma at ≥6 years (IRR 1.35, 95% CI 1.30-1.41) and at ≥13 years of age (IRR 1.19, 95% CI 1.08-1.33). Antibiotic exposure in infancy is associated with an increased risk of asthma up to adolescence. The association detected at older ages is not explained by reverse causation; however, confounding by respiratory infections not leading to hospital admission cannot be excluded.
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Affiliation(s)
- Gisella Pitter
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Via Loredan, 18, 35131, Padua, Italy
| | - Jonas Filip Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 17177, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, 70185, Örebro, Örebro, Sweden
| | - Pierantonio Romor
- Friuli-Venezia Giulia Regional Health Information System, Informatica per il Sistema degli Enti Locali (INSIEL) S.p.A., Udine, Italy
| | - Loris Zanier
- Epidemiological Service, Health Directorate, Friuli Venezia-Giulia Region, Udine, Italy
| | - Renzo Zanotti
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Via Loredan, 18, 35131, Padua, Italy
| | - Lorenzo Simonato
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Via Loredan, 18, 35131, Padua, Italy
| | - Cristina Canova
- Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padua, Via Loredan, 18, 35131, Padua, Italy.
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12
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Francino MP. Early development of the gut microbiota and immune health. Pathogens 2014; 3:769-90. [PMID: 25438024 PMCID: PMC4243441 DOI: 10.3390/pathogens3030769] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 08/29/2014] [Accepted: 09/19/2014] [Indexed: 12/13/2022] Open
Abstract
In recent years, the increase in human microbiome research brought about by the rapidly evolving “omic” technologies has established that the balance among the microbial groups present in the human gut, and their multipronged interactions with the host, are crucial for health. On the other hand, epidemiological and experimental support has also grown for the ‘early programming hypothesis’, according to which factors that act in utero and early in life program the risks for adverse health outcomes later on. The microbiota of the gut develops during infancy, in close interaction with immune development, and with extensive variability across individuals. It follows that the specific process of gut colonization and the microbe-host interactions established in an individual during this period have the potential to represent main determinants of life-long propensity to immune disease. Although much remains to be learnt on the progression of events by which the gut microbiota becomes established and initiates its intimate relationships with the host, and on the long-term repercussions of this process, recent works have advanced significatively in this direction.
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Affiliation(s)
- M Pilar Francino
- Unitat Mixta d'Investigació en Genòmica i Salut, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)-Salud Pública/Institut Cavanilles de Biodiversitat i Biologia Evolutiva (Universitat de València), València 46020, Spain.
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13
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Chu LM, Rennie DC, Cockcroft DW, Pahwa P, Dosman J, Hagel L, Karunanayake C, Pickett W, Lawson JA. Prevalence and determinants of atopy and allergic diseases among school-age children in rural Saskatchewan, Canada. Ann Allergy Asthma Immunol 2014; 113:430-9. [PMID: 25129487 DOI: 10.1016/j.anai.2014.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/27/2014] [Accepted: 07/07/2014] [Indexed: 12/27/2022]
Abstract
BACKGROUND There have been few investigations of farming-related activities or specific characteristics resulting in the associations between those exposures and atopic disease. OBJECTIVE To study the associations between farm-associated exposures and atopic diseases. METHODS As part of a longitudinal study of lung health in rural residents, a cross-sectional baseline study was conducted in rural Saskatchewan, Canada. This included an initial survey phase followed by a clinical testing phase. A subsample of 584 children (grades 1-8) completed skin prick testing to assess atopic status. Atopy was defined as a positive reaction to any of 6 allergens (local grasses, wheat dust, cat dander, house dust mite, Alternaria species, or Cladosporium species) of at least 3 mm compared with the negative control. RESULTS Of those who completed clinical testing, the prevalence of atopy was 19.4%, that of hay fever was 8.8%, and that of eczema was 27.4%. Based on skin prick testing, sensitization was highest for cat dander (8.6%) followed by local grasses (8.2%) and house dust mite (5.1%). After adjustment for potential confounders, home location (farm vs non-farm) was not associated with atopic status. However, livestock farming was protective against atopy (adjusted odds ratio 0.38, 95% confidence interval 0.17-0.88). In contrast, current residence on a farm was associated with an increase in the likelihood of hay fever in these children (adjusted odds ratio 3.68, 95% confidence interval 1.29-10.45). Also, regular farming activities in the past year were associated with an increased risk of hay fever. CONCLUSION In children, livestock exposure has a protective effect on skin prick test positivity, whereas farm living and activities increase the risk of hay fever.
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Affiliation(s)
- Luan M Chu
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Donna C Rennie
- Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Donald W Cockcroft
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - P Pahwa
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - J Dosman
- Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - L Hagel
- Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - C Karunanayake
- Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - William Pickett
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Joshua A Lawson
- Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Yildirim P, Majnarić L, Ekmekci OI, Holzinger A. Knowledge discovery of drug data on the example of adverse reaction prediction. BMC Bioinformatics 2014; 15 Suppl 6:S7. [PMID: 25079450 PMCID: PMC4158658 DOI: 10.1186/1471-2105-15-s6-s7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Antibiotics are the widely prescribed drugs for children and most likely to be related with adverse reactions. Record on adverse reactions and allergies from antibiotics considerably affect the prescription choices. We consider this a biomedical decision-making problem and explore hidden knowledge in survey results on data extracted from a big data pool of health records of children, from the Health Center of Osijek, Eastern Croatia. RESULTS We applied and evaluated a k-means algorithm to the dataset to generate some clusters which have similar features. Our results highlight that some type of antibiotics form different clusters, which insight is most helpful for the clinician to support better decision-making. CONCLUSIONS Medical professionals can investigate the clusters which our study revealed, thus gaining useful knowledge and insight into this data for their clinical studies.
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Affiliation(s)
- Pinar Yildirim
- Department of Computer Engineering, Faculty of Engineering & Architecture,
Okan University, Istanbul, Turkey
| | | | - Ozgur Ilyas Ekmekci
- Department of Computer Engineering, Faculty of Engineering & Architecture,
Okan University, Istanbul, Turkey
| | - Andreas Holzinger
- Institute for Medical Informatics, Statistics & Documentation, Medical
University of Graz, Graz, Austria
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15
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Hoskin-Parr L, Teyhan A, Blocker A, Henderson AJW. Antibiotic exposure in the first two years of life and development of asthma and other allergic diseases by 7.5 yr: a dose-dependent relationship. Pediatr Allergy Immunol 2013; 24:762-71. [PMID: 24299467 PMCID: PMC3995010 DOI: 10.1111/pai.12153] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 01/16/2023]
Abstract
BACKGROUND Antibiotic use in infancy disrupts gut microflora during a critical period for immune system development. It is hypothesized that this could predispose to the development of allergic diseases. We investigated the associations of antibiotic use in the first 2 yr of life with the development of asthma, eczema or hay fever by age 7.5 yr in a longitudinal birth cohort. METHODS Subjects were 4952 children from the Avon Longitudinal Study of Parents and Children (ALSPAC). Child antibiotic use and asthma, eczema and hay fever symptoms were maternally reported. Atopy was assessed by skin prick tests at age 7.5 yr. The total number of antibiotic courses was considered as the main exposure. Data were analysed using multivariate logistic regression. RESULTS Children reported to have taken antibiotics during infancy (0-2 yr) were more likely to have asthma at 7.5 yr (OR 1.75, 95% CI 1.40-2.17), and the odds (OR, [95% CI]) increased with greater numbers of courses: once 1.11 [0.84-1.48]; twice 1.50 [1.14-1.98]; three times 1.79 [1.34-2.40]; four times or more 2.82 [2.19-3.63]. Increased antibiotic use was also associated with higher odds of eczema and hay fever but not atopy. The effect appeared to be associated with cumulative rather than a critical period of exposure during the first 2 yr. CONCLUSIONS A robust and dose-dependent association was found between antibiotic use in the first 2 yr of life and asthma at age 7.5 yr but did not appear to be mediated through an association with atopy.
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Affiliation(s)
- Lauren Hoskin-Parr
- School of Cellular and Molecular Medicine, University of BristolBristol, UK
| | - Alison Teyhan
- School of Social and Community Medicine, University of BristolBristol, UK
| | - Ariel Blocker
- School of Cellular and Molecular Medicine, University of BristolBristol, UK
| | - A J W Henderson
- School of Social and Community Medicine, University of BristolBristol, UK
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16
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Heintze K, Petersen KU. The case of drug causation of childhood asthma: antibiotics and paracetamol. Eur J Clin Pharmacol 2013; 69:1197-209. [PMID: 23292157 PMCID: PMC3651816 DOI: 10.1007/s00228-012-1463-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 11/27/2012] [Indexed: 12/15/2022]
Abstract
AIM The rising prevalence of bronchial asthma has led to world-wide efforts to understand and stem this development. Cross-sectional studies appear to show that early childhood use of antibiotics may be an important contributory factor, with paracetamol as an additional suspected cause. However, mounting evidence, which is reviewed here, points to various confounding factors as the major reasons for these reported associations. METHODS PubMed and EMBASE were systematically searched for studies on associations between antibiotics and/or paracetamol with asthma and/or wheezing, published up to November 2012. A total of 64 pertinent studies were identified, 35 focusing on antibiotics, 19 on paracetamol, and ten addressing both antibiotics and paracetamol, bringing the number of relevant datasets to 74. RESULTS Numerous studies were cross-sectional and made no adjustment for the indication of antibiotics or paracetamol; consequently, they were unable to dismiss possible confounding by indication. Where such adjustments could be performed (mostly in longitudinal studies), they substantially weakened or entirely eliminated the association with asthma or asthma surrogates present in the unadjusted data. CONCLUSION The weight of evidence of the collected studies in our review strongly suggests that the association of antibiotics with childhood asthma reflects various forms of bias, the most prominent of which is confounding by indication. Recent studies and meta-analyses support the same conclusion for paracetamol. Truly indicated antibiotics should not be withheld from infants or young children for fears they might develop asthma. Likewise, there is no sound reason to replace paracetamol as the preferred pain relief and fever medication in this age group.
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Affiliation(s)
| | - Karl-Uwe Petersen
- Institute of Pharmacology and Toxicology, RWTH Aachen University, 52072 Aachen, Germany
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17
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Ou CY, Kuo HC, Wang L, Hsu TY, Chuang H, Liu CA, Chang JC, Yu HR, Yang KD. Prenatal and postnatal probiotics reduces maternal but not childhood allergic diseases: a randomized, double-blind, placebo-controlled trial. Clin Exp Allergy 2013; 42:1386-96. [PMID: 22925325 DOI: 10.1111/j.1365-2222.2012.04037.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The prevalence of atopic diseases has increased rapidly in recent decades globally. The administration of probiotics to reduce gastrointestinal inflammation has been popular, but its role in the prevention or treatment of allergic disease remains controversial. This study evaluated the effectiveness of prenatal and postnatal probiotics in the prevention of early childhood and maternal allergic diseases. METHODS In a prospective, double-blind, placebo-controlled clinical trial, pregnant women with atopic diseases determined by history, total immunoglobulin (Ig)E > 100 kU/L, and/or positive specific IgE were assigned to receive either probiotics (Lactobacillus GG; ATCC 53103; 1 × 10(10) colony-forming units daily) or placebo from the second trimester of pregnancy. Both of clinical evaluation performed by questionnaires concerning any allergic symptoms and plasma total IgE, and allergen-specific IgE were obtained in high-risk parents and children at 0, 6, 18, and 36 months of age. The primary and secondary outcomes were the point and cumulative prevalence of sensitization and developing of allergic diseases, and improvement of maternal allergic symptom score and plasma immune parameters before and after intervention, respectively. RESULTS In total, 191 pregnant women (LGG group, n = 95; control group, n = 96) were enrolled. No significant effects of prenatal and postnatal probiotics supplementation on sensitization, development of allergic diseases, and maternal IgE levels between placebo and LGG groups. Symptoms of maternal allergic scores improved significantly in the LGG group (P = 0.002). Maternal allergic diseases improvement was more prominent in pregnant women with IgE > 100 kU/L (P = 0.01) and significantly associated with higher interleukin-12p70 levels (P = 0.013). CONCLUSIONS LGG administration beginning at the second trimester of pregnancy reduced the severity of maternal allergic disease through increment of Th1 response, but not the incidence of childhood allergic sensitization or allergic diseases (ClinicalTrials.govnumber, IDNCT00325273).
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Affiliation(s)
- C-Y Ou
- Department of Obstetrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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18
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Epidemiological measures of childhood asthma: cross-sectional and longitudinal consistency. Respir Med 2012; 106:1226-35. [PMID: 22705292 DOI: 10.1016/j.rmed.2012.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 02/18/2012] [Accepted: 05/23/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Defining childhood asthma varies considerably, and the extent of agreement between various measures is not clearly understood in the absence of a recognized 'gold standard'. We compared different definitions of childhood asthma, identified characteristics that might have influenced their accuracy and an acquisition of an 'asthma' label in wheezy and treated children. METHODS Using a prospective, population-based birth cohort of 623 children followed up to the age of 14 years the concordance between parental opinion, doctor's diagnosis reported by the parent and asthma's diagnosis in general practice (GP) was analysed using latent class analysis (LCA). RESULTS At the age of eight, 'ever asthma' prevalences ranged from 15.5% (parental opinion) to 21.5% (GP record). 35% of children by the age of eight years had at least one reported label of asthma, reflecting both cross sectional and longitudinal inconsistencies. By the age of 14 years, 16% of children were inconsistently defined as 'ever asthmatic' by their parents. The prevalence of 'ever asthma' estimated by LCA was 19.3%, indicating a parental report of a doctor's diagnosis to be the most sensitive and specific definition. The likelihood of being labelled with asthma was higher in those with a parental or sibling history of asthma, but not determined by socio-demographic characteristics. CONCLUSIONS Although the estimates of prevalence were similar for parental reports and GP records, agreement between the three sources was less than expected. Parental report of a doctor's diagnosis of asthma is sensitive, specific, longitudinally consistent and not subject to large socio-economic bias.
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Ly NP, Litonjua A, Gold DR, Celedón JC. Gut microbiota, probiotics, and vitamin D: interrelated exposures influencing allergy, asthma, and obesity? J Allergy Clin Immunol 2011; 127:1087-94; quiz 1095-6. [PMID: 21419479 DOI: 10.1016/j.jaci.2011.02.015] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/03/2011] [Accepted: 02/03/2011] [Indexed: 02/06/2023]
Abstract
Current evidence supports a role for gut colonization in promoting and maintaining a balanced immune response in early life. An altered or less diverse gut microbiota composition has been associated with atopic diseases, obesity, or both. Moreover, certain gut microbial strains have been shown to inhibit or attenuate immune responses associated with chronic inflammation in experimental models. However, there has been no fully adequate longitudinal study of the relation between the neonatal gut microbiota and the development of allergic diseases (eg, atopic asthma) and obesity. The emergence of promising experimental studies has led to several clinical trials of probiotics (live bacteria given orally that allow for intestinal colonization) in human subjects. Probiotic trials thus far have failed to show a consistent preventive or therapeutic effect on asthma or obesity. Previous trials of probiotics have been limited by small sample size, short duration of follow-up, or lack of state-of-the art analyses of the gut microbiota. Finally, there is emerging evidence that the vitamin D pathway might be important in gut homeostasis and in signaling between the microbiota and the host. Given the complexity of the gut micriobiota, additional research is needed before we can confidently establish whether its manipulation in early life can prevent or treat asthma, obesity, or both.
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Affiliation(s)
- Ngoc P Ly
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
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20
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Abstract
BACKGROUND Many studies have reported an inverse association between birth order and the risk of respiratory allergic disease. In recent decades, the prevalence of atopy has increased alongside reductions in fertility rates. AIMS OF THE STUDY To quantitate how much of the increased prevalence of atopy, measured by skin prick test or specific IgE, can be attributed to temporal changes in family size in the United Kingdom. METHODS Through a systematic literature review (MEDLINE, 1965-2009), five studies of UK populations were identified and their data were included in the calculation of a summary odds ratio for the risk of atopy for each birth order. Information on changes in UK family sizes between 1960 and 2001 was obtained from Eurostat. On this basis, expected increases in the prevalence of atopy were calculated by weighting the proportion in each birth order category for 1960 and 2001 by the summary odds ratio for that category and then calculating the relative risk of atopy in 2001 compared with 1960. RESULTS The pooled summary odds ratios for atopy were 0.90, 0.69 and 0.69 for those born second, third and fourth (or higher), respectively. The expected relative increase in the prevalence of atopy resulting from a change in family size between 1960 and 2001 was 3%. CONCLUSIONS Despite the strong associations between birth order and atopy, reductions in family size in the last 40 years account for little of the increase in atopy.
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Affiliation(s)
- S Upchurch
- Occupational & Environmental Medicine, Imperial College School of Medicine (NHLI), London, UK.
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21
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Current world literature. Curr Opin Allergy Clin Immunol 2009; 9:79-85. [PMID: 19106700 DOI: 10.1097/aci.0b013e328323adb4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW To describe what is currently known about the role of virus vaccines in the pathogenesis of asthma and atopy and summarize their role in the prevention of morbidity due to childhood asthma. RECENT FINDINGS The development of virus vaccines and their incorporation into infant and childhood immunization programmes over the last few decades of the twentieth century have been accompanied by a striking concomitant rise in the incidence of asthma and atopy. However, a causal relationship is not supported by the majority of observational studies. The role of childhood immunization against respiratory viruses in the reduction of morbidity from asthma is another important public health issue. Recent findings suggest that influenza is not strongly associated with exacerbations of asthma in children, despite recommendations that this group should be immunized against it. SUMMARY Current evidence suggests that virus vaccination is well tolerated and does not lead to an increased incidence of asthma or atopy in children receiving vaccines. Debate continues regarding the place of respiratory virus vaccination in the therapeutic armamentarium for children with asthma. In the case of influenza, there appears to be an absence of harm, but benefit seems to be limited to younger children.
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Matheson MC, Walters EH, Simpson JA, Wharton CL, Ponsonby AL, Johns DP, Jenkins MA, Giles GG, Hopper JL, Abramson MJ, Dharmage SC. Relevance of the hygiene hypothesis to early vs. late onset allergic rhinitis. Clin Exp Allergy 2009; 39:370-8. [DOI: 10.1111/j.1365-2222.2008.03175.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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25
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Bibliography. Current world literature. Genetics and epidemiology. Curr Opin Allergy Clin Immunol 2008; 8:489-93. [PMID: 18769207 DOI: 10.1097/aci.0b013e32830f1c83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Law GR. Host, family and community proxies for infections potentially associated with leukaemia. RADIATION PROTECTION DOSIMETRY 2008; 132:267-272. [PMID: 18945723 DOI: 10.1093/rpd/ncn263] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Three hypotheses have proposed the involvement of infections in the aetiology of childhood leukaemia, suggesting either a specific leukaemogenic infection or a series of common infections that lead to a dysregulation of the immune system. Much of the evidence for the link with infections has been based on epidemiological observations, often using proxy measures of infection. Proxy measures include population mixing, parental occupation, age distribution of incidence, spatial and space-time clustering of cases, birth order and day care during infancy. This paper discusses the proxies used and examines to what extent a commonly used proxy measure, birth order, is a fair representation of either specific infections or general infectious load. It is clear that although leukaemia, and other diseases, may be linked with infections, one needs to (1) measure specific and general infections with more accuracy and (2) understand how proxy measures relate to real infections in the population.
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Affiliation(s)
- Graham Richard Law
- Biostatistics Unit, Centre for Epidemiology and Biostatistics, Room 8.01, Worsley Building, University of Leeds, Leeds LS2 9LN, UK.
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Jordan S, Storey M, Morgan G. Antibiotics and allergic disorders in childhood. Open Nurs J 2008; 2:48-57. [PMID: 19319220 PMCID: PMC2582823 DOI: 10.2174/1874434600802010048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 05/02/2008] [Accepted: 05/05/2008] [Indexed: 12/28/2022] Open
Abstract
AIM This paper explores the possible association between antibiotics prescribed in infancy and allergic disorders, mainly eczema and asthma, in childhood. BACKGROUND No-one fully understands why childhood asthma and eczema have become so common. Some authorities suggest that there may be an association between eczema and asthma and antibiotics prescribed in childhood; however, others disagree. METHOD/EVALUATION: The available literature was reviewed to examine the links between prescribed antibiotics and childhood eczema and asthma. FINDINGS/KEY ISSUE: Some, but not all, research indicates that antibiotic administration in pregnancy, childbirth or infancy may be linked to childhood asthma and eczema, but much uncertainty remains. None of the papers identified stated the doses of antibiotics prescribed. In addition, we were unable to locate studies reporting the interactions between antibiotics and the developing immune system. CONCLUSION Health care professionals should be selective when prescribing antibiotics. Further prospective work is needed to guide the prescribing of antibiotics in childbirth and infancy.
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Affiliation(s)
- Sue Jordan
- School of Health Science, Swansea University, Swansea, SA2 8PP, UK
| | - Mel Storey
- School of Medicine, Swansea University, Swansea, SA2 8PP, UK
| | - Gareth Morgan
- School of Medicine, Swansea University, Swansea, SA2 8PP, UK
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Simpson J, Smith A, Ansell P, Roman E. Childhood leukaemia and infectious exposure: a report from the United Kingdom Childhood Cancer Study (UKCCS). Eur J Cancer 2007; 43:2396-403. [PMID: 17826085 DOI: 10.1016/j.ejca.2007.07.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 07/24/2007] [Accepted: 07/31/2007] [Indexed: 12/01/2022]
Abstract
Data from a national case-control study are used to explore the relationships between childhood leukaemia, infant infection and three markers of infectious exposure - birth order, infant-activity group attendance and area-based deprivation. Amongst controls, clinically diagnosed infection in the first year varied little with birth order and infant-activity group attendance - with 4 in 5 children having at least one infection, and each child averaging around 2.9 (2.8-3.0). Amongst cases of acute lymphoblastic leukaemia (ALL), the levels of infection increased as the indices of infectious exposure increased - for example, odds ratios associated with at least one infection in the first year being 0.9 (95% confidence interval (CI): 0.6-1.4) for birth order one and 1.6 (95% CI: 1.1-2.2) for birth order two or more. By contrast, interview data were misleading, with mothers - particularly case mothers - consistently under-reporting. We conclude that the findings based on clinical data, combined with the markers of infectious exposure, confirm the observation that immune dysregulation among children who develop ALL is detectable from an early age.
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Affiliation(s)
- Jill Simpson
- Department of Health Sciences, University of York, YO10 5DD, UK.
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